My practice is in a small rural Wisconsin town just down the road from a large military base. I see soldiers pretty regularly these days; they stay here for several weeks of pre-deployment training before shipping off to Iraq. They come from all over the country–men and women of various ages, some single, some married and with families. Their health-care needs aren’t too different from those of my civilian patients: maternity care, chronic illness management and the usual scrapes and bruises. I like having them on my schedule; their Boston accents and Georgia drawls make a pleasant change from my neighbors’ familiar, made-for-radio Midwestern monotone.
I don’t dwell much on what these soldiers do for a living. I do my best to take care of their needs and move on to the next patient. Once in a while, though, I run into one who sticks in my head at night as I lie in bed trying to make sense of the day.
Captain America is one of these patients. Sitting on my exam table, this 29-year-old man looks like a cross between G.I. Joe and the Terminator, his well-sculpted V-frame a walking advertisement for the U.S military. He is soft-spoken and polite, concluding his answers to my questions with “sir.” We mere mortals admire guys like this; they make us feel stronger and manlier by association. He’s the kind of guy I would like to join for a day of fishing, smoking cigars and swapping tales.
He tells me that he’s recently returned from two tours of duty in Iraq. Prior to that, he served in Afghanistan. As a captain, he led troops in clearing city neighborhoods of “insurgents.” He’s the guy you see on television, rifle in hand, breaking down doors.
Since returning from his last tour, a year ago, he has not been himself.
“I just feel whipped. I ache all over, and I’m tired all the time–no stamina. I get short of breath, and my chest aches just walking up a hill. I can’t even sleep at night, doc.”
He used to run six miles in under forty minutes, but now has trouble completing one. “Hell, you wouldn’t believe the stuff I used to do.” I can tell he wants me to know how tough he is, and that he’s not looking for sympathy or a ticket to early retirement.
“Patch me up and send me back,” he tells me.
As I listen to his story, I sift my memory for any reference to Gulf War syndrome. Was it real? What did the government’s final report conclude? My gut tells me that the captain is depressed and possibly suffering from post-traumatic stress disorder. But I can’t exclude the possibility of a toxic exposure to an as-yet-unidentified Agent X. How would the captain accept a diagnosis of depression? Would it offend this embodiment of strength?
He tells me that his last tour of duty was very stressful and left him disappointed and confused. Proud of what he’d accomplished during his first tour, he felt that what he’d seen this last time was unprofessional and reflected badly on our military and our country. “Unprofessional.” Now there’s an interesting choice of words.
I hesitate–afraid to ask for details. Despite my antipathy to this war, I still want to believe in my country. Hearing a first-hand account of the horrors of war, the inevitable mishaps and even the intentional and inherently human evils that occur, would force me out of the comfort of my insulated world. And yet I don’t want to be complacent–a passive co-conspirator.
A series of lab tests, a chest x-ray, pulmonary function tests, electrocardiogram and a cardiac stress test reveal no clear explanation for this man’s symptoms. The diagnosis of depression weighs heavy on my mind.
When he returns the following week, I admit that I’ve found nothing concrete to explain his dwindling strength: no kryptonite here. This should be good news, right?
He accepts a trial treatment with antidepressants. Within three weeks he’s remarkably better. “I almost feel like my old self, doc!” But I can see that he’s still troubled.
“Can depression really explain the way I was feeling?”
He confesses that he’s questioning his role in this war and his career in the military. He doesn’t think he can do another tour and is considering a desk job here in the States. This bothers him because he was good at what he did, and the military needs experienced captains.
I feel troubled as well. It’s quite possible that he suffered some physical injury in Iraq. I know that he’s been dealing with depression and PTSD, but I still can’t be sure that an Agent X didn’t trigger his condition. I also don’t know how well the military will deal with him or with the many other soldiers who return with significant psychiatric disorders after their Iraqi experiences.
We talk awhile, and I ask him to stay on his medications and to see me back in one month. He agrees; we shake hands.
I never see the captain again. Perhaps he shipped out for his fourth tour. Maybe he retired early. I try to contact him, but without success. Like I said, some patients just stick in my mind.
I like and respect this man of steel. I am awed by what he had to endure and sacrifice in Iraq. My feelings about this war do not make him any less of a hero, any less deserving of my admiration and affection or of the best medical care possible.
And yet, I’m left feeling unsettled. This man’s name and face remain etched in my mind. He’s but one of the thousands of young men and women left to carry the scars of this ill-conceived, needless war. I feel angry at our government for perpetuating it–and ashamed at my passivity as my young patients continue to ship out. My mind keeps circling back to a single thought: damn it, he should not have been there.
About the author:
Marc Tumerman MD has been a family physician practicing in Wisconsin for twenty-five years, during which time he has held various leadership roles involving practice management and quality improvement. “Like many, I have chosen to write about some of my more meaningful patient relationships because it’s become clear that it is these relationships that give meaning and fullness to my life. In addition, writing serves as a way to help me deal with some of the frustrations and limitations that life places on us at work and at home.”