Rule Number Two: Lessons I Learned in a Combat Hospital

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Ashley Bowen, February 13, 2012 (view all comments by Ashley Bowen)
This book poses many more questions than it answers-- but in this case, that is a good thing. I do not think anyone knows how to make war "tolerable" and Dr. Squier Kraft's perspective is illuminating. It is not easy to read, tears filled my eyes more than once. However, it is worth picking up for anyone interested in war, mental health, or PTSD.

After reading Rule Number Two I revisited the idea of "triage." Mirriam Webster's Dictionary defines triage as, "the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors" (emphasis added). Although that word only shows up twice in this book, it seems like an appropriate way to think about battlefield clinical practice and as a metaphor for understanding institutional priorities.

Triage as practice and metaphor does not qualify "surviving"-- in this framework, it is more of an all-or-nothing state. Traumatic brain injuries and PTSD problematize "survival"; suddenly quality of life becomes a much more urgent question and one that is incredibly difficult emotionally, ethically, and legally to understand. Battlefield medicine is getting much better at absolute survival (e.g. lowering numbers of KIA or DOW) but has yet to catch up to the less absolute forms of survival.

I think it is worth noting that Dr. Squier Kraft's memoir tells the story of mental health in Iraq. Her story is fascinating on several levels, but ultimately her job was to figure out who needed to go home, who needed basic treatment, and who needed a chance to cry. In fact, she acknowledges that, "In a normal situation, I would have time to work with [a patient] and and help her move toward the appropriate treatment. Out here, I knew only one thing: she needed to go home"(118). In a sense, the mental health care available in Iraq amounted to triage. Had Squier Kraft's story continued to the US' VA system, we might have learned more about the full spectrum (or lack thereof) of care available to members of the USMC. As it stands, her account suggests the ways in which her practice became about maximizing "survivors"-- and for mental health, "surviving" seems to be about returning to the unit.

Finally, four mental health professionals served 10,000 Marines in western Iraq (3). No wonder their job boiled down to basic triage. If we assume that the military saw front-line mental health only as the most basic level of triage, this makes some degree of sense. In a war zone, I completely understand why you might prioritize surgeons and nurses over "shrinks." However, if the goal is to ensure a more holistic survival, the military has radically underestimated the need. On one hand, I do not fault the military for emphasizing absolute survival over the more nuanced quality-of-life interpretation of "survival." On the other, is there a similar kind of "golden hour" (or week/month) for mental health? Could better front-line mental health interventions prevent/lessen PTSD?

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Shoshana, April 17, 2010 (view all comments by Shoshana)
Kraft was a navy psychologist who was sent to Iraq for 7 months. This memoir recounts her deployment. She and her team seem to have spent much of their time doing immediate response for medical traumas, some critical incident debriefing, emergency psychiatric evaluation, and regular appointments. This is described against the backdrop of Kraft's wrenching separation from her young twins.

I would have wished for more technical descriptions of the therapeutic work. While Kraft goes into her countertransference and other emotional responses, I'd have liked to read about this in a deeper context, even if it was in composite cases.

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Ronald Gould, January 1, 2008 (view all comments by Ronald Gould)
This is a facinating first person account of serving in the Iraq War. This book should be a mandatory read by any person even thinking about running for President of the United States in 2008. Imbedded within the book is a first person account of holding the hand, while in medical treatment, of the first Medal of Honor recipient of the Iraq War. More power to the medical doctor author for writing such an honest assessment of her perceptions of the war for which few sacrifices have been made. Thank you Madam Marine!

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Product Details

ISBN:

9780316067904

Author:

Kraft, Heidi Squier

Publisher:

Little Brown and Company

Foreword by:

Gregson, W. C.

Foreword:

Gregson, W. C.

Subject:

Women

Subject:

Psychologists

Subject:

Personal Memoirs

Subject:

Military

Subject:

Social Scientists & Psychologists

Subject:

Iraq War, 2003

Subject:

United States - Women

Subject:

Biography - General

Publication Date:

20071031

Binding:

Hardcover

Language:

English

Illustrations:

Y

Pages:

243

Dimensions:

8.58x5.84x.90 in. .83 lbs.