HOT SPRINGS, Ark., - Army Sgt. 1st Class James Powell badly needed someone to answer the phone.
He couldn't recall crying in 20 years, but the Arkansas National Guard full-timer had broken down, cried, struggled to breathe, had what he later realized was a panic attack and threatened his first sergeant and a lieutenant.
He had been sent home. The next day, a fellow noncommissioned officer from his battalion took Powell to a Veterans Affairs hospital emergency room.
Neither knew that if they told someone Powell was facing a mental health crisis he would vault to the front of the line.
Instead, after several hours waiting, Powell was seen by a doctor. The mental health provider had gone for the day. Powell was sent home with Ambien and Xanax prescriptions, encouraged to sleep and told to call tomorrow to schedule an appointment.
Which was what he was trying to do.
"I kept getting the runaround and talking to machines, and I finally lost it and attempted to hang myself," Powell said.
It wasn't always like this for Powell. The citation and supporting documentation for his 2007 Meritorious Service Medal, the highest of his numerous awards, lauds his performance as, concurrently, combat medic, readiness noncommissioned officer, training NCO and - as a staff sergeant - acting company first sergeant.
He served in the regular Army, Reserves and National Guard after his 1994 enlistment, holds multiple military occupational specialties, beginning with Infantryman, mobilized in response to Hurricane Katrina, twice deployed to combat zones as a line medic and rose relatively rapidly through the ranks.
"Unsurpassed Soldier care and seamless mission accomplishment are non negotiable with SSG Powell," MSM documents state. "SSG Powell leads all his NCOs and Soldiers by text book example, on the ground and out front."
Soldiers taking care of Soldiers saved Powell. When he didn't report as expected at the 296th Medical Company (Ground Ambulance) readiness center here, two junior enlisted Soldiers went to his home, where they cut him down from the noose attached to plant hooks in his ceiling.
"Didn't even know I was contemplating suicide and missed the warning signs myself," Powell said, "until I went over the edge and did it."
It was an accumulation of small things.
He went straight back to 12- to 16-hour workdays after his most recent deployment. Seeking both to recapture the adrenalin of deployment and to avoid the rare sleep that brought nightmares and flashbacks, he used diet pills. To offset the pills, he drank more alcohol than was his habit.
He broke up with a long-term girlfriend. He set aside no time to unwind.
He was jumpy. In restaurants, he instinctively reached for his weapon after he was done eating, and he cleared his vehicle before driving off. Sudden movements, crowds, dead animals on the asphalt, fireworks and war movies all bothered him.
"I didn't really believe in the whole (post traumatic stress disorder) monster until I got it," Powell said. "I thought it was fake. I'd been on a tour before and didn't have any problems and saw a lot worse stuff than I did this time."
As a line medic, Powell treated numerous fellow servicemembers and third country nationals immediately after incidents, such as improvised explosive devices and mortar attacks, that resulted in mass casualties.
"The injuries and the blood and the guts and the gore, that really doesn't bother me," Powell said. "As a medic or as an Infantryman, you grow pretty numb to that, or at least I did."
It's the accumulated responsibility for people he could not save, for Soldiers in his own unit he feels he did not help through difficulties and a sense that he could no longer perform as he once did and is thus letting his fellow Soldiers down that eats at Powell.
As a young Soldier, Powell lost an even younger one to suicide. Powell was a 19-year-old specialist. The Soldier who died was 17.
"I'm closer to some of the guys out of the military than I am to my natural family," Powell said. "I feel responsible when they kill themselves. It almost feels like I pulled the trigger. Like I killed the kid, because I wasn't there for him and missed the warning signs."
On his first Iraq deployment, Powell chatted one night with a Soldier he felt as though he had practically raised since the guy's days as patch-less private.
It was the Soldier's first deployment. He was young. His girlfriend back home had disappeared with their child. Her Facebook page showed her with a new boyfriend. The Soldier's brother was jailed on drug charges. The Soldier's mother was diverting his entire pay check, and he could not afford a haircut.
"I just tried to comfort him and tell him it was going to be OK," Powell said. "Try not to worry about what's going on in the real world, just worry about the here and now, staying alive and taking care of your Soldiers."
Powell sent the Soldier to bed.
Only in retrospect does he know it would have been better to escort the Soldier to his chain of command, a chaplain, a behavioral health care professional or a primary healthcare provider.
The Soldier failed to show for muster the next morning. Medications were missing from combat medic supplies.
Powell found him overdosed on morphine and valium. He administered first aid. He escorted him from Talil to Balad and on to Landstuhl, Germany, before returning to duty.
"He seems to be doing well now," Powell said, "but I still feel responsible that he ever went down that road."
These are the images that bother Powell most at night. Not so much the blast injuries, more the people he feels he did not save.
"You have people's lives in your hands, and there's only so much you can do," Powell said. "You feel responsible for that person's life, and when he or she doesn't make it, you feel even more responsible.
"For me, it's being responsible for others, whether it be an injured Soldier or one of my Soldiers that goes out and does something stupid that maybe I should've caught."
Add to that Powell's recognition that he is, at least for now, not the Soldier he once was.
"I'm no longer able to perform my job to the best of my ability of what I used to be," Powell said, "and I feel responsible. My performance has fallen too far for me to accept continuing doing this job, as much as I love helping people and wearing this uniform. My standards are higher than where I'm performing right now."
Early intervention and an expert's listening ears are crucial to saving troubled Soldiers, Powell said. "The biggest thing is to find somebody more knowledgeable than you are on the subject," he said.
Someone who can cut through the red tape, shorten the waiting times and give you phone numbers where there is a real person at the other end.
"It really helps to have an advocate," he said. "Someone who's borderline suicidal, the last thing they need to do is be talking to answering machines all day. All that does is push you over. 'Nobody cares a s**t anyway, so I might as well go ahead and have one less Soldier they have to worry about, just take care of it right here.'"
Powell said he perceives that Soldiers are reluctant to seek help, because they fear showing weakness, worry their military careers will be over and, rightly or wrongly, feel stigma surrounds mental health issues.
After Powell's attempt to kill himself, he received five days of observation - with no counseling - at a Veterans Affairs hospital and a week of convalescent leave before returning to duty.
"It's been a struggle this entire year ever since then," he said. "I keep returning to duty, and I last about a month, and then I have a breakdown or my PTSD symptoms will flare up, especially when I'm around a large group of Soldiers."
Powell has remarried to a supportive woman, who has a young child. His father is in bad health, and he tries to help. "I've got a lot of people counting on me, so I've got a lot of reasons to live," he said. "I think I did the whole time. I was so busy focusing on helping other people with their problems that I wasn't focused on myself."
Last June, Powell spent eight weeks in an in-patient treatment program for servicemembers diagnosed with PTSD.
"When I quit trying to seek [outpatient] treatment once I was discharged, I started spiraling downhill," he said. "I should've continued trying to seek treatment. I'd probably be OK now."
Now Powell is in weekly group therapy, which he praises, because he is able to talk with other servicemembers sharing similar struggles. Another Soldier's ears are in his opinion the best therapy. He attends church, takes his boat out, fishes, camps and canoes. He no longer hunts after selling his last weapon last summer as a precaution against his own impulses.
He still struggles. On April 3, a member of his unit who had never deployed killed himself. Powell served as a casualty assistance officer. That latest death and the prospect of this interview about his own challenges prompted a week of nightmares about suicide.
"I'm trying not to work myself back to where I was," he said. "I still feel responsible, and I still try to do as much as I can, but when I reach that point where I'm about to blow up or lose it, I just walk away for a little while."
But he wants to help.
"We can't just put blinders on and pretend that they're not there and hope it'll go away," he said. "The problems will go away - and so will the Soldiers. We'll put them in the ground. … We're just going to continue to bury Soldiers from non combat-related deaths, which is unacceptable. If you're going to die for your country, you should at least do it overseas trying to protect your buddy."
Powell plans to get more involved in ministry, volunteer at Veterans Affairs hospitals and start a support organization for veterans after he completes his military career.
He has an appointment before a two-day medical board scheduled for this month.
"I would like to be either medically retired or discharged under honorable conditions, because I don't feel I'm able to perform my duty like I should anymore," he said. "If I could just stay deployed, if I didn't have a wife and a kid now, I probably would just try to stay deployed all the time, because it's so much easier over there: You really only have one focus, and that's staying alive and keeping your guys alive."