During a routine patrol outside a small village in eastern Iraq, a four-vehicle convoy was suddenly blasted with an improvised explosive device (IED). Michael (not his real name), a 22-year-old combat medic who was riding in one of the vehicles, lost consciousness for several moments. As he regained his senses, he saw that the gunner had been thrown from the turret. Michael immediately scrambled out of the mangled vehicle and began to apply first aid. After stabilizing the injured soldier, Michael proceeded to the next truck ahead to see if there were further casualties. As he approached, a second IED detonated. Michael was knocked out again. When he came to, he saw that the driver was seriously injured. Michael gave him CPR and struggled over him for 10 minutes, but the man died in his arms.

Two days later, as part of the routine follow-up to such an incident, a psychologist with the unit's combat stress control team conducted a debriefing of the members of the convoy. Throughout the discussion Michael was quiet and reserved, showing no emotion. Then, six days later, he appeared at the psychologist's quarters and reported that he was having trouble sleeping, was experiencing nightmares, had lost his appetite and had an intense fear of going on future missions.

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