Tuesday, April 07, 2009

Battle rages inside for many Iraq veterans

Ken Klotzbach/Post-Bulletin

Gabe Cruz struggles while talking about his memories of the Gulf War and the care he has received in the Veterans Administration system. He carries worn papers and a notebook with him to keep his experiences and treatments in order.

By Jeff Hansel
Post-Bulletin, Rochester MN

One moment he's talking about his Dachshund named Gia, with relaxed joy evident in his face, voice and posture.

The next, an uninvited memory pushes into his mind and tears begin to stream from his eyes.

"I've tried to commit suicide a couple of times. But the damn gun didn't go off," says Cpl. Gabe Cruz, a veteran of the first Gulf war. "I had a 12-gauge shotgun with a slug in it and it just went 'click!' -- and then faith kicks in."

As veterans re-enter the civilian work force, return to their families and their neighborhoods, many will enter a lengthy healing process.

They'll need the help of friends, family, neighbors and co-workers to find a renewed sense of grounding, said Mark Frenzel, program manager with Operation Enduring Freedom/Operation Iraq Freedom with the Veterans Administration in Minneapolis.

It's important for veterans and their kids to get reacquainted. Spending time together, perhaps going through photographs from special events or looking through report cards, is a good way to let that happen, Burnes said.

Cruz says he served in Kuwait and Iraq during the first Gulf war as a "tanker" with the Army's 2nd Cavalry Regiment. He was responsible for the tank turret and eventually became a gunner, firing 9mm and M16 guns. He has documents that confirm his 100 percent war-related disability.

"There was six of us. There's two of us left," he says. "There was six of us and four of us are gone, sir, and they did take a gun to their mouth. It just hurts. It just stings. It really stings."

Suicide among veterans of the Iraq and Afghanistan wars is high.

"The suicide rate among this group of veterans is twice that of the national average. And suicide is a very real outcome from being in combat," said Katie Burnes, a psychiatric nurse practitioner who works full-time helping soldiers at the VA Clinic in Rochester.

A note left behind by one of his crew members, Cruz said, explained "'I just can't take this any more. I'm sorry for the pain I've caused you. But whatever I caused you, it isn't half what I'm going through' -- and then he pulled the trigger."

Thousands of U.S. soldiers are coming home with concerns, memories and injuries they -- and you -- will have to deal with.


Copyright 2009 Post-Bulletin Company, LLC


Veterans struggle to truly come home

By Jeff Hansel
Post-Bulletin, Rochester MN

After returning stateside from serving in the Gulf War in 1991, Gabe Cruz had a stable job.

He was a surveillance specialist with the Lubbock, Texas, Health Department, tracking the incidence of sexually transmitted diseases in the west Texas population. He was considered a public health expert, especially in the field of HIV/AIDS.

"I oversaw 42 counties. I dressed in shirts and ties and I worked in nice clothes," he says.

But he experienced a personal tragedy and an emotional breakdown at work, and he lost his job. Anything can trigger such an unexpected downward spiral for veterans who might think they've returned to normalcy.

"I went crazy," Cruz says, showing his disability documents that state, "you were found running barefoot in the street, claiming people were shooting at you."

He had a flat tire and "I just started crying. I couldn't get it together."

While on active duty, most routine things are predetermined, so changes in routine can throw off veterans.

"I remember one guy getting off the plane, met his wife and family at the airport, went to have a meal and felt completely overwhelmed because the waitress put a menu in his hand," said Katie Burnes, a psychiatric nurse practitioner who helps soldiers at the VA Clinic in Rochester. "Because he didn't have to choose anything. He didn't have to choose what to eat for 16 months. And he didn't know how to act. He didn't know how to respond."

Cruz uses the disability statement as if it's proof for non-believers.

"I read it over and over (because) I forget," Cruz says. "I think any logical person would say they'd want to forget the worst parts."

He has formed a relationship with a woman and her two children, but he struggles. In post-war relationships, when a woman rolls her eyes in response to his behavior, he says, he knows it's over.

"I sleep in the garage because I don't want the kids to see me. ... It's cold in the garage. It's more embarrassing, though, if they were to see me," he says.

Severe panic attacks are the problem. Any unexpected noise can set one off.

"You just see some little kid's head split open....," the words spill out of his mouth almost too fast to follow, an intrusive memory that he'd rather not relive, but he stops himself with fits of sobbing, then regains control.

Delayed stress can hit veterans

Delayed post-traumatic stress affects veterans, often years after they return from war, said Mark Frenzel, program manager with Operation Enduring Freedom/Operation Iraq Freedom with the Veterans Administration in Minneapolis.

Veterans specialists like Frenzel and Burnes want Minnesotans to understand that they can help veterans return to stable civilian life. But it's a long road.

"Don't make any quick decisions," Burnes advises family members. "It takes over two years to reintegrate to home life. If they're deployed for a year, it's going to take two years to readjust and re-establish their roles."

It's better to get help early, she said, because recovery will take longer if the veteran delays getting help.

"They left, they've been gone a year, year-and-a-half. The wife, the husband, the parents have moved on. They've all established sort of normalized roles during that time and all of a sudden the veteran has to come back and reinsert themselves," Frenzel said. "Being in a war zone, combat, you need to be hyper vigilant. The adrenaline's flowing. How do you replace that high they've been experiencing?"

When Cruz seeks care, he's often in the midst of a crisis, desperately in need of medication to ease intrusive thoughts, auditory hallucinations he can not suppress.

"I hear tanks. I hear gunners," Cruz said. "You can hear your commander talking to you and your fellow soldiers yelling at you."

Cruz doesn't want to be medicated into a zombie state, so he avoids medication, walking a thin line between loss of control and overmedication. But when war thoughts take control of his mind, he needs help to escape them. That's when he visits health providers, hoping for a prescription to stave off flashbacks.

But, seeing his agitated state, it's easy for health providers to believe he's an addict.

He says he doesn't drink or take street drugs. Alcohol, for him, would make the flashbacks, nightmares and reaction to loud noises even worse.

Cruz says his pain is real. He believes his back problems came from shrapnel from a mortar round that scraped across his back, knocking him down.

"The concussion just folded me backwards," he says. "Right when they get close you hear them -- 'sceerrrr!,'" he says.

Variety of stresses

Returning veterans experience a variety of stresses, Frenzel said.

One in four returning veterans has a traumatic brain injury. Brain injuries can cause impulsive behavior, agitation and outbursts of frustration. And 44 percent of returning vets have mental disorders such as post-traumatic stress, depression or another diagnosable mental illness.

Cruz has a scar along the side of his head from an improvised explosive device or mortar round.

"I took this blow here. I'm not exactly sure how I took it off of a tank, they say I took it off the tank," Cruz says. "Part of my brain still works. But if you ask me what street I turned on five minutes ago, my memory's shot."

He doesn't trust the Veterans Administration and has been banned from a Rochester medical center after missing too many appointments.

Cruz says he no longer believes in God.

After he'd been back in the United States a while, he was sleeping at his parents' house one night when a thunderstorm rolled through. He awoke in a fit and hit the wall next to his bed.

"My fist went right through it, and my dad was like, what the hell is wrong with you?"


The effect of war can be tough on friendships, too.

"These soldiers form their strongest bonds with their fellow soldiers, so they may not be willing to talk about their experiences in Iraq," Burnes said. "If it's a non-military friend, that non-military friend needs to accept that. And they also need to understand that the veteran has changed, because you can't go through combat and come back the same. So don't plan on having the same relationship. Accept that growth and maturity have happened while they've been gone."

Cruz agrees.

"I miss the Army. I miss my friends. I miss being able to tell somebody I got your back," Cruz says.

He would serve again if he could, to protect the children of today from having to go to war.

"I would do this over again, 1,000-billion times," he says.


Employers, coworkers and health-care workers all need extra patience with returning veterans.

Most likely, a veteran will never share his or her entire story with you.

"Understand that they may have little patience, or they might be irritable. And coworkers need to not personalize that, because the veteran may have been triggered by something and is privately trying to deal with that," Burnes said. "Kind of back off and kind of give them some space. The last thing they need is somebody to be really in their face."

For Cruz, memories flood back without invitation.

He was responsible for setting up the tank's turret and eventually became a gunner, fighting against Saddam Hussein's Republican Guard in the Medina Division.

"We had the largest tank battle since Patton. It was rough, because you see all these hoards and hoards of people surrounding you," he said. "There's nothing worse than cleaning someone, or you actually hit someone that's full of gangrene and you've got to clean that off your tanks -- watching the dogs eat -- we shoot them. I saw kids getting out trying to dig holes to bury these people. Then you get to Kuwait City and you see that they killed women and cut children up, and after that you shoot them in the forehead.

"You are slightly spooked all of the time, and afraid," he said. "There are some horses that, if they get spooked, they are useless." That's the way Cruz feels; incapacitated by a fear.

Health care

One medical center in Rochester won't see Cruz any longer because he took too many pain pills, and another won't because he keeps missing appointments because of his memory loss, he says.

He writes notes to himself in a notebook, as many people with brain injuries do. He even wears a watch with an alarm to remind him of the appointments.

"Then they beep and I'm like, what's it for? And then I start going through the (notebook) and I began thinking, what am I looking for?"

To a medical provider not used to such a high number of people living with brain injuries, the patient might appear inappropriately angry -- frightening enough to ask the veteran to leave.

Instead, Burnes said, health providers should take time to figure out what's going on with the patient.

Patients should be assessed for depression, post traumatic stress and brain injuries, she said. "It may be beneficial if they know that they're dealing with a veteran to do a reminder call, that's because the memory component can be affected. Watch for signs of alcohol abuse."

It's important to remember the trauma veterans have experienced, Burnes said.

"What I hear from veterans is please ask people not to ask questions like 'did you kill somebody or did you see anyone die,'" she said. "Because, more than likely, that happened. That's not something these veterans are ready to talk about."


Perhaps it's part of Cruz's healing process to speak out.

"I want people to learn. I want people to see -- it's human life," he said.

A woman at a local medical organization hung up the phone on him after he became agitated.

"She told me to just deal with it and during the conversation, she got real snippy. I was like, look, lady, the advice you're giving me, you may as well just give me a bottle of whiskey and a shotgun with a round in it and let me blow the back of my head off. I'm going crazy here. And she said, 'Oh well' -- and hung up. ... Why don't they understand that I'm afraid? I'm always, always, always, always, always afraid. ... It's just not fair not to be able to get angry."

About 20 percent of veterans will continue to struggle on a relatively long-term basis, Frenzel said. But there are many services, including many new ones, that can help. But veterans or their loved ones must take action to get help.

Burnes said most veterans, after adjusting, are able to return to a stable life.

"There's hope," she said. "The bad news is that you have it -- PTSD or TBI. The good news is that it's treatable."


Reporter Jeff Hansel covers health for the Post-Bulletin. Read his blog, Pulse on Health, at Postbulletin.com.

Copyright 2009 Post-Bulletin Company, LLC


Anonymous said...

Thanks - that was an eye opener. I printed that section out to remind me of what they've gone through for all of us and what we take for granted. I do believe in God and I believe that we have an evil adversary also. But God will ultimately win this war here on earth - we can be sure of that. I hope you don't mind me saying that. Take care. KM

Bob said...

Hey KM, glad I went back and saw your comment. It's supposed to let me know when someone does. Oh yeah, the battle is coming and the players are already lined up.