“ Post-traumatic stress"

The Real Cost of War

By Mark Boal

Looking back, Adam Koroll was not surprised when he heard the news that Jacob Burgoyne had stabbed a fellow soldier to death. Private Burgoyne predicted he would do something like that during their very first meeting at the Army hospital in Kuwait. Koroll, a medic, listened intently as Burgoyne, his patient, explained himself: After what he had seen and done in Iraq, he had little to lose and even less control over his reactions. He already felt, he said, like "a murderer in his heart." Why not kill again?

Koroll, 23, a National Guardsman in the sixth month of his first tour, was working as a mental health nurse. He recalls the young desert-tanned soldier, fresh from the fighting on the other side of the border, slumped on a rickety bed in a drab room at the 865th Combat Support Hospital. At first glance Burgoyne appeared to be in outstanding physical shape, a six-foot blond warrior with a muscular build and a buzz cut -- he was what the Army calls a trigger puller. But Private Burgoyne was hunched over, holding his head in his hands; tears were streaming down his lean, hollow cheeks as he spoke.

"I'm going to do a quick check of your vitals," Koroll told him. He ran his stethoscope over Burgoyne's chest and back, listening for abnormalities in his heart rate. The medic tried to make small talk as he worked, but his patient's behavior disturbs him to this day. Burgoyne would crack a joke and laugh, and an instant later his face would tighten into a snarl. He'd rant about killing women and children. Tears of remorse would pool in his eyes. Then he'd come back to another nasty joke.

But no matter what shocking act of violence Burgoyne described, his eyes remained flat -- "dull and vacant," Koroll recalls -- even when they were wet from crying.

psychological injury of war. ” Burgoyne had been brought into the hospital by one of the other soldiers in his unit after he had been found doubled over in his bunk, having tried to kill himself with an overdose of antidepressants. The attempted suicide, plus the lack of expression in his eyes and his "rapid cycling behavior" from rage to grief and back to rage, were the symptoms of a dangerously ill man. Koroll sensed he was looking at a severe case of post-traumatic stress disorder, the clinical term for someone who continues to experience trauma long after the event has passed. This reexperiencing of the original event can take the form of insomnia, flashbacks, paranoia, panic attacks, emotional numbness and violent outbursts.

These symptoms are treatable, Koroll knew. If he could transfer Burgoyne to a safe, comforting environment, the young man might be restored over time to full health and capacity. That meant getting the soldier out of the dusty chaos of the Kuwaiti Army base, where he was temporarily stationed after a bloody tour in Iraq, and sending him to a hospital in Germany where he could rest on clean white sheets in a quiet room in a first-class psychiatric facility.

It was Koroll's job as the on-duty nurse to make the decision about whether to evacuate Burgoyne. He was ready to do it based on what he'd seen. But he needed to ask one final question before he could order the evac in good conscience.

"So," Koroll said, "right now, at this moment, do you have thoughts of harming yourself or others?"

Burgoyne, he remembers, looked up through those flat, vacant eyes and said quite clearly, "Yeah. Yeah, I do."

Koroll picked up the soldier's chart and wrote in a clear hand, "Evac."

photo: Thomas Dworzak/Magnumphotos

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