Military culture reinforces stoicism and decades after they leave the service, former soldiers still can feel that stories of their wartime experiences are best left unsaid. Until that is, they reach the end of life when talking about the war, and their part in it, is what that they want to tell and understand.
Not all veterans, of course, will feel this way during the last months of their lives. But hospices have recognized that military veterans have special needs during end-of-life care that can differ from those of lifelong civilians. For some, one of those needs is finally being able to share a traumatic story.
They may have been on the battlefield or on a dangerous mission, experienced post-traumatic stress syndrome or been a prisoner of war.
"Veterans may have unique needs based on combat experience and which war they served in," said Irene Henderson, vice-president of volunteer and professional services at Tidewell Hospice, which serves Manatee, Sarasota, DeSoto and Charlotte counties.
"Most veterans have had a good experience in the military, I want to point that out. But if they haven't had a good experience, once they come into hospice all of those issues can come into play," said Henderson.
Tidewell asks everyone who enters hospice care about his or her military service and for details such as military branch, rank, where they served and when. More than 25 percent of those receiving palliative care from Tidewell are veterans.
Tidewell wants to raise awareness amongst doctors and the community about veterans' end-of-life needs, said Henderson. It is part of the National Hospice and Palliative Care Organization that partnered with the Department of Veterans Affairs to create the We Honor Veterans program that focuses on veterans' care.
Training for Tidewell staff members includes learning how to watch for any signs of returning post-traumatic stress syndrome and how to listen when veterans want to talk.
"We have had a lot of veterans who don't want to talk about it or care to talk about it. We never push but we're there to listen if they want to," said Henderson.
One service that veterans seldom turn down is the pinning ceremonies sponsored by Tidewell. Teams of volunteers go to assisted living homes, hospitals, hospice houses and private homes to present veterans individually with pins and certificates honoring their service.
Veterans don't have to be hospice patients for a pinning ceremony.
"We give them a pin and certificate on behalf of a grateful nation and for advancing the hope of freedom and liberty for all. We salute them and say thank you," said Ted Czerwinski, an 84-year-old Korean War veteran who lives in Bradenton.
Czerwinski is part of a three-man team that has performed more than 300 pinning ceremonies in Manatee County over the past 2- 1/2 years.
"Sometimes we do three or four a week. Once we were at hospice to do two. Before we left, other people were asking for them and we did three more," said Czerwinski.
"The veteran is so grateful he got something, especially the Vietnam veterans. It's very poignant," he said.
Tidewell also draws on the expressive arts to help patients in end-of-life care. Expressive arts facilitator Jane Welsh will give them ideas that they might want to pursue as much as they are able.
Many who were in the military have good experiences to remember. She helped one veteran create a scrapbook about his close-knit group of buddies that formed when they were young and serving together.
"Fifty years after their service, they still met every year. He had pictures and stories to tell about every barbecue," said Welsh.
For another who had Alzheimer's, she helped create a shadow box of his World War II medals.
One man had a remarkable story that she captured in a video for him and his family. In World War II, the man had been a pilot in an air squadron that dropped food over Germany. They decided to drop candy one Easter.
Last year in Venice, in a ceremony commemorating his service and the candy drop, he was thanked and hugged by people who had been children in Germany and got the candy bars.
Welsh made a video of the presentation with pictures of his family and a photograph of the plane he'd crashed in and survived.
Including the story of family members is important, said Welsh.
"Tidewell is very honored and proud to serve veterans. It was a huge part of their life service and it wasn't just a job they did. It affected their children and their wives, too," she said.
Welsh has noticed that many veterans seldom describe their service as heroic.
"They will say they were just doing their duty for their country," she said.
A last recognition from Tidewell comes when a veteran is admitted to one of its hospice houses. A red, white and blue flower arrangement goes into the room and a flag is placed outside the door so everyone knows the patient is a veteran. When the veteran passes, he is draped in an American flag for his transport.
Susan Hemmingway, Bradenton Herald health correspondent, can be reached at email@example.com.