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Monday, May 26, 2014

Memorial Day

I've never thanked a veteran for his or her service.

By this I mean I've never said "Thank you for your service" to someone I know has served in the Army, Marine Corps, Navy, Air Force, or Coast Guard. Even though this is one of the first things you are instructed to adopt once employed at the VA - thank you for your service - I've still never found myself saying those exact words. And it's not that I don't recognize the particular sacrifice, especially of those who have been deployed and served on the front lines. It's not that I'm not grateful for their service. I'm particularly grateful to those men and women who helped found our independence and freedom. But I don't know that I am necessarily any more grateful for the service of our country's armed forces veterans than I am of this country's firefighters, teachers, community organizers, or mental health providers. And I don't go around generally thanking these professionals either. But maybe I should. Maybe we all should. Maybe we all should be telling more people "thank you" on a regular basis, demonstrating our awareness and appreciation for those individuals and groups who are contributing members of society. I'm sure there's a "paramedic recognition day" on the calendar somewhere, but it's certainly not a federal holiday.

And while I don't "thank" the veterans on my caseload for their service, I absolutely treat them with the utmost respect they deserve. Just as I would anyone. But particularly given the history of treatment of veterans in this country. Most of the people I work with, they have indeed "served" and made considerable sacrifices, likely ones that they couldn't or didn't necessarily anticipate. They probably imagined that they would be vulnerable to explosive devices, shoot guns, or even kill bad guys. But I bet they didn't realize that they would think of the injured Iraqi kid who had his face blown off every time they try to look at their own son. Or that they would no longer sleep in the same bed as their wives, because, well, because they have such tremendous difficulty falling asleep and staying asleep, and if they do get any shut eye, they toss and turn so badly or snore so loudly they are made to sleep on the couch (did you know OIF/OEF veterans have an inordinately high rate of sleep apnea compared to their civilian peers?). I bet they didn't realize not only how many friends they might lose in battle, but how deeply this would affect them. How alone they would feel though amongst their family and friends, who just don't understand, knowing that some of their comrades are back overseas on night watch, or at home drunk and contemplating suicide, or had died while serving leaving behind a heartbroken family. Or what anxiety they would feel trying to re-acclimate to civilian life, to re-enter a world they once existed in but no longer feel they belong. Or that they would lose their leg during battle, considering themself "unlovable" and "broken," but still wish they could return to service on the frontlines because civilian life is "boring." Or the apathy - they couldn't imagine how little they might car about anything, their spouse, their children, their futures.

Memorial Day is not about thanking a veteran so much as remembering those who have lost their lives while serving. And it's a particularly interesting "political" holiday this year, amidst the headlines of the "growing VA scandal." I know my two cents ain't worth much, but I am proud to say that the veterans who are referrred to and followed by our polytrauma team at the Portland VA hospital get some of the best care I could imagine. Sure, they've often had to jump through more hoops than a circus dog, wait in lines longer than those for the Frozen ride at Disneyland, and fill out more paperwork than even a prospective VA employee. But once they're in, they are getting excellent treatment. They are asked questions and being truly listened to. They have respect. Professionals are collaborating to coordinate and optimize their care, from sleep studies to GI appointments to regular mental health care to applications for service dogs. Unfortunately, this does little to make up for the VA's past grievances, the trauma so many have sustained in the Middle East, or the current talk of veterans dying while waiting for appropriate healthcare. 

So maybe this Memorial Day, I won't only spend a few minutes honoring the service men and women who lost their lives while serving, but also thinking of my patients, many who lost themselves while serving - a death of a different kind, thanks in part to advances in science and medicine, but not in peacekeeping. And also about the system as a whole, and of those service men and women who are still living - still living and standing in line, waiting, waiting for the care that I sure hope they get before it's too late.

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