“Puppet” Show

Karen Grimord, President

Wednesday, March 31, 2010

Today was oh so very slow in the WWMC and that is oh so very good in terms of wounded arriving, but oh so bad for making the day extremely long.

I did have some patients come in just to talk or give me feedback from their doctor’s appointments.  Yesterday, we had two patients arrive at once.  I was working on a project as another volunteer explained the WWMC to the patients.  She asked them what they needed.  The one patient knew he needed sweats and a jacket, but the other said he did not know.  She told him they had toiletries, snacks, and clothing and he could look around.  He said he just didn’t know what he needed.  I turned around and left my task, as I have heard that plea before.  I went to his side and slowed things down a little bit for him by going over each item, one at a time.

Sometimes we are in such a hurry to help, we forget to slow it down just a little.  Many patients with Post Traumatic Stress or Traumatic Brain Injury cannot process more than one thing at a time. They cannot take a list of 5 or 6 items and decide if they need each of those items.  It must be broken down for them.  They cannot process putting a bag together,  talking about their tour, their family, or even the weather outside at the same time.  Many put on a really good “puppet” show, as one patient called it yesterday, but they are very lost.

Once we got the bag together, he felt a little more comfortable and told me that he had been in the dining facility and had a little bit of a panic attack.  This is completely normal and is actually part of lessons they are given to get back into a crowd and be able to work through it.  We talked for about 20 minutes when his wife called.  He shared with her what happened, but she had her own crisis happening at home and it was very unfortunate that she could not listen to what he was going through, since he was in no position to deal with what was happening at home; so he hung up on her.  As he sat with his head hung down, I asked if he wanted a hug.  He said no, which did not surprise me since he had already had a panic attack, so I held out my hand, allowing him to take it if he wanted to and we sat there holding hands quietly for a few minutes.

WWMC 2010

We have combat stress classes on Tuesday, Wednesday, and Thursday.  It is a one-hour informal class with patients that wish to attend.  It is not mandatory and many only come because on Tuesdays we have Popeye’s Chicken, on Wednesday we have pizza and Thursday we have Subway sandwiches.  It is an open forum to talk about some of the issues they might be struggling with.

Guilt seems to be number one on the list.  Guilt for leaving their unit, for surviving an attack, for being away from their family, for what they did – or maybe they feel they failed to help a battle buddy.  The second seems to be anxiety.  This can be anxiety for their own health, their career, their family at home, or their unit “family” downrange.  Then follows hyper-vigilance; I call this always having the ears on.  Even sleeping, you can hear conversations and respond, you become overly security conscious.

Other issues are obsessive-compulsive behaviors, isolationism, difficulty sleeping, flashbacks, nightmares, intrusive mental images and memories, anger at themselves or God for letting this happen, or for not stopping it, depression, avoiding emotional intimacy, reluctance to get close to people, short term memory loss, confusion, lack of concentration, continual fear for those left behind or for what is ahead in their health care, denial of any health problems or personal problems,

We then give them some good tools to use.  Some work better for one patient than they do for another.  Each patient can discuss what tools they think would work best for them.  We also talk about what tools are ineffective tools.  I have been known to use some of the ineffective tools and learned they just cover up and extend the recovery from any combat stress.

The class usually starts very slow as no one is willing to share, but by the end we usually have everyone participating.  It is the beginning of what might be a long trip back to a new normal.

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