SUNDOWN IN ZION

CHAPTER TWO

In the last chapter we found Gideon Nelson at the Little Rock Veteran's hospital. Before his appointment, he learned from a young friend that a young student had been murdered.

            Nelson continued through the main waiting room of the hospital. He entered a large seating area in which veterans sat waiting for prescriptions to be filled. Digital signs announced the numbers being served at that moment. Their owners sat before open windows expectantly, like prisoners awaiting release papers. The uncalled sat staring into space or dozing. A walkway divided the two groups and a security guard at the nearest end and chatted with a young nurse. As Nelson approached, the guard looked at him with a hint of a snarl, saw no challenge, and returned his attention to the nurse. Nelson stepped through the area quickly and proceeded to a bank of elevators.

            On the seventh floor, he followed a twisting maze of hallways to a door marked “Surgery” and entered. Several veterans, some with family members, occupied seats in a large reception area. They looked at Nelson as he entered but showed little interest. He walked to a window where a pleasant-looking lady sat typing into a computer. She looked up, smiled, and took the ID card he produced. Looking at it, she said, “Mr. Nelson,” let me log you in.” As she entered his name into the computer, he studied the room. It was worn, but comfortable, the furniture sturdy, and the walls decorated simply with posters advertising support and benefits offered by the United States government.

            The woman returned his card through the window and said, “If you’ll take a seat, we’ll call you when your time comes.” She smiled and he took the card. “Some of our veterans like to keep up with the latest,” she said, handing him a brochure labeled “Your VA.” He took it and found a seat among those lined against the wall.

            He didn’t read the brochure. Instead, he studied the room. The atmosphere was calm and lifeless. Most of those in the seating area stared ahead, lost in some memory, fear, or dread to which they alone held access. One looked a magazine but didn’t appear to be reading it. One man held the hand of a companion, likely his wife, although the ages of those in the room defied easy placement and a daughter would have been a possibility. A stout woman in her 30s sporting close-cropped hair fingered an I-pad, smiling. A tattoo emerging from her shirt sleeve identified her as Navy. She glanced once at Nelson, showed no recognition, and returned to the device.

            The opening of a door violated the quiet, floating atmosphere of the room. A Nurse’s head appeared and said “Mr. Owens.” A thin, frail man wearing a baseball cap with the words “Korean War Vet” embroidered across its front stood, and on shaky legs, followed her through the door. Nelson watched as he left. The others in the room paid no attention as they again seemed to float quietly in place.

            The nurse continued to call names. More of those in the room departed in obedience to the call and they were replaced by new arrivals. The woman at the reception window greeted each arrival as if they had been the first of the day. When one complained that his prescriptions hadn’t been filled properly, she smiled and assured him that his primary physician would want to know all about it. When the room became quiet again, Nelson set the brochure aside and looked at his watch. It was two minutes before his appointment time. At that moment, the door opened and the nurse called his name. He rose and followed her into the hall.

            She proceeded to his left and he turned sharply to follow her. When he did, and had taken a single step, he stopped and bent forward. He grabbed he muscle above his right hip with a grimace. The nurse turned to see the color drain from his face. “Mr. Nelson,” she said as she walked back to him.

            “Spasm,” he said.

            She stepped back to him and placed one had on his back and the other under his elbow. She said, “Are you all right?”

            “Spasm,” he said again. “Give me second.” With that he set his jaw and, with the nurse’s assistance, moved to the side of the corridor and placed his free hand against the wall. With obvious effort, he began to take deep breaths.

            “Shall I get help?” the nurse said.

            “No,” he said between clenched teeth. “I’ll be okay.” He used the wall to straighten himself. He smiled at the nurse. “It happens from time to time.” She appeared puzzled and he said, “That’s what I’m here about.”

            When she attempted to help him again, he removed her hand and took a short step of less than a foot. With clenched teeth, he took another, then another. The color returned to his face and he motioned for the nurse to lead the way. When she did, he followed.

            They entered a small room and the nurse seated Nelson on the edge of the examination table. She asked him to remove his shirt and undergarment and, as he did, she busied herself disinfecting her hands from a dispenser attached to the wall. The she said, “Let’s get your vital signs.”

            When she had finished, she collected leftover materials and walked behind where Nelson sat to discard them into red disposal can. She stared a maze of scars across his lower back. “Oh my,” she said. “I can see why you may have spasms.”

            Nelson didn’t respond. She came around to his front and told him that “Doctor” would be with him in a moment and asked if he was comfortable.

            “Relatively,” he said.

            She laughed. “Some of our veterans complain that they get cold while they wait,” she said. “But I suppose you were trained to withstand the cold.”

            He shifted on the table and said nothing. She busied herself with a computer keyboard. An x-ray appeared on a large monitor. It elicited another “Oh my.” It clearly showed a view of Nelson’s torso with a black object an inch or so to the right of his spine.

            “Shrapnel,” he said.

            She said, “Where?”

            “Afghanistan.”

            “How long ago?”

            “A couple of years,” he said.

            Before she could respond, the far door opened and the doctor walked in. He was a Caucasian man in his forties, with a soft appearance and a pleasant smile. His hairline had begun to recede onto the top of his head, and his face and chin were melting into his neck. Neither event seemed to cause him any major concern. He greeted Nelson with a handshake. “How are we today, Mr. …,” he said as his dark eyes glanced to the file in his left hand, “Nelson? I’m Doctor Thurman Roberts.” Releasing the handshake, he began flipping through the file.

            Nelson waited and looked around the room. It was sparsely outfitted and smelled of antiseptic and age. A stainless-steel cabinet held the usual assortment of cotton swabs, tongue depressors, medicines. He stirred. There was a coldness about the room that spoke to sterility and mortality. No thinking person, no matter what the pain, would want to linger here.

            Doctor Roberts finished scanning the file and looked at Nelson. “There is more missing from your file than is contained in it,” he said. He laid it on the examination table and smiled. “You must have been up to some high-level mischief.”

            Nelson smiled in return, but said nothing.

            The Doctor turned to the x-ray, waiting on its screen like a dark puzzle. He touched the dark mass of shrapnel. “I guess this is what we are here about?”

            “It looks smaller than it feels,” Nelson said.

            The Doctor looked at it again and then at Nelson. “Problems?”

            “From time to time,” Nelson said.

            The Nurse spoke. “We had an incident with a spasm while coming from the waiting room.”

            The Doctor leaned toward Nelson. “Spasms?”

            “And dull pains at times.”

            “How severe are the spasms?”

            Nelson thought. “Enough to stop me from what I’m doing at the time.”

            “Could you put up with them for a while longer?”

            “A while longer?” Nelson looked confused.

            The Doctor glanced at the file and smiled. “I don’t imagine you are used to anyone’s asking you whether or not you can put up with pain.”

            “Not recently,” Nelson said.

            “Reason I asked,” said Doctor Roberts, “is that the reports from your primary physician, and your x-ray history, indicate the shrapnel is migrating.”

            Nelson said, “Migrating?”

            “It happens,” said the doctor. “Very rarely and it’s highly unusual, but can happen. Usually it is bad news. In your case it is good news.”

            When Nelson didn’t reply, he continued. “In your case it is migrating away from the spine. We would like to let it move a bit farther before we operate.”

            Nelson spoke. “And if it doesn’t?”

            “Then we will operate although the closer to the spine, the greater the danger.”

            Nelson said, “Will there be other complications?”

            “It may still aggravate nerves as it does now. The spasms may continue but we can treat those to mitigate them.”

            “Sound fair,” Nelson said.

            “Good,” the Doctor said. He turned to the nurse. “Could Mr. Nelson and I have a few moments?”

            “Certainly,” she said, surprised. “I’ll be next door if you need me.” She looked them both over and then exited the same door that Nelson had entered.

            When they were alone, Doctor Roberts motioned for Nelson to dress and he, himself, sat it the room’s only chair. He relaxed and looked at the ceiling. “Are you in a hurry?”

Nelson looked at him, evidently confused.

“My next veteran had to cancel,” Doctor Roberts said. “Thought I might take a break if you have a moment or two.”

Nelson said, “I must return a call, but it can wait.”

“Thanks,” Doctor Roberts said. He leaned forward and clasped his hands around his knees. He said, “I understand that you know Dr. Merlin Garrison.”

            Nelson looked surprised. “I do,” he said. “Do you?”

            “I went through some surgical specialty training with him in Austin last year,” he said. “Nice chap.” He folded Nelson’s chart and placed it on the table. “He and Luther had my wife and me over for dinner one evening. We enjoyed the hospitality.”

            “Merle and I served together in Afghanistan,” Nelson said.

            “So I understand. He called me, you know.”

            “I did not,” Nelson said.

            “He knew that with my specialty, I might be the one treating you. So he called to make sure I, or whoever else it might be, took good care of you.” He released his hands, uncrossed his legs and leaned back. “He thinks highly of you.”

            “And I him.”

            “He said you saved his life.”

            “Actually, he saved mine,” said Nelson, gesturing toward the x-ray. “There would be a lot more there if he hadn’t been on the scene.”

            “He gives you the most credit.”

            “That’s Merle,” Nelson said.

            “He would like to assist the operation when the time comes,” Doctor Roberts said.

            “Is that why we are waiting?”

            “No, the reason we’re waiting is the reason I gave you.” He lowered his voice. “But I must tell you the Veteran’s Administration is not in any hurry, either.”

            “Oh?”

            “We get caught in these eternal budget struggles. Concern for you guys tends to evaporate in direct proportion to the distance you are from battlefield.”

            “Some things never change,” Nelson said.

            “Some things,” Doctor Roberts said. “Plus, we have new maladies to treat.”

            “New maladies?”

            “Post-Traumatic Stress Disorder is eating us alive. So far it hasn’t interfered with a needed surgery but it eats resources and invites malingering.”

            Nelson cocked his head. “Is there really such a thing? I mean such a thing as PTSD?”

            “Do you doubt it?”

            “I have no way of knowing,” Nelson said. “I am just naturally suspicious of—as you call them—maladies that suddenly appear from nowhere.”

“Oh,” Doctor Roberts said. “It’s not new. In the Civil War it was ‘soldier’s heart’ and in World Wars One and World War Two it was ‘shell shock’ or ‘combat fatigue.’ In WWII they discovered that prompt return to the soldier’s unit could prevent long-term disability. The name PTSD was coined in the Viet Nam era and politics and compensation for veterans got so mixed up with it that it’s difficult to sort out the medical realities anymore.”

“It sounds a little slippery,” Nelson said.

Doctor Roberts nodded. “I suspect that some of the PTSD veterans had pre-existing psychological factors and might have had a similarly dysfunctional present even without the exposure to war trauma. Alcohol and drugs are often involved. Now, with multiple deployments, it can be a real phenomenon.”

            “So the problem is?”

            Doctor Roberts looked toward the door and then turned back. He said in a low voice, “All I can give you are generalities. I think it is a real condition, but I think it has been wildly over-diagnosed, has been fostered by well-meaning psychologists who lead patients to fixate on their symptoms, has been politicized, and is hard to define objectively since it is based on self-reported symptoms.”

            Nelson said, “If I say I have it, you have to treat it?”

            Doctor Roberts nodded. “What really disturbed me was when the DSM expanded the definition. It’s no longer just trauma that happened to you personally. Now it can include witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.”

            “And the medical community goes along with it?” Nelson said.

Doctor Roberts said, “By these criteria, watching the evening news or learning that your elderly grandfather had died of a stroke could precipitate PTSD. This goes beyond ridiculous. Over-cautious psychologists are attempting to prevent PTSD by crisis counseling, but studies have shown they do more harm than good.” He stared off. “A friend of mine was a boy in Germany during WWII and he had to walk through a liberated concentration camp full of dead and mutilated bodies with his mother. His counseling? She told him not to look, which of course he did anyway. He never developed any kind of symptoms.”

“But,” said Nelson, “it now seems everyone becomes afflicted.”

Doctor Roberts smiled, “It has become more of an excuse for poor coping skills than a disorder. Hell, we had a fellow in here that spent his entire four years at an Air Force base in Florida and claimed he was suffering from it.”

            “Fly-boys,” said Nelson as if he found the word sour to the taste. “And you didn’t believe him?”

            “He was worthless drunk and a wife-beater when he enlisted and was more of a worthless drunk and a wife-beater when he was discharged.” The Doctor looked away. “Years of war and an all-volunteer military have caused us to lower our standards. We have to take some in that we wouldn’t have given a thought to in times gone by. Some of them find redemption in the military and make good troops, even outstanding troops. Others drift through, hone their bad habits, get out worse than when they started, and then want to waste our time and resources and would let real wounded warriors wait, if we let them.” He turned to retrieve Nelson’s file. “Sadly enough, that includes the ones who are paying the price for our little experiment with Agent Orange during the Vietnam days.”

            “So,” said Nelson, “if I were to tell you that the shrapnel has caused me to have bad dreams, you might move me up on the list?”

            “I’ve not had to do that to anyone yet,” Doctor Roberts said, “but you wouldn’t do that to me would you?” He smiled.

            “I can wait.”

            “I thought so.” The Doctor said. He turned and retrieved Nelson’s file and made notes in it. “I’ll give you a shot of cortisone and prescribe some muscle relaxer, say Flexeril. You don’t have any strenuous activity planned for the next few months, do you?”

            Nelson said, “Thought about taking a course at your local university. Carrying textbooks okay?”

            Doctor Roberts smiled. “As long as they aren’t medical textbooks. You need a wheelbarrow to move some of those.”

            Nelson shook his head. “English Lit, maybe.”

            “Study Tennyson if you are still interested in tortured souls.”

            “Will do,” Nelson said.

            “Thanks for jawing awhile. You enjoy yourself,” Doctor Roberts said. “Take a vacation. Even though I can’t tell much from your file, I suspect you’ve earned it.”

To be continued …