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05 April 2017

Rainbow In The Dark

Previously: https://stillinthedesert.blogspot.com/2017/03/vamc-er-follow-up-to-follow-up.html

After I went to the emergency room because my PTSD symptoms were getting out of hand, I got an appointment with primary care/mental health-- the next available date and time was March 28, a month later. Other than some drunk, angry, and probably confusing tweets I haven't said anything about that appointment, so let's just fix that.

This time, my sister volunteered to ride along. She's retired, but she worked alongside a lot of people who are veterans-- many of them Vietnam vets and many of whom really do know a thing or two about post traumatic stress disorder. That some of the things I've been saying and doing lately matches up with what she knows of what those friends have said and done raised a few red flags.

Getting this appointment took calls to two VA medical centers (Madison WI and Atlanta GA), one trip to the Atlanta VAMC's patient advocate, one trip to the Lawrenceville CBOC, and one trip to the Atlanta VAMC emergency room-- a total of six weeks of going back and forth and not getting any actual help with my PTSD. Even after all of that I really didn't have high hopes for success. I figured the best I'd be able to do was wait and see. This appointment had an "acute" label attached, which applied to someone who's physically injured implies that they might really be hurt and need attention. I made it through the month by alternating between numb and disassociated, and angry and triggered.

It was an 1100 appointment, earlier than I wanted-- I only took a morning appointment because it was the first I could get. I've worked (and hacked) nights long enough now that I just don't do mornings. As was often the case in Wisconsin, I ended up staying up all night the night before this appointment because I was afraid that if I slept I'd not hear my alarms. (I'm not one of those veterans that sleeps lightly-- once I'm asleep, I'm out, usually dreaming something like Redeployed to the Desert XVI.) Allowing for traffic and parking, we left at 1000.

At the clinic: no parking available. It's in one of those "professional" areas, subdivisions of strip malls containing anything from sub shops to Japanese restaurants to medical clinics. I waited for several minutes while another veteran with a cane walked to his truck; there was already a veteran in another truck waiting for that space, so after first guy left and second guy took that space, I took the "no parking" zone space to wait in. After a few minutes, the process repeated with me pulling into a space.

Inside the clinic: found the check-in kiosk, scanned my ID card, went to sit down. Sister had brought books (plural) to read, having been in a VA waiting room before. 1100 came and went, and following the sign on the wall I went to the desk to let someone know that it was now 15 minutes past my appointment time. Front Desk asks who my appointment is with, huffs when I say I don't know, asks for my name. She'll check with someone. Fine. (Truthfully, I don't know my provider's name because I've decided that it probably won't be worth taking the time to memorize it.) 

A few minutes later, a social worker appears and makes a weak ass attempt at apologizing for being 15 minutes late. I was actually early, which for my chronologically challenged self is an accomplishment. I follow her down a couple of different hallways in The Back, to an area that I assume is the Mental Health area.

The office has two chairs, two indirect lighting lamps, and a desk with a computer and another chair-- an almost exact carbon copy of the exam room (or whatever it's really called) that was at the Vet Center. I take one of the patient chairs, she takes the chair at the desk. In order to see the computer, she has to face away from me.

The appointment begins with me explaining two things: that I under no circumstances consent to being made an inpatient, and that I am not even going to entertain the thought of being put on medication ever again.

I have good reasons for my stance on these options for treatment-- being an inpatient for mental health reasons opens the door to having someone else make decisions about my life, liberty, and pursuit of happiness. There are also questionnaires in the world where having to answer that you've stayed overnight for mental health reasons means you can't do, or be, certain things. I learned a lot about both when I was homeless, because in the grant per diem program/transitional housing the threat of being deemed unfit to manage one's own life was implied often. I was also in crisis level groups, where the other veterans in the room had done the several days stay in the hospital and weren't overly fond of it.

Medication-- in my life I've been on citalopram, sertraline, venlafaxine, bupropion, prazosin, and at least one or two more that I'm forgetting-- has upon further review (remember that I've had a month to think about it since my emergency room visit) not really solved the whole PTSD thing. It was probably a very good thing that I was put on citalopram in 2000, because it diverted me from a pretty dark path, but in the end it didn't fix anything. None of the others really did either, and in reviewing my notes from 2010-2015 I think being on meds may have in fact been a net negative (during that time I washed out of college twice and was homeless three times). So no, no meds.

The rest of the appointment, as I somewhat expected, was taken up filling out an intake questionnaire that included questions like "are your parents still alive" and "what was your childhood like" and "do you have a support network" and "do you have a job and a place to live". It also included a standard set of suicidal thoughts questions, which I expected, and I answered honestly; my research suggests that my answers should have been lighting up warning signs, which is of course why I went to the emergency room in the first place.

"Filling out the intake questionnaire" meant that the social worker turned to look at the computer (away from me) to read each question, looked back at me for the answer, and then turned back to the computer to type in the response. Where I'm from this is a job for a clerk-- it's simple data entry, and this social worker put about as much emotion into it as I used to put into entering a customer's pizza order into the computer when I delivered pizzas.

These were also the same questions that I'd answered at the Vet Center (over four one hour appointments), at my initial visit to primary care, and in the emergency room. All of this information was already in the machine, and in my records, which meant this was essentially duplicated effort. I tried to play along anyway. The wheels fell off one by one as the questions went on-- at one point she asked if I owned any firearms (I currently do not), but even after I'd answered that yes I had thought about specific methods of suicide she never asked about the means (I own, and regularly carry, sharp and pointy things).

Nothing I said in response to anything really got any reaction at all. After I gave an answer, she'd turn around and type the answer into the computer and go on to the next question.
 
The last of the wheels fell off when she asked what branch of service I'd been in. I sat there for a second, not saying anything: did she really just ask that? Do these people really not know? I said something along the lines of "um, excuse me?", wondering if maybe I'd heard it wrong. Nope, that's what she asked, followed by asking what years I was in and assuming I'd been in Iraq (I wasn't, I was in Saudi Arabia).

The subject of treatment came up, finally. I expressed my interest in the twelve week cognitive processing therapy that I'd previously done, but this time focused on specific things from the Desert. I also expressed interest in prolonged exposure therapy, again focused on the Desert. When asked about group therapy, I said yes to that because talking to other veterans helps. I asked when any of this might start.

Social worker's response was that she'd send a consult/referral to trauma recovery and that I'd have to do the three hour intake there first.

Wut.

I explained why I hadn't been to trauma recovery walk-in, why to get there I'd be driving through two hours of Atlanta rush hour traffic on 24 hours without sleep with no guarantee that I'd be seen, and that hell would have to freeze over before I'd actually get there. SW's response got defensive quickly-- this is the process, you have to go through it, it takes time. She did offer to put in the consult a request to either have someone from trauma recovery travel to the primary care clinic, or to do the intake via video conference.

As this point, I was done. Whatever politeness and patience I had left were gone (I'm a very patient person-- that I worked at help desks for eight years should suffice for credentials about that). I got up to leave, she walked along as far as the front desk, and I indicated to Front Desk that I needed whatever I needed to get right the fuck now. Appointment in hand I asked for directions back to the Front, told my sister we were leaving right the fuck now, and walked out without looking back.

It's been a week since that appointment; I've heard nothing from the VA since. I should hear from trauma recovery, but I haven't. The person who called to follow up from my emergency room visit promised to call after this appointment, but I've not heard from them either. That I have an appointment scheduled for three weeks from now really doesn't mean anything if it's not an appointment to start actual therapy.

That intrusive thoughts about suicide are showing up in my dreams and at random times doesn't automatically mean that I'm about to do something drastic. On the other hand, these aren't normal for me. I usually see a variety of fucked up visions and dreams and feelings about missiles and chemical weapons and shit blowing up. I do wonder, daily, if today's the day that I can't come up with a reason to keep going and try to accomplish something in spite of what's in my head. I tell myself that I made it back, made it through all I've been through since then, for a reason. There's something in life that I have yet to accomplish, and it-- my life-- therefore has some meaning.

It is becoming increasingly difficult to come up with an answer to the question of "what meaning does my life have?". No job. No school. On disability. Few friends. Few options. Not much hope that any of that will change.

When the PTSD gets bad, and lately it's been pretty bad, I withdraw and disassociate and get really really guarded about everything. I don't trust anyone, I don't believe that anywhere is safe, and so I don't leave the house except to get groceries-- and for that I go after midnight, when there's no one but stockers in the store and I can do self checkout. A victory is getting into the truck and going to a convenience store to get diet Dew, because driving through the night in my truck listening to music I can almost feel human for a few minutes before the bad shit kicks back in.

After my appointment last week, I stopped for soda on the way home. I also picked up two 24oz cans of Mickey's Malt Liquor, admittedly one of my favorite brands. Being a malt liquor, it has a higher alcohol content (5.6). I don't buy it that often, because I don't drink that much-- a six pack of 16oz cans of Miller High Life (my usual choice) often lasts for a month or more in my fridge. Mickey's lasts longer. Last Tuesday, after I'd parked my truck and put my keys away, I took my 48 ounces of Mickey's and a folding chair out to the storage shed in the woods, and proceeded to get drunk, the kind of drunk that happens quickly. Then I wandered around in the woods drunk for a while (bear in mind I'd been awake for almost 30 hours by that point) and eventually made my way into my bedroom where I passed out and slept for 16+ hours.

People, I don't drink like that. 

In the distant past, think 2004 and before when I was married and hadn't yet learned what PTSD was, I drank a lot-- my social life was dart leagues, bowling leagues, softball leagues, all of which were in Wisconsin and all of which centered around drinking. My ex-wife drank a lot, and so did I. At some point around then a switch flipped and getting drunk wasn't fun anymore, so I didn't.

That I came home from a VA appointment and got drunk-- it wasn't a random act, I had to stop at a convenience store, stand looking at the assortment of beer for a few minutes, and decide to get that much Mickey's-- should be a huge ass flashing neon sign saying "HOLY SHIT DUDE SOMETHING HERE AIN'T RIGHT".

Suicide-- my opinion here-- takes many forms. You can see it as physically ending your life, where a person does something drastic and then that person isn't alive any more. A life can also end when someone just stops living, even though they're technically (medically) still alive. During the time I was a Veterans of Foreign Wars (VFW) member, I saw that happen. Even among some of the officers of the post I was a member of, life was about getting and being drunk. That the membership reports got sent to the state office regularly wasn't about anything more than making sure the bar stayed open. Meetings, honor guard, whatever the activity, there was always (lots of) alcohol.

That's a huge factor in why I haven't been to a VFW (or American Legion) post in Georgia. I know it's being unfair to people who I haven't even met, but past experience really makes it hard to try. I have never wanted my life to amount to being the grumpy veteran sitting at the far end of the bar at the VFW, spending my disability money getting drunk night after night after night. That's not living, that's life being over. That it doesn't immediately involve death doesn't make it not suicide.

Self medicating doesn't fucking work, for the same reason that letting the VA medicate me didn't fucking work. Psych meds, whatever form they take, don't make the problem go away. Maybe they give you some room, some peace, to deal with the problem, but they don't make it go away like aspirin takes care of a headache.

My fear in all of this is that the strength (or resiliency, or whatever it is) that's gotten me this far is a finite quantity. That at some point I'm not going to be able to fight this shit any more. That's why I went to get help with PTSD again, to find and build and sharpen some new mental weapons against it. It's the only thing that does help.

Yes, I have an appointment in three weeks. Big fucking deal. It's not an appointment for therapy, since I haven't even discussed actual therapy with the VA here yet. The schedule says it's a 30 minute appointment, the word "acute" doesn't appear like it did for last week's appointment-- so what exactly am I supposed to expect beyond maybe logistics planning for talking to trauma recovery. Then the trauma recovery intake where they'll ask me all of the same questions again that I've already answered. Then, maybe, after that I'll get an appointment to start the therapy I want to do. This will happen when, in May or June? 5-6 months after I first asked for help?

Fuck it. Fuck. The. V. A. They're not helping.

Unless something about the VA changes, drastic and soon, I'm going forward on my own. It'll take longer, it might not work as well, it might not work at all, but self therapy is 100% more therapy than I'm getting when I ask the VA for help. I'm not ruling out eventually being back in therapy, but I'm not counting on it either.


No sign of the morning coming
You've been left on your own
Like a rainbow in the dark
--Dio

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