Wake Me Up Inside

HELPING SOLDIERS AND VETERANS RECOVER FROM WOUNDS THAT RUN DEEP

Linda Stanley used to love crawling into her bed at 7:40 a.m. after her nightshift as a charge nurse at the 32nd Medical Group in Balad, Iraq. She lived in a sparsely furnished dormitory at the Balad Air Force Base. She duct taped a screen meant for a car’s windshield to her only window to block the sun while she slept. She had a locker, a table she made out of scrap wood and family photos taped to the wall. But it was Stanley’s bed that gave her refuge from the war around her.

She draped her twin-sized bed with a colorful comforter. She reinforced it with a slat of wood to keep the sagginess at bay. She topped it with a foam cushion so she wouldn’t feel the worn out springs that poked through. Best of all, she washed her own sheets so they smelled like Downey fabric softener, rather than the grime of filthy fatigues, masked with military-grade laundry detergent in industrial washers.

One night, however, while she slept, a mortar hit close to her trailer. Even now, six years later, the smell of Downey takes her back.

“I didn’t hear any sirens go off when the mortar hit,” says Stanley, who still prefers not to discuss the details of that night. “All I remember is waking up on the ground and then hearing the sirens. It was the only time I really felt helpless.”

Stanley ’12 (MSN) served as a nurse in the military for 20 years before joining the Hahn School of Nursing and Health Science’s inaugural psychiatric mental health nurse practitioner class. Today, she works in an emergency psychiatric clinic at the VA Medical Center in La Jolla, Calif. She shares her own story of Post Traumatic Stress Disorder (PTSD) and helps other veterans suffering from its effects.

“I share my story and my journey to nurses, residents, doctors, generals and members of Congress,” she says.

“I need people who are taking care of veterans with this condition to understand and have empathy for what’s going on in their heads. If they understand it better, they’ll take better care of veterans.”

While Stanley takes care of veterans here at home, Elizabeth Thometz ’06 focuses on soldiers abroad.

Her work is all about helping wounded troops regain a sense of normalcy in their lives. She helped develop an adaptive sports program for Army soldiers who are part of the warrior transition unit in Vilseck, Germany, a small town in northeastern Bavaria.

Thometz isn’t an athlete, unless, she says, you count the fact that she played basketball her freshman year of high school before realizing that the show choir was more her speed. She was never in the military, even though for a brief period at USD she thought she’d go into an officer-training program for the Marines and worked out diligently with other candidates before deciding it wasn’t quite the right fit.

In the end, Thometz went on to graduate school at the University of North Carolina, Greensboro. She earned a master’s in athletic training and went on to work as an athletic trainer at the U.S. Army base in Fort Jackson, S.C. Nearly three years later, she got a call from a former professor who’d heard about a new job that was being created to help wounded soldiers in Germany.

“Soldiers are taken out of combat or other units and assigned to this unit,” says Thometz, who moved to Germany in September 2011. “Their sole mission is to focus on getting better — to recuperate and heal.”

There are nearly 200 soldiers in the unit. They may stay between six to 18 months, but most are rehabilitated in about a year. Soldiers who need more complex care — either because they have lost limbs, sustained massive burns or severe wounds, or, because their physical injuries are combined with a traumatic brain injury or PTSD — bypass the Warrior Transition Unit altogether and are brought back to the United States.

Thometz has the soldiers swim and cycle, practice archery, play seated volleyball or wheelchair basketball — all of which allows them to be active, increase their heart rates and get an endorphin rush without putting direct pressure on their injuries. They like wheelchair basketball, but also get a lot of benefits from archery.

“These soldiers are used to holding a weapon, but because of things like PTSD, holding a weapon that goes boom is not advised,” she says. “Archery gives them the opportunity to focus on something else, to concentrate on their breathing, on their sightline, on the angles of the wind. It requires a high level of concentration, but gets their mind off whatever else may be going on in their lives.”

Helping these soldiers physically also helps them heal in other areas. Thometz tells the story of a soldier who had a heart condition. If his heart rate increased, even slightly, it would cause chest pain and send him into coughing fits. So this soldier, who had always relied on both his brains and his brawn, had to give up physical activity. He began to gain weight. Every additional pound on the scale and every notch loosened on his belt led to frustration, then irritation, then anger.

“The anger was really built up,” Thometz says. “But once he started playing wheelchair basketball he absolutely loved it. Within a few weeks, he started to lose weight and he started having a better grasp of his heart rate and how far he could push himself before it was time to back off.

“He saw the improvements he made, his overall mood improved and he was just ecstatic,” she continues. “We see the benefits of adaptive sports — not just because of the physical fitness aspect, but the mental and emotional side too. We want soldiers to spread the word to others that they aren’t completely helpless and that they can still do things even if they’re injured.”

Even though an ocean separates them, Stanley and Thometz are doing parallel work: helping members of the armed forces heal from the wounds of war. Stanley patches them up, Thometz rehabilitates them. Between the pair, they cover every aspect of recovery — physical, mental and emotional.

“I have a passion for Post-9/11 veterans,” Stanley says. “I don’t want this generation of veterans to end up like so many of those who returned after Vietnam. I want them to know that there are therapies that can help their PTSD. They don’t have to live with it for the rest of their lives.”

Sally Brosz, dean of the Hahn School of Nursing and Health Science, says it took the school only two short years to launch the new psychiatric mental health nurse practitioner class, in response to requests from the community. She says she’s proud of Stanley’s work — her clinical work, the role she plays with veterans and the decision she made to testify on Capitol Hill on behalf of veterans who, like her, suffer from PTSD.

“She understands the importance of direct patient treatment, as well as political policies that can help patients,” Hardin says. “Veterans are showing more symptoms of psychological stress than those from any other war in history. The work Maj. Stanley is doing on all fronts is invaluable.”

Stanley joined the military in 1990, just months after graduating from nursing school. For her it was a patriotic decision — a chance to serve her country and a chance to practice nursing. Her brother was in the Air Force as a navigator in the Special Forces. Her father was an Army man who couldn’t wait to join. He lied about his age to get into the U.S. Army and, at age 14, went to Europe at the tail end of World War II. He was 16 before his superiors found out about his true age and sent him home. He returned at the age of 18, this time during the Korean War, and served two more years before going on to become a teacher, a principal and finally a district superintendent.

Stanley herself bridged both branches — serving for six years in the Army before switching to the Air Force, where she served 14 more years.

She went to Iraq in 2006 and was stationed in what was known as the Sunni Triangle. She worked at the main trauma hospital — and the only one that offered neurosurgery. Her patients came in with severe burns, head injuries, gunshot wounds, amputations and injuries caused by improvised explosive devises, or IEDs.

The hospital took in an average of 330 traumas each month. Stanley served from January to May and says not a night went by without casualties. Mass casualties, she says, were not uncommon. She wore a weapon more often than not — even in the operating room. She lived with the constant whomp, whomp, whomp of helicopter blades overhead and worked amid screaming sirens, exploding mortars and the ominous warnings over the loudspeakers that let everyone know to take cover, and fast.

“Incoming!”

It all became routine — removing bullets, setting bones, patching wounds. Sometimes in the middle of the night, someone would bang on the door of her trailer calling her into action for an emergency at the hospital. Even on her days off she would find herself returning to the hospital because she knew it was where she was most needed. She was always ready to respond.

“In the military — and in emergency response — your body is always alert and ready to go,” Stanley says. “You learn to go from being in a deep sleep to being revved up to 100 percent in seconds. You always have to be ready.”

It was her body’s natural inclination to go from zero to 60 that eventually made her realize something was starting to go wrong. She began to have nightmares. The sound of helicopters made her tremble. Her body would instinctively go into fight-or-flight mode at the sound of sirens or the smell of burning flesh. For a long time, she brushed it off.

She told herself, “I’m a tough person. I can handle this. Just suck it up.”

She decided that if she could just be with her husband, who was working for the Department of Defense overseas in Italy, everything would be OK. The Air Force told her if she went to South Korea for a year, then she could go to Italy to reunite with her husband. She left Iraq in May 2006 and went to a remote base in South Korea seven months later.

Stanley sought help on a couple of occasions. Once, with a chaplain, and another time she tried to talk with her supervisor.

“I shared with him that I had a few problems, that I couldn’t sleep,” Stanley recalled. “He started tearing up. He gave me a look that I knew meant we just couldn’t go there. He had his own issues. It’s just something we don’t like to talk about so we didn’t.”

Over time, Stanley realized that PTSD was robbing her of her memory. Once, after a long day at work, she came home to study for board exams. She studied for a few hours and, after she closed her books, she couldn’t remember a thing.

For the next two years, she continued to hide her PTSD. She did a good job covering it up, but began pulling away from people — taking odd shifts at work, shopping in the wee hours, heading off for long walks by herself and avoiding people whenever possible. She felt empty inside, numb. She knew she had to get help when a patient died unexpectedly and she, surprisingly, felt nothing.

That was 2009, midway through her tour. Stanley knew it was time to take action. She found a therapist and dove into treatment. She started with prolonged exposure therapy, recording her memories and listening to them six, seven, 10 times a day on her iPod.

“The first month, I actually felt worse,” Stanley says. “Every time I talked about my feelings, I felt like I was getting my leg broken and reset — over and over again. It was hard bringing up those memories and I couldn’t do it without breaking down.”

Stanley is grateful that she kept a journal throughout her time in the military. One entry in particular describes her dedication to her profession, her patients and her country.

“I took care of a patient tonight and I know I will never forget him,” she wrote. “He had been on patrol and lost his foot to an (IED). For some reason, his bloody boot symbolized all the trauma patients that I’m taking care of — the vision of his boot, the sound of painful cries and the smell of death are my senses … I find life in these senses, and it reminds me of what is really important in my own life. I am still glad I deployed and I hope I will always remember these feelings.”

The journal, she explained, was essential in helping her put her memories back together.

“When you’re in fight-or-flight mode, an electrical charge gets attached to that memory,” Stanley explains. “But with PTSD, the memory gets chopped up and rearranged in your brain in the wrong way. So later, when you think of it, the electrical charge causes your body to respond. Prolonged exposure therapy allows you to put all the pieces back together the right way.”

Stanley also found it helpful to paint — she drew a particular Marine’s face over and over again. But what was most helpful was creating a video to illustrate her jumbled thoughts. The song that plays in the background, by the band Evanescence, is called, “Wake Me Up Inside” — a fitting title, given her quest to quell the numbness.

The lyrics help tell her story.

How can you see into my eyes / Like open doors? Leading you down into my core / Where I’ve become so numb / Without a soul / My spirit sleeping somewhere cold / Until you find it there and lead it back / Home / (Wake me up) / Wake me up inside / (I can’t wake up) / Wake me up inside/ (Save me) Call my name and save me from the dark / Save me from the nothing I’ve become.

The video she created shows flashes of her memory — the good, the bad, the real, the imagined — all tangled together in a mass of confusion that perfectly depicted the chaos in her head.

“One minute I’d be happy, hanging out with friends and then it would flash to my trailer blowing up,” she says. “It showed my husband what I was thinking and feeling and it helped my therapist understand why I felt a loss of myself.”

Eventually, she started to feel better.

“After a while I had hope that I would be happy again and feel good inside again,” she says. “I have setbacks, we all do, but after a while it gets easier and easier — and now I can go out and speak to hundreds of people and share my story.”

Stanley retired from the military in May 2010 after two decades of service and enjoys her work with veterans in La Jolla. No matter where she goes, she can often be seen with her service dog, a 2-year-old English lab named Willow, who’s part of the At Ease service dog program at nearby Camp Pendleton, which places dogs in the San Diego area.

“What a dog does for PTSD is amazing. She picks up on how I feel when helicopters fly over and comes to sit next to me,” Stanley says. “She wakes up and is happy to see me. She makes me remember that every day is a new day. I learn from her to live in the present and not in the past. That’s a good lesson in life!” — Krystn Shrieve