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DoctorSteelLapwing11
It happens almost every night. It happened last night and it’ll…
It happens almost every night. It happened last night and it’ll happen again tonight. I’m tired of it. I’m weary of waking up in the wee hours of the morning panic stricken and slick with sweat. It has been three weeks since I got back from Baghdad and I haven’t had a single decent night’s sleep since. I’ve hardly said a word to my wife or son. I don’t feel I belong here, or anywhere else for that matter.
I never wanted to hurt people, I never wanted to kill…anyone. I didn’t neutralize an insurgent, I didn’t pacify an active cell member. I didn’t any of the things we are suppose to say when we kill someone. I simply killed another human being. I didn’t do it to save my own life and I didn’t do it to save someone else’s life. I can’t even claim that I was ordered to do it. I did it because I was angry and scared and because it was expected of me. I walked up while he was wounded and trying to crawl away and I fired three 5.56mm bullets into his back. I did it casually with no more thought than swatting an insect.
Jim and I met in Riyadh and hit it off right away. Just one of those funny circumstances where you meet another person and you instantly know that you’re going to be friends for the rest of your lives. We would talk about our families and how we would take the wives out for dinner when we got back. We laughed at the idea of getting older and married life on the base.
It was nearly 4 months ago that our life long friendship ended. It ended in the dusty street of an alley with a sniper’s bullet. We were down at the local market and just moved into the alley when the first shot whizzed past my head. I heard what sounded like an angry wasp buzz by and a half second later the screaming report of the shot came: “Sniper, front, cover!” and we scattered. We crouched in doorways, behind rubble, and inside buildings, anything that would conceal us and hopefully stop a bullet. I had just started to run when the second shot rang out. I heard Jim grunt and I turned. He was down, a red stain spreading out from a hole in his upper left leg. “I’m hit!” he screamed. “Man down!” I yelled and ran back to get him. I grabbed his webbing and started to pull him to cover. “Cover fire!” I heard someone scream and the squad opened up. I never heard the third shot but I was hit in the chest. I remember that there was no noise, it was silent and in perfect peace. I remember thinking that my wife would cry when she found out that I was dead. Then, I remember seeing this dust covered face and being dragged to cover inside an abandoned building. As I recovered from the impact of the bullet I realized that there was no blood. The vest that I was wearing had stopped it right at the trauma plate. I was alive and as the pain and shock passed I was back on my feet.
I looked through the broken windows and saw Jim lying in the street. He was looking right at me, one hand on his leg and the other stretched out toward me. The sniper had finished what he started. A small hole was now visible just above his right eye. Our life long friendship was over. It lasted less than 8 months. My fear vanished, burnt away as my anger ignited in a cold blaze. A detached fury where intellect functions but conscience sleeps. I know what evil is: it is intellect without conscience. The whole squad now radiated fury. Fifteen men with technology, the training, the will and the purpose to achieve a single unified goal. We were going to kill the man that had killed one of us. Nothing was going to get in our way. The local mosque was a good 600 yards away and the minaret about 100 feet high. Our sniper was up in that tower.
We moved fast. Our training held as we leapfrogged from cover to cover. We engaged any movement without thought. We moved, fired, again and again. In short we were at the door of the mosque. It was locked but a breaching charge would change that. I was the first man in. My ears were still ringing and the bitter metallic taste of DM12 filled my mouth. Through the smoke I saw the figure of a man struggling, trying to crawl away. I could see by his state that he must have been by the door when it
blew. I fired a three round burst into his back and stepped over his body. We swept into the building, spread out and started to search. I went up the stairs of the minaret. I was listening for any sound. Both the 50 cal and the 20mm rounds had penetrated the masonry. Structural damage was extensive but the holes had enhanced the available light. After about 5 complete turns up the stairs I found the first spent casing. A 7.6×54, only one weapon I knew chambered that cartridge: the Russian Dragunov SVD. A first class sniper rifle. As I continued up I saw the blood first. It had run down the stairs and was pooling on each step before continuing its earthward journey. I was close, I knew it. Each step I took was forced and I cursed the sound of crunching stone beneath my boots. I turned the final corner and found the sniper.
He was sprawled on the stairs. It was hard to tell for sure but I think it was a 20mm round that had killed him. The rifle was still in his hands. I used the radio and told the squad that I had located the sniper and that he was dead. I returned downstairs.
It was oddly quiet. Most of the squad was just sort of standing around. To my surprise there were thirty or so children huddled on the far side of the room. Most seemed to be about 10 or 12. They all seemed terrified. Then I heard him crying…I turned the corner and there on the floor was the man I had shot in the back only minutes before. Kneeling in the blood soaked dirt beside the corpse was a young boy of about 10. He held on to the body’s blackened, still twitching hand. Tears streaming down his face as he repeated “papa, papa” over and over. He looked at me with tear filled eyes and said something. I don’t speak Arabic or Kurdish but I knew he was begging me to help, to do something, anything. There was nothing to be done and I didn’t know what to say. I just walked away.
I have been home for three weeks. Early rotation due to stress. Carole has caught me a few times watching Dylan play and asked why I’m crying. I can’t tell her the truth. I can’t tell her that I see that Iraqi boy everyday. God Damn it! I can’t seem to separate them. Every time I look at my own son I see them both. It is like they are superimposed over each other. I look down at Dylan sleeping in his room, his clothes and schoolbooks, scattered about. His desk and computer in the corner. A 36 inch TV and Play Station still on. His face peaceful and serene. At the same time I see the Iraqi boy squatting on the dirt floor kneeling in the blood of his father, holding a burnt and blackened hand. I don’t even know if his father had ever done anything to hurt anyone. He was just in the way and I killed him for it.
I am on rotation but I am not going back there, ever. I’m not ever again going to enter another home without permission. I can’t kill a boy’s father and expect forgiveness or understanding. I no longer care for anything. Every day creates new nightmares. My friends and family don’t understand. Now my cause is simple. When the sun goes down each day I’m going to sleep knowing that I’ve hurt no one. That I have not added to another’s misery in any way. I’m going to make sure that each and everyday I help someone. That in some small way I have contributed to the wellbeing of another person and helped make their life just a little better. It is my hope that if I can do this for long enough, enough days, then perhaps one day I will be able to sleep in peace and one day I can look at my boy and see only him.
Clinical letter assignment
When you read the clinical case, I want you to imagine that you are not reading it but instead you have a client/patient in front of you and he/she/they is telling you their story. Based on what you “hear” you are required to send me a clinical letter indicating what you believe to be the diagnosis and how or why you came to this conclusion. However, there is a very specific format that you must follow.
1. A cover letter that contains your name and student number
2. The paper WILL have the following subheading:
3. A referral question
4. Your quick autobiography
5. Your clinical opinion
6. A point-form summary
7. Summary and recommendations
Note: you are allowed to create the client’s gender, name, military rank, and age
Under the subheading of referral question:
It is important for a professional to indicate why you have seen this patient. So, create a couple of lines as to why you have been asked to see this patient.
EXAMPLE: Thank you Dr. Lopes for referring this client to my attention. I had the opportunity to complete an assessment on Cpl. Blogins to address the questions of a possible diagnosis, suitability to return to duty, and treatment recommendations.
EXAMPLE:
CONFIDENTIALITY WARNING
Cpl. Blogins was assessed on 2020 November 6th. Cpl. Blogins was notified that the assessment is not confidential, and that a report of this assessment would be provided to Dr. Lopes and the Department of National Defense (DND). Cpl. Blogins was informed about his prerogative to decline to participate in the examination. He was warned about the limits to confidentiality. He was also notified that the examiner does not have a doctor-patient treating relationship with him, and that he is not to assume the existence of such a treating relationship.
Under the subheading of Autobiography:
Many times, it is important for you to indicate your credentials. Why are you the one that is doing this assessment?
So, add a quick paragraph indicating your credentials. Here is the fun part… because this is only make belief (an academic exercise) you are allowed to be and have any credentials that you want. So be creative!
EXAMPLE:
I have 5 Doctoral degrees from various ivy league universities including Oxford and Cambridge. Among my many degrees, I have a PhD. in clinical psychology and an MD with specialization in neurology and psychiatry.
I was the first psychologist in space. My military record includes having served in various military conflicts around the world and I have been awarded the Queen Victoria Cross by Canada, the Congressional medal of Honour by the United States.
Under the subheading of Clinical Opinion:
Here you will be providing the diagnosis and the reasons for it. The best way to do it is when you have the diagnosis, Google it (unless you have a copy of the DSM) to find out the DSM5 criteria for it and see if the symptomology fits.
In fact, use the DSM’s criteria to discuss why you believe that to be the diagnosis (to create the body of your discussion).
offer the client’s own words in quotations to show that he/she is showing signs consistent with a specific symptom required to fit the criteria of a diagnosis. provide a comprehensive discussion which is well written and logically composed. It should be, at least, a few paragraphs long for you to cover your diagnostic discussion fully.
If you feel that the person qualifies for more than one diagnosis you can include that as well.
Under the subheading of Point-form:
This is normally included so that a professional who is about to see a client can have a quick review without having to read the entire report. So, list it in Point-form (without explanations- you already did that in your clinical onion above).
When we had the DSM IV TR we used to call this section the 5 axis.
Axis I: This is where you include any psychiatric diagnosis. (e.g. PTSD, Schizophrenia, Depression, and so forth). You can also add “disclaimers” with your diagnosis (Put them in parenthesis)- the disclaimers are OPTIONAL
Example: Depression (queried), Psychosis (in remission)
Here are a few:
(queried)- That means that you are questioning the possible existence of the diagnosis. You did not have enough symptomology to assign it, but you feel that it is possible that it is there.
(deferred)- Again, that means that you are fairly sure that the person has a diagnosis but you are deferring it to the next professional to examine it closer.
(in remission)- That means that the client may have had the diagnosis in the past but it is not longer apparent. You can also break it down further into (early remission, remission, and full remission) depending of how long it has been.
Lastly, you can informally also add your own explanation in the parenthesis, e.g. Substance Use Disorder (in early remission- in a supervised setting) that means that the person stopped using drugs only recently and because he/she is in prison and drugs may not readily available.
Axis II: This is where you would note a possible diagnosis of either a personality disorder OR intellectual deficiency. Only these two go in here. Nothing else. Quick tip: you client for the purposes of this paper does NOT have an axis II diagnosis. So, don’t worry!
Axis III: This is where you note any MEDICAL diagnosis. Any possible medical history that could be relevant to the Axis I diagnosis. For example: Hyperthyroidism. Depression can be a symptom of Thyroid problems. Again, for the purpose of this paper, outside of the fact that you may note that
your client was shot (on a trauma plate), the client has no other medical issues that you know (don’t create what you were not given).
Axis IV: PAY ATTENTION this is the second part of the paper where you will receive a lot of marks (if you do it right). This is the section where you list in point-form all the Psychosocial difficulties in the patient’s life. Psychosocial issues are a huge issue when you are dealing with mental health. Given that for many of you going into counselling, nursing, social work, or any other profession where this is important, I want you to pay careful attention. This client has a huge bag load of psychosocial issues going on in his life (from the time at war to present with his family). I expect that you will have a very long point-form list here.
Few examples (notice that I’m listing it in POINT-FORM):
Has been to war
Has seen his best friend die
Has killed a likely innocent man
Etc…
I’ll give you one more given that it is hidden (so look for hidden psychosocials as well): At the end, you client’s make statement that are indicative that he may no longer be willing to follow military orders. That means that he could be in the future looking at legal issues such as disciplinary actions if he disobeys orders. So, it will be up to you, in your recommendations, to decide if he is ready or not to return to active duty.
Axis V: Don’t worry about it. This was a weird axis even when we were using it! It was called the GAF (global assessment of function). It was a number between 0 and 100 to indicate where the person’s level of function was at (at the time of admission in a hospital and later upon release). It was not well defined, and most people did not pay attention to it. I’m just adding it here to let you know what the axis v was…. Don’t worry about it.
Under the subheading of Summary and Recommendations:
Here you will add a VERY quick review of the client (a couple of lines to a short paragraph) along with any recommendations that you want to make.
Examples:
You may recommend some form of treatment (psychological or psychiatric)
You may recommend that he be reviewed for the possible introduction of a class of drugs (e.g. antidepressant, anti-anxiety,…)
Do you think that he should be looking at couple’s counselling?
You may want to make recommendations to how DND should proceed. (return to active duty, or not yet, and any other options).
Many of you always ask, “how many pages?”
less than 5 and you have not done your job well and over 10 you have gone way out of what you need to do here.
