The Stories That Heal

A U.S. Marine CH-53 Sea Stallion helicopter lands in the Jazeerah Desert, Iraq, to pick up Marines taking part in Operation Defeat al Qaeda in the North, June 24, 2008. U.S. Marine Corps photo by Sergeant Jason W. Fudge.

A Marine sergeant came to my care a few months ago. He had suffered serious burns when an improvised explosive device detonated under his vehicle. He lost good friend in that explosion. We spent time talking about that traumatic day - his grief, his guilt, his sense of great loss - not only for his friend, but for the career he loved, as his multiple injuries have led to medical retirement from the Marine Corps. He made slow but steady progress.

One day he surprised me. He walked in, sat down, and immediately told me that he had been watching old M*A *S*H re-runs the night before. He had seen an episode that made him think of me.

"It's the one," he enthusiastically went on, "Where Dr. Sidney Freedman, the psychiatrist, comes to the 4077th to care for a Chinese-American soldier who was stressed out about fighting people from the country where his grandparents once lived." I nodded. I remembered the episode well.

"Under hypnosis," my patient reminded me, "Dr. Freedman gave the soldier a replacement symptom, a twitch he would experience instead of feeling guilty."

"Do you remember?" my Marine asked me. "Hawk-eye is talking to Sidney at the end of the episode. He says, 'Sidney, I think our jobs are easier than yours.' Sidney says, 'Why?' And Hawkeye tells him, 'Easy. Because we can see where they're bleeding."

I paused, and looked at my patient in silence. His shoulders were huge, and his desert utility uniform stretched taut across them. His sleeves were rolled tightly at his biceps. After multiple surgeries at the skilled hands of one of our best plastic surgeons, today - several years after he was injured - it was difficult to tell that he was ever burned at all.

"It's hard, Doc, isn't it?" my patient asked me. I realized I'd been staring at the faded scars on his forearms.

"What's hard?"

"Just like Hawkeye said. To try to take care someone when you can't see where he's really hurting. Someone like me."

"Oh." I cleared my throat. He leaned forward his chair and looked at me, twisting the red metal bracelet he always wore with the names of the friends he'd lost since the start of Operations Enduring Freedom and Iraqi Freedom. "Well, sometimes, sure. I guess it is. But that's my job."

He smiled at me. "Well, I know it's hard. Thanks for doing it anyway, Doc."

★★★

The U.S. Marines took care of us in Iraq. They always do.

We were the Navy medical personnel - doctors, nurses, corpsmen - who came together in the desert to become a surgical company on an austere base in the hostile AI Anbar province. The year was 2004, a year in which too many wounded Marines were treated in that surgical company.

So, when Marines came through our doors, we took care of them, too. We always do.

We treated traumatic injuries, performed stabilizing surgery, provided their daily medical and dental care, and watched over them as they recovered. We also listened, day after dusty, scorching day, to their stories of war. Some of them told tales of courage, loyalty, and friendship in the midst of chaos. Others spoke of loss - of fear, vulnerability, anger, guilt, and grief. I didn't know in 2004 that these stories of resilience and hope would be the first of many that would pave a road of healing for my Marine patients, for their leaders, for the sailors who have always been at their sides, and for me.

Through the blistering heat, through the absence of fresh food, through the incoming rockets, through the heavy casualties, through the unpredictability of each and every moment for seven months, we struggled, we listened to each other's stories, and we survived.

I met a Marine corporal in the post-op ward on a stifling Iraq summer morning. Our surgeons had removed several large pieces of shrapnel from his forearm and hand after the vehicle in which he had been riding hit an improvised explosive device (IED). I sat on his cot and we talked - about his tattoo, his hometown, his unit. He told me about the explosion, and his eyes glazed over as he explained that it was not his first. It was his third. And he had only been in Iraq four months. This young man, built like a linebacker, described each day as if it were yesterday. He showed me scars from each explosion. And then he buried his head in his pillow and sobbed. I waited.

When he could speak, he beckoned me close to him. He confessed in hushed tones that he was afraid to go back. He wondered if, unlike a cat, he might only have four lives. He screwed his eyes shut and whispered that, above all, he was ashamed of that fear.

"No one else in my unit feels like this, Ma'am." His voice was low and dark.

Karen Lovecchio Clark, Heidi Kraft, and Katie Foster Saybolt (left to right) in front of the barracks at Al Asad, September 2004. Photo courtesy of Heidi Kraft

"Has anyone else in your unit received three Purple Hearts in a half a deployment?" I asked innocently. He admitted that no one had. I rested my hand on top of his unbandaged fingers. He turned his functional hand, and squeezed. We sat in silence a long time. I eventually tried to use some therapy techniques I knew. I attempted to normalize his experience. But there is nothing normal about three purple Hearts.

War will change you, our Marines told us. They were right. I watched as it changed them, and my colleagues. I tried not to admit, for a while, that it changed me as well.

I was not myself when I returned from Iraq. I couldn't sleep well for months. I suffered as I struggled to connect with children who had grown from babies to toddlers in my absence. I acutely felt the chasm between myself and my family, friends, colleagues, and even patients - all of whom I believed simply did not understand.

I left active duty, and proceeded to take several years off from clinical work. The avoidance of my chosen profession was one of many complications that stayed with me even as my months in the desert faded into a brown blur. I sprinted away from the memories of helplessness and vulnerability, only to find that they are impossible to outrun.

★★★

Some of those memories had been recorded while I was in Iraq, formed into a poem I called "The List," and sent by email to my husband. He forwarded it to 25 people. By the time I returned home in September 2004, the poem had been forwarded around the world. A very wise Vietnam veteran and author, retired Marine officer Otto Lehrack, saw the poem and contacted me. He told me that every line in the poem should be a chapter in a manuscript. He convinced me to write it all down. He encouraged me to turn around and face what I had been avoiding. Exposure therapy, via the keyboard. One year and 250 pages later, I emerged myself again, along the way learning firsthand that storytelling heals.

I did return to clinical work with combat veterans, and began speaking to groups about combat trauma. I have come to realize that the curative effect of people's stories deepens with everyone I meet.

★★★

Today, I am privileged to care for a Marine Master Sergeant who was injured in Iraq several years ago.

He has struggled with a brain injury, multiple physical injuries, and post-traumatic stress as he has slowly recovered. One day, we sat together in an office that looked out over the front of the hospital at a running crack. My patient expressed frustration that afternoon - at his own newfound physical limitations, with which he wrestled nearly every day. As we discussed his plan, I looked out the window and saw a Marine running on the track - with a prosthetic leg. I called my patient to the window. I asked him if he thought that young Marine might come to him one day.

"What if he says, 'Master Sergeant, I'm afraid?'" I asked. "What if he says, 'I'm afraid that I'll never be the same again?'" My patient didn't hesitate. He said, "I would tell him this: 'You will NOT ever be the same again, Marine. You will be better.'"

★★★

Rule Number Two: Lessons I Learned in a Combat Hospital By Dr. Heidi Squier Kraft Little, Brown and Company.

I believe good doctors learn from their patients every day. As I watched him start to mend over the next few weeks, I realized that the permission he gave that Marine in his imaginary conversation was actually the permission he gave himself. I asked my patient if I might tell that story, since I have had the opportunity to speak with multiple groups of our warriors, leaders, caregivers, and families. I share his words often, and find that they have a universal effect. We support, encourage, and heal one another through our tales of hope and resilience.

What the Master Sergeant expressed, I tell everyone - combat stress is an injury. It is not an illness, a dysfunction, or a psychiatric disorder. Like a badly sprained ankle that will take time and treatment to heal, the injuries caused by traumatic events in the form of impact, fatigue, loss or grief, or moral complication can and will heal. In fact, just as that ankle can become more flexible and stronger after rest, ice, and physical therapy, a person can grow through trauma to emerge stronger, more resilient, more patient, and better.

War will change us. And we will move forward, telling our stories, hoping that as we grow and heal, the change will make us better. We will communicate many things to one another through the telling of those memories, including permission to feel it - whatever it is.

Dr. Heidi Kraft is a clinical psychologist and former Navy officer who now serves as a consultant to the Navy and Marine Corps' combat stress control programs, primarily through public speaking and providing treatment of combat trauma in active duty patients. She is the author of Rule Number Two. She lives in San Diego with her husband, a former Marine pilot, and her seven-year-old twins. Purchase her book on Amazon.com.

★★★