Pleasantly Surprised By Madigan Army Medical Center

One of the downsides to being recalled to active duty is having to switch to Army medical providers, instead of the civilian doctors I've used with great satisfaction. It was with no little trepidation that I decided to "bite the bullet" and get integrated into the system at Madigan Army Medical Center, known to the locals as MAMC...or "MamCee", as Doctor Al Jolson would have surely called it.

While I knew my medical records were filed somewhere in the main building after I reported for duty last fall, I had not in-processed through the Tricare Service Center at MAMC, so I hadn't been assigned a Primary Care Manager or clinic. When my good old Iraq burn pit cough resurfaced a couple of weeks ago, I still resisted the idea of going to MAMC, and requested authorization to be treated by my civilian pulmonologist. I ended up seeing him anyway before Tricare ruled on my request, and got treated. When my cough persisted past its usual time, I figured that it'd be smarter financially, and also for documentation purposes, to get going with the Army medical folks.

The few experiences I've had with MAMC have been relatively positive. A couple of blood draws for my required HIV test and pre/post deployment medical exams were handled quickly and competently. On the other hand, I still remember how dorked up dealing with Army docs usually turned out to be, and the patient administration end of things was always a nightmare of bureaucracy...and you know how much I hate dealing with bureaucrats!

I was therefore pleasantly surprised when I called the central appointments phone number on Tuesday, in order to be assimilated into the "Borg (MAMC) Collective". While I got the anticipated initial response of, "If you aren't in the system, I can't make you an appointment!", the call-taker actually listened to my reason for needing an appointment, and got me scheduled for what she called an "Establishing Care" visit to one of the clinics. Not only did I get an appointment, but within 24 hours of my call...So far, so awesome!

Now one of the frequent horror stories I've heard about appointments at MAMC is the requirement to arrive at least an hour, preferably two hours, in advance of your appointment time in order to find a parking place. Those stories are true. I drove through four different huge parking areas without success. I ended up parking almost a mile away from the hospital. I didn't mind the exercise, although the streets and sidewalks were coated with ice, but wondered what a less-able bodied patient would do if stuck with a similar situation. Of course, if I had even briefly entertained any thoughts of whining about the trek, my route took me past the Warrior Transition Battalion buildings, and a morning formation of Wounded Warriors armed with canes, crutches, and wheelchairs. Nope, no whining from this guy.

I made it to my appointment on time, and was handed a relatively small bunch of forms to complete. Once those were filled out, I was immediately shown into the exam room, had my vital signs recorded, and within minutes met up with the friendly civilian Nurse Practitioner (NP) who was my new Primary Care Manager. Didn't take her long to get up to speed with what I needed, and so after an exam confirming my malady I was out the door with a referral to an Army pulmonologist, a prescription for super heavy-duty cough syrup, and a note permitting me to stay home from the Army for two days.
All this cost me a total of Zero Dollars, which certainly overturned the conventional wisdom of "You get what you pay for." (Yes, I know fellow taxpayers, we did already fork over the money for my treatment.)

Getting my prescription filled took close to three hours. The pharmacy waiting area is almost as big as a high school auditorium, and you take a number when you arrive. There were over 100 people ahead of me. (Thanks to the kindness of a friend from the American Legion who gifted me with a spare number slip which was over 50 spots lower, I got my prescription before my tour of duty expired...Thanks, Karen, I owe you one!)

So despite my dire predictions of uncaring military medical bureaucracy, I can honestly report that Madigan Army Medical Center provided me with competent medical care, and great customer service. While it might have been more entertaining for you to read about everything going horribly wrong today...and believe me, I would have ranted about that in great detail...this was a better outcome by far. Besides, there are enough dumb things going on with the other aspects of my military life to provide this blog with lots of snivel-ammo.

UPDATE: Knew it was too good to be true...Got a call last Monday, scheduling me for my appointment at the pulmonology clinic. Yep, it's for a MONTH from now. Hopefully my cough will have subsided by then, although that'll surely trigger the old, "Why did you request this appointment?" response. In the meantime, I'm still "sleeping" in the living room recliner, covered by my trusty poncho liner, alternately dozing and coughing a lung up every 30 minutes or so. Thanks to the sleep deprivation, I can handle about a half day in the office, doing my Val Kilmer "Tombstone" impression. Just waiting for the first person to call me "Lunger"...

"Grant Me the Serenity..."

When it comes to being adversely affected by mindless bureaucracy, I have learned to suffer in (mostly) silence, like the average lower-ranking drone that I am these days. While "silence implies consent", I believe that consent can be withdrawn at whatever point the stupidity becomes more trouble than it's worth.

I've become an observer of my particular "military microcosm", given my substantially different background and experience, and what I'm seeing on a daily basis saddens me. Not heart-ripping despair, to be sure...This is more like the dull ache of a wisdom tooth emerging after close to six decades of lurking beneath the surface of my jaw.

Speaker of the House John Boehner has reportedly taken to reciting the "Serenity Prayer" during his frequent moments of frustration, and he's taken a lot of heat from the media and political opponents for doing so. Fortunately I have a significantly lower profile than Rep. Boehner, so nobody has seemed to notice when I mumble my own version in the aftermath of another "Drive-By Stupiding" incident.

At least I've come to the realization that it is highly unlikely that I am going to effect even a modicum of change upon my military organization. I'm not even going to be successful in just "doing what has to be done" by flying below the radar and focusing on key tasks I know will lead to accomplishing my missions. Instead, I see now that I'm stuck in "Crazy-Tasty Town". (I got that phrase off of a single-serving packet of Spam, and have been trying to insert it somewhere in a relevant way for the past year!). By the way, for the record the ratio is 89% Crazy, and only 11% Tasty, which falls well below my minimum acceptable standard for a non-deployed environment.

So, this leaves me with a couple of rational choices: I can resign myself to another winter, spring, summer and fall of my discontent, and then repeat it once more, or I can explore healthy, positive ways of bailing out and returning to my previous situation. Bailing carries some risk of a financial downside, both short and long-term, but with an offset (also long-term) that would partially balance things out.

In the meantime, I'll just keep muttering the Serenity Prayer under my breath, and do my best not to let the Droids of Dumbass piss me off to the point where I try to change the things I cannot.
("It's Chinatown, Jake!")

Hooray for the VA "Burn Pit Exposure" Registry!

As one of the hundreds of thousands of people who was continuously exposed to an open "burn pit" while deployed to Iraq and/or Afghanistan, I was very pleased to read that the Department of Veterans Affairs, aka the VA, has been ordered to establish a "Burn Pit Registry".

President Obama signed legislation Thursday requiring the Veterans Affairs Department to establish a registry for troops and veterans who lived and worked near open-air burn pits used to dispose waste in Iraq, Afghanistan and elsewhere overseas.

In addition to including new requirements for providing a casket or urn for veterans with no known next of kin and establishing care for a military cemetery in the Philippines, the Dignified Burial and Other Veterans Benefits Improvement Act, S. 3202, aims to pinpoint the number of veterans who may have been exposed to burn-pit smoke so VA can track their medical histories and keep them apprised of new treatments for associated conditions.

Troops deployed in support of contingency operations and stationed at a location where an open burn pit was used will be eligible to register.

Veterans advocacy groups and families of service members who have become ill since their deployments hailed passage of the law as a “victory.”

“It validates the truth behind every death, every illness associated with exposure,” said Rosie Lopez-Torres, co-founder of Burn Pits 360 and wife of former Army Capt. LeRoy Torres, who developed a rare lung disorder known as constrictive bronchiolitis after serving in Iraq.

VA said Thursday it will announce directions for signing up when the registry becomes available. (The Army Times)

Although the Department of Defense (DoD) and the VA first took official notice of the respiratory effects caused by long-term exposure to these burn pits in 2006 or 2007, and ordered the open pits to be replaced by low emission incinerators, very few of the Forward Operating Bases (FOB) fully transitioned to clean burning alternatives. 

In my case, while stationed at FOB Kalsu in beautiful Diwaniah Province, my Containerized Housing Unit (CHU) was filled most nights with noticeable amounts of foul-smelling smoke. Since my CHU was located only 500 meters downwind from the burn pit, I had to "embrace the suck", so to speak. After a couple of months of almost nightly exposure, I developed a deep persistent cough, which remains to this day, although at varying degrees of effect.  The docs at the FOB aid station provided me with an inhaler, and more importantly, documented this stuff in my medical records. When I redeployed, a similar notation was added to my medical file. 

Without going into detail, although I continue to receive treatment the effects remain. And whenever I get exposed to someone with a cold, I develop a heavy duty cough which sometimes lasts up to 3 weeks. That's the condition I find myself in right now, and it's pretty crappy.

You can bet that when the VA opens up registration for the Burn Pit Exposure group, I'll be right there.

Simple Truths About Golf

John Kim is a very talented golf writer who was kind enough to share some really true thoughts about the game of golf, written by Fred Shoemaker in his book, Extraordinary Golf. Here the link to John's blog post:  http://www.pga.com/news/golf-buzz/golfers-message-himself-goes-viral

Read it if you are a golfer, used to play golf, or are considering taking up the game. Mr. Shoemaker's words inspired me, that's for sure. I may not reach my goal of breaking 90 this year (yep, same goal as last year), but if 2013 features anything close to the golfing camaraderie, improvement, and sheer pleasure that 2012 provided, I will continue to be that Lucky Leprechaun!

December Golf at Chambers Bay: Cold, Refreshing Pleasure!

Slainte'!

My Review of "Fire and Forget"

“Fire and Forget” is a powerful, depressing, and unsettling collection of short stories. These stories were written by veterans of the Iraq and Afghanistan Wars, and while they are fiction, I have no doubt that most if not all are based on real experiences.

“Depressing” is an adjective I rarely use to describe fiction. In this case, it comes with the territory, because so much of what occurred over there or upon return was/is terribly depressing. These short stories manage to capture the essence of what many service members have experienced, but for the most part it’s doesn’t make for comfortable reading.

Some of the stories are downright sad. “Play the Game”, by Colby Buzzell effectively transmits the mixed emotions one combat vet experiences, turning his brain into an organic “Wheel of Fortune” as he wanders around in a fog on the streets of Los Angeles. “New Me” by Andrew Slater manages to describe how traumatic brain injury created a slippery slope between normalcy and borderline dementia for one returning soldier, while his friends and family remain earnestly clueless.

Mariette Kalinowski’s gut-punching story, “The Train”, perhaps affected me the most of all. I’ve experienced “survivor’s guilt” myself, and Ms. Kalinowski’s portrayal of how that plays out really rang true. As an added bonus, if there are any Americans who still possess the mistaken belief that women haven’t been serving in combat, they need to read “The Train” to assist them in pulling their heads out of their rear ends. On the flip side, “Tips for a Smooth Transition” by Siobhan Fallon really nailed the equally-difficult challenges faced by spouses during and after deployments.

Finally,  I need to say something about what was for me the most disturbing piece of this collection: “Bugs Don’t Bleed”, by Matt Gallagher. Having read Gallagher’s superb non-fiction account of his tour in Iraq, “Kaboom”, I expected something similar from him here. I was way wrong.  His portrait of “Will”, a tank crewman, illustrates something that the best writers of war fiction deeply understand: Serving in a combat zone really screws up soldiers, although in varying degrees.  Those who participate in direct combat operations are affected differently than those who support the folks who do the fighting, but the crazy shit that we see and do changes us forever.  I’ve known a number of soldiers similar to “Will”, who appear physically normal (whatever that is), but have their wiring re-connected in a slightly different  pattern.  That’s what disturbed me the most about this story. There are an awful lot of men and women similar to “Will” among us, and many of them aren’t getting the help that they need. While the concept of the “broken combat veteran” is surfacing in the media and popular culture, solutions seem to be a long way off.

There are a lot of essential truths packed into “Fire and Forget”.  For those of us that have been there, or know people who served in these wars, it is important reading. It is even more important for those of you who haven’t got this connection to begin to grasp the powerful and long-term effects on your sons, daughters, brothers and sisters, or that guy you went to high school with. You may not enjoy “Fire and Forget”, but you will remember it.

Note: "Fire and Forget" will be available next month, February 2013. It was edited by Roy Scranton and Matt Gallagher, and published by Da Capo Press.