ARI SHAPIRO, HOST:
As Vietnam veterans age, some are facing the end of their lives with complicated memories of the war. And what some of them want before death can be very different from the approach civilians want. April Dembosky of member station KQED explains that that makes it hard to support some of these veterans.
APRIL DEMBOSKY, BYLINE: Ron Fleming is 74 now, but he's spent most of his life trying to recapture what life felt like when he was 21, fighting in Vietnam.
RON FLEMING: I take issue with those who say we lost. We didn't lose that war. Everywhere I went, we literally kicked the crap out of them.
DEMBOSKY: Fleming was sent into battle day after day as part of a helicopter crew.
FLEMING: I was a door gunner. My job was to hang out the door on a strap with a machine gun in my hands.
DEMBOSKY: Fleming fired 6,000 rounds a minute, but he never gave much thought to catching one himself.
FLEMING: But you see, at 21, you're bulletproof. Dying wasn't on the agenda.
DEMBOSKY: But now it is. Fleming has congestive heart failure, arthritis and breathing problems.
ERIC WIDERA: Mr. Fleming...
WIDERA: Hi. It's Dr. Eric Widera again from the palliative care team.
DEMBOSKY: He often lands here, the VA hospital in San Francisco, with asthma attacks. He thinks about death now.
FLEMING: I wish it'd get off its [expletive] and come on me. I'm sick of this crap. You see, dying is the easy part. Living's what's hard.
DEMBOSKY: Fleming was diagnosed with PTSD 10 years ago. And for some Vietnam vets, symptoms of terminal illness like pain or breathlessness can trigger PTSD, making vets feel as threatened as they did on the battlefield.
VJ PERIYAKOIL: The war memories start coming back. They start having nightmares.
DEMBOSKY: Palliative care physician VJ Periyakoil says the opioid medications that are often used for treating pain and breathlessness can make PTSD symptoms worse.
PERIYAKOIL: The side effect of those medications - they make you fuzzy headed.
DEMBOSKY: And they weaken coping strategies for warding off flashbacks.
PERIYAKOIL: I've had patients who've told me, I would much rather tolerate the severe physical pain than take opioids and my defenses crumble. And they don't want that.
DEMBOSKY: Sometimes the best thing doctors can do in these situations is stand back. But hospice nurse Patrice Villars says doctors and nurses, just like soldiers, hate doing nothing.
PATRICE VILLARS: We talk about the moral distress that we have sometimes about really knowing that we're doing the right thing for this individual so that we can be present for their suffering the way they need to do it.
DEMBOSKY: Some vets feel like they deserve their pain.
FLEMING: Sometimes I think that now I'm being paid back for all the men I killed. And I killed a lot of them, more than I can count.
DEMBOSKY: For Ron Fleming, doctors have been begging him to consider mental health counseling or antidepressants, but he's refused.
FLEMING: I don't want to take psychiatric drugs and such. The vets call them the happy pills to warn you of those because they change you. I don't want to change. Ain't nothing wrong with me.
DEMBOSKY: Do you feel like you deserve to be happy?
FLEMING: I don't know. That I don't know.
DEMBOSKY: The thing is, the pain is what connects Fleming to the past. He was awarded 18 Air Medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn't want treatment that might make that go away. For NPR News, I'm April Dembosky in San Francisco.
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SHAPIRO: This story is part of a reporting partnership with NPR, KQED and Kaiser Health News.
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