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Steinberg: ‘Pain is the great destroyer of language’

Dr. Dawn McGuire, a neurologist, writes poetry about the veterans she treats for head trauma.

Dr. Dawn McGuire, a neurologist, writes poetry about the veterans she treats for head trauma. | Provided photo

Neurology, the official journal of the American Academy of Neurology, publishes papers on brain science with titles like “Vesicular acetylcholine transporter defect underlies devastating congenital myasthenia syndrome.”

It also, marvelous to relate, prints poetry. And yes, the poems are peer reviewed.

In 2012 it published “Poems from the Aphasia Cafe,” from a book by Dawn McGuire, a San Francisco neurologist and poet. McGuire’s poems echo her work with shattered minds, particularly wounded veterans — “aphasia” is a term for loss of speech through brain injury. McGuire, who grew up in Appalachian Kentucky and studied at Princeton and Columbia, does not mince words when talking about the vets under her care.

“They come back and are expected to reintegrate without any attention to the fact they are often very young men who have been asked to really split their psyches and do things that the culture and family they grew up in would find abhorrent,” she said. “There’s nothing like boot camp for reintegration, where they can see they’ve been split by these experiences, by what they’ve done, what’s been done to them. There’s no way for vets to re-enter the regular community.”

Boot camp for returning vets is a great idea. We put soldiers through intensive training before they serve, but they’re left on their own when they come home and often need help most.


“About 20 percent of vets coming back from [war zones] have head trauma,” McGuire said. “Seventy percent of the head trauma is from concussions, most of that being too close to an IED explosion. So they can physically look fine, but the blast wave acts as a concussive force, like an auto accident.”

The more patients hurt, ironically, the less they are able to describe what’s happening.

“The veterans I see come to me because they have some neurologic condition, but that might not be the main thing going on,” she said. “It can be very difficult to get an accurate history. Often I have to dig that out. Typically they come to me with pain, and pain is the great destroyer of language. We’re reduced to monosyllabic grunts.”

Pain begets painkillers, opening up new vistas of woe. The pain of injury is dulled by the trap of addiction. Then vets are caught by the latest health care trends as their relief is yanked away.

“These vets are being kicked to the curb. I see it all the time,” she said. “What is frequently the case, they get hurt in theater, are given opiates, then come back and physicians are under enormous pressure, because of the opioid epidemic, not to prescribe.”

Vets sometimes only discover they have been cut off while standing at a pharmacy window.

“They go on to heroin as an alternative when their opioid supply is cut off, and attention isn’t paid to their dependency and the underlying issues of their mood disorder,” McGuire said.

We talked about a lot more — she has a new book of poetry, “American Dream With Exit Wound,” being published next month. It offers fine writing and much closely observed wisdom, such as in the title poem: “She looks at belts differently now. . . . A hole too close to the buckle. . . . Belt, tourniquet, cinch —.”

Or the last lines of “Situation Room:”

Rehab, relapse, rehab.

Every bedroom, ransom.

Every day the war.


On many fronts. The VA scandal in 2014 was about vets dying while awaiting treatment. Not much has changed. An internal study of a dozen VA medical centers released this month found employees falsifying dates. The VA claims 10 percent of vets wait more than 30 days for care. The true figure is 36 percent.

“The VA fudges its numbers as far as time veterans have to wait,” McGuire said. “It’s a bit scandalous, actually. The average wait is supposed to be 30 days or else the vet gets a voucher to go private. The wait turns out to be three months or longer. The Veterans Administration cooks the numbers. We’ve been misled as far as the timeliness of care. And sometimes it’s too late.”

“We’ve been misled.” There’s a lot of that going around.