Lessons Learned

Josh Dobbelstein drives as close to the middle of the road as he can. Over on the side... he knows the enemy hides bombs.

Just the other day he dove to the floor of a vehicle he was riding in when he mistook the sound of a trucker hitting his brakes for a machine gun.

They are the kinds of precautions that keep soldiers at war alive. But Dobbelstein left Iraq more than 16 months ago, and for him they are vestiges of a war he can't seem to shake.

CNN News reported this week on a clinic that helps veterans cope with the after-effects of war.

There is a lesson here for all of us. Sometimes people act irrationally for very rational reasons. When someone reacts in a manner we deem strange, it's good to consider that they may in fact be coping the best way they can with the after-effects of some unseen experience or trauma.

I tell this story from time to time to illustrate that point. It's not one of my proudest moments...

During the late 1980's I was an evening-shift Emergency Department patient registrar in a community hospital. You know, the person who unsympathetically demands your social security number, date of birth and insurance card shortly after you stumble through the door in pain, throwing up, bleeding and/or gasping for breath. I was pretty good at it. I entered data into the computer system efficiently, and managed to remain relatively calm while the poor patients suffered all the afore-mentioned woes.

There were patients I knew by name.
"Hi Mr. Jones, what seems to be the problem this evening?" (As opposed to say, three nights ago when you were here last.)

There were also patients that broke my heart.
The sixteen-month-old who toppled off a patient cart to the floor in one of the treatment rooms while her mother stood in the far corner shaking her head and saying "I'm not picking her up. I told her to sit still, maybe this will teach her to listen!"  (Yes, Social Services was called in case you're wondering.)

The hollow-eyed parents of a teenager killed while driving home from school on a sunny Spring afternoon. The combination of too much speed and too little experience irrevocably changed their lives in one deadly instant.

One person remains vivid in my memory for a different reason.
He was Vietnamese, probably in his late twenties. He came in to provide information on a patient who had arrived by ambulance. Anyone who has ever worked in an ED knows that speed is of the essence when generating a computerized chart for a patient already undergoing emergency evaluation and treatment.

Suddenly, and for no reason that I could fathom at the time, he began speaking excitedly in Vietnamese. In apparent fear he jumped up and literally ran out of my office, and right out of the building. I was... perturbed. I stood there feeling quite aggravated, all the while picturing the ED nurses with their hands extended asking "What's taking so long? We need that chart!"

When he finally returned a few moments later and offered absolutely no explanation for his odd behavior I rather brusquely finished my task and ran the completed chart back to the waiting clinical staff.

Some time later that day that I figured it out.

His sudden agitation and run for the door coincided with the Life Flight helicopter landing just outside of the ED, a sound I was so used to it barely registered. Vietnam; helicopters; and someone who would have been a young, frightened boy in the late 60's or early 70's. How narrow my view of the world not to have grasped the connection sooner.

I realized later that as soon as he watched the helicopter land he calmed down and came back into the building. As for offering an explanation, how does one explain fearing the sound of helicopters blades cutting through the air to someone who has never had reason to fear?

It's a lesson I won't forget.

Comments

[Kim]

You should check out "The Differential", Medscape's blog by five medical students, one of whom, Ali, is going to medical school in Iran. His editors asked him to discuss something of politics, which usually you won't see on the site.

He discusses almost the same thing - what it is like to be in, actually live with the repercussions of war.

And you know what? His post just proved again that we all are more alike than we know. If you didn't know Ali was in Iran, you would never guess from his posts about medical school.

You can get to it through a link from Emergiblog if that is faster...

[Mama Mia]

Yes - you are so right - rational behavior is entirely in the eye of the beholder. Great post.