Preparing the mind for difficult situations

Lt Col Brian L. Slade started as an enlisted man in the US Army as a diesel mechanic. After he got his commission as an officer he then stated flying Apache helicopters. Shortly after a very long and arduous deployment he decided to transition into the Air Force in an attempt to save his marriage.

His first deployment was for twenty-three months and he had only been married for five months prior to that so for the first two and a half years of the marriage they were separated for two. The problem is often not the separation but when you come back together again and military personnel who are dealing with potential trauma in a very strong comrade type team often find it very difficult to go back to a routine husband, wife and children environment.

Brian’s ex-wife had also had a mental disorder borderline personality disorder so the relationship was really tumultuous. In some ways it was more traumatic than some of the things he was being asked to do in the military because he wasn't as prepared for the dynamics. The military prepares you for certain dynamics that you are going to experience. You are used to a certain regimentation and interaction that didn't work with the relationship.

Brian’s book is about trauma and the reason he wrote it was because when he was deployed as an Apache pilot there were crazy, traumatic, intense experiences that he was exposed to. He started asking why would he experience post-traumatic growth rather than the post-traumatic stress we always hear about. He looked at his peers and although they had the same stimulus they had different results. Brian felt he had grown from his experiences and that they increased his resilience and his ability to see things as opportunities rather than obstacles that would drag him down. Other guys on the alternative end of the spectrum were thinking about taking their own lives - that's a very big spectrum for the same stimulus

Brian’s book outlines seven principles. Things like growing a healthy perspective, how do you do that when you experience things that pull you into a myopic perspective but need to maintain that macro perspective?  How do you build a healthy support system and what does that look like. What are we talking about when we say we need to release hate? That's a big one that we don't really talk about. There are a couple of meanings to it. When you are at war, when you have to kill someone it makes it easier to de-humanise them and make them into something they aren’t. Harboring a hate for them is a coping mechanism but it’s not a healthy one.

As well as releasing the hate for the enemy you have to release the hate for yourself. As we start doing the things that the ugliness of war calls for we start painting ourselves as ugly to, that that's part of who we are. You need to remember that just because you’re there doing things other people wouldn't do it doesn’t make you an ugly person - it makes you a proxy for the people who aren’t suited to doing it or cant do it.

This is similar to a disassociation technique and it plays back to one of the other principals of defining and embracing your honorable mission. Brian’s honorable mission wasn't really to get Osama bin Laden, that was what got him on the plane but realised his honorable mission was to make sure that as many of his brothers and sisters in arms made it back. You are going to do ugly things at times to make sure that your honorable mission is accomplished,

How do we avoid festering, emotional wounds? If you're a banker and go to work and you have a transaction or something happens that's interesting you go home and talk about it. It’s so much harder to do when your job is blowing up twelve people but the fact still remains that your honorable mission is to make sure the ground guys make it home safely. It’s harder to talk about it but that’s how you avoid the festering emotional wound. You just talk about it in a matter of fact way.

Building resilience is never ending. With an honorable mission there’s a beginning and end. There are moments of high adrenaline and then lots of time doing mundane things. The mission allows you to compartmentalise things. There is the focal point that we are looking at and around that are lots of ugly things but when we pull the trigger we have just completed our honorable mission. We know there is lots of auxiliary stuff in there but that stays there because you’re in the ugliness because of your honorable mission. You don't have to take that home with you. Part of that is sharing it. You share it as matter of factly as you possibly can. You use humor because it makes it easier to share. Brian realised humor was his stepping-stone to talking about it seriously. In a way it’s doing the same thing with hate – you’re coping but it’s a positive emotion for coping not a negative one. It's a lily pad to being able to talk about it.

Brian also uses chair flying which is an aviation technique. He added the meditation and role playing pieces to the visualisation aspect. A lot of people will struggle with anxiety if they are visulising a very stressful event so you control the environment through meditation and create a safe space where you plant the things you want to grow and get strong. Breathing exercises help to get in the right headspace and then start to visulise an emergency procedure.

One exercise has a co-pilot and engine getting shot out. In a matter of seconds you need to react to the rotors going down. The co- pilot is screaming in the background and you automatically think that's the first thing to deal with but in fact its number three on the list. The rotor is most important. The flight controls are jammed so that’s the second action then the co-pilot but it all needs to happen in one or two seconds. You don’t get through that by thinking about it. In the leadership world they practice so they get it right, in the military they practice so they don't get it wrong. Things do go wrong but the risk reduction is there. The noisy drama is not always the first thing to do!

You can find out more about Brian at https://www.clearedhot.info/ or find his book Cleared Hot.

 You can listen to the podcast in full and find out further information here. Our upcoming guest list is also available along with our previous blogs.
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Military physician to telehealth entrepreneur

Laura Purdy MD is based in Nashville, originates from southern Kentucky and grew up in Indiana. She did her medical training and first seven years of medical practice in the US Army and when her contract ended she moved into the telemedicine or digital medicine sector. Laura is licensed in 50 states so has patients all across the country as well as four children under the age of nine so she really ‘gets’ things from a working mother’s perspective. She is also an entrepreneur and currently has two businesses in the Nashville area that she owns and runs as well as having been heavily involved in telehealth start-ups as a co-founder, senior advisor and executive.

Laura started her military career in Washington DC where she did her training at Walter Reed Military Hospital before moving to Fort Benning in southern Georgia. She also served at Fort Bragg in north Carolina and Fort Campbell in Kentucky which led her back to her roots. She also spent time in Hawaii, Seattle, Texas and Virginia.

As a physician in the army you can practice at clinics where you deal with children and veterans so it’s similar to working in general practice. Laura did this but also spent time as a unit physician and in a hospital in-patient role dealing almost exclusivity with soldiers or veterans. Here the most common problems were musculoskeletal but there were also heat, blast and war injuries as well as a tremendous amount of mental health and behavioural health disorders.

As well as PTSD and trauma, adjustment disorder, depression and anxiety were very common. Military personnel are constantly being moved around – they are relocated, separated from their friends and family as well as having to live up to high expectations of performance and physical challenges. Work requirements mean early starts, late nights, weekend working and uncertainty about taking time off. Even if you don't experience deployment, war or combat, the military is a very stressful and demanding lifestyle so its not surprising that adjustment disorder, depression and anxiety are prevalent. The family network can also be an asset or a liability as can the quality of the professional support system which can greatly impact the outcomes and trajectory of the people going through a stressful or challenging situation.

In business, mindset and change are often linked together. Some people feel that the military is far more capable of dealing with adjustment because the level of constant change is more natural and frequent.  This can create its own set of problems with constant frequent movement either creating higher adjustment disorder or helping your ability to deal with change.

Laura’s last job in the Army was as Chief Medical Officer of the Warrior Transition Battalion where she was dealing with soldiers who were no longer physically or mentally fit to serve. Over 50% of that population had some behavioural health condition. This may have been the reason for their discharge or it may be comorbid with something else. Whilst there are a lot of people out there who are exceeding, excelling and doing well with that operational tempo, Laura also spent a lot of time working with people who had trouble adjusting – they weren’t a good fit for the lifestyle.

After her seven-year residency Laura knew would not be staying in the military until the end of her contract. She was stationed apart from her husband for the first three years of their marriage and during that period she had a baby and was effectively a single parent for nine months. There had been an option for them to be together so at that point she decided the best thing for her was to leave as soon as her contract would allow. It took eight years for her contract to end and it took a few years to arrive at the point where she wasn't bitter, angry or passive aggressive. She had to get to the point where could make some mature decisions, that she was going to make the best of it and going to choose to get as much out of it as she could.

A lot of people who leave an occupation like the military or after achieving something like an Olympic medal often find it difficult to decide where to go next or what to do with their life. Laura started by deciding what she didn’t want to and then doing a backwards plan. This was how she arrived at telehealth, entrepreneurship and digital health – all were things she felt would be components of a lifestyle and career she could create that would keep her out of the things she didn’t want to do.

Laura feels she is really a businesswoman disguised as a doctor and as a soldier. Her father was a businessman and did his MBA when Laura was in high school. She was really interested in what he was doing as well as in his business so she spent a lot of time discussing it with him. When she graduated in 2008 she was uncertain of what she was going to do but her father told her she should go into healthcare. She had seen the sacrifices he had made to keep his business going so she followed his advice. She then spent considerable amounts of her time getting out of providing healthcare and into the administration and business of healthcare because that was what she really enjoyed.

In the army you have complex problems to solve with fixed or few resources and a short timeframe in which to do it and that's what Laura feels entrepreneurship is.  Innovation, creativity, rolling up your sleeves, self sacrifice and dedication are all values of entrepreneurship so Laura feels her army and entrepreneur careers are directly related.

Laura feels telehealth and digital health are the progression and future of healthcare. She sees healthcare as following the way the banking industry has evolved – we do almost everything remotely, rarely go to the bank and when we do its’ an inconvenience. If healthcare follows that trend, as technology is developed and adoption increases it will get to the point where the first thing we think about in getting care is how do we do it digitally and the last thing we think about, unless its an emergency and needs in-person care is actually going to see someone. Laura feels this will disempower institutions and health insurers and give access to care in new ways and bring cost reductions, increased efficiency and, in some ways, better care. With the progress, changes and innovation there will be a complete transformation in the entire way we do health care.

Every day Laura comes across circumstances where she finds herself reflecting back to people she knew, positions she had, decisions she needed to make, life lessons and values of the military and she feels her military experience has had a tremendous positive impact on everything she does.

You can find out more at https://www.linkedin.com/in/laura-purdy-md/

 You can listen to the podcast in full and find out further information here. Our upcoming guest list is also available along with our previous blogs.
Find out more about our innovative Resilience and Burnout solutions.