Thank you for your service


I just got back from a Veterans Day assembly at my kids’ elementary school. The gym was decorated with flags and cute artwork and the program was full of patriotic songs and poems. I was one of approximately 50 veterans representing a total of 360 years of service. The kids were of course adorable and squirmy and they used words like bravery and heroism and strength. Sitting there, watching them recognize the hard work and sacrifice, I couldn’t help but feel pain for a silent war being waged by soldiers, past and present: a war of self-destruction where thousands are dying every year.

I realize that it’s not a popular thing to bring up veteran suicide on a day meant to honor them, but I think the best way to really do that is to be honest about reality for many veterans. If you feel that it is inappropriate, then I ask you to just scroll on past or maybe come back another time. I can only speak from my own experience and don’t claim to represent all veterans. Some of them may disagree with me for bringing this up, and that’s ok.

I recognize that many people don’t know what to say on days like this one, where the spotlight is on veterans.  I get so many quick “thank you for your service” comments. I realize that people may be uncomfortable delving deeper into why so many of us who are veterans dislike that phrase.  It holds the truth at a comfortable arms-length and means we don’t talk about moral injury or invisible wounds or anything else real. It stops the conversation before it even begins.

The latest report statistics for veterans suicide conducted by the VA came out the end of September . The numbers were reported as dropping from 22 a day to 17 per day. If you just read the headlines, that looks still not great but possibly encouraging.  But the fact is that the numbers haven’t decreased, only the way they are calculating them has changed, leaving out active duty, National Guard and reservists from the numbers. This is just a different way of presenting the fact that America is losing veterans at an alarming rate.  From 2007 to 2017, the rate of suicide among veterans jumped almost 50 percent. The numbers have increased steadily over the last four years.

I wasn’t going to write this post, but I feel compelled to bring this up because yesterday  I found out that one of my best friends took his life on Friday. He was one month away from his 20th year of service and the end of his contract. He was a fellow Army medic and he was one of the best.  He was smart and compassionate and he had 8 combat tours. He also fought long and hard against PTSD.  He saved countless lives. A few years ago he got out and worked as a civilian paramedic for a while. But he was lost, and didn’t adjust well to civilian life. We had a lot of long conversations while chugging coffee; about tribe and feeling displaced and restless and what it all meant– the work that we do in emergency medicine, tricks of the trade, and where we put all the stuff we can’t get out of our heads and how we cling to compassion as the last vestige of it being worthwhile. We had shared language and could always be real and honest and yes, at times a little dark in our humor. I can’t believe I will never see him again.

He rarely slept, and he was always in motion. He had nightmares and held it all very close. He ran and biked and rode his motorcycle and tried meds and quitting drinking and  yoga and all the rest but he couldn’t find his way through. He avoided the VA, always saying that was for people with worse issues than him. He didn’t want to take resources from soldiers he thought were “more deserving”. He ended up re-enlisting three years ago and spent most of the last two years in Syria training Kurdish medics. I just talked to him two weeks ago. He sounded tired but not hopeless. We always joked how we were trauma bonded. He was one of the few people I would answer the phone for.  He was there for a lot of the toughest moments of my medical career–many times his eyes were the ones looking into mine across a patient we were trying to save. He was the co-bearer of those experiences and knowing he is gone leaves me untethered and feeling a sadness that is impossible to describe. He was a ginger too and ironically always called me “Red”. He was strong and smart and also broken and I didn’t see it coming. It doesn’t even feel real.

He’s one of those 17 a day now. But so much more than that.  All of these numbers are people. They are brothers and sisters and husbands and wives and mothers and fathers and no matter how the numbers are presented, its clear that whatever we are doing, it isn’t working. The de-briefs we received after deployments were basically a check the box exercise. The unspoken culture is still to stay strong, silent and not let on that we are suffering.  That culture is causing casualties long after the fact.

So on this Veterans Day, maybe check in with your veteran. Be willing to go deeper, beyond what makes you comfortable. Many of us have complex emotions surrounding our time served.  We remember when we were idealistic and service-oriented and struggle to say that while we are grateful for the experience, and feel honored to be among a small percentage of citizens who have served, many of us carry some degree of moral injury as a result of that service. We’ve lost friends and many of our lives have been irrevocably changed by traumatic brain injuries, wounds and PTSD.

Veterans are flawed people who are revered on days like this one, but deep down may feel they can’t live up to being seen as a super hero. It’s a tough burden and can make us feel even more disconnected when we are already struggling.

We live in a time of perpetual war. We have been sustaining a high operational tempo for almost twenty years.  In the early days, the increase in numbers of veteran and active duty suicides got the attention of the Pentagon and many of us were on the receiving end of countless awareness programs and de-briefings. But as time has passed, apart from many incredibly dedicated suicide-prevention organizations, the urgency has faded.  This new report with it’s lower numbers will be seen as an improvement. It’s not.

For some soldiers, the connection to others and the bond even in the worst of conditions is rarely experienced again once they leave the service. It’s a loss of purpose and identity that can be difficult to navigate. And we need to do better in how we support soldiers during times of transition, after deployments or in leaving the military, which is when many of these deaths occur. We need to re-focus on connecting with each other in real life, on a deeper level, not just on social media where it’s easy to put on a brave face. I’m going to continue to try to use my words where and when I can. Because I don’t want to lose any more us.

RIP, G. I will miss you always.



When you become an ER nurse, you get yourself a front row seat to some of the toughest moments a human can experience.  Over time, you absorb a lot of other people’s trauma. For many of us, there is a fine line between accepting the randomness of things while still believing in the inherent good of the world vs. plunging headlong into fear and anxiety about lurking danger and beginning to see death around every corner. If you spend enough time seeing really messed up things, you may begin to think of the universe as some kind of demented Rube Goldberg contraption where each swinging lever meets up at the exact right time with a rolling ball, causing calamity. In my work, I see how all it takes is a single second of distraction, a missed phone call, a misperception, a momentary lapse of judgement that cascades into something terrible. Nothing will ever be the same again. Everything from that point forward will be demarked into “Before” and “After.”

I naively entered the gaping maw of Emergency and Combat medicine with a desire to help. I threw myself into the role of healer, of “fixer”. Eventually I found myself dependent on the rush, then over time, when the unfixable things started coming fast and furious, I internalized all of that cumulative damage.  Instead of looking for ways to unpack and unload, I just absorbed it with a sense of “this is just who I am now”. I think I saw it as the price  to pay for the privilege of getting to save lives, and on some days, being the one there in the sacred moment of death. It is a heavy burden and a calling. For me, my inability to unload all of the absorbed traumas devolved into a sense of self-loathing and punishment for not being able to handle it all better. I came to see myself as the unreliable narrator of my own life. I accepted the idea that once damaged, I would stay that way. The solution was to just find a way to numb it all since I felt myself being constantly, internally divided into Before and After.  I developed a lot of hyper-vigilance, trying to control every little detail as if I could ward off the horrors I saw, make it not be MY family, my little world, my patient. I thought that somehow I could keep it from happening by just trying to control, to manage everything, to avoid the swinging levers and when I couldn’t, when I “failed”, then I would drink to numb myself. Addiction blinds us to many things, especially our true selves. I was operating under the false idea that my self was irrevocably broken because I just wasn’t strong enough. And every time my hands started shaking I just saw it as proof.

In year two of sobriety, I took a deep breath, and decided it was time to look into the abyss of my PTSD. I started going to therapy, looking for tools to help me move past some of the things that haunt me, learning how to practice saying “I am just feeling triggered right now. I am safe. This isn’t happening right now.” At first, I kept getting stuck in wishing that I hadn’t chosen the life I had. I wanted to go back and re-write the past. I thought about the roads not taken, my own choices to wander down the tough paths I have.  I wonder what might have been had I not traveled down the road of trauma and addiction.  If I had accepted myself, my identity as a lover of solitude and quiet. If I had chosen the life of a writer or professor, instead of running headlong into adrenaline and excess because I wanted to appear strong, and feared a small, quiet life.  The irony is that now, coming out the other side, that is what I long for the most.

Alcohol was originally a coping mechanism to turn down the noise, to slow my racing brain, temper my tendency to fly too high and then crash.  And it worked for a long, long time. Until it didn’t. I knew at about 25 or 26 years of age when I was in the Army that my drinking wasn’t normal.  I was the classic apex predator of MORE. I had no off switch once I started. I would lead the charge at the bar, was always there when the lights came on. I rolled back into our barracks at 0200 only to be in PT formation at 0500 with my fellow soldiers, the cloud of alcohol fumes no doubt streaming behind us as we ran in darkness singing loud cadences. Most of us were probably not clinically sober when we started our duty days. I had a few painful consequences to my drinking, but they weren’t bad enough to make me really stop. It also wasn’t out of the ordinary in that warrior culture to be a heavy drinker…I believe the military, with it’s focus on being tough and strong and the realities of war can engender addiction in those of us who may be predisposed.  We are told to be cast iron, the last line of defense. We aren’t supposed to be afraid. Feelings make you vulnerable and get you killed, so you just stuff them down. So many sacrifice their mental health in order to never appear weak. I certainly did.  My second profession has many of the same expectations or subliminal messages: Keep it together, get the job done, don’t break down, don’t fail your patient by letting your emotions override your skill. Don’t let anyone know how scared you are.

Many of us who have lost years to addiction and dysfunctional patterns of survival wish we could go back and do things over. We can get stuck feeling the need to constantly make amends for errors of judgment, for our very “lostness”. In my first few months of sobriety, I had an overwhelming urgency to make things count, to grow, to head a thousand miles an hour down the road in the opposite direction.

At the beginning of this journey, I applied a lot of force to my recovery in typical impatient, “I’ve gotta work this out, heal this, fix this NOW” black and white thinking.  In therapy, I started digging out all of the things I had been stuffing down and tried to rush through them. I was just going to be the best patient ever, and I would have this all figured out in no time.  I would do all the homework I was given and then press even more, and if I failed, then I would just charge back into it. It was the same extremes I had been swinging between for as long as I can remember.

And then, six months ago, with 950 odd days of sobriety, I drank for three consecutive nights. I didn’t drink to excess. I applauded myself for making my drinks in a glass, with ice and appropriate mixers like a “normal” person.  I didn’t guzzle straight out of the bottle. I didn’t pour another and honestly, I sat for a moment enjoying the pleasant buzz, the temporary muting of my inner noise. I didn’t call or text anyone, which is what I should have done when I found the bottle hidden. I didn’t dump it out, just quietly planned to drink it once the kids were in bed.  I just wanted to stop feeling broken and full of holes. I wanted to numb and to change my state. And it did. For a bit. With almost the first sip, my old worn neural pathways kicked in. I felt that familiar old sense of well-being, the relaxation of my tense muscles, the smoothing out of my rumply thoughts and then I slept.  Dreamless, blissful oblivious sleep that had been eluding me for months as I was excavating old thought patterns and working through old traumas. I didn’t plunge headlong back into drinking in the morning or blacking out. I just woke up on day 4 and decided “no more.”

Reliving that feeling of looking at myself in the mirror with a sort of film over my eyes–everything muted, turned down low and muffled made me realize something. I don’t want that feeling anymore, nor do I need it. I like the razor sharp clarity, the quickness of mind that comes with being 100% present and unaltered. Over those 950 days sober had become my new default. I knew that deep in my bones.

The first few weeks after my slip were a jumble of thoughts, regrets, trying to understand how I got to that place. The waves of worthlessness that had prompted me to pick up the glass only grew taller in the weeks after, and the darkness that lies under my surface became enveloping. I know deep down that alcohol doesn’t mix well with my mental health. But I drank. I felt like a failure, like someone was going to pull up to my house with flashing lights and revoke my “sober blogger” card.

I told my closest friends and sober sisters, then sat down and did a long inventory. I made a pretty long list of warning signs that had been brewing.  I had some back to back really bad shifts at work that were very reminiscent of my last few months of drinking when I was at my breaking point. I felt constantly triggered. My insides were shaking, my heart and thoughts were racing and I was distracted, disorganized and doubling down on being hard on myself.  I was also struggling with deeply painful changes in some important relationships. At the same time, juggling three kids and their school and sports schedules on my own had reduced my self care to basically zero.  When I wrote it down in black and white, it was clear to see how I had been escalating for weeks before I ever picked up the drink.

I’ve grown a lot since I started writing this post. I had actually written the first part before my slip. I’ve done a lot of hard work and soul searching since then, and a lot of changes have resulted from what I saw as a failure.  But with time, I see it as a perfect alignment of that swinging lever that bumped into the ball and caused a cascade reaction.  Except it wasn’t a calamity.  It was a catalyst.

In the half year since, I’ve continued going to therapy, and I’ve expanded my tool box considerably. I’ve learned new coping mechanisms. I still have some really bad days but I’m allowing myself to take my time, to float in things. I’ve started taking medication for what has been a lifelong struggle with undiagnosed type 2 bipolar/ADHD. It’s been hard to admit I needed more help, but it became clear that if I am going to keep doing the work I need to do to that it was time to try meds. I had tried literally everything else. Including nearly drinking myself to death.  My therapist told me a few weeks ago that my “kinetic energy” has toned down a lot. I think that was a nice way of saying I’m no longer so hypomanic. But it feels good to be at peace with not needing the extremes. I don’t feel less like myself. I actually feel like I finally have a chance to understand who that is, with the constant head noise turned down a little. It’s definitely a work in progress. Some days are rough. I still want to rush, to get to wherever I think I should be immediately.  And then other days I’m a river of zen. (So maybe my extremes aren’t quite gone).  But there are more days where I can hold loosely and work through the anxiety, the days of the mean reds, knowing that it will pass.  That I’m ok.

I think perhaps the hardest part to accept has been the loss of my vision of myself as a perfect rocket launching into sobriety. A new ghost ship sailed away as I waved from the shore: that story line wasn’t one that I could claim, perhaps wasn’t meant for me. I will never know. But looking back, I’m glad it happened. It cemented for me that I want to be sober more than I want to be safe. I want it more than anything.

“I’ll never know, and neither will you, of the life you don’t choose.  We’ll only know that whatever that sister life was, it was important and beautiful and not ours.  It was the ghost ship that didn’t carry us. There’s nothing to do but salute it from the shore.” -Cheryl Strayed


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