A LONG TRIAGE
A work of creative non-fiction
© 2018 Francis J. Sullivan Jr.
All rights reserved
PART ONE – WELCOME TO THE WAR
SEPTEMBER 1968 – OCTOBER 1969:
They called us rear echelon motherfuckers, even when they knew our names. REMFs for short. Not all of them, but enough of them to piss me off. They were no different than the schoolyard bullies I fought against when I was a kid.
When they harassed me, and tried to intimidate me, I wanted to let them die or kill them myself. But that wasn’t going to be good for any of us. In reality, whether we wanted to admit it or not, we depended on each other to stay alive.
They were the grunts, infantry soldiers fighting in the worst conditions of combat. We were the troops providing them with the support they needed for their missions. But we weren’t one of them. So, they treated us like shit.
They were jealous of us because we had more creature comforts at our bases of operation than they had out in the bush: beds, showers, and hot food just to name a few. And their lives were often in more obvious danger than ours. But I refused to accept their derisive attitude towards us. We were all soldiers serving our country during America’s war in Vietnam. We were supposed to be “Brothers in Arms” fighting for a common cause in support of our Nation.
I’ve worked to put my tour of duty in Vietnam behind me and manage my emotion. But the memories haven’t disappeared. They still haunt me. Regularly. And too often they flood my mind with daydreams, nightmares, and flashbacks of my own close calls with death and impact my daily life in very real and very destructive ways.
I survived my time in Vietnam and came home physically in one piece. I was lucky, and I’m grateful. But even now, more than fifty years later, unexpected events trigger memories that rekindle my fear of injury or death, stoke the resentment I have for that period in my life and cause me to have outbursts and out-of-body experiences.
At first, I hear fluttering in my ears. Then I hear whistling followed by flashes of light that blind me. Sometimes I panic and dive to the ground. I’m frightened, and I wait for the sounds of the explosions I’m sure will follow. My heart pounds rapidly, blood rushes to my head in pulsating aching throbs, and my mind spins like a child’s toy top. I’m back in Vietnam, cramped into the fetal position, my eyes piercing the sky waiting to die.
Other times, I stay somewhat grounded, but I lose focus. I perceive any little unexpected event as life threatening. My fight-or-flight response kicks in. I lose control. I can’t tell friend from foe. My temper flares up, and I aggressively defend myself from the people around me: my face turns red; my voice becomes crackly and loud, and the people I’m with move away to avoid the confrontation.
My doctors say I suffer from Post-Traumatic Stress Disorder (PTSD). And they call these episodes startled reactions, which are triggered by the unexpected events.
Usually after a short time, my heart slows down, my mind clears, the pulsating throbs fade away, and life resumes a somewhat normal course. But this most recent episode has been the worst of them all and seems to be never-ending.
JANUARY 17, 2014:
The last thing I remember before waking up in the hospital surrounded by a team of doctors was eating lunch at a restaurant with a group of my fellow court appointed attorneys. My cell phone vibrated in my shirt pocket I excused myself from the table, left the restaurant, sat in my car, and answered the call.
It was Annie, one of the probation officers I worked with on a regular basis. I was used to the way she always seemed to act with superiority over court appointed attorneys. But this time her attitude was unacceptable.
“Attorney Sullivan,” She said. “I wish you hadn’t gone to lunch. It’s Friday and I have the afternoon off.”
“Annie, I went to lunch at the close of morning session, like everybody else.”
“Well I’m going to ask the judge to send your client back to jail. I’ve got plans for the rest of the day and I can’t wait for you to get back here. I’ll get someone else to cover the case.”
“I can be there in half an hour.”
“Don’t bother rushing back to court for this case. It will be done before you get here.”
I couldn’t believe what I was hearing. An image of her pale freckled face with the map of Ireland written all over it surrounded by her fiery red hair flashed in front of me. It was like the grunts versus the REMFs all over again.
“Bullshit,” I screamed into the phone. “You’re violating my client’s constitutional right to counsel.” I shouted at the top of my lungs.
“Not really, he’ll have an attorney.”
“But he has a right to his own attorney. And that’s me.”
“Take it up with the judge, when you get here.”
When she said that, I tasted anger burning my throat. The fluttering and whistling of rockets and mortars punctured my ears, a pain exploded in my head like a bomb and traveled through my blood vessels and nerves to my stomach. I became nauseous, began to vomit profusely, and everything turned black.
I woke up a couple days later lying in the hospital bed. Bright fluorescent ceiling lights blurred my vision. And the noise in the room was earsplitting. But I could hear the doctors talking to my wife, Patti and my daughter Kacia.
“Mrs. Sullivan, when he arrived by ambulance his brain was hemorrhaging. So, we performed an emergency craniotomy and evacuated an actively bleeding subdural hematoma. Do you know how he hit his head?”
“As far as I know he did not hit his head. This whole thing came out of nowhere.”
“Why do you say that?”
“When his friends called and told me he was being brought to the hospital by ambulance, they said he had been eating lunch with them and just stepped outside to answer a phone call. One of his friends went to see why he was taking so long and found him unconscious sitting behind the wheel. So, he called 911.”
“It’s a good thing he did. He saved his life. Spontaneous Subdural hematomas can be fatal.”
“Will he recover?”
“We’ll have to wait and see. He had an adverse reaction to the anesthesia. As the anesthesia worth of he was in a state of delirium screaming incoherently about REMFs and grunts, incoming rockets and mortars, and gooks coming through the wire.”
“Under those conditions I’m not surprised. He does that when he wakes up form nightmares about Vietnam.”
“How long has that been going on?”
“As long as I’ve known him. He was diagnosed with PTSD about twenty years ago, went through a psychotic break and tried to commit suicide. Then about ten years later it happened again when he had open-heart surgery.”
All kinds of medications were prescribed for me to take for a variety of reasons. But the one that concerned me the most was Dilantin. Evidently seizures would be possible to occur as a result of my brain surgery.
A psychiatrist was added to my team of caregivers. My rehabilitation and recovery included physical therapy, occupational therapy, and speech therapy for the brain injury and symptoms of stroke. And psychotherapy was added to help me with my PTSD.
My goal became threefold. Not only would I need to overcome my physical problems, I needed to get the reality of my experiences during the war into focus and purge myself of some deep seated anger, which the doctors said was most likely not only related to my experiences in the war but related to my life experiences before and after coming home from Vietnam.
They kept me in the hospital for a few more weeks. But the hospital was not properly equipped to handle patients with delirium. Not all of the staff had been properly trained to accommodate a patient that required sensory deprivation therapy. And the environment surrounding me was too busy and too noisy. I felt like I was stuck in a subway station with no idea where to go.
When the nurses and other staff members came into my room, they would turn on the lights and leave the door open. I could hear the conversations of people in the hallway clear down to the nurse’s station that was at the end of a long hollow tunnel. People came in and out of my room all day and night waking me up to check my vital signs, and forget to close the door and turn off the bright ceiling lights as they left.
Because I was under doctor’s orders not to get out of bed without assistance, I’d press the call button for someone to come back and turn off the lights and close the door. But by the time someone came back to my room it would be time for more invasive procedures to my body. And the irritating cycle would start all over again.
So, I went without sleep for several days at a time, remained in an agitated state and continually engaged in arguments with the staff. All I could think about was getting out of there.
After several more days of enduring this egregious and unhealthy environment, a friendly doctor with a soothing voice came into my room and introduced himself as Doctor Alok Ransing.
His appearance caught me off guard. I went into a kind of mental tailspin. I thought I was looking at some kind of hippie from back in the 1960s. He was a handsome guy, about six feet tall, and thin. He was probably in his early thirties. He had a noticeably round face, a dark complexion that was almost mahogany in color, and the large, round eyes I’ve always associated with people from India.
The hippy look came from his kurta, a traditional shirt worn by people in his eastern culture. I remember seeing the followers of the Hare Krishna movement and the radical hippies wearing clothes like his during the anti-war protests that were occurring all around America back in those days.
I sat there like a zombie staring at him with a blank look on my face thinking about how the protesters had sabotaged my return home from the war. I don’t know how long he waited for me respond, but when I came to my senses he was no longer in my room.
While I was eating breakfast in bed the next day, there was someone knocking on the door to my room.
“Good morning Mister Sullivan. It’s Doctor Ransing. We met yesterday. I’m the psychiatrist that was assigned to be in charge of your treatment team. May I come in?”
“Yes of course. Nice to meet you Doctor Ransing. Good morning to you too. Sorry about blanking out yesterday.”
“How do you feel this morning?”
“That’s understandable, considering the circumstances.”
“What do you mean?”
“Mr. Sullivan, you just survived brain surgery, which is one of the most serious operations a person can undergo. And seeing that you had an adverse reaction to the anesthesia and emerged from it in a state of delirium with the symptoms of a stroke I was not surprised by your catatonic state yesterday.”
“So, you don’t think I’m crazy.”
“No, I don’t think you’re crazy. But after reading your medical and psychiatric reports I see other complications that we will need to deal with during your recovery that concern me.”
“Well I have concerns too doctor. But most of my concerns right now have to do with the lack of respect most of the staff has for my condition.”
“What do you mean, Mister. Sullivan?”
I gave him a detailed explanation of the irritating conditions that had been going on during my stay in the hospital up to that point in time.
“I apologize for the problem. I will definitely speak to the nursing supervisor.”
“Thank you for understanding, Doctor.”
“You’re welcome. This won’t resolve all of my other concerns though.”
“What are your other concerns?”
“Well on the surface you appear to be one of the lucky Vietnam veterans because you came home in one piece and adjusted fairly well to civilian life.”
“I don’t know if I can agree with that statement.”
“I’m just referring to the basic facts. You got married, stayed employed, raised a family, and graduated from college and law school.”
“Yes Doctor, that’s true. But ‘ve I had to work hard at keeping myself under control while doing those things. And I was not always successful”
“Yes, I can see that from reading your records and talking with your family.
“What’d they say?”
“They’ve told me that for the first twenty years after you returned home from the war and managed to accomplish those things, you regularly lashed out in anger at the people around you while self-medicating with alcohol and drugs. You smashed up several motor vehicles, had a psychotic break, and tried to kill yourself.”
“Yes, that’s true as well. But back then I was on a strange cocktail of medications that made everything worse, and I didn’t want to hurt other people. So, I took it out on myself.”
“Well, we’d like to keep that from happening again.”
“So, would I. How do we do that?”
“Your treatment team has developed a partial discharge plan to get you home.”
“That’s great to hear.”
“We are scheduling you for speech therapy, physical therapy, and occupational therapy for your medical conditions on a daily basis in your home for several months. And we are recommending Narrative Therapy for your PTSD.”
“What does that actually mean, Narrative Therapy? I’ve been through about every type of therapy program there is for PTSD.”
“Yes, I know you have. But now you also will be dealing with the symptoms of a traumatic brain injury.
“So how is this going to be any different than those other therapeutic programs?”
Doctor Ransing spent quite a bit of time explaining that the other programs were structure around the person being a problem. But in Narrative Therapy the patient is not seen as the problem, the events that trigger the psychotic episodes are seen as the problems.
He recommended that I write a narrative about my memories of serving in Vietnam. He assured me that the experiences would be therapeutic because it would let me see the events that happened there as separate from me. As a result, he said, I would develop a better understanding of the problems I was having in the past. And he said that with help from my treatment team, I could learn to control my reactions to events that may startle me in the future.
He asked me to continue writing at home after I was discharged from the hospital and that when I was finished to schedule an appointment at his out-patient mental health clinic and bring my written work with me when I came for my first appointment.
A week later I was finally discharged from the hospital, although I continued to exhibit the symptoms of stroke. I still couldn’t see clearly or identify whole objects. For instance, I would eat half the food on my plate because I couldn’t see the other half. Then either Patti or Kacia or my son Kelsey would spin the plate and I’d see the rest of the food and continue eating. I couldn’t speak clearly, so we had to communicate with hand signals and note pads.
To make matters worse, I couldn’t keep my balance or walk without assistance. Fortunately, we lived in a garden-level apartment with no stairs at the front entrance. So, I was able to get inside without much trouble. But once I was inside the apartment, Patti or Kacia or Kelsey needed to help me manage my daily activities: showering, shaving, dressing, and being reminded of the order in which the activities were to be done.
Kacia had flown out from California where she lived and worked as a graphic artist. She had arrived while I was still in the hospital to help Patti get me home and settled in. But she had to get back to work. Before she left, Kelsey came from Maine, where he lived and worked as a Bird Biologist.
I was grateful that both our children had committed themselves to alternating as caregivers alongside Patti until we could manage on our own. And the interactions we had through this ordeal gave me a since of pride and appreciation beyond description. Our children had grown up to be responsible and caring successful adults. As a parent, I couldn’t ask for more.
The hospital had arranged for the outpatient team to provide me with the services I needed in our home until I could commute to the outpatient mental health clinic. Each day of the work week, a different therapist came to our home and worked with me for a couple hours doing different activities: balancing exercises, writing, drawing, speaking with clarity, and moving my eyes in circles and reverse circles to help eliminate the visual disturbances. And a nurse arrived once a week to take blood samples for the lab and check my vital signs.
The in-home routine went on for several months. During that time, I felt like a child. The stroke like symptoms kept reoccurring on a daily basis. And I had to keep learning how to walk, talk, and write all over again. But I took Doctor Ransing’s advice, instead of keeping my anger bottled up inside I put my energy into gaining my skills back and writing my therapeutic narrative.