MELISSA BLOCK, host:
In February of 2004, Heidi Squier Kraft left behind her husband and 15-month-old twins and deployed to Iraq as a Navy clinical psychologist. She was part of a combat stress platoon. She's spent more than seven months at Al Asad Airfield in western Iraq, providing mental health care for some 10,000 Marines. And she's written a memoir of that time titled, "Rule Number Two: Lessons I Learned in a Combat Hospital."
In one chapter, Kraft writes about a young lance corporal she met on her hospital ward as he recovered from surgery.
Dr. HEIDI SQUIER KRAFT (Navy Clinical Psychologist; Author, "Rule Number Two: Lessons I Learned in a Combat Hospital"): I remember the tattoos on his arms. One said USMC. And one, he told me, used to say simplify. After that day's car bomb had taken out most of his forearm, only the S and the E remained.
I remembered his tears and the way he swiped mercilessly at them. He felt fear. He felt shamed that far outweighed the fear. He went on to explain that he had been in Iraq for almost two months. This injury would earn him his third Purple Heart. He told me he was afraid his luck was about to run out. He was ashamed to feel afraid.
I remembered struggling to form the words that would normalize this 19-year-old man's experience. And using a therapeutic technique that I made up as I went along, I consciously decided to take another path instead. I told him there was nothing normal about three Purple Hearts in two months. I told him there were no feelings that were usual for people in that situation. I told him he was going home.
He laid his head on his pillow and sobbed without making a sound. I sat with him a long time.
BLOCK: Do you remember when you were telling him there's nothing normal about this, do you remember feeling satisfied with that answer as a psychologist?
Dr. KRAFT: Yes. I do remember feeling satisfied with that answer. It was interesting. I think one of the things I learned about this deployment is that many of the truth that I used to hold as a psychologist sort of flew out the window. Things that used to make sense for me ended up not making very much sense anymore. And to be able to share that unknowing feeling with the patient is not something that I typically would have done, would have explored ambiguity, frustration, vulnerability, you know. It sort of, it's a lot more structured when we're talking about more everyday type situation. There's no way to really rationalize this, or make it something that can be compared. It's so unusual and so extraordinary.
So there was a lot of that I found over the seven and a half months. This idea of admitting that I had no idea why certain things happened and being okay with that.
BLOCK: There's a moment where you talk about being called to take care of a lance corporal who is suicidal, and you find her in a bathroom. She's locked in a stall with her M-16 and there's a note at her feet saying I'm sorry.
Dr. KRAFT: Mm-hmm.
BLOCK: And you ultimately get her out of the stall and you get her gun. What could you do for her when you were there in Iraq?
Dr. KRAFT: Stabilize her. That was it. We needed to - unfortunately, we're in a situation there where we don't have any kind of impatient capability, really. We were able to stabilize people psychiatrically. And then if they were a danger to self or others, then they were medevaced home. And in her case, she was clinically depressed and suicidal and not fit to be in a combat zone.
So as soon as I have that diagnosis, I was able to get her home where she could get the treatment she needed.
BLOCK: Do you have any idea what happened to her?
Dr. KRAFT: I have no idea what happened to anyone.
Dr. KRAFT: It's so frustrating as a doc to be in that situation, but I really don't. I - of course, all the names of all the patients in the book and identifying characteristics are changed. But I remember them. I remember their names. And I don't know that I could find them even if I wanted to.
BLOCK: That's got to go to so much against the grain of your training, I would think.
Dr. KRAFT: It does. It's very difficult to let people go who have been really, really intensely connected with you as a therapist. And I had to. I had to let them go, all of them. And with no idea what ended up happening to them.
Dr. KRAFT: And only that hope, I guess, that it made a difference that we had some time together.
BLOCK: You would have moments in the hospital of patients actually, in some way, taking care of you. You write about a story that's related to you about a triple amputee who's telling jokes from his gurney and when he's medevaced out, using his one arm to give a thumbs up, right?
Dr. KRAFT: That was a gunnery sergeant in the Marine Corps. And I really wonder how he was doing. But he came in to that surgical unit and he singlehandedly helped an entire group, a surgical team that was really burned-out and really at their wits' end by a serious flow of casualties. He was a triple amputee. He was waiting for his medevac and he called his nurse over and asked her how many Irish men it takes to change a light bulb, and she looked at him and said, I beg your pardon? And he said, it's just too serious in here, ma'am. You guys have got to lighten up. He started telling jokes. And singlehandedly this patient changed the mood of that room and kept everybody going.
BLOCK: There's a point toward the end of your tour that you write about where you realize that you have become completely numb to feeling. It's like you're anesthetized, you say.
Dr. KRAFT: Mm-hmm. Mm-hmm.
BLOCK: How frightening was that to come to that point?
Dr. KRAFT: Interestingly, I don't really remember being frightened. I remember noticing it almost as if I was looking at myself from outside my body, almost a dissociative moment. Noticing that I was numb. Knowing that I was numb. Knowing that my patients could cry but I could no longer cry. What I didn't realize at the time was that that was going to be difficult to get that feeling back upon returning home. That it would take some time for that anesthesia to wear off.
BLOCK: So how do you get past that? Does it just take time?
Dr. KRAFT: It does take time. In my case, it also took treatment. I had to - about three months after returning realized, as I look at my own symptoms, it's kind of interesting as a shrink to realize that you have symptoms of something that you've diagnosed before. But when the nightmare started and some intrusive images that I couldn't get out of my mind, feeling far away, sadness, and kind of disconnected on every level. And I realized that I actually needed some help from my own traumatic experience. And so the doctor sought the doctor when I went and looked for help and found someone that could take me through my process as well.
And in that same moment, as I was in my own therapy, I also started writing the book. And not realizing it at the time, of course, I was undergoing an established form of trauma treatment. Writing about the experiences is something that I do with my patients even today, that re-exposure to the memories allows them to become less and less salient in the mind, so that they let go and the anxiety lets go with them.
So as I wrote the book, it got easier and easier every chapter and by the time it was finished, I felt pretty solidly back to myself.
BLOCK: Well, Dr. Kraft, it's great to talk to you. Thanks very much.
Dr. KRAFT: You're very welcome. Thank you.
BLOCK: Clinical Psychologist Heidi Squier Kraft. Her memoir is titled, "Rule Number Two: Lessons I Learned in a Combat Hospital."
You can read an excerpt at npr.org.
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