The Patient Was…

The patient was a middle-aged male, an Air Force sergeant still on active duty after more than twenty years of military service. He was, by far, the oldest member of his flight crew, having served in the Army Air Corps in WWII as a gunner in the belly of a bomber. Now, he was filling the same role in the Viet Nam conflict, twenty years later.

The common practice at his air base in the western Pacific was to use two parallel runways for simultaneous takeoffs or landings, allowing more planes either into the air or back on the ground at the same time. Once planes launched, their flight patterns diverged so they turned away from each other as they swooped up into the sky. (I’ve had the experience of landing in a relatively small jet at the same time as another plane did on a parallel runway, and the experience of seeing another aircraft so close to your own is unnerving if you’re not used to it.)

One morning, on a “routine” bombing run, his plane and another launched into the air on parallel runways. For some unexplained reason, the flight instructions to both pilots led them to turn toward one another instead of away. The sergeant, from his position in the belly of the aircraft, saw that they were on a collision course, and expected a sudden change in the flight path or a command from the captain to bail out.

The sergeant was the only member of his flight crew who had actually bailed out under crisis conditions. In WWII, his plane was shot up by enemy fire, and the entire crew bailed out under their captain’s orders. All of them survived and were rescued by allies.

Now, seeing no change in the flight pattern and awaiting a bailout order, the sergeant realized that a collision of the two planes was imminent. Hearing no bailout order, and with only seconds to spare, he bailed out of his aircraft. Moments later the planes collided in a massive explosion. Everybody on board both planes was killed.

His survival was hailed as a miracle. Nobody could explain how anyone had survived that explosive collision. People hailed him as some kind of hero although he himself knew he had done nothing heroic.

In war, people who survive in critical situations where others die sometimes develop a reputation for invulnerability. They seem impervious to danger, as if touched by a divine presence that insures their survival. Other people want to serve with them, as if the aura of protection would somehow rub off on them. They are lucky charms incarnate, human rabbits’ feet.

So it was with the sergeant. And he felt completely unable to tell the true story of what happened: He had bailed out without orders, had abandoned his position and crewmates, and saved himself.

He was granted R&R (Rest and Recuperation) and flew home to where he lived near the air base where I was stationed as a Medical Officer. The results of his R&R were disastrous. During the period where rest and relaxation were supposed to restore one’s sense of normality, the sergeant developed increasing anxiety and depression. It was entirely contrary to expectations. He couldn’t sleep, he hardly ate, he rarely spoke. Nobody could explain it, including his immediate family in whom he had not confided.

He was examined by the Flight Surgeons at our base. Flight Surgeons are Air Force doctors who have special training in dealing with medical issues of flying, and  virtually all personnel on flying status are  treated by them. They found nothing physically wrong with the sergeant, as indeed there wasn’t. And their concern about his mental and emotional state were focused largely on whether he could return to duty, not on the causes or non-duty-related aspects of his health and well-being.

I was the Medical Officer in charge of what was called the Air Force Clinic, which was primarily for family members of military personnel. It was obvious that many of the complaints that brought patients to our clinic were largely emotional in nature: anxiety about their active duty family member, stresses arising from not having a lot of resources, living in small quarters, being away from extended family, etc. While many of my medical colleagues either did not have or did not display a lot of empathy for these patients, I had developed a reputation for listening to them and trying to help them.

So, the sergeant, who was clearly not suited for further active duty and was in the process of retiring from the service, found his way to my office. Remember, nobody except the sergeant himself knew the details of what had happened on the day of that aircraft collision. He had seen several doctors since his disabling symptoms had begun, and he began by saying he knew I didn’t have a lot of time; he actually seemed anxious to get out of there. I said I had all the time he needed, and asked him to tell me about himself. He began with his symptoms of not sleeping, not eating, feeling anxious and depressed, and looked a little surprised when I didn’t immediately react to them. I said I knew about those from his medical record, but would like to hear about his long career in the military, what it was like to serve in the World War as had some of my relatives. 

Slowly, almost reluctantly at first, then with more energy he revealed the fascinating story of his WWII experience, the fear and then exhilaration of his plane being hit by enemy fire and parachuting to safety with his crewmates. Fast forward to his recent terrifying experience in the Pacific, realizing a disaster was about to happen, remembering that bailing out was a path to survival, then acting on that knowledge and experience on impulse without orders, being hailed as a hero and somewhat of a miraculous human being, while knowing that his crewmates perished in the explosion.

Suddenly, he broke down in front of me. He cried, he shook, he almost collapsed. Was it survivor’s guilt  —  an accomplished mystery writer has described an ex-policeman “familiar with the knowledge that guilt can corrode a life right down to the bones.” Was it fear of condemnation for concealing the truth of what happened and repercussion for disobeying orders, a personal sense of cowardice, or all of that and more?

Whatever the explanation, he said he felt overwhelming relief at being able to tell what happened, and not be immediately condemned. I assured him that his story would remain with me until he decided to reveal it. He was going to tell his immediate family, he was going to retire honorably from the service as planned, and he was going to be seek professional help.

Today, his symptoms would probably be recognized quickly as PTSD, or post-traumatic stress disorder, but that term did not come into use until the 1970s and was not recognized officially by the American Psychiatric Association until the beginning of the 1980s.  Now, there are specific counseling techniques available, even including online therapy, and various psychotropic medications to aid in managing this condition.

I never saw the sergeant again, but I like to think that with growing awareness of disorders like PTSD, and proper knowledge- and experienced-based therapy, that he and others like him are functioning better in an increasingly complex and stress-filled world.