Ghost Soldiers

It may be a cliché or a too often used title.  But I couldn’t think of another name to describe them.  If you believe in ghosts/spirits, you have to see beyond the here and now, beyond what is right in front of you. In order to see the ghost soldier I speak of, you have to see beyond the person in the hospital bed. Frail, elderly, afraid, maybe young, maybe displaying behavior you would rather not deal with.  You have to see in the wrinkles and the withdrawn eyes the soldier they were.  You must see a young man (for I have not yet encountered a female combat or otherwise wounded veteran, though I wager that I will before my career is over) who was once fit, strong and in another, more frightening situation beyond their control.

Morning report turned from specifics of the patient, late 60’s, male, bilateral knee replacement, to discussion of the patient’s weight, which exceeded 400 pounds.  Both the day nurse and myself (and I am not the skinniest slice in the loaf) shared our negative opinions and perceptions of morbid obesity.  The usual talk-“they let themselves get this big, then we have to move them around”.  You’ve all heard it, maybe, if you work in health care, you’ve even said it.

I went in with a smile, introduced myself and started my “nursing stuff”.  As I worked, I asked him what he had done to mess up his knees.  He said, “I jumped out of a helicopter at a hundred feet.”  Curious, I asked him why he would do such a thing.  He answered, “Because it was on fire.”  He went on to explain that he was a Vietnam Veteran and this particular incident happened in Laos (remember, we weren’t in Laos, right?).  He was the only survivor.  A sense of guilt and shame washed over me.  I had judged him as someone who didn’t care about himself, when really, he was a wounded hero.  A Ghost Soldier.  Disabled by his knees.  Coping with the past by eating (a habit I can relate to). Still fighting a battle we cannot see or understand.

A man in his 40’s who had compliance issues with his physical therapy after knee surgery and came back in for revision of scar tissue and infection.  In report I heard all about that and further, that he was an “asshole”.   When I went into his room and started my “nursing stuff” he was withdrawn, humorless and irritable.  And he wanted pain meds now.  I gave him the pain meds and sat down and asked his story.  He had joined the Army out of high school and was “ hoooraaah” all the way.  He wanted to do it all.  He eventually became a “jump school” instructor (he taught guys to jump out of perfectly functioning airplanes with a parachute).  He loved it.  He was good at it. Then he injured his knee and was medically discharged.  He was devastated.  He cried at that point and yelled, “I went from hero to zero in sixty seconds.”  We got along fine.  He was still withdrawn, humorless and irritable, but I understood why and didn’t take any of it personally and because I didn’t react, he didn’t act out as much.

Fast forward two years.  I am orienting to the ICU with an awesome preceptor.  We received an admission from the ED.  A man in his 70’s who had fallen, literally in the gutter, and was acutely intoxicated.  Disheveled, smelly and definitely drunk, he arrived in our unit.  We put him on telemetry and then put him directly in the shower.  As I settled him in bed, I talked with him.  I asked him how he ended up in that gutter.  He was a Vietnam combat veteran.  He had nightmares.  He drank to sleep and make them go away.  He had lost his wife to divorce, such a common occurrence for veterans, and then she had died.  He still loved her and missed her.  He had distanced his children.  Another Ghost Soldier.  

My preceptor was one of the most professional nurses I have ever worked with.  She is no nonsense, smart and a good teacher.  I came out of his room and she asked me how I felt to be taking care of this man.  I responded that it was the one of the saddest situations I had encountered in a long time.  She smiled and said, “I’m glad you said that because if you had judged him harshly I would not have wanted to precept you.”  She didn’t claim to be totally guiltless of nursing judgmentalism (my new word), but we had a long and valuable talk about it, why we do what we do and what we are really here to do.  

I am on my own a few months later.  A frequent flyer that I had cared for a few years back on med/surg is admitted for COPD exacerbation.  I hear in report that he is anxious and an “asshole”.  Swell.  Immediately after report he “lost his air” as he called it.  He escalated quickly to panic and started screaming at me.  I could not open the window or turn on the fan quickly enough, respiratory therapy wasn’t coming quickly enough, etc.  To top it off, because he was mouth breathing/panting with his oxygen in his nose, I simultaneously suggested he put, and then tried to put his nasal cannula in his mouth, as this often helps get more oxygen in and decrease the panic.  He pushed my hand away and ordered me from his room, yelling I was not to come back.  He continued to yell obscenities and accusations.  

I work in a small hospital and the ICU is all of four beds, all clearly visible from the desk.  I sat down, called the supervisor and informed her that Mr. so and so had fired me and she needed to look for another nurse.  Not too many people to choose from in a small place with only a handful of ICU workers.  So I sat and watched the monitor and thought, “well, he is a full code, so if he goes down I can go back in the room.”  

People with COPD have a lot of anxiety.  Struggling to breathe is very frightening.  On top of that, he was at the age when most men start to have some bladder trouble.  So, in the course of this episode, he was incontinent of urine.  Not unusual for him, but still humiliating.  He barked at me to get him a new brief.  I went to the door of the room and calmly reminded him that he had told me not to come back and as of yet I didn’t have a replacement.  He heaved a deep sigh and said, “Please help me.”  In I went and we started over.

He shared his story.  Divorced, alone. Marine Corp combat veteran.  Long rage patrol, Vietnam.  I liked him just fine.  We came to an understanding.  I would ignore his crankiness and language as long as he didn’t direct any more of it toward me.  Agreed.  Moving on.  Semper Fi.

In the last two years I have read two books that, for me, have forever changed my attitude and approach to hospitalized vets.  The first was “We Were Soldiers Once, And Young” by Lt. General Harold G. Moore (Retired) and Joseph L. Galloway.  The second was, “Band of Brothers” by Stephen Ambrose.  I cannot see how anyone can come through experiences such as these and not be scarred by them.

The WWII vet who has been in several times with old age related stuff.  Missing parts of his hands, scarred, frail body, mind losing its clarity.  My hero.  Another WWII vet in his 90’s who takes an outrageous amount of clonazepam to sleep at night or he wakes up screaming and swinging.  His wife appreciates this medication.  I did too.

One particular ghost soldier last week got me thinking about all these and so many other veterans I have met.  “He is a pain in the ass” and “he yells a lot” accompanied the official details of the report I received.  Here we go again.

The story.  A Vietnam Special Forces Vet who led LRP’s (long range patrols) into Laos (remember, the country where we weren’t again?)  Yep, he yelled a lot.  His ears damaged by the noise of guns and other things that go boom.  He complained a lot and fussed at me.  A leader, in a situation he could not control.  Hands that shook and couldn’t hold a razor to shave and yet, they used to hold a rifle on target.  For hours.  He made crazy eyes at me.  Paranoia and PTSD kicking in when startled or I moved too close to him too fast.  He got frustrated and refused to do treatments.  He cried.  He talked to me. About war and being Native American.  About the divorce, fabricating a story so the blame was on her and not on the demons of his past.  The “pain in the ass” was just another Ghost Soldier.  Still fighting.  Worthy of respect and empathy.  

No, I don’t tolerate everything from them, but they pretty much have a free pass with me.   As long as they don’t intentionally hit me or throw anything at me, I will let the yelling and other behaviors that get you labeled a “pain in the ass” in the hospital roll off me like water on a duck’s back.  Because I figure, if you bothered to pull on a uniform and a set of boots in service of this country, you deserve a little more leeway than your average asshole.  If you went ahead and fought and/or bled for this country you deserve that and so much more.  I will remember you Ghost Soldier. I see you. I believe in you.  I will listen to your story if you can and want to share it.  I will pray for you.  And by the way, I really enjoyed knowing you and hearing your story, no matter how you acted.  For you see, I can go home at the end of the shift and get into bed and that battle is over.  For you it never is.