by Marc Dauphin
But I did have it. I was emotionally flat most of the time. Christine had even lost her temper with me one night and threatened to leave. I had just shrugged and thought, Oh, so maybe our marriage is over, and answered, in a matter-of-fact tone, “Okay. If you want to.”
For weeks I couldn’t bring myself to walk on grass.
I made scenarios in my head: when crossing a bridge, I would roll down my window, even in winter. They were electric windows, and when the car would plunge into the water, it would short the motors, and the car would have time to sink before I could get out.
Once, as Christine and I were waiting at a red light, a police car came screeching to a halt in a parking lot next to us and the policemen got out at a run. I grabbed Christine’s arm, threw the car out of gear (it was a manual), and started to pull her out because I was expecting shooting to break out at any time.
Another time I slammed on the brakes in the middle of Hochelaga Street in Montreal because I had seen an empty pop can on the pavement ahead.
In the psychologist’s office, I would plan where to put up the sand bags to make sure everyone was safe from bullets. Wherever I went, I always planned an escape route.
How could I be like that, when I wasn’t anxious?
The psychologist, Dr. Pascale Brillon, an expert who had written books on PTSD, explained it to me.
“What was your greatest fear when you were over there?”
“F---ing up.”
“Well, there you have it. You were afraid of messing up. So you are still sensitive to that. That is why you had a panic attack when you thought you had messed up.”
She let that one sink in for a while, then added, “Military, police, firemen, and ER people don’t need the ‘A2’ criterion to have PTSD. They are so well trained to keep their cool that they never experience overwhelming fear, horror, or helplessness.”
So that’s how I came to accept that I have PTSD. I know a lot of my people have turned up with it. I have tried to let them know that it’s okay to admit it. And to do like me: take the goddamn pills and shut up. Just kidding. I’m still a proud guy. But if telling my story can help my comrades who are suffering get help, then it’ll be fine with me.
It is December 2012 now, and I’m most of the way back. Christine has started to become goofy again. She had been so serious for so long…. Yeah, I know, she was hurt too. But we’re both coming back.
Oh, and if you’re wondering what happened after Jinder’s piece aired on CBC Radio, well, that was the day they arrested that guy Williams from Trenton. So, not many people heard the piece. And those who did weren’t offended by my choice of words as much as by what had happened in southern Ontario.
You have to get lucky sometimes.
* * *
1 We are just before publication and the new manual of diagnosis of mental disorders (DSM 5) has entirely removed criterion A2.
Chain of Evacuation and
Principles of Care
In life, there are three pleasant relationships: friendship, love, and comradeship.
Friendship is easy to define. It can be more or less intense, more or less intimate as to which inner thoughts are shared, and the extent of the definition can vary from one person to another. Some people have one or two friends. Others have hundreds. The main thing about friendship is that it’s a mutual decision. Each participant willingly chooses to be friends with the other.
Love, although difficult to define, is, surprisingly, fairly clear: most people think they can recognize love.
The third is comradeship, or, according to Webster, camaraderie. This is that very special attachment between individuals that is initially imposed on them by their being in the same place and facing the same obstacles (my definition — so there, I’ve made my contribution to the sum of human knowledge). I might add that, very often, the individuals in question would not even consider being together or even being acquaintances in their usual social circumstances. Many Hollywood films have been made about people from different backgrounds being forced by happenstance to face obstacles, and finding that, even if they are from different backgrounds, and have different outlooks on life, they can overcome these differences in order to triumph over the obstacles, and in the process develop a special relationship with one another. One of the most famous of these relationships is in The African Queen.
That is camaraderie, or comradeship.
The world’s various armed forces, especially during war, need such intense comradeship, and actively foster it (with varying degrees of success) through training and hardship. These relationships are very often stronger than the will to live. Indeed, many a soldier would readily give his or her life for a comrade without as much as a thought. Yet, most often, these intensely close relationships do not survive once the people involved are not together anymore. The most inseparable comrades in war don’t even call each other after getting home. Comradeship rarely evolves into friendship, and hardly ever into love.
This story is a bit about comradeship. It is perhaps not as intense as that among soldiers who are constantly in combat (although in Afghanistan we were regularly shot at, albeit not very expertly), but it involves people who were constantly fighting against death on a scale I had never seen before in my quarter-century of ER medicine.
In 2007, I volunteered for a six-month rotation in Landstuhl, Germany, to help coordinate the repatriation of our severely wounded soldiers from Afghanistan. My expertise with ER medicine was certainly a factor in the CF choosing me, and my familiarity with ICU medicine may have also contributed, but the most important personal attribute that I brought with me was that I spoke French. Indeed, I am and have always been 100 percent Québécois. My ancestors arrived here sometime in the early 1600s, among the first Europeans to set foot in North America. So I was a logical choice for that deployment during Roto 4, a French-speaking roto from Valcartier, near Quebec City. Not a very distinguished reason for being brought back into military life, but I really wanted to do my part.
I was also a little tired of trying to treat patients in a health care system that can best be described as not running on all cylinders (my personal view from Sherbrooke, Quebec, where I was working at the time). Being forced to sustain severely mentally ill patients for months while awaiting a psychiatric consultation because I did not have the expertise to establish the proper diagnosis or to give the correct medication, while at the same time helping that patient fight the insurance company that wanted to cut off his benefits because he had been sick longer than the prescribed time to “cure” that condition, all the while being told by the overwhelmed secretary at the psychiatrist’s office that no consultant would be available for another four, five, or six months, was a time-consuming, wasteful, frustrating misuse of my professional capacities. Plus, I hate to see helpless people get screwed.
When one adds the same problem with orthopaedists (in 2006, two years to get a consult for a non-emergent case in Sherbrooke), radiology (one year, in Sherbrooke, for a non-emergent ultrasound — six months or more for an MRI), and a host of other specialties, one can perhaps be forgiven the gradual buildup of anger toward a system that no one seems to be able to fix.1 Instead, the CF offered me the chance, indeed, the privilege, to use my professional abilities to a great good: the care of my injured brothers-in-arms.
The military’s is one of the best health care systems in Canada. Plus, they were ready to spare no expense: transportation, lodging, communications, and support. Plus training (in my case, refreshing my training) in air evacuation (AE). And Afghanistan was a major operation, the first since the Korean War. “You want a med tech in Germany? We’ll get you one. Anything else, doc?” Well, maybe not that easily, but compared to civvy street, a lot more efficiently.
First, so that you understand what we are talking about, a bit of general military knowledge. (You can skip this part, although knowing what it contains might make your later reading more enjoyable.)
Let’s start with the evacuati
on chain. What happens to a soldier once he’s wounded?
a) The soldier is kept alive in the field.
b) He is evacuated to Kandahar Role 3, where his wounds are attended to.
c) Once stabilized, he is evacuated to Germany, either directly from Kandahar or through Bagram (the USAF airhead in Afghanistan).
d) From Germany, once stable, he is evacuated to Canada, where definitive treatment is given.
e) Then, in Canada, the rehab takes place.
Let’s look at this in more detail.
Our soldier is Jim. He is on patrol, out in some dusty Afghan village, and something happens to him. The first response of his buddies will be to control the situation, to eliminate the threat. This may seem different from the “traditional” war movies in that today, as long as the unit is under fire, everybody’s first job is to eliminate the bad guys shooting at you. And “everybody” includes the medics. They, too, must be able to fight to protect their lives and that of their patient. Once the threat is eliminated, only then will Jim’s comrades attend to him and the other injured. Of course, it is very difficult to shoot at the bad guys while seeing Jim bleed to death. So, even today, many times someone will attend to Jim even while bullets are flying. Indeed, in Afghanistan many medics have been awarded decorations for their courage and selflessness under fire. I am privileged to know some of these people.
The first one to Jim’s side is often his brother infantryman. All combat troops are trained in combat first aid. This is a specialized and more advanced form of first aid that all deploying troops must know. So Jim’s buddies will attend to him as best they can. Then Jim will be taken under the care of a TCCC-trained (tactical combat casualty care–trained) comrade.
TCCC is a specialized two-week training course in advanced combat first aid care for non-medics. It was started in the U.S., then was adopted and adapted by the CF. The TCCC training given in Valcartier is of the utmost quality, as attested to by a surprising mastery of life-saving techniques by ordinary infantrymen. I must say that, having witnessed, in Valcartier, the pitiless, gruelling way in which the instructors impose realism to stress the trainees to the maximum, and having received, in Afghanistan, casualties who had had their lives saved by advanced techniques performed by simple infantrymen, the results are impressive. Score another one for the CF.
Soldiers who survive the gruelling TCCC course, and then pass the difficult exam, are allowed to wear a patch on their uniform that says “TCCC” (what else?). And they are extremely proud of it. Perhaps you have seen that patch on pictures of your soldier friends or relatives. Oh, one more thing: they get to wear it only as long as they are qualified. They must re-certify every ninety days. Yup, that’s right, they have to re-certify in Afghanistan. And re-course every eighteen months. If they fail to do so, they cannot wear the patch, and are not issued a TCCC pouch. So they put in the effort, and study like hell. Reminds me of university.
If there is more than one casualty in the incident, the TCCC-trained soldiers can handle the complex job of triaging, giving care, and organizing the evacuation. That’s how good they are.
Usually, the TCCCs will operate under the guidance of the medic who is out with them. Those medics can do almost anything to save a life. We sure have come a long way (and I have been vindicated many times over) since the days of those first aid competitions for the medics. C’est comme ça. It’s not necessary to win the first quarter, only that you be ahead when the clock stops.
Combat medical technicians (also called med techs, or combat medics), in addition to their regular education, have to go through a gruelling condensed and intense day-and-night period of training in Suffield, Alberta. This course is called TacMed and every medic must redo the whole thing every time he or she deploys to a war zone, even if he or she has just come out of one. They hate having to do it over again, but when they finish the course the big grins on their faces say it all. Score another one for the CF. The first group put through the Suffield course was for Roto 3. Another improvement from the “lessons-learned” department.
When you’re on patrol in Afghanistan, you carry everything you need with you. First, you wear your uniform with sleeves rolled down — no short sleeves here, no matter how hot it gets. And the hottest day that I was aware of, in the summer of 2009, it was 51°C in the shade. Thus the bad joke that became a running gag: “If it’s 51 in the shade, that’s too hot. Avoid the shade.” All we had to do in that heat was walk around and triage patients. But those soldiers out on patrol, they had to carry a heavier weapon than ours, body armour (about seventeen kilos), plus their helmet, plus a tactical vest. This neat contraption is a sleeveless vest with pouches. You wear it over everything else. In the pouches you carry handy stuff, such as your safety glasses, a Gerber (the Canadian equivalent of a Swiss Army knife, but much sturdier), your first aid kit, a combat tourniquet (or two or three) ready to use, and whatever else you deem necessary. Plus your ammunition — lots and lots and lots of ammo. Our automatic weapons can fire away a lot of lead in a very short time. So you have to carry a lot. And ammunition is heavy. Very heavy.
In addition to all the stuff a soldier on patrol has to carry, he will also take with him four to eight litres of water (or more) in an ingenious device we call a camel pack, or CamelBak. It’s a soft rubber container that you carry on your back, and from which a straw-like tube sticks out. You bend the tube forward and fix it on the top of your tactical vest and voilà! Instant water at the turn of your head.
A word or two about hydration. When you first arrive over there in the spring or summer, your body is not acclimatized, so you drink a lot. The supply folks at KAF and on FOBs deposit crates of bottled water all over the camp, and you can grab one anywhere. Why do you have to drink so much in the heat? The only way your body has to vent off heat if the surrounding air is hotter than your body temperature is through evaporation. That’s because when you’re wet the water on your body evaporates, and that consumes heat in the process. Simple, no?
Now, when the air is humid, it contains a lot of water, in the form of water vapour. At some point the air cannot take on any more water. It is saturated. And that includes the water that your body wants to give away in the form of evaporation. So you sweat, but it doesn’t evaporate, because it doesn’t have anywhere to go. You get hotter. In response, you sweat more. And so on. That’s why when it’s hot and humid you’re always soaking wet and you have to drink a heck of a lot more to compensate for your body secreting so much.
Not so in Afghanistan. There, it’s hot and very dry. You sweat just a little, and “Boom!” as John Madden would say, it evaporates, even before you get the chance to feel wet. So, in Afghanistan, you’re always dry, even if it’s very hot. Plus, after a few weeks your body gets used to the heat, and you drink a little less because you sweat less. Except if you’re exerting yourself. If you exercise the least bit in that kind of heat you upset the delicate balance, the fragile bargain your body has struck with the environment, so that you sweat more and begin to feel wet. Such as when you’re on patrol, say, carrying a lot of stuff on your back. Plus, when you’re wearing body armour and a helmet, your body does the sweating part but the sweat, having no access to the air because it’s caught behind all your gear, can’t evaporate; thus, no cooling effect. So your body secretes more sweat and you lose a lot of fluids. And that is why, when you’re out on patrol, you have to drink a lot. The middle of an Afghan field is not a good place to get heat stroke.
The combat medics carry all that stuff too, and follow the patrol. Those medics also have to carry their medic kit with them. It’s bulky and it’s heavy. There is no space left in their patrol pack, what with all those litres of water, so they strap those medic packs to their thighs. So, in essence, combat medics carry more stuff than your basic patrolman. Of course, some of those patrolmen also carry radios, or mortars, or a mortar base plate, or a heavy machine gun, or ammo for one. But the medics carry more than their share of the load.
&n
bsp; Oh, and by the way, the Taliban have figured out that the one carrying the leg pouches is the medic. And since the Taliban haven’t yet found the time to sign the Geneva Conventions, they like to shoot at the medic. That really screws up a patrol. So, no red crosses either. The medics are conspicuous enough as it is.
A small word about the Geneva Conventions, designed (among many other things) to protect medical personnel from all sides. It states that medical people (MDs, nurses, med techs, pharmacists, padres, and a few others) are to be protected. They are to wear a red cross or a red crescent on their sleeve to identify themselves. They are to carry a special Geneva Conventions card in their wallet. They are not to carry a heavy weapon, only a weapon for their personal protection (a 9 mm pistol — useless at more than fifty feet — or a C7, a darn good weapon that the medics carry on patrol). If they are taken prisoner, they are to be treated in a certain way (they are not prisoners of war, technically; they can only be used to treat their soldiers; they must be free to visit all POWs; they must be exchanged back to home ASAP, et cetera). But, as I said, since the Taliban haven’t signed the conventions, we don’t wear the armbands, which would make us a target over there. And we don’t identify our medics as such. The med techs are just infantrymen with special knowledge; they carry the same weapons as any other infantryman. If they are captured, they expect no special treatment from the enemy: they get slowly beheaded in front of a video camera just like any other infidel. Thus the concept of “The last bullet is for yourself.”
Now you understand, if you’ve done the math, that some of our female medics carry more than their weight out on patrol, in fifty-degree heat (in the shade — in the sun it can easily top sixty). If you ever have the privilege to meet one of these medics, I hope you’ll give him or her the respect they deserve. I sure do.