It’s Not Just Sex

A good approximation of how sex and intimacy is regarded by the U.S. Armed Forces can be summed up in the phrase I heard recently: “If you needed a wife…we’da issued you one.”

These days, the U.S. Army is perhaps the most chaste and constrained military organization on planet earth.  No drinking on duty, no sex, no pillaging, no cavorting…and go easy on the damn swear words.

Contrast this with the Russian Army, and German, which frequently serves beer with lunch; the harder stuff after dinner.  And numerous armies – no joke – provide prostitutes to their deployed troops.  Effectively, a little mini-platoon comprised of practitioners of the world’s oldest profession gets sent to war zones right along with the soldiers.  No doubt this idea  is regarded by these armies as a Godzillian leap up the ladder of human rights.  In the past, when victorious they just raped the women (and men) of their vanquished quarry.  At times, a veritable sexual bonanza was promised as the leading incentive to engage in vicious battle in the first place.

Members of the U.S. Armed Forces by contrast, seem expected to never have sex of any kind.  If sexual organs didn’t come already attached to the bodies of their troops, I’m rather certain the Army would have confiscated all tissue related to human reproduction – and especially the related pleasures of it – on the first day of basic training, relegating every appendage to iron storage boxes next to the gold bars in Fort Knox.  “You can have your clitoris back after your 20, soldier.  Until then, kill stuff.  And like it.”

I’m a happily-married, loyal-to-death-do-us-part, honest-to-a-fault type of husband who, with the perfectly understandable exceptions of Rachel McAdams and Jennifer Connely, can provide infinite assurances to his wife that she has minimal reason to fear infidelity (in kind, if she ever meets Johnny Depp in a smoky, sultry, bean-baggy, beatnik bar…she has my blessing).  That said, I think the “Hooker Platoon” is a great idea.  Presumably, said professionals are well-paid, in control of their lives, and free of drugs.  Like it or not, humans are sexual beings and they go about obtaining it in a myriad of ways.  Might as well make it safe, fair, protected and consensual, even if questionably moral.

But what about the ones who aren’t deployed?  Or the ones who, by choice, remain celibate as they await – with admirable fidelity – their dear lover back home?  What about the people who have returned from over a year’s deployment, waay beyond ready to re-start a healthy, loving sexual relationship with their spouses?

Unfortunately, many soldiers return from war zones with major emotional and physical damage – and major problems having sex.  PTSD, insomnia, chronic pain, depression and anxiety all affect sexual ability.  And these problems are like cockroaches…if you have one, you probably have others.  Worse, the meds used to treat the above problems often severely inhibit sexual function too.  Am I the only one who sees the Faustian irony in “You can be happy…OR you can have sex.  Not both.  Your choice.”  For many (including me), that choice is an oxymoron…emphasis on moron.

While not always the problem, erectile dysfunction is one of the more common issues I deal with.  Given the ubiquitous commercials displaying medically-enhanced virile men, one would think ED wouldn’t be such a problem.  And it is true…a pill can solve the problem sometimes.  Cool, right?  A nice, easy fix.  The problem is that sex is considered by the Army to be something of a sport.  Golf, but morally suspect and generally distrusted.  As if to clarify their position, one of the more odd policies I’ve seen is the meet-you-1/20th-of-the-way idea of providing 6 pills of Levitra per month for up to 3 months for erectile dysfunction.  6.  For 3 months.  Then…good luck.

But 6 pills?  A month?  I know they’re expensive – something like 10 bucks a pill – but who came up with a number like that?  Was he (or she…or it) ever in a loving, happy sexual relationship?  Had it already donated the entirety of its copulation gear to NORAD for weapons testing?  Turns out the decision comes from the Department of Defense.  Yep.  The guys buying fiber-plated bombers and infra-red rifle sights and inventing bombs that suck your inner organs out through your maxillary sinus, are also the ones who decided that 6 sexual encounters a month should keep the average couple happy.

Truth is, for many of my returning soldiers, sex and intimacy isn’t simply a nice addition to their lives after over a year of living in austerity.  It is life.  This seems to be especially true of the committed, married soldiers I work with.  Their marriage, and the love they share within it, is often the only salve on wounds that cover their bodies and souls.  Imagine falling into the yearning arms of your wife after 15 months alone, after encountering horrors on the battlefield you will never describe, only to have to say you’re sorry, you just aren’t the same as you were…even as a lover.

A patient recently said to me (to paraphrase), “My wife and I LOVE to have sex, doc.  It’s an every day thing, if not two or three times a day.  At least, that’s how it was.  Now we spend most of the time we would have spent in bed – or in the kitchen, or in the microwave, or in the neighbor’s tool shed, or on top of the dresser, or under the aquarium, or in the chimney, or dressed up as Tonto and the short curly-haired lady from Cheers – with a counselor, trying to figure out what’s wrong with me.”

Most (not all) healthy, vital, loving relationships are comprised of sex more than just once a week with an occasional “two-fer” on the weekend.  Especially if one of the partners has been gone for over a year.  If returning injured soldiers have anything to look forward to, for many of them it’s their longsuffering, waiting, pent-up, willing spouse.  Divorce is a catastrophe, especially when it’s between a broken soldier and the person who typically is the last one standing in their corner when the world is running down.  Seems to me that we could forgo a couple of those useless air-to-air combat fighters everyone’s arguing about and use the money to give these soldiers as many nights of intimate bliss as we possibly can.

Never Offer To Cut Off Your Own Leg

At least, not in the Army.  They might just take you up on your offer.

Joe (do I really have to tell you that this isn’t even close to the guy’s real name?) had problems with his left leg after 2 deployments to Iraq and multiple exposures to high-velocity trauma.  Lots of problems, shall we say.  The leg often doesn’t work much at all.  Sometimes, this overwhelming feeling of burning pain spreads from his mid shin up to his knee and then pulses up into his thigh for hours.

But what’s debilitating leg pain got to do with being in the Army?  At least, that’s how Joe sees it.  Unlike most soldiers in the WTU, Joe is determined to stay in the military.  He wants to be sent “down range” (deployed) again.  Tomorrow, if possible.  He loves his unit and enjoys the excitement of his job. 

Joe does not understand that a soldier who can’t walk probably isn’t going to do well in a war zone.

Actually, Joe is quite smart.  He understands perfectly well that a debilitated soldier can’t perform a required in a combat situation.  But he doesn’t care.  He loves the Army.  Lives for the Army.  So he has worked with a lawyer for over a year now to keep himself in the Army.  The WTU doc before me has worked to this end – admittedly with some bemusement – for the past few months as well.

Recently, Joe met with a special review board comprised of high-ranking commanders.  They evaluated his chart, looked over the reports of his injuries, and then interviewed him personally.  I think this occurred at Walter Reed Hospital, in Washington D.C. in – the Mecca of Army Medicine.  As you might imagine, this was a big deal.

I don’t know the exact specifics of that interview, but here’s my reenactment:

“Soldier, you’ve served your country well.  We thank you for your sacrifice and heroism.  After thorough review of your file, we have determined that you are no longer qualified for active duty and will therefore be separated from the military with full medical coverage and benefits.  You will be given an honorable discharge and should have no problems entering civilian life.”

“Sir, it’s the leg, right?  That’s the problem?” Says Joe.

“Correct, Sargent.”

“What if the leg wasn’t a problem?  What then, sir?”

“Why, you’d stay in the military, Son!  Send you down range week after next.  Get you back in the fiiigght, boy!”

“Then cut it off!  Just cut the damn thing off!  I can run on a prosthetic.  There’s less to clean up if I get crosswise of an IED (roadside bomb) again, right?  Just send me down there with a couple of extra legs in my pack and I’m all good.”

This – honest to God – is a relatively faithful reenactment of this soldier’s conversation with his Army superiors.  Admiring his courage and commitment, I was more surprised to find that, following this meeting, our doctors in the WTU received this order from on high:

****de, de, d, d, deeeee —Official communication from High Command:  SGT Joe to be referred to surgery for evaluation of chronic leg dysfunction and pain.  Consider surgical correction.  Amputation a viable option.——-de, d, d, deeee,

***** Stop.

Gotta Love Pain

You can get all kinds of things by being in pain.  Especially here in the U.S., where pain is considered the “fifth vital sign.”  I have a colleague in Japan who said they never treat chronic, non-specific pain with narcotics.  Not so here.  You can totally work the system, too.  Narc addicts barely even have to try these days.  Did you know you can be admitted to hospitals with the diagnosis of “pain”?  You don’t even need a source.  Just pain.

Here’s a recent paraphrase of a conversation I had the other day:

“How are you today, Mr. Davis?”

“I’m still in pain.”

“Do you think you can go home?”

“I really truly wish I could, you know.  But.  I’m still in pain.”

“I think you’re probably better.”

“No.  Pain.”

“You sure?”

“Yep.  10 out of 10.  Worst ever.”

“Like, the kind of pain you might have if someone poured acid all over your body and then threw you into a wood chipper?”

“Wow.  How did you know?  Yeah.  Just about like that.”

“Where?”

“All over.  It won’t go away.  You haven’t done anything to help me.”

“I’m not sure there’s anything we can do.  I really think I should send you home.”

“Ok.  Fine.  The pain is centered around my chest on the left side and I’m pretty sure I’m going to kill myself over it.”

“Congratulations, Mr. Davis, you’ve just earned yourself another 4-6 days in the hospital while we work up your suicidality and chest pain.”

“Thanks.  You’re a great doctor.  When can I have my meds?”