This Fourth of July, many combat veterans like Sabin will try to stay far away from fireworks displays. Fireworks take them back to combat, when the sounds of explosions meant sudden death and injury, not colorful rockets lighting up the sky on a peaceful, happy holiday.
"I get nervous and anxious and then I start thinking about mortars. And then the explosions you start reliving it," said Sabin, who is being treated for post-traumatic stress at the Zablocki Veterans Affairs Medical Center in Milwaukee. "I start sweating, I get anxious and then hypervigilant. Then the next thing, I've got to go. Even if I'm looking at them, I still have problems."
Psychiatrists at VA hospitals in Milwaukee and Madison know the Fourth of July holiday is difficult for veterans, so they begin talking to their patients several weeks in advance to come up with plans to handle fireworks. Some veterans check themselves in to the VA to avoid them, and some increase their work hours to make sure they're busy at night when fireworks are shot off. Others hunker down in their homes, avoiding crowds or family gatherings where someone might ignite a bottle rocket or M-80. Some self-medicate to get themselves through the stress, or go off into the woods and camp to get away from civilization.
"It can be a really challenging and difficult holiday," said Eileen Ahearn, a psychiatrist and medical director of mental health at the William S. Middleton Memorial Veterans Hospital in Madison.
"Parades, big celebrations, even a hero's welcome can be difficult for veterans with PTSD. While we're thinking we're doing a good thing, it can be difficult for the veterans," Ahearn said.
Military members are trained to be vigilant and hyperaware of their surroundings and for some it's difficult to shut that off when they return to the safety of their homes, said Michael McBride, a psychiatrist at the Zablocki VA Medical Center.
"It's good military training. You have to train your body to respond to that threat. You survived your experience in a combat zone. But the deeper parts of your brain are not willing to let go of that response," McBride said.
McBride, who has worked as a psychiatrist at the VA hospital for five years, spent eight years in the Army Reserves and was stationed in Iraq in 2008 and 2010. He's now a commander in the Naval Reserves and recently learned he will go to Afghanistan. Sensitive to noise, McBride avoids family gatherings where firecrackers might be set off.
"We're so well-conditioned. Even though in your mind you know you're in Milwaukee and you're safe, the body just can't shut off," McBride said.