Hidden Battles on Unseen Fronts

by Patricia Driscoll

  Today we see an unprecedented partnership between DoD and the Veterans Administration to improve access and care for our warriors. That partnership reports frequently to Congress on the progress of improved care of soldiers with trauma, TBI and psychological health problems. This applies even to those cases which are still under investigation. Research funds allocation and America’s superior resources on important healthcare issues allows America to keep its promise to its warrior veterans. Every day we are committed to meeting the healthcare needs of those who have sacrificed for our country, and I am proud to be involved with this collaborative and cohesive effort.

  “Treatment is most effective when the patient is in charge and the ultimate expert in his or her recovery. Treatment works best when the doctor or therapist acts as a kind of expert consultant. As Home Depot puts it: ‘You can do it, we can help.’”

  —“Healing the Troubled Mind Takes More Than a Pill,” The Washington Post, February 10, 2008

  5

  BRINGING THE WAR HOME

  The Story of Army Chief Warrant Officer Richard Gutteridge

  “Reliving the horrors of evacuating fallen soldiers’ and Marines’ remains, searching through body bags for dog tags and watching soldiers die was too much. I became more withdrawn and distant from my family. I was having what I was later told were ‘suicidal ideations.’ I also began to increase my use of alcohol to cope. I am not proud of this, and it is difficult to admit.”

  Richard Gutteridge almost ended his life on Christmas Day 2007. “I no longer had a desire to continue. I felt as though my condition would never change. I just wanted it to be ‘like before,’ and quite honestly I couldn’t fathom staying like this.” Late that evening he phoned the nurse practitioner who had been seeing him at the military clinic in Ansbach, Germany and told her what was going on.

  “I felt relieved calling her, but knew that as soon as I placed the call my career would be over. After I told her that I was ‘safe,’ she told me to come see her the next morning in her office. When we met she told me that I needed more help with my PTSD than she could give. She told me that I could go to Landstuhl Medical Center on my own, or else I would be taken there by force. I couldn’t see a way out so I gave in.” Richard opened the office door to see his wife standing there with his suitcase. She was accompanied by his brigade commander and a chaplain. “Reality kicked in. I only had time for a quick goodbye and I was on my way to Landstuhl in a van. I never felt more alone in my life.”

  Earlier that year he had returned home from Iraq to Germany where his wife and two young sons waited to greet him. The homecoming was sweet. “I was required to complete a Post-Deployment Health Assessment after returning. At that point, I didn’t feel like I had any problems that needed immediate attention. Completing the required forms was a ticket to begin leave and I didn’t want to be delayed.

  “I began to clear my unit in Friedberg, Germany—the 1st Brigade of the 1st Armored Division was casing its colors and returning to the States. Friedberg was closing.” Since Richard wanted to stay in Germany, he executed a Consecutive Overseas Tour (COT) and moved to Ansbach. While he was in-processing to his new unit, he was told that he had failed to complete the 90-day Post Deployment Health Reassessment (PDHR).

  “I had been back from Iraq for about four months when I started to have the nightmares. Gradually more and more things reminded me of what it was like being over there. Besides the constant reminders I started having these intrusive horrible thoughts about what had happened, specific moments. I found myself becoming easily angry at the littlest of things—the kids being too loud or a car pulling out in front of me. I was also having trouble sleeping and I’d begun to withdraw from my family. So for whatever combination of reasons this time I answered the PDHR more “honestly.” After a doctor in Ansbach reviewed the assessment he told me that I had chronic PTSD and combat stress.” He was referred to the Behavioral Health clinic in Ansbach. Facing a mental health issue was not how he envisioned his return from combat.

  The second oldest of seven children of a loving, “very Catholic” family, Richard was living in Greensboro, North Carolina when he graduated high school in June of 1982. Although his father had a well paying job, college wasn’t an immediate option. “The Army was a way for me to get money for a college education. I joined for the VEAP money [Veteran’s Education Assistance Program] which was a recruitment tool used for a short time between the G.I. Bill and the ‘new’ G.I. Bill.”

  Richard spent his first tour in the Army at Fort Bragg as a paratrooper in the 82nd Airborne Division, and then spent the next eight years in Germany followed by another tour in the 82nd as a Sergeant First Class, and then four years at Fort Hood, Texas. During the next sixteen years he would deploy for Operation Desert Storm (Saudi Arabia to Kuwait and Iraq and then back to Saudi Arabia), Bosnia, Kosovo, Turkey, Romania, and twice more to Iraq as part of Operation Iraqi Freedom. While based in Germany he was assigned to the 1st Armored Division and deployed to Baghdad in 2003 for thirteen months. He returned to Germany in July 2004 and then redeployed to Iraq in December of 2005, serving in Al Anbar Province fourteen months until February 2007.

  “During my last deployment I was the Battalion Motor Officer for the 1-36th Infantry Regiment of the 1st Armored Division. I was in charge of a combat outpost in the city of Hit [pronounced “Heat”] which housed my maintenance operation as well as the Battalion Aid Station. During this time I was also in charge of day-to-day operations of a combat outpost with 57 soldiers. My outpost also contained our detainee center where we processed over 2,000 detainees during my stay. I was also in charge of day and night Medevac missions, receiving casualties, coordinating with the air crews, relaying information between the battalion surgeon and his team of medics to the air crews, setting up the landing zone, organizing litter teams, helping with providing triage, and loading the aircraft in a timely manner due to the frequency of mortar attacks, sniper and small arms fire.”

  During Richard’s fourteen months in Hit, over 100 US soldiers and countless other combatants as well as civilians were Medevac’d out. His task was to remove the human remains from destroyed vehicles and search through body bags for dog tags to help positively identify fallen US troops. “I was involved in handling the remains of more than a dozen dead soldiers, Marines and combatants. We didn’t have any mortuary affairs personnel, so three of us handled the task: Dr. (Major) John Rumbaugh, our Battalion Surgeon, Specialist First Class Gregory Wilson and myself.” Because they didn’t want to expose any young soldiers to what they were doing, they did it all themselves. “We took this task as seriously as defending our outpost, so we did it slowly with dignity and respect.”

  On a September day in 2006, Richard was checking serial numbers on destroyed vehicles that were to be taken out of service. As he opened the door of a blown-up Humvee his arm was suddenly smashed up against the vehicle. It was a sniper. “I was taking my chances walking out to check the vehicle. It was located within the boundary of our outpost, but in direct view of the city only 100 meters away. I didn’t hear the shot. I felt like an idiot because I had been so careless.” After controlling the bleeding, he called the battalion aid station on his hand-held radio and told them what had happened. “The medics cleaned my wound and prepared me to be Medevac’d but I refused because I wasn’t leaving my men—I was in charge.” Two days later he drove to Al Asad Airbase and had his forearm x-rayed. Sure enough the image showed four slivers of bullet fragments.

  It was the body bags, not the near brush with death that Richard would talk about to the nurse practitioner psychiatrist throughout the fall of 2007. “I began therapy sessions on August 2, 2007 and thought the first ones went pretty well. As a result of one of my earliest sessions she recommended that I adjust my Cytalopram [Celexa] medication and told me to call the clinic if I needed to.”

  But his condition worsened. “I continued to have nightmares and I felt as though I was losing control. I called the clinic in Ansba
ch a week later to see the nurse again but she was on leave and her next appointment was not for twenty days. I inquired about seeing a doctor and was told that the next available appointment was twenty-one days from then. I told the receptionist that I would drive to Landstuhl Hospital to see a doctor (two and a half hours away). But she told me that was not possible. Instead she told me that she would place a telephonic referral for me to speak to a doctor who was “deploying soon” from Vilseck, Germany and that he had 72 hours to contact me.” Richard was asked if he was “suicidal” because being suicidal was the only way to get immediate help. “But I didn’t feel suicidal at that moment; I just felt panicky, and that’s what I told her.”

  He felt frustrated and angry. “I e-mailed the Wounded Warrior Hotline and told them that I needed help now. I said that I was a senior Warrant Officer with 24 years of active duty and that I had served in Iraq during Desert Storm and that I had two extended Iraqi Freedom tours. If this is how I was being treated, how would a young infantry soldier be treated?”

  It wasn’t long before he received a phone call from the Wounded Warrior Hotline, and shortly after that a phone call from the doctor who had been given his telephone referral. “We discussed my condition, and he made recommendations concerning my medication. I began to feel better.” Weeks later he resumed his one-on-one care with the nurse practitioner. But as the fall progressed his memories became particularly disturbing. “I was reliving the horrors of evacuating fallen soldiers’ and Marines’ remains, searching through body bags for dog tags and watching soldiers die, and it was too much. I became more withdrawn and distant from my family. I was having what I was later told to be ‘suicidal ideations.’ I also began to increase my use of alcohol to cope. I am not proud of this, and it is difficult to admit.”

  Once he got to Landstuhl, Richard was admitted to the in-patient psychiatry ward. He was issued a hospital gown and socks with tread woven into the soles. “When they snapped on the hospital bracelet, reality really set in. Having to be observed 24 hours a day, shuffling around in socks behind locked doors marked ‘elopement risk’ was humbling.”

  “I was observed twice daily for the next seven days for signs of alcohol withdrawal. I had to answer simple questions and was instructed to hold my hands out and steady to see if I was shaking. Even more humiliating, I was watched when I shaved or ate (with plastic utensils). My only reprieves were the ‘fresh air’ breaks—two cigarettes in quick succession while standing out in the cold winter air wearing a hospital gown under the constant supervision of one of the staff. Eventually I realized that the purpose of my being in a lockdown ward was for my own safety. It was tremendously difficult for me, but ultimately I have nothing but great respect and admiration for all the personnel who worked on that ward.”

  As New Year’s Day 2008 approached, one of his psychiatrists told Richard that he was recommending medical retirement. He was to be sent to Walter Reed Medical Center to out-process from the Army via the Warrior Transition Brigade. He was told that he would receive PTSD care at a Veteran’s Administration facility after he was separated. “I cried for the first time since returning from Iraq. I was heartbroken. I didn’t want to retire.” He said goodbye to his wife and two sons and then flew to Walter Reed on New Year’s Day.

  After landing at Andrews Air Force Base in Virginia, Richard was taken by bus to Walter Reed. He was allowed one quick smoke before being escorted into the hospital and taken to Ward 54, the in-patient psychiatry ward. “I had never been to Walter Reed, but I had heard the stories and was very apprehensive. Once I got to the ward I realized that having been through the initial ‘drill’ at Landstuhl I wasn’t as apprehensive of the in-processing procedures. A short while later I was back in a hospital gown with a ‘new’ bracelet. But I was now able to wear shoes without laces instead of those socks.”

  On Ward 54 Richard soon reacquainted himself with a few of the soldiers he had met at Landstuhl. They assured him that the ward was “cool.” “I felt much better then. I began talking with psychiatrists and psychologists who were very kind and understanding. I immediately expressed my desire to not be medically retired, and they told me that I would be my own best advocate so I made the decision to make the best of it. I participated in group therapy and followed orders; I made friends with my fellow patients. But even so the smoke breaks continued to be all that I looked forward to—those and phone calls to my wife.”

  Once Richard heard of the Specialized Care Program at Walter Reed specifically geared toward PTSD he made up his mind that being admitted into that program would be key to fulfilling his goal of recovery and staying in the Army. He had hope for the first time in weeks. Even so there was one group of patients who “got to” him.

  “I quickly became disgruntled with the Initial Entry Soldiers who were also on Ward 54. These trainees were still learning to be “soldiers,” and I’d sit in group therapy listening to them, people less than half my age, complaining that they could not adapt to the Army, could not get along with their Drill Sergeants and so on. Our experiences had nothing in common.” Richard’s disdain of the entry soldiers was shared by other combat veterans who had PTSD issues. They soon branched off into their own group and shared their own stories about combat stress and how to deal with it on the battlefield and at home.

  “My whole being was focused on getting moved to Ward 53—the outpatient psychiatry ward. After almost two weeks on Ward 54, I was released to Ward 53 and moved into Abrams Hall. This time I almost cried tears of joy.” The new environment was “a breath of fresh air.” The staff was friendly and accommodating. The atmosphere was refreshing and hopeful. Richard had made his intentions clear early on about wanting to be admitted to the Specialized Care Program specifically geared toward the treatment of PTSD. He began a series of interviews with psychiatrists, psychologists and social workers from the Deployment Health Clinical Center at the hospital. “Initially I was discouraged because I felt that I had not made the cut during the final phase of the process, but I began the program on February 4, 2008.”

  “The Specialized Care Program was awesome. From the very first day I knew I was in the right place. I looked at the other seven soldiers in the program and I saw the same worn, haggard, distant look that I became accustomed to seeing in the mirror each morning.” The intense, three-week PTSD program provided an overall health care assessment as well as an understanding and recognition of symptoms of PTSD.

  Richard learned to normalize his reactions to combat experiences. Coping skills such as breathing techniques and yoga were coupled with one-on-one therapy with doctors and nurses to help him reduce his hyper-arousal and vigilance. And then there was telling his story to others who had had similar experiences.

  “To me it was the group therapy with my fellow PTSD sufferers that made the biggest difference because we were all providing each other with mutual support. The program saved me. I can now manage my depression and grief associated with PTSD. I am now aware of selfcare and available resources. I feel like a husband and a father again. I owe the staff of the Specialized Care Program my life.” Today Richard continues to serve his country as the Brigade Motor Officer for the 12th Combat Aviation Brigade in Ansbach, Germany.

  MEDALS

  Two Bronze Stars, Purple Heart, 3 Meritorious Service Medals, 12 Army Commendation Medals, 10 Army Achievement Medals, 4 Army Good Conduct Medals, 2 National Defense Service Medals, Armed Forces Expeditionary Medal, Southwest Asia Service Medal with 3 campaign stars, Iraqi Campaign Medal with 3 campaign stars, Global War on Terror Expeditionary Medal, Global War on Terror Service Medal, Armed Forces Service Medal, Military Outstanding Volunteer Service Medal, Non-Commissioned Officer Professional Development Ribbon with number 3 device, Army Service Ribbon, Overseas Service Ribbon, NATO Medal, Saudi Arabia Kuwaiti Liberation Medal, Kuwait Kuwaiti Liberation Medal, The Combat Action Badge, Parachutist Badge.

  “There is a lag between the time someone experiences trauma and the time he or she reports sym
ptoms of post-traumatic stress. This can range from days to many years, and it is typically much longer while people are still in the military.”

  —“Counting the Walking Wounded,” Professor Lawrence Wein, The New York Times, January 26, 2009

  6

  HEALING THE HUMAN SPIRIT, HOUR BY HOUR

  By Barbara V. Romberg, PhD

  In the spring of 2005 I heard a story about a young man who had returned home from Iraq. He was clearly experiencing severe repercussions from his experience in combat. Unfortunately, he had no idea what was happening to him. He lost his job, his wife and kids, and was living out of his car.

  At about the same time I was driving with my two daughters through Bethesda Maryland, a suburb of Washington, DC. As we often do, we saw a homeless veteran on the street corner. He was wearing fatigues and holding up a sign that said, “Homeless Vietnam Vet. Please help. God bless.” My oldest daughter, who was nine at the time, turned to me and asked, “Mom, if that man fought for our country how come he’s homeless?” Soon after that I founded Give an Hour.

  My father was a veteran of World War II. He served in the Navy and was injured during a battle in the Pacific. He never talked about the war, but my brothers and I saw the consequences of his combat experience. Growing up in a rural community in California during the 1960s and ’70s, I saw many young men head off to Vietnam. Some never returned; some returned but were never the same. They became the homeless men that we whispered about and crossed the street to avoid.