Читать книгу Welcome Home From Vietnam, Finally - Gus Kappler MD - Страница 17

From Highway 1, overrun in 1968 by the North Vietnamese Army (NVA) during the Tet Offensive, a sharp turn entered our hospital compound. Directly to the west was an immense, densely arranged sprawl of old hooches each encased to a five-foot height by a doubly thick wall of sandbags. More deteriorating sand-filled dark-green bags reinforced the stability of the corrugated metal roof. These battered structures were home to thousands of 101st Airborne fighting men (Screaming Eagles) who were all our responsibility. The hills visible in the far west distance were “Indian country” (enemy infested).

101st Airborne on Highway 1

Sequestered within a small green plywood shack protected by walls of sandbags, a group of seriously tough-looking MPs guarded the 85th Evac’s front gate.

MPs in front the 85th Evac front gate

Our mission statement was posted with large black letters on a tungsten white wooden board. It read, “To provide hospitalization in support of United States Army Vietnam (USARVN) Free World Military Assistance Forces (FWMAF) and civilian war casualties (CWC) located within northern I Corps tactical zone.”

Mission statement at the front gate

What those words meant to me was that the 85th Evac in 1970–1971 was tasked to treat the wounded, maimed, disfigured, and dying American grunts whose sacrifices were of little consequence in the global politics of a distant country the US government had not only invaded, ravaged, and poisoned with Agent Orange but also decided in 1969 to gradually back away from and desert. This distorted relationship with South Vietnam was well understood by the troops, and a sense of desperation clouded their existence. Each soldier entered Vietnam alone, not with a unit as in this current century’s deployments. They were shunned when first in country as the F–ing New Guy (FNG) who was totally inexperienced and who could “get you killed.” These men quickly learned that they were not fighting for democracy, our country, or a free society; they were fighting to survive and go home. The troops, of all colors and descendant nationalities, fought bravely and were guided by the emotion of the brotherhood they shared with their buddies.

Has not history repeated itself in Iraq and Afghanistan?

With due respect to the mission statement, we administered to few Vietnamese, and if we did, there were limitations. During the past few years, I have confronted my attitude toward the Vietnamese people I encountered during my tour at the 85th Evac. What I realized is that the dehumanizing process that allows the soldier to more easily kill another human being had infected my psyche. I did not leave the United States with this attitude. It evolved in country.

A constantly present, extremely friendly Vietnamese young man interpreted for us in the ED.

He appeared useful, efficient, a friend, and was eventually revealed to be Viet Cong. One day, he vanished (most likely executed) with our emotionally charged trust betrayed and an intensified need to protect ourselves against them.

5 In the x-ray room; our Viet Cong friend to the right

One could not determine friend from foe, so all Vietnamese became second-rate distrusted humans who were killing our precious young men. I was seduced by circumstance into shunning the weighty message of the Hippocratic Oath I had recited upon graduation from medical school. My moral compass morphed from the stateside moral code of a secure nation to the “you’re not in Kansas anymore, Toto” war-zone moral code.

The wounded Americans were treated preferentially; the Vietnamese casualties were overflown to their (ARVN) hospital in Hue, where survival was circumspect. There was no Vietnamese blood-banking system. As a priority, the American precious lifesaving liquid was given to our boys. A limited supply was available for the ARVN wounded. The outdated blood was sent from our blood bank to the ARVN hospital in Hue.

These disclosures may horrify some. They should, but visualize your son’s desperation as he screamed in unrelenting pain with his life’s blood oozing from his wounds onto the ED concrete floor only to be directed to a drain by the spray of water from a nearby hose.

Dehumanizing the Vietnamese people was part of the war-zone moral code and condoned putting American boys first in line for treatment. Would I be capable of defaulting to the stateside code upon returning home? Many who served are still in limbo wanting to engage their original stateside-default moral code so to be capable of navigating normal society but are unable to completely shed their guilt or even create a boundary around the perceived sin of succumbing to the war-zone moral code.

To those now denouncing me, I must stress that when we did operate on the Vietnamese, we did so with the same intense level of professional commitment rendered to our boys.

We were not without compassion. One evening, a captured North Vietnamese (NVA) enemy soldier was brought to the ED with abdominal pain. I was on call, decided he had appendicitis, and brought him to the OR. Phu Bai Fred was a big man and stood ready to induce general anesthesia. The prisoner was consumed with terror not understanding what was transpiring. Was this white room a torture chamber and Fred in his scrubs the instrument of torture? I comforted the neutralized enemy by cradling his head and held his hand as anesthesia was induced. He did have a hot appendix.

As touched upon previously, the moral compass of a safe society does not translate to a war zone. All who serve in combat are changed forever. One observes and participates in horribly unspeakable occurrences.

In accepting the new definitions of a war-zone moral code, it is intensely imperative that the combatant’s violence be confined within parameters of warfare that avoid atrocities. This ability to restrain emotionally driven responses at times is a very gray area when adrenalin driven during a fire fight and just grasping for survival.

Being unable to save a battered wholesome eighteen-year-old patient despite all your skills in the OR traumatizes one’s soul. Killing a fellow human being tears the soul apart and if not healed, results in a weakened and fragile psyche. The clinical dysfunction was referred to in the sixteenth and seventeenth centuries as Nostalgia, the Civil War as the Soldier’s Heart, Shell Shock in World War I and Battle Fatigue in World War II. Now, all the world recognizes the term post-traumatic stress disorder (PTSD).

I would recommend reading War and the Soul by Ed Tick, PhD. He references the native American Indians’ isolation, away from the tribe, of the returning warriors to allow them to complete the “warrior path before reintegrating into their peaceful tribal society.

There are volumes written about the etiology and treatment of PTSD. I believe if the military were as dedicated in reconditioning a combat survivor with techniques of dealing with healing his soul after witnessing carnage or actually killing as the instructors were dedicated in basic training in conditioning the warrior to kill, instituting a preventive measure of temporary separation prior to discharge for reconditioning would be instrumental in a plummeting incidence of PTSD.

This reverse-warfare conditioning must be accomplished while the soldier is still on active duty and before his unit is dispersed, isolating returning combatants before discharge within their unit structure and defusing traumatic experiences by allowing and encouraging open and honest discussions that are free of a superior’s distain and of possible punishments for perceived moral or military rule infractions. The military must allow them to switch back to the default stateside moral code and be reassured that abiding by the combat moral code in a war zone was a justified and a humanly natural and mentally stabilizing adjustment, which they undoubtedly will experience again on redeployment.

It is ludicrous to expect all returnees to reintegrate into a civil society by the current sink-or-swim mentality of our military. This method is our country’s present approach. There are a few pitiful attempts at counseling prior to discharge, but they are totally ineffectual.

A proactive preventive approach to PTSD will be so much more effective than chasing its symptoms once this life-destroying malady has engulfed our young members of the military.