Outside the Wire

by Richard Farnsworth

I sat in an uncomfortable plastic chair looking across an industrial steel desk at my new doctor. The black plastic nameplate read; Mark Capon, MD, FAPA, FACP, and below that Staff Psychiatrist, Veteran’s Affairs Administration Hospital.

  Before this impromptu appointment we had never met. His thin neck held up a too-round head. The thick titanium-rimmed lenses and beak of a nose accentuated his bird-like appearance.

  “Good afternoon, Captain Rogers.”

  I hated to be addressed by my old rank. That had been an entire lifetime ago.

  He seemed to be waiting for a response.

  An old clock on the bookshelf audibly ticked the seconds away.

  “May I call you…” He looked down at his notes. “John?”

  I nodded. He could call me Bucky the Wonder-horse for all I cared, as long as I got my meds. I had been denied my prescriptions when I tried to fill them at the VA pharmacy and was told I needed to see this joker first.

  “Well, John, I am Doctor Capon, and I have been assigned to your case.” He affected a serious expression and said carefully, I am not sure if you’ve heard, but Doctor Roman passed away.”

  He looked at me for a response.

  “Doctor Roman died in a car accident last month.” He said it slowly as if to press the point home.

  Everyone dies. Having only met my previously appointed Staff Psychiatrist once before, his loss made no impact.

  “Well, I’ve been reviewing all of Doctor Roman’s case files.” He glanced down at my folder. “You have a diagnosis of chronic Post Traumatic Stress Disorder with attending Obsessive Compulsive manifestations.”

  The clock ticked a few more seconds. He looked at me expectantly.

  “I’m just here to refill my prescription. The pharmacy was closed yesterday and today I’m out.”

  “Yes, well I thought it would be a good idea if we met first, before I authorized release.”

  The low angle of the sun cast long shadows across the small office.

  “Will this take long? I’d like to be home before it gets dark.”

  “No, it shouldn’t be too long. I just need to go over some things with you before I feel comfortable with the current treatment modality.” He smiled primly.

  I nodded and he looked back down.

  The small room contained new VA-issued furniture and boxes of medical texts on the floor. He hadn’t been there long. The Medical diploma on the wall behind him was just four years old, so this was probably his first real job. He even smelled new.

  “Alright, so Doctor Roman had pursued a primarily pharmacological approach. I have you here on Fluvoxamine at three-hundred milligrams with recommendations that you attend a VA-sponsored PTSD support group.”

  He looked up at me but I didn’t respond.

  “First, that dosage is extremely high, and second I can’t seem to find any evidence of your attendance at a support group meeting, John.” He leaned back in his chair expectantly, fidgeting with a gold Cross pen.

  “Is that a question?”

  He smiled slightly and said, “Not really. Should I be more direct?” He paused. “You’ve been treated her for almost seven years and not once have you participated in any sort of therapy. Why is that, John?”

  I shrugged. A gusting wind keened against the window, warning of a change in the weather.

  “I’ve found that in treating PTSD, especially presenting with anxiety disorders that exposure and response prevention therapy, combined with the appropriate medications is the most efficacious treatment. We teach ERP in several of our support groups.”

  “Great,” I said, trying not to show too much enthusiasm. “Listen, I’m not good with psychobabble.”

  “In my residency at Cambridge hospital I actually co-authored a paper on anxiety disorders. It was a literature survey of various treatments for PTSD, following a cohort from Desert Storm,” he said authoritatively.

  “Your mother must be proud.” I suppose my tone lacked sincerity.

  For a full three ticks of the clock he looked at me expressionlessly before looking back down at my file.

  “From the answers on your Yale-Brown, I question if the diagnosis was appropriate, John.”

  He paused expectantly again and seemed disappointed when I didn’t respond.

  “Listen John, I am going to need your help here if we are going to be able to provide you an effective treatment.”

  I could so easily snap that thin neck. But that would wrong, I supposed.

  “We’re on the same team here, John.”

  Hardly. Most of my team was buried in Arlington National Cemetery. I sighed and then squeez

  “Great. Let’s talk about the images that you seem to focus on, and the behaviors which you feel compelled to perform, shall we?” He waved his little pen like a baton.

  I nodded. A faint smell of metal hinted at his enthusiastic perspiration.

  “So, would you say you engage in activities you feel compelled to perform, that occupy you for say, up to an hour a day?” he asked.

  “No.”

  He wrote that down.

  “Well, that’s good. How about the obsessions? Do you feel that you spend a significant amount of time dealing with unwanted or unpleasant ideations?” He twisted the body of the pen to drive the point in and then back out.

  “Yes. Images, mostly,” I said. There, I could be forthcoming.

  He wrote that down too.

  “That’s good, John,” Capon encouraged.

  “The meds help me keep the lid on.”

  He nodded at my progress.

  “And how would you best characterize these images?”

  “I try to avoid thinking about them. As I said, the medication keeps the lid on.”

  “It’s okay; we’re going to work through this.” I didn’t respond, so he continued, “What do you feel will happen if you give in to these obsessive thoughts?”

  Again, I didn’t respond. The clock ticked. It ticked again. I heard squeaks on the tile as someone walked down the hall beyond the office door. Probably going home for the day, it was after five.

  Finally I said, “I may become unpleasant and hurt someone, badly.”

  He didn’t have an answer for that. The frail little man could see from my records that I was capable. But my records didn’t reveal everything.

  “I see you were in Somalia?”

  I nodded.

  “Operation Restore Hope?” he asked.

  “Continue Hope.” He looked at me blankly. While I was undergoing my trial by fire he was probably still having his lunch money taken away by the big kids.

  “Continue Hope, then. That was where this all started?”

  I nodded.

  “Why don’t you tell me about it?” He folded his hands expectantly.

  Through the window I could see the branches of a leafless elm whip with the gusts of wind. The clock ticks almost echoed in the austere little room.

  “Well, in a nutshell, I was deployed to Somalia, injured, fixed and left with some problems,” I said. “Medically discharged with one-hundred percent disability. PTSD with OCD. Don’t you have it all there in the file?”

  “I’d really appreciate your cooperation, John.”

  Left hand to his right mandible, right hand to his temple and twist. His long thin neck would break at the fissure between the first and second cervical vertebrae like a piece of dry wood. It would be so easy. I tried to think of something else.

  “It’s a long story.”

  “I have time.” He smiled that prim little smile again and fidgeted with his pen. His fingers were long and slim. He probably played piano well.

  “Listen John, I don’t want to just go through the motions here. I really would like to get to the bottom of your troubles and see if we can’t make some progress?”

  “Cure me?”

  “I have helped others with your condition.”

  “I doubt you’ve ever helped anyone with my condition.”

  “Well, how will I
understand exactly your condition if you don’t share with me?” he countered.

  “My current treatment modality seems to work. Wouldn’t it just be easier to let me have my pills?”

  “No. If you don’t cooperate I am afraid that I will not be able to authorize any medications,” he said.

  “Holding them hostage?”

  He shrugged assent. Though it would make me feel better, snapping him in half wouldn’t get my prescriptions filled any quicker.

  “Okay then. I was team leader with the Thirteenth Special Forces, Operational Detachment Echo. We deployed to Somalia to help keep the militias from interfering with international aid:” It came easier than I had thought it would.

  “I saw Black-Hawk Down,” Capon offered.

  “Perhaps then you should explain to me what it was like?” I let the clock tick away a few seconds.

  He seemed to get the point.

  “That was Task Force Ranger’s story, mine is a little different. In August of ninety-three my Special Forces team and I executed a number of small operations outside of Moge with the intent of eliminating the flow of arms into the city.”

  “Is that when you were injured?” Capon asked.

  “Yes, on my team’s last mission.” I could see the thick seams between the tiles as I stared at the floor between my feet.

  “Why don’t you tell me about it, John?”

  I sighed. And then told him. The telling wasn’t the same as the seeing. And I saw it all again, vivid and real and tried my best to convey the depth my experiences in mere words.