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12 May 2017

Driving Crazy

This past Saturday, I was on the road again-- this time to Greenville SC.

I woke up out of a dream (or a nightmare, I'm not sure which) at around 0800 to the sound of heavy machinery outside my window. There was some random guy operating an industrial front end loader, clearing out the kudzu that's taken over the hill on that side of the house. I found out later that this had been a planned event, that sister's ex had hired the guy and his equipment to do this, but no one had mentioned it to the guy with post traumatic stress disorder that lives here (meaning of course, me).

My reaction to hearing the noise of both the tracks moving and the shovel doing its thing was something very close to what would happen if someone had entered my locked room, shook me awake, and yelled "INCOMING SCUDS!!! GAS GAS GAS!!!". It took a few minutes to register what was going on, but it didn't really matter (or really register), because I went from zero to GTFO in exactly zero seconds. Heart racing, can't breathe, running around the room in circles grabbing gear, the whole bit. I was wearing earplugs, and the window was closed, and it still sounded like the machine was inside my head.

I grabbed my laptop, a tablet, my backpack, and headed downstairs and hopped in my truck-- followed by laying a patch (or as close as my old truck comes to laying a patch) as I pulled out. I didn't know, and didn't care, if anyone saw me leave. I didn't pass by anyone else in the house on the way out. I just hauled ass.

The problem with noise, any noise, is that at minimum it's a distraction because if there's a noise it must mean something and I have to think about what it means. Is it a threat? An alarm? What do I need to do because this noise was made? This is why I have so much trouble in classes and in offices at work, because there's always so much noise that my brain has to process. Sudden noise is even worse, because my brain goes straight from zero to full on PTSD mode.

Noise made by machines, especially the kinds of machines that are used in industry to move shit around, is a special case above all of that. In the Desert, the unit I was 'tactical', which means a lot of different things but in this context means that all of our stuff was mobile. It had, or could have, wheels attached, and if the wheels weren't attached it got moved by forklift or crane or something similar. All of our equipment also required electricity, both for the electronics inside and for air conditioning to cool those electronics-- so there were also a lot of generators and climate control units running all the time in addition to shit often being moved around.

This is why now, I'm completely irritated by things like leaf blowers, lawn mowers, snow blowers, generators, heavy construction equipment, and absolutely anything that has a backup/movement beeper. Anything that sounds like it did in the Desert takes me back there, and so waking up in the middle of a weird dream to that kind of noise just completely set me off.

Normally, one of the ways I cope with noise is keeping ear plugs close at hand. I have a set of Decibullz custom molded earplugs that I wear much of the time when I'm working or moving about the house, and I also wear them in places like restaurants and stores to cut down the level of noise. (I don't really "endorse" products here, so no link, but Amazon has them.) For keeping my world quiet, this is often a good solution, but the noise from the front end loader blew right through them.

I realized a couple of things after pulling out of the driveway; first, I couldn't hear the radio very well, and this turned out to be because I still had my earplugs in. Second, I hadn't had any coffee or any breakfast. So, first fix was easy, second fix was I stopped at random convenience store for soda and one of those pickled sausages that I've developed a taste for. I headed east from there, towards Athens GA, and once past that promptly got lost.

For a minute or so, I considered visiting the base where I'd been stationed in South Carolina-- it was from there that I deployed to the Desert. It likely would have been pretty strange being there, since I hadn't been there since I'd ETS'd. It was a fair distance away. The deciding factor was that my unit no longer exists, so there really wasn't much to visit anyway. Instead I looked at the map, saw Greenville SC was the next nearest city that I'd never really been to, and told Google Maps to take me there.

Not long after reaching I-85 (which among other places runs between Atlanta GA and Greenville SC), I realized that all I'd had to eat or drink in the hour and a half since waking up didn't amount to breakfast. I stopped at the first truck stop I came to, a Petro. I don't have a particular favorite truck stop chain, but I mention this because when I'm driving I need to be able to find the thing I'm stopping at that matches the log on the sign on the interstate. If I can't see the place I'm stopping at before the exit, I get a little panicky and don't stop, so since this was easy to see and find that's where I ended up.  

Truck stops-- the real ones, not the gas stations that just happen to have diesel-- are one of my safe zones in the world. One of the things about them is there's comfort food of some kind, it's not outrageously priced, and it's often available on a buffet. The other is that they're populated by people who drive trucks for a living, rather than families with screaming kids like you'd find at a lot of normal restaurants.

Anyway, next stop was at the South Carolina welcome center at the state border-- sometime soon after breakfast I'd remembered that such a place has a lot of brochures of things that a tourist or traveler would be interested in visiting. I figured I'd find at least one interesting thing to go check out in Greenville, and I was right; the American Legion has a military museum there. So I entered the address in Google Maps, and headed towards that. (The actual full name is the American Legion Post 3 Cecil B Buchanan War Museum.)

I found the block that the museum was supposed to be on, and in looking for the entrance I found a small area containing several Confederate monuments next to a cemetery that also apparently contained a number of Confederate soldiers, so I spent some time looking at the monuments and such. I'm not a "Civil War buff", I'm not nearly invested enough to wear that title, but I am very interested in both the war and the politics-- I've been to a number of Civil War battlefields, historic sites, museums and even a few reenactments-- so when I see things like this, I actually read what's printed or engraved on them.

I'm going to go off on a slight tangent here, and it might be a little politically sensitive, so fair warning.

The Civil War, the reasons it began, the battles, the politics, the aftermath, everything, is a really ugly business. As a country, the United States still hasn't completely resolved all of the issues it raised (or in some cases caused). I know this to be true but I don't have answers for these questions. I've met people who fly Confederate flags because they think it represents one thing, and I've also met people who fly the same flag because they think it represents something else.

When I come across a monument or a marker that says something about the Civil War or about the Confederacy, I read what it says. I try, in my somewhat limited knowledge, to put it into perspective-- what was the world like that someone put up a monument to an idea that led to a rebellion after the war was lost? What lessons are there to learn from all of the things that happened? When these monuments and markers are removed, the opportunity to ask those questions is (at least partially) removed with them.

I'm not trying to pick a fight here, I know that people will disagree and I respect your opinion if you're one of those people, but hear me out (or not).

Any given war is started by politicians, it's run by politicians, it's ended by politicians. It's fought, however, by people like me and if you're military or a veteran, you. Most of us are just everyday people. We come from every possible background, but many of us are people whose parents worked hard and often struggled for what they provided us. Many of us came from broken homes or worse. Many of us joined up because it was a chance to do defend our country, to do something bigger than ourselves, to do something with our lives.

The kids-- and many of them really were kids-- that signed up to fight for either the Union or the Confederacy weren't any different than either me, or the kids (I don't mean this in a bad way, I was still a kid when I signed up) that join the military today. We don't always get to decide why we fight, we don't always get to decide when or where. The philosophy of right and wrong in most cases is above our pay grade. A soldier's a soldier. A grunt's a grunt.

I never did find the entrance to that museum in Greenville. After about 20 minutes of looking at the monuments and markers, I started to feel a panic attack getting going, so I punched the address of the house into Google Maps and got back in my truck. As I was headed back toward I-85, I saw the sign for the entrance, just around the corner from where I was. I'll likely make a return trip another time to actually see what's in it.:)

The entire trip, there and back, breakfast at the truck stop, the welcome center, the museum, even the thinking about the soldiers that fought the Civil War-- was all avoidance. It was me reacting to noise that I didn't expect, that was too loud, that was a trigger that reminded me of the Desert. (It was also me getting away from all of the drama and bullshit and noise that having more people in the house I'm staying in brought with it, but that was more of a side effect.)

Had I not got up, got dressed, and left, what would have happened? I'd have become more and more anxious, more and more agitated. Eventually I'd have stormed out of my room, thrown around a few what the fucks and motherfuck this and motherfuck thats. Anything that got in my way that could have been picked up and thrown at a wall probably would have been. Maybe I'd have broken something, maybe not. A heavy equipment operator who had no idea what was coming would have suddenly had a pissed off vet yelling at him above the noise, and either defending himself or calling the cops would have been entirely reasonable things to do. My sister's ex probably would have reacted equally and oppositely badly, and I might have ended up being told to pack up my shit and GTFO. 

This
is what I mean when I say there's a line that I don't want to cross, or even approach-- other than perhaps spending a little more money that I planned on this month, there were no real repercussions from me leaving. No one, in fact, noticed I was even gone until hours later. I was able to make the decision to just get up and leave and not make things worse, even though it probably wasn't a decision that my brain did a whole lot of logical analysis on. Leaving was just my first reaction. My fear is that at some point, if the PTSD keeps getting worse, if my brain keeps developing reactions based on the PTSD and not on the right things, that instead of making good or even passable decisions I'll start making really bad ones.

The line is where that change happens, and I can't tell if I'm close to the line, far away from the line, or walking right on the damn thing.

-----

I have heard from a couple of readers over the past few years who have said that one of the reasons they visit is to get a feel for being around their own veterans-- it's said that a picture is worth a thousand words, and it's also true that one comment or email is worth many more, so those comments do mean a lot. I have also heard people say that being around a veteran (or really anyone with PTSD) can feel like walking on eggshells; it's often impossible to know that what you do or say will turn out to be a trigger for us.

On the other hand, I as the veteran with PTSD can't fathom how no one would not know that the noise a front end loader on tracks makes would make me feel like I was back in the Desert and therefore I'd be totally triggered. Seriously, people, what the fuck? This is exactly how I felt on Saturday. Not saying it was right, or even justified, but it's how I felt. 

It's taken me a long time-- years, and lots of therapy-- to be able to calmly and politely ask someone to stop doing something that's triggering me. It is still difficult most of the time, because the response is often indifference or in some cases, openly hostile. In the case of indifference, asking again or asking in a stronger way can sometimes escalate the situation into something more than it should be. In every case, having to ask more than once makes the situation more anxious for me. When the response is hostile (or let's just say, less than polite) things ramp up very quickly because now in addition to the initial trigger I'm also threatened and ready to defend myself.

How do I know that the noise from a front end loader is a trigger, or that the sound a truck makes when it backs up is a trigger? I really didn't until 2012, when every street around my apartment as well as the campus physical plant a block away were all under construction at once. Every day, all summer, at 0500 the trucks and jackhammers and shovels and all the other heavy equipment would start up and run all day. It wasn't until I found myself thinking that it felt like being in a war zone to realize that yes, it did feel exactly like being in a war zone.

If you read my blog, especially a post like this, you probably know more about what triggers me than anyone-- even more than the therapists I've had. Much of the therapy I've had didn't deal directly with triggers, instead focusing on other things. Mindfulness especially, the "leaves on a stream" bit, has a lot to say about just accepting thoughts as they come; this is perhaps all right when the intrusive thought is about the baked chicken and rice a roni that the family cooked this week and how it reminds you of when you had baked chicken and rice a roni for several weeks at a time in the Desert.

There's a story behind this. When Iran held 52 Americans hostage at the embassy in Tehran for 444 days, the Americans were often fed chicken and rice. At one point in the Desert, it was said-- I'm not sure by who-- that the reason we were getting chicken and rice so often was that based on what the hostages said after leaving Iran it was commonly believed that that's what Americans liked to eat. MREs suddenly tasted a lot better after hearing that.

Unless I told you the story, and unless there's a reason for it to come up (i.e you cooked me chicken and rice for supper) you'd never know it's a trigger. I have at times just sucked up the emotion and ate the damn chicken and rice because it's either all the food I'm going to get (I have no money and it was free), or I'm in a situation where it would just be really too complicated to have to explain.

It is the rest of the triggers that are the problem. Many times I don't know something is a trigger until I encounter it. Still other times I don't think about it because I'm not anywhere that I expect it-- in a toy store, sure I expect to hear at least one kid screaming. In the middle of nowhere on Saturday morning I don't expect to hear a front end loader when there's no reason that I can think of for one to be outside my window.

I can tell you, as I've told my family that's here visiting, that I don't like and need to avoid loud noises and that I don't handle surprises well. It will still take someone walking up behind me in the kitchen and my turning around and yelling "DON'T FUCKING WALK UP BEHIND ME" for you to understand. It will still take me disappearing for several hours for no apparent reason, and you still won't get that by loud noise I mean exactly things like a front end loader doing its thing outside my window.

The hard part is that I still don't completely understand everything that's going on in my head, and probably never completely will. People are normally rather flaky animals, and someone with PTSD is even more so. The really hard part is that as a person's environment changes, as the world changes, so too PTSD changes. What wasn't a trigger before, might be tomorrow. What is now, might not be so much a year from now.

Sometimes, getting in the truck and driving to the next state over for a few hours is just the best that I can do. S'all I got.

05 May 2017

Trust and Consistency

I feel like I need to write something down that other people can read. I've been putting a lot into my personal journal, some of which probably needs to be let out. Things aren't going well, saying "I'm on my own" doesn't convey the half of it, and as much as I try I can't come up with even small steps to try taking. I know from experience it takes lots of small steps to actually get anywhere, that the first step is the hardest to take, etc. but lately I'm just standing here.

My sister's ex-husband, who owns the house where my sister and I have been staying since last fall, is in town for a couple of weeks. Mostly he's here to do things that need doing to the house, the yard, etc. He also has some other business he needs to attend to here, so he's here about twice a year. His sister also snowbirds, so she's along for the ride and stays here as well.

The result of this is that there are now two additional people in the house, who each have different ways of doing things and different habits. My sister and I are both pretty quiet people, she stays in her part of the house (the basement) and I stay in mine (the second floor) except for meal times. Other than suppertime, which is usually around 2300, we each keep our own schedules and really don't interact that much.

My schedule is pretty similar from one day to the next. I wake up, start the coffee maker, cook myself breakfast while the coffee maker does its magic, then head back upstairs with my coffee and food. I'll get cleaned up. Then the first part of my day is spent mostly at the computer reading or working with occasional breaks for more coffee or more food or the occasional breath of fresh air. Since I'm having so much trouble with PTSD symptoms, I can't concentrate on shit and my blocks of actual doing anything are fairly short. This is my "morning", which loosely translates to what normally happens between starting work and lunch. After a longer break, I'll try again to read or watch or work or whatever for a few hours until it's time to think about cooking supper.

I'm going to take a detour into family dynamics for a bit, but ride along with me and hopefully in the end it will all make sense.

Sister's ex used to live here, and did so for a number of years, so when he's here he acts like it's his house. This sounds wrong, I know, I mean it is his house, but his habits and way of doing things are a lot different than the rules and procedures my sister and I have worked out. In general, his opinion is that whatever we've worked out is wrong and things need to be done his way. If one of the sand castles my sister or I have built to manage things for ourselves is in the way of that, well, too bad.

It's not that he's a mean guy, it's just that for him this is how things are.

He doesn't know, and doesn't understand, that things like having a spoon on a paper towel next to the Mr. Coffee are things that are a part of how I get through the day. So he sees a spoon on the counter and immediately moves it to the dishwasher. If it's afternoon and he sees coffee in the pot, he pours it out, not considering that I don't drink the entire pot at once and often come back downstairs into the evening to refill my cup (warming the cold coffee in the microwave). I finally moved the entire coffee maker, the coffee, the filters, etc into my room upstairs so it wouldn't be fucked with.

While he's here he cooks, although for the first few nights. I'm always worried that at some point he's just going to say "get the fuck out", so I made it a point the first few nights he was here to cook a couple of the meals. I also made sure there was food in the house to cook with, which included one of those three pound tubes of ground beef. One night after he'd cooked supper, he made a remark about "who bought that cheap shit beef in the fridge?".

I'm on disability-- I only get a certain amount of money a month, and it ain't much, so I cut corners and save pennies whenever I can. That means less lean beef, because it's a good deal cheaper. I'm also really sensitive to being on disability, I don't like it, I'd very much rather be able to have a normal job and a normal life. It doesn't help me to have someone remind me how much less well off I am when they didn't spend any time in the fucking Desert. 

This past weekend, I was in Florida again. My sister still had two storage units holding stuff that needed to be retrieved. There is a much longer and deeper story that I won't get into, I'm skipping a lot, but we enter the story with me, sister, and sister's ex in a van on the way to south Florida.

It's about a 12-hour drive, and whenever I go anywhere here (or anywhere, really) my navigator is Google Maps. This is something else I do to cope with PTSD symptoms, because it relieves me of the responsibility of figuring out where the fuck I'm going as well as lets me know if there's slowed traffic ahead. PTSD and surprises don't get along. If I know something's about to happen, I get a chance-- even if it's just a small one-- to get in the right frame of mind and even do something like a couple of tactical breaths to calm down in advance.  This trip we're not using Google, we're using the van's internal GPS and maps and sister's ex is navigating the first few miles.

Okay in about a mile you're going to go around a sharp curve and then there's a stoplight and then you have to turn at the next light and then there's another...

No. This is why Google Maps works for me; it speaks in a predictable way. It says things like "in 500 feet turn right on Bob's Road". It doesn't explain, it doesn't offer opinions, it doesn't in fact say anything if there's nothing to say. My brain is constantly busy with intrusive thoughts and hyperawareness and all of that, so the less different inputs I have the easier it is for me to process them.

Through all of this the van's GPS is also giving instructions, that are slightly different than what sister's ex is giving, so this isn't much fun. I find that I'm repeatedly asking for clarification, asking for more specific things like the name of the road to turn on.

 

In case you're not familiar with Georgia and Florida: I-75 south through GA and part of FL, then Florida's Turnpike all the way down to south FL, then a short stretch on I-95 south. I more or less know the way, having been this way a few times, and it involves less road changing than when I go to the convenience store I go to here. Simple is good.

Florida's Turnpike is a toll road. It costs about $20 to go where we're going. The van's GPS wants me to go east to the coast and ride along the coast the rest of the way. I ignore it, because that's fucking stupid, and after several minutes of it not realizing that it needs to reroute itself I turn it off. Sister's ex is sleeping in the back of the van until I stop at the first service plaza/rest area on the Turnpike, and when he wakes up he's not happy that we're on the Turnpike-- a miles long discussion ensues on the unconstitutionality of toll roads, on double taxation without appropriate representation, and blah blah blah. 

I don't care. I like simple. My sister likes simple. Pay the tolls, get there faster. In general, the less complicated driving is for me, the better-- especially on a 12-hour trip that I'm going to have to repeat within 24 hours. It's decided that we're going to take state road 60 from the Turnpike directly east to I-95 and go south from there. Hwy 60 is out in the middle of fucking nowhere. There's no place to stop, and if you get stuck you're going to be there waiting for help for a long, long time. My opinion, the world isn't a very safe place and being in the middle of nowhere in a place where help can't reach you isn't a good idea.

Anyway, we get to I-95 and get pointed south again. As we finally approach where we're headed, another discussion starts on which exit we're going to take. There are several options, all of which are discussed, and while the discussion is going on I'm in the left lane with the cruise control set at 75mph. This means that the window of time for reaching a decision is rapidly shrinking, and at a certain point I have to yell "MAKE A FUCKING DECISION. WHICH EXIT?"

There's a lot to this idea; you need to give me clear and simple instructions on what you want, and give me a little bit of time before you expect an action to happen. (Two different voices saying two different things at once while you hash shit out just makes things more anxious and triggers me, and then I can't think at all.) Again, this is why things like Google Maps are good-- they act in a predictable way and they always give instructions that are clear.

This happened all the time in classes at Wisconsin (and to a much lesser extent, MATC) where a professor would be lecturing about something and then stop in the middle or get lost or look at something on the screen and say "oh, no, wait, we need to change this or that". I'm having a devil of a time concentrating and staying on track, and now the track I'm following is gone and I'm left standing in the middle to figure it out on my own.

Back to the trip, we go and pick up a rental truck. This is a 17 foot box truck, which I'm driving because it's a 17' box truck. If you've not spent any time in south Florida, the streets are made so that if you're going one direction and want to get to something on the opposite direction side, you have to do a U-turn. Instead of painted on turn lanes down the center, there are curbs so that turning cars don't meet in the middle. U-turns are also allowed and often required at stoplights.  None of this helps you if you're driving a box truck that needs two lanes to do nearly anything involving a turn.

It should be noted that I learned to drive truck in a mobile US Air Force comm unit, where there are no small trucks and damn near every truck that could pull a trailer (itself the size of a truck) did so. I also drove a school bus for a short time in Milwaukee WI, where there are one-way streets that allow parking on both sides. Therefore do I know something about driving a large vehicle in spaces made for cars, which is that everything takes at least twice as much space, distance and time in a truck. So when it comes time to have to do a U-turn over a set of railroad tracks at a stoplight to get into the first self storage place, I ain't having it.

Now I'm driving a box truck down a street I don't know in a city I don't live in, trying to explain to my sister that I need more room than that to turn, while my phone is now ringing because sister's ex doesn't understand either. I push the button to silence the phone, which probably pisses sister's ex off, and explain that I need either normal left and right turns at normal intersections or a really big parking lot. Eventually we make a left at a light, then a series of right turns that get us back on the right road in the right direction.

Finally in the self storage place, where I want to put the truck doesn't work for sister's ex. It has to point the other way. This results in me having to make a blind Y-turn at the end of the row; if you've never had an urban self storage unit, this won't mean much, but it's not a trivial thing. Once the truck is pointed the right direction, sister's ex wants to stand in front of the moving truck to show me how and where to park it. This process ends when I roll down the window, yell "MOVE OR I WILL FUCKING RUN YOU OVER WITH THIS TRUCK" and shift into park.

It's taken me years of practice and a ton of hours of therapy to get to the point where I can get through a normal day. I'm not on medication, I don't drink, I don't use, I don't have those kinds of things to rely on. I've done a lot of work towards realizing and knowing my limitations. If I say I've got something, I've got it; if I didn't, I'd step back and say so. It's important that I be able to trust people around me, but it's also important that people in my environment are able to trust me-- if you don't trust me, then why not? I have to then wonder if I can trust you, and then I don't.

As soon as I'd descended from the truck cab, sister's ex wanted to know why I didn't turn when he did, why I didn't answer the phone, etc. I said that since I was the one driving the truck, I made the call that I didn't have enough room.  Trust isn't just exchanged between people, it's internal too. I trusted myself.

The trip back was mostly uneventful. Sister and I stopped in Ft. Pierce FL that night to relax a little and get some sleep-- it was already Saturday evening and I hadn't slept since Friday night. Again, I made the call to get a room at a Days Inn rather than sleep in the cab of the truck. I definitely will do all I can to save pennies at a grocery store, to the point that I call myself cheap, but the fun and excitement of sleeping in a vehicle ended when I was homeless.

Where we stopped was, not by accident, right between I-95 and Florida's Turnpike, which meant getting there and getting going in the morning would be easy. I'd also called the Days Inn before booking the room to make sure there was room (and permission) to park the truck. There happened to be a lot of stuff there, so it was also easy to find food. (If you're ever in/near Ft. Pierce FL, try Pappy's Pizza.)


The trip back was also via Florida's Turnpike, with Google Maps navigating. Again, there's not that much navigating to do between south Florida and the house in Georgia. The Turnpike runs right into I-75 north, and that gets me very nearly all the way back here.

At several points, my sister's phone showed alerts that said "Traffic incident--Florida's Turnpike" but didn't specify location/mile marker or direction, so they were useless. Google Maps on my phone didn't alert, so I didn't worry about it, but this is also something important-- with PTSD, everything is an alert. It's really hard sometimes to sort out what's an alert that needs something done, versus an alert that's just something that happened that can be ignored.

At least right away, there's no difference between "I think something's wrong" and "The house is on fire". All alerts are triggering. In the Desert, if the PA system that was used to announce that missiles were inbound, I didn't listen to the voice message. I heard the audible click that the microphone makes when the push-to-talk button is pressed, and knew that I needed to grab my chemical warfare gear and haul ass or die. I didn't need to worry about context or evaluating the situation. In the present, context matters because most things aren't as well defined. It's hard to determine an appropriate response to a vague threat (and in fact, my brain will drive itself crazy trying to do so). Don't tell me that something is wrong. Tell me what. I'm not at all saying that you shouldn't speak up for fear of triggering me, but make sure that you're as specific as possible about what's going on.

Since getting back from Florida, meaning all of this week, I've spent most of the time in my room alone. I haven't felt very social anyway, and everything that happened before and during the trip convinced me that sister's ex (and his sister) are just people who don't understand. I'm not saying that they're terrible people, they're actually very nice, but I was already feeling pretty shitty. When they were here in fall, I felt halfway decent, but I don't now-- which to them is likely really confusing. That I keep really weird sleep hours and don't come downstairs for meals is probably quite foreign to them.

Earlier this evening, sister's ex pounded on my door to let me know supper was ready. The rest of the week, supper's been left out for me in the kitchen (which is really appreciated, but if no one cooked for me I'm capable of foraging for myself). I responded with "what?". Sister's ex called my name. Again, I responded with "WHAT?", thinking if I yelled it a little louder it might make sense that I'd really like to know what the fuck you want and why it's necessary to pound on my door. After that I finally got the answer, that supper was ready and what it was. Why today required pounding on my door, I don't know.

This is something else that's attached to a memory-- when I was homeless and lived in transitional housing, they'd always knock on my door and whatever they had to say usually wasn't worthwhile or good news. There, they always expected me to come downstairs to eat, or be social, or whatever. The dining room there was always noisy, always chaotic. People would yell across the table at each other, then the TV would be turned up, and the cycle would repeat until no one could hear anything. It's not that bad here, but supper still has to be in front of the TV that's turned up too loud, and then I'm expected to participate in conversation since I'm sitting there.

Sorry, I don't want to talk, and I don't want to have to be an asshole and tell you to leave me the fuck alone and let me eat in peace, so I mostly stay upstairs until everyone has gone to bed.

I'm really not doing very well lately. PTSD's getting worse, a lot worse.

Outside of the normal family bullshit that accompanies any road trip, the trip to Florida this past weekend gave me both a lot of time to think and my first real time away from here since last fall.

The mission to help get my sister moved is complete, all of her stuff is now here. As far as me being able to help her sort things (not just material goods) out, well, that's pretty much complete too. We have different ways of looking at things. I've offered my solutions. That's really all I can do. Her life, her choices.

If I'd gone somewhere other than here, I'd still have PTSD and all of its associated problems. I don't blame being here for my PTSD getting worse. The world is changing, as it always does, plus there are a bunch of things that I've been avoiding that are no longer avoidable. I don't blame "here" for things not going well.

"Here" though, is someone else's. It's my sister's ex's house. I have a nephew and a niece here, and their families are here, but this here-- the life they've all built here-- belongs to them. I just ended up here because I was brave/kind/crazy enough to help my sister get moved, and because I didn't have anywhere else to go. Georgia, and in fact the southeastern US, was not on my dream sheet of places to end up. I hope that doesn't sound awful, it's not meant that way. People here are in fact mostly pretty nice, including my family, but this isn't home and I'm not sure it ever will be.

In spring 2011, after I'd failed most of my classes again even with academic accommodations for PTSD, I made the decision to stay in Madison. I did stay, even after I lost first one apartment, and then another; even after I'd started living in my car in Lot 17. Lately I've been thinking about that decision, not necessarily second guessing, just wondering why I made it. What made me so passionate about staying? Having been away from Wisconsin for a while now, it's not so clear-- I don't miss being there.

I stayed, endured being homeless, and returned to school at Wisconsin, because it was the easy way out.

I thought for a long time that if I could just run fast enough or far enough, stay up late enough, work hard enough, I'd eventually get past this PTSD shit. At some point I'd be able to say that I won the battle, that I'd overcome it, put it behind me. Walking the stage and being handed a bachelor's degree would do a whole lot towards proving that I'd done just that.

I never asked myself if UW-Madison was the right place for someone with PTSD, or more specifically, for me with PTSD. I never asked myself if Madison, WI was the right place. Instead I just made the decision to stay there and figure things out, when perhaps the real solution was to look wherever necessary to find not just a university, but the right university. Not just a city, but the right city.

Staying-- even including all of the shit that staying eventually included-- meant that I never had to make those decisions and answer those questions. Leaving and/or transferring would have meant that I'd been wrong in lots of different ways, would have meant that I'd have to go through all of the difficulties in finding and moving to a new place and essentially starting my life over again. I'd done that in 2004 when I'd left my ex-wife and moved to Madison, and in 1999 when I'd moved back to Wisconsin in the first place. I'm not entirely sure why I was afraid to pull up stakes, only that I was.

I have thought about this before, although not quite in these terms; see here from last June when I still was thinking I was headed for California. A year ago I didn't even see the questions clearly, so I don't feel quite so bad now about not having the answers. (I was right about the VA not being much help, sadly.) It's taken this amount of time, and this distance, to be able to see things as they are.

Having to interact (and ultimately choosing to avoid interacting) with family over the past week or so, asking for trust and not getting it, and having to stand my ground has helped put some things in perspective. I really do a lot of different things to cope, things that no one else sees, and it's really very frustrating when other people blunder into the middle of what I'm doing. During the several intakes I've done (which is all I've done) at various VA appointments over the past few months, when I've been asked what my goals are I've always answered that I want to have something that resembles a normal life. Perhaps that answer shares a common thread with my decision to stay in Madison as long as I did, and is it just the easy (or easiest) answer?

A better answer is that I'd like to have a job that I can do well at, a stable place to live that's quiet and not triggering, some real friends that I can trust. I'd like to feel that I have liberty and freedom. I'd like to have enough resources to do what I need to do to cope when changes happen, to never be trapped in a situation that I cannot control or escape from. I'd like to wake up and not see a struggle to get through the day looming ahead. (I'd really like to not have to look in the mirror and find a reason to be alive to do the same thing tomorrow.)

28 April 2017

Still on my own

I still had an appointment scheduled with a social worker in Lawrenceville this afternoon. At my family's urging, I went (note the emphasis, I'm completely ready to just say fuck it).

But wait-- there's more. There's always more.

This morning, I got a call from a psychologist from the intensive outpatient recovery program (IORP). This is apparently who I was referred to from the trauma recovery program (TRP), who I saw last week. IORP is a six-week program that meets four times a week for about half a day each session; it's a group oriented thing. It sounded very much like the Transitions program I did in Madison WI in 2012, exactly five years ago through Resilience and Recovery.

The next group, or sequence, or whatever it's called doesn't start until June-- this I expected, you usually can't jump into a group that's started, you have to wait until the first session comes up again. It really doesn't matter, though, because I said no.

My first reason is the same as the reason I didn't go to walk in at trauma recovery in the first place. The clinic is 55 miles from the house. On a very good day, it's a little over an hour to get there. Considering that I-85 (which I'd take to get there) is effed up, and considering normal Atlanta Traffic, it's a trip that really requires planning on two hours driving (and/or sitting) time each way. So let's do some math here: four trips a week, two hours each way, that's eight hours a week just for travel time. It's 110 miles round trip, assuming Google Maps doesn't need to get creative, so 440 miles driving per week. Depending on the price of gas, and my truck's gas mileage, that's about $55-$60/week for six weeks just to get back and forth, or $360 for the entire six weeks. This math would work fine if I was doing this to get to and from work, where I'd get paid, but it's my money and gas I'm spending. 

My second reason is that this isn't what I fucking asked for.

I've been very clear throughout all of this that I want to do Cognitive Processing Therapy (CPT), but this time around (I've done the entire 12-week program before, but focused on childhood sexual abuse) I want to focus on the Persian Gulf War. I've made my peace with everything that happened when I was a kid-- now it's time to make peace with the Desert. In looking over my notes and blog posts over the years since then, a lot of the problems I've encountered with PTSD haven't really been addressed all that well (certainly not enough). I still use my notes and worksheets from that first time, but this really isn't something I can do alone. Accountability from a mental health care professional really makes a difference.

So I explained all of this to the psychologist who called, and she completely saw my points and agreed. Kthxbye.

Now we can talk about the social worker at the Lawrenceville clinic. I got there about 20 minutes early, traffic somehow being pretty light. Checked in at the kiosk, indicated that I was completely dissatisfied with the time it took to get the appointment, and sat down. There is of course a TV on the wall with the volume turned up loud enough that foam earplugs like the kind you'd wear in a factory can't block out the noise.

My appointment is at 1330. 1330 passes. At 1345 I go to Front Desk, wait there several minutes while person cleans the lid to her coffee cup (priorities, right?), and then explain that it's fifteen minutes past my appointment time. Now, it's Friday afternoon-- there were plenty of spaces in the parking lot, and only a couple of other veterans in the waiting room, which are indicators that this isn't the busiest time for this clinic. After talking to Front Desk, I wait another few minutes before SW shows up.

Three times I've been to the CBOC in Lawrenceville GA for scheduled appointments. Three times I've had to let someone know that I'm fifteen minutes past my appointment time.

SW asks what kinds of problems having. She doesn't have access (?!) to my records on the computer. I explain, list all of the symptoms I've been dealing with. I explain what's happened with trauma recovery. I state as clearly as possible that I want Cognitive Processing Therapy, and then I list each of the people (including her) that I've told that I want Cognitive Processing Therapy.

It turns out that the person from trauma recovery that does cognitive processing therapy at the Lawrenceville clinic happens to physically be in the clinic today. Well, shit. Yes, go talk to that person and tell them what's going on. After that happens a couple of times, I'm being put in the queue for CPT, which may take a month or so to actually get scheduled for. Another month. 

Turns out that whoever this guy-who-does-CPT is, he knows my name and my situation. He must have been in on the meeting last Friday when patients were talked about. So at that meeting, even though I have specifically asked several times, including at my appointment with the staff psychologist at trauma recovery who was also at that same meeting, no one was doing anything to get me into CPT.

I make it very clear that no, I don't want to wait another month or so, I've been waiting for four months now, but fine put my name on the list. It's as close to therapy as I've been through this entire process.

Had I been referred to the this specific person, or at least someone that does cognitive processing therapy, back in February when I first visited primary care I might be two thirds of the way through the therapy right now. Instead I've been passed from one person and place to another, each one acknowledging the problem, each one "doing their job", yet not doing anything to help.

So I'm on my own, still. Me and my demons.


-----

Let's review, for those of you who are keeping score at home, the number of mental health professionals employed by the VA that I've talked to so far without getting into PTSD therapy.

Social workers: 5
Medical doctors: 1
Psychiatrists: 1
Psychologists: 3

This doesn't count any of the other VA staff that have looked at my case in reviews or meetings, or other appointments.

I haven't called the Veterans Crisis Line, because everyone they'd possibly refer me to, I've already either visited or talked to directly.


26 April 2017

No help from the VA, so I'm out.

So the appointment with a psychologist at trauma recovery was last week (see https://stillinthedesert.blogspot.com/2017/04/one-last-try.html). I managed to get there about 10 minutes early, which I'm slightly proud of considering that I have both no sense of time and I'd never been to this clinic before. My iPhone's calendar and its travel time function and Google Maps deserve all of the credit for me getting anywhere on time. It's, as expected, a pretty nondescript office building. The most I have to say about it is that it's the kind of office building you'd see near a mall.

At the front desk there's a check in kiosk, but the front desk person just asks for my name and last four and checks me in. There is a customer satisfaction survey included in the check in kiosk's screens that asks if you're satisfied with the time you had to wait for your appointment. I'd imagine that if you wanted to keep veterans from filling that part out you'd be proactive in manually checking people in, but hey, whatever, right?

Front desk does not give me a clipboard or a pen, which I find unusual. Generally, mental health clinics have at least one standard questionnaire for me to fill out-- depression, anxiety, PTSD, etc.

Ten minutes after my appointment time, psychologist appears with a pen and a clipboard and about ten pages of questionnaires for my to fill out. These are the standard questions I expected, plus a few extra. It takes me about fifteen minutes to fill them out, perhaps a little longer because I have to insert ear plugs to block out the ever-present TV that's on and turned up too loud for no reason. I'm a fast reader, and I've seen all of these questions before, and I've been thinking about my mental health a lot, so I don't have to dwell on answers. If this was my first time ever in a mental health clinic, I'm betting it would have taken me a half hour or more to fill all of them out.

So now it's about half an hour after my appointment time, and I take the clipboard and pen to the front desk. No, front desk says, the psychologist will come back out for that. So I wait another several minutes in the waiting room until psychologist shows up.

This psychologist has an office with a window, but it's the same as any other office otherwise. Desk, chair, computer, bookshelf with appropriate titles. Ever been to a TGI Friday's or a Cracker Barrel or an Applebee's and seen the standard yet unique yet familiar stuff in every one of them? Same concept in decoration. I get that it's a federal agency and everyone has to order from the same GSA catalogs, but seriously.

As with the social worker before him, psychologist sits at the computer and asks me questions, then types my answers (I'm assuming that's what he types, but I can't see the screen). He doesn't score any of the questionnaires, just sort of looks through them and identifies things to be concerned about. Many of the questions he asks are straight from the standard forms, he asks for clarifications on some things.

He's not just strictly doing data entry, he's at least asking questions that are a little deeper and require that I give more detailed answers. It's at least a little apparent that he's an actual psychologist and might even give a shit about this stuff. It's not therapy, but it is at least a conversation, even if I've already given these same answers to these same questions to several different people already.

Or maybe I'm doing just enough Tactical Breathing that I'm not completely pissed off yet.

Towards the end of the meeting (it's not really a session), he produces two handouts. One talks about solitary confinement being a punishment. The other talks about accepting that other people aren't perfect. That there are bundles of these stapled together suggests to me that these are handed out to everyone. I'll get to those in a minute, because there's a lot to say about these things.

The meeting is over, and I don't have an appointment or a plan for therapy. What's going to happen is that he's going to take my information to a meeting on (last) Friday with the staff from the clinic and they're going to review it and decide what, if anything, the trauma recovery clinic can offer me.

So I was right. It was just an(other) intake appointment, and there's no therapy or help coming. Remember, this appointment was ultimately the result of a trip I made to the emergency room at the Atlanta VAMC on February 27.

I'm trying really, really hard to be patient at this point. It takes literally everything I have not to just flip over every table I see on the way out.

Fast forward to Monday of this week; psychologist calls shortly after 0800 (I give up on this), leaves a voice mail, I call back, leave a voice mail. He calls back today, again shortly after 0800. I'd again been up for over 24 hours, otherwise I'd have never been awake that early. It took an extra day to call back, he says, because of zibba zabba fibbety foo. (Whatever. I don't care, it's another excuse. Just say you were fucking busy or you forgot or whatever the real reason is.)

The people (the staff, whoever they are) reviewed me on Friday and decided they're going to refer me to some other people who are going to look at all of my records back to the beginning of time and then make a determination on what to do with me, if there's anything at all they can offer me. After that, which might take a week or longer, they'll call me to set up some sort of interview.

It's the last week of April. So this puts the next thing happening into May. Once the powers that be review whatever it is they're going to review about me, and decide what they're going to decide (if anything), then someone will call me and we'll play telephone tag for several days to set up yet another meeting to discuss... what exactly? I don't know. If things proceed as they have been, that meeting will happen sometime around the second week of May (or later), and then there will probably be even more meetings after that, so now we're into late May, and

You know what? FUCK IT AND FUCK YOU.

I'm sorry. I really am. I don't want to give up. I don't want to do this on my own. I need help, there's a lot about my life that's really very fucked up and with anxiety and depression and PTSD I need someone outside my head to help straighten it all out.

I have asked for help. I have begged for help. I have been to a Vet Center, I have been to primary care, I have been to trauma recovery, I have been to the emergency room. There is nothing short of showing up with a loaded gun (I don't even own a gun, btw) for me to try to get someone's attention that I really do need to get back into therapy. I've needed to get back into therapy for more than two years now. It took me that long, and being several states away from home, for me to engage with the VA again.

I'm really at a loss. I've tried to stay positive, tried to tell myself that this is worth it in the end, that once I get back into therapy and do the work and make changes-- eventually, it'll all pay off and my life will be better and I'll be happier and there will be unicorns shitting sprinkles and rainbows outside my door. Well, maybe not the last part, but I'd like things to end up better than they are now. I'm enough of an optimist to believe that my life can be better, but this is just fucking ridiculous. I don't need to solve every single problem right now, I just need to talk to someone and start sorting things out. I probably can't just solve everything right away. I recognize that, but I have to start somewhere. The problem is that there's just nowhere to start.

-----


About the two handouts.

First, that solitary confinement is a punishment-- I get it. People need other people, and being in a house out in the middle of nowhere without much contact with other humans is ultimately a bad thing. I didn't mind, and actually enjoyed, having other people around when I was at Wisconsin and sitting in some hallway hacking or studying. I enjoyed working at the help desk because I enjoyed answering questions and collaborating on finding solutions for people, and especially being able to train other people. That I asked for disability accommodations that kept me isolated from everyone else was so I could concentrate and actually build the things I was trying to build. That I need a low level of noise and distractions doesn't mean I want to live on a fucking desert island.

Given a choice, yes, I would like to have a small circle of friends. I would like to actually go and do things and experience life more than I have been. Right now it's difficult because of logistics-- I'm out in the middle of nowhere-- and because I'm just not feeling well. I don't have a lot of money to spend on going out and doing things. These are excuses, I know. The main issue is that I don't trust people. I've been burned too much, too often. This is one of the things I want to deal with in therapy. This is why I've tried engaging with the Vet Center and mental health.

The second, that people aren't perfect-- no, they're not. I get that too. It's easy to say that you should just accept people as they are because nobody's perfect, except when you've done that and people have turned out to be wolves disguised as sheep. I've been abused, taken advantage of, shot at, left on the street to fend for myself, and ignored (childhood, ex-wife, Desert Storm, VA transitional housing, my last employer). Who's left in life for me to actually trust? You, just because you say so?

I recognize that none of these have easy fixes, which is why I'm trying to get into some kind of therapy in the first place. I know that cognitive processing therapy helps, so that's the kind of work I want to do in therapy now. I'm willing to accept imperfection in this process, but there has to even be a process first. I just get shuffled from one place to another-- for weeks and months on end! I'm happy you have a handout or two for me, but handouts don't make problems go away. Therapy does. If after all of this time, and all the trips I've made back and forth between BFE and Lawrenceville, and BFE and Atlanta, all I get is a couple of fucking handouts, I'm better off doing this on my own.

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.