Ed note: The stories and pictures of D-day remind me of my patient, Harold. He was one of the many heroes of that day, a day which affected his emotional well being until his life’s end. I wrote about Harold in Facing Death: Finding Dignity, Hope and Healing at the End.
I always looked forward to Harold’s visits. Harold knew that he had life threatening pulmonary fibrosis. He also knew that doctors didn’t have the faintest idea what was causing this, even though they used rather toxic medications to keep it under control. Prednisone seemed to work best.
Somehow, Harold forgave me for all the shortcomings of medical science. He liked to chat about his life during office visits: his grandson playing football at Notre Dame; his granddaughter who loved soccer; the holiday celebrations that were special in his family. Over time I thought I had gotten to know Harold pretty well. But did I, really?
He would come in cheerful and bubbling, with a tendency to wave off such symptoms as shortness of breath. His lungs were progressively filling with scar tissue, which blocked oxygen from getting into his blood effectively. A portable oxygen system helped, and Harold accepted it with grace. With his wife present we had some serious discussions about end-of-life questions, and he had completed an advance directive affirming that did not want to be placed on a breathing machine unless doctors were confident he could return to a meaningful existence. His wife would be in charge if he was unable to make decisions.
One day, during a routine visit in the office, I noted that Harold’s severe lung dysfunction had been quite stable for more than a year. “Harold,” I said casually, “you know you’re really lucky to still be alive.” I meant to be encouraging, but my patient burst into tears.
“What’s going on,” I said rather helplessly. “Did I say something wrong?”
“You don’t know how lucky I really am to be alive.”
“What do you mean?”
“I was a paratrooper on D-Day,” Harold said. “I came down behind the German lines like all my buddies. I didn’t know where I was or where they were. It was pure terror. I saw all these terrible things, and I shot a lot of people. It’s never out of my mind.”
I immediately realized my cluelessness. I didn’t know Harold well at all. Here was a true WWII hero trying to live a normal family life, trying to fight a serious illness, yet suffering from disabling post-traumatic stress disorder from fifty years past. Somehow, I hadn’t found a way to listen deeply enough.
Harold’s defenses took hold again rapidly.
“I’m sorry, Doctor. Sometimes it just grabs me.”
I tried to reach out and refer him for counseling, but Harold would have none of it. “Doc, it’s OK. I don’t want to see some shrink.”
In future office visits he continued to deflect questions about PTSD, though Harold’s wife confided that he had frequent night terrors, shouting in his sleep and awaking drenched with sweat.
Harold survived two more years until his pulmonary fibrosis finally caused his demise. I wish I could say that his death was peaceful, but as he weakened the terrors took hold and would not leave. Our palliative care team used enough sedation and narcotics to essentially put him in a medically induced coma. Harold’s PTSD didn’t really die until he did.