Always bring a list to your doctor’s visit,” the patient

guidebooks recommend. “That way, you won’t forget

important things to discuss with your doctor.” I agree.

Lists are a good idea, but until I saw Charlie’s list I had

never been so saddened by what was written.

Charlie was an 85-year-old World War II veteran. He

had osteoarthritis of the hip that used to plague him until he

had a joint replacement. His hands still ached, and he took

glucosamine that he bought at Walmart.

Charlie had an excellent primary care doctor who took

care of his medical needs. Nevertheless, every year for more

than a decade, Charlie made a trip to my clinic. At these visits

in the spring, we talked, I examined his joints, and I happily

gave him a clean bill of health. Each time I scheduled Charlie’s

next appointment, I worried that I would never see him

again. The Greatest Generation is dwindling away.

Knowing Charlie well, I anticipated an easy visit and,

when I entered the examination room, I saw him sitting quietly

in a chair. He was a thin man, wore a black baseball cap

that said “World War II Veteran” in gold letters, and had

thick glasses that made his eyes look big.

I was happy to see Charlie, knowing that he had survived

another year at a time in his life when survival is precarious.

I shook Charlie’s hand. His fingers were bony.

“How are you?” I asked.

“Okay,” Charlie answered, his voice subdued.

“Arthritis bothering you?”

“Only sometimes.”

“Anything bring the pain on?”

I was expecting that Charlie would say the cold, but instead

he said, “I keep thinking about things.” He looked troubled.

“What things?” I asked tentatively. People whose arthritis

worsens with thought usually have bad things to

think about. A new diagnosis of cancer. A spouse who dies.

A child who turns out rotten.

“The war,” Charlie said, his eyes misting.

“Iraq?” I asked.

“No, my war. I think about my friends. I was in the

Second Infantry Division.”

It was then that Charlie handed me his list. The paper was

yellow and lined, and he wrote in capital letters that slanted to the

right.

“You can have the list,” Charlie said, handing me the

paper as if he wanted to discard it. “I got the information

in books I read.”

I glanced quickly at the list, which described the history

of his division during the war in Europe:

Campaigns: 5

Days in combat: 327

Miles traveled to Pilsen: 1750

This was as far as I got when I turned back to Charlie.

“I was the only 1 of 3 corpsmen who made it after the first

day,” Charlie said with a shaky voice, explaining that he landed

on Omaha Beach on 7 June, right after D-day. “I was only 22,”

he said. “My job was to take care of the casualties. I took fire like

everyone else, and I saw things I can never forget.”

“Did something happen to make you think about

these things now?” I asked.

Charlie shook his head. “It just happens sometimes, but I

think more and more about those days. If I can’t keep busy,

my mind wanders. You can’t believe how many people died

then.” His face looked empty. “I had to go through the bodies,

looking for anyone who needed help. But, you know, I

think that some of those boys shot themselves. You can’t get a

wound in your upper arm from someone else’s gun,” Charlie

said, pointing to his own arm, where the slack flesh drooped

under a red plaid shirt. “I lost so many friends.”

At an age when my daughter cavorts gleefully in the

mall, Charlie trudged through killing fields flooded with

his buddies’ blood.

Charlie then told me about the push through France and

the Battle of the Bulge. He quieted, and his tears flowed.

“I retired early from the factory,” Charlie said, trying to compose

himself. “It’s strange, but I always felt better by myself.”

I felt weary and dispirited as I watched Charlie. Perhaps he

sensed that he would die soon and wanted to unburden himself

before the end. I asked Charlie if he had ever sought help. He said

that he had attended sessions at a posttraumatic stress disorder

clinic. “I mostly listened,” he said. “Everyone else was from Vietnam.

They all thought that their war was bad. What could I say?

Compared to World War II, that war was nothing.”

“Should I make a referral to our mental hygiene

clinic?” I asked.

Charlie nodded yes.

“Good,” I said. “I’ll set it up. See you next year.”

When I left the room, I finished reading Charlie’s list.

As the patient guides say, lists are helpful so that you do

not forget. Here are the other items on Charlie’s list:

Battle casualties: 15,066

Killed in action: 2999

Missing in action: 109

Wounded in action: 10,924

Prisoners of war: 1034

Thank you, Charlie. We will not forget your list.

David S. Pisetsky, MD, PhD

Duke University Medical Center

Durham, NC 27705