I refer to some of my veterans as the walking wounded. Another term we use is the “walkie-talkies”. These patients are ones who’ve sustained injuries such as strokes or traumatic brain injuries and for all intents and purposes have no “outward” appearing deficits. They can walk fine. They talk normal. They have all their limbs. There are no visible scars. They are the walking wounded.
The other day I had a veteran (I’ll call him Jack) come in for therapy whom I evaluated a few months back for cognitive deficits from TBI and a couple strokes. He came in with his wife and after educating them both about cognitive rehab, he agreed to sign up for treatment and scheduled 4 visits, one week apart. After he no-showed for the first 2, I cancelled the last 2. It didn’t take long before he reached out to the schedulers and begged for me to reconsider and reschedule these appointments. I agreed, scheduling only one visit and planned on stressing to him the importance of showing up for these appointments. I also took the time to set him up with some tools for remembering his appointments, which is all part of the therapy.
When Jack showed up this time, he came alone. He is black, 61 years old (in fact, it was his birthday) and he is able to walk without use of any devices and has no deficits with his speech. So a “walkie-talkie”. If I didn’t have access to his medical records, I would have guessed this man was in his early 40s. He shared that he doesn’t drive anymore and because his wife couldn’t accompany him to today’s visit, he had to ride the bus. He had me in stitches telling me how embarrassed he was riding this bus. How the bus drivers came to his door and actually looked over his shoulder asking “is Mr. X here?” (Because he looks so young, they were expecting probably an elderly appearing man who was more than likely in a wheelchair). He then proceeds out to the bus and the driver has already lowered the ramp (for wheelchairs) onto the sidewalk. Not wanting to be rude, he steps on the ramp and when they pushed the button for it to start raising up, it made the “back-up” beeping sound and SLOWLY raised him up so he could step onto the bus. He was joking that all of his neighbors were probably watching and bitching about him abusing the system!! When he got on the bus, there were other veterans already on it, many of which were in wheelchairs or missing limbs, all of which he said were giving him the stink eye!
As we settled into the session and got “serious” about Jack’s deficits, I mentioned to him the term “the walking wounded”. That, yes, it was hilarious hearing his story about his experience taking the bus, and that there may be some truth in what people thought they saw and their opinion of him. That is, a perfectly healthy, young black man, taking advantage of the veteran’s bus system. When he is able to walk and talk just fine. He looks young and healthy. He’s not missing any of his limbs or needs a cane, walker or a wheelchair to get around. He’s casually dressed and not wearing any military garb to indicate that he is a veteran. But nobody knows what’s going on inside him. Nobody knows what he saw while he was in the military. Nobody knows whether he has PTSD or not. And certainly nobody knows that he has memory deficits resulting from a TBI he sustained 10 years ago, that affect him so profoundly that he is becoming more forgetful worrying about it all the time. So, Jack is one of the walking wounded.
Another example of the walking wounded is one of my best friends, Shari. She was mauled by a German Shepherd 5 years ago. Shari had picked up Dax from the shelter as a potential dog that we could adopt out through our German Shepherd rescue. When she got him to the vet clinic to get checked out, Shari was in the room with him and one of the vet techs and Dax, out of nowhere, attacked Shari, grabbing her ponytail and scalping her. Shari survived the attack and other than a bite mark on her shoulder (which she covered with a tattoo) all of her scars from the attack are underneath her hair. She had leech treatment during her initial stay in the hospital (to promote blood flow on the scalp in order to salvage as much tissue as possible), she underwent 2 expansion surgeries (done to expand the scalp to allow hair to be spread more evenly along the dead tissue on the scalp), she had skin graph surgery. Shari does not drink and is in excellent physical shape. And because of this, she was able to make a miraculous recovery and if you saw her today, you would never know that she almost lost her life doing what she loves best, saving dogs. Surprisingly, Shari got right back into rescue and to this day is back helping dogs in need and loving every minute of it. But as you can probably imagine, Shari’s scars are below the surface. She suffers from PTSD from the attack. She suffers from anxiety attacks and even admits to sometimes experiencing difficulties meeting a new dog (understandably). Shari is one of the walking wounded.
The other day, Shari shared with me that one of her friends in the rescue business got attacked by her cousin’s Cane Corso. This time, however, the dog bit her friend in the face. She showed me pictures of it and her entire cheek is swollen and the scars don’t look to be healing well. Shari recommended her plastic surgeon and is offering her friend emotional support, as she’s been there! Shari and I started talking about the scars and how those hidden scars (like Shari and so many of my veterans) can be somewhat of a hinderance. It’s great for that person, in that they don’t have the outward appearance of being wounded. That every time they look in the mirror they’re reminded of the event. But what about the bigger part of them? The PTSD of the actual event? The anxiety, stress, anger and depression? Not to mention the guilt and shame, could they have done something different to prevent this?
And then it hit me, everything I just mentioned…anger, anxiety, depression, guilt, shame…is everything I’ve experienced coming off alcohol. I’m one of the walking wounded. My fellow PATH members are the walking wounded. We are all the “functional” drinkers. Nobody (except maybe a few of our closest friends and family) knows the extent of our drinking or the damage it has done to our lives.
And because of this, I think it takes even more courage to seek help. My veterans whose outward appearance is “normal”, but they can’t hold a conversation with their loved ones because they cannot stay focused for even 2 minutes. Shari, whose hair has completely grown back covering all the scars Dax left behind, has trouble doing dog intros because she may experience an anxiety attack at any moment. And for me, turning down a drink from one of my best friends and trying to explain that I “got off alcohol” may send me into a full blown craving.
Courage is what keeps me going. I think it’s what keeps my veterans coming back time after time to work on their cognitive deficits. Courage is Shari, with a capital C. It takes freaking guts to keep showing up and doing this thing called life!
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