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28 February 2017

Visiting a VA Emergency Room

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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


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


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