Pulse
Coming Home
Physicians need to understand how the combat experience can affect the physical and mental health of returning soldiers and their families.
Kevin Murphy, M.D., knows what it’s like to be shot at, watch a fellow soldier die, and fear a suicide bomber. As a division surgeon for the Minnesota National Guard’s 34th infantry, he experienced those things during the second of his three tours of duty in Iraq. “It works on your mind,” he says.
Murphy also knows what it’s like to go from the frontlines to the home front. Now, he’s in charge of helping some 2,600 soldiers make that transition as well. As surgeon for the infantry’s first brigade combat team, which returned to Minnesota in July after spending 16 months in Iraq, he is in charge of both their medical care and their transition from soldier to civilian. “Those who are having difficulties end up in my lap,” says Murphy, a physical medicine and rehabilitation specialist who runs Gillette Children’s Specialty Healthcare’s northern Minnesota clinics.
It may be too soon to tell which soldiers will have trouble readjusting to civilian life, however. According to Murphy, most of the soldiers in his brigade are coming off the honeymoon. “Everyone feels wonderful, then the celebrations go away and they’re back in their private life, and they’re not the celebrity they were when they came home,” he says.
It’s during this period when the first signs of depression, anxiety, and post-traumatic stress disorder may occur. Those conditions could affect up to 30 percent of returning soldiers, according to a 2007 report by the office of the U.S. Army Surgeon General.
“You give a significant portion of your life to do something pretty unique. How do you come home and readjust? How do you go back to the same old patterns? How do you frame your experience? It’s bound to cause a letdown for some people, and that letdown can manifest as depression,” says Lt. Col. John Morris, a chaplain with the Minnesota Guard who has been helping soldiers return to civilian life.
Murphy says returning soldiers are often locked in a “battle mind” mentality. “When you leave the safety and security of the bases in Iraq, you have to be prepared to kill someone before they kill you,” he explains. Soldiers learn to be hypervigilant, secretive, and mistrustful, knowing that a displaced rock in the road may be hiding a bomb or that word getting out about a mission could endanger lives or that someone believed to be a friend may be an enemy. “It’s a great way to survive in that kind of a theater, but it gets to be a problem when you come home and you can’t relate to your wife and family,” he says.
A Cry for Help
Chaplain John Morris became aware of the effects a military deployment could have on families when he was stationed in Fallujah in 2004. His daughter, then a fifth grader, started having stomachaches. His wife took the girl to the doctor. “When she presented to the doctor, that’s what he saw and heard: stomachache,” says Morris, who is a lieutenant colonel in the Minnesota National Guard. “He wasn’t aware that this child’s dad was in mortal combat in Fallujah.”
Although his daughter eventually got help from a child psychologist, Morris doesn’t want to see such symptoms overlooked in others who have a family member stationed in a war zone. As co-founder of Beyond the Yellow Ribbon, a Minnesota National Guard initiative to help soldiers returning from service in Iraq and Afghanistan, Morris is trying to make physicians and family members aware that the soldier isn’t the only one who suffers as a result of an overseas deployment.
He says physicians need to ask patients whether they have a family member serving in the military and whether that person is in Iraq or Afghanistan so they don’t miss the emotional trauma that may hide behind stomach problems, colds, difficulty sleeping, overeating, or loss of appetite. “A spouse doesn’t always come in saying ‘I’m depressed because my husband is in Iraq.’ It’s ‘I have to show up for work, and I’m really not doing well. Is there something you can give me so I can feel better?’”
Morris says that as the war goes on, military families will become a bigger segment of all physicians’ patient populations. “There have been 15,000 Minnesotans fighting in Afghanistan and Iraq since 9/11, and there’s another 1,000 there now, and there’s no end in sight,” he explains. “This is an issue we will be dealing with for a long, long time.”—K.K. |
Soldiers may begin to feel sadness and guilt—emotions that may have been suppressed during a tour of duty. “It’s easy to fix a bone or sew someone’s ligament up or put their shoulder back in, but fixing the emotional stuff is much harder,” Murphy says. “And it affects every level of family life.”
A Family Affair
In order to ease the burden, Morris co-founded Beyond the Yellow Ribbon, a Minnesota National Guard initiative aimed at helping soldiers return to their families, jobs, and civilian lives. Upon their arrival at Fort McCoy in Wisconsin, the returning soldiers undergo physical and mental health screenings and get help with employment, insurance, and legal problems. They then attend day-long follow-up sessions 30, 60, and 90 days later that address issues such as relationships with spouses, parenting, substance abuse, and anger management. Family members attend the sessions, too, to help them understand how to help themselves and their soldier.
The fact that this war is being fought by an all-volunteer military, in particular, by reservists and National Guard members, many of whom are married and have children, makes it unique, Morris says. “In a draft army, we were drafting single young men. That affected mom and dad primarily. This time, it’s affecting mom, dad, the spouse, the significant other, the children.”
Since last summer, Morris has educated community and health leaders about the needs of combat veterans and their families. He helped convene a conference that was jointly sponsored by the Army National Guard, the Minnesota Department of Health, and the HealthPartners Institute for Medical Education. The April 20 event drew about 100 physicians and other providers. In October, Blue Cross and Blue Shield of Minnesota held a seminar on combat stress along with Triwest Health Alliance, which administers the health insurance program for members of the military and their families, and the Minneapolis Veterans Affairs Medical Center. More recently, officers from the Army Medical Department have given talks on reintegration at Mayo Clinic.
Returning soldiers “may not appreciate that they have a physical or mental injury related to their service, so they return to the community, and that’s when the physicians in the communities start seeing some of these personnel about problems that may or may not be related to their service,” says Carl Patow, M.D., executive director of the HealthPartners Institute.
Asking Questions
One byproduct of the HealthPartners conference is an initiative at Stillwater’s Lakeview Hospital to educate physicians about the needs of returning soldiers and their families.
“Awareness is one of the primary issues with returning soldiers, even if they’re coming in for a routine checkup or cold,” says Nicholas Meyer, M.D., a surgeon with St. Croix Orthopedics who practices at the hospital. Meyer is also a volunteer with the Military Family Support League, which helps families with a loved one deployed overseas manage day-to-day activities. “When they first come in, they may not make it known that they’ve been overseas.”
Meyer says the goal is for physicians to routinely ask whether a patient has been in the military and served overseas and, if so, to follow up with the right questions: How are you doing? How is your relationship with your family? How is your job going?
For More Information
To learn more about the mental and physical health issues affecting returning soldiers and their families, contact chaplain John Morris at 651/282-4085 or Kevin Murphy, M.D., the MMA’s military liaison, at 218/260-7009.
Twin Cities Public Television will air four 30-minute segments from the conference sponsored by the HealthPartners Institute for Medical Education starting this month. Health care providers who watch will be able to earn CME credit. You can find the schedule or learn how to earn credit at www.joiningforcesonline.org. |
If a patient has been in Iraq or Afghanistan, physicians should inquire about trouble managing anger, difficulty sleeping, anxiety, and lethargy, which may be signs of post-traumatic stress disorder or other problems. They can ask about memory problems, headaches, or difficulty with reading or math, which may indicate traumatic brain injury. “The goal is to try to minimize any negative incidents—suicide, substance abuse, divorce, all those things that unfortunately are higher than average in this patient population,” he says.
Morris, who has spoken to the Stillwater group, believes continuing to educate physicians about returning soldiers is key. “This isn’t a short-duration war,” he says. “Every doc will have to deal with combat vets and their families at some point.”—Kim Kiser