Indoctrination into military culture begins on Day 1 of basic training.
Important skills are taught to keep soldiers alive in warfare. Stoicism is promoted. Familiar phrases such as "no pain no gain", "suck it up" and "take that hill at all costs" are well known to most soldiers and have become a creed by which they learned to live.
This doctrine is vital in building a fighting force, where camaraderie is essential and killing instinctive but not useful when comfort and peace are your goals. Fear and pain are seen as signs of weakness, which makes death a battle in the mind of a veteran. Treating symptoms such as pain becomes difficult because they are busy "sucking it up."
They have been conditioned to fight - not surrender.
In hospice care, life review is used to process or recall past events and memories in an effort to find meaning and achieve resolution of one's life. Unresolved conflicts are of particular importance to the life review. The life review gives the individual an opportunity to resolve or understand the conflicts of earlier life.
Some say death can be accepted only through resolution of conflicts.1 Conflicts uncovered with many of our veterans include horrific battlefield events where they have killed, seen death and carnage many times on a daily basis for extended periods of time.
Combat is traumatic and life changing. It defines who the soldier was and what he became. Sometimes the effects of the combat experience have been buried for years only emerging when the veteran is sick and dying.
Many of the veterans I work with have compartmentalized their wartime experience. By this I mean that they have tucked it away and not spoken of it to family or loved ones. It is only when they begin their life review that these untold stories surface.
For many, the stories are still painful and laden with guilt, shame and unresolved grief.
An example of this is the story of Mr. H., a WWII Navy veteran who was at Normandy on D-day.
As he began his story the tears began to roll down his face. When I asked what he was remembering, he conveyed this story:
On June 6, 1944, he was in an amphibious landing craft attempting to land on the beach head at Omaha Beach. His lieutenant was screaming at him to get the dead bodies out of the way so they could land the craft.
He states that, when he closes his eyes each night since that June day, he sees the faces of those young men who never had a chance at life. That was more than 60 years ago.
I have learned that listening is where the power is. We have to bring the person we are into the situation; not just the clinician. Nurses can connect to the veteran, so that we hear the warrior wisdom and learn from their suffering. In hospice care, we talk of presence.
Presence is not just listening; it is truly being present in the moment with that patient. The fear factor comes into play for the clinician because they are unsure of how they may react to difficult stories of war.
Some of the stories I have heard can be gut wrenching but certainly have given me insight into who that patient was, how much they have suffered during wartime and what struggles they may encounter as they progress towards the goal of a peaceful death.
I could do nothing to change Mr. H's story but join him in his journey, allow my heart to open, listen and affirm his story.