I would like to share with you a summary of two recent incidents I experienced with the Veteran’s Administration Health Care Center to which I am assigned. One illustrates the disdain with which Veteran’s complaints are often met by the so-called professionals employed by the VA, and the other would be a potential malpractice suit were it to occur in the private sector. Both are personal examples of the lack of respect and inept treatment I routinely encounter within the VA system.
This is long. Feel free to skip to the section entitled “what the actual fuck” near the end if you can’t hang.
Incident number one:
It’s hard to make this first one brief, so it may seem like there’s more to the story, because there is. I am merely giving you the highlights. Two months ago, I made an appointment with my primary care physician because I was experiencing unmanageable anxiety as a first-year law student. I say unmanageable because my classmates had seemed to find a groove at that point, however tenuous, and I was still overwhelmed, not sleeping and not remembering, which was the real bottom line. One must remember lots of stuff in law school. She and the medical student who happened to be starting her internship with her that day both related to my situation. Law school and medical school have a lot in common, the rigors of which are unparalleled in other graduate programs. We thought maybe I had a latent learning difference that could be accommodated or worked around. We all agreed that saving my academic record was a smart move for now, while we sorted this out. I gave them my medical withdrawal paperwork for law school, which was signed and returned to me.
They prescribed some medication for anxiety and sent me to see a physician’s assistant (PA) who would schedule neuropsychological testing and do a preliminary screening regarding my memory and mental status. The PA did just that, and then handed me an article on advances in Alzheimer’s treatment and said, “read this.” She spoke to the specialist who asked that a CT scan and some blood work be run before he saw me. She made me a follow up appointment with herself for two weeks later to check on my tolerance of the medication. That same day, I had the CT scan. Two days later, my primary care physician called to say that my scan showed premature cerebral atrophy. I was stunned. It looked like the PA’s implications were correct.
Two weeks later, with the CT Scan results in hand, the PA gave me that same article to take with me, saying that I should consider contacting the author to learn more about available therapies and maybe I could find a clinical trial in which to participate. She recommended that I contact a lawyer, both to “get my affairs in order” and to find out if there was any advantage, anything prudent to do, before receiving “the official diagnosis” from the neurologist in a few weeks hence. In an attempt to make me feel better, she backtracked by saying, “we don’t know anything yet.” But she had just told me to consult an attorney and get my affairs in order. She sees this stuff all the time. She must know. I appreciated her trying to ease the blow, though. Wild-eyed and half out of my mind, I did stop by an attorney’s office on my way home. The fact that they never called me back is likely testimony to just how crazy my inquiry had been. I proceeded to spend the next weeks listing the pros and cons of remaining here or moving back to my hometown, where at least I would have some family who knew me. Here, I was alone. My research suggested that the oldest memories are the last to be lost to many dementia patients, so I thought I might be able to live independently longer back home than I would here. I looked for places to live back home, and even got my rental application approved by one landlord. I reserved a Penske truck. I asked a friend to help me move. I resolved to wait for the official diagnosis.
Fast forward: I spent more than six weeks making plans for how I would spend the remainder of my days and years. It was tortuous. I was not in school, knew virtually no one in town, and had nothing but time to think about the impending doom. Then, like a switch being flipped, the Neurologist said I absolutely did not have dementia, based on his thirty years of experience, but I might have a partial seizure disorder. Not dying of brain rot, but might wreck my car and die on any given day. What types of school or employment might be appropriate for me if I have tis seizure condition? Possibly none, he said, depending upon the extent of the problem. I agreed to try the anti-seizure medication because I was terrified and desperate to find answers.
I proceeded downstairs to the walk-in social work office, where I had been walking in for two weeks because I thought facing a terminal illness warranted some support, and no one had thought to refer me to mental health to address my anxiety, the problem with which I had originally come to them. Now in our third visit, the social worker told me that she only had 20 minutes for me, that sooner or later I would need to decide if I was moving back home or staying here (as if it had been three months instead of three weeks), and when I made my decision, she could refer me to mental health, if appropriate. I had just moments before been told I wasn’t dying after six weeks of believing I was, and that I might have a very serious brain condition that could irrevocably change my life, and all this woman could offer me was invalid criticism for being indecisive. Oh, and she also said I “should avoid catastrophizing.” The staff tells me that I am dying and to get my affairs in order, and I am the one who is catastrophizing? Unbelievable. I had nothing to say. I left there feeling beat down and stunned.
Incident number two:
I was suffering with horrible itching that intensified over two days. I sought relief at the VA clinic since I heard that they take walk-ins (many don’t). I was left waiting, while actively itching like someone covered in fire ants, for over two hours in the waiting room. This was not completely unexpected, though it became clear that there is no triage at this clinic. When I eventually spoke with her, the screening nurse asked accusingly if I had “even tried to make an appointment” with my primary care doctor. She took my vital signs and read them to me from the monitor I could clearly see, declaring, “these are all within normal range.” She also looked at a small section of my skin where I lifted my shirt and said “all I see is marks from you scratching.” Clearly, she was expecting something else. I had many thoughts at this point that I did not vocalize, such as, “well, yeah, that’s what I said, I’m practically ripping my skin off from itching here! Do I need to have a rash to itch? I didn’t expect that I had a fever, so what are you implying?” Nope. I didn’t say any of that. I just sat there like an errant child receiving a scolding, except I was still scratching incessantly. Then she told me to go back to the waiting room and she would “talk to the doctor when she had time.” Yep, that’s what she said. I wish I had a bucket with which to catch her dripping sarcasm. I literally could not stop scratching. That was clear to everyone, and I felt bad for making my fellow Veterans uncomfortable with my crazy, non-stop scratching. I felt like I was a freak show and I was in agony. The nurse was hostile and insulting and that was completely unnecessary and unprofessional.
Fortunately, my primary care physician and her nurse, when I eventually saw them, were as helpful as ever and gave me two injections to stop the itching and provide relief. My primary care physician thought I was reacting to the new medication that the neurologist had prescribed, as I had also suspected. Though they were a short walk apart in the same building, they apparently played phone and message tag and were unable to connect. After an additional hour of waiting for them to consult, now relieved of my intense itching, I walked up to the other clinic to see if I could speak with the specialist directly, the issue being whether to continue that medication. He came out to see me in the waiting room, sitting down next to me. Like the first nurse earlier, he asked “where is this rash?” Taken aback by the implication that he expected me to partially disrobe in the waiting area, I tried to gather my thoughts through my antihistamine fog. When I explained that it was intense itching and the only rash I had was the one from scratching, he said quickly it was not the medication he prescribed and I should keep taking it. If I wanted, I could stop for a week and then restart. I expressed my concern for this incident repeating itself. He stood, said he would be interested to know what I decide, and walked off. Clearly, my allergic reaction had insulted and inconvenienced him as it had the nurse earlier.
What the actual fuck?
I can’t help but ponder the fact that I was perceived as an inconvenience by the staff. They attempted to punish me for troubling them by leaving me wait longer, by shaming me, and by their implications that I was making up my itching just to bother them. I am really blown away by this. Yes, this attitude was part of the military culture in some settings, particularly at clinics that served combat arms and basic training units. Fear of this type of shame and humiliation is what kept many servicemembers from even reporting their illnesses and injuries. They just sucked it up. That’s why so many of us have chronic health issues and need care now that we are older. But how did this attitude, which was a minority view even in military medicine, follow us into the private sector? How do these doctors and nurses, most of whom have never spent a day in a uniform, learn to treat veterans with such disdain? Are they taught to treat us like this during orientation? In case you weren’t informed, we are now private citizens who faithfully served our country. You have a job because we exist, because we served. What have we done to earn your scorn?
I know I’m pissing in the wind here, but since I’m having out with it, let me complete my thoughts on this systemic mistreatment of Veterans by the VA.
To healthcare professionals, I offer this reminder:
This is the job. Being kind to sick people – regardless of whether you think their sickness is legitimate or not – is your job. Helping them find solutions is your job. Helping to relieve suffering is your job. If you think a patient is delusional and you feel put out by their presenting complaint, it’s your professional duty to keep that to yourself and treat them with respect. At the VA, you have the option of sending a patient to the walk-in mental health clinic if you think they are indeed delusional. What if the Veteran did have a mental illness and you treated them the way you treated me? What if, unbeknownst to you, the patient was depressed and anxiety-stricken and suicidal and you scoffed at them and shamed them and humiliated them for their symptoms because you didn’t think they were “real”? Would it be fine with you if your actions caused them to go home and kill themselves? Would you ever even know? Do you think about anyone except yourself?
Let me give you some advice. I left the military because I saw that my outlook was incompatible with me continuing to serve. I could no longer be effective. I left my career as a retailer after a dozen years for similar reasons, I had become jaded and could no longer serve my customers well. If you are a doctor or nurse or technician in the health sciences and have a bad attitude, please get the fuck out. Do not come to work with your bad attitude and your hate for life and vomit it all over me. I have my own problems.
Oh, and most definitely do not tell me I have Alzheimer’s before the evaluation is complete and then act as if I am being unreasonable because you tortured me with that incorrect diagnosis and I began to “get my affairs in order” as you suggested. And don’t even get me started about how you have still failed to address my original problem, the anxiety, which has been exacerbated twenty-fold by your actions. You won this round, you assholes. You shook me to my core and stole my confidence. But I will rebound.
The Veterans Administration so clearly despises Veterans. It is ingrained in their corporate culture and their staff reflects it. I would love some free healthcare right about now, something that didn’t cost me my dignity and peace of mind. I think all Americans deserve it, don’t you?