Every war has its heroes, and every war its wounded.
Sometimes it's arms or legs, sometimes eyes or ears, or disfiguring and disabling burns.
And sometimes, it's the mind.
Years later, something a Nebraska man or woman in uniform couldn't put behind them preys on their ability to sleep, to concentrate, to connect with those who love them.
As much as any of those battered and bloodied physically, these are the walking wounded.
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It's not long after the invasion of Iraq in 2003, and Cozad native Annette Lavelle and the 222nd Transportation Company have arrived from Arizona. They're headed down the road in convoy formation with a gun truck at the front and another at the rear.
Standard operating procedure in a combat setting is to move from Point A to Point B without stopping -- for any reason. Stopping makes convoys more vulnerable to ambush.
As she keeps the nose of her 18-wheeler squared up on the vehicle in front of her, Sgt. 1st Class Lavelle hears scattered shots. And then, suddenly, she sees something -- a small somebody -- in her path.
At age 44, almost a decade later, the vision is still with her.
"All I know is there was this little dark-haired kid. ... The mother pushed him. They wanted us to stop."
Instead, Lavelle followed orders. She did not stop.
"There are some of these things," she would say years later, "that go against every moral fiber that you've got."
* * *
Annette Lavelle told this story in 2010 in a small office at the Department of Veterans Affairs Clinic in east Lincoln.
In the few minutes it took, her tough-as-nails persona began to crumble. Her normally gravelly voice began to waver. And then it became a wail of grief.
"Thank God I've been going to therapy for the last five years."
Yes, Annette Lavelle, who now lives at Syracuse, can tell you about post-traumatic stress disorder.
"I know it happened to me," she said, her body slumped and her words wrapped in sadness. "I know it happened to a lot of other people."
* * *
Psychiatrist and Pakistani immigrant Ahsan Naseem came to the VA hospital in Lincoln a decade ago from Detroit. Working here, in an under-served area for mental health, was part of his commitment after graduation.
"I got my green card about six years ago," Naseem said. "And the reason I decided to stay on is literally because of this work."
He wears several hats: head of the Post Traumatic Stress Disorder Clinic; telehealth coordinator; medical director for the Operation Enduring Freedom and Operation Iraqi Freedom transition clinics.
Over time, his efforts and those of his VA peers in combating PTSD in the Midwest have expanded to include in-patient treatment in Des Moines and St. Cloud in Iowa and Minnesota, and in the Black Hills of South Dakota.
In Nebraska, there is on-site therapy available from a dozen psychiatrists based in Omaha, Lincoln and Grand Island.
Naseem sounds especially gratified with telemedicine connections forged in the last few years with outpatient clients at clinics in Holdrege, North Platte, Norfolk, and most recently this year, in O'Neill.
Many of the people deployed from Nebraska came from rural settings.
Earlier this week, telemedicine allowed Physicians Assistant Sue Shade to have both visual and voice contact from Lincoln with Vietnam veteran Dick Clark, who will turn 67 on Monday, in Grand Island.
Clark, a former Army medic, still has nightmares of what he experienced in 1969.
"They come up," he said, "but I guess I would say I'm feeling better."
In the fiscal year that ended in September 2010, Naseem said, treatment professionals had 559 encounters with clients through telemedicine. For the fiscal year that ended in 2011, the number was 1,843.
Making services more accessible has paid off.
"That's extremely heartening to see that we've been able to minimize their travel time," he said.
In Clark's case, he could come 40 miles from his Kearney home to Grand Island, rather than 150 miles to Lincoln.
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While the increase in encounters says something good about accessibility, it's harder to know what it says in a more troubling vein.
How many veterans are coming back to Nebraska from Iraq and Afghanistan with emotional issues severe enough to threaten their relationships with spouses, children and the other people in their lives and to make some contemplate suicide?
Last year, The Associated Press reported "a huge tide of troops returning ... with post-traumatic stress."
In 2009, The New York Times cited a California-based study that showed that more than a third of Iraq and Afghan war veterans enrolled in the veterans health system after 2001 had been diagnosed with mental-health problems.
Psychiatrist Naseem is not one to have his professional and personal passion for his work dulled by statistics from afar.
Nor is he willing for veterans to return without asking for some support from their home state when the homecomings are over.
"You can just go down the list as to how the ripples carry out in a person's life. So when that type of sacrifice has been made, a community cannot let that somehow dissipate with time."
* * *
Annette Lavelle can give some personal dimension to broader statistical measures.
"It destroyed my marriage," she said.
Furthermore, "in my small detachment, which was only 52 total, there were over three-quarters of us divorced within a year or two of getting home."
Her husband told her to get over it. "You do not get over it."
In fact, not until the last year did Lavelle feel up to telling her mother, who lives in Weeping Water, about the truck incident. "My mom always had an adage," she said: "'I may not like what you do, but I will love you anyway.
"That's unconditional love. And she understands why I am what I am today."