Nurses Working with PTSD and Combat PTSD Patients

Some of our peers are privileged to work with the men and women who have served in our United States military. Many of them come home with Combat PTSD.  In your career working in your nursing facility you may never come in contact with a Combat PTSD survivor, but you will come into contact with peoople with PTSD.   I encourage you to read my interview with a Combat PTSD survivor, and you will be able to see some of the similar traits.  Both types have had traumatic events in their lives, and it is our job to identify, help treat and care for these people.  What you see in quotes will be the reaction of the combat survivor.

Jason is a close friend of our family who has suffered dearly with Combat PTSD.  He has been successful in bringing his symptoms under control but only after he sought help from qualified psychiatrists and psychologists who are specifically trained to deal with this issue.  He had a very rough road after his return from Afghanistan, and for awhile he was not ready to deal with the severe depression that had enveloped him.  Jason said that the best thing anyone feeling severely depressed or “out of place” returning from combat is to seek out therapy and not wait!  “If you wait, like I did, then you will sink deeper and deeper into your own private hell. Remember, you have to do the seeking because they won’t come looking for  you!  I didn’t want to admit I had a problem. I didn’t want to relive what happened in Afghanistan.  I was home…..but I was only ever half-way home.”

When Jason returned home and became a civilian again he felt that he had lost control of himself. “There was no time to adjust, reconnect slowly or decompress. I was in way over my head very quickly.” He said he literally felt that he was carrying around a 100 pound sign suspended from his neck that said PTSD.  To deal with his depression he became addicted to the pain medication he had been given for his injuries obtained during his jumps. Others, he said, used opiates and alcohol to escape the daily emotional pain of what they had endured.  In the first 1-2 years after Jason was home, three of his service friends committed suicide because they just could not cope.

After returning home he isolated himself almost immediately as he did not feel safe.  “You have to remember I was a trained fighter and trained to react immediately.  I was in survival mode 24/7.  I was trained to kill or be killed….killing was good because that meant you survived.  This was my mindset every second I served, and I killed hundreds of people.  Some of those people were innocent children, women and elderly; but they are still alive in my nightmares.”

Jason told me that you learned to trust no one. He said that a lot of the Afghanistan soldiers turned out to be traitors, so he and his buddies slept with one eye open and a finger on the trigger of a loaded weapon.  He said that many nights he “slept” side-by-side with a known traitor.  “I was always ready to kill and take a life.  Many of the injured from combat came to our base for treatment in our hospital.  It was after one battle that a man came carrying his child who was about the same size as one of my daughters.  Tears streaming down his face he held her bloody dismembered body in his arms and sobbed.  I was snapping inside because I was tired of carrying my commrades to a waiting helicopter….they were already at rest and passed on to a better place.”  Jason said that he questioned his Christian beliefs and wondered where God was or even if there was one.

Jason said that when he returned home after his devastating tour of duty, he could not shut off the thoughts.  He isolated himself and didn’t feel safe anywhere, and he hated leaving home.  He hated going into resteraunts or crowded buidlings because they weren’t safe.  He felt that at any time there could be a bomb hidden in a building, a backpack or under a jacket; and he had to get back to his safe place – home.  However, even home was not safe because with every dog bark, every unknown car pulling up to the curb outside of his home or any other strange noise, he went on alert thinking that someone was coming for him. “I was constantly in fight or flight mode, and I literally trusted no one all the while my emotions were either distrust, numbness, confussion, anger or rage.”  He said that everyone and everything annoyed him.  His anger was so out of control that he had thoughts of punching someone in the face many times or literally breaking their neck.   For this reason he avoided debates, arguing or anything that would trigger his rage or that he could perceive as a threat.  “Every whisper was about me, and every noise was unnerving. Mistrust was my inner demon; and if anyone did anything to cause me to mistrust them, I never trusted them again.”  He said it was during this time that he and his wife seperated.

When Jason went into therapy, it was for himself, but mostly his kids.  “I wanted to be a functional dad.” I asked Jason to tell me what he and other soldiers with combat PTSD could tell health professionals and the general public. He said that we, as health care providers, need to remember that TRUST is the number one issue in those with PTSD.  Never do anything that would cause the person to mistrust you.  Every PTSD survivor is unique in their own issues and memories they have battled.  Be familiar with the combat veteran, and know the signs and symptoms. Those symptoms included agitation, anti-social behavior, explosive behavior, serious risks of self-harm and substance abuse to name a few.  Be very careful with medications and how they interact with each other.  Be careful in asking a lot of senseless questions, as tolerance for this is minimal.  Nurses need to remember that the patients of PTSD, in many cases, have low self esteem.  When they ring the bell and you don’t answer, if you promised coffee and don’t come back or you don’t check in on them to see if they need anything enforces they are not important. “Just remember we are not a bag of meat in a bed….treat us with respect.  Ask only the right questions. This may include, if we have feelings of hurting ourselves or others, how are we sleeping, are we having nightmares or is there anything you could do for us.  Be kind always, and don’t take our behaviors personally…we are recovering.

written by Linda Dawson

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