A Soldier Shot Himself in the Leg

I fought the colonel determined to punish him for it

In 2008, I lived on a remote U.S. Army base, one of three psychiatrists in northern Iraq. Our mental health team consisted of me, two social workers, and four enlisted techs: a small group with limited resources. During my week-long involvement in this soldier’s life, none of us deciding his fate met in person.

“He’d almost left Iraq,” the regimental surgeon said, the first to call me about him. “He was headed out to the plane on the tarmac. Then my boss ordered him back. He wants to court-martial him here.”

Only a commanding officer, not a doctor, can approve a service member’s medical evacuation from a combat zone.

“And he’s not from this base?” I said.

“His squadron is assigned to a combat outpost in Mosul. My boss is having him attached to one of his units on your base because you’re there. He wants a psychiatrist to watch him until he can try him for malingering.”

“Because he shot himself in the leg?” My shock and anger grew the more he explained. No one seemed to consider, or even ask, if this plan was a good idea.

“Straight through his calf. You could see through it. An orthopedic surgeon in Balad patched him up for now, with the plan to send him to Germany for definitive care. Said he was tired of this place.”

I wondered if he meant the orthopedic surgeon or the soldier, but didn’t ask. “This is crazy. He’s a very high risk for suicide. Once you’ve crossed that barrier to shoot yourself…”

“I agree. I’m just the messenger.”

Later that day, I told the doctor who ran the small Troop Medical Clinic on our base about this soldier’s imminent arrival. She immediately worried about infection, bleeding, and all the potential complications. We had no surgeon there to help.

I met Toby two days later. His temporary unit brought him straight to me after he arrived on base. Its commander had already started a suicide watch, so soldiers took turns standing around him all the time. His crutches and bandaged leg already brought attention, and now the suicide watch caused constant shame, not to mention the additional duty it put on other soldiers. The colonel was showing his soldiers how little he could care about one of them.

The soldier watching Toby helped him sit in a chair in my office and then left. Toby had the size to have played high school football, but now, his stocky frame remained slumped over after he set his crutches on the floor. He rested the heel of an exposed foot on the floor. Dirt covered his bandaged calf. At least I couldn’t see any redness around the wound, but it still kept my attention. To me, the hole underneath that bandage was the clearest proof of Toby’s struggles. I couldn’t imagine the emotional turmoil that caused him to point his rifle against his leg and pull the trigger. I also couldn’t imagine the strength of will it took to do it.

He told me he now wanted to kill himself and was waiting for the chance. He’d been depressed for months before he shot himself in the leg and looked like it: slowed speech and movements, blunted facial expressions, defeated. What he’d seen and done over the past ten months haunted him, and he saw no point in treatment with me. When he’d wanted help, his unit’s constant missions had kept him from having time to seek help. Now, he’d rather die than remain in Iraq any longer.

Toby and I agreed he needed to leave Iraq. My boss agreed. Frankly, it seemed everyone agreed he shouldn’t be in Iraq anymore, except for one man. I wanted to talk to this colonel, but didn’t have a number for him. The commander of the unit watching Toby agreed to pass along my message that his soldier needed to leave Iraq and that I wanted to talk.

I met with Toby every day. His resolve to shoot himself again didn’t lessen. One morning, he reached for a soldier’s rifle propped in their living area’s corner, but his injury slowed him enough that its owner beat him to it.

Within a day of sending my message to the colonel, I received the first of two phone calls. A psychiatrist called me from Baghdad. He worked for the colonel’s boss, a general. He monitored the mental health of the general’s several thousand soldiers spread across Iraq, an administrative role. He wasn’t directly treating patients, and answered to a non-medical boss. A physician in such a role can advise a senior leader in ways that improve his soldiers’ mental health, but it can also dangerously shift a physician’s allegiances away from patients.

Being in the Navy, I knew few Army psychiatrists. I’d never met this one. We were of similar ranks, mid-level, a major and lieutenant commander. Many physicians take administrative jobs with non-medical military units to make their promotions more likely. Others have affinities for the regular military, or they want the experience. Maybe they’d been regular officers or soldiers before becoming doctors, or they’d always wanted to be.

The psychiatrist started with normal enough questions: How was Toby doing? What were his diagnoses? Then he told me, with what sounded like sincerity, he didn’t see a reason for Toby to leave Iraq. He began asking me how I didn’t know Toby was faking his depression, made up his story of months-long suffering, to get out of the trouble he was in.

I couldn’t believe that another psychiatrist could put an action like shooting yourself in the leg in an emotional vacuum. People don’t shoot themselves out of the blue. I wished I’d stayed calm and thought of something like that to say. Instead, I asked him, “Have you even fucking talked to my patient? Until you do, don’t tell me he isn’t depressed.”

Our phone call didn’t last much longer. I told him he’d be accountable for interfering in this soldier’s care if he stays and kills himself.

The next day the colonel called me.

“He’s going to stay here, Doc, and it’s your job to keep him safe until I can punish him for malingering and destruction of government property.” He meant Toby’s leg was the property.

“If you’re going to do that, sir, why not punish him back at your home base in the U.S.?”

“Because that’s what he wants, and I have to send a message to his peers.”

“Do you really think soldiers are going to shoot themselves to get home if they see him leave?”

“We’ll try him here and then keep him here for his punishment. He’s not going home.”

I’d found before, at least in the Navy, senior officers determined to listen to their anger over reason only responded to the risk of public shaming. But I needed to remain respectful. My frustration with him couldn’t become the main issue. He had to hear me so he’d hopefully change his mind.

“All right, sir. If you do that, I guarantee you he will kill himself. And, sir, you should know that I’m going to document this conversation in his medical record. I’ll be happy to tell the Army and CNN and his parents and anyone else about it when they investigate his death.”

I can’t recall his exact words, but he went ballistic. I didn’t interrupt. It wasn’t the first or last time a senior officer cussed me out for telling him what he needed to hear. While he ranted at me, I watched a scorpion crawl across the floor of my office and disappear behind a file cabinet.

My boss told me later that I’d caused quite a stir with the colonel. He’d called our command and complained about me. I thought to myself, “What’s he going to do, send me to Iraq?” My boss didn’t mind his response. She agreed something needed to happen.

Two days later, I learned the colonel had changed his mind. Toby was leaving for Germany.

Don’t get the wrong impression. Many senior officers in the military care for their soldiers’ well-being and support them in seeking mental health care. They understand service members struggle against many stressors, both personal and the larger political or cultural implications of an unpopular, unjust war. Plus, they get that good mental health among their soldiers helps them succeed in their missions. It’s what we in military mental health called a force multiplier. During my twenty years, however, I encountered a few Army or Marine colonels or Navy captains who got angry when a subordinate seemed to quit. They took it personally, without considering what was happening for that person. They lost empathy, like when Patton famously slapped his soldier.

I never heard what happened to Toby. The colonel probably still punished him, but I hope he also received the mental health care he needed. At least, he made it home. That’s the best I could hope for in a world that felt like it was fighting against him and my efforts to help him.