A WORLD APART IN TIME OF WAR Learning Points

Issues Raised in the Vignette Major Romy Bennett has come from being an illegitimate child and low-income woman to attaining the rank of field grade officer and Head Nurse. One night, Tricia, a young staff nurse who reports to Romy sexually assaulted

Trish starts taking diuretics and stops drinking water to avoid using the toilet at night though she knows that dehydration in Iraq can be deadly. Still it would be worth the risk to prevent a similar rape reoccurring. A few days Tricia dies of dehydration. Romy is enraged when the Base Commanding Officer refuses to have DNA tests run on all the male soldiers. Romy becomes the next assault victim but the attempted rape is interrupted, by a Sergeant Major who had been called off the case by the Base CO though he had been a police detective in civilian life. Romy is left afraid, vulnerable, sad, angry, and distraught.

Romy is enjoying an affair with Chief Surgeon. If only COL Bruce would break the news to his wife and make real all the romantic hopes and dreams he has nurtured in Romy for a life of comfort and affluence and travel she could then believe this dream come true. He acknowledges his affair over the phone with his wife, addressing marital frustration, failure and that he cannot forget or forgive a previous affair his wife had years before. COL Bruce is shot and killed defending the hospital compound from insurgent attack. Romy grieves the loss of her lover and the hope for a life they might have shared.

While in Iraq, her exposure to a continuous stream of traumatic combat events, including pain, suffering and death represented in the countless wounds that she and her nurses treat day in and day out have taken their toll. During a call from home, Romy learns that her alcoholic, unemployed husband has been making sexual advances on her pubescent daughter who is bulimic and frequently flees to stay with Grandma, fearing she’d be raped. Romy requests and gets an emergency family leave.

Her homecoming is met with anger, stress and family crisis. It’s a disaster zone. Kate, the daughter, has been expelled from school, and she and Romy’s mother, have kicked Joe out of the trailer home. Kate is angry, and feeling abandoned by her mother in favor of “a stupid war. Who gives a damn about Iraq? Who goes to war?” Kate screams at Romy who is weary from a 16- hour flight. No hugs. No kisses. No welcome home.

Romy attempts to transition back to family and community concerns, but personal issues in individual therapy sessions, and family issues in family therapy seem so futile. Feeling overwhelmed, helpless, and depressed Romy commits suicide.

II. Issues Addressed in Therapy a. Individual Therapy

Sadness and the loss of her lover and of the dreams and hopes for a comfortable life. Traumatic memories from countless wounded soldiers, along with pain, suffering and death. Acute stress symptoms, including depression, guilt and impaired sleep. Frustration, guilt, and helplessness in the unresolved conflict with her struggling daughter. Low self-worth as a woman living in a trailer, and recently married to 3rd husband who was sexually inappropriate with her daughter. Major Bennett and her mother have difficulty communicating with each other.

b. Family Therapy

Daughter Kate feels angry and abandoned. She misses her mother and struggles with peers and school. She reports feeling unloved and abandoned by her mother during this traumatic period when her stepfather was sexually approaching her in the absence of her other’s protection. Kate also feels unsupported in dealing with peer pressure to act out sexually, and low self-esteem and shame from being poor and living in a trailer. Romy’s mother and daughter are upset at Romy for leaving both of them alone with her inappropriate 3rd husband.

Discussion What was done well? What was missed? What would you have done?