Tag Archives: portsmouth naval medical center

Broken and Unlikely to Get Better: Military Mental Health Care

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Well, my friends it’s time for me to get on the PTSD soapbox and go “Smedley” on the military mental health system. The fact is the system is broken, maybe not as bad as the VA, but broken nonetheless. The biggest part of the problem is not that there are not enough providers, there are not even though many more have been hired. The biggest part of the problem is that the system has lost any humanity that it once had, all in the name of efficiency and the budgetary bottom line. The fact is that the bottom line actually matters more than people and bean counters, not providers have the final say.

Marine Corps Major General, and two time Medal of Honor winner, Smedley Butler wrote after he retired in his classic book War is a Racket:

“I have visited eighteen government hospitals for veterans. In them are about 50,000 destroyed men- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital in Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed home.” 

Two years ago, the Navy seeing a increase in healthcare costs decided to bring as many people back into the Navy Medicine system as possible and cut back on referrals for active duty personnel. I understand that, money is short and Lord knows we need to save it wherever we can in order to buy aircraft like those in the grossly over-budget, behind schedule and substandard F-35 Lightening stealth fighter plane program, or ships like the Littoral Combat Ship which are over budget, under armed and not designed to survive the slightest combat. Mind you, none of the F-35s are in service, despite a decade of tests and production delays, costing hundreds of billions of dollars. But I digress…after all, war is a racket.

Now let me be honest and as fair as possible. There are many great mental health providers in the military and the Navy Medicine system; active duty, reserve, civilian and contractors. These people actually do care, but often they don’t get to make decisions that they think are right for their patients. At the same time there are others working in the system that are just in it for job security or the money. However, all of them are at the mercy of commanding officers that decide how they want to spend their budget, and dictate to their providers, sometimes at the threat of their job, contract renewal, a positive fitness report or promotion recommendation what they will approve, or more likely, deny. Thus in some cases commanders will support their providers doing whatever possible to get patients help, while others look at the bottom line. I have had both experiences.

I have been getting mental health treatment for PTSD since July 2008 when my life fell apart after Iraq. I have had mental health providers in the Navy Medical system. I also had a civilian psychiatrist who I was allowed to see when I was at Camp LeJeune, even after Navy Medicine decided to bring people back into the Navy Medicine system.

You see at Camp LeJeune, the old hospital commander, who I worked for, and the Director of Mental Health who I worked with realized that as a Chaplain that my personal and professional privacy, and my need for continuity of care was important. They realized that I needed to feel safe. There I was treated with professional courtesy, with humanity and I felt like people actually cared about me. That was was something that I needed then, and still need now. Unfortunately that is not happening now.

When I returned to the Hampton Roads area I knew that I still needed mental health care. I finally got my first visit and intake evaluation in June. My first appointment with a psychiatrist came on July 7th. The psychiatrist herself was not the issue. You see I used to work at the Naval Medical Center for two years and continued to work at the Naval Hospital Camp LeJeune for another three. I am fairly well known in the Navy Medical Region East.

I suffer a tremendous amount of anxiety. I admit it, I am still bat-shit crazy. I have the PTSD “Mad Cow.” The night before my first appointment I could not sleep, most likely because of being anxious about going to the Naval Medical Center outpatient mental health clinic. The fact is, it is really big and impersonal, and frankly that scares the hell out of me. I can’t go to big churches for the same reason. I feel terribly unsafe in them.

My worst fears were borne out. The waiting room was crowded, and after waiting I had my name and rank called out for everyone to hear, so much for the expectation of privacy, in fact I think that was a HIPPA violation. In the intake room I was met by three very junior hospital corpsmen. I didn’t even get a “hello, how are you doing sir?” from them. Instead one told me to take off my shirt, one told me to step on a scale and after that I was told to sit down, and got my blood pressure taken. My blood pressure was twenty points, actually almost 30 points higher than normal, even after I have just had a bunch of caffeine, which I did not on July 7th. I have to attribute the rise in blood pressure to the anxiety of just going in to the clinic, there is no other reason. After I had my vitals checked, I was asked a series of rapid fire questions that were very personal in nature and that I would prefer a doctor or nurse ask. I was then told to go back and wait.

The whole process was impersonal, embarrassing and dehumanizing. But it was very efficient, and the bean counters should be happy. That being said it was the absolute worst experience I have had with military medicine, and that includes having a thumb stuck up my ass and having to duck walk at the Military Entrance Processing Station. That was a rite of passage, but this scared the absolute hell out of me, I did not feel like I mattered as a person to anyone in the clinic.

When I saw the doctor she was pleasant. I told her of my experience and requested that I be referred to a provider in town as I had at Camp LeJeune. I was told that she would submit the request to her division officer who is a doctor that I know, and get back to me in a day or two. I didn’t hear from her. I waited two and a half weeks, and finally decided to e-mail the doctor on July 24th asking what was going on. Today I got an e-mail telling me that “my case could not be sent to the civilian network.” No reason was provided. The time between that appointment and the denial of my request was almost four weeks, totally unacceptable by any standard of care, military, civilian or even Klingon.

I was given the option of seeing a provider at an outlying clinic however the one close to where I work would be similar to the main hospital, crowded and impersonal. The other option was using a resource called “Military One Source” where I could get up to 10 or 12 appointments with a civilian provider in town with no guarantee that I would be able to see them after those visits were up without approval from the same people who just told me that I couldn’t be seen in town. If I do that my medication would then be managed by my PCM instead of a shrink. At this point I no longer have any trust in the military mental health system, at least for me, and the Military One Source providers are not really there to deal with long term chronic conditions.

I knew that I was being blown off. In military speak it is the old adage that “a mission passed is a mission completed.” The fact is that I do not matter to these providers. Unlike the people at Camp LeJeune, they have no personal investment in me as a patient or as a professional colleague, so why should it matter to them? I don’t write their evaluations, the bean counting admiral does so, why would an old and broken chaplain who doesn’t work with them matter?

Likewise I am being treated like a child in regard to medication. I have no history of drug abuse, prescription or otherwise. Unlike LeJeune where my doctor put refills on my as needed PRN anxiety medicine, I now have to subject myself to the industrial “production line” inhumanity of that clinic, just to get a refill each month.  Even if I didn’t want therapy I would have to endure the ignominy of the inhuman treatment at the clinic 12 times a year just to get a pittance of very low dose anti-anxeity medication. I don’t need that kind of abuse, and that it exactly what it is no matter what the bean counting admiral calls it.

But here’s the deal. I am a senior officer. No wonder so many senior officers decline treatment, attempt to hide their symptoms and self-medicate. The treatment in the system is demeaning and the stigma is there. I have known of a good number of senior officers, Marines, Navy and Army who have ended up losing their careers or lives over untreated PTSD. Right now I am debating even if I should go back to therapy. I know I need it, but if it is a choice of the abuse I am going through at the mental health clinic or maintaining a semblance of human dignity, a good craft beer tastes far better than Xanax.

Not only that, but an even far more important reason than me and my needs, that of the junior enlisted personnel who seek help or are directed by their commands to get help from mental health. Now I cannot imagine what it would be to be a powerless junior enlisted soldier, sailor, Marine or airman. But wait I can, I enlisted in the National Guard back in 1981. However, back then I wasn’t broken, and I cannot now imagine what is is for young, powerless enlisted personnel have to go through what I am going through when getting mental health treatment. That is the bigger issue.

Is it any wonder that the military suicide rates are still high and that this year the Navy is up from the same time as last year? According to statistics released last week, there have been 36 Navy suicides this year, last year at this time there were just 24 with 43 for the entire year. I wonder if that has something to do with pushing people into an often uncaring bureaucratic system that is more concerned with saving money than meeting the needs of patients.

I was talking to a friend, an officer at the Medical Center today while at a different clinic where I am treated with great compassion, care and dignity, a clinic that is not afraid to get me the medical help that I need, even though it is expensive. This officer and I served at Portsmouth together back in 2008-2010 and that officer told me today that the place has changed. He said it was all about business, impersonal and machine like, devoted to the bottom line, with lip service being given to actual patient needs by those in senior leadership.

Thank God I won’t have to stay in the military medical system the rest of my life. The good news is that when I retire I get to go to the amazingly proficient VA system for that care. Won’t that be grand?

No it won’t. Not for me or any of the tens of thousands, maybe hundreds of thousands of military personnel with PTSD, TBI or Moral Injury. We’ve all read about the problems in the VA, they are persistent, endemic and won’t change anytime in the near future. That is shameful.

General and former Secretary of State Colin Powell famously said “you broke it, you buy it.” Of course he was talking about Iraq, but the same principle should apply to those who have put their lives on the line during the last 13 years of war and come back broken. It is a moral obligation, it is something that we as a nation promised. The country pledged to care for those who served, and the fact that it is barely a half percent of the population who have served in war for the last 13 years, men and women who now have to fight for the basic care that a civilized, and as the Religious Right likes to call a “Christian nation” should provide as a matter of basic human decency. It is not special treatment that broken veterans deserve, it is simple decency and honoring a commitment that we made as a nation.

Yes I am going “Smedley” here, because war is a racket, and it is a racket that those inside the military, the government and the private sector promote.

I’m sure that I will get some blowback from this from some in the system, but I don’t care. The system is broken and until we as a nation stop bullshitting and admit there is a problem and elect to do something about it won’t get better. The bean counters, war profiteers and bureaucrats need to be held accountable by our elected representatives.

I am going to be contacting the Admiral that commands the medical center as well as my Congressman, and probably the chairmen of both the House and Senate Defense committees because I suspect from what I hear from soldiers, sailors, Marines and airmen around the country that this is not an isolated instance. So, if someone like me, a senior officer still in the system doesn’t do this who will?

I hope that this post will become viral so that our sailors, Marines, soldiers and airmen get the quality care, delivered with compassion and humanity that they deserve. For some it will be a matter of life and death.

Pray for me a sinner.

Peace,

Padre Steve+

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Filed under healthcare, Military, PTSD, US Navy

To Iraq and Back: Living Wills, Immunizations Gone Bad and More Sleepless Nights

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This is another installment of my To Iraq and Back series which tells of my deployment to Iraq with RP1 Nelson Lebron in 2007 and 2008.

One of the sobering things as you get ready to go to war are administrative issues that deal directly with your mortality. They are mundane actions when we do them in peacetime but chilling when you put them in context of going to war.

In our society in which people do all they can to push back even thinking about death discussing the issues that deal with your possible dismemberment, disability or your death are taboo. The month before I deployed  Iraq Judy had me take out an additional life insurance policy that doubled what the military would provide in the event of my demise.  At that point Iraq was a cauldron, hundreds of casualties each month and I was going to the heart of the action in Al Anbar province.

Part of our processing to go to combat was a will and power of attorney update.  We had not updated our wills since well before coming to the Hampton Roads area so I took advantage of this time to get it done.  The will itself was pretty easy since we have no children and have not been married to anyone else.  That was the easy part.

The next part was dealing with various powers of attorney, a general power of attorney and a medical power of attorney. The medical power of attorney is something that I routinely deal with at the hospital. I have dealt with them before in other places.  At the same time they become somewhat disconcerting when you are getting to go into a combat zone where there is heavy fighting going on. For most that is disconcerting enough, but chaplains go into action unarmed.

Sometimes when I fill out one of these I pray that I don’t end up like Karen Anne Quinlan or Terri Shaivo.  When I did it this time all I could think about was me being so badly wounded that it would be like the movie The Naked Gun.  I someone telling Judy “Doctors say that Dundas has a 50/50 chance of living, though there’s only a 10 percent chance of that.” While this is going on I could just see me unable to respond trying to say “give me one more at bat skip, just one more chance…please.”  This may not seem like the most spiritual thing for a Priest to be saying but I don’t want to be in the afterlife before my time. It would be bad form.

Legal matters finished we had to get our immunizations. When you deploy the military always ensures that you are vaccinated against about everything imaginable. These include typhoid, anthrax, smallpox, malaria, yellow fever, certain regional diseases and probably others that I have forgotten.

I had received many of these before at various times. This included my first Anthrax vaccine. On this second occasion something happened and ti had a reaction to it.  My bicep felt like someone had shoved a baseball in it and the sucker hurt like hell. By the next morning I knew that my reaction was not “normal” because the first one I had did not do this.

I thought back to the Anthrax scare right after September 11th 2001 and I didn’t want to take any chances regarding something that the media said could be dangerous. What if they had messed up and given me a bad batch of the vaccine. Hell, just because I’m paranoid doesn’t mean that they are not out to get me. Besides if I was going to die for my country I didn’t want it to be from a reaction to a vaccine and not something heroic.

So I went back to the immunization section. Like a typical officer I simply “excused” my way past the queue of sailors waiting to get PPDs read and went to the desk. I figured that I wasn’t going to wait in line behind people with routine stuff when things looked like they were getting sporty for me.I call it “self-triage.”

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The Corpsman at the desk was polite and asked what he could do.  I told him that “I think I’m having a reaction to the Anthrax vaccine.”  He gave me a funny look and asked which one in the series this shot was. It was the second and since I figured that the next question would be “did you have a reaction the first time?” I continued “This didn’t happen the first time.”

The Corpsman looked at my arm and said “Obviously sir the first time you had no antibodies to Anthrax so it had nothing to react to….”  I was thinking “no shit Sherlock” when the young man went to get his Chief. The Chief came in, looked at my arm and said: “Gee sir it looks like you are having a reaction to the shot.”

I was thinking well no shit but didn’t say it. So the Chief took me back to his office and started having me checked to make sure that I didn’t have a fever or a number of other things, like if I was dizzy or was having trouble breathing. No I was neither dizzy nor experiencing breathing difficulties but was simply in pain, a bit scared and really pissed.

After his battery of questions and a couple of phone calls asked me “do you think that you are safe to drive?”

At that point I would have said anything to get the hell out of there and get on with what I needed to do to make sure that I wasn’t going to die.  So I said “of course I am.”

He asked if I was sure and I reaffirmed this to him in a convincing enough manner for him to send me over to Portsmouth by ambulance.

Portsmouth Naval Medical has a small office manned by a couple of nurses whose job it is to report bad vaccine reactions up to the FDA and God only knows who else. These ladies were very pleasant and when they got a look at my arm they were impressed.  Once again I heard “Yes sir you are having a reaction.”

I got to answer yet another battery of questions and they took a couple of pictures of the baseball sized knot on my left bicep.  One of them made a couple of phone calls and a few minutes later I was told that I would be okay. The explanation was that the subcutaneous injection had caused the vaccine to be encapsulated in my arm rather than doing what it needed to be doing. I was told to inform whoever gave me my next shot in the series to make sure that they got in the muscle. I was told to take some Motrin for the pain and swelling and do a lot of push-ups, pull-ups and massage the bicep to help the swelling dissipate faster. My fears eased and I left the hospital and reported back to the processing site where all of my fellow sailors had already left for the day.

I spent another tense and sleepless night with Judy, the emotional distance still there.  We talked about various things but nothing serious. I don’t think that either of us was able to vocalize well what we were feeling.

Even Molly seemed differed, I’m sure that she sensed that something was going on as I had continued to pack and re-pack my gear from EOD. Molly does not like it when either of us pack as it usually means that one or both of us is leaving.

The next morning I repeated my “Groundhog Day” trek back to Norfolk Naval Station fighting the idiots driving to work on the I-264, I-64 and I-564 battle zone where matching wits with the witless I safely picked my way through traffic while drinking my black coffee.

This was our next to last day of processing and we checked and re-checked paperwork, received our signed wills, living wills and powers of attorney. That morning I met with Father Pat Finn a mobilized reservist and Episcopal Priest from South Carolina and we had a nice chat where we were joined by Fr Steve Powers a retired Navy Chaplain and Rector of St. Brides Episcopal Church in Chesapeake.

Following that I was asked to assist with a sailor who was having some personal difficulties getting ready for the deployment.  These tasks completed I went back to muster with the others and sat down next to Nelson. Following this we went out where the Storekeepers and other supply staff had our gear.

We gathered outside where we lined up and given a sea bag in which to put our issue.  There were boxes of stuff everywhere and a couple of civilians and sailors stood by to ensure that we got what we were going to get.  Uniforms with all of our name tapes rank insignia and qualification pins sewn on were there as well as more socks, t-shirts and other assorted gear.

Our stash was a bit lighter than the others as we already had much of what was being issued. When this was done and we were released. I told Nelson to go home as his family was coming into town from New York.  Taking the newly issued gear home I again went about packing and repacking and took Judy out to dinner after which we spent our time alone together pondering the future.

Peace,

Padre Steve+

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Filed under iraq,afghanistan, Military, ministry, to iraq and back, Tour in Iraq

Transitions in the Military: New Assignments

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In the Navy, as well as most military branches in the United States the officer community regardless of their specialty have branch, corps or specialty managers. These men and women work with the services and the individual officers to fill assignments. In the Navy these men and women are called “Detailers” and the process of assignments called detailing.

This afternoon I received a call from my detailer. I am coming up on my “projected Rotation Date” or PRD in October and have been negotiating for orders. The process was disrupted by some other changes in the system and I have been waiting a bit longer than normal to find out what I would be doing next.

In my last two assignments I had no choice. In 2006 the assignment that I thought I had was changed and in 2008 I was requested by name for an assignment at Naval Medical Center Portsmouth and in 2010, a year before I expected to rotate and less than a week after I had been selected for promotion to the rank of Commander I was informed that I would be assigned as the Command Chaplain at the Naval Hospital Camp Lejeune North Carolina. I have now completed most of that tour and was awaiting word.

What I wanted to do was to teach and be the Chaplain at the Joint Forces Staff college in Norfolk. It has been an assignment that I have wanted for a number of years. It combines being an instructor in Ethics for students from the Army, Navy, Marines, Air Force, Coast Guard and foreign officers attending the courses at the college, as well as having chapel responsibilities. However I was told a couple of months ago that the assignment was going to another chaplain. I was disappointed because it was a billet that I thought that I was uniquely qualified.

I had spent 17 1/2 years in the Army, been a company commander as well as battalion, group and brigade staff officer before becoming a chaplain. Additionally my military and civilian education which include the Marine Corps Command and Staff College and a Masters Degree in military history and some rather unusual assignments including a joint tour in Iraq as chaplain to American advisors in Al Anbar province as a member of the Iraq Assistance Group, made me, at least in my opinion an ideal choice.

However as of a couple of months ago the billet was already filled. Thus I had no idea what assignment that I would get and since there were very few assignments available in my detailing “window.”

I was expecting a call in the next week or so, but I did not expect the detailer to tell me that I would get the Joint Forces Staff College job. I am happy to get it. It will mean that I will return to the Norfolk area in the September-October time frame. The position will allow me to teach in a very interesting setting as well as pastor the chapel congregation.   It will also allow me to continue my academic education and writing. It will also allow me to be at home after a three year tour away from my wife Judy. For that I am most grateful.

Since it is a non-deploying billet it probably will not help my chances too much to make Captain in a view years, but that is not my goal. My goal is to be at the place where I can do the most good, take advantage of my skills and experience and which will challenge me to continue to grow as a human being, priest, chaplain and Naval officer.

It is good news and I am happy that the detailers and senior leadership honored my request for the assignment. The timing allows me to finish well where I currently serve and contribute the the continuing mission of healing the minds, bodies and spirits of Marines and Sailors, including those wounded, ill or injured in war at Camp LeJeune.

It is a good day.

Peace

Padre Steve+

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Too Young: In Memory Commander Marsha Hanly, Nurse Corps US Navy

LCDR Marsha Hanly caring for a patient in the ICU of the USNS Comfort 

“Nursing is an art:  and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit?  It is one of the Fine Arts:  I had almost said, the finest of Fine Arts.”  Florence Nightingale

This afternoon I was stunned to learn that a very dear co-worker and friend from Naval Medical Center Portsmouth had unexpectedly passed away. Marsha Hanly was a ICU Nurse who arrived at Portsmouth about the same time I did in 2008. She had just completed a Master of Science in Nursing at Duke with a specialization in Adult Critical Care nursing.  Marsha exemplified all that is good in nursing and was as devoted to her calling as Florence Nightingale described.

I remember what seem like countless times where I stood beside Marsha as she cared for critically ill or dying patients, comforted their families and helped the other nurses and physicians in the ICU. I also cannot count the number of times that she stood by me as I prayed for patients as they lay in critical condition. She was an outstanding nurse and Naval Officer as well as one of the most kind and compassionate people that I have ever met. She was devoted to her husband and children and to the welfare of those committed to her care. She was funny and joyful person who was real. She was a committed Christian, wife, mother and fantastic nurse. She could laugh and she could cry, she really loved and cared for those that she served.

Last year Marsha deployed on the Hospital Ship USNS Comfort as part of Operation Continuing Promise, a medical mission to the Caribbean Sea, South and Central America. While deployed she was selected for Commander in the Nurse Corps. She returned late in the Summer and in November was diagnosed with Cancer. She underwent successful surgery which left her cancer free but in need of Chemotherapy to ensure that she remained so. She returned to work in late April and began her Chemo this week. Her last post on her Caring Bridge blog ( http://www.caringbridge.org/visit/mahanly )talked about how she described what she believed would be the course of her Chemotherapy, side effects and how long it would take. She was looking to the future and even to this weekend with her children. I don’t know the circumstances of her death but imagine that it was a sudden and catastrophic event related to the Chemo in some way.

When I read the news on Facebook, where I keep up with my friends from that ICU as well as so many others in my life I was stunned. As I read the comments of her fellow nurses and my former co-workers, nurses and physicians alike I felt like I had been kicked in the gut. I couldn’t believe it because I simply expected this otherwise healthy, young and vibrant woman to sail through Chemo and completely recover. I am so stunned that I cannot believe that his has happened.

This is one of those times where I ask God “why?” I have to admit that I cannot understand this and I have a hard time with the whole “God’s will” thing when things like this happen to people like Marsha. People that devote their lives to caring for others and raising their young children.  I grieve for her husband and kids, I remember her bringing them in to work sometimes.  I pray for her husband Scott and their two young

Likewise I grieve for those who knew and loved her in the Portsmouth ICU. For those that have not been closely connected with those that labor in critical care specialties like a busy ICU there are few places where people bond so closely. Critical Care Nurses and Physicians work in a surreal world where life is constantly hanging in the balance and as a result have a camaraderie that is much like combat soldiers, police and firefighters. This is not just a job, it is a calling, in a sense a sacred vocation. Marsha exemplified the best of her profession and what it is to be a friend.

Even though I left Portsmouth in October 2010 to come to Camp LeJeune I still count the staff there as my friends. We went through a lot together. Many of them were there for me when I was going through difficult times as their Chaplain. Marsha was one of those people. I cannot imagine her not being there when I go back at some point or not seeing her serving and caring for Sailors, Marines and their families somewhere else.

Last week we honored Nurses during National Nursing Week and the anniversary of the founding of the Navy Nurse Corps. Marsha was the best of both. The Nurse Corps has suffered a terrible loss.

Marsha touched so many lives. I know that my former co-workers and friends at Portsmouth are taking this hard. It doesn’t seem right and it doesn’t seem fair. I have a hard time theologizing deaths of people like Marsha. While I am sure that the Lord has her with him I don’t understand her loss here.  While I fail to understand I do still pray that God must have a purpose and I do give thanks for the honor and privilege of knowing Marsha and working with her. In times like this I find some comfort in the prayers of the liturgy and find this one from the Book of Common Prayer to be one that I can pray in good conscience even when I struggle.

“O God of grace and glory, we remember before you this day our sister Marsha. We thank you for giving her to us, her family and friends, to know and to love as a companion on our earthly pilgrimage. In your boundless compassion, console us who mourn. Give us faith to see in death the gate of eternal life, so that in quiet confidence we may continue our course on earth, until, by your call, we are reunited with those who have gone before; through Jesus Christ our Lord. Amen.”

Rest in Peace Marsha. Rest in peace.

Padre Steve+

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Suicide isn’t Painless: The Epidemic of Suicide in the Military

I leave the Naval Medical Center Portsmouth Virginia tomorrow and toward the end of October report as the Command Chaplain for Naval Hospital Camp LeJeune North Carolina. My last time at Camp LeJeune was as part of the Portsmouth SPRINT (Special Psychiatric Rapid Intervention Team) mission to care for Emergency Department personnel at the Naval Hospital and Base Fire/EMS responders to a particularly gruesome suicide of a young Marine who had recently served in Iraq and was preparing for another tour.

As a Chaplain and in my previous life as a Medical Service Corps officer commanding a Medical Company in Germany and Brigade Adjutant in Texas I have dealt with a lot of suicides, attempted suicides and the lives left shattered by suicide.  Likewise I have seen the results of suicide attempts as a trauma, emergency and critical care chaplain in major medical centers. I have attended the DOD Suicide Prevention Conference on a number of occasions and gotten to know many of the experts working in the field.

As I said I began my career as an officer in the Army Medical Service Corps. We had a close connection to the movie and television series M*A*S*H and the theme music to that movie is emblematic of the feelings of many combat vets who continue to deploy even after making many combat deployments. http://www.metacafe.com/watch/3444418/suicide_is_painless_johnny_mandel/

Through early morning fog I see
visions of the things to be
the pains that are withheld for me
I realize and I can see…
[chorus]:

That suicide is painless
It brings on many changes
and I can take or leave it if I please.

I try to find a way to make
all our little joys relate
without that ever-present hate
but now I know that it’s too late, and…
[Chorus]

The game of life is hard to play
I’m gonna lose it anyway
The losing card I’ll someday lay
so this is all I have to say.
[Chorus]

The only way to win is cheat
And lay it down before I’m beat
and to another give my seat
for that’s the only painless feat.
[Chorus]

The sword of time will pierce our skins
It doesn’t hurt when it begins
But as it works its way on in
The pain grows stronger…watch it grin, but…
[Chorus]

A brave man once requested me
to answer questions that are key
‘is it to be or not to be’
and I replied ‘oh why ask me?’

‘Cause suicide is painless
it brings on many changes
and I can take or leave it if I please.
…and you can do the same thing if you choose.

Last week four soldiers, one a highly decorated senior NCO and all combat veterans are believed to have committed suicide at Fort Hood Texas.  The base which has already seen more than its fair share of tragedy with 14 confirmed suicides this year is stunned that these occurred in one weekend.

Defense Secretary Robert Gates commented about the stress on the all-volunteer force: “No major war in our history has been fought with a smaller percentage of this country’s citizens in uniform full-time — roughly 2.4 million active and reserve service members out of a country of over 300 million, less than 1 percent,” as a result the wars have been fought by a small proportion of the country, for many they are “a distant and unpleasant series of news items that does not affect them personally.” While the distance grows between those that serve and the general population military families are under even more stress, with anxiety and disruption inflicted on children, increased domestic strife and a growing number of suicides. Divorce rates in the Army have doubled since the wars in Afghanistan and Iraq began.

In the years prior to about 2004-2005 the military suicide rate was almost always below civilian rates in all demographics.  This is something that we took legitimate pride in.  That began to change as the war in Iraq shifted from a “Shock and Awe” campaign to a rather nasty and intractable insurgency this began to change as the deployment tempo increased and the Army increased its “boots on ground” time from a year to 15 months with a one year dwell time between deployments. Even as Iraq calmed down and the US role shifted many troops remain and Afghanistan has become a much more difficult war than it was even a few years ago. The Marines retained a 6-7 month deployment schedule but as the war went on and personnel requirements increased many Marine units were doing 6 months in country and 6 months home.  The difficult of what was described as “dwell time” for the Army and Marines was that for all intents and purposes it wasn’t. The units would get a few weeks leave and stand down time on their return home and then begin preparing for their next deployment. These preparations out of necessity entailed much time in the field training including trips to the Fort Irwin National Training Center (NTC) or the Marine Corps Air Ground Combat Training Center at 29 Palms.  Speaking from experience before 9-11 I can say that a Marine battalion going to 29 Palms in reality makes a short but intense deployment which is taxing on the organization even as it sharpens combat skills.  The same can be said for Army units going to NTC.  Thus the time that is nominally considered time at home to recuperate is not that and instead serves to keep the pressure on already stressed units, leaders and soldiers/Marines.  In the intervening time those that present to mental health providers or chaplains are provided with care to get them back in shape for the next deployment but never really get to deal with the deeper psychological and spiritual wounds. These include “moral injury”  which often involves unresolved grief for the loss of comrades and real or imagined guilt for their own actions in war.  Such wounds ultimately create despair, loss of faith and eventually cause some service members to make attempts on their life with varying degrees of “success” in “completing” the suicide.

The result is that those who have experienced the moral injuries that come as a result of combat, seeing comrades killed and wounded, participating in actions where they are directly or indirectly involved in killing the enemy, see the “collateral damage” of civilians, including children killed and maimed go right back into to fight.  Since this war has now gone on longer than any war in US history and we are fighting it with an all volunteer force of limited numbers with many making multiple deployments, some as many as 5 or more these wounds are pushed aside.  The effect of this is a cumulative grinding down of those that serve in harm’s way. Many suffer from some form of psychological, neurological or even spiritual injury that in combination with other life stressors make them particularly vulnerable to taking their lives.  In regard to moral injury “Many of the troops kill themselves because they feel that those kinds of experiences have made them unforgivable,” said Dr. William Nash, a top PTSD researcher. “It’s a lot harder for most people to forgive themselves than to forgive others.”

Unfortunately there is a stigma attached to seeking treatment or admitting that one is suffering from depression, anxiety or any other condition associated with either seeking help on their own or being “command referred” for psychological/psychiatric help.  Since that stigma is real many war fighters don’t seek help and take “refuge” in destructive behaviors such as alcohol abuse, drug abuse (to include prescription drugs) and risky behaviors.  One wonders how many of the single vehicle accident fatalities that occur late at night to combat vets are not accidental at all but are suicides by another more “socially acceptable” means.  If a forensic psychological profile was done on every service member that dies in such events I would guess that the finding would be a lot more suicides not an accidental deaths as we would like to believe. Yes all of these deaths are tragic but it is far easier to rationalize death in an auto accident than death by gunshot, knife wounds, overdose or hanging.

I am not proposing any solutions for this problem.  I do believe that somehow the deployment tempo needs to be slowed down to allow troops to actually recover and get help.  This is one of the suggestions of the DOD Suicide Prevention Task Force.  Their report is linked here: http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20report%2008-21-10_V4_RLN.pdf

When I go to LeJeune I know that as a Chaplain at the Naval Hospital I will be collaborating with our mental health professionals to provide care to Marines, Sailors and their families that are living this daily.  The Marine situation is poignantly show in this article: http://www.nctimes.com/news/local/military/article_3dc03ec3-6a37-5608-8563-aca88f635271.html

I have served with the Marines almost 6 years and from what I see the Corps has changed.  It is battle hardened but less resilient than it used to be.  The Marine Corps’ suicide rate has reached 24 per 100,000, a rate that surpasses all the other services. The rate was 13 per 100,000 in 2006 when I finished my tour at Marine Security Forces. The latest available figures put the civilian suicide rate at 20 per 100,000.  The problem extends past active duty as Veterans Affairs Secretary Eric Shinseki, the former Army chief of staff, said the suicide rate for men aged 18-29 who have been discharged had gone up by 26% from 2005-07. Likewise, “of the more than 30,000 suicides in this country each year, fully 20% of them are acts by veterans.” This means as Shinseki said “on average 18 veterans commit suicide each day. Five of those veterans are under our care at VA. So losing five veterans who are in treatment every month, and then not having a shot at the other 13 who for some reason haven’t come under our care, means that we have a lot of work to do.”

There is also an effect on military health care providers of all kinds and chaplains. These individuals not only have to deal with their trauma but the trauma and hopelessness that they see in many of their patients or parishioners. These caregivers have no respite between deployments because their reason for being is to care for the Soldiers, Marines, Airmen and Sailors that present to them be they deployed or back in a military hospital or clinic.

The work will be hard and long after the last Marine, Sailor, Soldier or Airman leaves Iraq and Afghanistan we will be dealing with this for years to come.

Peace

Padre Steve+

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Filed under healthcare, iraq,afghanistan, Military, Pastoral Care, PTSD

Passages: Thoughts on My Last Week at Naval Medical Center Portsmouth

“Andre Dawson has a bruised knee and is listed as day-to-day. Aren’t we all?” Vin Scully

“It’s a mere moment in a man’s life between an All-Star Game and an Old-timers’ Game.” Vin Scully

“The oldest pitcher acquires confidence in his ball club – he doesn’t try to do it all himself.” Burleigh Grimes

Every day is a new opportunity. You can build on yesterday’s success or put its failures behind and start over again. That’s the way life is, with a new game every day, and that’s the way baseball is.”  -Bob Feller

As any of my regular readers know I relate most of life to baseball. For me it resonates more than more than almost any other part of my life.  I think by now with over 29 years in the military that I count as a seasoned veteran who has been dinged up some and had to try to recover from injuries to his body but also to his self confidence and ability to stay in the game. My assignment at Naval Medical Center Portsmouth has been one of those assignments that was a lot like a rehab assignment to get me back in form for an assignment on a new team where I will be the number one starter in the rotation instead of a rehabbing pitcher making spot starts and relief appearances.

Today I finish up most of my administrative out processing from NMCP as I prepare to transfer to Naval Hospital Camp LeJeune. I have been at the command two years and it has been an eventful tour.  During the assignment I was forced to deal with the effects of my tour in Iraq, notably my PTSD and its related physical, psychological and spiritual impacts which included a loss of faith and absence of God that left me for a year and a half a practical agnostic. I also had to deal with the end stages of my father’s struggle with Alzheimer’s disease which culminated in his death in June of this year.  While this was going on I also dealt with a nasty Kidney stone that sidelined me from almost all human activity for over a month, a tooth that had abscessed and had to be replaced by an implant after a root canal failed and various nagging injuries to my shoulders, elbows, a knee and ankle from Iraq.  Most recently I have had to struggle with my hearing, I have something called Auditory Processing Disorder as well as some really annoying Tinnitus, I can hear lots of noise but somehow my brain is not processing it correctly. With all of this in the background and sometimes the foreground I worked and often struggled through the assignment which despite my skills as a critical care chaplain was more difficult than I could imagine.

I compare my time at Portsmouth to a baseball pitcher that goes to a new team but has injuries that he thought were manageable but which were severe enough to take him out of the game and into a rehab mode.  Of course not all teams give older pitchers that chance and that is true more often than not in the military when injuries to an officer are severe enough, especially emotional ones to keep him from functioning at top form.  I was fortunate as Chaplain Tate gave me the chance to heal and looked at my potential rather than my weaknesses when writing up my evaluation reports.  I can say that that is not the norm in much of the military where I probably would have been given reports that would have kept me from being promoted and resulted in me being placed in second tier jobs until I was able to retire.

I was fortunate however because during the assignment I was given time to recuperate and begin to heal.  That has not been easy by far but I am doing well enough now to handle things that would have sent me down the toilet of tears a few months ago. I give a lot of credit to Chaplain Jesse Tate and my therapist Dr. Elmer Maggard, better known as “Elmer the Shrink.”  I couple of retired Navy Chaplains on our staff also were men that helped me through the very rough times; Monsignor Fred Elkin and Reverend Jerry Shields gave me much spiritual support and provided me the opportunity to vent as I needed to during really difficult times.   As I got better and able to handle more responsibility Chaplain Tate started putting more responsibility on me, especially after I was selected for promotion to Commander.  It was like I was done with the rehab work and being put back into the game.  He held me accountable and was like a pitching coach or manager working with me, pushing my limits and making corrections even while encouraging me.  He did this with the purpose of getting me ready for my next assignment where I will be in charge of a staff of 6 personnel.  The past couple of months were high pressure due to all the activities the department was engaged in. These including a retirement, two major conferences and the transition of our Pastoral Care Resident Chaplains as one group finished their residency and a new group went through orientation.  In that time I had to deal with a lot more pressure than I had been exposed to most of my tour. After the last conference ended I realized that I could now function at a high level again and not just in my clinical areas.  I am now sure that I can do well in my new assignment and I am looking forward to the opportunity.

As I leave NMCP I will be leaving a lot of friends in my department as well as the rest of the hospital, especially the staff of our adult, pediatric and neonatal ICUs.  Some of these staff members will continue to serve at NMCP, others are now either deployed in harm’s way, have transferred to other commands or have left the service or retired.  I have to thank them as well because each in their own way has been a part of my recovery.

Most people do not get this kind of opportunity to serve and to heal at my age, rank or time in service. Most are put out to pasture until they can retire.  To quote baseball immortal Lou Gehrig “today, I consider myself the luckiest man on the face of the earth.” As I re-read his farewell speech a lot of it resonated with me even though I’m not to my knowledge dying and he was.  I’m blessed and somewhat lucky and I am grateful for all that I have experienced at NMCP.  I will leave many friends and if I am lucky enough hope to continue my career as a chaplain in Navy Medicine and return to Portsmouth, perhaps to finish my Navy career.  When I depart on Thursday it will be with a grateful heart and I will miss those that I worked with at NMCP. I am fortunate in one respect that my next assignment is a Naval Hospital and that I will know a good number of the staff at it from my time at NMCP or other duty stations.

Peace,

Padre Steve+

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Filed under Baseball, Military, Pastoral Care, philosophy, PTSD, remembering friends, US Navy

Rehab Assignments

There are times in life that many of us experience some kind of injury; physical, emotional or spiritual that puts us in the position that we cannot function at the level that we are accustomed to doing. For some people this might be the result of some kind of traumatic event, perhaps a serious illness or physical injury or even something that causes us to lose faith in God or in whatever higher power that we ascribe meaning in our life.

As any regular reader of this site will recognize I interpret or frame much of my life experience through baseball and baseball analogies. In my case I frequently frame that through pitchers or older ball players that have encountered injury or rough spots in their careers.  I think about pitchers a lot because the craft of pitching involves such a degree of connection between the physical and mental dimensions of the game.  There are many times when a pitcher suffers a physical injury that requires changes in his delivery or the kinds of pitches that he throws.  When this happens it also affects his mind as he may lose confidence or over think what he is doing as he tries to make adjustments, also while experiencing residual physical pain.  Some pitchers are able to make the adjustment, for others the adjustment is more difficult and they are not as effective as they were previously. Still others either cannot recover from the physical injury or never make the adjustments and end up out of the game.

Those that experience injury as they recover are sent back to the minor leagues, or if they are in the high minor leagues to a lower level league in order to get back to the level that they were before the injury.  Even when they get back to the majors or to triple-A the pitching coach and manager may still go easy on them in order to ensure they are 100% and do not re-injure themselves.  This is called a rehab assignment and it is part of the game.

In the military we seldom get that chance unless the injuries are so significant that we need to put on some kind of limited duty and a placed in a non-deployable status until they are considered fully fit for duty. I returned from Iraq in February 2008 with several nagging chronic physical injuries to my ankles, knees and shoulders and an elbow which coalesced to sideline me from much physical activity. Even worse I was dealing with PTSD which was not recognized or diagnosed until late June of 2008 when I was falling apart having flashbacks, night terrors, chronic anxiety, insomnia and moods that alternated from anger to despondency.  When I left EOD Group Two I for my assignment to Portsmouth Naval Medical Center I was still in denial of sorts, though I knew that I was in ragged shape I went into the assignment trying to act as if and perform as if I was uninjured.  I threw myself into the job pouring working on the average 65-75 hours a week for almost a year mostly on the ICU and PICU before my boss finally stopped me and put me on more administrative duties with minimal clinical duties and plenty of time to get back in physical, emotional and spiritual shape.  Not many senior officers would give a subordinate that kind of grace nor would they rate an officer under them with an eye on their potential versus what they were doing for them at the moment.  Mine did, I will be forever grateful to Chaplain Jessie Tate for giving me that grace.

Eventually his patience as well as my hard work and a lot of God’s grace were rewarded. Things started to turn around in December of 2009 in what I call my “Christmas miracle.”   Slowly my physical injuries healed and I can now say that I am in as good or better shape than when I went to Iraq. I had to make some adjustments to my physical training regimen as well as confidence to believe that I was not going to re-injure myself.  My mindset in my physical training went from timid to confident as I gained in strength, speed, dexterity and endurance.  This was coupled with the loss of 16 pounds and a body fat percentage that went from 32% (when I ballooned from 167 to 194 pounds between April and November of 2009) down to 22% as of last week.  Spiritually I began to believe again. Most of the time after Iraq I struggled with faith sometimes even doubting the existence of God or at best feeling alienated and rejected by him and many of his people.  My spirituality has changed as has the way I approach my faith being much less doctrinaire to relational focusing on the grace, love and mercy of God and to trying to show that to others as St Francis said “preach the Gospel at all times, use words when necessary.”  Psychologically I was able to come to grips with my PTSD and make the adjustments that I needed so that I might be able to function.  I am much more in touch with feelings and what is going on in me than I was before and my observation of other people has improved, I guess once a person has had everything fall apart that they become more sensitive even to the unspoken things when they are around others.

In a sense this assignment became a rehab assignment for me. I was able to come back and become not only functional but able to be in the game again.  When I was selected for promotion my boss had no hesitancy in nominating me for the supervisory Chaplain at Naval Hospital Camp LeJuene. I can see the future again and it is good.  My plan was for Portsmouth to be an “All-Star” game for me where my clinical and academic skills would enable me to be a water walker but it was different, it was a fight to remain in the game a fight to regain confidence, overcome injury and return to relatively normal life.  My rehab assignment is over and I am back in the game performing at a level that I expect.

For those that are in similar circumstances I hope that you have a boss with the grace to help you through the difficult times and not abandon you as “broken” or of little use to the organization. I know that happens in the military and outside of the military, even in churches.

Peace and blessings,

Padre Steve+

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Filed under Baseball, christian life, faith, Pastoral Care, philosophy, PTSD, Tour in Iraq