Night is when suicidal vets usually show up at the emergency room of the San Francisco VA Medical Center. But a few weeks ago, the ER had one who came in at 10 a.m., frantic and saying he had a gun. "He was haunted, desperate," says Chad Peterson, medical director of the center's posttraumatic-stress-disorder team. "He was going to be redeployed to Iraq and said suicide was his only way out." Peterson managed to talk the man out of killing himself and into a program, but weeks later the counselor is still struggling with memories of what the man told him. "How can you sleep after something like that?" he asks. Peterson has spent thousands of hours treating vets who came home from Iraq and Afghanistan with PTSD, and their horror stories have gradually rubbed off on him. "I'll hear about the things they've seen or done, the close calls, and my pulse quickens," he says. "I'll get agitated or feel hopeless because I can't take this person's pain away."
The problem afflicts thousands of people like Peterson who work with combat vets. Some experts call it "secondary PTSD" or "vicarious traumatization"; others prefer "compassion fatigue." The Army's term is "provider fatigue." Although it's not listed as an illness in the standard diagnostic manual, it can be seriously debilitating. Symptoms range from nightmares and "invasive thoughts" to anxiety, insomnia and hypervigilance. Case studies often mention a dread of work, including failure to keep appointments and carry out necessary follow-up with patients; in addition to absenteeism, effects often include errors in judgment, difficulty in concentrating, emotional numbness and religious doubts. The symptoms are part of everyday life to many Department of Veterans Affairs caregivers and to staff at military hospitals like the Walter Reed Army Medical Center.
The military is looking for solutions to the provider-fatigue problem. A 2006 internal advisory on health care for troops in Iraq reported that 33 percent of behavioral-health personnel (counselors and psychiatrists) and 45 percent of primary-care specialists (doctors and nurses) complained of high or very high burnout. The rate among chaplains was 27 percent. Last summer the Army launched a pilot "provider resiliency" program to help cope with secondary PTSD, and Maj. Edward A. Brusher of the U.S. Army Medical Command says the plan is to take the program worldwide. Landstuhl Regional Medical Center in Germany—usually the first stop for wounded troops coming out of Iraq—set up some of the first provider-fatigue workshops after the war began. Similar therapy groups are scheduled for May at Walter Reed.
The VA encourages its personnel to talk out their feelings at weekly sessions, but the stress builds up anyway. Counselors need to know how to spot the problem in themselves, says Matt Friedman, executive director of the VA's National Center for PTSD. "If a therapist finds that they can't listen to another awful war story or that they can't shut down once they're at home with their kids, that should be a warning sign," he says. Fixing the problem can be something else again. Like many others who work with the VA system, Bob Schwegel is a veteran himself. He helps Iraq vets apply for benefits, but it's tougher and tougher for him to continue as he listens to their stories. "I get flashbacks of Vietnam," he says. "Sometimes I have to just get up and walk away." One thing is sure: the VA's problems won't solve themselves. The system is already overwhelmed. Now homecoming vets have to deal with one more kind of collateral damage: traumatized caregivers.