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02 August 2015

22

For a while-- a long time, actually-- I had a lot of faith in the VA, that they were really doing the best they could (often with limited resources), and that things were in general improving.That faith was broken, probably permanently, by everything that happened in the grant per diem/transitional housing program. For the VA to proudly proclaim that they were going to end veteran homelessness while at the same time allowing the people actually operating the program (I'm looking at you, Porchlight) to put veterans back on the street and forget about them (which is what happened to me) is hypocritical at the very least. Once that happened, any faith I had in the VA really wanting to solve problems for veterans was gone.

The VA is still my health care provider, though, mainly because I don't have a lot of any other affordable choices that also have experience dealing only with veterans. I've dealth with civilian (non-VA) providers, all of whom completely missed diagnosing my PTSD. There's also something to be said for helping other vets, and bringing problems with the VA to light helps get them fixed. Which ultimately helps other vets (besides me just letting off steam). Right?

The social worker/therapist I had until last fall was a permanent staff member, but she's since been promoted to another position. My psychiatrist had a kid, came back, and then left for good this spring to go into private practice. My primary care doctor isn't a doctor, she's a different nurse practitioner at every primary care appointment. My current psychiatrist isn't actually a psychiatrist, she's a pharmacist that knows a lot about psych meds. My current mental health providers-- the social worker/therapist I'm seeing for prolonged exposure therapy, and the social workers/therapists that are facilitating my weekly prolonged exposure therapy group-- are all residents (aka interns).


This means that almost every time I am at the VA Hospital for an appointment, I have to give my story. The PTSD, the being homeless, the learning to manage the PTSD, the recovering from being homeless. The getting my own place again last year only to be hit with being diagnosed with diabetes soon after. I'm quite seriously thinking about writing a personal FAQ to hand to every provider I see that I haven't met before. Every appointment the provider types stuff into a computer, which the next provider reads. None of them know about what's happened before the last couple of appointments. They see the current diagnoses, and that's as far as they dig.

A couple of weeks ago, the intern that I'm working with on prolonged exposure therapy called in sick. I didn't get a call, and so I showed up at the VA Hospital for that appointment to find out that she wasn't there. Because she "manages her own appointments" I needed to talk to her to reschedule an appointment-- she called the next morning to set up a new appointment. I haven't (yet) called back. Things have in general been somewhat difficult lately, I don't like talking on the phone very much, and chances are that when I call her she won't be there. Since the staff at the front desk can't make an appointment for me, what good is telephone tag?

Yesterday I had an appointment with my not a psychiatrist but a pharmacist at 1430. She called in sick, I didn't get a message (again) and so there I was standing at the desk really needing to talk to someone about getting my PTSD medication adjusted because my PTSD symptoms have been getting steadily worse lately, and getting back on meds regularly has been an adventure in and of itself, and I have to talk to someone who is qualified and able to write a new prescription for a higher twice daily dose of venlafaxine and school starts again in a month and it takes time for a higher dose to take effect and I really need to get this shit ironed out so I can have something resembling a normal life, k?

*sigh*

The staff person at the desk apologized ("someone was supposed to call"). Someone is always someone else. Whatever. I explained that the reason I had scheduled an appointment several months ago was that I knew I'd need to have my meds doses adjusted and for that I needed to talk to someone who could actually write a new prescription.

"Oh."

Staff person made a couple of calls; my appointment was in a building separate from the main hospital, not at the main mental health clinic. She tracked down someone who actually had made it to work, but that person was busy for the next hour. Me: "Fine, I'll wait." I've long ago learned that once you're at the VA Hospital because you need something, the best thing to do is stay there until you actually get it. It's a hospital. Someone has to be able to write a damn prescription. Also, don't leave without making a followup appointment at a specific date/time if you need one.

Anyway. Waited a while in the not-in-the-main-hospital waiting room, and staff member says I need to go wait in the in-the-main-hospital waiting room but I don't have to worry about checking in, the person who I'm going to see knows what I'm wearing and she'll come find me. I'm curious what description the admin staff person gave-- I'm imagining "hey, there's a pissed off scruffy looking guy in a Harley hat coming upstairs to see you because we fucked up his PTSD medication review appointment".

Anyway, in the regular waiting room for a few minutes until person-who-can-write-scripts comes out to find me. Introductions. She asks how I'm doing. To myself I think "I'm doing just fine, I have PTSD from having missiles lobbed at me from an insane dictator's army. How are you today?" I didn't pay attention to what her name was, because I don't intend to try to remember it. Chances are good that after getting what I need, I'll never see her again.

She skims the notes from the last time I saw not-really-a-psychiatrist. I have to go through the PTSD/homelesness/feeling like hell/symptoms presentation as usual. She types a few things. I say I want to increase my venlafaxine dose by the minumum amount possible and come back in three months; the normal increase would be to double the dose, but since I've had trouble stomaching meds I'm taking increases slowly. She agrees, types a few more words into the computer, and I'm on my way to the pharmacy to pick up new pills.

22.

It's been said that 22, or possibly more, veterans commit suicide every day. Whenever a brother or sister takes their own life, there's always talk of how they fell through the cracks. In many cases (I don't have a reliable reference for how many) the veteran had already been to the VA or was trying to get into the VA. Or maybe they'd never been to the VA in the first place because they've heard how fucked up things are. People in suits discuss how they're going to stem the tide. Something must be done, they say.

I'm pretty stubborn. I'm pretty resilient. I've managed to avoid alcoholism, managed to avoid drugs, managed to keep myself out of jail and out of trouble. Maybe I'm a little lucky, too. Maybe I'm a lot lucky. I don't know. I keep going, some days I think it's because of a warrior spirit and some days I wonder what it is that makes me want to see another day because I really don't know. I'm not better than any other veteran, I'm just still here.

When they ask at the VA if I've had any thoughts of harming myself or others, I honestly say no. Wanted to end my life? No. Gotten angry at someone for some stupid imagined slight? Sure. Seriously wanted to beat the crap out of someone? Not enough to actually do it, so no. They always ask this question. I'm sure that there are times when someone does say yes-- I know some of those veterans who have said yes-- and the VA takes those situations very seriously.

I plan to live to be an old, cantakerous headbanging hacker. Someday when I'm in the old folks home I'll phreak the internal phone system so whenever someone calls the place they'll get redirected to an extension that only plays fart noises. Or I'll fix it so that whenever I enter a room, the soothing and relaxing music being piped in will be replaced by Metallica. Point being, I'm not going anywhere.

I'm not every veteran, and not every veteran is me. We're all human. We can only each take so much, especially from an agency that's supposed to take care of us.

"Oh, so-and-so called in sick today so we cancelled your appointment."

I understand, people get sick and call in sick, or something happens and they need to get a day off, or even they need a mental health day. If I worked in a VA mental health clinic I'm sure I would need a day off now and then-- but for fuck's sake, is it that damn hard for the staff that are there to find someone to cover for a provider that's out for a day?

"I can fit you in tomorrow at 1500 if you can call me back right away in the morning."

You mean that you can fit me in when it's convenient for you, provided I can call back when it's convenient for (guess who?) you. In the mean time, whatever energy I spent getting mentally ready to come in and work on prolonged exposure therapy was wasted. And now I'm pissed off, and feeling like you don't give a fuck. It'll take some time for me to resolve that, after which I'll have to play telephone tag with you to get a new appointment set up which won't happen for a couple of weeks because your schedule is full.

You also know I work nights, and that by calling me in the morning you will either a) not get an answer (most likely) or b) get an answer from a veteran who is asleep and probably in the middle of a nightmare about something you can't even imagine. While you're trying to sound helpful you're pointing out how little you actually care.

"Oh, well, yeah, there was a communication error. Sorry."

Ok. Make sure you find out why there was a communication error-- why even after I called to say I was coming in for group and that I'd be a few minutes late, no one thought to mention that the group facilitator wasn't even in that day. Also find out why the front desk staff let me sit in the waiting room for an hour without telling me that she wasn't in that day. And then, fix the problem so the next time someone calls in sick, I actually get a message.  

"Well, yeah, that's the VA for ya."

So fix it. You. Not someone else. I know that one person can't fix the VA on their own. I know that the VA is a slow moving, bureaucratic beast. That doesn't mean that you as an employee have to subscribe to being useless.

I'm not that fragile (that I'll admit), and also I understand that things go wrong. Sometimes, when things to wrong, people at the VA are really good about trying to get things fixed.

Still, when the VA cancels appointments, or doesn't consider what the veteran needs over what the intern needs, or drops the ball and wastes a veteran's time-- these things add up. No one is going to the mental health clinic because life is going well (even if some parts of life are in fact going ok). I have my own set of PTSD and related problems, and as bad as mine can get there are veterans who have to deal with a ton more shit than I do.

I can't tell you why each of the veterans that have ended their own lives made that choice. I can tell you that when providers cancel appointments and don't offer backup, or VA employees just brush off problems that they think are small, that these are things that contribute to a feeling that no one cares about us. If the VA doesn't care-- the government of my country-- who does? It's a very slippery slope from there. 

Did I get what I needed from the VA yesterday? Yes. I got a new bottle of pills after I made enough of a fuss that someone did something so that I could.

Did anything happen to reduce the PTSD that was the reason I was there in the first place?

I got a new bottle of pills.

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