I froze when I heard the KA-BOOM . This sound was different from the periodic detonation of incoming mortars and rockets. This was during daylight; it was more powerful, somehow deeper. The metal frame building shivered, dust oozed out of the walls. I glanced at my mental health technician through the office doorway. She was staring back at me, not moving. I primed myself to drop out of my chair and roll under the table if anything else happened. We were both motionless, waiting. After a minute, nothing changed. I got up and glanced across the hallway. The logistics sergeant looked out of the supply room. “Whoa” he mouthed silently. Minutes passed. Nothing else happened. Slowly everyone went back to their work routines. I sat back down at the computer, but I couldn’t focus on my patient documentation. I shook my head, “What am I doing here in Iraq?” I thought. I smiled at myself and recall that not that many years ago, I had left home and headed off to college. A kid raised outside a small remote town, driving a 25-year-old car with four or five colors of paint, undercoat and rust. I had a big plan; become a civil engineer. I had thought maybe I would work at an engineer firm in the big city two and a half hours from home like my oldest brother did. But, years later, here I am in Iraq, in a war zone, a military clinical psychologist . How life twists and turns.

Approximately 30 min after the big boom, an overhead announcement informed us a massive VBIED (Vehicle Bourne Improvised Explosive Device) had detonated outside a security gate followed by an unsuccessful insurgent attack. Fortunately none of ours were killed in the incident. I happened to hear days later, from a patient, the blast was so potent they found not a shred of the driver of the VBIED and only a few parts from the vehicle: the engine block, an axle, and a pretzeled steering wheel.

When 9/11 happened, I had no premonition that what became my 20-year “marathon” as a military psychologist was just past the warm-up stage . I had joined the military, frankly, for financial reasons. I was a young husband and father. We were saddled with student debt from my graduate degree programs. At the time, our immediate financial future seemed to stretch barrenly ahead of us. For my school mates, the most typical path forward would be a 1-year low-pay clinical internship with moves at both ends, and then finding a job after internship. In addition, one would have to find the time and energy to complete a Ph.D. dissertation and then study for and pass the national licensing exam. My decision to join the military meant a relatively high-paying internship , a guaranteed job after internship and family medical coverage. It also meant that I, a farm boy, was launched onto an international pathway.

Over the years, each time the decision surfaced to leave or stay in the military, I found myself thinking about the men and women wearing the uniform and the high percentage of them who dedicated their lives to making the massive bureaucracy function . I also thought how sometimes I was able, in small ways, to help the men and women who smooth that process.

Immediately post-9/11 , the military medical system was energized, but chaotic. There had been plans on paper to manage large scale deployments for years. Reality, particularly as the initial surge settled into a long-term process of deployments, was apparently unaware of those carefully laid plans. I came to understand over and over again, it is the smart, dedicated individual service members who make the military work—individuals from “paper-pushers” to “fuel guys/gals” to “wrench turners” to “eye-in-the-sky watchers.” The military really does work hard to prepare all levels of medical personnel for work in the field. But, once on the ground, the reality is always different.

Deployed life is distilled down to the basics: work, eat, sleep, pee, poop, and a minimum of personal chores. At some sites, there is even a no-pay laundry service, assuming you don’t mind losing a t-shirt or a sock once or twice a month. Some individuals find deployed life disturbing and stress-filled. Deployed life strains every resilience “muscle” they have; every day is a challenge not to fold into oneself and abandon responsibilities. Others thrived in the simplicity of deployed life. Some actually prefer deployed life and are reluctant to return home.

Unexpectedly, a portion of my days were not so different from the work I did every day at stateside assignments . Individual airman, soldiers, sailors and marines come in to share and hopefully shuck some of their burdens: hobbling stressors, too-skinny sleep patterns, or buckets of glitches with spouses or children or friends. Yep, just like my office stateside … if every square inch of horizontal space was spritzed with dust and fine sand 2–3 times per day, the walls were either canvas or cheap plywood, the space was squeezed down to half, furniture was folding tables instead of desks, seating was either plastic shackable lawn chairs or canvas sling chairs or cheap couches covered with burlap-like fabric which wheezed dust every time someone sat down.

The textbook definition of “mental health ” doesn’t apply during deployment . I was regularly called upon to deal with or advice in situations someone thought was “mental health.” There were many examples. Not too many weeks into the deployment, a medical technician started crying and ran out of the ER during an influx of bloodied soldiers. A day-shift leader who wanders through the clinic at odd hours night after night. But when anyone asks him shouldn’t he be sleeping, “Oh, no, I’m good … just checking in.” The distraught buddies of a soldier who died from huffing compressed air. The angry-beyond-words nurses who were handed an unidentified small bundle from a Special Ops helo and it turned out to be a toddler with a severe head injury. Why didn’t they tell us they were flying in a child? The muttering, glaring unit members of a wounded service member who had gathered outside the medical building. They found out the insurgent, who reportedly shot their battle buddy and was currently in trauma surgery, had been shot in the leg, was captured, and was now in the ER receiving care for his own gunshot wound.

To me, above are examples of normal people trying to manage when the craziness of war tromps on their daily life, not the pathology or mental illness popping out. But, all those incidents listed above were “my people” and figuring out a way to help was part of my responsibilities. No textbook held any answers. No classroom or seminar had addressed such problems.

Often I found myself thinking back to various personal and professional mentors who had kindly eased my life. What would they do in this situation? What would they say to console this soldier? Help me think of what to say to a teenager, who just a few hours previously, had witnessed his friend breathe his last after a rocket-propelled grenade detonated against the cab of their truck pulverizing his friend’s face and leaving his skull mushy and misshapen? Tell me how to help a young medical tech who had been assigned to monitor and be with a mostly unresponsive patient with a severe head injury. A patient who was going to die in the next few hours because there was no additional medical treatment to give and there wasn’t a chopper available to fly him to a major medical facility.