Some days, what she hears is not thunder in the distance, but bombs falling on her medical camp in southern Iraq, "far forward" on the front line.
Fireworks pull the same trigger. So do hospital or police helicopters whirling above. To Tara Dixon, a former Army Reserve trauma and critical care surgeon, they're bringing more of the wounded for her team to patch up.
During two tours in Iraq, Dixon's team saved every casualty who showed any sign of life -- and "a couple who didn't." Yet three years after returning from war, Dixon suffers from post-traumatic stress disorder so severe that it drove the surgeon who saved so many lives to nearly take her own.
Though she's healed some, her PTSD has forced her to quit "doctoring." "I don't do well with loud noises. They make me flinch," Dixon, 39, said. "That's dangerous with a scalpel in your hand."
Instead, she moved to Charlotte in July, where on this Veterans Day she's become a face and voice for thousands of veterans returning from Iraq and Afghanistan, attempting to re-enter civilian life. She travels the country telling her story and urging medical personnel, charities and civic organizations to take a special interest in the needs of returning veterans.
As the drawdown begins in Afghanistan, the need is great in her adopted hometown, one of the country's fastest-growing regions for a new generation of veterans (ages 18-34). Already, 6,000 new combat veterans with a variety of physical and psychological wounds have moved here. An additional 7,000 to 10,000 are expected in the next 12 to 18 months, according to the U.S. Department of Defense.
Of the 2.5 million Americans deployed after 9/-11 -- a third more than once -- many are homeless and jobless. A significant percentage of the nation's 63,000 homeless vets served in Iraq and Afghanistan. Thousands can't find jobs because of lingering problems: 12.1 percent of all veterans are jobless. Among the youngest veterans, ages 18-24, 30 percent are unemployed. The suicide rate among veterans remains alarmingly high, nearly one every 65 minutes across the country; one every 18 hours for active duty troops.
"It's going to take a national effort of communities to find a place for 2.5 million returning vets to land safely," Dixon said. "The people who can help need to understand that these folks got a lot of training to go to war -- but very little training to return to normal life."
She moved to Charlotte after months of coaxing by Tommy and Patty Norman, founders of Charlotte Bridge Home -- a group helping veterans transition -- and veteran and author Paula Broadwell, a friend and mentor.
Yet as she helps other veterans, she's first had to save herself.
Last weekend, she gave the keynote talk at a fundraising gala for Patriot Charities, a Charlotte group that raises money for wounded warrior programs.
She left the crowd standing, applauding and wiping tears. She told them how she and her team had to operate wearing "battle rattle," combat gear, because their operating room had twice been bombed. How, in her second tour near the Iranian border, they spent more time in the bunker than operating.
She told them about the suicide attempt.
Then, showing a photo of her young niece, her voice trembling:
"I did what I did because it was the right thing to do. I went over there and I risked my life and I saved lives because it was the right thing to do. Despite all that happened after that ... if I can keep her (her niece) from ever having to see what I've seen, if I can keep her from ever having to be threatened the way we were threatened, I'd do it again in a heartbeat."
Drawn to trauma
From the start, Dixon took to school as she helped work the family cattle farm in Camilla in southern Georgia. Graduating valedictorian from tiny Westwood Schools, where she excelled in math and sciences -- and sports -- her grandfather, Ray "Big Ray" Dixon decreed: "You're going to be a lawyer or doctor."
By the time she graduated magna cum laude at Berry College in Rome, Ga., she'd resolved only that she didn't want to practice law -- but was a reluctant medical student.
Yet after wrangling horses in New Mexico and working an assortment of jobs in Atlanta, she took the entrance exam for medical school to please her family, and did well.
At Mercer University's medical school in Macon, Ga., she was instantly drawn to trauma
"Trauma surgery forced you to use your instincts and your knowledge of anatomy and physiology to get the job done," Dixon said. "You don't have a plan for gunshot wounds."
Armed with an MD, she began the journey of most young doctors: A surgical internship in Santa Barbara, Calif., in 2000; then an anesthesiology residency at Johns Hopkins University that quickly switched to surgery. She finished her residency in 2007 in Portland, Ore. By then, she'd joined the Army Reserves. Two aunts who'd been in combat told her the frontline was short on trauma surgeons.
During a trauma and critical care fellowship in Irvine, Calif., she quickly caught the eye of doctors, nurses and patients.
They called her Dr. T.
"T. was beyond gifted," said Jean Necas, head of nursing. "She had incredible hands in the OR and when a patient was unclear, she had this instinct to know what the problem was.
A week after Dixon finished the fellowship on June 30, 2008, she was deployed to Iraq as an Army Reserve trauma and critical care surgeon.
"She told us, 'our men and women are getting blown apart ... I can do some good over there,' " Necas said.
In a 'surreal space'
Dixon arrived in Iraq during the U.S. troop surge. The Army sent her to a base an hour south of Baghdad by helicopter. There she treated coalition troops: Americans, British, even soldiers from El Salvador and the republic of Georgia. There were occasional Iraqi civilians and "bad guys, too."
She was prepared for the injuries, but not the relationships with patients.
"They were guys who you ate breakfast with and a few hours later you're putting stitches in a heart from an AK-47 wound," Dixon said. "Surgery is different when it's your brother."
Her team operated constantly. She became "paranoid and hypervigilant. I would want to recheck and check and check and recheck, knowing if I screwed up, this 24-year-old soldier with a wife and two kids won't make it home."
After her tour ended in November 2008, Dixon flew to Portland hoping to build a surgical practice. Technically, she was discharged from the Reserves but could be called back to active duty through 2035.
She'd changed. She'd drop her grocery bags in a parking lot if she heard a helicopter: "I'd hear it and think 'if I don't get to my operating tent, they're going to die.'" Thunder sent her running
Necas, the California nurse, saw the change during Dixon's visits. Nightly fireworks at nearby Disneyland sent Dixon scrambling under a table. "She was taken to her other world" during frequent helicopter flyovers at a nearby military base, Necas said.
Thirteen months later, in January 2010, Dixon redeployed to Iraq, this time 15 miles from the Iranian border. She was assigned to the Army's 915th Forward Surgical Team squarely on the front line, operating with a half-team of one or two surgeons (often she was the only one), two RNs, paramedics and a nurse anesthetist.
Robb Zimmel, an Army first sergeant and a paramedic, worried about Dixon the moment she got off the plane. "She looked absolutely horrible," Zimmel said. "I said to myself, 'I need to keep my eye on her.'"
The bombing was constant, often several times a day.
Dixon and Zimmel became fast friends, taking morning walks around the small camp, often 6 to 8 miles to work out anxieties. "Those walks saved me from going crazy," Zimmel said. "We were a life raft for each other."
She was troubled being back in Iraq. But in the operating tent, she was in "complete control," Zimmel said. "As soon as patients were brought in the tent, T. was captain of the ship. There were other surgeons, but because of her background in trauma, T. was revered. With her there, you focused on your job and T.'s voice."
As the bombing continued, attempted suicides rose on base. Suddenly, Dixon was filling out death certificates for suicides and patching up psychological wounds. Sexual assault cases, men and women, were sent to her.
"I wasn't a shrink and we had no mental health people there," she said. "It was baptism by fire."
'I was hopeless'
Her second tour over, she returned to Portland broken, embarrassed as she tried to hide her frailties.
Finally, she sought help, consulting the defense department's Military OneSource website to find a therapist. She said none in Portland -- where there were no military bases -- had experience with combat-related PTSD.
Frustrated, she moved in with friends near Sacramento, Calif. There, she found another therapist through the military website, then hired a private one.
In February 2011, six months after her return from Iraq, she was in bed one morning and suddenly heard gunshots. The next thing she knew she was a mile away, taking cover under a fallen tree.
"When I realized what had happened, I was embarrassed. I was hopeless," she said. "I had been to four different therapists and nobody was going to fix me."
Dixon bought three bottles of aspirin and 9,000 milliliters of Tylenol, and checked into a hotel room. She took all the pills -- wanting to die.
When she didn't come home, her worried friends called state police. The police found the hotel in time. An ambulance rushed her to a hospital. The aspirin damaged her kidneys and stripped her stomach lining. But remarkably the Tylenol didn't harm her.
As she recovered, her family in Georgia found The Refuge -- A Healing Place in Ocklawaha, Fla., to help her.
She had no health insurance because she couldn't work. Yet there, after nine months her savings were gone, but she got her life back.
Not a 'scarred person'
In July, she moved to Charlotte, using a $10,000 grant funded by the Patriot Charities to rent an apartment.
Here she found the embrace of a city "that gets it," she said. "The word's spreading out there that Charlotte cares about veterans and wants to offer them a safe landing."
She's spoken in Orlando, Fla., Las Vegas and spent time at Fort Bragg and in Chicago, tandem skydiving with an all-veteran team to raise awareness for the problems of returning veterans.
At last weekend's Patriot Charities gala, former Marine Sgt. Jason Hyde, medically retired, and wife Michelle were in the audience. Jason, too, suffers from PTSD after two deployments in Afghanistan. On the second, he witnessed his best friend die "as he tried to hold him together so he wouldn't bleed out," Michelle said.
It was comforting to hear Dixon's story, she said. "It meant a lot to me to hear this physician, this strong woman, admit she couldn't fight it on her own," Michelle said. "And that (PTSD) is not something that just goes away."
Jason spent much of Dixon's speech outside the room calming down another Afghan war vet with PTSD. "Her talk was bringing back a lot of bad memories," he said. "It's hard for us to make people understand what we're going through. She's a doctor, a surgeon -- people will listen to her."
In time, with the help of her service dog Pax, Dixon is doing better. Helicopters and thunder don't bother her as much.
"I've learned that just because I have scars, that doesn't mean I'm a scarred person," she said. "When I hear helicopters now, I've learned to say, 'OK, I'm safe.' I look out the window and see all the greenery and know that I'm in Charlotte.
"Because, Lord knows, there was nothing green in Iraq."