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26 December 2015

PTSD is a bitch.

PTSD has been a bitch lately.

I've been trying, some ways successfully and others not so much, to wrap my head around what's going on inside my head. If you've read my blog for any length of time you know I've had, and continue to have, a difficult time dealing with the couple of years during which I was homeless. It wasn't so bad, I suppose, that I lived out of my car for a while-- what really had an effect, what really changed me, was everything that happened when I was evicted from VA transitional housing. Porchlight, the agency charity company that ran the shelter, was particularly heartless. The VA didn't do anything to help either though-- not the person who ran the program for the VA, not the mental health clinic at the hospital, not the social work office at the hospital. My US Senator, Tammy Baldwin, likewise did nothing to help. 

I'd write letters to someone else, but I'm out of people to write letters to-- no one here cares.

I once believed that the VA-- and in a larger sense, my country-- had my back. Much of the therapy I went through really did help, the medication seemed to be helping, I'd had initial trouble during my first semester at UW but I'd rebounded. I won't go through the entire timeline, it's already written down, but I never thought I'd fall as far as I did. I don't think I was excessively proud; I just figured there had to be a way through, and if I worked hard enough and did the right things, with help, I'd make it. 

Once I was actually homeless, some of people at the VA hospital here put extra effort into helping-- appointments were easier to get, I was able to get meds from the pharmacy quickly, things like that. People understood that I was in a difficult spot, I think, and did what they could to help. That really mattered. I didn't see it at the time, that even though I'd been through so much therapy and was taking a handful of pills twice a day I'd still ended up homeless. The system the VA had in place to prevent veterans from becoming homeless hadn't worked for me, and no one really was worried about it not working. 

When Porchlight evicted me, the VA did nothing to stop them. Patient advocate? Social work? Mental health? Talked to them all, and got the same response-- we can't help you. The person who ran the office that handles homeless programs in Madison would later write in my medical records that she believed that I wasn't really in crisis, just out for free meals and a free bed. Now, every provider that takes the time to look back through my medical (and mental health) records at the VA will see that note. 

Now, a couple of years (!) later, I'm not seeing anyone at the VA. Most recently I was attending a weekly drop in group for veterans who have been through prolonged exposure (PE) therapy. I stopped going when I got a letter in the mail that said the group only allowed six visits within six months-- it had been shortened to 30 minutes a week, as well. Half an hour is a waste of time. Even if only two vets show up, by the time each of us says who we are and what's going on, the time is used up. When I was attending the group, I'd already used up four of the six visits. And, a personal peeve of mine, it was (is) run by interns-- people who were (are) there to put in their time and be transferred to somewhere else. It reached the point where I stopped learning their names.

Add to that, my last experience at the Vet Center-- my person there told my I'd used up my number of visits and that since I was doing just fine (I actually showed up for my appointments, which was apparently enough to decide that) I didn't need to come in any more.

I need to make my yearly primary care appointment at the VA hospital, and I need to make an appointment in the eye clinic. I also need to make an appointment with mental health to get my medication adjusted, because I'm not entirely sure of how much good it's doing. I track my PTSD symptoms weekly, and they're consistently high. 

I'm avoiding all of this, and have been for a while, because I don't want to deal with the experience. For Primary Care, I'll see a PA or a nurse who I don't know, who will fill out the fields on a form on a computer screen. They'll weigh me, take my vital signs, enter those. I'll explain to them that the last diabetes medication they gave me still makes me throw up, like clockwork, 30 minutes after taking it-- and I'll have to fight to get them to give me something milder instead of giving me yet another pill to take that's supposed to calm my stomach down (it doesn't). I won't ask the provider for their name, because I'll never see them again. My yearly appointment having been executed, that's all I'll hear from them.

At mental health I'll talk to a psychiatrist or a pharmacist (!). I'll tell them that I think I need either more of the venlafaxine I'm taking or, almost preferably, a different medication. I'll add that I'd like to be involved in some kind of cognitive therapy again because it helps. I'll explain my frustration with the PE support group. I won't ask this person for their name, because I won't likely see them again either. I will probably get some new pills to take though.

No one will check in to see how I'm doing, or if they do they'll call in the morning when I'll never answer my phone because I live on hacker hours and that's when I'm asleep. I'll ask at the appointments if they can follow up via secure messaging, but they probably won't. It's a rarity to find someone at the VA that actually uses the damn thing, especially the interns. Everything that goes through the secure message system on MyHealthEVet gets recorded in your medical records, where it can actually be reviewed later. Phone calls? Nope.

Side note: a veteran can learn a lot about the VA by reading the VA Office of the Inspector General (OIG)'s periodic reports on VA facilities. 

Being homeless changed me a lot-- living on the street requires that you rewire your brain to keep track of all of the potential threats. Weather. Police. Finding a bathroom. Food. Other homeless people. People in general, because people don't want homeless people around. Madison especiallIy doesn't think much of homeless people. At the same time as you have to hide in plain sight, you have to be hyper-hyper-aware to keep track of yourself and your surroundings. That's just basic survival, one day to the next. 

Being evicted from transitional housing changed me a ton more. Take all of the hyper-awareness that comes with PTSD; the belief that the world isn't a safe place because you've been in the middle of a war that proved the world isn't safe. Add all of the reasons that make the world unsafe, even in the middle of the American Midwest where things really are basically safe most of the time. Now take away the safety net that the VA is supposed to provide-- you find yourself out on the street, with all of the bad things plus all of the normal PTSD stuff, plus the fact that now you know the VA won't save you and neither will anyone else when you fall.

Judgement Day is always today. Or tomorrow. Doesn't matter either way because your brain is always telling you that it's imminent. Whatever choice you make, whatever direction you move, you know that you're on your own-- and it's quite frankly scary as hell. So you take some of the survival skills you learned as an abused kid in a broken home, and some of the survival skills you learned during your military service, and add in some of the things you learned while you were on the streets. You find comfort in routine, in things that are predictable. You hide in plain sight even when you don't have to, but right now it's all you know. You avoid a lot of things that might upset the apple cart-- upsetting the apple cart is bad, bad, bad. Life is the apple cart. As long as you keep it stacked up exactly right, you can push it forward. One wobble, no matter how small, can tip the whole fucking thing over. So you avoid anything that you even suspect might cause a wobble. 

That's essentially where I am right now; handling PTSD on my own. It's a huge stuck point. I don't trust the VA to help. I go back and look at my worksheets from past therapy, where I'm supposed to challenge thoughts-- is it likely that the VA will not help? But the answer, legitimately, is that yes, it is possible that the VA will not help me. This has happened. 

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I acknowledge that this is an indicator that yes, I do need some help getting past all of this. :) Being forced out of transitional housing affected me far more than I realized-- it was a major, major hit to my self esteem, my sense of safety, and the way I see the world. I know myself, and I know the PTSD, at least that well now. I'm looking at some different options, reading papers about different medications and other forms of therapy. I read a fair amount of journal articles on PTSD and mental health every week. Even so,the only conclusion I've been able to reach is that I have to keep working, keep fighting, keep changing the parameters, and keep trying. With the VA, or without it.



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