09 March 2017

Do you have thoughts of

I went to the Atlanta VAMC emergency room on February 27 because I was feeling in crisis and having a great deal of trouble managing my PTSD symptoms. Part one is here, you should read that first. This post is an update. I'm still feeling as bad, or worse, than I was that day-- I have yet to see or talk to anyone about my PTSD symptoms.

The psychologist that primary care referred me to (my primary care appointment was on February 14) never did call back again. I got a letter in the mail a few days after I'd been to the emergency room that he was closing the consult, even after I'd left two messages on his voice mail and even after the emergency room said they'd inform him that I'd been there.

Someone else from primary care called to set up an appointment; I was able to call back and get an appointment set up with still someone else in mental health, on March 28-- that date is a full six weeks after my visit to primary care, and nearly four months after I first visited the Lawrenceville Vet Center on January 3.

Trauma Recovery called, so that referral was finally/actually put in by someone. They called twice, but I haven't called back. I'd been told by the Atlanta VAMC emergency room that I was being referred to Trauma Recovery Program for an appointment and that TRP also accepts walkins on Monday and Tuesday at 0830. The phone messages said walkins on Monday and Tuesday at 0830. Now I have a letter dated March 1 that says Tuesday or Wednesday at 0830. There is an "intake process" at TRP that takes three hours beginning at 0830.

That there's a discrepancy between what I've been told (we'll get you an appointment) and reality (it's walkin, you might get seen that day you might not) kinda knocks me off center, because it's another example of why I've lost faith in anyone at the VA that says they're going to do something to help. The logistics involved in getting to TRP are why I haven't called back.

I live about 45 miles from the address listed for TRP. Because it's a walkin thing, I figure I need to be there early so my arrival time realistically should be 0800. There are a couple of different routes I can take to drive there, and Google Maps is pretty accurate picking which one is the right one given traffic conditions. I've also asked family who live here for advice. Google Maps and family both agree that I need to allow two hours to get there, so that means I need to be out the door and in the truck at 0600 (earlier if I need to stop for coffee on the way).

I need, and try to allow for, two hours from waking up and opening my eyes to being useful for anything. It takes that long to figure out where I am and what day it is; I often ask Siri: "Hey Siri, what day is it today? Hey Siri, where am I?" Then I need to make breakfast and eat it, make coffee, get showered, figure out what to wear (a not insignificant thing when your brain moves a million miles a minute), get dressed, and get in the truck. So that puts my alarm setting at a few minutes before 0400.

Assuming I actually wake up when my alarm goes off, and further assuming that I don't have a panic attack or disassociate while I'm doing all of this, and even further assuming I've left enough time for traffic and finding the place, and finding a place to park, I might make it there on time.

The part about waking up when the alarm goes off can be scratched, because there's no way I'll be able to fall asleep the night before. I'm lucky to even be in bed by 0400, much less asleep, so that's not going to happen. The only way I'd ever make it there is to stay up all night and just not sleep. I'd be driving for two hours in Atlanta rush hour traffic after not sleeping for 24 hours, and then have to try to be coherent for three hours of questions about my mental health.

Tell me again how this is going to help?

Let's assume I make it there and get through the "intake process", and get into the "treatment planning" part of the agenda. There are a couple of possible options, based on what I've encountered in therapy before. One is individual treatment, things like cognitive based therapy and prolonged exposure therapy (both of which I know I want to do again, they're the two things that have really helped). For those there has to be someone available that's trained to do those things, and that person might not be available for days or weeks depending on case load. The other is group therapy, and many groups once started don't take on additional people if they work on a sequence until the sequence starts again. So the group I want, if it started a week ago, might not be available for another eight weeks (that's two months!). And all of that assumes that I don't have to go through n sessions of just one-on-one therapy before getting to those things.

Tell me again, again, how this is going to help?

Allow me to be crystal clear on this: I'm not avoiding the treatment or the therapy. I've been through cognitive based therapy and prolonged exposure therapy, and both are extremely difficult. They take a shitload of energy. I'm not afraid of either, not scared of facing the thoughts and images and memories. Right now, facing this PTSD shit head on is what I need. I'm trying to get to a place where I can do that, and no one's fucking listening. I have to jump through hoop after hoop after hoop.


Something I've noticed-- from the first time I talked to the Vet Center here, from primary care, from the emergency room at the VAMC-- is that everyone has asked if I'm having thoughts of harming myself or others. It's on every on hold message every time I call a VA extension. It's on posters and signs. There are times when I've expected the guy mopping the floor in the hallway to ask me if I'm feeling suicidal.

It was in the emergency room in the Atlanta VAMC that it really registered, that once they ask you "Do you have thoughts of harming yourself? Do you have thoughts of harming others?" and you say no, everything changes. Up until that point, people stand up straight, they look you in the eye, they hang on every word you say and try to make sure they record it exactly. They are concerned, watchful, on point.

Once you say no, the air is let out of the balloon. Shoulders that were square a second ago are now slouched. Eye contact is lost. They exhale. They sit differently, stand differently. The tone of their voice changes. In that instant, once you say no, you're not going to kill anyone, they go from trying to save you to taking your dinner order.

It's led me to wonder just what a veteran has to do to get anyone's attention.

I have my next (technically, my first) mental health appointment on March 28. It will most likely be yet another intake appointment, with the same standard set of questions that it took four weeks for me to answer during my visits to the Vet Center. They will know that I've been to the emergency room, when and where and why.

One of the first things they will ask is "Do you have thoughts of harming yourself or others?" 

My answer has always been, when someone else asks me this question, simply "no". There are repercussions to saying anything else, to responding with anything that can even be interpreted as "yes", but here's what my answer is going to be the next time I'm asked. It's the real, honest answer.

At this very second? No. But every day when I wake up, sometimes out of a nightmare and sometimes not, I think about why the fuck I'm still here. I wonder, if I disappeared today, would anyone even miss me? I wonder why I need to get up and get dressed and try to get through the day. I find a reason, any reason, no matter how small it seems, to be alive today. I look at my pocket knife, I look at the blades on the sink next to my safety razor, and I make the choice every day to live for just one more day. My answer then, is also yes, every day since one muggy night when I stepped off a plane in South Carolina and realized I was back from the Desert, almost exactly twenty six years ago. That's 9400+ times I've looked at myself in the mirror and decided that I still want to be here. I don't know at what number of times I'll be overdrawn, and I don't want to find out, so why don't you stop with the stupid fucking questions, stop trying to cover your ass, and let's talk about why I'm really here.

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