VJ Periyakoil, MD, a palliative care physician at Stanford, first met Mr. M, a 78-year-old veteran with heart failure, in the remaining few weeks of his life - when he was wheelchair bound and tethered to an oxygen cylinder. She asked him about his condition, his pain levels, and his military service, but he would share little at first. He vehemently denied having PTSD, with his wife simply saying, "He doesn’t like to talk about war."
Mr. M’s medical records showed he had chest pain and trouble sleeping, but he just shrugged and refused any pain medicine. Over his next few weeks in the hospital, as Periyakoil grew to know her patient better and he grew to trust her more, the veteran began talking with Periyakoil about his war wounds, and he revealed a heart-wrenching tale.
Periyakoil writes about Mr. M in a perspective piece published today in the New England Journal of Medicine, telling readers:
Even if the war they fought is long over, many veterans are perpetual prisoners of an ongoing inner war that rages silently in their heads. Men and women on active duty may be forced to commit actions that directly conflict with their ethical and moral beliefs. Their stoicism and "battlemind" may serve them well as long as their psychological defenses are intact. At the end of life, however, their previous coping strategies may crumble, especially if they're taking mind-altering medications to relieve pain. Many may even prefer to bear severe pain and avoid pain medications, which make them fuzzy-headed and can unleash war-related nightmares and flashbacks.
What unfolds in the piece is a the tale of a brave solider, still on active combat duty battling the mental wounds of war daily the best he knows how: "The nights were pretty bad for him. He was hyper alert but exhausted, and he often prowled the hospital hallways on his electric scooter all night long," she writes.
On one of those nights, while Periyakoil was treating the weeping ulcers on his ankles, Mr. M told her about the pivotal event from the war, the one that haunted him at night, keeping him from closing his eyes to sleep:
Finally, Mr. M looked straight into my eyes and said softly, "The girl was pregnant. I noticed it after... you know ... as I was cleaning my knife. Whenever I close my eyes, I see her face, that split second when she understood what was about to happen. I cannot get it out of my head."
The story continues:
After several minutes of companionable silence, he asked, "VJ, am I going to hell for killing two innocents?" Without waiting for a response, he continued, "Well, I’m going to find out soon enough."
As a nationally recognized leader in geriatrics and palliative care, Periyakoil, is both a researcher and a clinician. But this piece is a reminder of just how important her work with patients is. She said she's telling the story of Mr. M in honor of both Veteran’s Day and the memory of the many veterans with similar stories who she has treated over the years.
Previously: Examining the scientific evidence behind experimental treatments for PTSD, The promise of yoga-based treatments to help veterans with PTSD, How a Stanford physician became a leading advocate for palliative care and Are veterans with PTSD at higher risk for medical illnesses?
