It's June 30th, the last day of National PTSD Awareness Month.  It's also exactly one month out from the trauma anniversary that has, historically, been very challenging for me to cope with.  It's with this in mind that I'm writing this blog post.  I wanted to bring a little bit of tongue-in-cheek humor to a serious subject and help to inform loved ones of how pending anniversaries can impact the daily lives of our veterans.  I also wanted to present how I cope with my PTSD anniversary in a way that would be immediately familiar and identifiable to anyone who has served in a combat zone.  So, here goes...

Pre-Deployment Processing (PDP):
When soldiers are getting ready to deploy, they go through an exhaustive review of their readiness from physical fitness to ensuring all shots and vaccinations are updated to drawing weapons and equipment to updating their life-insurance beneficiaries and their wills.  It is a focused and direct approach that ensures that each soldier is fully-equipped to confront the challenges they will face when deployed.  When I am preparing for the emotional and physical buildup that stems from a pending anniversary, I take stock in much the same way - to ensure that I know the status of my resources and to shore up any weaknesses in my coping mechanism.  I take stock of how well I've been sleeping.  If I haven't been sleeping well recently, I make a point to go to bed earlier to try to compensate for this.  If I haven't been active and exercising, I make a point of increasing my activity levels - it helps you sleep better and it has been proven that exercise improves your mood.  I start paying particular attention to events that could potentially trigger my PTSD (the Fourth of July, for example) during the month leading up to and immediately following the anniversary.  I do what I can to prepare my family for what could be a bumpy ride.  Marshalling and evaluating the readiness of your resources is key to a 'successful deployment',  whether into a combat zone or in preparation to confront and cope with your PTSD triggers.  In the past, I have tried convincing myself that I don't have to do this and that believing that the anniversary won't impact me would see me through - Epic Fail.  Don't fall victim to the Five P's (Piss Poor Proper Prior Planning).

Battle Damage Assessment (BDA):
After a battle, a unit goes through what is called a Battle Damage Assessment to evaluate the readiness of their troops and equipment.  This is a critical process - after the BDA is complete, it allows the unit commander to redeploy his resources in the most effective way possible, given the readiness and condition of his assets.  It is much the same after something has triggered your PTSD.  It is vital that you evaluate how much of your emotional reserve has been depleted by coping with the trigger and fighting to regain control.  It is also very important that you evaluate your physical condition.  There is almost always a strong adrenalin response when I am triggered and it can disrupt my sleep and my physical energy reserves can become dangerously depleted.  After I have re-stabilized, post-trigger, I perform a BDA so that I can redeploy my coping resources more effectively.  Sometimes that means taking naps to catch up on lost sleep.  Sometimes that means making sure I have time to decompress built into my day.  Sometimes it just means staying in for a day to recover.  I do whatever I have to do to ensure that my resources last as long as possible.

Make no mistake:  Effectively coping with anniversaries is like fighting a campaign with each trigger event being an individual battle.  Winning or losing an individual battle may not win or lose you the campaign, but without proper planning and resource allocation, you will lose out to attrition and loss of morale.  Don't try to ignore the warning signs - you'll get blindsided.  It would be like a convoy not sending out scout vehicles and being surprised when they get decimated by a near ambush with intersecting fields of fire...

Calling in Reinforcements:
Sometimes you will find yourself in a situation where you know you're about to be overrun.  In the past, I have let my pride get in the way of asking for help and have paid dearly for it.  Reinforcements are not unlimited so it is imperative that you know what reinforcements you have access to and how often.

• The Airstrike:  Sometimes you can tell that you are being encircled and all you need is someone to blow you a hole in enemy lines so that you can get your people out.  Calling in a targeted airstrike can do just that.  Air strikes are ideal for situations where you need overwhelming superiority for a short amount of time, just to get yourself out of a bad situation.  Since its use is of short duration, it has the opportunity to return to base and refuel and rearm fairly regularly.  My wife is my Airstrike.  When I tell her I feel the walls closing in, she takes my daughter out for an afternoon or down to her parents for the day, removing all distractions and external stressors from my environment so that I can focus on getting through that moment.
• The Quick Response Force (QRF):  Sometimes you know that you are vastly outnumbered and you find yourself facing a determined enemy and in a situation that you can't easily extricate yourself from.  You've tried utilizing an airstrike but it had about as much impact on the opposition as a squirt gun on a hornet's nest.  The QRF is perfect for this scenario - it can roll in, assess the situation and reinforce your lines where they are weakest, while also bringing substantial firepower to bear.  They are better equipped for longer deployments in the field but need more time to repair and resupply after they leave the field.  My family is my QRF.  Sometimes I need the love, support, and help of my whole family to get through really bad patches.  This seemed to happen more often when I didn't plan ahead and prepare myself for what I knew was coming, but should the need arise for sustained reinforcement, I know I can count on my family to 'take the ball' and give me the time and space I need to muddle through.

After-Action Review (AAR):
After every campaign, commanding officers get their officers and their NCO cadres together to evaluate the performance of the unit over the course of the campaign, to better identify recurring weaknesses in strategy or to identify resources that were more rapidly depleted than planned and accounted for.  This is a high level review that allows commander to respond and react to lessons learned and properly account for them in future deployments.  It's important to do the same with PTSD after the anniversary has passed.  Once things have returned to the status-quo, it's important to take a look at what you did right and where there's adjustments that need to be made.  It's important to talk to your friends and family and get feedback, should it be necessary.  If you don't incorporate lessons learned in preparation of the next anniversary, you're not doing yourself any favors.  As a commander, if you knew that deploying your troops differently in response to a threat would save lives, you'd want to know it.  Treat coping with your anniversary the same way.

So there you have it.  I hope you find this helpful and humorous at the same time.  If you have any questions or feedback, don't hesitate to comment on this!!

Have you ever heard of the TV Show, 'Hack'?  I hadn't either, but it was available in Netflix and its premise sounded interesting.  I cop that made a mistake, lost his badge, and started over as a cabbie or hack in Philadelphia.  The show starts Andre Braugher and David Morse so I figured I'd like it.

I'm glad I gave it a chance.  The show ran for two seasons in 2003 and 2004.  It has excellent lessons in morality and it's massive scale of grey, love, hope, and family.  Then I started watching Season 2, Episode 14, named "Fog of War".  The main character's godson came home from Iraq after being wounded and they depicted PTSD, raw and unfiltered.  They showed how he tried to numb his mind with pain killers and alcohol.  They showed how corrosive the effects of survivor's guilt can be on the soul.  They illustrated the particular way in which our anger can flare - by raging against inanimate objects and scaring the crap out of our loved ones.  It illustrates moral injury and the cost of war upon the human condition.  What gave me chills was the manner in which the actor playing the soldier depicted intrusive recollections.  The unconscious twitch of the body, the quasi-nauseous shudder and the thousand yard stare.

It also shows how quickly dependency and depression, combined with survivor's guilt, can lead to suicidal ideation.

One thought kept on popping into my head:  "This Could've Been Me."

PTSD didn't really reach mainstream awareness and acceptance as the signature wound of this conflict until 2006 and 2007.  What really gave me goosebumps was the date that this episode aired:  Feburary 7, 2004.  Just five days after I returned home from overseas - I was one of the vanguard.  One of the first to return home from Iraq.  They didn't even have support services in place for the conflict in Iraq.  My support group was comprised of veterans of previous conflicts, predominantly Vietnam.

I watched the episode four times in a row, with tears in my eyes every time.  Every time I watched it, the more poignant I realized it was - and just how aware the writing team was of the enduring costs of war.  I would warn against watching this episode if you are still learning to cope with triggers, but if you are in the right frame of mind - take the time to watch this episode.  It will be particularly educational for family members.  The show demonstrates just how important fidelity, unconditional support and love are to our returning veterans.

The veteran depicted in the show had a father who was a hard-nosed cop.  Old-school.  The show no weakness type of man who thought his son should just forget what happened and 'just move on' in his life.  The main character, who over the course of one and a half seasons has found his compassion and his own code of morality, lights the way to a positive solution to the show - not with his virtues but with acceptance of his flaws.  It is masterfully done and in such a way as to give hope to those who watch it that their loved ones with PTSD can learn to cope and live with their experiences.

I really didn't see this episode coming at all.  It even depicted the politics of the time from both sides of the aisle in a way that showed the validity of both standpoints without being argumentative.

Take the time to watch this show if you have Netflix.  You won't regret it.  It is truly an episode for the ages.

Well, that was an unexpected turn.  A few days after the horrible nightmare I had last week, I suddenly found myself motivated to examine how I had been living my life.  It wasn't pretty.  I wasn't doing everything I know I am able to be.  I wasn't being a partner to my wife, I wasn't pulling my weight at home.  I was anxiety eating myself into diabetic shock, slowly gaining weight, pound by pound.

TRIGGER WARNING:  GRAPHIC CONTENT

I have to work tomorrow.  Tomorrow, of all days, is the last day I want to be around anyone.  It's the 'anniversary' of the incident that changed everything for me.  I don't normally write about the actual event that was a major contributing factor to my PTSD, but this anniversary is different.

It still feels like yesterday, but tomorrow makes ten years to the day that 1LT Leif Nott died in a friendly fire incident in Balad Ruz, Iraq.  I still struggle with what happened every day.  I remember the sounds, the smells, the feel, everything.

This is the first time that I have mentioned the incident specifically.  I don't know why I feel compelled to share it now.  I just couldn't let another year go by without honoring those that were injured and those that died that day.

I can't bring myself to recount all that happened, but you can read about that night and the cover up HERE.

I tried to 'suck it up' but I landed myself in the Combat Stress Control Clinic at Balad Air Field a week later.  Everyone back at the unit I had been attached to was acting like nothing had happened.  I felt compelled to make sure the truth was known - so I contact JAG and CID and reported the friendly fire incident and violations of the rules of engagement.  I also reported my suspicion of attempts to sweep the whole thing under the rug.

A week later, I was released back to duty by the clinic.  My reporting the incident should have remained confidential.  Somehow, it made its way back to the commanding officer of the unit I was supporting and I instantly became persona non grata.

Things went downhill fast from there.  I was denied R&R and mid-tour leave because I was a 'mission critical asset' - yet the rest of my team and all of the other attached special operations teams we worked with got to rotate home for two weeks.  I isolated and shunned by all but my colleagues.  The sectarian violence ratcheted up soon after and the trauma continued to build.

Six months later, I found myself being sent home, a danger to myself and others.

The greatest travesty:  The unsung heroes that never received the recognition they deserved for jumping into action.

When it became clear that we had shot up our own, the direct support Psy-Ops team, two young medics and myself ran out to conduct triage.  It became evident that we needed another vehicle so I ran back to the TOC and ordered some privates to clear out the Psy-ops turtleback so that we could use it as an ambulance.  The next few minutes were a blur.  I remember SGT Anderson being carried into the medic bay.  Same with SPC Devers.  I remember returning to the scene to continue to help and things become disturbingly clear in my mind.

I remember the old man, blood and bone chips flowing away from the mangled mess of his leg to pool in the dust on the side of the road.  Somehow we managed to stabilize him.  When the medevac birds arrived I positioned myself to lift the old man's upper half into the stretcher and discovered that he had a gaping wound on his back.  I had put my arm, almost up to the elbow into his chest cavity.  I cannot adequately describe the sensation of feeling someone's heart beating from inside their body.  Those sensations and smells will stay with me until the day I die.

To this day, I still don't know if those two young medics or the Psy-Ops team were ever recognized for their actions.  I know, like me, they ran out there in untied boots, brown t-shirts, no protective gear, and M-16's on their backs.  We didn't think, we reacted.  And it is with the utmost humility that I need to express my admiration for their actions that day.

I just wish, on tomorrow of all days, that I could remember the medics' names,  Or the Psy-Ops teams' names.  Maybe this blog will reach them somehow.

Most importantly, I need to express my most sincere condolences to the family of 1LT Leif Nott.  Until this year, I couldn't muster up the courage to even do that.  The memories were too much to handle.  Honestly, they still are, but it's been ten years.

I couldn't be silent, reticent anymore.

Requiescat in pace, Lief.  It is in honor of your service and sacrifice that I have finally mustered up the courage to share this.  May you and your family find the comfort and peace you deserve.

Well, I had another session with my individual therapist today.  We did a lot of talking about my recent realizations about being black and white about everything.  We still haven't come anywhere close to a work around or work-through.  One realization that I did make was that survivor's guilt plays a huge role in setting the standards I hold myself to (and my inability to forgive myself for not being good enough) and why I can't forgive others for disappointing me (well, violating my trust is more accurate).  There's a lot more to this that I still have to work through, that's for sure.  One of the things she told me is that she's concerned that because I need to have people fall into one category or another (Trusted or Not), I may try to force people to fit into those narrow categories, even when they don't belong there.

We talked about this for the vast majority of the session and she asked me if there was anything else bothering when I unintentionally dropped a bomb on her.  I could tell it concerned her greatly because her demeanor went from relaxed and attentive to focused and intense.  Here's the situation:

Last week, Thursday night into Friday, I lost a day.  What do I mean by that?  I went to sleep a little after midnight and the next thing I remember coherently is waking up and realizing I have to be at work in 45 minutes - work started at 2PM.  I slept for over 12 hours.  I remember nothing in the interim.  The next thing I remember clearly from that night is helping to clean the slicers at the end of the night.  I know interacted appropriately with my coworkers, but I have absolutely no sense of the passage of time for that night.  None.  I have no idea whether I was asleep all that time either.

I drove home that night wondering whether I was going to be walking into a shitstorm at home.  I had no idea.  After talking about this with my therapist today and seeing how concerned she got, it raised some alarms in my head and I ended up not working on the newsletters I wanted to send out today - I could barely concentrate on writing this blog post.  So I decided to take a break and watch a movie or two.  I couldn't concentrate on anything and it was starting to ratchet up my anxiety something fierce.

What I thought was strangest was the timing.  Everything was going well.  My PTSD symptoms were wll-managed.  The only thing I can think of is that it happened the night after I talked to the consultant about incorporation and foundation documents for the non-profit and I had a funding proposal that I put before a local veterans group for consideration.  I was extremely excited.  I was thinking that maybe my body doesn't know how to tell the difference between excitement and fear.  I know my adrenalin was pumping like crazy.

Unfortunately, the end result was the same - I lost a day.

So now, I have to track when this happens to see if there is a pattern.  I did some looking online and the specific information about the symptoms of TBI seem to fall in line with some of the issues I have with short-term memory, loss of sense of time, anger, etc.  Anyone out there know more specifics or resources online that articulate this better?  I don't want to pee up a tree and send doctors looking for ghosts if there's nothing to this.

A good friend of mine asked me to address this question.  He recently made the realization that he may have crossed over from acceptance to giving up on himself and having a good life.  As a result of this, I wanted to very carefully address this (unfortunately) all too common occurrence.

One of the most important steps we, as veterans with PTSD, have to make is accepting that what happened was not something we could have prevented or changed the outcome of.  As Rod Deaton says, we veterans are 'intensely intense'.  Most, if not all of us, feel that accepting what happened means that we stop fighting the guilt that it is our fault.  Here's the hard part:

The instinct to fight is what also keeps us motivated to continue fighting for a better life.

Many of us (myself included) have tried to accept what happened.  What we were really doing was feeling guilty that what happened was out of our control.  We end up surrendering to the guilt.  It can feel a lot like acceptance, but it is not.  It's insidious.  What has really happened is that by surrendering to the guilt, we have given up fighting and we convince ourselves that giving up on having a good life - it's just something else we have to 'accept'.

When I made this realization about myself, I felt even worse about myself, knowing that the last thing that I wanted was to give up on myself.  It was back to square one with the idea of acceptance.  In short, I hadn't actually accepted anything.  I just gave in.  That's what made me feel worse about myself.

So there you have it.  I hope this makes sense.

This question was a serious gut check this past weekend.  After my last blog post where I explained my struggle to stay motivated to get healthy, I talked with my mom about it.  She said that one of the things she has always loved about me is my gentleness.  I only become a fighter when absolutely necessary.  While I don't entirely agree with her assessment, it did turn a different light on:

I can fight for a cause.  I can fight for my loved ones.  I will fight for ideals worth fighting for.  But me?  Am I worth fighting for?


Yeah...as is said, gut check.  I realized immediately that survivor's guilt had a big role to play in this story.  The guilt eroded my self-confidence and self-esteem.  I have a very low opinion of my self-worth.  On top of that, I have stumbled and fallen down a lot as I learn to effectively cope with my PTSD.  I think that I am afraid to even try most of the time because I am afraid of failing again.  My lack of confidence turn this fear into a self-fulfilling prophecy.

So how do I get past this?  How does a person learn how to value himself again?  I should have a better opinion of myself.  The PTSD has tried very hard to destroy my life and my family.  Yet, I have persevered and held it all together.  What I realized is that I thought THEY were worth fighting for despite my inability to fight for me.

What a mess.  I literally hate the image I see when I look in the mirror and I wonder how much of that hatred stems from my guilt for having come home from Iraq when other I knew didn't.  Am I punishing myself?  Is that what's going on here?  I don't know.  I do intend to figure it out.  This may take more hand-holding than I thought, though.  The only way a person can truly improve their self-image is by having their worth validated regularly by those who love and care for him.

I don't want empty compliments and platitudes.  I need the people that love me to demonstrate to me why I am a good person.  Maybe I should talk to my parents, my sister, my wife, and others about having them write letters to me.  The idea would be explaining to me why they love me.  What they love about me.  That way, on a down day, I could pull out the letters and remind myself of how my family views me each and every day.  Hmm...

What a long week.  I keep on trying to find the time to write this post and others, but life intervenes.  What is frustrating is that I always feel better after I get out my thoughts in this blog, yet right now there doesn't seem to be enough time in the day.  *sigh*

Anyways, this past CPT session was pretty stressful.  One of the guys brought the kid of a friend to group.  The kid was in his early to mid 20's (wow - I just called someone in their 20's a kid.  Must be getting older...).  He was shot in the shoulder over in Iraq by a sniper.  He was ghost white from the pain and the pain meds.  His PTSD was deep and very severe.

And it felt like I was looking at a shadow of myself before I got help, when I first got home from overseas.  His life was in shambles and he was pushing everyone in his life that cared about him away but you could tell he was desperate for the loving touch of the ones who loved him.  He was a ball of jitters, anger, depression, catastrophic thinking, paranoia and guilt.  It was hard to look at, hard to watch.  I wanted to reach out to him and let him know that he was going to be OK.  The state he was in, he wouldn't have believed a word I said, even if I said the sky was blue.  He had insomnia, partially from the pain of his injury and partially from his wounded soul.

I didn't have the physical injury, but the rest...well, I don't like to think about the shriveled husk of a man that I was before I got help for my PTSD.

Here's the good part, the part that gives me hope:  Every guy in group, no matter how bad their situation was, reached out to that young man with compassion and knowing love and support.  We all told him he had a place with us if he needed it.  The common bond of traumatic experience brought us all closer in that one moment.  I think is was a benchmark moment for all of us in group.  I don't know why, but something about that moment changed the dynamic in group and changed it for the better.

A lot more happened in group in addition to this.  It was an eventful session.  But that is a tale for another post.  Off to hug my daughter now.

I was at work this weekend and I ran into my therapist from CPT group.  I talked to him about having gotten the increase in disability rating.  It was strange.  In that moment as I was talking to him a lot of things came clear to me.

I felt guilty.  I felt like I didn't deserve the rating I received.  When things got really bad over in Iraq, I had a ritual every morning.  When I first woke up, I asked myself whether 'today was the day that I would die'.  I had to confront that fear (and likely reality) every day and accept it .  I had to accept it or I wouldn't have been able to make it through the day.  That's what makes all of this so hard.  Guys who never accepted that they could die, never accepted their fear are the ones who didn't make it back.  They were the ones who had the fire and desire to live.  I was the one who 'gave up', that deserved their fate.

Because of this, I have experienced many a sleepless night since I got the decision in the mail.  What is strange is that my doc told me that most veterans with PTSD that he has worked with have shared these same sentiments.  How about that.  I guess we'll have a lot to talk about in group this Wednesday.

July 30th, 2003.  The day the course of my life irrevocably changed.  The day that I remember every year with trepidation, sorrow, guilt, anger, and gratitude.  It made me question everything I believed.  It shattered my psyche, shredded my soul.

Quite honestly, I am surprised I survived long enough to make it home.  Every day after became harder and harder to bear.  The horrific scene that haunted my mind, the smell and taste of blood...

Yet here I am, writing about how that experience and others that followed after changed me.  I don't want to remember what I experienced, yet I am afraid to forget.

Change the date and any veteran could have shared this.  The scary truth: Every veteran with PTSD I know has an anniversary.  A day that makes them pause, unwillingly, and remember horrific experiences.  A day they can't reconcile with physically, mentally or spiritually.

I have had many people ask me why I mark this date on the calendar.  They don't understand why, when it is so horrific, that I am forced to remember.  The answer I give them is always the same - Because I still am unable to accept what happened.  That, to me, accepting it would feel like a betrayal of those that died.  After almost a decade, I still feel this way.  I feel this so strongly that you might call it conviction.

My answer leaves many people shaking their heads in incredulity.  They ask me why I punish myself this way.  The answer:  I don't know.  Is it self-imposed punishment for surviving to talk about it when others never had the chance?

I'll make you all a deal.  When I figure it out, I will let you know.