365 Days (15 page)

“He’s not from your unit?”

“No, he was with C Company up at Lang Vei. They’d been taking shit for about three days, then yesterday they got overrun. The gooks really whipped their ass.”

The grunt made to leave, when he suddenly stopped and turned back to Kohler. For a moment a hint of animation flickered across his face. “They had tanks,” he said. “Can you believe it, they took Lang with fucken tanks?” He shook his head and walked out the door to the landing area.

Kohler motioned over a corpsman. “Better take him to the ward. Give him 150 milligrams of thorazine IM and repeat it every hour till he falls asleep, then keep him asleep for at least two days. You can use a wheelchair.”

They kept Dienst sleeping for two and a half days, then stopped his thorazine and let him wake up. When Kohler saw him next he was on the neuropsychiatric ward.

There were no locks on the ward, no guards. Despite the diversity of symptoms and patient types, some of whom had been brought in incredibly violent and disoriented, there were no provisions for security. It looked like any other convalescent in-patient ward. All the patients were in T-shirts and fatigues; some were cleaning the room, others sitting alone, reading comic books or writing letters, while here and there were small groups talking among themselves.

Kohler walked through the ward, nodding to those who looked his way. His patients were there to get well, not to dwell on their symptoms. From the moment they were admitted they were expected to get better—or at least to act appropriately. They were still in the Army and despite his own concerns and prejudices, he never allowed them to forget it. Even though the patients were in a neuropsychiatric ward, they still wore their uniforms and maintained their unit affiliations; they were given details, and they obeyed orders. Restraints were necessary occasionally, but only for very short periods of time.

Kohler was surprised at the results. To him, as to so many other analytically oriented psychiatrists off the East Coast, the military machine with its emphasis on interpersonal rather than intrapersonal psychopathology had come as a bit of a shock. At first, he had been frankly skeptical, certain that conversion and anxiety reactions removed without sufficient uncovering techniques would only reestablish themselves in other ways. But his experience with the numbers of patients he had to take care of, no less than the shock of suddenly being dropped into the middle of something as different as war, had quite turned him around.

Before he was drafted he had thought he had it made: a more than comfortable practice, a nice suburban home and family, a good life of reading, teaching, and working. And now, here he was worrying about getting killed, taking care of kids from places he had never heard of, much less even thought about, in a world he had never dreamed could exist, a middle-class psychiatrist treating patients every one of whom had murdered or been almost murdered himself.

When Kohler came to see Dienst, he found the ward master in the nurses’ station, charting the new admission.

The ward master quickly stood at attention.

Kohler motioned for him to relax. “Harold, did the neurologist see our boy?”

“Yes, sir.”

“What did they say?” Kohler asked, glancing at the chart the ward master handed him.

“Nothing wrong, sir. No neurological reason for his paralysis.”

“Good, Harold. And now...” Kohler looked out at the ward, “now, for the new psychiatry. You know, sometimes I wish it didn’t work so well. I really do.”

Dienst was lying on his bed, staring at the ceiling. Washed and dressed in a new set of fatigues, he made no move of recognition as Kohler approached.

“Hi, Corporal. They tell me you can’t move your legs.”

“Yes...yes, sir.”

Kohler pulled up a chair. “You’ve been in Nam how long?”

“Eight months...sir.”

“In the boonies the whole time?”

“Yes sir—except for a week when I got hit and was at the 45th surg.”

“What happened?” Kohler offered Dienst a cigarette.

“No thanks, sir.” Dienst seemed to relax a bit. “We got ambushed. I took a piece of a claymore in my hand, sir.”

“What happened this time?”

Dienst looked blank.

“What happened, that you got evac’ed this time?”

“I don’t really know, sir.”

“Well, what is the last thing you remember?”

Dienst thought for a moment. “The tanks, I guess,” he said hesitantly.

Kohler waited. “Then?” he prodded. Dienst suddenly looked very nervous. “Then?”

“I couldn’t move.”

“This ever happen before?”

“Huh...?”

“Your not being able to move—did it ever happen before, at home or at school?”

“No. No, sir.”

“Were you scared?”

Dienst looked confused.

“It’s OK,” Kohler said, waving away his question.

“Yes, sir.”

“We’re going to talk about this a few more times. Everyone handles fear and difficult situations—like you were in—in their own way. For some, it’s diarrhea; others can’t see, some can’t move. This paralysis you are experiencing now will pass. We’ll talk about it, though, so you’ll be able to understand exactly what happened to you. Why you became paralyzed, and why you’re here. But while we’re talking, I expect you to go about your normal duties and to listen to the ward master and corps-man.

“But I...”

Kohler held up his hand. “That means everything,” he said matter-of-factly, though pleasantly. “The mess hall is down the hallway about twenty meters. That’s where the patients in this ward eat. We don’t serve food in bed here.”

Dienst looked terrified; adolescent confusion and fear was etched across his lean sunburned face. “But...but I can’t move,” he said desperately. “I can’t move my legs.”

“Yes, you can,” Kohler said softly, “but if you don’t want to, you can crawl there.” he stood up. “Or go hungry. It doesn’t matter to us. Whichever way you want it will be fine. I’ll see you tomorrow.”

The next day the ward master called to report that Dienst hadn’t moved.

“No lunch?” Kohler asked.

“No sir, and no breakfast either.”

“OK, Harold; I’ll be right down to see him.”

“Sir, the 45th surg just called in. They got three guys there, looney as hell, but they can’t get ’em out till maybe tomorrow. They’re really gettin’ hit hard. Two Dust Offs got lit up trying to get into the LZ; their surgeon’s dead. The medic running the show wants to know what medication to zap these guys with.”

“Tell him to give ’em 250 mgm of thorazine IM each, every four hours till they’re asleep. Tell him not to worry, just get ’em to sleep.”

“Sir, would it be OK with you to go out with the Dust Offs to get ’em?”

“What if you get lit up?” Kohler said. “You know how important you are to the ward, Harold. The blacks need you there. They need to see a black face in charge.”

“It’s my old unit, sir. I could help them.”

Kohler hesitated. “OK, then, but watch yourself.”

Dienst didn’t acknowledge Kohler’s greeting. His eyes were sharp and focused, but he still lay staring into space.

Kohler sat down on the edge of the bed so that Dienst had to shift his weight. The movement broke the rigidity of his posture.

“You look angry,” Kohler said. “You’re still in the Army, son; I expect you to look at me while I’m talking to you.”

Dienst reluctantly turned his head.

“You must be hungry,” Kohler continued matter-of-factly. “You know, I’ve looked through your 201 file, and you’ve been a fine soldier. A bit stubborn, maybe. You must have been strong-willed all your life. That’s an important thing to be. Not many people are.”

Dienst frowned. He looked confused.

“I know you’re hungry. You haven’t eaten here, and I know you didn’t have time to eat where you came from. Where was it again, now?”

“Lang Vei.”

“I bet you didn’t do much complaining there, either. I mean, you’re not a complainer.”

“No, sir,” Dienst said, softening.

“Tell me what happened out there,” Kohler said softly. “Tell me, son. Tell me about the tanks.”

“Gentlemen, what I want to do now is give you a history of military psychiatry, the theoretical basis for our recent advancement, and why we in the military feel that it works.

“Freud is dead. He was a great man, but we simply can’t use him any more. Let me read to you two quotes from one of his disciples, from a book published in 1957 called Captain Newman, M.D. Captain Newman, an Army psychiatrist during World War II, is the chief of a psychiatric service at a large Army hospital. I quote:

We deal with sickness, the kind of sickness that doesn’t show up on sphygomographs or fluoroscopes. A patient may run no fever, or hit 104 out of the blue. Don’t think they all babble gibberish; most of them make sense, if you listen to their vocabulary long enough and hard enough. They’re using English, but speaking a foreign language—the language of suffering, which requires special symbols. A man can have a pulse that suddenly beats like a trip hammer or one that doesn’t register much more than a corpse’s. There’s a reason, there’s always a reason. To call someone mad is meaningless. There is only one thing you can be absolutely sure of; every, I repeat, every man who’s on my ward—no matter what he says or what you hear or what the textbooks say—is sick.

“Now if that’s not enough, there’s this—I quote from another chapter:

“What’s worrying you, Newman?” asked his ward master.

“Jackson’s hallucinating again. He dived under the bed before breakfast, yelling the Japs are here and he wouldn’t come out. He keeps screaming and shivering and begging to go home.”

“Did he get his medication last night?”

“Yes, but it’s worn off.”

“Have you tried to coax him out?”

“Nurse Blodgett spent half the morning on the floor.”

“A man would be a fool to come out for old frozen puss. Has he eaten anything?”

“No.”

“Does he have any special favorites in food?”

“Chocolate malts.”

Captain Newman wrinkled his brow.

“OK. You put a nice big chocolate malt and some cookies on the floor, right near the bed. Let him see you. Tell him he’ll hurt my feelings if he isn’t back in his bed when I start morning rounds.”

“None of it sounds quite right, does it? A little too occupied with illness and a bit too sentimental. But during the Second World War it was the Newmans expressing just those concerns who were running all the military psychiatric services. The Newmans were not so much wrong as ill-equipped to handle the war; they tried, but in most cases just compounded the difficulties; and the V.A. hospitals, twenty-five years after the war has ended, are still catering to their patients. Chocolate malts are a good idea, but there were too many patients and not enough malts to go around. The Newmans got lost in the flood of military patients and ended up in their concern and confusion by declaring a frightening number of healthy men incapable of military service, to be discharged to the V.A. hospitals nearest their homes.

“A few facts: During the early years of the Second World War one out of every four soldiers evacuated out of the combat area was evacuated out as a neuropsychiatry patient, and one-half of the medical discharges granted at the time were granted for psychiatric disability. It was not a new problem. The Freudian-oriented Newmans were just handling it in a different way. Combat neurosis, battle fatigue, exhaustion, whatever you want to call it, has always been a problem of battle. In the First World War it was called ‘shell shock.’ The psychiatrists, unfortunately, had a part of that too. If you came out of the battle or bombardment unwounded but sweating and shaking, disoriented, paralyzed, or simply unable to go on, you were diagnosed as having been too close to an exploding shell. The psychiatrists, trained and experienced in the organically oriented institutionalized psychiatry of the late nineteenth and early twentieth century had decided, presumably because they had to say something, that these visibly shaken men had something truly wrong with their brains—not their minds, but their brains. They concluded that the concussion from the exploding shells must have in some strange way rattled these poor soldiers’ brains. Despite hundreds of fortuitous autopsies that showed no evidence at all of brain damage, they persisted in giving these boys a diagnosis of shell shock and with it the implication of irreversible destruction of brain tissue.

“It was a convenient theory. If the shell-shocked patient recovered completely, the concussion had not been severe. If he did not, the damage was complete and irreversible. If the patient intermittently lapsed back into bizarre behavior, the damage lay somewhere between the two extremes. The disaster, though, of all of this squeezing of observable facts into an established though inappropriate theory, was not that these men were labeled, but that the label, once attached, was encouraged and the diagnosis maintained not only by the psychiatrists but the patient himself, his family, his friends, and a nation that demanded each one of its boys be a hero. The shock wave from the exploding shell was a convenient excuse for everyone, though in truth a deadly one. The shell did it all. The patient was just too close to the explosion. To admit otherwise would have meant that the patient, the son, the father, the lover, had indeed failed, that he had been a coward, that he had been unable to take it and run away, leaving his buddies out there to die. It was as difficult to admit then, as it is now....”

“Look Dienst,” Kohler said, “I know things were tough and you’d been pushing a long time. Believe me, there is an end point to anyone’s resources. There’s a place when all the will power, motivation, training, concern, and leadership simply isn’t enough any more. Everyone handles that point in his own way. Some guys decide to surrender, or say fuck it and charge. Some panic and get killed; some even decide to just sit there and get court-martialed. You’re too tough for that, though, and too concerned. You might be a bit too brave for all of this. No, no, I mean it. But let’s talk more about you and how you do things later. Still, I have to repeat, we don’t serve in bed here. I want you to get to the mess hall on your own. I know, I know,” Kohler said, raising his hand to keep Dienst from complaining, “but this isn’t a hotel. When you go back to your unit...you’re going to have to walk.”