Supporting The Troops
Posted on | February 18, 2007
In today’s Washington Post, we get a peek behind the curtain at the Army’s Walter Reed Medical Center, new home to many convalescing troops:
Behind the door of Army Spec. Jeremy Duncan’s room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses.
This is the world of Building 18, not the kind of place where Duncan expected to recover when he was evacuated to Walter Reed Army Medical Center from Iraq last February with a broken neck and a shredded left ear, nearly dead from blood loss. But the old lodge, just outside the gates of the hospital and five miles up the road from the White House, has housed hundreds of maimed soldiers recuperating from injuries suffered in the wars in Iraq and Afghanistan.
The common perception of Walter Reed is of a surgical hospital that shines as the crown jewel of military medicine. But 5 1/2 years of sustained combat have transformed the venerable 113-acre institution into something else entirely — a holding ground for physically and psychologically damaged outpatients. Almost 700 of them — the majority soldiers, with some Marines — have been released from hospital beds but still need treatment or are awaiting bureaucratic decisions before being discharged or returned to active duty.
They suffer from brain injuries, severed arms and legs, organ and back damage, and various degrees of post-traumatic stress. Their legions have grown so exponentially — they outnumber hospital patients at Walter Reed 17 to 1 — that they take up every available bed on post and spill into dozens of nearby hotels and apartments leased by the Army. The average stay is 10 months, but some have been stuck there for as long as two years.
Not all of the quarters are as bleak as Duncan’s, but the despair of Building 18 symbolizes a larger problem in Walter Reed’s treatment of the wounded, according to dozens of soldiers, family members, veterans aid groups, and current and former Walter Reed staff members interviewed by two Washington Post reporters, who spent more than four months visiting the outpatient world without the knowledge or permission of Walter Reed officials.
This is the other side of George Bush’s filthy little war cult, where the broken are discarded in secret. These are the people he wants you to forget.
Comments
4 Responses to “Supporting The Troops”
February 18th, 2007 @ 8:55 pm
Speaking as a former case manager and a traumatic brain injury survivor, I have to wonder if conditions are so bad in Building 18, why was a pool table and air hockey table were purchased, as opposed to repairs being done? (If that is all that the funding was used for, whoever held it up was RIGHT to do so, as those two items are NOT necessities.)
Also, as one who has completed traumatic brain injury rehab, successful rehab is HARD WORK. In some cases it can be lifelong. And, if a person has a problem with keeping appointments, it is up to the person to contact the case manager, not the other way around. (If that is not possible, that could possibly indicate an even bigger problem.)
Third, although it may not have been the intent, this Wapo piece comes across (to me anyway) as a cheap shot at case managers who do the best they can under the increasing limits that are placed on them.
Fourth, this is not to say that I do not sympathize with anyone who has a brain injury or other disability, believe me, I do. But, I will repeat, successful rehab is HARD WORK. And, no one can do the work but the person w/the brain injury or other disability, if he or she WANTS to. (I realize that last sentence is difficult to understand, unless a person has been thru rehab.) I realize that this comment may sound cold, but it is, in fact, reality.
February 19th, 2007 @ 7:40 am
Terri, I saw no cheap shots directed at case managers; their first mention includes the adjective “overworked.” The story indicts, too, the practice of putting patients in charge of other patients based on military seniority. That’s nothing new—this is standard Army procedure everywhere beyond the reach of a regular chain of command—but it seems uniquely unsuited to complex medical treatment.
As to patients’ responsibility for owning their own treatment, I would say only that military hospitals are a special case. These patients were wounded directly or indirectly as the result of lawful orders, and until discharge, they remain under orders. The responsibility is ultimately the commanders’ and the Commander-In-Chief’s, as these are not private citizens. Even after discharge, the VA’s mission remains “to care for him who has borne the battle…” and not just to offer treatment for those who manage to find their way successfully through the maze of red tape.
The portrait here is of profound dereliction by those in charge of funding and management. I don’t think that the story is treating case managers unfairly by pointing out how little support for their mission there is. As a former NCO and platoon sergeant, I also have a lot of sympathy for those platoon sergeant-patients, who are forced to manage not only their own recoveries, but those of the strangers next to them.
Walter Reed used to be the jewel in the crown of military medical treatment. An ill-conceived war mismanaged at every level, though, has turned it into a dumping ground for the wounded and the broken, and a nightmare for their families.
February 19th, 2007 @ 5:37 pm
John,
First, I would like to apologize for any ambiguity or misunderstanding as it is impossible for a person to “own” his/her medical treatment. “Owning” one’s medical treatment is not possible, as the average person lacks the knowledge and skill to do so. Again, it was not my implication that it was.
Second, as we agree that case managers are overworked, (and I speak as one who has been a client and a case manager) case management is a VERY tough job. The fact of the matter is that caseloads are so large, it is impossible for a case manager to check on EVERY client/patient on a daily basis to determine if ALL medical advice/treatment is being followed/performed. That is what I meant when I referred to the person (or a family member) contacting the case manager if there is any difficulty.
It is not my intent to justify the practices described, but, regular, two-way communication is VITAL for any rehab to be successful. And, as I said earlier, if that is not possible, that could possibly indicate an even bigger problem.
Third, I have never been in the service, so I will take your word re: the experiences/attitudes (and about Walter Reed). I do agree that placing others who were critically injured (and in need of assistance themselves) in charge of others in the identical situation seems odd. Being put in charge of for others, even on a limited basis, is something that a person doing the WORK of recovering does not need. (Making it through the red tape is yet another nightmare.)
I agree that this war has been mismanaged, and further feel that it should have never taken place. But, the fact of the matter is that it did and those who have a disability as a result NEED to recover, just as those who are civilians NEED to, again if they WANT to. That is one thing that I feel has not been adequately addressed, motivating a person to WANT to recover.
As previously stated, I have been in traumatic brain injury rehabilitation and was a case manager. I have seen both tragedies and miracles. Were some tragedies preventable? I don’t know, I’m not a doctor. Are there preventable tragedies described in this piece? Sounds like it, but I have not read the casenotes. (I am thinking like a case manager as I write the last sentence.)
Final Observations: One thing that is often overlooked by many is that every disability, be it military OR civilian is a tragedy AND a nightmare for all involved. There is no easy way to put this, but families can be (and often are) destroyed.
February 19th, 2007 @ 8:07 pm
No apologies needed, Terri. I believe that you know far more about health care than I do.
“Owning” one’s treatment is often a necessity, though—to the extent that that is possible. The experiences of someone close to me, who juggled GPs and specialists for decades as she managed a few little-understood conditions, have convinced me that one must keep careful track of what each physician and nurse contributes to the process. I pity my brothers and sisters in arms who have to sink or swim (or get educated, quickly) while coping with devastating injuries.
In these days of HMOs and PPOs, insurance and other pressures conspire to distract the professionals from their duty to treat the sick, and sometimes the one person who is paying sufficient attention is the patient. I have good insurance, for now, and feel lucky not to have to depend on the crumbs doled out by an overstressed VA system.