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12 March 2017

VAMC ER Follow up to the follow up

This past Thursday, I got a call from someone in the Atlanta VAMC emergency room following up on my recent ER visit. Okay. I called back in the afternoon, a different someone answered. It's strange how people from the VA just answer with their first name, not "Office of Inefficiency, Martha speaking" like I've been taught at all of the places I've worked, but whatever. I explain that so and so called to follow up on an emergency room visit where I went in for PTSD.

That a different person answered than the person who left me a voicemail tells me it's just people calling from a list, not that someone specific is assigned to follow up and see how I as a particular person am doing.


They ask about my visit to the ER, and I go off-- I explain that it was essentially a waste of time and money. Yes, I got an appointment-- a full month after my ER visit, but that's also nearly four months after I first contacted the VA looking for help. I tell her that I never did get an appointment in mental health via primary care. I tell her that the Lawerenceville Vet Center dropped me without reason or followup. I also explain the part about the logistics involved in me getting to Trauma Recovery at 0830-- that me staying up all night and then driving through two hours of morning rush hour in Atlanta isn't going to happen.

 I think I heard a sigh of relief when I explained that last part, about the traffic-- Atlanta Traffic is legendary enough without a sleep deprived veteran with mental health problems. You'd probably have to have lived around Atlanta to find that funny-- which it almost, but not quite, is.

She checks my records, and yes there was a referral made from the ER to mental health. That's how I got the appointment I have. The referral was also copied to the same psychologist who I was referred to from primary care; that's the guy who I left two different voicemails for the week before I went to the ER, and who never called back. ER person asks for the psychologists's name, and when I give it to her she can't find his name listed on my records.

I have a letter (actually a bad photocopy of a letter but that's what I was sent) from psychologist postmarked March 1 saying "oh we tried to contact you but couldn't so we're closing the referral". This psychologist ignored two voicemails and me being at the emergency room, didn't follow up, and then put it on me. I tell ER person this, and then point out that the letter includes the psychologists telephone extension.

"Oh, you have the doctor's extension?"

Yeah. Nice try though.

ER person says she's going to see if she can expedite things and calls the psychologist, and then calls me back a few minutes later. It seems that the psychologist, or at least someone in his office, is perfectly capable of answering that extension on Friday afternoon when it's someone from the VA calling-- but when I called, they were too busy. This is starting to sound a lot like what happened with getting a Primary Care appointment, where calls went straight to voicemail for me but when I went to the Patient Advocate and asked them to call, the call was picked up (see https://stillinthedesert.blogspot.com/2017/02/traveling-veterans-seamless-care.html).

Anyway, the result of the ER calling the psychologist is that the psychologist isn't going to do anything because I have an appointment already scheduled-- ER explains that the psychologist said they are just a "point of contact", that this is the treatment plan, and that they won't do anything before my appointment March 28th.

All of which adds up to, I made a 100 mile round trip to the emergency room, sat there for three hours, talked to a triage nurse, a doctor, two social workers, and a psychiatrist-- and the best they could do for me was tell primary care to call me to set up an appointment, something that primary care could have had done two weeks before.

Over the past several years, I've complained loud and often that no one from the VA ever follows up. It is worth noting that the ER here at least made the effort to call-- but a) it took two weeks and b) it didn't change anything about me getting help. If you're not able to do anything meaningful to help when you call to follow up, don't call to follow up. 

A good portion of my working life has been spent in IT support, either at a formal help desk or as part of an IT department. It's a common thing that when a problem ticket is opened, and you reply to the customer with either a solution or a request for more information, a clock starts ticking. After 30 days (as was the case where I last worked) the ticket would automatically be marked as resolved if the customer hadn't responded or no other action had been taken.

Occasionally, there were tickets where we needed to walk the customer through something, either via remote desktop or just on the phone. In those cases, it was part of my job to make sure that all of the information that was needed was assembled and noted in the ticket and a phone person assigned to call that customer. All of the phone people were students, so as a customer you didn't have a particular support person. You got whatever agent I had available to volunteer to call you.  If we got your voicemail, we'd leave as much information as we could as well as a ticket number and a way to look at your ticket online (which would include all of the information we had about your issue).

It would also often happen that we'd escalate a ticket to a particular team of technologists, and in the course of trying to fix whatever the problem was those technologists would ask us to contact a customer for more detailed information or to see if the problem was actually really truly resolved. This occurred with service outages as well-- if you called because you couldn't access a particular service during an outage, we'd call or send an email to let you know when the service was operational again.

The overall concept was that if you called with a problem, the problem was important. There were different levels of important, depending on how many people were affected. If only your printer won't print because the print queue service was having problems, that's different than all of the printers in all of the libraries (the campus had 40+ libraries) won't print. If your laptop's battery wasn't holding a charge, that only affected you, but we'd still do whatever we could to find a way for you to get a new battery. It didn't matter if you were the head of a department, a freshman undergrad, a scientist trying to cure cancer, or the custodian emptying trash cans. We'd do everything we could to try to get you an answer and/or a solution. (Even if you weren't eligible for support, we'd at least Google your question and try to point you in the right direction.)

If your ticket was automatically resolved after 30 days, you'd get an email saying that the ticket had been resolved and if you still had questions you were welcome to contact the help desk again. Usually this was okay, but sometimes there actually were unresolved questions and we'd start work again from there.

It was rare in my experience that someone's question completely fell through the cracks, but it did happen. Since I was a quality assurance person, it then became my job to figure out what the customer needed-- maybe there was a simple answer we'd missed, maybe the technologists the ticket was assigned to were asleep at the switch, maybe both the customer and us were both waiting for an answer from each other, and maybe someone just fucked up. The priority wasn't pointing fingers and blame, the priority was getting the customer's problem looked at, properly addressed, and resolved. There were times when I'd have to send an email or make a phone call that would include saying "my name is ___, I'm the person in charge right now, I'm reviewing your ticket, I most royally screwed the pooch on your issue; here's what I am doing to get this fixed for you".

There were other times when, for whatever reason, the agent on a call got in over their head and the customer on the other end of the line was really, deeply unhappy. It was also my job as quality assurance agent to put on the headset and say "Hi, my name is _____, I am the senior agent on staff right now. How may I help you?" I didn't always have the answer that the customer wanted to hear, and since I worked nights I couldn't always get a resolution until the next business day when the people I needed would be there.When that person next spoke to someone from the help desk, they'd say they had talked to me.

Often, to get things fixed, I'd have to write a long, detailed email to my supervisors explaining exactly how badly and completely I/we'd fucked up, complete with my name in the signature block, even if I'd had nothing to do with the ticket until that point.

It's called taking ownership of a problem.

There were several times-- I lost count-- during that followup call from the ER that the person said things like "I know, we have problems" and "we have some things to fix" and "I'm sorry that happened".

Here's a list of all of the unique people I've talked to or tried to reach in Atlanta, trying to get help with PTSD (I'm leaving out people for other health issues):
  • VAMC Atlanta GA eligibility
  • Lawrenceville GA Vet Center social worker
  • VAMC Atlanta GA Traveling Veteran coordinator
  • VAMC Atlanta GA primary care scheduling
  • VAMC Atlanta GA patient advocate
  • VAMC Atlanta GA primary care nurse
  • VAMC Atlanta GA primary care physician
  • VAMC Atlanta GA primary care psychologist
  • VAMC Atlanta GA emergency room
    • Triage nurse
    • Doctor
    • Social worker
    • Psychiatrist
  • VAMC Atlanta primary care/mental health scheduling
  • VAMC Atlanta ER followup
There were cases where a help desk ticket would bounce around for a while, without a resolution-- when one landed on my desk, it was my job and my responsibility to put my name on it, take ownership of the problem, and do what was necessary to get the customer what they needed. The majority of these cases weren't life or death-- critical to the mission of a large research university, yes, but if you lost emails during the transition to Office 365 it likely wasn't going to kill you.

I'm sliding. I'm getting, and feeling, worse.

Last night, I went for a drive-- to get a soda, but to nowhere really, I got as far as the eastern edge of Atlanta before circling back. That's my thing lately, if I haven't been out of the house all day and/or haven't encountered any other people I'll get in the truck to go to some convenience store for a soda. Between here and Atlanta itself there isn't much to see, especially at night and in the rain. Going somewhere, even just to get a soda at some random store, I feel almost human.

I didn't stop for the soda until I was almost back to the house. Most of the small stores here close at 2100 or 2200, but there's one store sorta close by that's open all night. Sometimes I'll just drive there, instead of a longer trip like I made last night. When I was waiting in line, the person ahead of me and the girl behind the counter chatted for a couple of minutes. When it was my turn at the register, the girl apologized for making me wait-- that's when I realized I'd been completely disassociated, numb, standing there. I could have been there for hours or minutes, I had no idea.

I started writing this several hours ago, when it was afternoon and the sun was out. It's just after 2100 now, it's been dark for hours, and I've had to stop typing several times because I lost concentration. Not, my eyes got tired or I needed to stretch-- I had no idea what the fuck I was even writing about. Where the time went between when I started typing, and now, I have no idea.

My laptop's display says its Sunday, but it doesn't feel like any particular day-- I can't remember when I really knew what day it was, what week, or even what month. That I'm chronologically challenged isn't new, but right now I don't even care what day it is.

The dreams-- the nightmares-- the Desert, being called up again, something new and bad happening, it's all mixed up and jumbled and confusing as hell. I'm convinced that I have to dream, that it's my brain trying to sort things out, but my brain just can't get it all in order, it's overloaded. When I wake up, I have to pace back and forth for hours, talking out loud to myself, trying like hell to get some grip on how I feel before I lose focus again, go numb again.

March 28. March 28. March 28. Have to hold on until then, but that's bullshit too. I already know that going to the emergency room won't help. Call the Veterans Crisis Line? What are they going to say? They're going to refer me to mental health, tell me to hold on until then. Breathe tactically? Fuck you.

I have my mental health binder, with all of the things from all of the sessions and groups, and I can't even look at it, can't focus on it to try to do anything on my own-- but if nothing happens at this next mental health appointment (which is what I expect), that's going to be all that I have. I'm going to have to do it all on my own. I have to be prepared for this possibility and I don't have any answers.


"But we'll follow up after your appointment on March 28." 

Sure, whatever. Fuck off.

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