Patrick Clary, MD

This user hasn't shared any biographical information


Posts by Patrick Clary, MD

Wounded Warriors: Their Last Battle

Wounded Warrior PinningThe Hospice and Palliative Care Council of Vermont schedules an educational assembly around flag day, Mid-June, at Lake Morey Inn, near the New Hampshire border — it’s a magical place, every meeting room facing the lake a few yards away, the mountains just beyond the further shore, the meeting more dominated by music and art every year.

I was leading a poetry workshop there in 2006 just after my second book, Dying for Beginners, was published, when my cellphone vibrated with a notice that someone with a 406 area code had just left me a message. Since my mother was quite ill on hospice care and it looked like a Missoula number, just north of her home, what we have for a medical Mecca in Montana, I left the workshop participants to struggle with a knotty suggestion for the first line of the poem we were working on, and stepped out by the lake to retrieve my voicemail. It was an oddly familiar voice — but not one of my sisters, and not Dr. G, Mom’s Attending of Record. “If this is the medic who dusted off my sorry ass August 12, 1969 when I got shot in the chest, give me a call back.”

After the workshop ended I called Clark Ferrell at the number he had left. I knew who it was as soon as I heard the voice, really, my first sucking chest wound, carried out of an ambush in the tall green of Long Kanh Province on a stretcher I improvised out of a poncho and two saplings, my ears still ringing with the industrial noise of a close-in firefight. I dusted one of Clark’s stretcher-bearers Sidney Gross off from the same LZ with a grazed arm he’d hardly noticed, his second purple heart, so he would get out of the field: a million-dollar wound.

We were doing cloverleafs in Indian Country. In some ways it was like internship would be ten years later, not much sleep, weeks of boredom, moments of terror. Ironically, we killed their medic in the confusion — he was carrying a standard US-issue aidbag filled with parenteral drugs I had no idea how to use when a grunt brought it to me for my inspection…except for the morphine we had in common.

Later I tore the NVA medic’s souveniered ears off Sparkie’s dog tag chain and threw them into the river. That was the second time I lost my M-16, retrieved by the platoon sergeant who offered a .45 as less likely to be cast aside in the excitement. I can still strip and clean that pistol blindfolded, though I only fired it once in the field and by accident, almost mutilating myself .

The effects of publishing a book are unpredictable — suddenly because of the magic of the internet I was talking to Clark again, the obsessive-compulsive volunteer pointman who would never let anyone else do his job because no one else was as good at it as he was. And he was there living in Missoula, with a bedroom dug into bedrock underneath his house where no car backfire could ever find him, just seventeen miles from my mother’s house in Stevensville where I spend weeks every year, sometimes months if I’m lucky.

Siegfried Sassoon titled his most anthologized antiwar poem “Dolce et Decorum est, pro Patria Mori,” referring to that Latin tag later as “the old lie.” It is not “sweet and decorous to die for one’s country,” but as long as we believe that, as long as we believe that those who fight this country’s battles are heroes “preserving our freedoms,” wars will continue to cut down the young, leaving the old, standing, mouthing platitudes.

It was hard for me to define exactly what about Glassman’s plenary made me uneasy while I was listening to it with tears behind my eyes. The amplified Hueys on her soundtrack were part of the stimulus for my tears — sweet and scary.

Of course I wanted to be welcomed home when I returned from Vietnam, and of course I got rid of my dress greens with their three rows of medals as soon as I could find a Goodwill that would take them, tired of being confronted as “baby killer, mercenary.” In some sense I was a baby killer and a mercenary — but I was your baby killer, your mercenary, doing your work. If you weren’t protesting, if you weren’t in jail as a draft resistor, you were implicated.

Pretending I was a hero and I fought on the “right” side as far as history is concerned will only make the next war more likely. When I am dying don’t call me a hero, don’t tell me you are grateful that I fought “for your freedom.” That lie will only be another injury. I fought on the wrong side in the wrong war, and my dead friends did die in vain except as they died for me; and that is cold comfort, because part of me died with them anyway. The best we thought would come out of that war was less likelihood of more wars and more young deaths. It had nothing to do with freedom and everything to do with pride and wealth…and blindness. When Morley Safer interviewed my platoon with a firefight raging photogenically in the background, asking the non-open-ended question “what do you think of the peace riots back home?” Morehead Sam answered “if they’s rioting for peace, they’s my men.” He was speaking for us, but his answer never appeared on your television screen.

A bereavement services colleague sighed, when the Second Gulf War started, “Not another one, we’re just starting to deal with the carnage left over from Vietnam.” I am absolutely in agreement with Glassman that veterans require special consideration…but let’s not lie to them. What they went thru should put them beyond lies about heroism, and allow us to sit with their suffering, hear what they have to say about that experience without jumping to any conclusions. Calling them heroes is jumping to conclusions. Some might have been.

Let’s not pretend that war is worthwhile in any way when we are not fighting for our survival…and let’s hope that our children won’t find themselves in another Vietnam, or another Iraq…or another Afghanistan. Some are unfortunately already there. God help them.

When Glassman asked veterans to stand up near the end of her presentation I stood, albeit uneasily. One of her volunteers pinned me with a pair of gilt flags, one stars-and-stripes and a blue one with the legend “honored veteran.” She hugged me, and I wept. But I was already wearing a miniature yellow campaign ribbon banded with green at both margins, three red stripes in the center. She didn’t know what that ribbon meant, but my brothers and sisters do. After wearing it for a day to get the feel of it, I took the American flag off my lapel, the last refuge of too many scoundrels…I’ll keep wearing the Vietnam Campaign Ribbon, a more subtle message based on the flag of a country that no longer exists, where 53,000 of us died physically and more lost the lives they wanted…while 3 million Vietnamese lost their lives for nothing more than our ignorance and arrogance. Don’t tell me the Gulf Wars are an improvement: they are only evidence to me that countries have a hard time learning.

With all due respect to Glassman and the VA, I suggest that they listen to their dying veterans more carefully…and if they must decorate pillows or lapels, do so with the appropriate campaign ribbons rather than symbols of our country’s blindness, faux honor and pretended heroism. We were there and that acknowledgment is a start. The rest is our story, not yours. Listen.

Patrick Clary, MD

Medical Director, New Hampshire Palliative Care Service

USARV 1969-1970 (Combat Medical Badge, ARCOM with Oak Leaf Cluster)

Compassionate and Mindful End-of-life Care: A Relational-Contemplative Approach for Clinicians

Roshi Joan Halifax is no longer afraid of getting what the dying have because she has recognized she’s already got it. We are all mortal. Both as a Zen priest and medical anthropologist she has paid 40 years of close attention to the marginalized position of the dying. At Upaya Zen Center in Santa Fe she long-ago established a training program, “Being with Dying,” that approaches the problems of suffering at the end of life by proposing an end to the duality that divides us from the dying. Compassion means “feeling with,” and today she gave us a very fast overview of the sources of our suffering not only as patients but as caregivers and clinicians, asking us “how can we create the conditions that will allow dying people to express themselves most fully?” We have wonderful therapies for physical pain but the “total pain” of losing the world is more difficult.

This can’t be made easy, but we can accompany our patients and loved ones more compassionately by recognizing our own struggles with burnout, compassion fatigue, moral distress, colleagial hostility, and the structural violence of our “system of no system.” Roshi Halifax proposed mindfulness practices as providing another way of relating more compassionately. Contemplative practices can teach us to focus our stable attention in a way that allows our open presence to patients in need.

Mindfulness practices have been established in RCTs as an effective stress reduction strategy. Roshi Joan’s critical insight seems to me to be the need to take better care of our patients by taking better care of ourselves as clinicians and caregivers.

I was left longing for the hour long dharma talks and half-day seminars that have been my previous contacts with her ideas. For more detail regarding the integration of contemplative practice and clinical work, please review the article Dr. Halifax coauthored with Tony Back and others in JPM volume 12 number 12 2009 pp 1113-1117, “Compassionate Silence in the Patient-Clinician Encounter: a Contemplative Approach.” Or better yet, enroll in “Being with Dying.” The 2010 spring session is full. I just signed up for 2011.

Patrick Clary, MD