Crossings

by Jon Kerstetter

  A sudden burning sensation floods over my chest and right shoulder. I feel my heart pounding and pulse quickening. Sweat beads on my forehead and then drips in my eyes. I signal a halt and crouch low to the ground. There’s a painful swelling over the front of my deltoid. It will not budge. I tell myself to disregard it and keep pushing forward.

  I struggle to move the team toward the downed aircraft. My mind races forward one hundred yards. I keep the team on target with the shooters on the flanks. I smell aviation fuel and the chemical smoke of an aircraft fire. I see the burning Apache.

  Sweat flows from my neck and forehead. Suddenly my footing is off-center. My balance tilts and I can’t adjust. I fall forward, striking my shoulder on a rock. My right shoulder erupts with burning, ripping pain. I imagine the pain that a tracer round causes when it hits human flesh. The pain disappears. I feel feverishly hot. Pain stabs my shoulder again. I tell myself I’m hit, but I hear no crack of enemy fire. I hear nothing at all. My arm is still moving. The pain fades but then flares up quickly and tears at my shoulder. I hesitate. I am lost in confusion. I recover from the fall and holster my pistol after wiping mud from the grip. I recheck the medics. They follow haphazardly. I yell, “Don’t bunch up. Keep moving.” One of the medics fades in and out of view, trudging forward, then dissolving backward. The other medics are advancing at a crawl. I feel my skin tighten. My heart beats so loudly I focus on its rhythm.

  I advance so quickly that I outpace my team. I halt and wait. The medics are moving too slowly. My right shoulder spasms in pain. I cannot move. I signal the medics to advance to my position. They finally reach me in what seems like hours instead of seconds.

  “What the hell is going on?” No answer. “Somebody answer me.” I clip my speech. “Let’s do this mission. Move.”

  The shooters are on the flanks, two on the left and two on the right, medics in the middle. I take point. Docs never take point. I take point. We advance once again. My mind runs a checklist. I advance another twenty-five yards. The team is on target. Walk in the park. Stop!

  Seventy-five yards at my ten o’clock, I see movement. I signal my team to halt and take cover. Eight Iraqi insurgents come into view and are moving directly toward the downed aircrew. They have a grenade launcher. The Apache flying cover is not engaging. It doesn’t matter. I am in position. I need to engage the enemy before they get to the aircraft. They are moving fast, almost at a run. They have not seen me. I have tactical advantage. I signal for my shooters to fire on my command.

  “Open fire!” My team does not respond. I repeat the order, this time yelling loud enough to be heard in Baghdad. “Open fire! Open fire!” The shooters fire and hit two of the insurgents. Their leader hits the ground and positions his men to return fire. A quick barrage of gunfire splits the air. I now face six insurgents. I have four shooters. I signal our medics to move to the aircraft crew. They shift to the right, then run to the Black Hawk as the shooters lay down suppressing fire. I must control the fight. I want to call in air support but cannot work the radio with my hands. Something is jammed. I cannot wait. I decide to move forward and focus my firepower. I hear myself yell, “Kill!”

  I don’t have enough men to try flanking or enough time to try anything fancy. I advance straight up the middle. I tell myself I don’t belong here as I push forward in a full upright stance and run toward the enemy. My feet adjust to the rocks and I feel like I’m actually running above the ground instead of on it. I become instantly aware of everything in my past and everything in my present. My brain creates a collage of movement and sound. I hear rapid startled movements, the burst-mode firing of assault rifles and the metallic click of bullet casings ejected from their firing chambers. I hear the sound of my heart in my neck and feel the cold winter air against my sweat. Broken images appear. Some vanish quickly; others attach themselves to the corners of my retina. The images coalesce: burning aircraft, wild desert terrain, winter mud, and endless sand. Parts of soldiers materialize, then dissolve. I catch full glimpses of body bags. The rapid flow of blood murmurs as it rushes through my carotid arteries. My screams and commands roar above the sounds of firing weapons. I hear the indecipherable yelling of my enemy as they position themselves for cover.

  I move with the full force and intent of killing my enemy, who has the full intent of killing me. I reach for my holster, attached to my tactical vest. My right hand squeezes the pistol grip. I yank to move it into firing position. Pain instantly wrenches my shoulder and shoots down my arm. I shout and groan. My pistol is snagged. I cannot pull it free. I cannot move my arm. I know I will die in a matter of seconds. I am an easy target. I shall die today. Today is my day.

  The Iraqi leader charges straight ahead, directly at me. He matches me stride for stride. He raises his weapon and begins firing rapid chaotic bursts. I see the muzzle flashes. I’m sure I am hit, but I feel nothing. I feel suspended in time—trapped in a slow-motion movie that I am watching from overhead and left of center. I hear the now-muffled sounds of gunfire. A single round of ammunition explodes from the barrel of my enemy’s assault rifle and cuts through the air. The round scathes through the fabric of my uniform just below my left hip.

  Reflexively, I grab at my holster again. I loosen the retention strap with a flick of my thumb and strain to jerk my pistol free. Nothing! Nothing except a wrenching pain in my shoulder. The pistol does not release. I yell at my men to fire at will. The yell becomes a scream, and I can hear it reverberating in the cold air. “Fire! Fire!” I am close enough to see the right index finger of my enemy as he pulls the trigger of his weapon, close enough to hear the metallic zing of spent casings as they spin through the air.

  I know one thing: I shall die in this moment of battle, in this finite moment of war. I know it because I cannot fight as I was trained. I know it because I stand exposed to an enemy whose orders are to kill. I know it because I let my tactical advantages become tactical errors. I should have waited for air support, dug in, flanked, or moved directly to the injured aircrew. I know I shall die because I have become confused and have lost my focus. I can hear myself screaming a prayer: “God! Help me!”

  I fade in and out of something that is real and something that is an illusion. I scream in pain. The terror in my screams jolts me. I thrash and struggle.

  In a final terrified attempt to return fire, I yell some guttural animal sound and rip my pistol from its holster. I pull it up and across my body, centered into firing position. My index finger strikes the trigger and begins pulling in rapid succession. I see the wild spray of bullets as my enemy fires his weapon. We lock on the target of each other. I feel every pain I have ever felt in combat, but I feel them all at once, compressed into a single pulse of time, compressed into a rush of adrenaline and fear, like the sensation people feel in that suspended second just before they are hit in a high-speed collision. I feel the burning of a bullet as it splits my skin. I’m hit! I’m finally hit! The force knocks me to the ground. The fever I have felt sporadically now floods my body and I drip with the warm flow of blood. I am floating in air, flying in slow motion. I feel the shearing of my arteries and the tearing of muscle. I hear the splintering sound of shattering bone. Time moves backward like a cheap home movie that rewinds itself over and over, showing a clip until it’s worn thin and bare. I see that my rapid-fire bullets found their mark in the center of my enemy’s chest. The movie runs forward again and I know I am still alive, but my shoulder has been hit. From my position on the ground, I survey the scene. The medics are alive and huddled together. Three of the enemy insurgents lay dead, covered with sand. I cannot see the others. I hear the faint sound of a helicopter mixed with the sound of an approaching scream. My wife fades in and out of the battle scene. She screams my name. She wanders aimlessly at first and then finally stands on the far edge of my visual field, as if to watch from the sidelines.

  I yell frantically, “Get down! Get down!” I must be dead after all. Yes, I decide I’m dead. My wife is coming to my funeral.
She’s early. God, she’s here in Iraq. She’s not supposed to see me like this. I yell for her to get away. I hear myself yelling. How can I hear myself yell if I’m dead? I’m not dead.

  My shoulder rips in pain and I struggle to stand. I fall. I yell at my wife to get down.

  “Look out! Get down!”

  She yells in return, “What’s wrong. What’s the matter?”

  “I’m hit! Get down! Get down!”

  “You’re not hit! You’re okay!”

  My left hand reaches to my right shoulder. I feel pain and swelling. “No—I’m hit. I’m hit!”

  “No! Wake up! Wake up! You’re in Iowa. You’re home. Wake up!”

  —

  Collin’s voice finally penetrates the dream. The soldiers around me fade. The enemy vanishes. The desert dissolves. The helicopter disappears. My wife struggles to hold my flailing arm. I can feel her touch. “You’re okay,” she says. “Don’t move your arm.”

  Our living room comes into focus. I feel the surgical dressing on my right shoulder bulging over my deltoid. The post-op shoulder immobilizer that held my arm to my chest dangles loosely at my side. My right arm is free. I feel stabbing and tearing pain in my post-op shoulder. Sweat soaks my shirt. I see our fireplace kicking out its gas-log flames. My recliner rests only ten feet away. An extra blanket is wrapped around my legs in a tangle. Collin coaxes me back to reality. I finally hear her voice clearly. I see her face. I am home, in Iowa. I emerge from the stranglehold of a nightmare.

  —

  For several hours I had thrashed and struggled in my recliner. My nightmare entangled two realities into a third where I faded in and out of the real and the imagined. The “real” from my post-op pain translated itself into the “imagined” struggles of combat. On a winter night in Iowa, I experienced a time warp of sorts—a post-traumatic stress nightmare where the force of one kind of memory collided with the force of another, where time and experience collapsed into a singularity, a black hole where my mind could not define cognitive boundaries.

  In a post-surgical dream, I found that I had become a time traveler. I traveled in a parenthetical world of war, a world bound by the forces of PTSD.

  After surgery and during physical therapy, I had difficulty with ongoing pain. Sometimes it hit me like a sudden rip of thunder. No warning—just a frightening boom and a shaking of the earth. Other times, it started like a dandelion seed parachuting down on a puff of wind, its weight no more than the heft of a childhood memory. It felt like the tiny barbs of a rose leaf drawn across my skin. When pain came hard and fast, a scream bubbled from my throat. I tried to choke it off, but usually I let it fly like the screeching caw of a crow. If it started like a seed, it was tolerable at first, maybe 2 or 3 on a pain scale of 10. Either way, thunder or dandelion, the pain festered and grew so in the end it felt like I was being tortured or burned or pulled through a keyhole. My pills did not work. I bit the back of my hand or cupped my ears. I was cursed by the witchcraft of pain.

  During recovery, I wore a shoulder immobilizer for six weeks, and my arm and shoulder muscles atrophied so much I could feel the tubercles on the bones. The pain didn’t resolve with surgery; it got worse. Added to that, my stroke affected the strength and sensation of my right arm and leg. The combination created an extra therapeutic challenge. Pain reinforced weakness, weakness reinforced pain. Peggy and the orthopedic surgeon told me it would dissipate over time.

  The first weeks of post-op shoulder therapy were the worst. Pain shot from my shoulder to my back, and even into my legs. Its onset was mostly the thunder variety. Peggy worked slowly at first, and then gradually added arm stretches with a rope pulley and another stretching routine where she held my arm and gradually, but firmly, raised it to my side and overhead as far as it would go, which in the first sessions was about twenty degrees. When she stretched it to a limit where scar tissue and pain kept it from going farther, she held it there to the count of ten while I breathed slowly to control the pain; then she would move it a fraction of an inch past that resistance point and I usually screamed and panicked.

  “Okay, okay. That’s far enough!” I screamed. It sounded like a cross between a plea and a warning. We did full sessions, and afterward I would feel drained and nauseous.

  —

  On alternate days I went to cognitive therapy. Cher continued with reading and some work on brain exercises. It had been six months since my stroke, the time frame I had initially thought it would take to get back to normal. I felt impatient and wanted to push my cognitive recovery, but I didn’t know how. She cautioned me that overreaching might be counterproductive.

  “Recovery takes time,” she tried to convince me. “If you try to push too hard, it only makes you stressed and frustrated. You’ll get a slower recovery.”

  “I just didn’t think it would take this long to see results,” I complained.

  “But you have seen results. You can manage a list and you are beginning to restructure your reading skills.” She sounded encouraging, but I was thinking more about what I had lost instead of gained.

  “I should be able to do more than make a list or read a children’s book. I used to recall emergency protocols and complex dosing equations in seconds. Now I can’t remember shit.”

  “Are you the same person you were six months ago?”

  “No, but I want to be the person I used to be. I’m tired of having a stroke.”

  “So you do recognize the difference.”

  Cher always had a way of digging into my psyche with facts. They were like being hit with a thump on the chest. I had tended to view cognitive therapy as a hybrid of voodoo and neuroscience and psychology, yet Cher practiced a nuanced approach that encouraged critical self-analysis. And that hard reflection led me to the truth that my brain had changed—was changing—and that I was a significant stakeholder in the radical thing called therapy.

  “Yes, I understand the difference,” I said, resigned to the notion of having had a stroke, but still wanting to slough it off as if it never happened. “I get it. It’s real.”

  “Yes, it is,” Cher responded. “Think of it as a battle injury. It has real consequences.”

  We left it at that, at the reality of having survived a stroke and the reality that cognitive rehabilitation demanded far more than just showing up for a therapy session. I knew all that, but I wanted more. I wanted to push limits, like I had as a soldier and a doctor, but the limits seemed hard and fixed. I didn’t know how to unstroke a stroke. I felt stupid: stupid, unintelligent, uneducated. I wrote four block letters in my journal—STPD. It was a mnemonic for “stupid,” Stop—Think—Plan—Do. I never used it because I couldn’t remember it.

  Adding to my emotional and cognitive frustration, persistent pain from my shoulder surgery blocked my full efforts with Peggy and Cher. They adjusted their sessions accordingly but wanted to keep going so I didn’t lose ground. We continued as best I could, working around the pain.

  Collin continued to drive me to appointments between the exercise classes she was teaching, and when I wasn’t in therapy I wanted her to drive me to a coffee shop because I was so tired of sitting at home alone. In the month of January I went to forty-five medical and therapy appointments. During one particular week I had eighteen appointments. Collin wanted to scream, did scream.

  At the end of the first month back in therapy, it was clear that my progress had come to a standstill. Cher had me retested and some of the tests showed a regression instead of an improvement. I suspected the neuropsychologist thought I wasn’t trying hard enough. I was frustrated with therapy and could tell that my therapists were frustrated too. Cher explained that they weren’t frustrated with me but with the distractions interfering with my therapy, namely my recent surgery, the persistent pain, and possibly PTSD. She was concerned about my continued resistance to PTSD therapy.

  “Did you understand that your test results were positive for PTSD?” she asked.

  “They would be positive for anybody
just returning from war,” I countered. The discussion would go back and forth and I would never agree or never consent to any presumed need for therapy.

  —

  As good as my outpatient therapy was at the University Hospital, Collin and I both felt it lacked the continuity and intensity of an inpatient stroke rehab program. We needed more progress because, frankly, we were both on the near side of desperate. Our lives had begun to revolve around my stroke and its persistent reminders of all that we had lost together. That was our primary focus and neither of us would let the other live like that.

  We had asked Dr. Leslie about inpatient rehab and she suggested St. Luke’s Hospital in Cedar Rapids, Iowa, as a possible alternative. St. Luke’s promoted an intense hospital-based stroke and brain injury rehabilitation program and had a reputation for clinical excellence. Dr. Leslie consulted with Neurology and with my military case managers at Rock Island and recommended an inpatient approach. Within a week, the Army made arrangements for an admission to St. Luke’s.

  On the day I was supposed to be admitted, a late March blizzard hit Iowa. The Highway Patrol cautioned that some roads would be closed if conditions worsened throughout the day. One of those roads was Highway 218 to Cedar Rapids. Collin was afraid if we drove to St. Luke’s, she might get stranded or have an accident. Rather than run the risk of delaying my admission, we called a friend and he agreed to drive us. It took more than an hour to drive the thirty miles and we arrived at about 11:00 a.m. The blizzard reminded me of the blizzard that hit Minnesota the morning of my medical school interview at Mayo. As I had with that storm, I refused to let a blizzard keep me from a hospital.

  St. Luke’s was a five-hundred-bed hospital, a combination of an older redbrick façade and modern steel accents. When Collin and I arrived, we rode up the elevator to the sixth floor. The physical therapy reception area had an open feel to it and there were several patients coming and going in wheelchairs. I saw pictures of Midwestern scenes on the walls, and overall it didn’t seem so much like a hospital. After my room assignment, I met with the doctor who led my therapy team. He specialized in physical medicine and rehabilitation and focused on brain injury and stroke rehabilitation. His bookshelves held plastic brains similar to the ones in Cher’s office. Over the course of thirty minutes he laid out a complete therapy plan and answered all our questions. Therapists who worked exclusively in stroke and brain injury rehab would work with me in different therapeutic blocks. I would participate in rehab sessions at least six to eight hours a day. Therapy was diverse: physical, speech and language, occupational, and even recreational therapy as well as psychology. If I needed medication for pain or a trigger point injection, the doctors there would provide whatever I needed. In essence, it was one-stop shopping for stroke rehab. It held the promise of preserving my body and career—medical and military.