A Hospital Visit

My first visit to the Veterans Affairs Hospital is during my terminal leave period, a few weeks after making the fourteen-hour drive up to Seattle from Twentynine Palms, CA. When you enlist in any branch of the United States military, the government promises to discharge you in the same or better condition as at the time of enlistment. I had unresolved dental issues (a couple of cavities) but not enough time left between my last deployment and my terminal leave date to get them resolved, so I deferred treatment until after my discharge. I didn’t end up getting around to it until several months after getting out.

I am late for my first appointment. I park my car and run in, and it takes a few minutes of scrambling hurriedly about before I begin to notice my surroundings. It is—well—a hospital. But, everyone is really old. Running back and forth between Building 1 and Building 100, I repeatedly pass a relic of a man, inching along with his aluminum walker. I want to ask him where he is going, throw him over my shoulder, and carry him to his destination. I walk past a trio of men with tubes in their noses, who watch me with suspicion. There are US flags and military unit insignia pinned to hats and lapels all around me. I feel more like I am wandering a VFW hall than a hospital. Suddenly, I realize that I belong in the former, just as much as in the latter. I am a veteran of a foreign war.

It’s kind of a weird realization. You hear the word “veteran” and you think of one of the guys I just described: World War II vets, septuagenarians with gray hair and grandkids, or Vietnam vets wearing old olive-drab army-issue jackets and haunted expressions. You probably don’t think of me. And neither do I. At least, not yet. At this point I am still trying to contextualize the four years I have just spent in another world, while simultaneously transitioning back into civilian life. I am not yet ready for such a drastic, reality-warping identity shift.

I am lost. I find an information desk and the attendant, a volunteer, gives me a photocopy of a hand-drawn map and shows me the most direct route in highlighter. It does not appear to be particularly direct. This, I realize, is a large hospital. I walk down long corridors lined with generic blue signage and dull carpeting, past the East Clinic and the Canteen. Several posters remind me to get my flu shots. I finally make it to Dental, and a receptionist tells me to wait until my name is called. I wait for quite a while. Hurry up and wait. This is familiar. I am still surrounded by old, old men. They have been here waiting longer than I have, but they are serene. This seems familiar to them, too.

The Seattle branch of the Puget Sound VA Medical Center was opened after World War II to accommodate the sudden surge of returning soldiers. It would seem that the hospital continues to provide service to many of them. I think of the hundred thousand troops that are in Iraq and Afghanistan now, my brothers-in-arms, and I wonder if they will build us any new hospitals. Because they are coming. And not all of them are coming back as unscathed as I am. Many of them will have more than just dental issues. The scale of the present conflict is smaller than past ones, but because of medical advancements—both in the field and in the rear—as well as ubiquitous and near-instantaneous medevac procedures a larger proportion of more severely wounded troops are coming home.

I had a conversation with a friend recently, who served as a medic in the Army. We talked about the ways in which the war in Iraq is profoundly different from previous ones. The home-front population is less engaged with this war. Instead of being reminded and moved by the images on television every day, people seem instead to have become inured. The discussion about the war seems increasingly to have shifted to its monetary cost: how much, and what else could be done with that money. The human cost of war seems increasingly to be fading from popular consciousness. The difference is that there were drafts initiated for World War II and Vietnam. Everyone had a stake, in viscera. So everyone cared. Not so, now. Now we are distant; we are images on a screen.

There is a television tuned to cable news in the waiting room. When my name is finally called, there is a report on about the war in Iraq, but the volume is too low for me to hear. I follow a dental assistant to a room with a dentist’s chair, and suddenly everything is normal again. The room is a normal dentist’s office room, the dental assistant is normal dental assistant-age, and the dentist, when she arrives, is normal dentist-age. She sends me to take some x-rays. We talk about cavities and wisdom teeth. I forget about old people. I forget about Iraq. I feel like a normal human being.

She sends me to set up another appointment. I am back among the nearly dead. I look into some of their faces. I realize that I am looking at the other side. Here, surrounded by these great, ancient, declining men, I am gripped by a visceral understanding of mortality that escaped me even in combat, with Kalashnikov rounds impacting at my feet and mortars whistling in the air above me. Not the glorious kind of death-before-dishonor mortality, but the slow, incremental, ebb-of-life kind of mortality. The kind of mortality that you come to understand as precious, after you’ve experienced the other kind, after you’ve made it out alive.

Most of these men and I, our experiences are worlds apart. Some of them have likely never served during wartime. Probably few of them participated in combat operations. But, some of these men have seen some of the things I’ve seen—and more. Our wars are different, theirs and mine, but there is an essential sameness to us. As part of the 31st Marine Expeditionary Unit, I was part of a reunion ceremony on the Japanese island of Iwo Jima for veterans of that battle. There was a retired Lieutenant General there who, as a Company Commander, had led his men into one of the historic battles of World War II. There, on that sacred ground, he gathered us around him and spoke to us as equals, gave us an equal share in tradition and heritage as he recounted his experiences through constricted throat and welling tears. Greeting us as brothers, he forged a connection with us there, reaching across generations, from his, the Greatest, to ours. On my way out of the hospital, I think of that moment of connection and begin to see the men around me not as old people, but old friends.

Over a year later, I am back at the hospital, having decided to volunteer. In the months since that first visit, I have returned several times: to have my wisdom teeth removed, to document my constant tinnitus, and to get diagnosed for Post Traumatic Stress Disorder. My case is mild. I sometimes have surges of adrenaline for no discernable reason, while during occasions that would seem to warrant it, I remain in a state of Zen-like calm. I am uncomfortable in crowds. I have had bouts of uncontrollable weeping. I cannot watch fireworks; the noise and the smell of cordite are too much. I have trouble falling asleep, and sometimes have hellish nightmares when I do. Still, I got off easy. I am mostly able to handle my symptoms, and I’m getting better. This is more than I can say for many of my friends. One returned home to a chaotic family situation and has turned to alcohol for relief. Another has become a desperate thrill-seeker, finding the closest thing to solace that he can in the adrenaline rush of extreme sports: bungee-jumping, sky-diving, and rock-climbing. Yet another was served his divorce papers shortly after returning from our last deployment. Away from his three year old son, he’s having trouble finding reasons to do anything. I can hear the uneasy directionlessness in his voice when we speak on the phone. I always urge each of them to get help, and a couple of them have, but most don’t.

At the orientation for new volunteers, I am by far the youngest of the group of eight. The others are between two and three times my age, and only one is not a veteran, though her husband is. The two other women are Navy vets. Two men, Army vets, are representatives of a Catholic fraternal organization called “Knights of Columbus.” There’s another soldier, and an airman. They all seem to regard me strangely, with a bit of suspicion, and I feel rather out of place, but only until it’s my turn to introduce myself. “I’m Joe, I was Marine Corps infantry for four years, ’02 to ’06.” Suddenly, the tension dissipates, and everyone, including me, relaxes. The Knights of Columbus ask me about my deployments, and we compare war stories. They fought in Vietnam, but some things are universal.

Having begun reminiscing, these two can clearly go on for hours, but they’re interrupted by the volunteer coordinator. We need to move on; we have a lot of orienting to do. First up is a half-hour film about veterans. It’s meant to show at once the diversity of servicemen and women and the hardships they face in service, but it’s mostly superfluous, since all of us have had this experience at either first- or secondhand. One point, however, is well made: that the end of active service is hardly the end of the military experience.

The battle at home that many of us face when we return from war is largely ignored. At the end of each deployment, we are subjected to a class on the transition from a combat zone to the rear. We cover such topics as dealing with civilians, driving at normal speeds, reintegrating into family life. Married men get an additional class. The general thrust is that, while it may seem like we are in a sort of stasis while on deployment, the truth is that we have been changed by our experiences, and our families and friends have changed as well. Nothing is static. The classes are a laughably small measure against the profundity of the changes we face, and many of us have enormous trouble dealing with home life: infidelity, public and domestic violence, divorce, and alcoholism are rampant. And if we are ill-prepared for our transition back from deployment, we are prepared even less for the transition back into civilian life. Finding employment, housing, preparing meals, these are things that few of us have had to deal with for years. Many end up having to move back in with their parents. Some re-enlist. Several of my friends are now working construction or low-paying security jobs. One is dealing blackjack at a casino. As it turns out, infantry experience doesn’t translate to the real world that well. I seem to be doing well, having taken advantage of all of the benefits available to me: the Montgomery GI Bill, VA health care, and VA-funded counseling; but among my friends, I am in the minority.

After the orientation video, we watch a PowerPoint presentation about the VA Health Care System. Our Puget Sound Branch serves more than 60,000 unique veterans in over 600,000 outpatient visits each year on a budget of $390,000,000, we learn. It is staffed by over 3000 employees, not including the corps of over 1000 volunteers. No one is particularly interested in the statistics. The volunteer coordinator rushes through the presentation, and we break for coffee. One of the Knights of Columbus turns to me and says in his Brooklyn accent, “You know, it’s been thirty years, and I still remember the names of every one of us that went over together, all except for this one guy. I can remember everything about him, what he looked like and where he was from, I just can’t put a name to him.” He looks down at his coffee. I’m not sure how I’m supposed to respond, but I wonder to myself whether the guy he’s thinking about made it back with him or not.

The guy I spend the most time thinking about died in Iraq, killed by a suicide bomber. He gave what Lincoln called “the last full measure of devotion.” Maybe that was Lincoln’s way of making sense of the intrinsically senseless. I’ve spent many a sleepless night trying to make sense of the fact that I am walking around, living my life, while he is inert, scattered ash. It’s one more aspect, really, of coming home from war: survivor’s guilt. Though I feel like my particular brand of survivor’s guilt is more valid than most. After all, I had a choice. I had already served two tours in Iraq and for logistical reasons they gave a few of us the choice between staying with our unit to serve a third tour or attaching to a different unit to deploy to the West Pacific. At that point, with two combat tours under my belt, I was one of the more experienced Marines in the company, and in a leadership position. It was an agonizing decision. I remember asking myself how I could watch my brothers walk into fire without me. But I did. And it’s unknowable, of course, whether my presence would have made a difference. But this is a guilt from which I will never be free, for which I will serve penance for the rest of my life, and no small part, perhaps, of why I am at the VA Hospital, volunteering.

I clock in for the first time a week after the orientation. I am assigned to the Spinal Cord Injuries wing. The volunteer coordinator introduces me to the night nursing staff: “This is Joe, he’s a Marine. He’s been to Iraq and all that and he’s here to help out.” At first they assume I’m a nursing student, and I have to explain that I am in no way affiliated with any medical profession, that I’m studying literature. They seem slightly puzzled.

Their shift is just beginning, and they start by listening to recordings that the last two shifts have left about the day’s events. It’s mostly descriptions of stool and measurements of urine and acronyms I don’t know. One patient has had a haircut. After the meeting, the shift’s head nurse starts to show me around. She has been here for twenty years, which must be most of her adult life. She shows me the linen closet, the food storage, and a few other rooms before getting distracted. I stand there for a while before another nurse offers to show me around. I follow her as she makes her rounds taking vitals, and she lets me know which of the patients are Marines. She has a long discussion with another staff member about whether or not a particular patient is a Marine. They decide that he’s Army, and, to my puzzlement, she asks me if I still want to be introduced. He turns out to be young, younger than me, and paralyzed from the waist down. He has a big-screen television in his room, and an X-Box. He seems cheery enough, and we chat for a few minutes. Our next patient is another Army guy, but older, a Vietnam vet. He’s in a wheelchair and seems excited to have someone to talk to. He starts to tell me all about his job as a JAG officer, and the base he was stationed at in Korea. The nurse motions me to stay and sidles off. I listen.

The place is sobering. Since I have been discharged, I have been able to compartmentalize my war experiences. I have had done with that old life, and started a new one. I have crossed a line, leaving behind bitterness, violence, and strife, to embrace warmth, love, and joy. On that side I was a trained killer; on this side, a student. On that side was death; on this side, life. But here my two worlds collide, and the distinctions begin to collapse. Here, the clean line separating death from life dissolves, leaving something much messier. Here is something in between.

My last task for the day is to feed one of the patients. He’s an older guy, paralyzed from the neck down, and connected by tubes to all sorts of apparatus. First he asks me to push the button to lift up his head. He asks me what’s for dinner. Salisbury steak and noodles with gravy. We start with the steak, and he asks me to please cut it into small pieces.

“How’s the steak?”

“It’s okay.”

“Green beans?”

“No, thanks, the green beans are pretty bad.”

I alternate between the steak and the noodles and we chat. He tells me he was in the airborne infantry, that he was a wrestler. I ask him a few questions about where he’s from and about his family, but then we grow quiet. I feed him the rest of his meal in silence, morsel by morsel, and then help him wash it down with tea and milk. I try to imagine what it would be like to be fed every meal every day, piece by piece, to be so completely dependent on others.

“Hey, well, I’m going to be here every week, so you’ll be seeing me around, alright?”

“Okay, thanks,” he says, and smiles.