Author's note
"The Needle” is part of a novel-in-progress, entitled
"Flight Patterns," inspired by a little-remembered episode in medical
and military history: the treatment of psychiatric casualties in World
War II. This fictional treatment is based on historical sources,
including Let There Be Light, a 1945 documentary made by director John
Huston for the U.S. Signal Corps and “A Short Walk with Erlanger,” by
John Hersey, which appeared that same year in Life magazine. The
narcosynthesis scene recreated here is based on an actual session
reported in "Men Under Stress," which the late Drs. Roy R. Grinker and
John P. Spiegel wrote when they served as medical officers in the Army
Air Forces. "Let There Be Light" was censored by the government for
four decades. Published in 1945, "Men Under Stress," continues to be
cited as a seminal study in bibliographies of the post-traumatic stress
disorder (PTSD) literature. Although the situation is based on
historical events, the characters and story are fictional and represent
my efforts to convey the effects of combat on the psyche and the
collective amnesia about that harm.
The
Needle
Around the Don CeSar Army Air Forces Convalescent Hospital, Corporal Francis X. Byrne was known as The Needle.
He acquired the
nickname because of his preternatural skill with a hypodermic
syringe—six inches of glass loaded with sodium pentothal, the
barbiturate Colonel Sears and the other shrinks used to draw out the
demons tormenting their patients, fliers who had survived combat with
everything but their minds intact. Byrne could insert a needle through
the skin into the antecubital vein so deftly they never felt the
pinprick; the other medics liked to say he could nail a virgin in her sleep.
After chow, Byrne
readied the treatment room for Sergeant Winters’ first session. 5C was
a narrow cubicle with a single cot, two chairs, a small wooden table
and, when the blackout curtains weren’t drawn tight, a dazzling view of
the Gulf of Mexico. The patients had their own name for it: the Flak
Juice Suite.
Working alongside
Sears, the hospital’s Chief of Professional Services and Psychiatry,
Byrne saw it all: pilots weeping over the boys they were supposed to
protect, gunners with frostbitten fingers thrashing through dreams that
made sleep impossible, navigators tortured by missed targets or—much
more rarely—targets hit, unseen beneath the clouds.
Byrne had barely
finished high school, but it seemed to him this psychiatry business,
for all the mumbo-jumbo about ids and superegos and psychosomatic this
and psychotic that, wasn’t that complicated. For most of these guys,
Byrne had decided, it all came down to one thing, whatever the docs put
on their charts: they lived, and they were happy they made it, but
couldn’t stop feeling bad about the ones who didn’t.
In this tiny room,
Byrne had learned his lesson about death in wartime. When someone else
bought it, you shook your head, pounded the ground, cursed the sky, but
the truth, the dirty secret way deep down where nobody could see, was
you were glad.
Inside, a little voice
was shouting for joy, delighted that someone else got it and not you.
You were so fucking glad you could have wept, danced a jig, or kissed
the CO for Chrissake. Instead, you moped around base with a sour look
on your face. You divvied up your buddy’s things—fur-lined boots,
smokes, Glenn Miller records, the stuff you knew would go fast if you
didn’t come back from a mission. You got drunk. Most of all, you prayed
that nobody else could see into that crevice in your soul where the
traitor lived who wanted everyone else to die but him.
On the table Byrne set
out gauze pads, a bottle of alcohol, a rubber tube, a kidney-shaped
enameled tray with a sterile syringe hidden under a white cloth, the
ampoules of distilled water, and the yellow powdered pentothal he’d
collected from the locked supply closet behind the nursing
station.Music drifted in from the wardroom radio—Mairzy doats and dozy doats and—
With a backward slap of his shoe, he shut the door behind him. If he
had to listen to that song much longer, he’d be the one cracking up.
Byrne had already
scanned the chart at the nurses' station: Sgt. Winters was a puker.
Upchucking three squares like clockwork. Between meals, always “hungry
as a horse” until the first few bites and then, whoops, all over the
plate, or, if the guys at his mess table were lucky, on his shoes.
Pukers usually sat by themselves, with everybody trying to ignore the
retching so they could finish their own meal.
Winters had been admitted 4 days earlier, along with the
latest crop of returnee airmen who had been referred, with the usual
diagnosis of “operational fatigue,” by the psychiatrists at the
redistribution station in Atlantic City. He was 25 years old. A B-17
gunner. Ball turret. Poor bastard, hanging off the underside like a
hemorrhoid, just waiting to be scraped off by an .88 shell.
Fifty missions over Europe.
Unaffected by first missions, but later developed
anxiety, insomnia, headaches, and loss of appetite. Vomiting began
after his 38th mission, when two wing ships, one carrying his closest
friend, were lost over Berlin. Symptoms include:20 lb. weight loss.
Hand tremor. No organic pathology apparent. No insight into condition.
This was Winters'
first session with the needle. A reconnaissance. Just long enough for
Sears to find the places Winters had refused to go during his
psychiatric history.
The door opened. Sears
walked in, crisp as always despite the withering Gulf Coast humidity,
in khakis and a white lab coat, leading a worried-looking little man by
the arm. In his other hand he held a clipboard and the chart.
Oh yeah. A puker all
right. Skinny frame swimming in a small maroon bathrobe that looked
four sizes too big. Pale-faced with purplish half-moons under his eyes.
“—going to talk about
the things that are bothering you,” the chief was telling him. “Just
hop up on the bed there. Okay, let's slip that robe off.”
Sears handed Byrne the robe. He hung it on the door hook.
“That's the boy. The corporal's going to give you a shot that is going to relax you. You won't feel a thing.”
Sears liked to keep
talking, distracting the men while Byrne made the final preparations,
drawing distilled water into the syringe, squirting it into the
pentothal ampoule to make a 2.5% solution, the test dosage, then
sucking it back in. He gave the needle a final tap and caught the
familiar whiff of garlic.
He reached over for
the rubber tube. In one fluid movement Byrne slipped it under the boy’s
arm, drew it snug against the tricep, and swiftly knotted it over the
bicep. He palpated the skin and watched the veins rise, blue
tributaries swelling on the landscape.
Sears took the chair
on the other side of the bed. He spread the clipboard on his lap. From
the breast pocket of his coat he removed his pen, a gleaming 14
carat-gold Skyline. He uncapped it, checked his watch, and recorded the
time.
Byrne shook alcohol
onto a pad and swabbed the crook of Winters' arm, rubbing back and
forth over the hairless hollow where the cephalic and median basilic
veins branched. He liked to make the swipe a bit rough; it was part of
his secret—using abrasion’s sting to distract from the needle’s
invasion.
Sears glanced up from
his notes. “This won't bother you at all. You're just going to relax,
son, this is going to make you feel better.”
Byrne picked up the syringe.
Winters eyed it nervously. “Man, that's some torpedo.”
“You won't feel a thing, son,” Sears said. “The corporal's got a light touch.”
“If you do, you get a refund,” Byrne chimed in. Their patter, as practiced as a vaudeville act, put the men at ease.
Winters turned towards the wall. “Can I look this way? I like it better if I don't watch.”
“Sure, Sarge,” Byrne said. “There's nothing for you to see here.”
“That's right, son,”
Sears said. “You're just going to talk to me as we go along. You're not
going to feel much of anything else. Just a little bit woozy, maybe.”
By now, after scores
of sessions, the chief didn’t have to signal beyond the slightest nod,
no more than a blink, for the corporal to slide in the needle.
“This may pinch,” Byrne whispered.
Anchoring the vein
with his thumb, he punctured the skin. He felt the needle’s beveled
point pressing against the delicate wall of the vein, like a pencil tip
on the thinnest parchment. He held his breath and pushed through the
membrane to the lumen’s passageway.
Byrne never told
anyone, not even the chief, but he swore he could feel the blood enter
the needle, the slightest current, as it swam up the hollow shaft. He
always waited for the crimson stream to pool in the barrel before
driving the plunger home.
Sears was pilot and navigator, but Byrne felt like the bombardier delivering a payload. He thumbed the plunger and pressed down.
“All right, son,” Sears said as the drug flowed into Winters' bloodstream. “I want you to count backwards from 100.”
Winters looked confused. Sears prompted him, “100, 99, 98—”
Winters nodded. He giggled self-consciously and began to count. “100, 99, 98, 97—”
The counting began the
process, the inversion marking their journey back to the place where
their battle memories played out like the movies and newsreels shown
daily in the in the auditorium four floors down.
“96, 95, 94.” Winters stopped. “93, 92,91,90.”
His eyes drooped, his breathing slowed.
“89, 88, 87, 86, 85, 84.”
Byrne eyed the syringe
and eased off the plunger. He left the needle in the vein in case
Winters needed more. Usually, it took just half a gram of pentothal and
under a minute for a man to stop counting and begin to snore.
“83, 82, 81, 80, 79.”
This was the point
when some men lifted their heads off the pillow and looked around,
blinked—the first sign of a transformation so subtle it didn’t
interfere with their count.
Byrne had seen the
sullen ones, curt, tight-lipped and hostile until the pentothal kicked
in and they opened like floodgates. He'd seen Sears make the lame walk
and the stutterers weep with joy — “God, I can talk. I can talk. I can
talk. Listen to me, I can talk. Oh God, I can talk.” The chief had
taught him about hysterical conversion, the unconscious mind's ways of
using the body to solve a conflict. A crippled arm cannot raise a gun,
paralyzed limbs cannot march into combat; a mute cannot give or respond
to commands. The mind betrays the body and gets itself off the hook.
He’d watched the strong, silent ones weep as they remembered the
ship on their wing break up, turn over and drift into a slow, smoky
spiral, while they prayed for chutes to open, please God, where are the
chutes? The memories had frozen over until the injection thawed the ice
inside; out came the screams, moans, furies, whimpers, the shakes and
shivers, the pitiful cries and the tears, streaming like a mountain
brook in the spring.
“79, 80, 81.”
“How do you feel right now?” Sears asked.
Winters' head fell back on the pillow. His eyes closed. “Whew, I feel drunk,” he said.
“Are you feeling sick to your stomach?”
“Yeah,” he said with a bitter edge. He fell silent.
“Why do you vomit?”
The abrupt question surprised Byrne. Once the drug had taken effect,
most patients needed a prompt to start talking. Sometimes nothing more
than a matter-of-fact statement from Sears: “Your plane's taking off on
the Ploesti
raid,” or “The flak's pretty heavy” did the trick. But
Sears was getting right to it. Byrne remembered the “no insight”
notation in Winters' chart.
“At Atlantic City, they said I was nervous,” Winters answered.
He shook his head. “Bullshit. I could do 150 missions.” The truculent
frown vanished, replaced by a quizzical look. “I think.”
“Why?”
“I'm a goddamn good gunner. Never got me, did they? They blasted away, but we just picked up a few holes. Good old Dickie.”
Sears' pen raced across the page, recording the dialogue.
Winters frowned again. “My goddamn head hurts.” He brought his right hand up to his forehead, massaged his temples.
“Hey, you know what? I'm getting drunk!” He seemed surprised.
Under pentothal, a
man’s mind was like a pinball machine. At times an entire bomber crew,
or a Nissen hut’s occupants, crowded room 5C. Other times it was just
the patient and Sears, penitent and confessor; or just a man on the
bed, shadowboxing with ghosts.
Winters' shoulders
rose in a tense shrug. He pressed his lips together so tightly they
turned white. When he finally spoke, his voice was choked with emotion.
“We got a rotten
deal,” he said, shaking his head. “Fucking officers.” Disdain turned
one end of his upper lip into a peak. “Think you can fly forever.”
A gust of wind ruffled the curtains, letting in a thin bar of bright sunlight that flashed across the cot. Winters ducked.
“Jesus, see that
flak!” he cried. “You can take a bath in it. Here comes one. Hey!” He
was sitting up now, on full alert, body tensed. Byrne bent over and
clamped the syringe with his palm to keep Winters from dislodging the
needle.
Byrne had never seen
combat, but the men who surrendered to his needle had schooled him
well. Flak was the constellation of greasy black blossoms of metal that
punctured the aluminum skin of their planes, shattered their Plexiglas
windshields, sliced off arms and legs, dove deep into their brains,
shredded their balls, gouged their buddies. Flak was the penalty they
paid for invading the enemy’s skies. Long after the missions had ended,
flak bloomed in their dreams.
A thin film of perspiration formed on the sergeant’s face. His eyes
were wide open but Byrne knew he didn’t see the room. This moment, when
the air war over Germany entered 5C, never ceased to stun him. There
was no doubt where Winters was: hanging upside down in the Sperry
plexiglass sphere, his hands grasping the twin wooden handles of his
motorized .50 caliber machine guns, his feet moving spasmodically on
the foot pedals.
“Did it get you?” Sears said.
“No, it got Robinson,”
Winters said. “He was in it.” He craned his neck forward and narrowed
his eyes as he peered through the turret's Plexiglas skin.
Sears said, “What do you see?”
“Robinson's plane,
spinning down. Oh Jesus. How many men we lost now?” He scanned the
horizon, holding his breath. “No parachutes.”
Tears ran down Winters' face but he didn’t wipe them.
He clutched his middle. “I'm sick, I'm telling you. I didn't want to fly this one, you son of a bitch. Take it easy, will you.”
He turned and looked
up. “Let's get the hell out of here, Dickie. This is too much flak.”
Byrne realized he was talking to the pilot.
His hands dropped to
his side and he lay back down. “What's the use?” he muttered. “In five
years you look like an old man. Fucking officers.” He grabbed his
stomach again, wrapping his arms around his rib cage. “I'm sick. I feel
sick.”
Winters sat up,
swiveled again and shouted: “Christ, Dickie, do something, even if it's
wrong. I'm sick. I'm sick. I never got sick in an airplane before.”
Until Sears had
assigned him to 5C, Byrne had never realized how many emotions a man
could experience in a matter of seconds—the pinball bouncing from rage
to resentment, then resignation, sending a ricochet to fear, fear,
fear, shock, fear, rage. Back and forth.
Winters grabbed the handles, his palms flexing as he fired the guns. “Watch it! ME109 coming in. Get him, for Christ's sake.”
He turned his head and looked off the wing.
“You shoot like a
bunch of goddamn rookies,” he said disgustedly. Byrne didn't know if he
meant his buddies or the German gunners.
Winters belched and then gagged, a retching that stiffened his chest and made his pale face redden with exertion.
“I've never puked in a goddamn plane but I think I'm going to.”
He scanned the horizon again.
“We got all kinds of
flak up here. You can get killed by that shit. Just like Robinson.
Where's that smoke?” he said, his voice rising in pitch. “It's awfully
dark.”
Winters jumped, nearly falling off the bed.
“Get me out of here.
What the hell? I feel like I'm drunk, but I don't get drunk. I can
drink any ten of you under the table. Fifty goddamn missions is too
many.”
He lay down on the bed and twisted his head from side to side.
“I'm sick, just like I always feel.”
The wind rustled the
curtains again. This time the beam of light flashed across Winters—
face. He sat up, a look of intense alarm changing his face. He paled
noticeably and began panting.
“Hey, Dick! Hey! Look
at my right arm. It's gone. Did it get hit?” He shut his eyes. “I don't
want to look.” He buried his chin in his chest. “If I haven't got a
right arm, pitch me out.”
“I'm going to throw
up,” he panicked. He reached to his head. “Get your helmet,” he
muttered to himself. He mimed taking the battle helmet off his head. He
gagged. He heaved, once, twice, with such violence that when the spasms
passed it was several moments before he began to breathe normally.
“We close to base?” Winters asked.
Sears didn't look up, but kept writing as fast as Winters spoke. “Almost.”
“Got to get out of this ball,” Winters said. He unsnapped an imaginary harness.
“Easy, Dick. Easy does it, you son of a bitch. We made it. You can't kill me. I feel drunk. I don't fly drunk.”
But the exaltation was
short-lived. He burped again and began to retch. “I'm sick. I'm going
to quit this racket. My damn stomach won't let me fly.”
Winters took quick
deep breaths. He gagged and choked, nearly vomiting. A sour smell
filled the air and Byrne felt his own saliva flow.
“Would you vomit,” Sears said, “if you didn't have to fly anymore—”
Byrne could never
predict when the chief was going to interrupt. Most of the time he
tried to keep the patient responding to the vagaries of his
unconscious, let the repressed experience and emotions write the script.
“Damned if I know,” Winters said.
Suddenly he started to
writhe around on the bed. “Somebody do something quick, even if it's
wrong. Goddamn officers. We don't matter a damn to them.”
His head whipped around.
“There goes another fighter.”
He squeezed the
handles and his arms shook with the recoil. “Think I got him. Hey, take
it easy, Dickie. Am I ever sick to my stomach. This is so stupid.
Flying day after day.”
“Where do you want to go?” Sears said.
“Home.” His chin quivered.
“Back to your wife?”
“Oh boy.” A smile wreathed his face. “She's a good kid. The best.”
“Would you still vomit if you could stay home?”
“How do I know? That's
a silly question. I'll tell you something. Something's wrong with me. I
can't eat or sleep, but don't tell Dickie.”
He dropped his voice
to a conspiratorial whisper. “He'll ground me, for sure. Then I'll
never get home. How long do I have to stay here—” His voice raised in a
whine. “Everywhere I go there are goddamn officers, the sons of
bitches.” He set his mouth in that defiant pout again.
Another beam of light snuck past the curtain. “See that flak?”
Byrne looked at the
chief for the signal to inject more pentothal. Sears shook his head.
Byrne eased the needle from the vein, pressed a fresh gauze pad against
his arm, and slapped a strip of adhesive over it.
Winters would just
keep returning over and over to the same moment, doomed to repeat it,
like a needle in the groove of a scratched record playing the same four
bars.
“Okay, son,” Sears said, his voice loud and firm. “You're going to wake up now.”
Winters frowned.
“The flak's not going to bother you anymore, son. You're out of it now. You're safe.”
Winters opened his eyes. He smiled, guiltily, as if he’d been caught doing something wrong. He looked younger.
“Hey, Doc.”
“How do you feel?” Sears said.
Winters yawned and stretched. “Man, I feel like I've been sleeping all day.”
“What do you remember?” Sears said.
“Nothing really.”
Sears pointed towards
the window. “Well, see the curtain there—” The wind ruffled the fabric.
“See how the light flashes when it moves.”
“So?”
“Well, every time you saw light you thought it was flak.”
“You're kidding?”
“No, I'm not. And you talked about Robinson. And the mission when he died.”
“I did?” He seemed honestly confused.
“Yes, and you also seemed upset with Dickie. Who's he, your pilot?”
“Yeah. Captain Dickinson. He's a great guy. Best pilot in the Eighth Air Force.” He frowned. “I could never be mad at Dickie.”
But then Winters'
expression changed as a gallery of emotions flickered across his face.
Confusion and fear gave way to sadness, guilt. Sears said, “Are you
sure? You seemed awfully angry at him during the mission when you lost
your friend.”
Winters' eyes darted
back and forth until he seemed to come to a decision that set his chin
and mouth in a stubborn jut. He stared at Sears, hatred brimming in his
eyes.
“I can't remember anything, Doc,” he said, daring him to fight.
(First published in slightly different form in Praxis Post, a now-defunct webzine for physicians, in the spring of 2001.)
