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18 April 2017

One last try

I'm trying to approach things from a less... emotional (maybe that's not exactly the right word) point of view here. Anyway. One more try.

At my last VA appointment I had a social worker ask me questions and type my answers into a computer, in much the same way as I used to ask customers questions on the phone filling out help desk tickets. One difference is that I had to wait a month after an emergency room visit to get my appointment, and another is that this last appointment the person has a master's degree in social work. I'll assume she's paid a certain amount based on that, which is probably much more than I got paid as an IT support agent who was also an undergraduate, for what is essentially the same work. Had this been my first ever visit to a mental health clinic or appointment with a useless social worker, my feelings might be different, but it wasn't and so I'm just not happy.

That appointment resulted in a phone call from someone in trauma recovery. I called back, left a voice mail, and then didn't hear anything for about a week. When the person did call back, they called at around 0800. I've asked everyone I've encountered at the VA to not call until after 1200 because I'm up very late every night, and before noon I don't hear the phone right because I'm asleep. I've been asking this for years. In any case, I happened to be awake because I'd been unable to sleep for about 24+ hours, so right after I missed the call I called back.

Turns out the person had been out of town, and that's why they hadn't yet called back. So whatever they had to go out of town for was more important than either calling me back to set a date and time, or to assign someone else the task of calling me back to set a date and time. You could argue that I'm being unfair, that life happens and people need to do things like go out of town all the time. Fine, but this person isn't the only person that works in whatever office this is. If I'd ever used that excuse with a customer when I worked help desk (sorry, didn't check on your ticket because I was at a hackathon) I'd have been fired.

So I have an appointment with this person tomorrow afternoon.

It's at some other building that I haven't yet been to, completely separate from the VA hospital. I have to go through/past a mall of some sort to get there, which doesn't sound appealing-- I'm not in the best frame of mind in terms of either patience or concentration, so I'm not especially looking forward to the drive there. I haven't been able to find out anything about the place itself, other than to get directions there and see a picture of the building on Google Maps. It doesn't look particularly dangerous, but it doesn't look particularly friendly either.

During the phone call, it was mentioned that I need to bring a DD214 along. When I asked why, the person's response was that the clinic needs it. Why? It just does. This is bothering me a great deal-- there's nothing on my DD214 that the VA doesn't know already, and in fact they've had a copy of the thing since 1992. The VA already knows that when I was in, what branch, what war, where, and when (and if they didn't know before, those questions were all asked by the social worker at my last appointment and they didn't need to see it).

It's not unreasonable to question being asked for a DD214. There's nothing really "secret" on it, but it does contain personal information and I'd really rather minimize the number of people in the word that store copies of it. More important, when I asked why it was necessary I was blown off. I need to be able to ask questions of the people who are providing my mental health care, and as a patient I have the right to do so-- being blown off about something so simple before I even go to the clinic isn't a good sign.

I'm also bothered that this has all the indications of being another intake appointment, where I sit in front of still another person and explain everything yet again. That's been the theme for the past few years, that every new provider is me reading my biography-- it was true in Wisconsin, too. I'm not expecting the VA to be like Cheers where everyone knows my name, but at the very least I shouldn't have to explain the whole story again and again. The story of how I got here and why I'm in the mental health clinic is long and ugly. It's triggering to have to sit and think about it (which is the reason I want to do work in therapy to begin with). I expect that this appointment will just result in another appointment, likely with yet another provider. If it's with yet another provider I'll have to tell my story again in a week or two weeks or a month before any therapy happens. Given wait times so far, that puts my start of therapy into May, or possibly June.

What I want to do, at the very start of the appointment, is ask "is this appointment going to result in me starting therapy at some definite point?" If the answer is "yes", then all right-- let's skip the bullshit and let's talk about the logistics of that. If the answer is "no", or anything other than yes, then I'm done. Words like "maybe" or "that's what we're here to talk about" or "we need to evaluate" are, right now, the same as saying no.

It's not that I don't want to do the hard stuff in therapy. I do.

Cognitive processing therapy is in some ways harder than prolonged exposure therapy (which it difficult too), because you have to think about what's going, on, question it, and write down answers-- and you have to do these things for every week for three months. You end up thinking about the therapy, and your questions, and your answers, for a lot of the time in between weekly sessions. It's serious mental pick and shovel work.

If I were looking for a quick fix, CPT isn't where I'd look. I'm not being a hardass about getting what I want from the VA because I want a quick fix or an easy answer.

All or nothing thinking is actually something that comes up in cognitive processing therapy, it's often an indication that important details are being missed. I'm trying to consider this when I say that if at tomorrow's appointment it's not immediately clear that I'm going to get into therapy, I'm going to bail. It is perhaps a stuck point for me that I went to the emergency room for my PTSD symptoms being bad and nothing really happened as a result-- I'm the only one that seems to consider this as being important. (Of course, I still consider it important that that VA put me back on the street and forgot about me in 2014, too.)

One of the things I've learned in all of this is that you don't take steps forward through PTSD until you're ready for them. The reason might be fate, or a higher power, or just natural selection-- I have no idea which-- but a lot of the forward progress I've made couldn't have been made any earlier. The rule is often that you can't get there from here, there's lots of small steps to make first. It's only after a lot of these steps that you look back and see that you've made progress.

Right here, right now, may well be one of those places and times where getting into therapy just isn't "supposed" to happen. Might be it's just chance, or that the VA's really just that dysfunctional here, or a combination of both. In Wisconsin, I always just sort of took what I was given. That's how the VA is set up, you don't really go through the process of choosing a therapist, you just get assigned the next one who has room on their caseload. If you really don't like your current one you can ask to be switched, but usually no one explains that.

I've been writing here (this blog) since 2008. There's a lot that's not included, but there's a lot that is-- I tend to shoot from the hip when I write, and what gets put on paper stays there. I'm careful to not attack people personally, which is why I use things like SW or Social Worker or Front Desk to refer to people I'm writing about. I know who the person is when I look back at previous posts, and especially lately I use those posts as guides to think about some of the therapy I've had before, what worked and what didn't-- and who worked and who didn't.
 
Before I ever was diagnosed with PTSD, I was diagnosed with social anxiety and was in a therapy group for that for about a year, every week except holidays. I have some, but not all, of both my notes and the psychiatrist's notes from that year. One of the very important things that came out of that therapy was the idea of subjugation, putting the needs of others before my own needs in relationships with other people. It's not a bad thing to be a generous and giving person, but it becomes a bad thing when you don't get what you need to be happy because you're not in a situation where you can ask for it. You end up giving until you're empty. One of the ways you counteract that is learning to stand up for yourself and not accept being put upon. This is why when the Vet Center canceled that appointment I had in February, I got so upset-- I was doing my part, but they were not doing their part.

I know that relationships such as romantic relationships and that of being a patient in a clinic are not the same, but in a clinic or hospital where it's your job to help patients you're obligated by that to actually help patients. You get paid. When it's the patient that's having to do all the work to get help, something's wrong. When I'm the patient and I'm asking for help and not getting anywhere, it's a bad relationship for me to be in.

That's why I'm not very encouraged by the entire process I've been through with the Atlanta VAMC in general-- I'm asking for help, I'm just getting shuffled around, when I have questions no one answers them. I'm just supposed to hold my tongue, just be patient, just wait and deal with it. Normally, I am still a pretty patient person-- I know I mention this often, but I worked at IT help desks for eight years, and if that's not credentials indicating patience I can't offer more. The response I get, especially at the last social worker appointment, is that people just do whatever they can to get rid of me and pass me on to the next person. I'm frankly tired of it, and it's making me feel worse instead of better.

So, because I want help, I will go to tomorrow's appointment. I will talk to the person. I will ask if I'm going to be leaving with a scheduled appointment for cognitive processing therapy, and if the answer's anything but yes I'm done with trying to get help from the Atlanta VAMC.

05 April 2017

Rainbow In The Dark

Previously: https://stillinthedesert.blogspot.com/2017/03/vamc-er-follow-up-to-follow-up.html

After I went to the emergency room because my PTSD symptoms were getting out of hand, I got an appointment with primary care/mental health-- the next available date and time was March 28, a month later. Other than some drunk, angry, and probably confusing tweets I haven't said anything about that appointment, so let's just fix that.

This time, my sister volunteered to ride along. She's retired, but she worked alongside a lot of people who are veterans-- many of them Vietnam vets and many of whom really do know a thing or two about post traumatic stress disorder. That some of the things I've been saying and doing lately matches up with what she knows of what those friends have said and done raised a few red flags.

Getting this appointment took calls to two VA medical centers (Madison WI and Atlanta GA), one trip to the Atlanta VAMC's patient advocate, one trip to the Lawrenceville CBOC, and one trip to the Atlanta VAMC emergency room-- a total of six weeks of going back and forth and not getting any actual help with my PTSD. Even after all of that I really didn't have high hopes for success. I figured the best I'd be able to do was wait and see. This appointment had an "acute" label attached, which applied to someone who's physically injured implies that they might really be hurt and need attention. I made it through the month by alternating between numb and disassociated, and angry and triggered.

It was an 1100 appointment, earlier than I wanted-- I only took a morning appointment because it was the first I could get. I've worked (and hacked) nights long enough now that I just don't do mornings. As was often the case in Wisconsin, I ended up staying up all night the night before this appointment because I was afraid that if I slept I'd not hear my alarms. (I'm not one of those veterans that sleeps lightly-- once I'm asleep, I'm out, usually dreaming something like Redeployed to the Desert XVI.) Allowing for traffic and parking, we left at 1000.

At the clinic: no parking available. It's in one of those "professional" areas, subdivisions of strip malls containing anything from sub shops to Japanese restaurants to medical clinics. I waited for several minutes while another veteran with a cane walked to his truck; there was already a veteran in another truck waiting for that space, so after first guy left and second guy took that space, I took the "no parking" zone space to wait in. After a few minutes, the process repeated with me pulling into a space.

Inside the clinic: found the check-in kiosk, scanned my ID card, went to sit down. Sister had brought books (plural) to read, having been in a VA waiting room before. 1100 came and went, and following the sign on the wall I went to the desk to let someone know that it was now 15 minutes past my appointment time. Front Desk asks who my appointment is with, huffs when I say I don't know, asks for my name. She'll check with someone. Fine. (Truthfully, I don't know my provider's name because I've decided that it probably won't be worth taking the time to memorize it.) 

A few minutes later, a social worker appears and makes a weak ass attempt at apologizing for being 15 minutes late. I was actually early, which for my chronologically challenged self is an accomplishment. I follow her down a couple of different hallways in The Back, to an area that I assume is the Mental Health area.

The office has two chairs, two indirect lighting lamps, and a desk with a computer and another chair-- an almost exact carbon copy of the exam room (or whatever it's really called) that was at the Vet Center. I take one of the patient chairs, she takes the chair at the desk. In order to see the computer, she has to face away from me.

The appointment begins with me explaining two things: that I under no circumstances consent to being made an inpatient, and that I am not even going to entertain the thought of being put on medication ever again.

I have good reasons for my stance on these options for treatment-- being an inpatient for mental health reasons opens the door to having someone else make decisions about my life, liberty, and pursuit of happiness. There are also questionnaires in the world where having to answer that you've stayed overnight for mental health reasons means you can't do, or be, certain things. I learned a lot about both when I was homeless, because in the grant per diem program/transitional housing the threat of being deemed unfit to manage one's own life was implied often. I was also in crisis level groups, where the other veterans in the room had done the several days stay in the hospital and weren't overly fond of it.

Medication-- in my life I've been on citalopram, sertraline, venlafaxine, bupropion, prazosin, and at least one or two more that I'm forgetting-- has upon further review (remember that I've had a month to think about it since my emergency room visit) not really solved the whole PTSD thing. It was probably a very good thing that I was put on citalopram in 2000, because it diverted me from a pretty dark path, but in the end it didn't fix anything. None of the others really did either, and in reviewing my notes from 2010-2015 I think being on meds may have in fact been a net negative (during that time I washed out of college twice and was homeless three times). So no, no meds.

The rest of the appointment, as I somewhat expected, was taken up filling out an intake questionnaire that included questions like "are your parents still alive" and "what was your childhood like" and "do you have a support network" and "do you have a job and a place to live". It also included a standard set of suicidal thoughts questions, which I expected, and I answered honestly; my research suggests that my answers should have been lighting up warning signs, which is of course why I went to the emergency room in the first place.

"Filling out the intake questionnaire" meant that the social worker turned to look at the computer (away from me) to read each question, looked back at me for the answer, and then turned back to the computer to type in the response. Where I'm from this is a job for a clerk-- it's simple data entry, and this social worker put about as much emotion into it as I used to put into entering a customer's pizza order into the computer when I delivered pizzas.

These were also the same questions that I'd answered at the Vet Center (over four one hour appointments), at my initial visit to primary care, and in the emergency room. All of this information was already in the machine, and in my records, which meant this was essentially duplicated effort. I tried to play along anyway. The wheels fell off one by one as the questions went on-- at one point she asked if I owned any firearms (I currently do not), but even after I'd answered that yes I had thought about specific methods of suicide she never asked about the means (I own, and regularly carry, sharp and pointy things).

Nothing I said in response to anything really got any reaction at all. After I gave an answer, she'd turn around and type the answer into the computer and go on to the next question.
 
The last of the wheels fell off when she asked what branch of service I'd been in. I sat there for a second, not saying anything: did she really just ask that? Do these people really not know? I said something along the lines of "um, excuse me?", wondering if maybe I'd heard it wrong. Nope, that's what she asked, followed by asking what years I was in and assuming I'd been in Iraq (I wasn't, I was in Saudi Arabia).

The subject of treatment came up, finally. I expressed my interest in the twelve week cognitive processing therapy that I'd previously done, but this time focused on specific things from the Desert. I also expressed interest in prolonged exposure therapy, again focused on the Desert. When asked about group therapy, I said yes to that because talking to other veterans helps. I asked when any of this might start.

Social worker's response was that she'd send a consult/referral to trauma recovery and that I'd have to do the three hour intake there first.

Wut.

I explained why I hadn't been to trauma recovery walk-in, why to get there I'd be driving through two hours of Atlanta rush hour traffic on 24 hours without sleep with no guarantee that I'd be seen, and that hell would have to freeze over before I'd actually get there. SW's response got defensive quickly-- this is the process, you have to go through it, it takes time. She did offer to put in the consult a request to either have someone from trauma recovery travel to the primary care clinic, or to do the intake via video conference.

As this point, I was done. Whatever politeness and patience I had left were gone (I'm a very patient person-- that I worked at help desks for eight years should suffice for credentials about that). I got up to leave, she walked along as far as the front desk, and I indicated to Front Desk that I needed whatever I needed to get right the fuck now. Appointment in hand I asked for directions back to the Front, told my sister we were leaving right the fuck now, and walked out without looking back.

It's been a week since that appointment; I've heard nothing from the VA since. I should hear from trauma recovery, but I haven't. The person who called to follow up from my emergency room visit promised to call after this appointment, but I've not heard from them either. That I have an appointment scheduled for three weeks from now really doesn't mean anything if it's not an appointment to start actual therapy.

That intrusive thoughts about suicide are showing up in my dreams and at random times doesn't automatically mean that I'm about to do something drastic. On the other hand, these aren't normal for me. I usually see a variety of fucked up visions and dreams and feelings about missiles and chemical weapons and shit blowing up. I do wonder, daily, if today's the day that I can't come up with a reason to keep going and try to accomplish something in spite of what's in my head. I tell myself that I made it back, made it through all I've been through since then, for a reason. There's something in life that I have yet to accomplish, and it-- my life-- therefore has some meaning.

It is becoming increasingly difficult to come up with an answer to the question of "what meaning does my life have?". No job. No school. On disability. Few friends. Few options. Not much hope that any of that will change.

When the PTSD gets bad, and lately it's been pretty bad, I withdraw and disassociate and get really really guarded about everything. I don't trust anyone, I don't believe that anywhere is safe, and so I don't leave the house except to get groceries-- and for that I go after midnight, when there's no one but stockers in the store and I can do self checkout. A victory is getting into the truck and going to a convenience store to get diet Dew, because driving through the night in my truck listening to music I can almost feel human for a few minutes before the bad shit kicks back in.

After my appointment last week, I stopped for soda on the way home. I also picked up two 24oz cans of Mickey's Malt Liquor, admittedly one of my favorite brands. Being a malt liquor, it has a higher alcohol content (5.6). I don't buy it that often, because I don't drink that much-- a six pack of 16oz cans of Miller High Life (my usual choice) often lasts for a month or more in my fridge. Mickey's lasts longer. Last Tuesday, after I'd parked my truck and put my keys away, I took my 48 ounces of Mickey's and a folding chair out to the storage shed in the woods, and proceeded to get drunk, the kind of drunk that happens quickly. Then I wandered around in the woods drunk for a while (bear in mind I'd been awake for almost 30 hours by that point) and eventually made my way into my bedroom where I passed out and slept for 16+ hours.

People, I don't drink like that. 

In the distant past, think 2004 and before when I was married and hadn't yet learned what PTSD was, I drank a lot-- my social life was dart leagues, bowling leagues, softball leagues, all of which were in Wisconsin and all of which centered around drinking. My ex-wife drank a lot, and so did I. At some point around then a switch flipped and getting drunk wasn't fun anymore, so I didn't.

That I came home from a VA appointment and got drunk-- it wasn't a random act, I had to stop at a convenience store, stand looking at the assortment of beer for a few minutes, and decide to get that much Mickey's-- should be a huge ass flashing neon sign saying "HOLY SHIT DUDE SOMETHING HERE AIN'T RIGHT".

Suicide-- my opinion here-- takes many forms. You can see it as physically ending your life, where a person does something drastic and then that person isn't alive any more. A life can also end when someone just stops living, even though they're technically (medically) still alive. During the time I was a Veterans of Foreign Wars (VFW) member, I saw that happen. Even among some of the officers of the post I was a member of, life was about getting and being drunk. That the membership reports got sent to the state office regularly wasn't about anything more than making sure the bar stayed open. Meetings, honor guard, whatever the activity, there was always (lots of) alcohol.

That's a huge factor in why I haven't been to a VFW (or American Legion) post in Georgia. I know it's being unfair to people who I haven't even met, but past experience really makes it hard to try. I have never wanted my life to amount to being the grumpy veteran sitting at the far end of the bar at the VFW, spending my disability money getting drunk night after night after night. That's not living, that's life being over. That it doesn't immediately involve death doesn't make it not suicide.

Self medicating doesn't fucking work, for the same reason that letting the VA medicate me didn't fucking work. Psych meds, whatever form they take, don't make the problem go away. Maybe they give you some room, some peace, to deal with the problem, but they don't make it go away like aspirin takes care of a headache.

My fear in all of this is that the strength (or resiliency, or whatever it is) that's gotten me this far is a finite quantity. That at some point I'm not going to be able to fight this shit any more. That's why I went to get help with PTSD again, to find and build and sharpen some new mental weapons against it. It's the only thing that does help.

Yes, I have an appointment in three weeks. Big fucking deal. It's not an appointment for therapy, since I haven't even discussed actual therapy with the VA here yet. The schedule says it's a 30 minute appointment, the word "acute" doesn't appear like it did for last week's appointment-- so what exactly am I supposed to expect beyond maybe logistics planning for talking to trauma recovery. Then the trauma recovery intake where they'll ask me all of the same questions again that I've already answered. Then, maybe, after that I'll get an appointment to start the therapy I want to do. This will happen when, in May or June? 5-6 months after I first asked for help?

Fuck it. Fuck. The. V. A. They're not helping.

Unless something about the VA changes, drastic and soon, I'm going forward on my own. It'll take longer, it might not work as well, it might not work at all, but self therapy is 100% more therapy than I'm getting when I ask the VA for help. I'm not ruling out eventually being back in therapy, but I'm not counting on it either.


No sign of the morning coming
You've been left on your own
Like a rainbow in the dark
--Dio

Video

28 March 2017

NOW you want to talk?

This is primarily an update to Why I'm Done With The Vet Center (see https://stillinthedesert.blogspot.com/2017/02/why-im-done-with-vet-center.html) but I'm going to recap a little about everything that's going on, just in case you're dropping into this in the middle.

After the Lawrenceville GA Vet Center dropped me through the cracks by canceling that appointment on February 15, I didn't hear from them again until a month later. No one noticed when I didn't show up for the group session that I'd been scheduled for the next week. After that appointment was canceled, and after I hadn't been missed for group, I didn't see any point in trusting the social worker who had bailed or the Vet Center as a whole.

I still don't.

When the Vet Center bailed on me, I figured I'd at least be able to get an appointment with someone in mental health. I'd just had an initial appointment with a primary care MD in Lawrenceville, and a referral was supposed to have been sent.Two weeks after I was at primary care I still didn't have a mental health appointment. After a week I got two phone calls from a psychologist; I called back both times and left voice mails and never got a response.

I went to the Atlanta VAMC emergency room on February 27 (see https://stillinthedesert.blogspot.com/2017/02/visiting-va-emergency-room.html) after my PTSD symptoms kept getting worse. After I'd been to the emergency room and after it was promised there that a referral would again be made to get me an appointment in mental health, I got a letter from the psychologist I'd originally referred to saying they were closing the referral.

I got a call from Lawrenceville primary care on March 1 to set up an appointment with someone in mental health. The soonest I'd be able to get in to see anyone would be March 28.

On March 9--  two weeks after I'd been to the emergency room-- I got a follow up call from someone in the ER (see https://stillinthedesert.blogspot.com/2017/03/vamc-er-follow-up-to-follow-up.html). The details of that call are in that post, but I did mention (loudly and often) that the Lawrenceville Vet Center had canceled my individual appointment, not missed me in group, and I hadn't heard from them since. The ER person doing the follow up couldn't (or wouldn't) do anything to get me in front of a mental health professional sooner than my already scheduled appointment on March 28.

That the Vet Center bailed on me and primary care bailed on me at the same time is what's making things so serious now. (Okay, so now you're caught up.)

On March 15, just about a week after that ER follow up call, the social worker I'd been assigned to at the Lawrenceville Vet Center called and left a message. She's called twice more since then-- on March 21 and on March 27. She wants to talk to me. She wants to set up an appointment.

Blah. Blah. Blah.
 
I haven't answered, or returned any of these calls. I don't intend to return any of them, ever. I won't go back to that Vet Center. I won't likely go to any Vet Center again, considering that this wasn't the first time that a Vet Center hasn't been willing to help.

In early 2015, I was back at the Vet Center in Madison WI with a new social worker. The SW I'd had before that had moved to a different job within the VA, and I was supposed to be reassigned to someone else-- the reassignment never happened. I had to go there in person to get assigned a new counselor. The new counselor told me after a few visits that I was doing just fine, and didn't need to come back for another appointment. That was two years ago, and until I decided to contact the Vet Center in Lawrenceville GA that was the last time I'd talked to anyone at a Vet Center.

I don't know if the person doing followup from the Atlanta VAMC ER called the Lawrenceville Vet Center and asked what was going on, or if someone saw my blog and put two and two together, or if my name popped up on a list of people that they hadn't had contact with for 30 days.

It doesn't matter.

In six weeks since they called and canceled that appointment, my mental health has gone from "there's a problem and I need to talk to someone" to "okay, what the fuck is going through my head" to "all right, I'm meeting all of the indications of being a short step or two away from suicidal".


Two Vet Centers in two different states, two years apart, I got dropped through the cracks twice.

I've asked myself more than once if I'm just speaking from emotion, not being logical-- isn't it all or nothing thinking to say that because two Vet Centers turned out to be useless, that all Vet Centers are useless?

At this point my conclusion is that they are. Not just useless, tits on a bull useless. Of course, YMMV.

I don't have a vendetta against them. I'm angry, I'm disappointed, I'm even hurt, but it's not personal. That's why I don't (and haven't ever) called out specific people. I've bounced around long enough now to have realized that it's not just one person, not just one location.

There was a time when I actually looked forward to my Vet Center visits, when I was getting help from someone who really gave a shit about the work she was doing. When she left to take another VA job somewhere else, not at a Vet Center, I wondered (although I never got a chance to ask) why she was leaving someplace where she was obviously doing good work.

Now I know.

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.