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withdrawn eyes the soldier they were.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“nursing stuff” he was withdrawn, humorless and irritable.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.
