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Edward Beal

In my decades as a psychiatrist, I've seen many different kinds of patients; only in the past five years, though, have I worked with soldiers.

I see them through TeleHealth, an organization that offers patients long-distance care via a sophisticated form of Skyping.

I originally took this job for financial reasons (during the economic downturn of 2008), but I quickly discovered its unique rewards.

Early on, for instance, as I stood waiting for an elevator, a quadriplegic soldier maneuvered his electric wheelchair alongside me.

When the doors opened, he looked up and said, "After you, sir." That's not a memory that fades.

Unfortunately, I also discovered the job's difficulties. At times, despite my admiration for the soldiers' heroism and bravery, I've found it hard to hear so many stories of death, loss and grief.

Also, commuting to work has become progressively more arduous. Initially I worked at Walter Reed Army Medical Center, but our TeleHealth group has grown so much that we've had to move twice. These days, in place of my original twenty-minute commute, I drive to the subway parking lot, walk to the Metro, take a forty-five-minute ride, then walk fifteen minutes underground to my new workplace.

Finally, since our building is controlled by the Department of Defense, we're subject to rigorous security requirements. No one can enter or exit the building or offices without the requisite badges and whistles, and the arrangements are complex and ever-changing--passes expire, codes change, bureaucracy is ever-present.

At times, this work's psychological and logistical stresses have made me wonder, How can I continue? and ask myself whether I should stop out of self-preservation.

All of which brings me to recent events.

This past week, less than twenty-four hours before my next telepsychiatry session, I suffered a personal trauma of my own: the loss of a beloved family member. Despite my grief, though, I never considered canceling the session; as always, it seemed to me that the soldiers' need for support outweighed mine.

The next morning I drove to the Metro, boarded the subway and walked to work as always. As I reached the building entrance, I suffered a horrifying realization: I had left behind all of my security passes. And without them, I couldn't work.

Deeply unnerved by this uncharacteristic mental lapse, I leaned against the wall.

Is this the beginning of a meltdown? I wondered. Maybe I'm just in denial about how I'm handling this loss and this work. Maybe I have to admit that it's really getting to me...that I just can't do it.

Pulling myself together, I called a colleague at the office, described my situation, confided in her about my personal loss, said that I'd be at least two hours late, and headed back to the Metro.

After a few stops, the train halted. There had been an incident at Gallery Place: someone had committed suicide by jumping in front of a train. Subway service was being curtailed. Besides being a terrible tragedy for the person involved, this meant that, if I wanted to get back to work, I would have to drive.

Can I trust myself to do it? I fretted over whether I could muster the needed concentration and coordination. But I made myself get into the car and go.

Arriving more than two hours late, I called the remote telepsychiatry location to start the session.

"Sergeant Johnson is here," said the secretary. "His appointment was supposed to start thirty minutes ago. He's demanding to see you, even if it's only for a few minutes. He seems agitated."

I remembered Sergeant Johnson well. He had been deployed in Iraq at least twice. He'd described seeing his best buddy get killed by a handmade bomb; the memory still gave him nightmares.

After his first deployment, he'd returned to a drug-addicted father who was dying in the hospital. Deployed again, he was brought back home after his mother developed cancer. He'd spent eight months taking care of her as she wasted away; she'd died in his arms. He had recently attended a criminal trial in which one of his siblings had been convicted and sent to prison.

Johnson's psychiatric sufferings reflected his real-life traumas. Anxiety, hyperalertness, sleeplessness, agitation, irritability, depression, intrusive thoughts...you name it, he had it.

Now he was demanding to see me. I had no idea what to expect; was he angry that I was late?

Apprehensively, I sat down in front of the monitor and logged on.

Sergeant Johnson appeared on the screen.

"Doc, I just want to say that the medication you gave me is really helping. My wife and I were able to go to a movie recently for the first time in years."

He looked straight at me.

"Also, I want to tell you how sorry I am for the loss of your father yesterday....I think you have real courage, showing up today."

How did he know? I wondered, then realized that my colleague must have shared the news.

Conflicting emotions engulfed me: lingering embarrassment and guilt over my lateness; relief that, rather than being irate, Sergeant Johnson was eager to express his appreciation for how much better he was doing; and astonished gratitude that such a courageous man would consider me courageous.

In that moment I couldn't convey any of this, but there was no need. He could see that I was speechless.

Finally I managed to say, "Thank you."

And that is why I work with soldiers.


About the author:

Ted Beal, a distinguished fellow of the American Psychiatric Association and a clinical professor of psychiatry at the Georgetown University School of Medicine, has been teaching medical students and psychiatry residents for more than forty years. He has published numerous academic papers and book chapters and also coauthored the book Adult Children of Divorce and coedited the book A Failure of Nerve. "While working with soldiers at Walter Reed Army Medical Center, I began writing essays about their experiences, partially as a way of coping with the trauma of hearing these experiences. I wish to thank my wife, Kathleen, and her sister, Ann Redpath, for encouraging me to write."

Story editor:

Diane Guernsey

Comments   

# Raymond 2015-05-28 22:42
So very well done.
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# Edward Thompson 2015-05-27 14:24
Nicely written. Reminds us how pain and beauty often walk side by side. Your much needed work is not done in a vacuum; keep it up.
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# Jeremy Shatan 2015-05-26 12:26
Great piece - I admire your dedication to this underserved population. Not sure if this is in the common literature any more, but my father (a psychiatrist who worked with Vietnam Vets) often referred to this paper by Sarah Haley: http://archpsyc.jamanetwork.com/article.aspx?articleid=491078

Best of luck.
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# Margaret Fleming 2015-05-25 14:27
Dr. Beal, my sympathy on the loss of your father. And I must add some sympathy for your new commute.

What struck me most about your story was your list of the Sargent's difficulties and the mention of their mirroring his life. I secretly, or not so secretly wish a copy of the list could be sent frequently to everyone who accuses cancer patients of "not focusing" in the doctor's office.

Thank you for writing this.
Sincerely, Margaret Fleming
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# Janice Mancuso 2015-05-23 18:48
Working all day today at my computer, on my first formal talk... Noticing my energy and confidence begin to wane, I decided it was time for a break. Time to read yesterday's Pulse.

Dr. Beal's essay evoked tears—first of sadness for him, his loss & anxiety…then of joy for Sergeant Johnson for feeling better and being able to offer comfort to Dr Beal…and finally of gratitude that Dr. Beal was strong and vulnerable enough to write and share this story.

Thank you Pulse staff, once again, for the forum you have created and the work you do… and for selecting the perfect piece for Memorial Day weekend.

PS I’ve decided to contribute $10 every time I’m moved enough to write a comment. That’s the least I can do. Now back to work…
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# R Aszalos 2015-05-23 10:49
Thank you for doing what you are doing and for sharing. I read and love many Pulse entries and never bother to respond. I do Addiction Medicine in primary care Fam Med residency clinic, trained and worked in Baltimore, worked closely with psychiatrists, and at some point worked summers at Walter. I could so connect with your story. As you should know, the world needs more people like you. Take care of yourself. And let yourself be ok with getting energy and strength from those you serve.
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# Louis Verardo, MD 2015-05-22 20:27
Dr. Beal, I have a daughter who is a career Army officer with several tours in Afghanistan already completed. Each of her deployments filled us with pride in her dedication and courage, and worry over her presence in a war zone.It is truly a comfort to know that a caring colleague such as you is there to render care to her and her fellow soldiers. As a fellow physician and a father, thank you for your service.
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# Fran Brahmi 2015-05-22 20:10
Diane,
I just finished reading your piece and I have goose-bumps all over my body. Thank you so much for sharing your incredible experience. I was totally blown away by it.
Thank you for the challenging work you do.
Fran
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# Laurence Bauer 2015-05-22 19:51
Wow. Incredibly touching. Thank you for your heart and commitment.
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