Treating Wounds You Can't See

Years of treatment followed. But the military kept its hold on him; he stayed in the Guard and became an officer after getting his college degree. In Iraq, he recalled, uneasiness and sometimes grief gripped him, rooted in his current experience but also emerging ghostlike from the past.

* * *

The young soldier had been at Rustamiyah, known as perhaps the most mortared U.S. base in Iraq; two months after coming home, when he closed his eyes, he would hear the whish-boom of the mortars coming in. "The clarity is phenomenal," he said, as if describing a recording.

* * *Another soldier, a captain, choked up in my office, describing a day in Iraq nearly two years earlier. "They were just kids, 18, 19 years old," she said. "They were playing like kids all day, jumping, swinging from a rope. And then that night, just a few hours later, they died."

"Did you send them out?" I asked.

Silence.

'Am I Going to Get Better?'

I was continually struck by the different coping techniques, including humor and irony, that my patients employed.

* * * Three soldiers were sightseeing in a Philadelphia park when a water main ruptured nearby, making a noise like an explosion. They recounted that one soldier dove for the wall, another hit the ground and the third ran. "People must have thought we were crazy," one told me. They felt safer indoors, so they went to the Betsy Ross House. "We spent two hours at the Betsy Ross House," another said. "We saw everything."

* * *Another soldier had PTSD and probably a traumatic brain injury; his injuries and the array of medications he was taking had seriously impaired his short-term memory and concentration. Like an amnesiac in the movies, he had notes posted all over his room detailing his appointments and medication schedule.

"Am I going to get better?" he asked urgently. He was just back from the war and would likely improve significantly in the months to come. But I couldn't tell him with any certainty whether he would one day function at his prior level. He was having so much difficulty concentrating that it took him eight hours to watch a movie. "It saves money on DVDs," he said.

* * * When the command for the Warriors Transition Unit -- for the soldiers who were at Fort Dix on medical hold -- scheduled a mandatory holiday party, some recently returned soldiers were terribly anxious about the crowd and noise. They worried for the whole week before the party. I was considering writing waivers to excuse them from going, but I hesitated to reinforce their anxiety. A former squad leader from Iraq resolved the issue: "We will get a table in a quiet corner," he told them. "We will all sit together and we will make it through this party."

* * *One soldier, a medic, recalled a particularly traumatic deployment that had involved collecting numerous bodies of both Iraqis and members of his own unit.