Have you ever been in the presence of someone having a severe flashback to a war that was fought over forty years ago? Let me paint a picture for you. I’m visiting a patient because he has had a really bad week and may need to be admitted to hospital if his mental status doesn’t improve soon. My patient is a very big guy at about six feet, four inches tall. He weighs well over two hundred fifty pounds. He is cowering in fear of being shot at in a far away jungle. The issue is that the jungle is in his head. To keep himself “safe” he is currently hiding behind a couch that he’s moved to the center of his living room. His wife has witnessed episodes like this too often in their long marriage. Tears stream down her face as she tries to wash the dishes. As if everything that’s happening in this moment is normal. As if washing the dishes makes everything happening in this moment normal.
“He’ll be fine in a few minutes,” she manages to squeak out, “he usually comes to when he realizes he’s behind our furniture. I’m not sure what triggered him today. It doesn’t take much. This is the third or fourth time he’s ended up having a flashback in the last couple days.”
Sure enough, within a couple of minutes, the patient comes back to the present. Audibly exhausted, he calls for his wife. She leaves a dirty dish in the sink, shuts the water off, and opens a kitchen cabinet. She removes a small lock box from the cabinet and turns to move into the living room.
“You’re okay. You’re okay.” The patient’s wife repeats this mantra as she moves to the other side of the couch. Her husband is soaked with sweat and hoarse from this episode. Together, they plop down on the couch and take turns sighing deeply.
According to the U.S. Department of Veteran Affairs, an estimated 31% of male Vietnam War veterans suffer from PTSD. My patient in this story is a Vietnam veteran. He was drafted, plucked from his home in upstate New York when he was barely nineteen years old. He was shot at in the deep jungles of Vietnam. His young friends, mostly twenty-somethings, were killed. He was one of five survivors in a platoon of over forty men. And he relived this nightmare nearly every day depending on his stress level. Beyond this, he didn’t sleep for more than a few hours every night if he slept at all.
His wife fiddled with the box and opened the lid as she handed it to her husband. He took out a small pipe and a medicine bottle. Out of the medicine bottle came a pinch of bright green cannabis. The pungent aroma filled the room before my patient even started smoking it.
“We’ve decided that this is better than Ativan, and all those other drugs that he’s been prescribed.” My patient’s wife explained to me as my patient lit his pipe. He took three puffs and exhaled the smoke away from where myself and his wife were sitting.
Within a few minutes, my much more relaxed patient explained some of the horrors that he had experienced while serving his country, “I can hear them screaming sometimes when I’m just going about my day. One of my brothers took four bullets in his back. He died in my arms, begging to go home. Some days, not an hour goes by when I don’t think about him.”
My patient continued to qualify his cannabis use to me as if I was just another healthcare professional about to pass judgement, “I’m supposed to be stopping this stuff. I have a substance abuse problem. I shouldn’t be doing this, but it’s the only thing that helps.”
“If it helps, then that’s what matters.” I said.
I had the full attention of my patient and his wife now. Apparently, they had very little experience with a nurse who would express anything remotely positive about cannabis use.
I went on to ask my patient and his wife about his cannabis use. I found out that my patient had smoked cannabis for decades. Ironically, he started smoking cannabis in Vietnam. He was consistently told by the VA Hospital that he needed to quit. Subsequently, he was diagnosed with cannabis-use disorder. Otherwise, he didn’t use tobacco, drink alcohol, or use any illicit substances. When he did quit smoking cannabis, his flashbacks would become a regular occurrence. His insomnia would worsen. He would become so angry, irritable, and frustrated that he would willingly stay in a motel up the street from his home. His wife said that he would never hurt anyone, but he couldn’t be around anyone while in that state. In fact, he lost several jobs because of his mental and emotional distress.
“He doesn’t get high. His goal is not to get high. He just wants to feel better,” my patient’s wife was now advocating for her husband. “I used to have a problem with this stuff because it stinks, and I didn’t want our kids to know that their father used marijuana. But he’s tried everything else. And this is what works best!”
When asked how cannabis helps with his PTSD, my patient readily answered, “It helps me to forget for a while. If the trauma bubbles up, I can stay here. Like here in the present, not caught up in my head. I can deal with it better. I don’t have a panic attack. And I don’t feel the rage and anger. Some days I have to smoke three or four times just to feel normal.”
His wife chimed in, “He didn’t smoke at all this week. Marijuana helps him sleep too. But he hasn’t slept in at least four nights. He’s trying to do what his doctor wants him to do, but I think it’s a bad idea. It’s just not worth it honey!” My patient’s wife was now speaking directly to her husband. “Please don’t go off of your medicine again!”
“I agree with your wife, sir, ” I nodded toward my patient’s wife, “You should continue to use your medicine. I think you can stay out of the hospital if you continue to use cannabis to help you with your symptoms. My only suggestions — you should work with a physician who understands therapeutic cannabis and PTSD. And make sure you obtain cannabis from a reputable source, such as a medical marijuana dispensary.”
My patient and his wife could get on board with that plan. And I could add their story to my constantly growing list of anecdotal evidence for the therapeutic use of cannabis. A few days later, I followed up with my patient. He was doing well, using his cannabis in the morning and before bed. He had slept relatively well, and was searching for a recommending physician who could help him gain access to the medical marijuana dispensaries in our state. Before we got off the phone, he thanked me for not judging him, for encouraging him to continue to use the remedy that helped him most. I could hear the relief in his voice. In that moment, I realized that I made a positive impact in this patient’s life. As a nurse, I always hope to do so. With this patient and his family, I had succeeded.
Gradus, J. L., DSc, MPH. (2017, March 30). Epidemiology of PTSD. Retrieved March 31, 2017, from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp