The Most Efficient Marine
Heidi S. Kraft
War changes people, my Marines always said. Having spent much of 2004 in western Iraq—a Navy clinical psychologist with a Marine surgical company—I am living proof. I am changed. A piece of me is injured. But another part is now more patient, more empathic, more flexible—and more thankful. Choosing to focus on growth that emerges out of trauma is therapy in itself.
Twelve years after my war, I’ve learned that combat shifted my perspective across facets of my life that still affect me today. As a psychologist, I am more tolerant now of silence during a session. I am also more likely now to actually touch a patient if the situation warrants it. As a mother, I am now capable of watching my children’s sporting events with gratitude, feeling thankful not just for their success and growth, but also (most of the time) for the little mental errors, missed serves, and strikeouts. I struggle not to judge those parents whose frustration with their children’s imperfection is obvious at these games. After all, these people have not lived what I have lived. They have clearly not held the hand of a dying Marine, who used to be a baseball star—and whose mother would give anything to see him strike out, just one more time.
Finally, as a San Diegan, I am infinitely more likely now to laugh at people who think 85 °F is hot. My story picks up there—on a summer day in Iraq, much warmer than 85. The day on which I learned what it means to be a combat psychologist.
The husband of one of our corpsmen sent an old wall thermometer—the kind you see at an outdoor pool. We hung it outside the front hatch at our barracks, for entertainment more than anything. By the middle of August, it had pegged at 132 °F every
Names and identifying details have been changed to protect the identity of my patients and the members of their commands.
H.S. Kraft, Ph.D. (*)
© Springer International Publishing Switzerland 2017 E.C. Ritchie et al. (eds.), Psychiatrists in Combat, DOI 10.1007/978-3-319-44118-4_6
day for weeks. We identified a tiny window of opportunity to meet up in the morning-while the thermostat needle hovered only in the low 100’s-and briskly walk that three quarters of a mile to the gym. And it was really early. Depending on who had been on duty the night before, a rotating group of us communicated by flashlight signal across the small field that separated the male and female barracks. That friendly flicker of light indicated that our partners were waiting. Together we would race-walk to that old warehouse, filled with older workout equipment that reeked of sweaty men, where we found the drug to which we had become genuinely addicted during deployment: aerobic exercise. At an intense enough level, it magically numbed our pain, flushed our fear, and uncluttered our minds for the day ahead.
This particular August morning was already stifling when I woke at 0440, laced up running shoes, and navigated the passageway by the blue lens flashlight that hung from my dog tags. I saw the blue flash across the field, and jogged across to meet up with Bill, one of our PAs. The predawn air hung heavy and hot in the aftermath of a sandstorm that had howled and screamed like some sort of rabid animal the night before. Before we left, I allowed myself a brief glance at that wall thermometer-108.
Bill and I focused on the ground in front of our flashlights, carefully avoiding the large potholes that littered the path to the gym, the earth literally ripped apart by incoming rockets and mortars. We had been in Iraq five months. Our small group of cherished friends, which had become my lifeline, counted down the days with big red X’s on a wall calendar, and rationed our twice weekly screenings of one episode of THE SOPRANOS. Meticulous planning early on ensured we would watch the season finale the week before we left for home. Home. Such a faraway, foreign place now-not just from this endless tan landscape, surreal sandstorms and brutal casualties of war-but from somewhere deep within me as well.
Feeling energized and renewed after working out, I returned to our barracks showers. I stood under the lame, icy trickle to wash my hair, thankful for running water. There was no makeup in Iraq. I looked the same every day. The good news was twofold: no one cared, and my short hair dried instantaneously upon emerging into the blast furnace we called outside. No need for a hair dryer. Not that I had one-nor that there was functioning electricity most of the time to plug one in even if I did.
After morning rounds with the surgical company staff, I met up with Jason, my partner and our psychiatrist. We walked to breakfast as we did every morning. Along our walk, on which no one ever joined us, we provided each other with supervision, consultation, and the chance to move the stories of trauma, fear and loss we heard from our patients all day, out of our own hearts and into the blast furnace between us. We ate powdered eggs and pancakes most days, sitting alone to debrief. Once in a while, fresh eggs would be hard boiled. Sometimes, the shells came off perfectly in one smooth, rolling piece, leaving an unblemished egg white beneath it. Those were good egg days. Jason and I still wish each other good egg days, 12 years later.
The shell on my hard-boiled egg that morning shattered under my thumbs into countless tiny pieces that embedded in the egg white itself, impossible to free. The egg became littered with tiny shards of shell. I should have known. I moved on to pancakes.
Clinic that morning was a carbon copy of every day in Iraq. Jason and I returned from breakfast and we were briefed on the schedule by our terrific psych techs, who ran our combat stress platoon with skill and professionalism. My first three patients were follow-ups, which was unusual—and a good sign. With the extraordinary operational tempo experienced by most of the units on the base, very few had the luxury of time for maintenance visits to combat stress. And then, before we would break for a delicious lunch of Meals-Ready-To-Eat, Corporal Miller arrived at my door.
His light brown hair, closely cut in typical Marine fashion, curled ever so slightly along his hairline, giving him a boyish appearance. His light blue eyes, although shockingly bloodshot and encircled with deep shadows, smiled before his mouth did. He extended his hand.
“Nice to meet you, Ma’am.” He held a surprisingly firm handshake for longer than expected. An edgy tone laced his words. Something was off for this young man. He struggled to keep his voice under control. We took a seat.
The Marine had a plastic bag with him. He laid it at his feet and propped his rifle against the back of his chair. He glanced my direction and then away, multiple times, tapping his boot on the concrete floor to the beat of a quick, silent song. He leaned forward and rested his elbows on his knees. Lowering his face to his hands, he ran all ten fingers through the short curls in his hair and then jolted straight up in his chair. He exhaled sharply and broke into a brilliant grin, revealing straight white teeth. The tapping continued.
“What can I do for you, Corporal?” I asked pleasantly. The Marine had self-referred.
“Where to start, where to start ...” His voice trailed off into an easy whistle—an upbeat, jazzy tune. He looked around the small room again, boot still tapping. Then he burst out in agitated laughter. Assuming he was extraordinarily nervous to be there, I attempted to make him feel comfortable. “Take your time,” I said softly.
His bright blue eyes locked with mine. The chaos behind them began to emerge. Words tumbled out of his mouth at a dizzying rate.
“OK, I’ll just say it. I can’t sleep. I mean, I don’t want to, really ... so that’s why I’m not really sure if I should be here or not. After all, who goes to the Wizard when things are going absolutely great? That would be insane. And I’m pretty sure I’m not insane. Let’s face it, no one is talking to me who isn’t there and I don’t see my grandmother or anything. Not that that would be a bad thing. I loved my grandma. She taught me to draw, a long time ago, but I never really did much with it. But now I’ve been drawing lately and it’s making me remember her. The funny thing is, I really like the drawings .”
“What do you draw?” I interrupted him gently.
He reached into the plastic bag and retrieved a stack of paper. He shuffled through them briskly and selected one, which he handed to me.
I could not take my eyes off the image before me. Two hands, every wrinkle and fold expertly sketched, were folded in prayer, and a Catholic Rosary was wrapped around them. It was exquisite. I looked up.
“It’s beautiful. You are very good. I see you have a stack of drawings there. When did you do all of these?”
“Last night, I think. Or the night before. I’m not sure.”
“You drew all of these in one night?”
“I got on a roll. Once I started, I just kept going.”
“All right,” I started, softening and slowing my words, hoping to model a more normal rate of conversation for him, and simultaneously help him feel safe. “Let’s talk about that a little. Can you tell me about the last time you slept at all, even a few hours?” He sighed deeply. Once again, the conflict was obvious as he struggled to remember, to find clarity. He scrunched his eyes together and shook his head.
“I don’t know. Maybe Thursday night?” (It was Monday.) “All the days feel the same out here.” I couldn’t argue with that. Ground Hog Day, we often joked.
“Is it possible you have not slept at all in three or four days?” He nodded enthusiastically.
“But here’s the thing, Doc. I’m not tired. Not even a little bit! I feel totally amazing. I worked out at about 0230 today. I guess that was about eight hours ago now? I mean, what time is it? Anyway, it was the best workout of my life. I must have done a hundred squats. Never done so many pushups in my life. Every muscle in my body is loving being out here. I mean, the heat is something else again but it’s almost like it doesn’t bother me the way it does everyone else. My roommate was just telling me the other day that I am like some sort of alien, the heat doesn’t affect me at all. I am like the energizer bunny, Doc ... going and going, you know?” He paused to wink at me flirtatiously.
“What was I saying? Oh, right ... I can work out all hours of the day and I feel fantastic and everyone in my platoon is jealous of me. I’m the perfect person to go on deployment. I might even find out that I have some sort of powers that are making me able to do what no one else can. It’s completely awesome ...” His words flowed faster with each sentence, and became genuinely difficult to understand.
“Corporal. CORPORAL.” It took significant intervention on my part to interrupt. He stopped talking, surprised. “May I have your permission to interrupt you when I have the information I need? I know there is so much you’d like to tell me and much of it is really important, but I also need to gather some specific details to be able to help, if that is all right.” He seemed briefly embarrassed. He nodded and lowered his head.
I asked about a history of similar symptoms. Nothing like this had ever happened before. No history of symptoms of depression, either. Or anxiety. Or psychosis. No suicide attempt and no thoughts of it now. I asked about family history, which he said was negative, but then admitted he was adopted and didn’t know his birth mother. There was no history of trauma, other than the indirect fire we’d taken there in Iraq, and the loss of a few Marines in his unit. He had never been treated for mental health problems, took no meds, and was healthy. No history of head injury. He denied use of drugs or supplements. He had done well in school, including competing on the swim team, and was on the fast track in the Marines.
“Oh, except that I might be in trouble .” He grinned at me, and started giggling wildly, burying his mouth in his hand like a teenage girl. I waited. But not for long.
“You know the Commandant? Of course you know the Commandant, you are in the Navy and are wearing our uniform. Well, I wrote him an email yesterday. At least I think it was yesterday. Anyway, I was thinking about you officers, you know? And how it’s so ridiculous that we are out here in a combat zone and people are shooting at us - did you know they are actually trying to kill us, Ma’am?” I nodded, but he didn’t wait for my response before he went on.
“Anyway, we are trying to be operational out here, you know? The Marines are the greatest fighting force in history and we have these uniforms to BLEND IN with the desert ... right? But there our officers are with SUPER SHINY THINGS on their collars. And people like you with SUPER SHINY WINGS on your chest. The rest of us wear dark brown insignia for a reason, right? I mean, do they actually want you to be targets? Cause if I were a bad guy - which I’m not, Ma’am—I would take aim at anything that sparkled, you know? My Major, he’s hard core and not nearly as good a communicator as I am - there was one time he literally had us doing the most ridiculous goat rope exercise and no one talked to each other at all, it was a game of telephone. You know that game you played when you were a kid? Not sure if you played it, but we did .”
“Corporal. Let me stop you there. Your email to the Commandant got you in trouble, you said?”
“It’s about to.” He stopped, and his eyes darted back and forth, avoiding my gaze. Then, without warning, they filled with tears. “I love the Marine Corps, Ma’am. I don’t want to get kicked out.”
He was still holding the stack of drawings. His hands trembled so wildly that the papers rustled. Both boots were tapping now, uncontrolled and clumsy. Overcome with sorrow for this bright, talented young man who found himself in the throes of his first manic episode, I reached out and placed my hands on both of his. The trembling ceased. He looked at me again, and bit his lip.
“Help.” His voice was a whisper now.
He did not completely understand. In all my time as a psychologist I had only seen two patients in the midst of acute manic episodes. They never quite understood, either. Mania is too much fun, they explained. Usually we meet them much later in their experience, when their mania gets them in trouble or they get hospitalized for delusional behavior, or a suicide attempt, or both. Thankfully, Corporal Miller came to my door before it got to that point. Somewhere deep inside the chaos, he had enough insight to know that despite how fantastic he felt, something was not right. And somehow he trusted me enough to believe me when I explained we needed to bring him to the hospital to keep him safe. And to protect his fellow Marines.
We walked over together and I admitted him to our one-room ward, sending a radio message to Petty Officer Patacsil and asking him to contact the Marine’s unit. It was the worst for my patient when our surgical company Marines came to take his weapon. He panicked, agitated and anxious to let them take it from him. I felt empathy, knowing how vulnerable I felt without my own 9 mm in my shoulder holster. And I don’t even like guns.
I ordered the routine MEDEVAC and sat down to write a basic evaluation to send with him. He would go to Baghdad, on to Germany and finally back home, where a treatment team would be waiting for him. He would be treated for Bipolar Disorder and receive the medication he needed before his medical discharge from the Marine Corps. This was a young man of many talents. Similar to my experience with other manic patients, he was very likable and a delight to interview. He was engaging and entertaining. He had insight and intelligence, and a fabulous smile. He would be okay. He simply could not carry a rifle in a combat zone any longer.
The ink had not dried on my signature when the echo of stomping boots filled the passageway. And a booming voice outgunned all the other sounds of a typical day in a hospital.
“WHERE THE FUCK IS DOCTOR KRAFT?”
I stood up and smoothed my blouse, smiling to myself a little as my gold wings caught the light. He was right, I mused. Why was I wearing gold collar devices and wings? In the next second, my patient’s Officer In Charge was in my face.
He was a Major. He was nearly bald, with huge shoulders and an angry snarl on his lips. His hands on his hips, he stood inches away and glared at me. I half expected him to touch his nose to mine, and found myself wondering if he was a Drill Instructor in his former life.
“What can I do for you, Major?” I smiled sweetly at him.
“I just got word that you have ordered the MEDEVAC of Corporal Miller,” he barked.
“Yes. He has Bipolar Disorder and has been experiencing an acute manic episode for several days.”
“You can’t take him.”
“Major, it is dangerous for this man to stay in a combat zone. We do not have the capability to care for him appropriately here. He is not fit for duty.”
He backed off a few inches and tried a different tactic.
“Doc,” he said, his voice much softer. “I know you know what we are up against out here. We are undermanned as it is, with those Marines injured and killed last month.”
“I’m so sorry for your loss.”
“Thank you.” He smiled. “So you can see why I need Miller. He does the work of two men, maybe more. Did he tell you that he single-handedly catalogued an entire warehouse of parts a few nights ago? IN ONE NIGHT? And he wasn’t even on duty! Every piece of equipment we need is now organized in a computer system. It’s nothing short of mind-blowing. I can’t lose him. He is my most efficient Marine.”
“Thank you, Major, for illustrating my point. He catalogued an entire warehouse in one night because he is MANIC. It’s a serious psychiatric condition and it will get worse without treatment. His life and the life of those around him could be at risk.” The Marine officer frowned.
“I want a second opinion.”
“Certainly. Let me call my partner, Dr. Bennett.” I picked up my radio.
“Forget it,” he growled. “Here’s the deal, Doc. Line overrules medical. I am overruling your decision. I am taking Miller back with me. Needs of the Marine Corps.” He spun on the heel of his boot and started out the door.
“No problem ...” I called after him. “I do need you to just sign this first, though, before I can release the patient to you.” I picked up a blank sheet of paper and started writing. I read out loud to him while I scribbled.
“I, Major Smith, have been briefed by Lieutenant Commander Kraft regarding the psychiatric diagnosis of Corporal Adam Miller, and understand that my decision to take this patient out of the hospital is being made against medical advice. Thus I understand that I am assuming ALL RESPONSIBILITY for any adverse event that occurs as a result of this diagnosis going untreated ...” I handed him the pen.
He looked at me for a long moment, his face a changing landscape of colors— orange, red and purple. He snatched the paper off the table and crunched it into a ball in one hand, then spiked it on the ground.
“SHIT!” He stomped out the door, his profanity-laced rant fading as he disappeared down the passageway.
I waited, frozen, until he was gone. And then my knees buckled beneath me and I plopped backward into a chair at the nurses’ station. The urge to burst into tears found itself strangely juxtaposed with a desire to howl with laughter. I did neither.
Symbolic of our entire deployment, which brought the best and worst moments of my life—sometimes at the same time—I often reflect on that hot day in Iraq through the lens of perspective and growth. I learned a few life-changing lessons that day. I will never forget them.
From my patient, I learned how terrifying a first experience with mental illness must be—anywhere, really, but especially in a combat zone. I learned that the courage it took to accept help, and the sorrow he felt in leaving his fellow Marines behind were both exponentially greater than the fear he felt at symptoms he didn’t understand. From his OIC I learned about the conflict faced by combat leaders, and about the agonizing choices they have to make every day, between doing what is best for the mission and what is best for their people. He didn’t express it very eloquently, but I am certain he felt it. And from somewhere deep within myself, I learned that no matter what obstacles might stand in my way, I can and will summon the strength to stand up for what is right. It will be my job, going forward, to raise children who understand. We defend those who cannot defend themselves. And it is always worth it. It turns out that if this is the definition of a combat psychologist—it is exactly what my Marines have been trying to tell me, all along.