Invisible war wounds can leave very deep scars

September 20, 2012

by Tom Philpott

On the stage, seated with a small group of wounded warriors sharing stories of grievous injuries and inspirational recoveries, is an attractive young woman with short and spiked blond hair.

When it's her turn to speak, she does so confidently and with a pleasing southern drawl.  Tara Dixon introduces herself as an Army Reserve major and a board-certified trauma surgeon with special training to care for burn victims.

Dixon got some of her surgical training at John Hopkins University in Baltimore and some more at the University of Southern California.  She spent two tours in Iraq, she explains, one during "the surge" at the end of the Bush administration and another in 2010.

At this point, listeners assume Dixon is part of this "Fireside Chat" at the MOAA/NDIA Warrior-Family Symposium in Washington D.C., to give a physician's perspective of the trauma warriors suffer and how, through timely care, they can survive and thrive.  There are, after all, so many incredible stories that have already been presented.  Watch videos at: http://www.moaa.org/wfs/

But Dixon's story is not what we assume.  It is so much more revealing about the impact of wartime trauma.  Given her burn and trauma training, Dixon was based far forward, "as I like to say that means the guys in the tent…working really hard to take care of our coalition forces as well as our Iraqi allies and occasionally some civilians and bad guys."

Surgeons forward, she says, must decide "who needs their leg amputated right away versus risking them bleeding to death [and] hours away from Baghdad or certainly from Germany or any what you would call real medicine…That was my job, my task and my privilege to make those decisions," she says.  U.S. medical forces forward, she assures us, are "incomparable to anything that we have every done, and certainly better than anybody in the world."

That confident tone begins to retreat as Dixon moves on to "some things that I wasn't expecting."  For the enemy in Iraq, this is "not a Geneva Convention war."  Red crosses on medical tents are targets for mortar rounds and therefore must be removed.  "We got bombed a lot," Dixon says.

Iraq also was different, she adds, because a guy you ate breakfast with would become "the guy a few hours later you're trying to repair a hole in his heart or liver or to re-sect his bowel." As a stateside surgeon, she says, "I don't know the people who get shot or stabbed or fall off of buildings.  They come to me [as] complete strangers.  It is a little different to deal with than someone who has been a comrade and a brother."

Then there is the unfathomable practice of the enemy to use children to get inside a base, perhaps to gain intelligence or just to reach allied forces with a bomb strapped to their chests.

"They knew that we had a soft spot for the locals…so we would occasionally see these two-month olds, or two-year olds, brought to us after either being dunked in boiling water or hands and feet burned. And that twists in your head," says Dixon softly.  "You're like, ‘This poor little kid was tortured because his daddy wanted to kill me.' "

At this point in her story, simultaneous with asking ourselves how anyone has the strength to handle this, we realize Dixon is being brave all over again by telling us she didn't.  She's a wounded warrior too, her mind and body fractured by constant assault through two wartime tours.

Adding to the stress, she continues, was having to see "a lot of military sexual trauma unfortunately, the green on green that goes on over there.  That I was not expecting.

"So I did real well in serving over there," she adds. "Made it back in one piece physically.  Had a hundred-percent save rate in both of my tours.  I never lost a coalition force."

The supportive applause ends and Dixon tries to continue.

"But the toll it took on me personally was more…" Her throat tightens with emotion and tears appear for the first time, and not on her face alone.

"I was," she says, pausing and starting again.  "PTSD takes many different forms.  And part of it is the things you've seen, the jumpiness from loud noises…I had some of that.  A more debilitating form is [that] I was obsessed that I was going to kill somebody. I became terrified that this guy I was eating breakfast with [would be wounded too and] I was going to make a mistake and he wasn't going to get to go home to his family."

She became "hyper-vigilant" over the care she provided, reviewing "everything over and over."  She went without sleep.  She lost weight.  She ran 70 to 80 miles a week in Iraq just as an outlet for the stress.

Returning to her civilian job, she couldn't turn off that hyper-vigilance.  She couldn't eat or sleep and spent nights checking her computer, over and over, for lab results on patients or reviewing her surgeries again and again.  Her physical and emotional health deteriorated.

Living in a town with no military, Dixon says, meant "no comrade to talk to, no understanding" to be found when, for example, while carrying groceries through a parking lot, a helicopter flew over and she dropped her bags to rush to wherever, for an imagined moment, wounded would be set down and, once more, their lives would depend on her response.

Six months after returning from her second Iraq tour, Dixon says, "I tried to kill myself" on an overdose of pills.  The physician who had saved so many couldn't save herself.  By then she had sought therapy on multiple occasions through Military One Source, a website touted as an extraordinary avenue for advice and support for military personnel and families.  Yet no therapist could be found with experience treating post-traumatic stress.

"I felt lost.  I felt hopeless.  I was an embarrassment to myself.  I was an embarrassment to my family and," voice cracking into silence for a long while, "I was an embarrassment to the Army."

Even as Dixon recovered at a local hospital, intensive care nurses checked with TRICARE and VA, and could find no facility to give full time care to a woman veteran with severe PTSD.  Her family finally found a private clinic where, after nine months, hope returned.  She got her life back.

Dixon works today as veteran services liaison for The Refuge – A Healing Place, in Ocklawaha, Fla.  She says she is passionate about bringing healing to others suffering from post-traumatic stress, especially veterans.

"It's not uncommon for somebody to call me on the phone and say, "Hey, I need you to call this guy.  He's in a hotel room.  He's got a gun.  But he said he will take your phone call.'

"I'm not a shrink," says Dixon.  "I like surgery because you can cut stuff out and be done with it.  You can't really do that in psychiatry or psychology.  But sometimes it's just being able to hear somebody who's been there, you know.  And so there is hope.  You don't have to give up.  You can live again, and be happy again.  And so that's what I've learned."

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