Pelios Has Departed

DSM-5 Criteria for PTSD

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence

Criterion B (one required): The traumatic event is persistently re-experienced

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma,

Criterion F (required): Symptoms last for more than one month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two specifications:

Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).

Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.

– Abridged criteria for the diagnosis of Post-Traumatic Stress Disorder from the DSM-V, American Psychiatric Association

1000 Thursday 24 May 2012

Staff Sergeant Aaron Hedlund

            Months later, it still feels odd for Aaron to walk up a flight of stairs with only one testicle—the swing of the legs, the rise of his boxers, the almost imperceptible different occupation of three-dimensional space. There are the constant dull ache and phantom presence of the missing organ, but no actual pain. There never really was any pain as he remembers, but in the medication-induced fugue he lives in, he is unsure of himself and his environment. Short of breath with sweat beading on his forehead, Aaron reaches the top floor of the building, which was only three flights of stairs. He grabs the handrail and pauses to catch his breath while cursing his significant physical decline. Aaron tries to chastise himself for being soft and weak, but all he can muster is an unintelligible mumble as his tongue feels like it’s glued to the roof of his mouth with drywall paste. The dry mouth is exceptional on this spring day, and he curses internally again when he realizes he had forgotten his water bottle.

He sharply inhales before exiting the stairs into the lobby and hears a woman’s voice calling his name. Visibly confused, he turns, opens the door to the stairwell, sees no one, and then pivots back to the lobby. “Aaron,” the voice repeats, louder this time. His concern grows, and he cautiously turns a slow circle to locate the source. It’s his first day back to the Intensive Outpatient Program since his release from his most recent inpatient stay on the psych ward, and he worries that his mind is already betraying him. Aaron freezes and tries to act inconspicuous and not draw attention and potentially expedite returning to the hospital. His eyes dart around the room at the few people present, but they have taken no interest in him, including the reception clerk who is enthralled by her phone. He nods slowly to reassure himself that everything is fine, takes a breath, and steps toward the counter to sign in.

Before he gets there, a gentle hand touches his arm, startling him. He recoils from the touch, and a sharp inhalation squeaks in the back of his throat. With wide eyes, his head whips around as a woman steps back and raises her hands apologetically.

“I’m so sorry; I didn’t mean to scare you,” she stammers. Her eyes betray a hint of fear at his reaction. Aaron’s heart thunders in his chest, but he forces his outward appearance to soften. He focuses on the woman and feigns polite recognition while batting at the cobwebs that clutter his recall. She is familiar, but he can’t place her in his clouded memory.

“Major Saunders,” he says with a constipated smile. Her uniform’s name and rank tapes provide a few moments reprieve as his mind scrambles frantically.

“It’s so good to see you again. Are you back for group today?”

So she knows my name and that I’m here for IOP, he thinks. He feels exposed and at a distinct disadvantage. A cold sweat beads on his lower back as his anxiety grows, but he has to put on a show of normalcy, so he sucks in his stomach and stands tall and calm. His uniform, a few sizes too small now, groans at the effort, but she doesn’t seem to notice or at least is kind enough not to mention it. He nods methodically in response. “Yes, I will be in group today.”

“That’s wonderful. We’ve missed you. Well, I’ve got to go to my one on one, but I’ll see you later. It’s great you’re back.” She moves to pat his arm but stops as he winces in anticipation of the unsolicited contact. She lowers her hand, offers a smile dripping with pity, and walks away.

Aaron remains glued in place while his heart rate decreases and the bile in his throat recedes to his stomach. He exhales into a slouch and shuffles toward the desk. He signs in, sits down to wait for his appointment, and browses through some magazines and leaflets, settling on a year-old hunting magazine. The magazine seems familiar as he reads an article on how to appropriately field dress a deer. Something clicks, and he remembers that he has indeed read this before, possibly in the same seat. He starts to laugh. It begins as a high pitched giggle that morphs into a tear-jerking guffaw.

“You all right, sergeant?” another male soldier who Aaron hadn’t noticed before asks from a seat across the aisle.

Aaron wipes his eyes and waves the magazine in front of the soldier. “Sure am!” Aaron jumps to his feet and plops down in the seat next to the soldier, who leans away at the invasion of his personal space. Aaron spreads out the magazine and jabs at the open page. “See this article here. I was reading it two months ago in that chair right there!” he says with excitement while pointing. The other soldier raises an eyebrow and adjusts his body to the other side of his chair to increases the distance from Aaron just a bit.

“Okay, sergeant. I gotcha. Great.”

“You don’t get it, private! This article right here,” Aaron says with a slap to the magazine. “I can’t believe it’s still here. So, this is about how to field dress a deer. You a hunter? Right, check this out. After you make the kill, make sure you have the deer’s belly facing down a hill, if possible, so gravity can help out. You make a large slit down the middle of the belly, careful not to injure the intestines. You pull all the guts out and let them slide down the slope. Then, get a handsaw, hatchet, or serrated knife and split the breastbone. Reach up and cut the esophagus and windpipe. Slice away the lungs and heart, and now pretty much everything is free except for the stuff down here.” Aaron grabs his crotch. “Take that hatchet again and split the pubic bone right in the middle, making sure not to damage the bladder or intestines again, or there will be piss and shit everywhere. Not a pretty sight and can ruin the meat. Finally, cut the butthole and the genitals away, and everything is free to be released. Pull the deer further uphill from the piles of guts, and you can start carving the meat or take the whole carcass out and do it later. Many people think that the main sit up muscles are your abs, but they’re not! It’s the tenderloin. They run along the spine, and oh boy, are they tasty. If you were in a situation where you had to eat another guy, hopefully, that will never happen, go for those first.”

“Thanks, sergeant, but I’m not much of a hunter,” the other soldier says. He shifts uncomfortably in his seat and puts more distance between the two of them to show his disinterest, but Aaron continues unabated.

“So, I was reading this magazine right in that seat. I thought to myself; there is some useful information here. My wife was riding me hard about having kids as if being responsible for a kid would help me out of this funk, you know? Well, not really riding me because my shit doesn’t work anymore. These fucking meds and whoop! Just a floppy noodle, am I right? Well, my wife was pressing and pressing, and I read this article, so I made a decision. If there’s nothing down here,” he says, slapping his groin, “then she’d shut up about having kids. Easy. Not like it works anyway. So, later that night, I popped some pills, had a couple of cold ones, and sharpened up a knife. I got one nut off and started on the second, but damn it if I didn’t pass out from the blood loss. My wife found me, lost her mind, and called the ambulance. Didn’t even get started on my pecker.” The other soldier sits mute and horrified, but Aaron doesn’t stop. “So, I woke up in inpatient rehab, again, and have been there since yesterday. Just one nut now, but not a worry. My wife left me, so no more pressure there, which is a relief. Women, right?” The other soldier stares with his mouth agape, unsure of how to engage when a voice from across the room releases him from the situation.

“Sergeant Hedlund,” the clerk calls from the desk. “You can head to room seven now.”

Aaron waves a hand in recognition to the clerk and tosses the magazine to the soldier. “Here, ya go. You should read it. Great article.” He stands, heads past the reception desk, and through the double doors to find his room.

“Come on in, Aaron,” a familiar voice calls out after he knocks. He enters and sits across from his nurse case manager, Mrs. Lightly. She is a lovely middle-aged woman with a calm disposition, but who demands a great deal from her charges. “Thanks for coming on time.”

“Couldn’t miss it with your emails, texts, and phone calls,” Aaron responds with sarcasm as he glances about the room like a nervous cat.

“Well, since I haven’t needed to call you in two months, I thought I would make up for it and let loose. Seriously, though, thank you for being here. It’s good to see you. How’re you doing?”

“I’m out of inpatient, so that’s good. Clara left me and took the dog.”

“I’m sorry to hear that. How are you doing with that?”

“I miss the knucklehead. Never judged me and always was happy to see me, even when I was in a shitty place,” he says with tender remorse.

“You’re talking about the dog?” He nods and his face with genuine surprise at her question. “And your wife?”

“I’m not sure yet,” he says flatly as the emotion evaporates from his voice. “The apartment is quiet, that’s for sure.” Her ears perk up.

“You’re home alone?”

“Yeah, there was no one to release me to, so they called me a cab and sent me on my way. It’s all good. It was nice to be back in my bed.” Mrs. Lightly purses her lips and nearly breaks her pencil as she furiously scribbles some notes.

“Aaron, I’m not happy they sent you home by yourself. I’m going to talk to them about that. Is there anyone who can stay with you?”

“My dad’s coming down tomorrow to spend a week or so with me. Dr. Sampson signed off on the plan before they discharged me.”

“Okay, well, I’ll be checking in with you this evening and tomorrow morning. When your dad gets into town, I’ll need to speak with him, too, okay?” Aaron nods as his eyes focus on a corner behind her desk.

“Your plant died.”

“What?”

“You used to have a plant over there,” Aaron says. Mrs. Lightly notices the tremor in his hand as he points across the room.

“This isn’t my office, Aaron. That’s in another building. It’s just the room I’m in today. The plant is fine.”

“Oh, that’s good.”

“So, after I talk to your dad, we will work out a long term living arrangement, okay?”

“Yeah, sure.” Aaron continues to look at the empty corner as he tries to reconcile the missing plant from the room and his fragmented memory.

“So, today, you and I are going to go over your medications since they just discharged you. Did you bring them, including a good med list?”

Aaron pulls a crumpled piece of paper out of his pocket and tosses it across the table. Then, he unbuttons his trousers’ side pockets, unzips his breast pockets, and undoes the hook and loop on his shoulder pockets with a resounding tear. He removes bottle after bottle until there is a haphazard pile of narcotics, anxiolytics, mood stabilizers, antidepressants, and tranquilizers on her desk. She snorts at him.

“Is that all?” She asks with the slightest sarcastic edge. He raises a finger and takes another out of a pocket and lobs it to her. She catches it mid-air with a less than pleased look on her face. “This is how you carry your meds? Can I get you a bag, at least?”

He shakes his head. “I’ll just set it down somewhere and forget it. I rattle like a gumball machine, but at least I don’t lose them this way.”

“Be careful, okay? Some of these are dangerous, and all of them are important.” Aaron huffs. She ignores him and smooths the list out in front of her. “Let’s go through what they sent you home with. I want you to tell me what you’re taking.”

“I can’t pronounce any of the names, but I’ve got the ones for pain. Another is for neuropathic pain. That one is for anxiety. This one’s for insomnia, which is pretty bad, and another for the nightmares when I do finally get to sleep.” She checks each off as he calls them out. “This is for the really bad anxiety attacks and another for the tremor it causes. Mood stabilizer is this one, and then one for the impotence from the mood stabilizer, but it doesn’t work. Still no boners. I’m also fat as fuck with all these meds. I look like a bloated whale on her period. Do whales get periods?” She shakes her head at him. “Did I miss any?” She picks up one small bottle and shakes it at him. He stares at it for a moment and then snaps his fingers. “Dry mouth, but it doesn’t do shit.”

“Language, Aaron.”

“Sorry, ma’am.”

“Okay. That’s all of them. Take the bottles, and I’ll update your list and give you another printout of the meds and times to be taken once group is over. I’ll also email you a copy of it. Next week you and I will go over your upcoming appointments.” He gives her a flaccid thumbs up.

“Head on over to group. They’ll be starting soon.”

“Thanks, Mrs. Lightly. See you soon.” He gathers his various bottles, stuffs them back into his pockets, and wanders out of the room, clicking and clacking with each step. He stops for a drink from a fountain, but the lukewarm and metallic water doesn’t mitigate his horrendous cottonmouth. He drifts aimlessly about the corridor and watches through closed doors other soldiers with their case managers. They reconcile medication lists, coordinate safety plans, and a host of other tasks as they shepherd their assigned flock of broken sheep. He stares at one session and wonders if the case managers’ herculean efforts reap any real benefits for their charges. He thinks of the soldiers who have come and gone and wonders what success looks like after leaving this place and the Army. Aaron quickly loses focus as his thoughts blur, so he meanders about until the appointed time to enter the group therapy room.

Even being absent for two months, the atmosphere of the room hangs heavy with disconnection. No solace is found in this place, and it serves as nothing but a holding pond in the sewage treatment plant that is his life. It’s a place to keep him occupied and idle until the Army has completed its obligatory due diligence at rehabilitation, and he’s booted. His nose wrinkles at the familiar odor of the stagnant room. It’s difficult to describe, but if it were a scented candle, it would be called Military Building. It’s a mixture of old sweat and humid funk from the HVAC system with an overtone of stale cigarettes and broken dreams. He laughs and then looks around at the unchanged environment. There is a circle of uncomfortable folding chairs and a table in the corner to put cell phones and bags since they are not allowed in therapy. You can have a water bottle, but no smoking or vaping. A fluorescent light, which has been on the fritz for a year, flickers and whines. It makes Aaron’s eyes hurt, so he chooses a seat with his back to it. Even then, he knows it’s there, so he closes his eyes and waits for the others to arrive. In time, the seats fill, and Dr. Sampson asks for everyone’s attention. Aaron slowly lifts his head and looks at the doctor through a cloud of confusion, not realizing that he had entered.

Dr. Sampson is a non-descript man, slight of build with glasses and curly hair, easily forgettable, and impotent of life. Aaron feels like he meets him for the first time at each encounter. Aaron looks him over and wonders if he is even real, a figment of his imagination, or an automaton that the Army built to proctor this perpetuated worthless gathering. There is always a stain on his unbuttoned white coat. Lunch. Pen ink. Coffee. Every day is a new one. He usually carries a clipboard, which is absent today. His pants are wrinkled and rise above his mismatched socks and scuffed loafers.

“All right, everyone,” Dr. Sampson starts in his methodical and unaccented voice, “Let’s get started. We welcome Aaron back to the group today. It’s so good to see him again. I think,” he says as he looks around, “everyone has been here before, but we will go over the ground rules again. This room is a safe place. Everyone has a right to speak their truth in turn. We don’t interrupt anyone, and everybody is free to speak or not speak. I will work to engage all of you at some point during the session, but I won’t pressure anyone, okay?” Silent apathy is the only response he receives.

Aaron glances at the clock far too early in the session and notices that they have started almost twenty minutes late, which means they will end at least forty-five minutes late. He grimaces and rubs his sore neck. He looks around at the others and notices the major from earlier sitting across the circle. So, I know her from here, he murmurs to himself. He squints and racks his brain at her background. It’s so hard in a room like this with so many terrible stories. They all just blend into a giant anthology of shit.

His gaze bounces from face to face, and he recounts the litany of the stories he can remember as his recollection is fuzzy on most days. She got raped. Her husband blew his head off in front of her. He was in a tank that caught fire and watched his friends melt. Accidentally shot a kid in Iraq? Maybe. He isn’t sure. That dude’s friend got shot and bled to death in his arms in some valley in Afghanistan. A helicopter crash killed everyone but her. Aaron thinks the major was raped or her kid died or something. When he hears what some of them have gone through, he feels like an imposter and wonders why he can’t handle his shit. The Army trained him to kill and be okay with it. No one gets trained to be raped, or beaten, or watch their husband commit suicide. He stops the fruitless exercise and tries to concentrate on what Dr. Sampson is saying.

“Does anyone want to share today? It’s an open floor.” Aaron raises his hand. “Aaron, first-day back and ready to get after it. Fantastic stuff. Go ahead.”

Aaron swallows and peels his tongue from the roof of his mouth. He focuses on his words as the medications have slowed his speech to near imbecile level. They all understand, so no one rushes him or gets impatient. It was a bit shameful to him, but for some reason, today, he just feels like talking. “So, I was in the shower this morning, and the water was hot. I mean, boiling. It got me thinking about Lieutenant Childress.”

“Who, Aaron?” Dr. Sampson asks while he scribbles in a small notebook that he pulls out of his soiled coat.

“She was one of our CSTs.”

“CST?” Dr. Sampson raises his head.

Aaron sighs. The civilian doctor irks him to no end because he has zero military background and never takes the time to understand or remember any lingo. “Cultural Support Team. C. S. T.” He pronounces each letter with emphasis. “A few females were assigned to us to handle the indig women and children if we picked any up out on mission.”

“Understood. Proceed.”

“So, the lieutenant, who was a badass, by the way, was killed the same night I got injured the first time. She was in a stack on the outer wall waiting for the assault force to clear the compound. Private Jumper was right in front of her and stepped on a pressure plate. She was standing right on the bomb when it went off. Boom. Then she was just gone like nothing left, gone. I think it’s described as total body disruption. We found some pieces of Jumper and the other guys but nothing of her. I was inside on the other side of the compound, and when the blast went off, a wall collapsed on me. Concussion and blood in my lungs, but not enough to send me home. They dragged me out, and I remember seeing the crater where they told me she was standing. We watched the drone footage a few times during the remainder of the deployment. It’s strange to watch someone you know just disappear. Like she was never even there. I think we die twice. Once when we stop feeling and then when we stop breathing.” Aaron pauses for a moment. “So, in the shower this morning, I cranked up the water until it burned my skin, and I wondered if that’s what she felt when she died. Even for a split second, did she feel it? Did she have time to know what was happening? Did she know that she was dead, and if so, what was that like?” Aaron pauses and looks at nothing through glassy eyes.

“How did that make you feel, Aaron?”

“Eh?”

“How did you feel when the water was burning your skin, and you were thinking about her? Did you feel like it should have been you? Did you feel like hurting yourself or that you wanted to be dead?”

“Not really. I didn’t feel much actually. I turned the water off and made breakfast. Toast and eggs. Wasn’t great.” Aaron looks at his hands and starts to pick at a cuticle.

Dr. Sampson scratches his temple and watches Aaron for a moment as he contemplates his next questions.

“Since he’s done, can we talk about how hard it is for me to drive to this group session and that I need accommodations?” Specialist Levine, a near cachectic kid from Louisiana, pipes up.

“Oh, for fuck’s sake Levine, again?” another soldier shouts, and if any connection between Sampson and Aaron was about to be made, it was now broken.

“Eat a dick, Scoggins, I almost died!”

“You crashed your car off post when you were reaching for your vape pen, you anorexic cracker. No one gives a shit.”

“Okay, everyone, calm down,” Dr. Sampson slides into the conversation, “this is a safe place, so let’s give Charlie our attention and respect. Go ahead.”

“Thanks, doc,” Levine says before he enters into a mind-numbing diatribe for the remainder of the time they have. When he’s finished, Dr. Sampson’s voice rouses a few of them out of their stupor.

“So, thank you, everyone, for your participation today.” They begin to stir and rise from their seats. “Before you go, remember that this is a holiday weekend, so no group until Tuesday.”

“It’s Thursday, doc. That’s four days away.” Aaron says with an edge of concern that sharpens as his voice rises.

Dr. Sampson turns to him. “Memorial Day is Monday, and the base is taking tomorrow off to make it a four day weekend for everyone who has been working so hard. Enjoy the time away, and don’t forget to take advantage of the holiday to fire up the barbeque and have some fun with your friends and family.” Aaron furrows his brow at the shit-eating grin on Dr. Sampson’s ignorant face. “Aaron, do you have a second?” Aaron shrugs his shoulders and approaches. “Are you going to be okay this weekend? Should I be concerned about you hurting yourself?”

“Because of the story I told?”

“Yes.”

“No, I’m good.”

“Great, I think so too,” Dr. Sampson says as he gathers his things and walks toward the door. “Make sure you touch base with your case manager each day this weekend, and you have my cell phone number, so call me anytime, okay?” His voice trails off as he exits, leaving Aaron alone in the empty room. Aaron looks up and watches the light flicker and buzz for a minute before he walks out.

Later that evening, Aaron is alone and one of the few things occupying his apartment. His wife took most of their stuff with her when she left, including the television and most kitchenware. He looks at his cell phone and thinks about the conversation he just had. His father called and said he isn’t coming. Some problems at the quarry, he said. Something about him needing to be there next week, and it doesn’t make sense for him to drive all the way, just to turn around and go back home a few days later.

He fiddles with a game on his phone and then sees that he has missed a few calls from Mrs. Lightly during the afternoon. He thinks about calling her back but puts his phone in his pocket and goes to the bathroom. On the counter are all of his pill bottles, which he organized earlier into a standard small-unit formation. The mood stabilizer is the squad leader and flanked by the pain medications. The one for the tremor is on point near the toilet to make sure the enemy doesn’t surprise the patrol. The sleeping pills and nightmare meds are the heavy weapons guys and are positioned behind the lead group. The dry mouth guy and the erectile dysfunction medication bring up the rear, where the worthless pogues like them usually are. He stares at the arrangement for a while and then looks at his watch. He sighs as it’s still hours before his next round of pills.

He turns off the light and heads back to the living room. He pulls out his phone again, looks at the missed calls, and thinks about making a call. He has two choices of who to call, and for lack of a better way of deciding, he scrounges around his apartment for a coin. He tosses it in the air but misses, and it skitters under the oven before he can grab it. He swears and gets down on the ground. He gets covered in dust and crumbs but manages to retrieve the coin. Heads. Now, which one was heads? He swears again. He makes up his mind and dials the number.

It goes straight to voicemail. “Hello, you’ve reached the voicemail of Dr. Sampson. Please leave a detailed message after the beep, and I’ll get back to you at,” Aaron hangs up. He slumps on the floor in a heap without any energy or desire to move and remains there until his watch alarm rouses him. Time for another round of meds. He slowly extracts his stiff body from the kitchen floor, shuffles to the bathroom, selects the prescribed pills, and downs each with a gulp of water. He lays on his bed and stares at the ceiling fan. The blades travel dutifully in their contracted circles, yet he can feel no air movement from their persistent effort. It’s Thursday evening. He doesn’t go back to group until Tuesday. He thinks that four more days is a long time to be alone with his thoughts. Like a heavy cloak draped over his shoulders, hopelessness joins him, but then the meds take hold, and his mind sways and then floats, untethered from his body. A trickle of drool escapes from the corner of his child-like grin and pools on his pillow. Happy Memorial Day, lieutenant, he thinks as the fog rolls over him.

Reed Kuehn is a combat veteran and an aspiring writer. While he has called Wisconsin, Washington DC, North Carolina, and Colorado home, he currently lives and writes in Providence, RI. His work has appeared with Akashic, Dream Noir, Notch Publishing House, and the Kurt Vonnegut Museum and Library

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