"Only the good die young"

My patient told me this today. He is a Vietnam vet, and apparently, that is what they used to tell each other over there. Was it to ease the pain or make it even more poignant? It can do the former - maybe - if one brings in some deity and decides that that "higher power" goes around choosing the good boys and girls and taking them away. It can voice frustration, reflected by those who have lost their buddies to war, as they try to communicate the value of the lives taken. Or it might, on a deeper level, also reflect some of the bitterness, self-hatred and guilt associated with being survivors.

My patient definitely expressed those last two sentiments. He spent memorial day cleaning up the graves of two of his friends killed in Vietnam. He was angry about what the holiday has become, especially given that we are currently in a war. He told me he was appalled when he went to a store that was handing out American flags to customers who signed up for the store credit card. "It used to be that you would get an American flag when you died in action. Now these stores think it's 'patriotic' to hand them out as a promotion for their business."

He had been severely wounded in that war, lost a few close friends, and killed people whose faces he cannot get out of his head. He thinks not just of his fellow soldiers who died back then, but also of the enemy men and women killed. He has suffered from years of PTSD, but he managed to get a good job, get married, have kids.

Lately though, he has been getting so angry that he feels that he can no longer think about the war, politics, and all the wrong he sees around him. He feels like it is going to kill him. He's got two close family members serving in Iraq, going on their second tour. Boys in his town join so that they can have a better opportunity in life, make money, and be heros... "but then some of them don't come back."

Now, his son is thinking of enlisting. My patient feels that it is not his place to object; and he tells his son to listen to his heart. But it is obvious that this is part of his anger and fear. He is haunted by the war he served in and disillusioned by the principles under which he served. At the same time, he cannot bring himself to criticise the military, the country, or the people. But he is angry: "These boys, they do not 'sacrifice' or 'give their lives'. They are killed. They do not volunteer to die. And some of them are barely 18 years old."

My patient came to us to discuss his high cholesterol. We talked - mostly I listened - for an hour. I felt ridiculous suggesting that he exercise and eat better, take walks with his wife, maybe return to the PTSD support group, and find old army buddies to talk to about how he feels. He was overwhelmed and haunted by his past and his inability to change the present. His cholesterol seemed so insignificant at the moment, though it really wasn't. It was just another symptom there was no way I could fix until the emotional stress he was feeling could be calmed.

There was nothing he said that I didn't agree with, but to me it was all an intellectual argument about justice and fairness, whereas to him, it was his entire life, like his soul was being slowly ripped apart.

It amazes me how easily we humans go to war. It is obvious from the men and women that come back that what they experience is often too much to completely preserve their humanity. The horrors of war die with the people who experience them, and yet they are so incomprehensible that there are always a new people ready to continue them.