Deployment: Cold to Hot

My husband deployed with the 785th Combat Stress Company, a reserve unit out of Fort Snelling, Minnesota, two and a half years later when he was a Major. The only combat stress unit in theater at the time, the unit was essential to providing soldiers with proactive, preventive, and restorative care. In addition to the day-to-day hardships of being in a war zone (as he would soon find out), soldiers had to manage household logistical issues, the distress of being away from their loved ones, and sometimes even breakups with their significant others. The 785th comprised the best group of people for the work that needed to be done at that time. They regularly went above and beyond, and everyone worked together in concert to help soldiers return to duty as quickly as possible.

They flew on a commercial aircraft off of an airbase that was near Fort McCoy, Wisconsin. January in Wisconsin is what my husband has described to me as “butt- ass zero below freezing.” After one failed attempt to depart due to mechanical issues, they lined up outside the enormous airplane with their rucksacks, duffel bags, and weapons. He was already missing his family (his then wife and two young sons) and didn’t want to fly farther from them, but he was bathed in warm relief when they were finally given the order to board. The soldiers lumbered up the stairs and sat every other seat with their duffels next to them and their rucksacks in their laps, and flight attendants gave them hot towels to wipe their faces. Other than having his gear, my husband felt like he was in first class.

As they flew to Maine to refuel then on to Kuwait, his attitude shifted to a fatalistic point of view. He took stock of his life up to that point and decided most of his decisions had never been ambivalent. Where he did his training, what field of medicine he chose, and even where he was stationed all were clear choices. But being deployed—that wasn’t in the plan. The only way he could reconcile it was to see this deployment as his destiny, something that was out of his control. He didn’t know it then, but this concept of acceptance and fatalism would be vital in getting him through the deployment.

After a 24-hours trip, he landed in Kuwait, a stark difference from Fort McCoy. It was butt-ass a hundred above boiling (my words—but he assures me it’s an accurate description). There were too many people. The portable toilets overflowed all the time. You had to stand in line 45 minutes for chow. And the commanders were making work for the soldiers to do while the unit waited for their vehicles to arrive from Fort McCoy. Another psychiatrist who was senior to my husband got bent out of shape about the experience, feeling the command wasn’t informing him adequately of the plans. Cloaked in his new attitude, my husband decided it was nice not to have to make any decisions (well, except for the decision not to make decisions). People told him where to be and what to do all the time, and all he had to worry about was following orders. During this lull he began to develop a relationship with his commander, who increasingly asked him medically relevant tactical questions and about his perspective on personnel management issues that were affected by extreme personalities. He capitalized on my husband’s rare experience of direct combat casualty care and made him the medical director of Combat Stress Company, as well as appointing him as the officer in charge of the treatment center in Baghdad. The senior psychiatrist who had been agitated upon arrival was unhappy he had not been named medical director. Rule No. 4: Command strategy may not always be readily apparent to boots-on-the-ground troops, and from the ground troop perspective, accepting that rather than becoming disgruntled will save you a lot of energy.

Although his training had paid off and he was energized about the mission, he was devastated four months in when he learned his six-month deployment had been extended to a year. He had grown weary of the constant, around-the-clock combat operations. Time was filled with tense, hot days and restless, anxious nights. Throughout the day he could hear gunfire and explosions in the distance, and at night he’d be woken up by what sounded like thunder on top of him and everything outside shaking. One night their treatment center, a converted Iraqi Republican Guard building, was damaged by a rocket that landed in an alley across the street, which funneled the shrapnel like a gun barrel. The shrapnel blew off their front door and shattered the windows, filling their house with smoke and debris. Everyone was accounted for and miraculously no one was hurt, but they couldn’t deny the front lines were becoming blurrier, the combat inching closer to them every day. He knew the longer he stayed the greater his risk of injury. And now he wasn’t even halfway through his deployment.

After the attack, and because his unit’s location was at an important intersection in Baghdad, they had to develop a defensive plan. If the base was overrun, they were supposed to hold their building for several days while the nearby hospital and government workers could be evacuated to a new rally point. A quick inventory of the one box of ammunition in the whole house made it apparent that they would be poorly prepared and equipped to meet this objective. They requisitioned the brigade for more ammunition, fixed the holes in their walls, and drilled for attacks and evacuation. They asked the nearby combat arms unit to help design their defensive fighting positions and guard towers. Recognizing that NCOs are the backbone of the military and provide invaluable counsel to leaders, my husband relied on them to hold regular drills so everyone could spring into action should things go south. The key for him as medical director was to leverage the skills and expertise in and outside his unit since he wasn’t about to pretend to be an expert on combat arms. Leaders make the decisions, but they should solicit counsel from those under their command. Rule No. 3: Knowing your limits and listening to your NCOs promotes success.

In the meantime, my husband and his unit were compelled to bring combat stress care concepts to the next level. The doctrine directing care came from years of theory since Vietnam, but (fortunately) military doctors had little opportunity for practice due to long periods of peace between the wars. First, the 785th evolved and improved doctrine based on lessons learned. For example, they expanded their mission focus to include anything behavioral health related, not limiting care just to combat stress patients. Getting patients to come be treated for anything mental health related was already challenging, so expecting patients to figure out which behavioral health provider to see at what center wasn’t reasonable. Next, they broke down stigma associated with accessing care. Their patient numbers swelled, averaging 120 contacts a week and made possible by their well-coordinated care team of psychiatric technicians, nurses, social workers, psychologists, and psychiatrists. Third, they removed the physical obstacles between them and patients by bringing the care to the patients. Troops were scattered across Iraq on small bases with few resources, and soldiers with combat stress couldn’t go convoying through hostile territory to come seek care for combat stress or another mental health issue. While all three of these actions were radical, this last one affected the most change in their concept of care.

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