by E. J. Noyes
Pace settled in the chair beside me, reached for a notepad and flipped to a fresh page. “What can I help you with, Captain?”
My stomach was so tight and painful I felt like I’d torn an abdominal muscle. Truth time, Sabine. Spit it out. “Sir, I haven’t been totally honest with you.”
“What do you mean, Sabine?”
Don’t cry, don’t cry. “I’m…struggling, Colonel. I’ve been struggling for a while.”
Pace nodded slowly, those bushy eyebrows drawing together. “Struggling how?” he asked quietly. “With what?”
I shrugged, gulped, and lost the battle with my tears. “Everything.” I pulled a gun on the woman I love.
Pace reached over to his desk, then set a box of tissues on the table between us. I pulled out a wad and wiped my eyes.
“Everything is a lot, Sabine.” His smile was indulgent. “Let’s get a little more specific. I think we can agree whatever you’re struggling with is related to your PTSD?”
“Yes, I would say that’s correct.”
“So, why don’t you tell me exactly what you mean?”
“I mean, aside from the anxiety, I just feel like I can’t get a grip on my thoughts. Some days it’s fine and others I’m just a mess, like I don’t know how to respond to something without overreacting. I’m worried all the time if something is going to set me off.”
“Have you noticed a pattern? Only on Wednesdays? Only on days when you eat pasta?”
I smiled slightly at his attempt at levity. “I think it’s usually when something upsets me, or I’m anxious. Which is more frequent lately.” I reached into my pocket for my notebook I’d been using to track my progress. “As well as your homework, I’ve been doing some more exposure therapy, and keeping a list of all the things I’ve been doing that make me uncomfortable and how I feel, to see if I can find a pattern.”
“Of course you’ve been tracking your progress.” Pace grinned and took the notebook from me, flipping through the pages. The grin faded until it was more like a frown. He glanced up, both eyebrows lifted. “This is a lot of extra exposure therapy, Sabine.”
“I know, sir. I just wanted to get it done.”
“I see,” he said carefully. “Do you think these exercises have helped you make progress?”
“Yes, sir. A little.” After a sigh I added an admission. “But in some cases it’s also caused more anxiety.”
Thankfully there was no told you so, or anything like that. Just a calm, “How are you resetting your thoughts when the anxiety comes?”
“Usually I close my eyes and do my breathing exercises or make my lists. It also helps if I can do something else.”
“Something like what?”
“Surgery, workout, talking to Bec, that kind of thing.”
Pace made some more notes. “So working, surgery, is beneficial then?”
“Yes, sir. Absolutely,” I said quickly.
“And do you feel your relationship is solid?”
“Mhmm.” As solid as it can be after what I’d done last night. “I’ve been having issues with intimacy, sir, feeling strange about it, about…being touched. We’ve also had some arguments over me withholding things.”
“I think we both know that feeling disconnected from intimacy with your significant other is unfortunately something that can happen with PTSD.” He leaned forward. “Did you resolve the arguments? Were you honest with your partner?”
“I’ve been trying to be honest, sir, trying to communicate better but it’s difficult for me. The most recent argument, um, it’s well, I think it’s mostly resolved.” My heart began to race, thudding hard against my ribs.
“Good. What about the medication? I know it’s still early, but have you noticed any positive effects on your thoughts or behaviors?”
I made the same noncommittal sound I always made when he asked if I was having any side effects.
Pace stared at me for a long moment until understanding dawned on his face. He expelled a long sigh. “You’re not taking it, are you?”
“No, sir,” I whispered.
“Why not?”
“Because I don’t want to.” Don’t want to admit I’m not able to handle this myself. Don’t want to admit that this thing is still with me.
“Could you explain why?” Though he wasn’t confrontational, his tone was all business—I was as close to being in trouble as I could be for not following his treatment directives.
“I’m not sure I could even put it into words that would make sense to you, sir.” I closed my eyes, and pushed out, “It makes me feel like I’m stuck on that day, every time I take a pill I’m reminded of every awful thing and all those awful thoughts.”
There was no answer, and when I opened my eyes I realized it was because Colonel Pace was writing. He took his time finishing five and a half lines on his notepad, and when he was done, he looked back up to me. “You’re not the first person to have said that to me,” he said gently. “Believe it or not, those words make perfect sense.”
“Thank you, sir,” I whispered.
“You know, Sabine, we may never get the anxiety element of your PTSD one hundred percent under control, but I’m confident we can get it to a level where you can deal with it without medication. The medication is just a tool. A step toward the endgame. It’s not a punishment, or an indication of weakness.”
“Yes, sir. Okay.” My leg was trembling, and I began to tap my heel on the floor to help cover it up.
Pace glanced at my foot. “Captain?” he asked gently. “What else?”
My mouth remained closed, teeth clenched hard on the words. Say it, Sabine. She deserves so much better than you diminishing what you’ve done. “Last night. I had a…” A what? An incident? A psychotic episode? A complete brain snap? I felt utterly sick at the thought of what I might have done if she hadn’t taken the gun from me. I could easily have shot her. Killed her. Not her, not just anyone. Bec. You could have killed Bec. Your girlfriend. The best thing in your life. “I think I threatened my girlfriend with a firearm.”
“You think? Can you explain what happened to me, Sabine?”
“I woke up, thought I was still at the FOB. But I don’t think I was really awake.” My voice cracked. “I heard a noise and I was so scared that I got her pistol from the safe, and I uh…I, kind of woke up again and I was pointing the weapon at—at…” I couldn’t continue.
“I see. What happened then?” he asked neutrally.
“I just need a moment please, sir,” I pushed out. Turning sideways on the chair, I covered my mouth with a hand as my stomach convulsed. Pace toed his wastebasket closer and I thanked the universe that I had been too busy and anxious to eat lunch.
Once I’d stopped dry heaving, he scrawled just a few words. “Are you able to continue? I’d like to know the rest.”
I pressed a fist to my mouth and when I was certain I wasn’t going to start gagging again, nodded. “It sounds so stupid, sir, but it really was like I was watching myself do it. Like those dreams you have when you’re an observer rather than a participant. She disarmed me and I sort of just came to. And I vomited.”
Another word joined the few he’d just written. “Would you call it dissociative?”
I frowned, mulling it over. “I guess that’s a good way to describe it. Talking it through with her this morning, I realized that I’d had a nightmare about the attack before I woke up, or sleepwalked, or whatever and…did that.”
“How did you feel when you discovered what had happened?”
“Disgusted. Embarrassed. Utterly terrified. Grateful that somehow I hadn’t actually physically harmed her.”
“May I ask why there was a gun in the house? You’re aware of guidelines that strongly recommend against that for people with PTSD.”
“Yes, sir, I know. I insisted Rebecca have it while I was deployed, sir. It made me feel better knowing she could protect herself while I wasn’t there. It made me feel much less anxious about leaving, so she went along wi
th it.” I blew out a breath and offered him the only explanation I could think of, flimsy as it was. “I think with everything else that’s been happening since I got back, we just forgot about it.”
Three-quarters of a line of scribble. “Tell me, Captain Fleischer, how many sessions have we had since you came back from this most recent deployment?”
I raised my eyes to the ceiling, rushing through the math. “Seven. Eight if we’re counting today.”
His study of me was intense. “So why now? Why, in seven sessions haven’t you told me how bad things were? I know you’re naturally reticent, Sabine, but I can only help you based on what you tell me.” He was still calm, not at all angry. Why was everyone being so goddamned nice?
I could feel my lower lip trembling and I wedged it between my teeth as I thought. Pace sat quietly, waiting for me to answer. After a minute or two, I managed to murmur, “Fear. Embarrassment. Guilt, I guess. I was scared.”
“Of what?”
“Being discharged before I can finish my contract to repay my debt to the Army for med school. Being judged unfit. Losing my license. I knew I could still work, regardless, so I thought I could just charge forward and get on with it.”
His smile was wry. “You and half the Army. So Rebecca knows about the PTSD and has been very supportive, right?”
“Yes, sir.” After a shuddering breath I admitted, “She’s basically keeping me together.” And I resented that she had to, that instead of a partner she was having to mother me as I fumbled through the new version of my life.
“Then why have you been withholding from her too? Isn’t an important part of a relationship honesty and communication?”
I couldn’t tell him how Bec was entwined with The Incident, and how that affected the way I shared, or didn’t share with her. I didn’t want any trouble for her because what we did was wrong at the time. And still would be. Despite the extra complication of DADT, she had been my superior officer. This was still the Army, after all. I sighed. “I guess I just didn’t want to bother her. I didn’t want her to think I was useless. I thought if I could just figure it out by myself it would be easier.”
“And has it been easier?”
Grimacing, I admitted, “Not really, no.”
“Well, there you go.” He glanced up from his notes. “Is Rebecca seeking help? I’m sure you’ve read the literature citing a high incidence of depression and mental illness in Army spouses. If she’s been with you since your accident, then I would think she needs a great deal of support as well.”
“Mhmm. She has a therapist.” Depression? Mental illness? No…not my Bec.
“Good. Now, I’ve asked you before if you’ve ever felt like harming yourself or others, but I’m going to ask again. Do you?”
I shook my head emphatically. “Absolutely not, sir. No.” Each word was spoken in absolute truth. “Which makes this whole thing so unbelievable. I’ve never even been in a fight or thought about hitting someone or anything remotely resembling violence.”
“Has Rebecca expressed any fears for her safety?”
“No,” I choked out. But just because she hadn’t said it out loud didn’t mean she wasn’t afraid of me, or what I might do. I clenched my jaw. She seemed okay. Surely she wasn’t afraid of me?
“I’m glad to hear that,” he said seriously. Then he added a casual, “And where is this firearm now?”
“Gone, sir. She took it this morning to get rid of it.” And sold it or gave it to a friend or tossed it in the river.
“Okay then, good.” His pen stilled. “How do you feel now that you have a few hours distance from the event?”
“Appalled. I’m incredibly upset with myself, and not just at what I did.” Understatement. “I’m upset that it took something like almost harming one of the most important people in my life to get this out in the open.”
“Unfortunately, sometimes it takes a major event to spur us into action, Captain.”
Just yesterday I’d thought something had to give soon, something had to cause a breakthrough so I could get better. Was this it? “Everything in my head is just all confused and messed up and I don’t know what to do with it. I’m a surgeon, sir. If there’s something that needs repairing then I do that. If there is something in there that shouldn’t be, then I take it out. But I can’t repair or remove this thing.”
“That’s true, but it doesn’t mean we can’t make it smaller, make it easier for you to live with.” He mused quietly. “It’s possible that your attempt to force yourself to unpack and confront your trauma in such a large way has had the opposite effect and opened a floodgate. Sabine, I think these symptoms are tied to stress, both personal and work-related. Last night you had an argument about what you’ve been struggling with—your feelings of shame and inadequacy surrounding your accident, and your inability to fully express your emotions about it. I believe the combination is what triggered this episode.”
Pretty much what I thought. I’d fucked up. “Sir, what’s going to happen now? I have a HPSP debt, and I can’t afford to be discharged, or forced to take extended psychiatric leave, or—”
Pace held up a hand. “One step at a time. Firstly, have you spoken to your CO?”
“Yes, sir. He said he’s going to contact you.” I cleared my throat. “Tomorrow, I start one week of mandatory personal leave, to be extended at your discretion.”
Pace glanced at the stack of call notes on his desk. “Good. Given your history, Sabine, our previous conversations and the circumstances surrounding this event, I believe this was an isolated incident brought on by extreme stress. I am going to make a report, which will go in your medical file but for now I don’t expect there to be any professional ramifications. That’s assuming you follow our treatment plan.” He eyed me over the top of his bifocals. “All of our treatment plan…”
“Yes, sir. Of course.” I fought the bristling down my neck. “With respect, Colonel, I would like to state for the record that I feel that a long period not working would be detrimental to me right now.” A few days or a week, sure. But weeks or a month of sitting around thinking about everything that’d happened was not going to help.
“I’ll take that under advisement. As for the medication that you are going to start taking, you may notice some minor side effects, but I’m sure you know how it goes.” He clasped his hands on top of the notepad. “For now, we’ll see if psychotherapy combined with medication helps. In addition to your Zoloft, I’m prescribing Prazosin to see if we can’t help with your nightmares.”
Clearly my expression gave my thoughts away and Pace raised his hand, smiling. “You know how this goes, we start with the lowest therapeutic dose and work from there. But we need to get serious, Sabine. And you need start being totally honest with me, and yourself.”
He didn’t have to say it. If I hadn’t been so evasive, if I hadn’t lied to everyone, including myself, if I’d taken the medication then this would probably not be happening. Now I was joining the ranks of deployed personnel on medication to help them with their issues caused by being deployed. Delicious irony. But I couldn’t blame anyone but myself. I exhaled to cover the sigh. “Yes, sir. I will.”
“Good. You know, Captain, people who go through their entire military career without incident still suffer from PTSD. You experienced a particularly traumatic event. There’s no shame here.”
“I know, Colonel. I just don’t want my life to be defined by this one thing, sir.”
“I understand, but at the same time I think we need to accept there’s a possibility it may always be a small thing in the background. We need to work on helping you cope with that, minimizing it, which I believe will help you move back toward normalcy.” He capped his pen, signaling the end of our impromptu session. Slipping around to the other side of his desk, he typed quickly and then after scrawling his name on the piece of paper that had just spat out of the printer, handed it to me. “Please go to the dispensary and have your prescriptions filled. Start the medicati
on. I’ll talk to your CO and be in touch before your appointment next week. But if you need to see me before then, about anything, you know where I am. Remember, you can still come in, even if you’re on leave.”
“I will. Thank you, Colonel.”
He stood again, and I hastened to my feet too, standing at loose attention. Pace smiled, this time a little sadly. “Sabine? I’m glad you told me.”
“Me too, sir.”
* * *
I texted Mitch and Amy to ask them to meet me in the hospital garden. Maybe pretending I was immersed in nature would help me spill my metaphorical guts again. Maybe if I said it enough, I’d stop feeling like I was about to vomit every time I thought about what I’d done.
They both did an excellent job of not appearing too incredulous when I explained and outlined my strategy for moving forward. In typical style, they practically fell over themselves when I told them that I needed their help—Amy sang a few off-key lines from “With a Little Help From My Friends”, while Mitch nodded silently, his face a mask of gonna fix this good determination.
I felt fractionally better after my second retelling, but by the time I left work, the guilt and self-loathing had reintensified. Knowing I had to face Bec again eventually and admit exactly why I’d had a brain snap made my nausea even worse. I’d filled my prescriptions, and the bottles lay in my backpack, taunting me. No, Sabine. Not taunting…waiting to help you.
When I let myself into Jana’s condo just before seven p.m., she was seated at the table, working on her laptop, piles of papers strewn across the surface and a half-full glass of red by her right hand. Time for retelling number three. My abdominals tensed, as though readying for a punch.
“You busy?” I asked inanely as I set my duffel and backpack on the floor beside her couch.
“No, I’m just working at home because I love it so much.” She grinned, and sing-songed, “Billable hours!”
