Letter 8.

Dear Mr. MOS,

I didn’t grow up in a military family, but when I trained at the VA Pittsburgh Health System (VAPHS) I found a new family—one that was different than my own, but had shared some not so obvious commonalities.  It was my VAPHS veteran patients and colleagues that instilled in me this sixth sense of identifying a veteran in a crowd.  That is how I knew that I should ask you about your military occupational specialty (MOS) before even asking if you were a vet.  When you sat in front of me, I saw what was obvious on the surface—a disheveled black man with patches of hair missing, older than your stated age, poor dentition, arms with track marks, hands with thickened skin and dirty nails.  I could sense that there was more than the picture in front of me.  Asking you about your MOS, seemed to get you to open up.   I don’t know this for sure, but it was almost as if looking into your eyes and talking to you was the first time you felt seen. I imagine people pass you on the streets and don’t acknowledge you.  

Learning that you served in the Army in Afghanistan and Iraq, I had a flashback of a patient I cared for at VAPHS.  The two of you actually looked very much like each other and both shared stories of how you were imprisoned by your experiences.  I will never forget the day I went into that patient’s hospital room, sat with him and pleaded that he tell me what is making him so depressed that he could not care for his 27 year old self.  He told me how he enlisted in the Army to serve his country in an honorable way and make something of himself, but instead it was taken away from him.   He was honorably discharged after being diagnosed with an illness that he viewed as stripping him of his identity all of which exacerbated the severe depression compounded by his PTSD.  I was probably a bit too curious and simply didn’t understand what he experienced so I pushed him to tell me what happened.  He told me I wouldn’t be able to handle it, but I persisted and with his eyes piercing towards the wall he narrated his experience as if it was re-playing in his mind.  He described an unimaginable nightmare not worth repeating and after a minute I stopped him because he was right; I couldn’t handle it.  So when I asked you, Mr. MOS, about your story I knew better than to ask about details, especially after you  told me that  your heroin abuse had started immediately after you returned home.  It made sense that a veteran friend of yours suggested that you try out heroin to get rid of the images imprinted on your existence.  It also made sense that you injected heroin into your body in an effort to block the pain, but it only worsened your circumstances.  

The service you provided for this country that allots me the freedoms that I take for granted daily has left you scarred.  You were injured in the war, honorably discharged and should be able to receive care within the VA Health System, but your mental health and addiction have left you homeless and in this downward spiral that makes it impossible for you to seek the help that you need.  To top it all off, we sat in jail together and I knew that these doors weren’t what incarcerated you.  I grappled internally with what I could possibly do for you at that moment.  The stories of the other veterans I have cared for allowed me to look you in the eyes and reassure you that the isolation and pain you felt were rooted in your experience and the disease of addiction you developed was rooted in masking those pains.  As I spoke, the blank stare that you had started off with slowly turned into tears rolling down your cheeks.  I told you that you mattered, thanked you for your service and then shared the resources that you deserve and are available to you as a veteran.  I did my other doctorly stuff, assigned you to housing, and as you walked out I wondered how your story would unfold.  I am not a vet, neither are any of my blood related family members, and I will never understand what it is like to be in your shoes, but I do know what it is like to not be aware of your disparities and to push forward despite feeling lost and alone.  The one thing that helped me along the way were the people who acknowledged my existence, told me that I mattered, and showed me how to develop tools to fulfill my purpose.  Mr. MOS, I saw you and I hope the words I shared with you filled your heart with the love that you deserve and was the bit of motivation you need to try to get the resources that are meant for you to fulfill your own purpose.

You matter,

Dr. A