284 Grief and Loss Across the Lifespan
became grief-stricken and in a very low and halting manner he said, “I saw
Bob die that day... .” He gently pounded on his leg saying, “When they take
this leg, it will be like losing my finger and Bob all over again.” He admitted
that he was having nightmares of the artillery exploding. He was afraid to
share the story with his “sweet and loving” wife. In fact, he never talked to
people outside of other veterans about his experiences; he said, “You cannot
understand unless you’ve been there.”
Subsequent visits found Wesley increasingly despondent. He was now
using oxygen. He knew he only had a few weeks to live. He did want to die
at home. He seemed more agitated; he wanted to stop the dialysis treatments
because it meant a 120-mile round trip to the closest dialysis center three times
a week. He was concerned about the toll these trips placed on Betty. In the final
weeks, he was sleeping more, and eating less. With the termination of dialysis,
Wesley’s loss of energy was quite noticeable. When I would visit, we would
reminisce about his military days and his life with Betty as best he could; he
did not want to discuss his impending death. He felt death was a fact of life
and he could do nothing about it. He did invite Betty to join our sessions to
share some of the learnings he had about his military experiences and how
it impacted his life and marriage. He brightened only when he spoke of his
children and mentioned that he had been dreaming of the children who died
many years before. He said those dreams were replacing the nightmares of his
military time he was having a few weeks earlier. Betty was by his side when
I left him the last day; she called me early the next morning to tell me Wesley
had died during the night.Discussion of End-of-Life, Terminal Illness, and Military Service
The recognition of Wesley’s role as a military veteran was pivotal to working
with him and his wife. Issues of his military service came to the forefront as
his current losses in functioning seemed to recapitulate the past traumatic loss
of his best friend in WWII and his own physical loss of his finger. Research has
revealed that PTSD is often underdiagnosed in WWII veterans and that stress-
ors that appear in later life may exacerbate the condition (Bonwick & Morris,
1996) or lead to a late-onset stress symptomatology (LOSS), a phenomenon
among older veterans that Davison et al. describe as “having (a) experienced
highly stressful combat events in early adulthood; (b) functioned successfully
throughout their lives, with no chronic stress-related disorders; but (c) begin
to register increased combat-related thoughts, feelings, reminiscences, memo-
ries, or symptoms commensurate with the changes and challenges of aging,
sometimes decades after their combat experiences” (2006, p.87). Furthermore,
aging veterans may have either late-onset PTSD or have been living with PTSD
for the past 50 years or longer following combat. For others, the symptoms
of PTSD may increase with age. The VA has recognized that having medical
problems and feeling not as strong as the veteran used to be also can increase
symptoms (www.ptsd.va.gov/public/pages/ptsd-older-vets.asp).
Wesley never had a diagnosis of PTSD on any of his military or health
records and despite occasional “bad dreams” as he called them, he never sought
treatment. His health was clearly declining with the progression of disease.