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No quick fix

Third in a series.

When Sgt. Loyd Sawyer arrived at Portsmouth Naval Medical Center, Va., after threatening to slit his throat in front of his company’s orderly room, he got just what he needed.

No sharp objects existed anywhere in the ward.

His door did not lock, making it easy for staff to check on him.

And doctors provided medication that allowed him to really sleep for the first time since he had returned from Iraq 10 months earlier in February 2007.

“They keep giving you drugs until you sleep,” Loyd said. “I still couldn’t sleep more than six hours a night, but it helped.”

But after 20 days in the hospital and 11 days of intensive outpatient counseling, he still had a lot of work to do. After spending six months in Iraq processing more than 300 bodies as a mortuary affairs specialist, and after several weeks at Dover embalming just body parts that came in without torsos attached, memories of those experiences overran his mind. Though he was no longer suicidal, the nightmares, flashbacks, anger and sadness remained.

“The first time he went to the hospital, he just wanted everything to be better right then,” said his wife, Andrea. “I think he got angry the first time he came out because he really did want a quick fix. There’s not a quick fix.”

Even after his time in the hospital, anger always won out over other emotions, leading to a yelling match at a Fort Lee, Va., Burger King with Loyd’s sergeant major when Loyd showed up in his physical training clothes to buy a breakfast sandwich.

After getting an explanation about Loyd’s post-traumatic stress disorder diagnosis, the sergeant major became one of his closest allies. But a second spat at the Warrior Transition Unit, where the chain of command placed Loyd after realizing he could no longer function in his job, led to further problems.

The cadre at transition units do Internet training to help them understand the special needs of soldiers with PTSD and traumatic brain injuries, which can lead to anger issues and memory problems.

But after Loyd began messing with his new Velcro unit patch one day, his platoon sergeant got in his face and yelled at the 36-year-old Loyd to write a five-page paper about the importance of the unit patch.

He threatened to kill his new platoon sergeant — and went back to the hospital, four months after his first inpatient stay.

“I didn’t see much improvement until after the second hospitalization,” Andrea said. “The second is usually more effective because they know the routine, they know they will be safe, and they know they are surrounded by people who want to help. They get more out of the treatment.

“The second time, after a week, he was just a whole new person. I finally started to see a spark of life back.”

Therapy that worked

Loyd continued to go to family counseling sessions with his eldest son, Caleb, then 7, who still suffered separation issues.

But he also began spending time with now-retired Navy Cmdr. Beverly Dexter, who served in Iraq during the same period Loyd did, and who spoke with Military Times during her deployment there.

In Iraq, she tried to help soldiers deal with their stress through cognitive processing therapy and eye movement desensitization and reprocessing therapy. But she didn’t meet Loyd until both were back home.

“She talked with me one-on-one about the feelings, the nightmares, my relationship problems,” Loyd said. “She listened, she asked me questions, she made suggestions. It was pretty much whatever I needed that day.”

And she spent up to 90 minutes with him in each session.

First, she used EMDR, eye movement desensitization and reprocessing therapy, an evidence-based therapy, to try to deal with his trauma.

With EMDR, she waves her hand back and forth in front of her patient while asking the patient to think about an event and to follow her fingers with his eyes. She then checks in with the patient occasionally to see how he’s doing and to make sure he does not sink too far into the trauma.

An important part of EMDR, she said, is keeping one foot grounded in reality while touching the edges of the trauma. The hand movement helps the brain process the trauma in both the left and right hemispheres.

“You essentially take the stuck memory and put it in narrative form,” she said. “EMDR allows the brain to work through all the things it needs to work through.”

She likes the therapy because it can be used in a combat zone without distressing troops so much that they can’t return to duty — unlike, she said, prolonged exposure therapy.

EMDR also can be used for veterans dealing with substance-abuse issues, which do not allow for prolonged exposure or cognitive therapies, and for veterans with security clearances who can’t talk about everything they saw — or have guilt issues and won’t talk about everything they saw.

She said the veterans start with a visual image, but don’t talk through this therapy — they just think about it.

Loyd said he believes it helped.

“I don’t understand the correlation of the movement of the eyes,” Loyd said. “We revisit the things that are causing problems. Sometimes, I was in tears. I can get very emotional. But that was rare. There were things I talked about then that were just horrifying, that caused an emotional response, that I can talk about now that don’t cause as much of an emotional response. I still feel sad; I still feel anxious — but not to the point that I’m sobbing.

“The problem is I have [six months’] worth of memories. There’s just so many things.”

Each memory can spark another one, and then he recalls things he had blocked out.

“It’s like a Pandora’s Box,” Loyd said. “The deeper you go, the more you find.”

Loyd said he thought the therapy was effective, but that he was so heavily medicated at the time that he didn’t feel any emotion. He said he thinks EMDR would have been more effective with less medication.

“I didn’t have normal emotional responses because I was drugged,” he said. “I was a zombie. But I started to come off with the counseling, working more with cognitive therapy and controlling my thoughts so that I didn’t have to take medication to stop thinking about it. I didn’t have to rely on the medication to keep my sanity and not beat people’s heads in.”

For Loyd’s cognitive therapy, Dexter tried to teach him concrete ways to deal with his stress.

“You start with thought substitution,” she said. “They may think, ‘It’s my fault,’ but it’s a completely irrational thought. So I might say, ‘If this happened to someone else, would you say it was their fault?’ You allow them to see it from a different viewpoint.”

She also let him talk until he felt as if he didn’t need to tell the story anymore.

She offered up practical remedies. When Loyd feels a flashback coming on — that quickening of the heart and change of scenery that lets him know his mind is heading back to Iraq — he focuses on a fuzzy rubber toy that Dexter gave him. If the toy is not handy, he uses other tricks.

“If I’m driving, I squeeze my steering wheel really hard,” Loyd said. “My steering wheel in my truck is rubber. The steering wheel in a Humvee is really hard plastic. I think, ‘I am not in a Humvee. I’m not in a desert. There is no need for me to be having these thoughts.’Ÿ”

He knows that if he allows himself to float back, he’ll feel depressed and angry and sad for the rest of the day.

“I can do it quicker now,” he said. “But if you get stuck there? Basically it just leads to more and more memories, dwelling. The longer I stay there, the more my heart rate goes up, the more my breathing goes up, the more agitated I get. Once I get agitated, I can stay agitated for hours. Then another little thing will get me more agitated and then some little old lady cuts me off and I’ll just be screaming.

“I have to be very conscious of how many straws are on the camel’s back.”

‘Barriers were coming down’

Dexter also helped Loyd think about his experiences differently. He had been keeping the memories of dead soldiers in the forefront of his mind as a way to honor them. But those memories left him unable to function back home at Fort Lee.

“It helped me try to think more positively about things, not dwelling on the bad stuff,” he said. “Basically letting the past be the past — focus on where I’m at right now. Where do I go from here?”

Medications helped control his nightmares, though he still experiences about one a night.

“I think I’m doing pretty good if I don’t remember the nightmares,” he said. “That was one thing Dr. Dexter taught me. If you’re not remembering it, so what? Don’t worry about it. But the wife remembers it when I’m screaming.”

Dexter believes that nightmares allow patients to work through some of their trauma while they sleep, and she recommends a therapy that allows people to have more control over, and therefore sleep through, their dreams.

Loyd said he tried it and found that the nightmares “aren’t as bad as they were. I’m not as scared when I wake up. My heart rate’s not so high.”

Dexter said Loyd’s case was particularly difficult because he dealt with so much — there weren’t just three or four specific incidents that caused him trauma. There were daily doses of blown-up bodies and young men and women’s faces that created a cacophony of images and memories in a tangled web in his brain. And when his first therapist did not get him proper care, Loyd lost hope in the military system.

“After a while, he became so disillusioned in the system that he got stuck in the past,” she said.

But Loyd’s wife, Andrea, began seeing progress as Dexter worked with him. Loyd talked more with his children. He tried to offer hugs to Andrea, even if he couldn’t necessarily offer the feeling of love that normally comes with it. He tried to help out around the house.

“The barriers were coming down,” Andrea said. “Sometimes they’d go back up. It’s always going to be a cycle. You hope that you have more good days than bad days.”

Loyd could feel it, too, though he quickly realized PTSD, for him, would be a lifelong battle.

“The therapy works if you’re open to it,” Loyd said. “If you’re not open to changing the way you’re thinking, accepting that you don’t have to feel guilty — survivor’s guilt — or learning that it’s irrational thoughts, [it’s not going to work]. Focus on the good stuff. Focus on what you’re going to do.”

NEXT in the series

Loyd makes progress with his therapy, but is so afraid to feel any emotion that he can’t fully reconnect with his family. As he struggles with appropriate decision-making, motivation to get out of bed in the morning, ostracizing himself by spending all his time in the basement with the computer, and not being able to feel love for his family, he and Andrea decide he needs more intensive therapy — a three-month hospital stay.