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12 March 2017

VAMC ER Follow up to the follow up

This past Thursday, I got a call from someone in the Atlanta VAMC emergency room following up on my recent ER visit. Okay. I called back in the afternoon, a different someone answered. It's strange how people from the VA just answer with their first name, not "Office of Inefficiency, Martha speaking" like I've been taught at all of the places I've worked, but whatever. I explain that so and so called to follow up on an emergency room visit where I went in for PTSD.

That a different person answered than the person who left me a voicemail tells me it's just people calling from a list, not that someone specific is assigned to follow up and see how I as a particular person am doing.


They ask about my visit to the ER, and I go off-- I explain that it was essentially a waste of time and money. Yes, I got an appointment-- a full month after my ER visit, but that's also nearly four months after I first contacted the VA looking for help. I tell her that I never did get an appointment in mental health via primary care. I tell her that the Lawerenceville Vet Center dropped me without reason or followup. I also explain the part about the logistics involved in me getting to Trauma Recovery at 0830-- that me staying up all night and then driving through two hours of morning rush hour in Atlanta isn't going to happen.

 I think I heard a sigh of relief when I explained that last part, about the traffic-- Atlanta Traffic is legendary enough without a sleep deprived veteran with mental health problems. You'd probably have to have lived around Atlanta to find that funny-- which it almost, but not quite, is.

She checks my records, and yes there was a referral made from the ER to mental health. That's how I got the appointment I have. The referral was also copied to the same psychologist who I was referred to from primary care; that's the guy who I left two different voicemails for the week before I went to the ER, and who never called back. ER person asks for the psychologists's name, and when I give it to her she can't find his name listed on my records.

I have a letter (actually a bad photocopy of a letter but that's what I was sent) from psychologist postmarked March 1 saying "oh we tried to contact you but couldn't so we're closing the referral". This psychologist ignored two voicemails and me being at the emergency room, didn't follow up, and then put it on me. I tell ER person this, and then point out that the letter includes the psychologists telephone extension.

"Oh, you have the doctor's extension?"

Yeah. Nice try though.

ER person says she's going to see if she can expedite things and calls the psychologist, and then calls me back a few minutes later. It seems that the psychologist, or at least someone in his office, is perfectly capable of answering that extension on Friday afternoon when it's someone from the VA calling-- but when I called, they were too busy. This is starting to sound a lot like what happened with getting a Primary Care appointment, where calls went straight to voicemail for me but when I went to the Patient Advocate and asked them to call, the call was picked up (see https://stillinthedesert.blogspot.com/2017/02/traveling-veterans-seamless-care.html).

Anyway, the result of the ER calling the psychologist is that the psychologist isn't going to do anything because I have an appointment already scheduled-- ER explains that the psychologist said they are just a "point of contact", that this is the treatment plan, and that they won't do anything before my appointment March 28th.

All of which adds up to, I made a 100 mile round trip to the emergency room, sat there for three hours, talked to a triage nurse, a doctor, two social workers, and a psychiatrist-- and the best they could do for me was tell primary care to call me to set up an appointment, something that primary care could have had done two weeks before.

Over the past several years, I've complained loud and often that no one from the VA ever follows up. It is worth noting that the ER here at least made the effort to call-- but a) it took two weeks and b) it didn't change anything about me getting help. If you're not able to do anything meaningful to help when you call to follow up, don't call to follow up. 

A good portion of my working life has been spent in IT support, either at a formal help desk or as part of an IT department. It's a common thing that when a problem ticket is opened, and you reply to the customer with either a solution or a request for more information, a clock starts ticking. After 30 days (as was the case where I last worked) the ticket would automatically be marked as resolved if the customer hadn't responded or no other action had been taken.

Occasionally, there were tickets where we needed to walk the customer through something, either via remote desktop or just on the phone. In those cases, it was part of my job to make sure that all of the information that was needed was assembled and noted in the ticket and a phone person assigned to call that customer. All of the phone people were students, so as a customer you didn't have a particular support person. You got whatever agent I had available to volunteer to call you.  If we got your voicemail, we'd leave as much information as we could as well as a ticket number and a way to look at your ticket online (which would include all of the information we had about your issue).

It would also often happen that we'd escalate a ticket to a particular team of technologists, and in the course of trying to fix whatever the problem was those technologists would ask us to contact a customer for more detailed information or to see if the problem was actually really truly resolved. This occurred with service outages as well-- if you called because you couldn't access a particular service during an outage, we'd call or send an email to let you know when the service was operational again.

The overall concept was that if you called with a problem, the problem was important. There were different levels of important, depending on how many people were affected. If only your printer won't print because the print queue service was having problems, that's different than all of the printers in all of the libraries (the campus had 40+ libraries) won't print. If your laptop's battery wasn't holding a charge, that only affected you, but we'd still do whatever we could to find a way for you to get a new battery. It didn't matter if you were the head of a department, a freshman undergrad, a scientist trying to cure cancer, or the custodian emptying trash cans. We'd do everything we could to try to get you an answer and/or a solution. (Even if you weren't eligible for support, we'd at least Google your question and try to point you in the right direction.)

If your ticket was automatically resolved after 30 days, you'd get an email saying that the ticket had been resolved and if you still had questions you were welcome to contact the help desk again. Usually this was okay, but sometimes there actually were unresolved questions and we'd start work again from there.

It was rare in my experience that someone's question completely fell through the cracks, but it did happen. Since I was a quality assurance person, it then became my job to figure out what the customer needed-- maybe there was a simple answer we'd missed, maybe the technologists the ticket was assigned to were asleep at the switch, maybe both the customer and us were both waiting for an answer from each other, and maybe someone just fucked up. The priority wasn't pointing fingers and blame, the priority was getting the customer's problem looked at, properly addressed, and resolved. There were times when I'd have to send an email or make a phone call that would include saying "my name is ___, I'm the person in charge right now, I'm reviewing your ticket, I most royally screwed the pooch on your issue; here's what I am doing to get this fixed for you".

There were other times when, for whatever reason, the agent on a call got in over their head and the customer on the other end of the line was really, deeply unhappy. It was also my job as quality assurance agent to put on the headset and say "Hi, my name is _____, I am the senior agent on staff right now. How may I help you?" I didn't always have the answer that the customer wanted to hear, and since I worked nights I couldn't always get a resolution until the next business day when the people I needed would be there.When that person next spoke to someone from the help desk, they'd say they had talked to me.

Often, to get things fixed, I'd have to write a long, detailed email to my supervisors explaining exactly how badly and completely I/we'd fucked up, complete with my name in the signature block, even if I'd had nothing to do with the ticket until that point.

It's called taking ownership of a problem.

There were several times-- I lost count-- during that followup call from the ER that the person said things like "I know, we have problems" and "we have some things to fix" and "I'm sorry that happened".

Here's a list of all of the unique people I've talked to or tried to reach in Atlanta, trying to get help with PTSD (I'm leaving out people for other health issues):
  • VAMC Atlanta GA eligibility
  • Lawrenceville GA Vet Center social worker
  • VAMC Atlanta GA Traveling Veteran coordinator
  • VAMC Atlanta GA primary care scheduling
  • VAMC Atlanta GA patient advocate
  • VAMC Atlanta GA primary care nurse
  • VAMC Atlanta GA primary care physician
  • VAMC Atlanta GA primary care psychologist
  • VAMC Atlanta GA emergency room
    • Triage nurse
    • Doctor
    • Social worker
    • Psychiatrist
  • VAMC Atlanta primary care/mental health scheduling
  • VAMC Atlanta ER followup
There were cases where a help desk ticket would bounce around for a while, without a resolution-- when one landed on my desk, it was my job and my responsibility to put my name on it, take ownership of the problem, and do what was necessary to get the customer what they needed. The majority of these cases weren't life or death-- critical to the mission of a large research university, yes, but if you lost emails during the transition to Office 365 it likely wasn't going to kill you.

I'm sliding. I'm getting, and feeling, worse.

Last night, I went for a drive-- to get a soda, but to nowhere really, I got as far as the eastern edge of Atlanta before circling back. That's my thing lately, if I haven't been out of the house all day and/or haven't encountered any other people I'll get in the truck to go to some convenience store for a soda. Between here and Atlanta itself there isn't much to see, especially at night and in the rain. Going somewhere, even just to get a soda at some random store, I feel almost human.

I didn't stop for the soda until I was almost back to the house. Most of the small stores here close at 2100 or 2200, but there's one store sorta close by that's open all night. Sometimes I'll just drive there, instead of a longer trip like I made last night. When I was waiting in line, the person ahead of me and the girl behind the counter chatted for a couple of minutes. When it was my turn at the register, the girl apologized for making me wait-- that's when I realized I'd been completely disassociated, numb, standing there. I could have been there for hours or minutes, I had no idea.

I started writing this several hours ago, when it was afternoon and the sun was out. It's just after 2100 now, it's been dark for hours, and I've had to stop typing several times because I lost concentration. Not, my eyes got tired or I needed to stretch-- I had no idea what the fuck I was even writing about. Where the time went between when I started typing, and now, I have no idea.

My laptop's display says its Sunday, but it doesn't feel like any particular day-- I can't remember when I really knew what day it was, what week, or even what month. That I'm chronologically challenged isn't new, but right now I don't even care what day it is.

The dreams-- the nightmares-- the Desert, being called up again, something new and bad happening, it's all mixed up and jumbled and confusing as hell. I'm convinced that I have to dream, that it's my brain trying to sort things out, but my brain just can't get it all in order, it's overloaded. When I wake up, I have to pace back and forth for hours, talking out loud to myself, trying like hell to get some grip on how I feel before I lose focus again, go numb again.

March 28. March 28. March 28. Have to hold on until then, but that's bullshit too. I already know that going to the emergency room won't help. Call the Veterans Crisis Line? What are they going to say? They're going to refer me to mental health, tell me to hold on until then. Breathe tactically? Fuck you.

I have my mental health binder, with all of the things from all of the sessions and groups, and I can't even look at it, can't focus on it to try to do anything on my own-- but if nothing happens at this next mental health appointment (which is what I expect), that's going to be all that I have. I'm going to have to do it all on my own. I have to be prepared for this possibility and I don't have any answers.


"But we'll follow up after your appointment on March 28." 

Sure, whatever. Fuck off.

09 March 2017

Do you have thoughts of


I went to the Atlanta VAMC emergency room on February 27 because I was feeling in crisis and having a great deal of trouble managing my PTSD symptoms. Part one is here, you should read that first. This post is an update. I'm still feeling as bad, or worse, than I was that day-- I have yet to see or talk to anyone about my PTSD symptoms.

The psychologist that primary care referred me to (my primary care appointment was on February 14) never did call back again. I got a letter in the mail a few days after I'd been to the emergency room that he was closing the consult, even after I'd left two messages on his voice mail and even after the emergency room said they'd inform him that I'd been there.

Someone else from primary care called to set up an appointment; I was able to call back and get an appointment set up with still someone else in mental health, on March 28-- that date is a full six weeks after my visit to primary care, and nearly four months after I first visited the Lawrenceville Vet Center on January 3.

Trauma Recovery called, so that referral was finally/actually put in by someone. They called twice, but I haven't called back. I'd been told by the Atlanta VAMC emergency room that I was being referred to Trauma Recovery Program for an appointment and that TRP also accepts walkins on Monday and Tuesday at 0830. The phone messages said walkins on Monday and Tuesday at 0830. Now I have a letter dated March 1 that says Tuesday or Wednesday at 0830. There is an "intake process" at TRP that takes three hours beginning at 0830.

That there's a discrepancy between what I've been told (we'll get you an appointment) and reality (it's walkin, you might get seen that day you might not) kinda knocks me off center, because it's another example of why I've lost faith in anyone at the VA that says they're going to do something to help. The logistics involved in getting to TRP are why I haven't called back.

I live about 45 miles from the address listed for TRP. Because it's a walkin thing, I figure I need to be there early so my arrival time realistically should be 0800. There are a couple of different routes I can take to drive there, and Google Maps is pretty accurate picking which one is the right one given traffic conditions. I've also asked family who live here for advice. Google Maps and family both agree that I need to allow two hours to get there, so that means I need to be out the door and in the truck at 0600 (earlier if I need to stop for coffee on the way).

I need, and try to allow for, two hours from waking up and opening my eyes to being useful for anything. It takes that long to figure out where I am and what day it is; I often ask Siri: "Hey Siri, what day is it today? Hey Siri, where am I?" Then I need to make breakfast and eat it, make coffee, get showered, figure out what to wear (a not insignificant thing when your brain moves a million miles a minute), get dressed, and get in the truck. So that puts my alarm setting at a few minutes before 0400.

Assuming I actually wake up when my alarm goes off, and further assuming that I don't have a panic attack or disassociate while I'm doing all of this, and even further assuming I've left enough time for traffic and finding the place, and finding a place to park, I might make it there on time.

The part about waking up when the alarm goes off can be scratched, because there's no way I'll be able to fall asleep the night before. I'm lucky to even be in bed by 0400, much less asleep, so that's not going to happen. The only way I'd ever make it there is to stay up all night and just not sleep. I'd be driving for two hours in Atlanta rush hour traffic after not sleeping for 24 hours, and then have to try to be coherent for three hours of questions about my mental health.

Tell me again how this is going to help?

Let's assume I make it there and get through the "intake process", and get into the "treatment planning" part of the agenda. There are a couple of possible options, based on what I've encountered in therapy before. One is individual treatment, things like cognitive based therapy and prolonged exposure therapy (both of which I know I want to do again, they're the two things that have really helped). For those there has to be someone available that's trained to do those things, and that person might not be available for days or weeks depending on case load. The other is group therapy, and many groups once started don't take on additional people if they work on a sequence until the sequence starts again. So the group I want, if it started a week ago, might not be available for another eight weeks (that's two months!). And all of that assumes that I don't have to go through n sessions of just one-on-one therapy before getting to those things.

Tell me again, again, how this is going to help?

Allow me to be crystal clear on this: I'm not avoiding the treatment or the therapy. I've been through cognitive based therapy and prolonged exposure therapy, and both are extremely difficult. They take a shitload of energy. I'm not afraid of either, not scared of facing the thoughts and images and memories. Right now, facing this PTSD shit head on is what I need. I'm trying to get to a place where I can do that, and no one's fucking listening. I have to jump through hoop after hoop after hoop.

-----

Something I've noticed-- from the first time I talked to the Vet Center here, from primary care, from the emergency room at the VAMC-- is that everyone has asked if I'm having thoughts of harming myself or others. It's on every on hold message every time I call a VA extension. It's on posters and signs. There are times when I've expected the guy mopping the floor in the hallway to ask me if I'm feeling suicidal.

It was in the emergency room in the Atlanta VAMC that it really registered, that once they ask you "Do you have thoughts of harming yourself? Do you have thoughts of harming others?" and you say no, everything changes. Up until that point, people stand up straight, they look you in the eye, they hang on every word you say and try to make sure they record it exactly. They are concerned, watchful, on point.

Once you say no, the air is let out of the balloon. Shoulders that were square a second ago are now slouched. Eye contact is lost. They exhale. They sit differently, stand differently. The tone of their voice changes. In that instant, once you say no, you're not going to kill anyone, they go from trying to save you to taking your dinner order.

It's led me to wonder just what a veteran has to do to get anyone's attention.

I have my next (technically, my first) mental health appointment on March 28. It will most likely be yet another intake appointment, with the same standard set of questions that it took four weeks for me to answer during my visits to the Vet Center. They will know that I've been to the emergency room, when and where and why.

One of the first things they will ask is "Do you have thoughts of harming yourself or others?" 

My answer has always been, when someone else asks me this question, simply "no". There are repercussions to saying anything else, to responding with anything that can even be interpreted as "yes", but here's what my answer is going to be the next time I'm asked. It's the real, honest answer.

At this very second? No. But every day when I wake up, sometimes out of a nightmare and sometimes not, I think about why the fuck I'm still here. I wonder, if I disappeared today, would anyone even miss me? I wonder why I need to get up and get dressed and try to get through the day. I find a reason, any reason, no matter how small it seems, to be alive today. I look at my pocket knife, I look at the blades on the sink next to my safety razor, and I make the choice every day to live for just one more day. My answer then, is also yes, every day since one muggy night when I stepped off a plane in South Carolina and realized I was back from the Desert, almost exactly twenty six years ago. That's 9400+ times I've looked at myself in the mirror and decided that I still want to be here. I don't know at what number of times I'll be overdrawn, and I don't want to find out, so why don't you stop with the stupid fucking questions, stop trying to cover your ass, and let's talk about why I'm really here.

28 February 2017

Visiting a VA Emergency Room

Two weeks ago today, I had a primary care appointment, finally. At that appointment there were several referrals generated, but one of (perhaps the) most important was a referral to mental health. I've been having trouble with anxiety, depression, and PTSD at a fairly high level since Christmas and what I was doing at the Vet Center (which wasn't anything but intake questions) wasn't therapy. After that primary care appointment, I almost felt decent because I'd finally got aligned and oriented in the direction of getting actual help.

Two weeks ago tomorrow, the Lawrenceville GA Vet Center canceled my appointment. I'd gone there for help with PTSD too, but that had never yet entered the discussion at any of my appointments. Four weekly individual appointments, and one group session, and nothing. I wasn't getting help, and I meant to bring that up at that appointment two weeks ago, but the appointment was canceled. I didn't call to reschedule, they haven't called to see why. I wasn't at group this week and no one called about that either. That appointment being canceled really changed a lot of things-- before that I was pointed somewhere good, maybe even towards feeling better. After, all of the bad things and bad memories and triggers have been like pouring gasoline on a fire.

One of the things I do to cope is talk to myself, out loud. It helps to hear a voice saying what I'm feeling even if it's my own voice-- once it's said, I can hear my thoughts and process them differently. I also pace back and forth if I'm somewhere that there's room, being in motion helps. I don't hold back on saying anything, and some of what I say can be gnarly. There are a lot of things that I just have to let out even if they're things that I'd never say to someone else. 
I use this, listening to myself, as a kind of indicator as to how I'm feeling. 

Some of the shit I've said to myself in the privacy of my bedroom has been especially harsh, things that I usually don't say, thoughts that I usually don't have. I've talked about there being a line, that's impossible to see until you've crossed it, where once you have crossed it you're past the point of giving a shit. Hearing myself talk I'm quite certain I'm moving closer to that line.

A psychologist from primary care has called me a couple of times now, in the morning when I'm not awake. I've called back and left messages both times, indicating in the clearest possible voice I can (remember, I worked in a tech support call center for seven years) that he should call back in the afternoon. Someone, or some thing, called me twice from the Atlanta VA on Saturday, but neither left a message.

Add the Vet Center canceling my appointment and essentially dropping me through the cracks, to it being two weeks now since primary care swore they'd get me in touch with mental health, and I'm not doing so well here. It's been two months that I've been in contact with the VA here, and I've yet to actually talk to anyone about the problems I'm having with PTSD. I'm getting, and feeling, worse. A lot worse.

A huge indicator was when I bought a cheap cell phone, for the purpose of having a burner for calling the Veterans Crisis Line. The thought entered my mind that being honest, even to an anonymous thing like the Veterans Crisis Line, and especially with some of the frankly scary shit my mind's been coming up with over the past two weeks might-- might, result in someone using my normal smartphone's location services to find me. That in turn would result in a call to local law enforcement, which in turn would result in a bunch of sheriff's deputies being dispatched to my location to deal with a veteran with PTSD in crisis. I don't have firearms here, but they wouldn't know that and it wouldn't be a good situation if that happened.
Now, there are a bunch of other reasons for a hacker to have an extra working cell phone that are legal and rational, and I'd been planning to purchase one for those reasons anyway. It was those reasons that kinda gave me the idea. That's not an excuse though. The idea that I'd even have to worry about having lots of cop cars show up because I started talking about my PTSD is pure, PTSD created paranoia.

And that's where I get off the fucking train.

Today (Monday) I reached the point of Peak Fuck It, woke up, got dressed, got in the truck, and drove to the emergency room at the Atlanta VAMC. 

The plan was, yesterday, that I'd wait to see if the psychologist from primary care that I've been playing telephone tag with was going to call-- if he did, I was thinking, that would go a long way towards making things better. When I woke up today, I knew he wasn't going to call. That's not being defeatist or letting negative thoughts take over, that's just reality. Nothing that's happened since I've been here has given me any indication that anyone's going to worry about me falling through the cracks. They just let it happen.

So fuck it. I went to the Atlanta VAMC emergency room today. For PTSD.

I've only ever been to a VA emergency room for mental health one other time, sixteen years ago. I've called a mental health clinic and said I urgently needed an appointment, but other than the first time I went in for mental health reasons I'd not been to an emergency room since then. Even during all of the shit I went through when I was homeless, and even though I thought about it at times, I'd never been to the EMERGENCY room. That's partly because I didn't ever want to admit that I couldn't handle whatever was going on, and partly because I'd met other veterans who had ended up in the emergency room only to find themselves admitted and staying overnight. I don't want to be admitted, don't want to stay overnight. That it's been so long since I felt I needed to be in the emergency room should, hopefully, indicate how serious it was that I decided to go.

I am writing all of this down for myself, to process it for my own sanity, but I'm writing it down where others can see it so there's some documentation of what it's actually like to show up at a VAMC emergency room as a veteran with PTSD. (If you're not enrolled in VA health care, it's a slightly different process-- they have to enroll you first. That was me sixteen years ago.)

Traffic on the way there isn't too bad. Google routes me a little differently than it did last time because of traffic. I paid attention to driving, tried not to think about anything too much. That there was a fair amount of traffic was probably a good thing. I stopped to get soda at one of my normal convenience store stops, since I'd just hopped in the shower and got dressed instead of making coffee like most days. Normalcy, if only for the time it took to stop for soda like normal people do.  It's chilly when I get there, so I grab the fleece I keep in the back seat of the truck for those times when I get somewhere and it's chilly out. I've been to the Atlanta VAMC before, once-- I went to the Patient Advocate when I couldn't get anyone to answer the phone when I was trying to set up a primary care appointment. So I manage to get into the parking structure, get parked, get into the building.

I look for and follow the red EMERGENCY signs. They lead me to a sign that says "line forms here". There's a small waiting room of chairs, most of which are full, but there's only one person in line and he's already being helped. There's a dude standing at a computer who waves me forward, asks for my name and last four, then points to the triage window. I fill out a form with my name, last four, date, and reason for being there ("PTSD"). I hand that to the triage nurse through the window, then I'm waved around to the door.

In the triage room, I'm asked for my name and last four again. I get asked a bunch of questions. Why am I there today, what symptoms, for how long. Am I thinking of harming myself or others. Am I carrying weapons. Do I have a place to live. The set of questions is a standard one, there's such a thing as a standard intake for PTSD. My vitals-- blood pressure, pulse, temperature-- are checked. My blood sugar gets checked too, since that's a thing I have to keep track of. I'm not told what my blood sugar number is, nor am I told or shown what my vital signs are. Once the intake questions are done I manage to look at the monitor, and only see my pulse: 110. The triage nurse gives me a paper bracelet with a bar code containing my SSN, my name, my birthdate, my picture, and a red A; she scans the barcode. I'm now admitted to the ER.

I'm also reminded of the tracking tags I've seen in the ears of livestock.

From triage I'm led into the ER proper, a big bright room with lots of people in the middle of the room sitting at workstations. It immediately reminds me of those places in airports where there are counters, stools, and charging stations except that here no one has luggage and everyone's wearing scrubs. Exam rooms line the outer perimeter, as do a few more workstations. I'm led to one in the corner that has four leather very medical looking chairs. It's the farthest from the entrance. There's an emergency exit just past the exam room. I pick the chair that's in the corner that most faces the door. Other than me the room is empty; a nurse sits at a workstation just outside the door, facing away from me. There is one camera that I can see, maybe another that I can't. Triage nurse says a social worker and a doctor will see me soon. I take my phone out of my pocket, turn it off.

I don't know what constitutes busy for this (or really any) ER. There are plenty of people moving around. The nurse sitting outside the room I'm in is helping keep track of who's where and who needs what. For more than a moment, I imagine what it would be like to try to just run like hell to get out of here. I wonder how many other veterans have sat in these rooms on these chairs because they came in and said they were having trouble with mental health. I wonder if at some future point I'll be sitting at the bar at some VFW post in Arizona talking to another veteran about The Room With Four Chairs. I didn't get escorted to the waiting room, I got brought here, which I also notice.

I try not to look at my watch, preferring instead to stare at the walls and the ceiling and around the room. There's some trash on the floor. Each wall is a different ghastly pastel color, there are marks on the walls from the chairs. The chairs are leather chairs, with equally icky colors that you'd only find in a hospital. I'm grateful that I'm in a room by myself. Time passes. I feel like crying more than once, but that passes too. Many times while staring at the ceiling-wall intersection of planes of different colors, I ask myelf how I've ended up in yet another VA emergency room.

A social worker walks in with a doctor. There is a longer and more detailed list of intake questions, the summary of which is "why are you here?". I explain that things have been getting worse and worse, that I've been having a lot of really fucked up thoughts, that I've tried to get help from the Vet Center and primary care and I'm not getting anywhere with it. I explain the story of the Vet Center canceling my appointment, that I went through five weeks of appointments and got nowhere before that. Social worker asks which Vet Center, and when I tell her it was the one in Lawrenceville GA they both wince and nod their heads knowingly.

An aside: if I'm ever elected president my first executive order will be to the VA secretary ordering him/her to immediately terminate the employment of any VA employee who hears that's something's really fucked up for a veteran and responds by just nodding. You're not part of the problem, you *are* the problem.


I don't know how long the questions went on; not that long. Social worker takes notes. Doctor just stands there and looks doctorly, mostly. They leave, and after a short while social worker comes back for some answers she's missing-- some questions she's already asked. Whatever. Social worker is going to put in a consult to a psychiatrist. Social worker comes back after some time with a printed "safety plan" with some of the answers I gave, things like people I can call if I need help and thing I can do if I'm feeling like shit. Whatever. Once again, I'm informed about the Veterans Crisis Line-- I imagine there's a directive from on high that if you don't give out that number or mention it every 10 minutes you're not going to heaven. I smell the distinct odor of ass being covered, along with the feeling that the Veterans Crisis Line has become the post-Iraq and post-Afghanistan way of saying "tell your crisis to someone else."

I'm being cynical, I know, but I'm already in the fucking emergency room. How much more in crisis do you want me to be?

Another while passes. The nurse sitting outside the door to the room of chairs is actually paying attention, and wonders what's going on with me-- he asks someone I can't see about the consult to mental health that was supposed to be in, and isn't. Person I can't see says something about the computer freezing up. It apparently gets sent through, because not long after that a psychiatrist shows up with another clipboard. She starts asking more or less the same questions I've already answered a couple of times. Another veteran comes into the room with chairs, picks one of them out, rearranges it so he can recline and get comfortable. He's been here before, knows what he's doing. Psychiatrist and I move out into the hallway near the emergency exit to finish talking.

Eventually we get to the part about asking where I want to go from here, and I say that I want to get into regular therapy again. She mentions that the psychologist from primary care has called me, and there's a letter being sent because I haven't called back-- I explain that oh yes I fucking have, I've left several voicemails. I also explain that I specifically want to get into cognitive based therapy and prolonged exposure therapy again, which she writes down. I'm being refered into "Trauma Recovery", and psychiatrist is going to carbon copy psychologist the referral since psychologist is my primary care contact (confused who's who yet?).

Trauma Recovery is apparently something different; psychiatrist doesn't explain what it actually is, but says they have walk-in hours tomorrow morning and I should go there tomorrow. I indicate that I don't know where "there" is and that I need the address and directions and some information about them or there would be nice too. She promises to get that for me, drops me off back in the room of four chairs where the veteran from before is stretched out and reclined and asleep (and snoring). On her way out, she tells the ER I'm cool to be discharged (meaning ok to go home) but doesn't leave behind any information about Trauma Recovery. The nurse who's station is right outside the room of four chairs is coordinating me leaving, and when I hear my name mentioned I kick out a "WTF? She said something about somewhere I'm supposed to go, tomorrow?" which causes confusion because psychiatrist didn't leave any instructions. She just said "discharge him" and left.

There's a form to sign to be discharged that I have to sign. Fine. I fuss at the nurse about where it is I'm supposed to go, and between him and Some Other Guy they figure it out and get me the address. Some Other Guy says no, don't go to walk-in, you'll just end up pissed off when they say they won't see you. He offers to do a referal, which I accept.

And then I'm done, very conveniently (or coincidentally, I'm not sure) at exactly 1700. As I'm walking out, Some Other Guy hands me a card with the number for the Veterans Crisis Line, the time allowed between reminders of the VCL's existence having apparently expired.

From there on home, it's just Atlanta Traffic. I catch a glimpse of my face in the rear view mirror of my truck, I look into my own eyes, and I absolutely look like shit.


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This week marks two months since I first tried to get help in Atlanta, and even after visiting the emergency room today I still don't have an appointment to see anyone in mental health-- not a social worker, not a psychologist, not a psychiatrist. I've been to a Vet Center, Primary Care, and the emergency room yet I've received no actual treatment. 


16 February 2017

Facebook, Twitter, LinkedIn

A while back, I reinstalled the Facebook app on my phone. I'd uninstalled it just after Election Day, when the signal to noise ratio went batshit over Trump being elected. I reinstalled it for the purpose of looking at my list of several hundred friends and paring that list down to people I actually might want to still be in touch with. I wrote a single post that said I was more or less stepping back from Facebook, and that if anyone wanted to get in touch they were welcome to do so via Facebook Messenger. Then I uninstalled the Facebook app again.

No one's been breaking down my door to get in touch. I'm not surprised. I haven't recently talked to many of the people that are still my Facebook friends, in some cases for years.

I have sort of stuck with Twitter; the majority of people I follow there aren't people I know, but are people whose work I'm interested in. I follow a lot of information security people, a lot of software developers and companies, and a lot of just plain 'ol hackers. Some are rock stars, some are not. I learn a lot from what these people tweet-- tools, research, best practices, just cool shit.

I have a personal rule that I don't listen to political endorsements (or political opinions) from celebrities. That you are an actor/actress, singer/musician, or whatever, doesn't qualify you as an expert. You're completely right to have an opinion and speak your mind, but I'm not going to agree with you just because I liked that one movie you were in. Airing one's thoughts on political issues is one way for a celebrity to continue to be a celebrity; this has always been true, but it's especially true on social media like Twitter.

I'm a hacker. I want to know everything. I want to learn new things every day. One of the ways to do that is to watch and listen to what other hackers are doing, see what tools they talk about, and read the papers and articles they write. Some days I can do this very effectively, some days I'm fighting off anxiety and depression and PTSD (all of which make it hard to focus and concentrate and work and learn). Signal-to-noise ratio matters. I can only process so much, and the less noise I have to sort through the more I can actually learn.

I'm also a veteran, and as such I see the world through that lens as well. Many of the people who are saying the most about politics lately aren't veterans-- they're people who never served in the military, have never seen the world in the same way as those of us who have. One of the factors in me bringing PTSD home from the Desert was what I saw every day, so when I see people loudly proclaiming things about foreign policy I ask what qualifies them to do so. The answer is often the same as it is for celebrities-- nothing.

I don't see people organizing protests against veteran homelessness, or diversity efforts towards hiring veterans, in the same way as I see these things for other types of people.

Over the past couple of weeks, especially since the inauguration, I'm finding that I can't spend more than a few minutes looking at Twitter. I used to spend a lot more time than that. Honestly, now it just pisses me off and I find myself wanting to change the channel-- except that there are no channels to change to. So I unfollow people here and there, I turn off retweets for some many people. Some people, I've decided to only follow their blogs rather than their Twitter posts, since those tend to be more technical in nature (and therefore more useful for me to read).

-----

A late update (this post was written a while ago, I'm just now catching up on getting things posted): I'm doing much the same thing with LinkedIn, going through my list of contacts and removing people that I know I'll never interact with again. I don't see the point in having n > m followers or contacts just to say you have that many.

Why I'm done with the Vet Center

Yesterday I had an individual counseling appointment scheduled at the Vet Center. At 0900 they called to tell my that my SW is out of the office today, so my appointment has been canceled. They don't offer to have me call if I need to talk to anyone, don't offer to have me come in and talk to anyone else-- just, you need to call to set up a new appointment. This is the second time in six weeks I've had an appointment canceled. The first was due to weather, and I get that snow and Atlanta don't mix. I was in fact letting that first time slide, for just that reason. It was the same thing though-- your appointment is canceled, no alternatives offered, it's on me to reschedule.

There might be a very good reason that SW wasn't able to be there today, just as there are a ton of legit reasons why any regular person might not be able to make it in to work on any given day. I'm not trying to say that SW did this on purpose, just to hurt me. This isn't personal.

Truth is though, I really *needed* that session today. There was some stuff about the group last week, plus some of the things about the primary care appointment yesterday, on top of the stuff we'd talked about two weeks ago that I'm working on. I wasn't going to the Vet Center just for shits and giggles. I'm trying to build some kind of support network up, part of that is the VA (for better or for worse), and it doesn't make sense for me to have support people that aren't going to show up. I've had enough of those kind of people in my life and I'm done with 'em.

It takes a lot, to go to a Vet Center and say you need help-- by doing so, you're admitting to yourself (and possibly people around you who know you're going there) that you can't do it alone. It's not admitting defeat, but it is saying that you've tried, or you're trying, and whatever you're doing on your own isn't working. Maybe you go there on your own, maybe you're referred there by a friend, maybe your wife or husband or girlfriend or whatever tells you you fucking need help, and that's why you go. At a certain level, you go there, and you decide you're going to try to trust them and listen to them, try doing what they say, and maybe that will help with whatever problems you're having.

Personally, it takes a lot of energy for me to go to a session. I have to think about what's really wrong, what I want to say, what I want to ask about. I talk it out to myself, I pace around the room, I write. It takes time, it requires work.

The first three weeks, and most of the fourth, were just a standard list of questions about me and my life. Last session (two weeks ago), we talked about me trying to do some things to establish a foothold here-- looking into setting up my own shop that's PTSD compatible, and checking out some options for making new friends and getting out and about with people in general. This week was supposed to be me talking about answers to those questions.

The short answers are, first with regard to setting up my own business, ain't gonna happen. If you can set up and run a business, then you're not disabled and you stop getting disability payments. Which is fine if the business is a success, and you make enough money to live on. If you don't, and the business dies (as most startups do), then you might not be considered disabled again the next time you apply. Reality says that I, with my social anxiety, depression, and PTSD, am probably not the ideal candidate to run a business so the likelihood of success isn't that great. This is a bitter pill to swallow. It means I'm basically retired, something I didn't want to be (or become). I didn't plan for this, and probably couldn't have anyway, but now what do I do?

The second answer, which relates to the first, and to the cancelled session today, deals with social life/social anxiety. The year of group social anxiety therapy I had was before I was diagnosed with PTSD, so none of that therapy dealt with it-- but there were some really valuable things I learned from that year of weekly group sessions. One of the most important was that in relationships, it's okay to ask for what you want and expect to receive it. If you don't get what you want from being in the relationship, it's okay to not be in that relationship any more. This is speaking in terms of romantic relationships, but it applies to friendships and professional relationships too.

It's telling that now, when I say I want something out of a relationship with another person, suddenly things change. Yes, I am going to wear this black tshirt today. Yes, my hair is going to remain this long. Yes, I have PTSD and I need you to stop making that noise. When I request ADA accommodations, I really do want and need them. And yes, if you are a SW and you make an appointment with me for a session at the Vet Center, I expect you to be there. You're getting paid to be there, while I'm burning gas for a 90-minute round trip to get there. You're sane, you have a steady career, I'm unemployed and disabled and effectively retired.

I could get back into the things I did during my social anxiety therapy-- one of those things was setting a goal of going out and doing things with people three times a week. I accomplished it a lot of weeks by participating in Meetups (see meetup.com). At one point I was in several groups, and I went to a lot of different events and met a lot of different people. At one point I had a girlfriend who I'd met through a Meetup group for singles. A few clicks, and my social calendar will be full. I could join the American Legion, or the VFW, or both. At any given post there are officer slots to be filled, volunteer work to do, etc. There's always enough to keep someone busy.

The problem with all of these things is I've been there, and I've done that, and that was all before everything that's happened. That was all before failing out of school again and again, it was all before being homeless, it was all before PTSD really started messing with my life. I haven't learned, or figured out, how to manage to do all of those social things in terms that include PTSD.

The other problem is that of all of the people I met, some of whom I called friends, are gone. When I went back to school and was too busy with that to keep doing all of those social things, those friends slowly faded away. It was the same as all of the people I knew from bowling, and darts, and pool, and softball that disappeared when my ex-wife and I split up. It was the same with the hackathon community, who tolerated my presence (and respected some of my hacks) but when it came down to it didn't care anything about me as a person.

I can build up a new group of people I know, make new friends, do all of those things, but there's nothing about life right now to suggest that the same thing that's always happened won't happen again-- after a while, after I make decisions about my life that they're not interested in, they'll all disappear too.

I could call the Vet Center tomorrow and reschedule.

That would mean that my next individual session with SW would likely be in two weeks, since next week I have a group session scheduled. If that's how it works, then it's a month between individual sessions. If I go to group next week, I'm going to be pissed off and triggered when I get there, which will (would) suck and not accomplish anything.

Me calling and rescheduling would also say to the Vet Center that it's okay to do that, to just cancel an appointment the morning of (and to call me at 0900 and 1100 when I've asked them more than once not to call in the morning). It's not right to just leave me hanging. Whatever else my SW had to do today, it was more important than talking to me. Whatever else the rest of the SW's at the Vet Center had to do today, it was more important than talking to me.

As I'm writing this, it's around 1600 the next day and I haven't heard anything from them. Which means that I've fallen through another crack. The only thing I'm really asking of the Vet Center, and anyone that works there, is to listen. I just need to talk to someone that's a veteran who will listen and hear and make an honest effort to understand. Maybe they can offer advice to change things, maybe not, but I need someone to listen.

There is a line, where once you reach or go past that line, the world changes. Until you get there, as long as you're on the good side of the line, there's still hope and still another way. It's the line where when you cross it, you give up hope and give up on there being another way. The doors are locked, the keys thrown away. All the fucks to that you've ever had to give have been given.

You can't see the line, so you don't know how far away it is or how close you are to crossing it. For some people, when they come back from the Desert or wherever, it's right at their feet and they can't take a step back home without crossing it. For others it's way out on the horizon, always in the distance. Maybe those veterans never reach it. For the rest of us it's somewhere in the middle, waiting for us to get to it.

The line, when it's crossed, is where the other shoe drops. It's where the last wheel falls off.

On the other side of the line, you show up for work with a loaded rifle and lots of ammo. You stick up a gas station. You hurt someone else. You crawl inside a bottle, never to leave. You decide that living on the street is better than trying to get off the street. You take your own life. All of the times that you've read about where someone who's a veteran does something like that, they've reached the line and crossed it.

I fear the line. I never want to go anywhere near it, much less cross it. It's my theory that the closer you are, the more likely you are to reach it, so I do everything I can to keep away from it. One of the things I do to try to stay away from the line is that when things get bad, even if I have to swallow pride to do so, I go talk to someone.

Vet Centers are supposed to be one of those places where veterans can go to talk to someone, to get help. To stay away from the line, to keep from crossing it. I didn't have the highest of hopes on January 3, when I went to the Vet Center to talk to someone-- I thought maybe I'll get to sit down with someone for about 15 minutes, long enough to share some idea of what I'm going through, get something started.

This week, my appointment was just cancelled without explanation. So much for building a support network, and so much for actually talking to someone who might understand. I'm no farther from the line than I was when I started, and considering how I've felt yesterday and today I may have moved closer to it.

I'm proud of myself, for getting up the nerve to go to a Vet Center in a city I've never really been in, telling complete strangers that I'm a veteran who's having trouble and that I need some help. It's not an easy thing to do. It took months to get myself to the point where I could even do that.

I tried for *six weeks*, 45 minute drive each way to get there, money for gas, Atlanta Traffic. Talking about all of the bad things that have happened in my life, filling out a checklist, but without being offered anything to make my life as it is now a better place. I feel worse now than before I started.

That's why I won't be calling the Vet Center to reschedule my appointment.