A lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.

“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the San Francisco VA medical center. “Everywhere I went, we literally kicked the crap out of them.”

Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.

“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”

But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.

“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”

Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a “rotten outlook” on life.

“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”

Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.

“The war memories start coming back, they start having nightmares,” said VJ Periyakoil, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.

“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”

She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”

Some vets see their pain or PTSD as retribution for their work in the line of duty.

“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”

The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.

But doctors and nurses, just like soldiers, hate doing nothing.

“We talk about the moral distress that we have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for their suffering, the way they need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.

For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.

“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”

He’s not sure if he deserves to be happy.

“That I don’t know,” he said.

His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.

What Vets Want at the End of Life Is Very Different From What Civilians Want 9 November,2017April Dembosky

  • James Higginbotham

    know just how HE FEELS.
    SEMPER FI TO ALL MY FELLOW VETS.

  • juliagrl

    I wish he could go back to Viet Nam with a vet group. The people there are amazingly accepting and forgiving. That could be real redemption.

  • Carolyn Eddie

    My heart goes out to you, incredible service followed by a hard reckoning. Wishing you that illusive peace in your final years

  • Keen

    Sad, I feel for him. He did his duty bravely, another casualty of war, but not in the record books.
    We must remember Ron & millions like him before we blithely send our young people out to kill & be killed.

    • Carol Wright

      This generally is the “reason” so many of us protested the War in Vietnam. We knew this war
      was to benefit the corporation..the gas industrialists.. and at that time young men were drafted, dragged into this horrible conflict whether they wanted to go or not. But we knew every guy had the choice.. Some like Donald Trump could wangle medical deferments (the go play college softball and sleep around, as he bragged he did).

      The common protest chant then was “hell no, we won’t go!”…what if soldiers/fodder simply refused to go, refused to fiht, refused to pull that trigger? The guys burnt their draft card, or fled to Canada. What if…what if…??

  • Judith Bunt

    got it
    sorry
    if youre still here, there’s a reason
    your mission is not yet complete
    you. still have something to contribute…. good luck… and god speed

  • Erik Heise

    I feel for Ron. I hear his story and can only think that he could be one of my stepfather’s friends. I wish there was a place where vets from the Vietnam era could hangout with a fridge full of cheap beer, some quality hashish and some good tunes on the record player and could have fellowship with each other. BBQ every day. Wash away the anger. Wash away the pain. Until it’s time to leave.

  • William Hull

    I don’t understand why some MDs and RNs continue to refer to palliative care as doing nothing–nothing could be farther from the truth.

Author

April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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