Endless Stories We Tell

The summer closes as Covid cases skyrocket. Interviews with exhausted healthcare workers again dominate our media. But now, vying for the attention of our capricious conscience is Afghanistan. Like the virus we tried to convince ourselves we conquered, this country we deemed our enemy will not be vanquished. The images of the desperate flooding the airport, the anguished parent lifting his baby over the barbed wire to the waiting arms of the Marine, sear themselves into our consciousness. We are not done with Afghanistan any more than we are done with the Coronavirus. Despite our fatigue and sense of entitlement, our desire to once more take to the open roads and seas, this is not going away. This demands a reckoning.

War and its consequences pose the gravest threat to public health. This has always been the case. With our mandate to advocate, to speak the truth as we are trusted to do, as a nurse I testify to the wanton destruction, to the heart-wrenching sacrifices demanded by masters of war. Here, then, three strands in the complex and tragic tapestry of devastation: the soldier/students; three vignettes; a call to conscience.

                                                      *

I was a student during the American war on Vietnam. First in high school and then in college, I honed my ethics against images of napalm and massacres and flag-draped caskets on military transports. By 9/11 I was a practicing hospice nurse and a novice assistant professor of Nursing at a mid-size state university in Michigan. On the morning of September 11^th, I drove back to Michigan from Chicago, having just dropped off my three children at their elementary school. By the time I reached Kalamazoo, I was much more afraid of the revenge my government would seek than I was of further terrorist attacks. The next morning I faced a classroom of frightened first-year nursing students, many of them away from home for the first time. As we sought to reassure them, I thought also of how their lives and career trajectories would be indelibly impacted by the freshly unleashed epidemic of war fever. And then our military response began-- a fast and furious assault upon a poor and ravaged country that never ended.

It was not until I left Michigan and assumed my position at the University of Illinois Chicago that the full magnitude of war’s sequelae began to emerge. We saw resources for primary care shrivel as funding poured into research on emergency preparedness and bioterrorist attacks. More ominous still was the influx of new students—mostly male but not exclusively so—who came through our doors fresh from military service, seeking something of the camaraderie and adrenalin rush they had found in conflict zones. In those early years of the wars in Afghanistan and Iraq, it was commonplace for students to cry in our classrooms. I taught Public Health Nursing and the social determinants of health impacted who went off to war and which communities experienced the greatest losses. One of Chicago’s largest VA hospitals stands across the street from our College of Nursing so there was no shortage of wounded comrades from the wars in Vietnam, Kosovo, and the Persian Gulf willing to share their experiences, profound distress, and sense of isolation.  But nothing adequately acknowledged the trauma associated with the wars. We talked about PTSD but the more precise understanding of moral distress and injury was still evolving. Two other faculty (a performance artist from Disability Studies and an Art Therapist from the Department of Psychiatry) and I facilitated a small workshop for our student veterans. We offered the expressive arts as an outlet and as a path to strengthen communities. For a semester in the fall of 2012, we met weekly—writing, drawing/painting/sculpting and doing improv. We called our project Vets Creative Strength (VCS) and it culminated in a small exhibition at the School of the Art Institute in Chicago. There were 12 of us: 6 veterans representing the Marines, Air Force, and Army; the wife of an active-duty Army sergeant, three faculty and two grad students from Nursing and Disability Studies. We disbanded in 2013. The Army sergeant and his wife are long divorced. The Marine was dismissed from the university. One of the Army majors retired with full benefits, married, and began to process her last military duty in Afghanistan: sorting through and returning to the families the personal effects found on bodies in the morgue. Last I heard the gifted visual artist had broken off his relationship and was living in the forests of the Pacific Northwest. When asked if I might share some of his words in the future, the Air Force Captain said this:

These are the journals and thoughts written during the VCS project from October to December 2012. I have attempted to capture some of the flow and format…Please feel free to use my words and thoughts if you feel that will help others in some small way, even if it is just to let them know their thoughts, fears, dreams, and nightmares are not just theirs alone.

The workshop provided comfort and respite but there is no healing from the trauma of wars which draw down but do not end. As a nurse, I found gratification in offering an intervention but I knew it was short-acting and palliative at best. War requires primary prevention. Once unleashed it becomes epidemic. As a nurse educator within the Public Health Nursing Department, I was called to use what was at my disposal. I published three articles calling on nurses to oppose the self-serving tenet of war’s inevitability and actively mobilize against it. I organized weekly vigils between the College of Nursing and the VA Hospital across the street. I designed and taught an interdisciplinary seminar entitled “Peace Promotion and War Prevention.” For 10 years I volunteered with an international humanitarian organization serving the victims of war. Emergency (en.emergency.it) was founded in 1994, the vision of Gino Strada, an Italian war surgeon, and his wife, peace activist Teresa Sarti. And in 2014, under the auspices of that organization, I went to Afghanistan for three weeks. Though the carnage in Iraq had been fierce and the premise for the war fraudulent, it was still Afghanistan that served as the symbol of all that was archetypically tragic about war. As an American Public Health nurse impotent to change the course of my government’s actions and as a hospice practitioner who witnesses the vast sorrow which accompanies even inevitable deaths, I wanted to be there, to stand on desecrated land, to feel the full weight of complicity.

There are three stories from my brief time in Afghanistan I would like to share.

*

I went to Afghanistan to seek atonement and to learn more about the work of Emergency. The closest I approached formal penance was when I sat in the back seat of an Emergency jeep as my Afghan guard denounced George Bush and the American media. My acquiescence to all of his points did nothing to stem the invective. It had been a long time coming and he let it rip and in ways not easily articulated, to bear the weight of his words was a relief.

 

I arrived on the cusp of Ramadan and the international staff at their hospital in Kabul warned me that this was often a time of escalated violence. The final night proved their prophecy. The ED overflowed and they began to utilize the triage tents set up on the grounds. The floors and walls were spattered with blood; I had forgotten how metallic the smell was. I held the hands of a woman with a gunshot wound to her jaw as she shrieked and pleaded in a language I neither spoke nor understood. Later that evening the medical director called me to a back storeroom where a 15-year-old boy lay on a gurney, dying.

 

The director told me he had sustained a fatal head injury and there was nothing to be done for him and there was no room yet in the hospital where he could be transferred. It was so dark I could not see the source of the wound, only that his thick black hair was matted with blood and his body was dirty, smeared with mud and shrapnel debris. Because he knew I was a hospice nurse, the director asked if I would stay with the boy until they could relocate him. I remained with him as a hospice nurse but as I washed his body I wondered about his mother and thought of my son at home in Chicago. I considered as I had so often in raising my children—here but for the grace of God go they, go I. As the night grew later, the pandemonium quieted. I sat by the boy in the dark, his breathing quiet and still rhythmic. Eventually, two transporters came and flooded the room with fluorescent lighting. The boy never opened his eyes, did not make a sound as they transferred him from the bloody gurney to another, both devoid of any coverings. His head bounced as they rolled him across and then one of the transporters turned a hose on the boy, full force. Knowing no Dari I registered a strong protest in English and the transporter responded with what seemed a well-worn and all-encompassing explanation: "DNR"–do not resuscitate. The next morning, I left for the Panjshir Valley. I did not see the boy again.

*

In addition to children mutilated by shrapnel and land mines and IEDs, there were wards of adults injured through other forms of violent conflict. Most were quiet, seemingly resigned. One young man stood out from the moment I met him. He called me by name each time I entered his ward. His left leg had been amputated below the knee after he accidentally shot himself with an automatic weapon provided him by the Marines with whom he was embedded as an interpreter. Far from being depressed, he was ebullient—garrulous with deep brown eyes and a flashing smile. He spoke as he had just arrived from Newark, N.J., his East Coast pronunciations pitch-perfect, his conversation riddled with slang. He told me he would see me someday in Boston. The Marines had promised they would bring him to New York. From there he wanted to see Fenway Park.

*

The Medical Center’s international staff was young, but many of them were veterans of multiple missions in the war-torn countries Emergency served. The head nurse was Serbian and although she looked to be in her early thirties, this was her third mission with Emergency, her second in Afghanistan. The staff living quarters were across from the hospital in Kabul; we crossed the street accompanied by a guard, the women with headscarves and long sleeves, despite the scorching temperatures. At the end of the day, however, the staff cut loose behind the high walls. Dinner was often late and staff stayed up for hours after, drinking wine and bourbon and, with the exception of a soft-spoken surgeon and a nurse, chain-smoking.

One of the non-smokers was Lily. She was British, a bit older than many of the others, and a doggedly dedicated practitioner. She often volunteered for the overnight shifts and she knew just enough cobbled Dari to hold her own. “As Salamu Alaykum” she would call out when she entered the wards. On my last night in Afghanistan, there was a particularly raucous party. I went to bed early and when I arose around 3:30 a.m. to go to the bathroom, I saw Lily sitting by herself amidst all the debris of the revelry. The ashtrays overflowed, and empty bottles toppled among the leftover food. Lily sat with her back to me, quietly eating her dinner, her long night on the wards now over.

The next morning she rose early to say goodbye to me and to change the bandaging on my infected elbow. She gave me a couple of extra dressings for the long trip home, hugged me and I left for the airport.

On a layover in Dubai, I lost my notebook with my boarding pass. I frantically retraced my steps and when I entered the women’s washroom the woman holding the mop who spoke no English gestured toward me, extending my notebook. When I offered her both my profuse thanks and what amounted to a $20 gratuity, she at first demurred but then accepted, her eyes soft and familiar above the veil.

In the Washington, D.C. airport, waiting to board the plane back to Chicago, the well-dressed American woman seated next to me turned to her husband and said, “God almighty, can’t they shut that kid up?” The object of her exasperation sat across from us, awaiting a flight to Detroit. It was a young couple dressed in white Islamic attire, trying to tend to their wailing three-year-old son who had sliced open his finger on a Pringles can. Their attempts to stave the blood with napkins were proving futile. I reached into my backpack and kneeling before them, I applied the bandages Lily had given me, an offering from my time in Kabul, Afghanistan.

*

Gino Strada believed in treating the wounds of all victims of war, regardless of their political affiliation. He also forcefully denounced the root causes of war, often quoting Einstein’s assertion that “War cannot be humanized. War can only be abolished.” When the United States initiated the final, chaotic troop withdrawal from the country against which it had waged war for 20 years. Strada wrote a final editorial which was published on August 13^th, the day he died, in the Italian newspaper La Stampa. He said, in part, that the rapid Taliban takeover “shouldn’t surprise anyone who has a discrete knowledge of Afghanistan or at least a good memory.” Both, Strada maintained, “…are lacking—or, better—both were always lacking. The war against Afghanistan has been—no more, no less—a war of aggression, launched after the September 11^th   attack, by the United States, to which all the Western countries tagged along.” Of the seven years he spent in Afghanistan, Strada said this: “I saw the number of wounded and the violence increase, while the country became progressively devoured by insecurity and corruption."

*

In an essay entitled “The Pain Scale,” author Eula Biss quotes the Reverend James Chase: “Pain is the hurt, either physical or emotional, that we experience. Suffering is the story we tell ourselves of our pain..”

The young Air Force Captain who shared his writing with the Vets Creative Strength Project is now a nurse and a father of two. A few years ago he sent me a more recent piece. He entitled it “take it apart, put it back.” Here is an excerpt from what he wrote:

 

I can demolish a house, rebuild, rewire and recover everything. In the

    Military, electrical systems, Humvees and firearms were always put back into         

    operation with a screwdriver, a solid kick, and some tape (even after I caught   

    fire.) So now I do similar feats with humans...

 

   Those who know me know I am a two-time veteran. Both times mortars were

   my alarm clocks, tracer fire my shooting stars, and heavy body armor my daily

   clothing. War took me apart each time and I’ve been trying to put it all back

   for the past eight years…

 

I went to Afghanistan, in part, to better understand our culpability as Americans in this war we initiated. Nurses, it seemed to me, had a particular moral mandate to speak out against the infliction of violence. As a hospice nurse, I wanted to see how Emergency cared for those who could not be saved. What I witnessed suggested that hospice was a luxury they could not afford. In times of perpetual triage, the care of the unsalvageable was a first-world concern. Some things cannot be put back together.

Long after the pain of the troop withdrawal fades, as summer turns to winter, Afghanistan will be the story we continue to tell ourselves.