I felt tears pool in my eyes and blinked at them angrily.
“Oh, for Pete’s sake,” I muttered, mortified. “I mean, how many times have I told this story? What is wrong with me?”
The captain smiled kindly at me, saying nothing.
Gary started speaking then, surprising all of us with a vivid description of a horrific scene at which he arrived as a first responder.
“— the Marine’s face was gone,” Gary ended, and swallowed hard. My own embarrassment forgotten, I leaned forward to touch Gary’s sleeve.
“I wish you would have come over,” I breathed, searching for eye contact. “Please, Gary, don’t go through something like that alone again. We’re right here . . .”
He looked up, eyes misty, and smiled slightly at me. I knew he wouldn’t ask for my help, but he appreciated my offering it.
And so it began. We talked about casualties, about the strain of listening to the grief and fear and loss of our patients all day, about sometimes having no idea what to say, about the incoming rockets and the baking heat at night and the contractors beheaded on video. Most of all, we talked about fatigue. We were tired, we told him, and we’d only been out here two months.
Captain Koffman listened to us for almost two hours. When he left our office that day, offering to drop Gary off at the regiment, Jason and I sat for a moment in silence together before we looked at each other.
“Well. That was interesting,” I started.
Jason nodded. “That was group therapy. That’s what that was.”
“You know,” I commented, as we rose to gather our covers and sunglasses from the desk, “I’m wondering if Captain Koffman really came out here just to check on the Seabees.”
“It’s pretty clear he was here today for one reason,” Jason said. “He was here to check on us.”
Later that evening, writing in my journal about our cathartic group, I remembered a book I had had to read in school. The House of God, by Samuel Shem, an entertaining and heartbreaking story about medical interns, had almost nothing to do with our experience out here — except for one character’s words, which popped into my mind now. He said, “How can we care for patients if nobody cares for us?”
We never forgot how the captain cared for us that day.
Mr. Oda
Special Forces (SF) soldiers are their own breed, and the ones who worked out of the secret compound hidden on our base were no exception. They wore civilian clothes and had longer hair; they appeared just slightly unshaven, and occasionally one would have a goatee. Their “concealed” pistols were obvious. Several of them loitered around the hospital, offering help if we needed it, since they were as skilled in first aid as any emergency medical technician. We soon figured out that these men were not spending their free time with us for altruistic reasons. The majority of the women on the base worked at the hospital.
“Excuse me?”
I looked up from the notes I was writing at the nurses’ station.
“I’m Trent, from SF.”
Trent was almost too good-looking, with a chiseled face, tanned skin, and intense brown eyes, one of which was hidden beneath long bangs. He smiled as he extended his hand. His teeth were straight and slightly too white.
“Hi.” He grinned.
“Afternoon.” I shook his hand without standing. “I’m Heidi Kraft.”
“Nice to meet you, Heidi,” he said. (A group of us later laughed at the fact that although he was a staff sergeant in the Army, Trent somehow managed to be just Trent, even to an officer in the Navy. And a lieutenant commander, clearly marked with an obvious gold maple leaf on her collar, became just Heidi. For some reason, he could get away with it.)
“What can I do for you?” I asked now, signing my discharge note illegibly and placing it in a stack.
“We have this problem . . . or rather . . . a situation . . . that’s come up,” he began. “I was hoping to ask you your opinion.”
“Sure.” I pointed to the chair next to me.
He looked around uneasily. “Is there a place we could talk” — he leaned forward and whispered — “privately?”
“No problem.” I motioned for him to follow me next door to our psych ward.
Our ward, a tiny room with a padlocked door, contained whitewashed concrete walls, a single sandbagged window, and two cots. Three two-by-fours hanging by traction from cord strung across nails functioned as unsteady shelves. Trent sat on one cot and I sat on the other. I propped one of the flat pillows against the wall, leaned back, and raised one boot over my knee.
“Okay, what’s up?”
“We have this Iraqi informant. He’s very important to us and has already given us information that’s led to the arrest of an insurgent leader. We have been keeping him safe since then. He has everything he needs, a bed, food, satellite TV . . . but none of us can really communicate with him, and now that the translators are busy with other things, it’s been a while since anyone’s really talked to him. Apparently he thinks he’s a prisoner.”
“Is he?” It was an innocent question.
“No. We’re keeping him safe until we can get him out of the country . . . it’s kind of the equivalent of the Iraqi witness protection program. There are several of us who’ve been working on getting him a new identity . . . but we’ve been really busy, and our chain of command needs to approve our plans. It’s no excuse, but it wouldn’t be safe for him to leave.”
“Where does psych come in?”
Trent exhaled. He finally got to the important part. “He tried to kill himself last night.”
“How?”
“He wrapped the cord from his lamp around his neck and tried to plug himself in. We came in just in time and several of us tackled him, but it would have totally fried him if we hadn’t.” I tried to imagine “plugging himself in,” but it was hard to conceptualize. Trent seemed to realize that. “Basically, he became the lamp. Anyway, he’s not talking to anyone now, just crying all the time and praying and saying he wants to leave. We’re afraid he’s going to try again.”
“Sounds like he’s pretty depressed.” Having stated the obvious, I made the obvious suggestion. “Is there a possibility you guys can talk to him more, explain where you are in your plans to let him get on with his life? Make him feel like he’s not a prisoner, since he’s not.”
“You think that would help?”
“I have no idea. I haven’t met the patient.”
“Do you want to?”
“Um. Well, no, not really. I mean, how would I interview him?”
“I could bring you some civilian clothes, some jeans maybe. We would take you to him, we could have tea and you could tell us what questions to ask and we could ask him. That way he wouldn’t know you were interviewing him.”
“What do you mean, he wouldn’t know?”
“Well, you would be sitting away from the table, and you could be telling the interpreter what questions you want asked. Women do not sit at the same tables as men in Iraq.”
“I see. Well, tell you what — how about you guys make sure this patient knows he’s not actually a prisoner, and let’s see if that works. I’m not sure what good I would do him in that sort of context. Okay?”
“Okay. Thanks, Doc.” We stood up and he extended his hand.
“Sure thing. Good luck.”
The next morning at rounds, all ten of our company’s doctors sat hip to hip, crammed on two facing cots in the call room. We discussed the patients on the ward, and I had started to tell them about my interesting run-in with Trent when there was a knock at the door. He was standing there, brown hair in his eyes and huge arms obvious in his easy-fitting cotton shirt. He didn’t flinch in front of ten Navy officers, just looked at me and said, “Can I talk to you, Doc?”
The news had gone from bad to worse. The nonprisoner/ patient had attempted suicide again this morning, taking all ten sleeping pills he had been given by the unit doctor. The Special Forces guys wouldn’t have known that, however
, if he hadn’t also taken the blades out of his razor and sliced up his arms and legs in a gory, but not lethal, attempt to bleed to death. The soldiers saw the blood on the floor when they came and checked on him, realized he was unconscious, and brought him to the hospital.
“He’s here now?”
“Yep.” So much for wearing jeans and having tea.
“Okay, bring him back.”
The nurses checked the patient in, took vitals, and made up a chart for me. At the bottom of the page, since we didn’t know his real name and the SF guys weren’t about to tell us, they wrote ODA.
ODA. Other Defense Agency. The first time we saw one of them, an enemy prisoner of war, Karen thought that Oda was the guy’s last name and referred to him for two days as Mr. Oda. The name stuck.
Walking down the passageway to the ward, I wondered what this Mr. Oda would think of being evaluated by an American military woman. Women did not drink tea with men in this country, let alone perform psychiatric evaluations of them. I glanced at the pistol hanging from my shoulder holster. I was sure he would love me. I knocked and entered cautiously.
Mr. Oda sat on a cot, his head down and shoulders slumped. He was a small man with a bony frame and a small mustache. His off-white traditional thoub was splattered with blood.
“Hello,” I said quietly. “I am Dr. Kraft.” He looked up, met my eyes for a fleeting moment, and then turned to face the interpreter, who translated. I extended my hand, but he did not take it. I sat on the cot opposite him and leaned forward.
“The soldiers here are worried about you,” I started. He kept his head lowered but raised his eyes to the interpreter. “They are worried that you want to end your life. Is that true?”
He talked to the interpreter then, gesturing wildly with his hands. His wide eyes appeared frenzied. The interpreter waited until he stopped and then summarized for me. “I am a prisoner! I just want my freedom. I want to leave. I tried to tell them, but they would not listen.”
“Were you in fact trying to end your life? Do you want to die?”
“Yes.”
“Why?”
He began to cry. His pressured speech was heavy with emotion, even through the language barrier. “I have nothing . . . to live for . . . no one . . . I don’t deserve to be alive . . .”
I took a deep breath. I needed to get some history. This would be slower going than I had expected.
It took nearly an hour to learn that his family was from nearby. He was one of many children. His cousin was the insurgent whose demise was sealed when the patient provided information to the Americans. He had been engaged, but after the arrest of his cousin, his fiancée was “gone.” He was twenty-four. He looked fifty.
We ended our conversation with a deal. I agreed to talk to the Special Forces CO and urge him to find a way to get the patient out of the country. He agreed not to kill himself on our ward. A very tall American soldier, with a 9mm in the pocket of his jean shorts, stayed with Mr. Oda, just in case.
I asked Trent to send for his commanding officer, then I left the building, covered in a fine dusting of grime, to watch The Sopranos with the guys. We had not finished the intro song to the episode when my radio barked. I ran down the back passageway to the hospital in time to see the lanky SF guy and Dave, our OR nurse, dragging the patient down the hall, his arms draped over their shoulders. “What happened?” I asked, moving toward them.
“We were smoking,” explained Dave as he and the soldier lifted Mr. Oda and brought him through the door. The patient muttered loudly in Arabic, a trancelike cadence to his words. They helped him to the cot, where he lay down, buried his head in the pillow, and began to weep.
“When we looked away, he lifted the big cement ashtray and crushed it over his head.”
“Please,” I said, approaching Mr. Oda.
He sat up then, looked at me with wild eyes, and began bashing his head against the cement wall.
“Please, you need to stop doing that. I will try to help you . . .” I reached out and touched his sleeve. He cringed as if my fingers had burned his flesh and curled up on the cot, knees drawn to his chest. He continued to slam his head backward against the cement, repeating the same anguished words in Arabic again and again. I turned to the SF guy. “Do not let him keep doing that — is that clear?” He had been sitting, but he nodded and got to his feet.
I left the ward and radioed Jason, ran the situation by him in thirty seconds flat, and relayed his order for intramuscular Haldol, a quick-acting antipsychotic medication, to calm the man down. I could not understand Mr. Oda, so I had no idea if his ranting words were psychotic and dangerous or simply an expression of grief from a man who had made the gut-wrenching choice of betraying his family. HM2 Patacsil gave him the shot.
Mr. Oda’s eyelids fluttered. He rested his head on the pillow and shut them. I breathed a sigh of relief.
“I don’t have time to wait for your captain to come tomorrow,” I told the tall soldier. “I’m going to need to have this patient leave this ward tonight. Can you relay that message?”
“Yes, ma’am.”
One hour later the CO arrived with Trent and several others. I explained to him that Mr. Oda was suicidal but that I couldn’t ascertain whether that was due to serious mental illness or not, since I couldn’t understand him. “For surgeons, this doesn’t matter,” I said. “For us, it’s everything. I’m sorry . . . we tried. But we can’t take care of him here.”
He tried to argue with me, but I was determined, so he left, saying he would “make a few phone calls.” When Mr. Oda awoke, the captain and four other civilian-clad soldiers joined him in the ward, closed the door, and presented him with some options. When the door opened an hour later, Mr. Oda was laughing. I came to the doorway.
“Are you going to be okay?” the interpreter asked him for me.
“Yes,” he said, smiling and standing. He briefly looked at me, and then talked to the interpreter, who translated. “He says for me to tell the lady doctor that he cannot thank you enough for being so kind to him. He says that you remind him of his mother.” Mr. Oda came forward then, took my hand, and shook it, all the while keeping his head bowed. I lowered my own head in deference to what I now know to be the ultimate compliment from an Arab man.
The captain stepped forward to shake my hand as the other four escorted the patient down the hall.
“Hey, Captain, what’s going to happen to him?”
“We’re giving him a car and money and he’s driving himself to a destination we determined.”
“Not tonight, he’s not,” I objected. “He’s still got Haldol on board.”
“When can he drive? Tomorrow morning?”
I admitted that he could. The captain nodded. Mr. Oda giggled as he walked. He was feeling no pain. All four of them walked with him down the hallway. I watched them disappear out the back door of the hospital.
My watch said 2300. I leaned against the wall, totally exhausted as the adrenaline left my body. “Good-bye, Mr. Oda,” I whispered to myself, “. . . and Godspeed.”
One week later Trent lingered around the hospital again, talking to one of the female corpsmen. He saw me coming to the call room for rounds.
“Hey, Doc,” he called out, leaving his chair by his friend and walking over. “Did you hear about your patient?”
“Well, he was never officially my patient . . .” I read his eyes for clues but found none. “But how is he?”
“Dead. We found him a few days ago. He was shot about twenty times. I guess he took a wrong turn.”
“A wrong turn.”
“Yeah.”
Reality
“Just so we’re clear, ma’am, I am not here because I need help. My Gunny told me I had to come, so here I am.”
“I understand, Private. Please, have a seat.”
I fought to focus my parched, stinging eyes on the young Marine as he sat down and rested his rifle across his thighs. The sandstorms of the past few weeks had included a ho
wling, fierce summer wind that sucked the breath from our lungs in hot, painful surges. I have never walked into an actual blast furnace but imagine it would be a similar sensation. My eyes suffered as well.
The private sitting before me was sent to us by his command. The gunnery sergeant who accompanied the patient spoke of “erratic behavior” and “scaring people in his shop.” He mentioned they had recently learned that the Marine had had a previous psychiatric hospitalization. Before I saw the patient, I asked our techs to contact the Naval medical center for details of his admission.
“How have things been going for you during this deployment?” I started my interview casually.
“Great. I love it here.” The Marine grinned widely at me.
“Your Gunny is worried about you, Private. He believes you’ve been acting differently lately.”
“Really.” The Marine, who had been making infrequent eye contact and mostly looking out the window, suddenly turned light blue eyes on me.
When I met his gaze, he flashed a phony smile. I began a standard psychiatric interview, starting with basic questions of demographics and symptoms, which he answered curtly but appropriately. I asked if he had ever been seen by a mental health professional prior to today. The smile faded. He nodded yes but refused to provide details. I asked about a family history of psychiatric problems. He laughed then — a deep, throaty sound that caused the hairs on the back of my neck to stand up.
“My family is fucking nuts. Isn’t everyone’s?”
I smiled. This was a reasonable attempt at humor, although the laugh still made me uncomfortable.
“Have you ever been hospitalized on a psychiatric ward?”
“Sure.”
“How long were you in the hospital?”
“I don’t know. Three days?”
“What can you tell me about that?”
Rule Number Two Page 10
