Yes, I’m fine.
Indeed, I have even had friends get in touch with me to make sure that the above is true, given how long it has been since I’ve posted. I’m happy to say that my absence has had nothing to do with my health.
Sadly, it has had a lot to do with the job I write about in this blog.
Just yesterday I received two very considerate e-mails, one from a VA administrator and one from a fellow VA physician at another facility. Both responded personally to some concerns that I had had about a VA webinar in which I’d participated about a month or so ago (although, frankly, I practically had to check my Thucydides to remind myself what had been the issue, given how historical a month can feel around these parts).
As I recall, I had been disappointed not at all in the quality of the presenters, but rather in the overall tone of the webinar itself, i.e., its sort of “Rah-rah, we’re the VA and we can do this” tone, as if “Kum-Ba-Yah” had finally met “When Johnny Comes Marching Home.”
Now, right: it isn’t fair of me to be asking an educational program from my employer to feature the latest update from Debbie Downer. I want to be uplifted as much as the next fellow. And can-do beats “fuhgettaboutit” any old day.
Still, as I also recall, on that day I had desperately tried to get out of one crisis in time to begin the webinar, while at the same time praying that another crisis would at least have the decency to take a smoke break so that I could finish the webinar. Perhaps at the moment I simply wasn’t in a mood to appreciate fully the bells and whistles of modern, interactive medical education.
As the kids say these days, my bad.
This comes on the heels of a couple of captivating news items from this past week. The first came out of our very own United States House of Representatives. It appears that some of the members of that august body’s Committee on Veterans’ Affairs are, shall we say, displeased with the senior leadership of my employer, primarily because of concerns with (how they see it) the leadership’s apparent lack of commitment to frugal educational conferences and the timely hiring of mental health practitioners. (These are indeed tough economic times, lest we forget.)
My superiors at the national level unfortunately will have to take the hits that they must take, and on that matter I have nothing to add, even if I were inclined to do so. I will say this, though: the last two VA educational conferences I attended certainly would have met the standards of the Spartans so heralded by our ancient Greek historian above. Of course, I shouldn’t overstate the case: we did get water at our tables, after all. That certainly was a plus. One of them even featured some hard-candy lozenges in various fruit flavors, smack dab in the middle of the table, right there for the grabbing. I took a particularly liking to the orange ones.
(Of course, the break tables of the organizations meeting in rooms next to ours rivaled those of the most decadent Capitol feasts that Katniss and Peeta had to endure in the various volumes of The Hunger Games trilogy, but as I’m sure those attending such conferences were merely entrepreneurs busily “creating jobs,” no harm, no foul.)
As to the Committee’s second concern, i.e., the pace of the hiring of mental health professionals, let me hold off my thoughts pending a meditation on the second captivating news event of the week, one which I first learned about from, of all things, Comedy Central’s The Daily Show with Jon Stewart, but for which, in all fairness, I will instead reference that other sad-sack warhorse of the lame-streamed media, The New York Times.
It appears that a bill came before said Congress of the United States (at least its Senate half) that was destined to provide funding for veterans to obtain jobs as, among other things, police and fire persons or as park rangers, the bill being sponsored by Democratic Senator Patty Murray of Washington, entitled the “Veteran Job Corps Act of 2012.”
I am very glad to report that such waste, fraud, and abuse was stopped cold by the Senate Republicans, by a margin two votes short of the necessary supermajority for a procedural vote, 58-40.
Thank goodness at least someone is looking out for our fiscal future, don’t you agree?
It gets even better, though. Last week, in another piece, the Times reported the words of two fine members of the Senate as they discussed their concerns about the wisdom of this bill. How could I put it any better than such statesmen have already so done?
Take, for example, Senator Tom Coburn, Republican of Oklahoma. As the Times reports, “‘Where is our honor? Where is our valor? Where is our sacrifice?’ thundered Mr. Coburn, immediately after suggesting that the bill cost too much.”
Well, land sakes: honor, value, and sacrifice, indeed.
Then the Times goes on to say, “[Republican] Rand Paul of Kentucky went further, saying he would block the bill until Pakistan freed Shakil Afridi, the doctor who helped the United States find Osama Bin Laden. He also wants to halt all American aid to Pakistan until Dr. Afridi is released. If that halts American aid to veterans, too bad.
‘I care deeply about the veterans.’ [said Mr. Paul]. ‘I care deeply about housing and helping the veterans who have fought for their country. But this is about whether we as a country and the American taxpayers will be asked to send good money after bad to our allies that are not acting like allies.’”
Well, of course it is. What else could a “Veterans Job Corps Act” be about?
It was the Times’ Lawrence Downes, dated September 19, 2012, who noted:
“It would be easier to admire the Republicans’ late-breaking fiscal scrupulosity if their motives–denying the Obama administration any kind of victory this year, whatever the cost to jobless vets–weren’t so transparent. It’s probably useful to remind Republicans like John McCain (a ‘nay’ on the jobs bill) that wounded, jobless, and homeless veterans aren’t a fact of nature. They’re a product of the wars that Congress members voted for, the war debt they piled on, and the economy they helped ruin.
“‘It’s unbelievable that even after more than a decade of war, many Republicans still will not acknowledge that the treatment of our veterans is a cost of war,’ Ms. Murray said in a statement after the vote.”
So true, Madam Senator, so true.
Yet how else could I end my little meditation except with the simple of words of Mr. Stewart himself:
“So, once again: $800 billion, unfunded, for war; but $1 billion–but paid for in a way you guys [i.e., Senate Republicans] aren’t crazy about–to help the guys who fought the war to get jobs afterwards? [Tsk, tsk:] We’re not made out of money, people.”
OK, so what? Well, how about this for a so-what (or two):
News from the Front I: the great tsunami of combat trauma has hit. The first waves have long left the shores and have begun to infiltrate the towns on the harbor. In other words, friends: the War has come Home (even if all the troops have not).
News from the Front II: I am having at least one, usually two young combat veterans coming to me for treatment of opiate addiction per week. That means that it is quite possible that fifty to a hundred young men and women will present themselves to me over the coming year–assuming that the rate doesn’t increase, naturalmente. Legally I cannot even keep that many people on my patient rolls! Fortunately I have a colleague who is coming out of retirement to help me out until we can finally find someone who is even interested in taking one of those jobs that was opened up last fall, i.e., the jobs the Congress persons were so outraged about not being filled. But even then, within a year or so we’ll be hitting numbers that will not only be unmanageable, but legally impermissible!
News from the Front III: we are still scheduled to have men and women in Afghanistan until the day when we in Indianapolis might not be able to take into our opiate treatment program anyone more from the previous thirteen years!!
News from the Front IV: Combat veterans come to our facility in crisis, into our emergency room, into our medical clinics, our mental health clinics. We do all we can that day to make things as safe and hopeful as we can. We do all we can (at least at our facility) to get folks into our outpatient department for assessment and treatment as quickly as we can (whether some might believe that or not).
In those outpatient assessments, however, we are required by countless regulations and rules, promulgated by both The Joint Commission and the VA, to get as much information as we can, detail after detail after detail, all of which should end up in the much-lauded “treatment plan,” which is wonderful, ideal, “best practice,” the whole bit–except when the veteran’s car breaks down, or his bus doesn’t show up on time, or his mother-in-law is late getting to the apartment to take care of the kids during the appointment, so that the appointment has to be rescheduled, or the veteran and the therapist do what little they can in the fifteen minutes they have instead of the sixty minutes they had hoped to have, or . . .
Or, who knows: maybe the veteran wasn’t even able to show up for the assessment whatsoever, maybe because he was still asleep from the Percocets he’d taken several hours before to stop all the screaming going on in his head, or because it turned out that his mother-in-law never showed up at the house at all, and then maybe the cell phone got cut off because he couldn’t pay the bill or he ran out of prepaid minutes, because he’s not been able to find a job (or at least one with which he could afford to pay gas for his mother-in-law to come over), so therefore he couldn’t call his VA therapist to say that his mother-in-law didn’t show up and that he needs to reschedule. Or how about because the phone had been shut off, he couldn’t call the Crisis Line the night before, when the screaming wasn’t quite as bad as he knew it was going to get, so he bummed those Percocets off his neighbor, and now he owes the neighbor something in return, and . . .
News from the Front V: Many VA facilities, especially the community centers, are not, shall we say, nestled in the Meccas of the High Life. Psychiatry is not a particularly popular field into which young physicians enter. It is a field from which many older physicians are more than ready to leave. Psychiatrists do not usually see themselves as small-town, Marcus-Welby-MD types. (Call us what you want; the truth’s the truth). So do the math: all the above is possibly not the best news for rural South Dakota. (In Indianapolis, last fall we didn’t get one single application for a newly-opened psychiatrist position, even though we do have enough of a High Life to get a Super Bowl every now and then and our facility is housed right next the only medical school in the state!)
News from the Front VI: I have found my work with combat veterans to be extremely rewarding. I do admit, though: it can be tiring (and ergo the period of time since my last post).
Many, many of today’s combat veterans from the conflicts in Iraq and Afghanistan are younger than thirty-five. They have a lot of energy (that’s why they volunteered for the military). Many are hurting, a lot. When young, energetic combat veterans are hurting, everybody around them knows it. Many practitioners in the community are wanting to do their part to help these men and women. I applaud them, and I will do what I can to help them.
Yet I have to be honest: I’m going to say that not a single one of those community practitioners has a clue as to the intensity of the emotional pain (and psychosocial pain) they might soon be asked to experience. (And one has to wonder what role all that plays in the number of psychiatric positions still unfilled.)
So, Ultimate News from the Front:
The mental health sections of many of the nation’s VA hospitals are rapidly becoming–well, honestly, have become–psychological M*A*S*H units suffused with rage and grief. Crises are the norm, never the exception: once one gets calmed, another one (or two) pop up. Once we then get emotions stabilized within our doors, we then have to send the selfsame veterans out of those doors into a nation that doesn’t have jobs for them, that isn’t prepared for the educational challenges they face after traumatic brain injury, that is, through some of its representatives, doing everything it can (with vim and vigor, I might add) to reduce whatever access they might conceivably have had to anything even closely approaching a social safety net–and then that has the audacity to waive some cheap, fifty-cent flag and say “Thank you for your service!”
So back to webinars.
I really can’t fault my colleagues and my superiors for their therapeutic enthusiasm, though at times I might roll my eyes and petition to the heavens, “How long, oh, Lord?” I do believe that most of them–even those in the central offices of Washington–have read the missives from the front. Sad to say, though: the truth is not exactly what everybody else in the nation is wanting to hear, even as eighteen veterans die a day from suicide. We’re a can-do country, and we will do.
With appropriate fiscal restraint, of course.
After all, who wouldn’t be excited to be sitting in a makeshift office in some semi-abandoned strip mall, two to three hours away from the nearest facility that can safely manage your young veteran who might be screaming at his girlfriend outside your door, hoping against hope that the telehealth equipment doesn’t break down again, wondering how you’re going to get that medication from the local pharmacy in time (and wondering whether the fee-basis office in that two-to-three-hours-away facility has actually been paying that pharmacy’s bills), all while being told that you need to be “coordinating care” more and doing so in sufficient time for you to be able to get out of that strip mall by dinner time, to get to the Walmart that’s no longer open twenty-four hours, in the next town down, to buy a couple Red Baron frozen pizzas (maybe even Supreme, if the truck came in earlier that day).
For your country, of course. The same one that can’t afford to send that young veteran, who it could once afford to send off to kill, now to find some meaningful way to live out his energy in service for the public safety of the community that he had once pledged to die for.
I mean we’re talking honor, value, and sacrifice here. The Senator said so.
Come to think of it: maybe my colleagues and I are more like the Spartans of old than I thought. I just focused on the wrong historian. It wasn’t Thucydides who memorialized our kind. It was Herodotus. Hey, you saw the movie, didn’t you, the one with Gerard Butler and David Wenham? About the 300 Spartans at Thermopylae?
They saved Greece, you know.
Too bad they themselves didn’t fare quite as well. But them’s the breaks. Sparta wasn’t made out of money, after all.