When I started reading this book, I didn’t really know what to expect. I was interested in the topic because our world is full of so much war and so many people are involved with the efforts. Recently, I’ve read a few books set in World War II, a time from which we are quite disconnected though the stories are still so fresh for some people. So when I picked up Erik Krikke’s memoir and saw the title “Surviving PTSD and moral injury” I didn’t know what I was getting myself into. The image in my head of people who experience post-traumatic stress disorder has always been that of soldiers on the front line, because that is how it has always been framed to me. I have seen stories in the news and seen films about how difficult it is for front-line soldiers to reintegrate back into their old lives, and how that can lead to serious mental health issues and even lead to suicide. Krikke’s memoir weaves through his experiences as a nurse in the operating rooms of a third world war hospital. The hospital in Kandahar where he worked was barely equipped with proper measures to ensure the degree of sanitation we expect in Western society operating rooms, and this opened my eyes to a world of war that many of us even forget exists. We often see and focus on images the front lines or the devastation from bombings and shootings which affect innocent civilians in (sometimes remote) villages and cities. We then hear stories from those who survive these vicious attacks, with the trauma and sometimes even missing limbs. What we don’t see or hear about is what happens when the injured are taken to the place where there are teams of people equipped and ready to make sure they survive. We don’t hear about the medical teams who are among the first people to hear about attacks, those injured, and ultimately casualties who sometimes don’t even make it to the hospitals prepared to treat them. What Krikke’s offers readers in the first half is an actual retelling of the experiences of someone who has been there. Krikke shares days in surgery that most of us would never expect to ever hear about, sometimes with lengthy and graphic detail for which I was admittedly not prepared for. Through his recollections, from his early days to the thick of his deployment, we are offered a glimpse into the mind of a person at war: not only the tangible war they are physically part of, but the war that is raging inside their own mind. In the second half of the book, Krikke brings to light the pieces of his puzzle that lead to a PTSD diagnosis and his treatment. What was really important for me was to see that the compassionate and therapeutic resources that he was offered seemed to be available and useful because he sought them out. This story is so important. Krikke was lucky to have been able to recognize that something wasn’t right with the help of his family, friends, and therapists. I hope that his story will open the conversation up for more people who come home from war-torn countries and experience similar things.

In 2007 Lt. Erik Krikke was deployed to Afghanistan for three months as an operating room nurse. Like so many soldiers sent to combat zones, he was mentally unprepared to deal with the horrific realities of war and even less prepared to deal with his return home while mentally still in full combat mode. Hoping to help others dealing with PTSD, Erik bares his soul. Erik is assigned to the NATO hospital at the Kandahar Airfield. The hospital policy is that wounded coalition forces will be stabilized and then evacuated to a higher level of care. Only the vital urgent surgery will be performed on coalition members. Most of their surgical cases will be Afghan soldiers and police and civilians. He is aware of stories of people experiencing PTSD after deployment. But it won’t happen to him. He will basically be doing the same work in Afghanistan as he does at home. But the circumstances will be so different. He writes of the devastation gunshot wounds and blast injuries have upon the human body. Time after time he questions if they are really helping an Afghan patient (whether an Afghan soldier, policeman, or child) when they amputate their legs, thus sentencing them to a life of begging. They will not be able to work and support his family. Patients beg the doctors to kill them rather than amputate their legs. He describes how blood collects under the operating tables, how they shove amputated limbs into red plastic bags and store them in a container along with all the other amputated limbs. He asks himself “Has the desensitizing started now that I don’t find this situation strange anymore?” He is starting to feel numb to the patients and their injuries.

I read this version in a record time! It is raw, pure and full of emotions and I will read it again (and probably again). Wow! Rebecca van Stalle

Surviving PTSD & Moral Injury is a nonfiction memoir written by Erik Krikke. Krikke had reluctantly come to terms with the likelihood that he would be deployed as part of NATO's Multinational Medical Unit, Role 3. Those at the hospital where he was currently assigned, who would have been called up before him, had either retired or been transferred. He was an operating room nurse who had been a member of the Netherlands Army for almost fourteen years when the call from the head of the surgery department reached him. Some colleagues congratulated him on what some said would be an adventure and a professionally rewarding experience, but Krikke would far rather have stayed home with his wife and two small sons. His three months in Kandahar were everything he feared and much more. Krikke soon realized that his group would not be given the same amount of support with acclimation and adaptation as the regular troops received. The adaptation program had for some reason been dispensed with for their team, leaving them to experience their frightening new world feeling more isolated than ever. The plywood hovel they called a hospital leaked in streams when it rained, and desert dust was an inevitable part of the very air they breathed. Worse yet was the steady inrush of horribly injured combatants, soldiers, and children. Krikke soon learned to both expect and to dread the victims' urgent entreaties to let them die rather than remove a leg. While his deployment was limited to a three-month stretch, the ramifications of that time in Kandahar and the resulting PTSD would affect him for many years to come. Krikke had grown up valuing his strength and self-sufficiency, but he nearly lost his life to PTSD, only finding it again through the help of the Veteran's Institute and the friends, family and therapists who worked so closely with him. Erik Krikke's nonfiction health memoir is an intensely powerful and honest account of one medic's struggles with a disease that still remains closeted and denied by many. As I read this book, I would occasionally remember watching the television series, MASH, which was about a medical unit during the Korean War. While the show was big on comedic touches and the antics of off-duty medics, it also showed them constantly listening for, and instantly springing up, whenever the distant noise of choppers began to filter in, and the theme song, Suicide is Painless, struck a discordant and prophetic tone. Krikke's story is harsh, gritty and real; he pulls no punches in describing the awful insanity of trying to fit oddly heavy limbs into plastic bags, and his growing discomfort at finding he cared more about saving some patients' lives and limbs than others. He's also infinitely generous in sharing the aftermath of that deployment, and the steps he's been taking to survive his PTSD and understand the moral injury which compounded it. This intense and gripping memoir focuses well-deserved and overdue attention on the medical personnel, whose own mental health issues as a result of their service, are often overlooked. Surviving PTSD & Moral Injury is most highly recommended.