The aftermath of trauma

Shaili Jain
Stanford University, Menlo Park, California, United States (Winter 2013)

 

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government. This writing is a work of nonfiction. In an effort to protect individual patient privacy, the patient stories depicted here are composites of various real encounters brought together to illustrate a particular situation.

 

marine
Photography by the United States Marine Corps

I try to stay in this moment: Dave, my patient, is telling me about his Saturday trip to the mall. His cheeks are slightly red with the heat of jubilation, and his voice is louder than usual, propelled by a mixture of excitement and disbelief. In the drafty space of my tiny office, he spills the details of his expedition: he had navigated the flow of human traffic from JC Penney to Sears and from Old Navy to the men’s bathroom without becoming drenched in sweat—some flutters in his chest of course, but no more heart-thumping panic. Instead of reflexive rage and verbal threats, the accidental brushing of shoulders or treading on toes he had tolerated with a no-worries attitude. His brain had not translated the hustle and bustle of a holiday crowd as danger; a man wearing a backpack did not imply a suicide bomber; and unattended shopping bags were no longer harbingers of death. The fused aroma of fresh-baked pizza, cinnamon pretzels, and salty French fries wafting from the food court was, once again, enticing. The thwack of our high five that marks the end of this session—this sound I try to retain.

I try to stay present with Dave and absorb the hope of his story, but I am distracted by his eyes. They remind me of another patient, also a soldier but barely of age, who had already served two tours in Iraq. With dulled blue eyes and a still face he told me how his duties had come to include bagging the bodies of his buddies blown up in Baghdad. Like Dave, this patient had also nodded his head in response to my explanations, suggestions, and recommendations. But his eyes had betrayed the truth that, despite his best efforts, his mind was pulling him elsewhere. His brain’s networks were misfiring, awry, and depleted. He was beyond my therapeutic reach, and I was rendered impotent by the limitations of my science.

***

I try to stay in this moment: a day at the beach—my skin is kept toasty warm by the steady beat of a noon sun, the scratchy feel of the grainy speckled sand slipping between my toes, and the comforting roar of the deep ocean. The scene playing in front of me holds more allure than the novel I am reading: young explorers bravely taunt the ice-cold water and fill the blue sky with their shrieks and howls as they try, with little success, to outrun the incoming tide. A smoky barbecue grill serves as the hub for a family reunion; women hug and chat over homemade salads and chopped up chunks of watermelon whilst the men engage in much back-slapping and glugging of beer. Hand in hand, a couple takes a leisurely stroll along the shore. The woman laughs in response to something her husband says whilst the sun plays with the gemstones of her wedding ring.

I try to stay present, immerse myself in the serenity encircling these happy families, but her ring reminds me of another—a plain gold band that was being fidgeted with by its young owner as she stifled tears. She told me that although her soulmate returned from war intact, she fears he left something essential behind in the desert. Her face is pale and her body sags from years of carrying the solitary burden of groceries, homework, and soccer practice. She told me that, while he was deployed, she did all these chores dutifully and with the superstitious belief that doing them perfectly meant he would come home alive. The loneliness of her days was balanced only by her nights, when she would dream of their reunion: his smile—broad and beaming—the tight embrace of his arm encircling her waist, the vigor with which he would scoop their daughter into the air, and the grip of his hand on their son’s shoulders. But the happiness of their initial reunion had been brief and quickly succumbed to a new reality. How long should she let her soulmate hunker in the den with only bottles of Budweiser for company? How long could her children survive on stories of the way Dad used to be? She aches for past times and fears nothing will ever be the same. This she did not sign up for.

***

I try to stay in this moment: children playing games in a park. Some run and climb, tag and tickle each other, whilst others hang upside down and swing like monkeys. On a bench, a brother and sister giggle over silly jokes. The bathroom humor in the last joke appears too funny to bear, and the little sister erupts into belly laughter. This is infectious and soon both are bowled over by uncontrollable waves, their eyes glistening with funny tears as they clutch their aching stomachs. I smile and marvel at how melodious the laughter of a child can be.

I try to stay present, indulge in this moment and allow its joy to permeate my being, but it is invaded by the sound of other children laughing under a Middle Eastern sun. Two of them, a boy and girl, enact expected rituals: they play, tease, and tell tales. Their mother, busy with daily chores, smiles and maintains a watchful gaze. I imagine she is no different from any other mother, in that her daughter is the apple of her eye and her son the master of her heart. But I have never met this family and will never know their names. I came to know about them through my patient, a veteran. He described a day when an IED ripped through childish giggles and squeals, and he was sent in to “clean up the mess.” The smell of burning flesh and the blood-spattered face of that mother still haunt his nights. The IED left in its wake destruction, terror, and, for that mother, silence. Forever silence.

***

I try to stay in the moment. But . . .

 

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SHAILI JAIN, MD, serves as medical director of the primary care behavioral health team at the Veterans Affairs Palo Alto Health Care System, is a researcher affiliated with the National Center for Posttraumatic Stress Disorder, and a clinical instructor affiliated with the department of psychiatry and behavioral sciences at the Stanford University School of Medicine. Her essay and commentary have appeared in the New England Journal of Medicine, the Journal of the American Medical Association, public radio, and elsewhere. She also blogs for the Public Library of Science (PLOS) at http://blogs.plos.org/mindthebrain/author/sjain/.

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