Potholes that dot Lawrence streets are just one of many reminders of combat in Iraq, said Felix Zacharias, a sergeant in the U.S. Marine Corps Reserves.

The Kansas University sophomore from Wichita is used to swerving from potholes to save his life. He recalled maneuvering his vehicle around a 15-foot-crater one day last spring in Fallujah, Iraq. The hole was created by a suicide truck that exploded the day before.

Transitioning from a war zone where anything that moves has the potential to kill you to civilian life can be difficult for veterans, their families and the health care providers working to help them.

The nature of warfare in Iraq is prompting changes to health care for soldiers. Richard Selig, the Operation Iraqi Freedom and Operation Enduring Freedom program manager for the Eastern Kansas Health Care System, said health care providers are facing a “neurobiological phenomenon.”

In previous wars, a soldier would gear up for the “fight or flight” phenomenon, deal with a crisis, and then “chemicals of excitation” would subside, Selig said.

Iraq war veterans are faced with a hyperarousal from a constant state of fear and anxiety, which leads to stress disorders, as well as traumatic brain injuries, the signature wounds of this war, he said.

“Our enemy doesn’t wage conventional war with us,” Selig said. “This war is exclusively in an urban setting rather than a jungle,” he said. “There are not clear battle lines, there is no clear-cut enemy … a large part of our casualties are due to IEDs (improvised explosive devices) or VBIDS (vehicle-borne improvised explosive devices). Aside from that, the next percentage of death is snipers.”

Defense mechanism

The hyperarousal causes desensitization, an effective defense mechanism in combat, but a difficult mentality to “turn off” when service members return, he said.

“Oftentimes soldiers will come back and feel incredibly bored and restless,” Selig said. “Nothing in our civilian world approximates to the level of excitement and stress that they are exposed to in harm’s way. There’s nothing here in our world that can approximate that.”

Army National Guardsman Kris Fisk, a 27-year-old Kansas University senior, said the transition to life in Lawrence has been more difficult than adjusting to life in Basra, Iraq, where he spent one year under frequent mortar bombardment.

“Instead of being in a place where you might die doing nothing, you come back to people being concerned with things that don’t matter,” Fisk said.

In Basra, life was simple, he said. He described going into “automatic” as he left the gates of Basra Palace, where he stayed, to conduct a classified mission in a city where traffic and shooting laws are sparse.

“There’s no time or inclination to think,” he said. “You don’t wonder what happened to the car that just exploded.”

He described killing as a “rush like nothing else in the world.”

“But it’s extremely terrible. You never get over the realization that that was a person. I’d say it’s one of the hardest things to live with,” he said.

Fisk said he learned to accept death, his own and others.

“From that moment on the sky was bluer, the grass was greener,” he said.

He said that freedom was an acceptance of being “OK with ceasing to exist.”

“That whole thing has been fading away,” he said.

After he graduates in May with a history degree, he plans to go to Afghanistan for one year with a different Army unit.

Redeployment

Selig said it’s not enough to try and reach out to service members when they return. He said soldiers often are redeployed, which can intensify their psychological problems. The Eastern Kansas Health Care System has a unique agreement with the Kansas National Guard to help soldiers and their families pre- and post-deployment. Selig said it has been effective in improving access and services in the U.S. Department of Veterans Affairs. Inpatient, outpatient and psychiatric services are provided.

“Not every VA has that level of continuum of care,” Selig said. “We just received several millions of dollars in additional funding we pumped into additional programs and development along all those lines.”

Carol Birt, a Lawrence psychiatrist who is federally contracted to help veterans returning from Iraq and Afghanistan at military bases around the United States, has experienced what she calls “chaos in the veterans system” in other states. She is in Sacramento, Calif., helping veterans at Mather Air Force Base and McClennan AFB, where she said funding and organization are needed.

“We are scrambling to invent new programs, groups, treatments, and we are doing all we can do,” she said.

Even with adequate care available, there is still no guarantee veterans will take advantage of it, Birt said.

But being offered so many opportunities to sit down, fill out forms and be evaluated isn’t appealing to some returning soldiers.

Neither Fisk nor Zacharias has sought therapy but said if and when they feel it’s necessary they will.

Both said they have had ample opportunities to see someone and complete a health care assessment.

“You sit through one and you think, OK, they’re looking out for us,” Fisk said. “Sit through three and you’re ready to kill someone.”

Fisk said everyone reacts to the transition home differently and he said he hopes people are mature enough to handle their feelings responsibly. Like many of their comrades, Fisk and Zacharias said they have their own self-help methods, which range from walks and talks alone to smoking and drinking.