Tina Shanahan

I spent 30 years in the Navy as a nurse caring for our Nation’s service men and women. When you’re in the military, you recognize early on the importance of your teammates – and no one wants to be the weak link. Caring for our wounded service members, many times in austere conditions, can be arduous and stressful.  America’s military healthcare professionals are always focused on saving lives and as a result, these caregivers fail to recognize their own needs to be cared for as well.

As healthcare providers we’re trained to identify the signs of mental stress and illness; we just often ignore it in ourselves to help others. We know all too well the signs of PTSD: anger, not sleeping, self-medicating, marital or work problems, all of which when left untreated can result in a rapid downward spiral. Military healthcare professionals may delay treatment or not seek it at all so that they can continue to carry out their mission.  We are trained to be tough and resilient, to serve in times of war or execute humanitarian missions in areas of the world torn apart by natural disasters where there is abject poverty, deprivation, and lack of a healthcare infrastructure.  The needs of those we help are great. So great at times, that the overwhelming and endless demands takes a toll on us.  Sometimes the wounds of war and human suffering affect us tremendously, but it is difficult to admit.  We don’t want to let our shipmates down, so we keep our chin up and keep going.

Recently, a lot has been written about caring for the caregiver.  The COVID-19 pandemic brought to the forefront the stress that healthcare workers must endure.  It’s hard to imagine but this is the kind of stress military health professionals experience for prolonged periods of time when serving during armed conflict.  Sometimes that stress spans 20-30 years.  I personally witnessed symptoms of PTSD in healthcare workers throughout my career.  There were times when I also experienced it: the prolonged exposure to high level stress, long hours, endless suffering.  The times when you feel like whatever you do it simply isn’t enough.  As a military leader, caring for my shipmates who care for others became very personal to me.

Perhaps my most stressful tour of duty was in Haiti after the 2010 earthquake. My unit saw firsthand the aftershock on a nation that was already economically fragile with little or no medical resources.  Where we served, most Haitians did not even have access to clean water.  Many had devastating injuries and no follow up care.  We set up a makeshift clinic in an abandoned school and a line of hundreds of people would form every morning.  The wait for care was long and the weather very hot.  Despite our efforts to pass bottles of water to those in line, many people, including children would simply pass out from heat and dehydration.  It was so hard for us to keep up but we wanted to care for them all.  Some moments were endearing; giving out eyeglasses so someone could see for the first time, seeing that our patients dressed up in their finest clothes because it was an honor for them to see a doctor for the first time in their lives. But so many other days were devastating, and the long hours, terrible conditions, and feelings of hopelessness had a profound effect on all of us. But there was no time to dwell on it as there was barely enough time to sleep.  We would have to wait to process our experiences, as is usually the way for those who serve.  Mission first!

I was surprised to find after returning home that my experience in Haiti had such a lasting but delayed impact on me. The camaraderie of being in a unit always helps while we were deployed.  Everyone is in it together but when we came home, I was taken aback by feelings of despondence and depression.  I felt like I hadn’t done enough, that I should have helped people more, that I wasn’t good enough. I was lucky to recognize the symptoms and was able to speak to someone early on. I needed to hear that my feelings were common and that many caregivers feel this way, but to this day, I still have occasional flashbacks and nightmares where people are depending on me to save their lives but I cannot reach them.

As a senior military leader, I used this personal experience to ensure that I always remained sensitive to the situation of those serving under my command.  Military leaders knowingly ask our service members to step into harm’s way.  We know the experience will be difficult and stressful.  Some may not return and some may return and be forever changed by their experience.  It’s hard for a leader to know that those for whom you are responsible may be struggling – it keeps you up at night. Towards the end of my career, I oversaw over 8,000 healthcare providers comprising the entire Navy Reserve medical community. Upon every deployment, I worried about every single sailor under my command and prayed each night for their safe return. PTSD can be extra difficult to uncover in our Nation’s Reservists because after deployment they return to their normal civilian life, far away from their shipmates and sources of support.  Sometimes they deny any residual feelings, or they self-medicate.  If left untreated, some spiral downward and suicide has been a chosen option for some.  The loss of even one life due to PTSD is to me untenable and we simply must do more. Our service men and women should not have to come home and keep fighting for their lives long after their deployment ends.  Though I am now retired after 30 years of service, this fight continues to be my mission to make sure we are doing all we can to take care of those who serve and protect us. It is important to highlight the fact that it isn’t only those who carry a gun who suffer the stresses of armed conflict.  Our Nation’s military healthcare teams are vulnerable as well.

Breakthrough PTSD research is being done at the National Intrepid Center of Excellence as well as the Department of Veterans Affairs, but research funding is often secondary to clinical care, equipment, and personnel costs.  Therefore, it is so imperative for the military to collaborate with private sector research to enhance our scope and ensure that military members have access to state-of-the-art treatment, because we must do better. Many sailors and soldiers these days are Reservists, and the total disruption of their lives, military service, then re-entry into the civilian sector can mean a delay in triggered symptoms of PTSD, affecting both the military and private arenas.

Collaborations with organizations like the Foundation of Hope that fund mental illness research are essential to help find solutions. The Foundation understands that PTSD and other mood disorders are complex mental health issues, and I’m proud to support the critical need for research around depression, addiction, and other mental illnesses.

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