The Broken Soldier

I was wrong about at least one of the folks at Knox.  A serious error in judgment.  A mistake I apologized for to the man himself.  Whether obtaining medical care or assisting me, within the limits of what’s permissible under Army Regulation, with my financial woes, this man truly seems dedicated to helping me.

I allowed past experience to influence my opinion of him.  His approach.  His attitudes.  His motives.  Given the way I’ve been treated this mistake is understandable I suppose, but nonetheless wrong.  Army medicine has a lot of problems.  Airing, discussing, and hopefully helping to resolve these problems is the purpose of this site.  It doesn’t follow that everyone who’s part of that organization is also part of those problems.  I won’t continue, let alone promote, traveling down the wrong road.

Got my instructions in the mail yesterday.  Looks like treatment will be about as fun as not-treatment.  Maybe that’s a blessing as, aside from what’s billed as a temporary pain increase, I won’t notice much of a difference.  Not sure my body can handle much more stress.  I’m sure 16 months of chronic pain has my SAMS/HPA about burned out.  Glucocorticoids destroy these areas.  That is, stress response kills the areas of our brains regulating stress response.  Who said God doesn’t have a sense of humor?

Limited activity.  >5 minutes of sitting, standing, and walking.  No bending or twisting at the waist.  Pain medications, though I’m probably not going to take them.  They’re meant to keep me “comfortable enough to resume basic self-care activities like eating, bathing, and walking to the bathroom.”  I had trouble doing that on 100 mcg/hr of Fentanyl.  I seriously doubt Vikes or whatever other joke of a medication will help much.  I figure smelliness is preferable to waking the Dragons of Opioid/Opiate Addiction.  Up and down the steps once a day.  No sexual intercourse for 4-6 weeks - there’s something very liberating about being completely useless to my wife.  No driving.

“Your inactivity in the last month has weakened your low back muscles and their strength must be restored prior to your return to normal activities.”  You aren’t kidding sister!  Now multiply that by 16, and you’re in the right neighborhood.  “Make your back exercise program a part of your daily routine.  Just like brushing and flossing your teeth!”  Yep, tried that.  Made things worse.  “Regular back exercise will minimize your chance of reinjury.”  Yeah.  Maybe if practically all other prognostic factors from current lit review weren’t working against me.

On the sunny side, I’m sure I’ll be able to work, that is, if ‘mattress tester’ is a real job.  I’ve put my CV on Monster.  Keep your fingers crossed.

I have weird dreams.  Especially weird when I’m sleep deprived and or angry.  I don’t put much stock in the idea that dreams necessarily mean or reveal something, my deepest apologies to those who favor and regale guests with Freud quotes at fancy dinner parties.  I had some awesomely crazy dreams this weekend.  Crazy by my own standards.  Last night I was at some sort of medical facility, a facility unlike anything I’ve seen.  Patients and doctors milling around in the same great room.  Everyone talking to one and other.  Procedures of all kinds, from exams to surgeries, performed out in the open.  Looky-loos rubber-necking, at times their heads pushed under the arms of those performing surgeries.

I was having another MRI in prep for surgery.  Sure, why not?  I’ve had several already.  What’s one more?  But this MRI machine was different.  In many ways it resembled an fMRI, though different in form and radically different in function.  A portion, like a robotic arm, of the machine moved over each part of the body and alerted, by some process unknown to me, the doctors of abnormalities.  These were shown on a 3D screen in front of me.  As well, when abnormalities were found, part of the image disappeared, and likely affected areas blinked giving the doctors a heads up about where to begin their search.  As no “Jimison dream” is complete without comic relief, the robotic arm part of the machine kept smacking me in the crotch as it passed over me, to the delight of staff and patient alike.

When the test and crotch-smacking wrapped up, I got off the bed, sure to use the “push yourself with you arm method” my physical therapist taught me, and began shooting the shit with one of the docs.  I think he was a neurologist.  We got onto philosophies of mind.  We were basically in agreement that traditional mind/body is something of a false dichotomy.  Though playing Devil’s advocate, I was sure to provide synopses of the strongest challenges.  I was impressed with his ability to answer these challenges.  Without a philosophy background, he had a good intuitive grasp of the subject.  Listen to me, impressed with a figment of my imagination.  Those around us who’d been listening in thought we were both fairly odd folks, looking at us sideways as we went our separate ways.

Later I got into an argument with some military folks.  Why they were there I’m not sure, though I’m also not sure a dream need be cogent.  It began when one of them asked me why I was there.  I answered, but apparently, given that I’m on a cane and unable to stand without struggle, didn’t bow low enough or didn’t hold the curtsey long enough to satisfy him.  He went on about customs and courtesies and their importance.  I kept Fred Astaire motioning to my cane.  This was lost on him.  I got pissed, which isn’t hard to do in my present state, and called him an asshole.  I tried to go on with a conversation I was having with a person sitting closer to me, but couldn’t over the affronted fella’s heckling.  I got up, hobbled over to him, and got in his face.  I said some-it like, “Don’t let the cane fool ya, my arms work fine, and if you don’t shut up you’re gonna find yourself in a paint brush or a choke of some sort.”  He and his buddies stood up.  He looked like the Shogun of Harlem from the Last Dragon.  You remember?  El De Barge?  Bruce Leroy?  Sum dum goy?  Chinese guys rapping, break dancing, and talkin’ 80s jive?  I think it won an Oscar.  Black exploitation at its finest.  My Creek Freedman great great grand dad is rolling in his grave.  But unlike the Shogun, this guy was like 15 feet tall, and dressed in half-drag.  Lee Press On nails.  A Dress Barn power suit.  Pumps.

What the fuck?  I need to be on anti-psychotics.  The good ones that turn you into a zombie and make you gain 100 pounds.  Then I could work as an stuntman airbag.  I woke up and watched Gladiator On Demand.  By strange coincidence, I got a call from Russel Crowe this morning.  No accent, I didn’t hear him throwing his phone at anyone, I assume it wasn’t him.  He wanted to talk to my wife about her application for a scooter - gotta do something about that $400/month going to gas.  My wife and I prefer eating to funding the military-industrial complex.

Well, that was pointless.  Lots of words saying a lot of nothing.  Finally I’m able to put my philosophical training to use.  If only I could be paid by the word.  I’m going to spin this as a departure from the bitching.  In reality, nothing has changed with my status, and I’m running out of different ways to complain about the same problem.

First things first, ‘labas’ to my Lithuanian friends.  It’s always kind of neat to see who’s reading, and where they’re reading.  “Achyiu.”  I’ll do my best to keep your attention.

I’m in a tremendous amount of pain today.  I had dinner with a buddy of mine.  Dan.  We went to college together.  He’s visiting from New Mexico where he works as an intel analyst for one of the agencies.  I’d love to be on drugs right now, but that love’s at odds with my pre-surgery instructions.  Hell, the only thing I could take is Tylenol.  Regular Tylenol has never really worked for me.  I’m sure the homunculus pulling the levers in my head wouldn’t find RT to be that funny of a joke.  For all the good they’d do I might as well stick them up my ass.  I’m in pain, pain that has made it impossible to get out of bed today for longer than 5 minutes, because I had dinner with a few friends.

This got me thinking about the phone call I got on Friday. Finding my blog, as though with between 500-2,000 hits a month depending on how much writing I’m doing it’s existence is some bloody secret I’ve done my best to conceal from the Army, and wanting to clear the air.  What an odd sense of proportion and prioritization people in the Army have.  As though blogging in real time of my impressions of what’s been happening and what’s not been happening is a matter worth discussing.  Especially when I still need medical care.

Add in that I’m in this boat because of the many bad decisions by those appointed over me, and an unwillingness to expend energies and resources to do much of anything to correct these decisions, other than threatening me and PR control, the lack of proportion and prioritization is astounding to me.  Disgusting is more apt.  I felt my confidence in the Army couldn’t be lower than it was.  I was wrong.

Let’s recap what got me here, though as one person from the Guard put it, “It’s water under the bridge.”  I don’t know.  When I wake up every fucking morning to pain and disability and collection calls because I’m not able to work it’s difficult for me to be as fucking Zen about it.  Dumb ass coerces me to attend training, holding my OCS bid hostage to do it.  He does so against Army Regulations, my contract, and my wishes.  He does so in order to accomplish certain things he was responsible for doing but failed to do.  During this useless training, useless because, contrary to what many in the Army think (using that term in its loosest possible construal), Marines and Army folks aren’t the only fucking members of the military who do field shit, my injuries came because of another stupid and pointless decision: “All 250 of you and your gear out of this room with two doors in 10 seconds.”  What’s the purpose?  What’s the training value?  Oh right, NONE!  Just another needle-dick with relative rank jerking off without regard for what his actions and decisions create for his ‘brothers.’  Osteopath in a bad mood.  Treats me to a heaping helping of insults rather than treating me medically.  Sure.  Why not?  With Feres and manpower concerns, what worry should he have?  Punching symptoms into WebMD is okay right?  The folks in Health Services seem to think so.  They defended this action.  An action that would have gotten any doctor not in uniform sued into the stone age.  DON’T SEEK CARE.  Remember that one?  Means more paperwork if the LoD isn’t approved.  Toon?  What else is there to say that hasn’t been said?

In spite of this, all of it, I’ve acted with restraint.  Those who don’t think so are sorely mistaken.  Soon to be much more sore.  I’m letting Bruce take over.  Completely.  See if he acts with the restraint I have.  See if your sense of proportion isn’t adjusted a bit.

Got a call yesterday from Knox.  The phone was upstairs or something.  I missed it.  I listened to the message this morning.  The doctor handling my case wants to discuss my referral, mentioned something about reading this site, and wanting to “clear the air.”  I called back right away.  It’s Saturday, and no one was there.   I left a brief message.  Now that Knox is ‘on to me,’ this is as good a place as any to discuss this matter.

There is no air to clear.  My position is straightforward, and I won’t be distracted by ironing out possibly false impressions, on minutia and matters not central to the medical and legal necessities of treating me.  I was injured on active duty.  The Army is required to treat me.  Period.  This injury is fairly common and there are conventional methods of treating it. Typically one to four months of conservative treatment - bed rest, anti-inflammatory medication, pain management, physical therapy, epidural steroid injections, etc.  If symptoms don’t get better, or get worse, as in my case, neurosurgical intervention becomes part of a conservative approach.  In instances in which bowel and urinary incontinence are observed, emergency surgical intervention is the conventional approach, as the presence of these symptoms are indicative of Cauda Equina Syndrome (my symptoms making more sense now that I know L3-L5 are degenerating too).  It’s been 15 months.  I’ve not responded to over a year of conservative treatment.  Surgical intervention is about a year overdue.  Surgery is not an unreasonable request.  It isn’t expecting to receive medical care “carte blanche.”

Dr. Toon, of whom you are all familiar, was handling my case.  Let’s review.  Dr. Toon was almost an hour late to our first appointment.  He rudely threw my wife out of the exam room.  He looked to confirm the MRI report of right side broad-based lateral disc herniation at L5-S1 on a sagittal image.  For those of you unfamiliar with reading MRIs or elementary geometry, follow me.  Perform an Atlanta Braves chop with the hand of your choosing, and keep your hand in that position.  Make a fist.  Bend your wrist so that the fingers of your balled fist are facing you.  Stick your thumb through your fingers - like “I got your nose.”  There’s a representation of an intervertebral disc herniation in three dimensional space.  Imagine, if you will, trying to find that herniation on a two-dimensional image - noting well that 2D provides length and width, but no depth.  See the problem?  Me too.  I asked him to look again.  He did, but on the sagittal image.  I asked him what accounted for such a radical difference of opinion, to which he responded, “It’s a judgement call.”  I asked if the first judgement matched my symptoms?  He said, “Yes, but that’s not what you have.  Civilian doctors tend to overcall.”

He then went on, after finding an L5-S1 disc herniation on the sagittal image, re-diagnosing it as a central focal disc herniation, to perform a series of physical exams.  He performed Waddle’s Signs - a test used, though not by anyone practicing medicine I know, other than Army doctors and docs working for Workers’ Comp Insurance companies, to identify potential malingering in the absence of a reasonable organic cause for pain and other symptoms.  Any herniation can cause nerve compression.  Even disc desiccation can cause nerve compression.  In other words, he performed this test after finding a perfectly reasonable organic cause for pain and symptoms.  In his report he mentioned I had two (2) of these signs.  For those who use this method, three or more are considered suggestive of malingering or a psychologic cause.  He didn’t bother mentioning which signs I had, if any.  Given that I knew what he was doing when he did it, and that I don’t recall any positive signs, I suspect he fudged the results.  But to perform this test in the first place given a reasonable organic cause, as well as an 8 hour car ride the previous day and walking around the hospital aggravating it, is questionable.  Failing to name the signs present even more so.

Dr. Toon then did a brief neurological exam.  He tested my patellar reflexes.  Note well that patellar reflexes are spared with nerve root compression at L5, S1, or both.  In other words, the test was meaningless given the results of the MRI.  Though he made quite a big deal about this reflex being spared.  He claimed the strength in my right leg and foot were normal.  This in spite of not being able to dorsiflex the lateral toes on my right foot, my right foot, or fully use my right calf.  Later EMG confirmed motor impairment at L5 - chronic L5 radiculopathy.

He then asked me to walk around the exam room.  I was already in pain from the ride to Knox and walking around the hospital.  Pain close to 10 out of 10.  He confused sweating and rapid heart beat and deep exhalation without deep inhalation as signs of de-conditioning rather than signs of extreme pain, claiming, “Look at you.  Sweating from walking around the exam room.  You’re really out of shape.”

He then sent my wife and I on a wild goose chase through Ireland Community.  Lab, X-ray, Physical Therapy for one appointment, an appointment I couldn’t keep by the way, and for another MRI.  I was suspicious given what had happened during the exam, but I did it anyway.

He sent me to the pharmacy for a script of OTC NSAIDs.  I grabbed his report, read it, and was so pissed off that I left without filling the script.  Claiming over an hour of face time when it was more like 20-30 minutes.  No mention of symptoms I had other than pain.  Claims to having performed certain examination techniques he hadn’t performed.  Blaming my weight gain for symptoms.  Getting my personal, educational and professional information wrong.

That was just the first meeting.  The second he forced me to go to Knox, 480 miles each way, to get an MRI.  Both technicians were aghast when we told them where we were from and why we were there.  The trip had aggravated my injury to such an extent that my legs were trembling and my back was spasming uncontrollably.  Both said they’d do what they could, but that the MRI would likely be unusable.  One of the techs angrily said, “If he had to have you down here, which I don’t know why he would, he should have at least given you muscle relaxers.  This trip is going to be pointless for you.”  From this likely unusable image, Dr. Toon found that my lumbar spine “appeared normal.”  This after finding a herniation on the first, along with signs of Intervertebral Disc Disease, the veterinary term for Degenerative Disc Disease, which, by the way, has no cure and doesn’t repair itself.  If he saw it on the first, it would be there on the second too, save for some miracle.  Given that I’m still symptomatic, I seriously doubt that a miracle took place.

I complained a bit, specifically about the bowel and urinary incontinence, something he failed to mention in his first report.  He mentioned it in the second, but did nothing about it (c.f. above standard approaches given these symptoms). My suspicion grew.  I filed a complaint with ICE.  They got back to me once.  I outlined my complaints and they never contacted me again.  It wasn’t until Bruce contacted the commander of Ireland with threat of naming her as co-defendent on a writ of mandate that I heard from them again.

I know my critics get tired of reading this, but I don’t really care.  I’m a U of M grad.  I have degrees in Physical Anthro and Behav. Neuro, among other things.  I was a combat medic.  I worked at the U of M Med Cntr as a clinical researcher in the Neuro Dept/Neuropsych Div.  Not as a coffee-maker.  Proficient use of SPSS Syntax is a handy talent.  I’m not grotesquely stupid.  I’m not ignorant of the applied/medical science relating to my injury, or of standard treatments.  And I’m not completely ignorant of the law either.  Time for patiently waiting is at an end.  Time for dialoging is at an end.  It’s time to treat me.  I alerted Bruce, and he and my attorney buddy will be filing the writ regardless of referral status.

No amount of talking could undo the pain and harm the Army have caused me.  Nothing could dispel the negative emotions I feel towards them.  I am broken, depressed and anxious - common in folks with chronic pain and likely to stay with me for the rest of my life, drug addicted, and financially ruined.  And I’m this way because of others’ bad decisions.  What is there to talk about?

I got a call from Henry Ford Macomb at 6 p.m. yesterday.  I almost didn’t answer in fear it was another bill collector.  I answered anyway.  It was this nice lady from Admissions I’d met when I did my myelogram and CT scan.  She has a nephew in the Army.  By strange coincidence, he and I have had similar experiences with Army medicine and Army bureaucracy.  Weird huh?  No problems.  Nothing to see here.

I answered a bunch of questions, many of them personal in nature.  What’s your favorite color?  Have you ever trimmed your long-haired chihuahua to look like a lion?  Have you ever been to a Turkish Bath?  Bastinado or falaqua?  (I’m Catholic.  Bastinado of course.) I have to do some blood work next week.  Other than that, all systems go.

The procedure I’m having has a 70-90% success rate.  That is, if done in a timely manner and without other complications.  Meaning, had the Army done what it was supposed to have done when it was supposed to have done it, there was a high probability I’d have fully recovered.  Things aren’t quite so sunny now.  When I asked the neurosurgeon, “What are my chances of being 100% again?” he answered, “You’re young.”  But he couldn’t look me in the eyes when he said it.

A bit of Molly tongue-in-cheek.  A gift.  Sorry.  The message conveyed is a good description of how many in affluent societies, like ours, think and behave.  We don’t hunt, we don’t gather, we don’t starve.  We don’t worry about freezing to death or being eaten by a bear.  We enjoy the relative safety the structure of our society provides without ever giving much thought to it, that things have been and could again be different, and who makes this life possible.

I’m tired from eating birthday cake and winning and defending the WWE Championship, so I’ll make this brief.  You don’t pay a garbage man a $1 a day.  You don’t pay a cop in leftover taco meat.  And you don’t treat our military the way our government, and by extension YOU, have.  You may wake up one day to find your comfortable lives - full of cage-of-your-own-design drama - uncomfortably different.

I will always place the mission first.

I will never accept defeat.

I will never quit.

I will never leave a fallen comrade.

The core of the Soldier’s Creed.  Pretty words.  Seriously.  Regardless of one’s metaphysical commitments to rules/ethics/morality, whether they are created to aspire to conform our behaviors to right actions, or if they’re a codified set of statements meant to glorify those actions already accepted in a given culture, thereby glorifying the culture itself, I think most rational people can see value in such things.  If I were training people for war, I’d want something like this governing their actions.  In itself, on its surface and even below it, there’s nothing wrong with these principles.  I’d say in our culture, we could all stand to be a bit more selfless.  But making war isn’t the only thing the Army does.  Herein lies the rub.  The same rub one finds when one applies rules too broadly.  If a hammer is the only tool on your tool belt, you’ll treat everything like a nail.

Those in power to make decisions not directly related to making war, though I’ve heard some argue that every action in this context ultimately relates to making war, are guided by their understanding of these principles.  Which is fine so long as they have the right understanding, and these principles governing Army conduct aren’t in conflict with principles governing other actions.  Such as those of professionals, like doctors and lawyers, etc.  If this collision must occur, then there must also be a method of resolving this conflict.  One a bit better reasoned out then the current method, which is to simply defer to the first principle, often with tragic and unnecessary results.

The Army’s website has a page devoted to the Warrior Ethos, and includes on it stories of soldiers said to embody each principle statement.  These stories tend to be war related, implying Army leadership has, at least on some level, an understanding of the limitations of these principles.  Though their actions don’t always comport.  Case in point:

http://www.chron.com/disp/story.mpl/front/5788103.html

This young man, an Army recruiter, and his new bride are dead by their own hands.  Pistols to be precise.  Dead, in my opinion, by the same approach that’s crippled me and crippled, killed, or otherwise harmed many others.  Specifically I’m referring to ‘placing the mission first.’

The mission, in this case, was having this man back to work in order to have as many recruiters working to replenish a generally strained military, Army mostly as it is doing the majority of the heavy lifting in Afghanistan and Iraq and wherever else our fearless leaders lead us from the comfort of their Washington estates.  This in spite of his obvious suicidal ideations, the products of co-morbid major clinical depression and PTSD, and numerous threats and past attempts to kill himself.  This man’s life was valued less than his job.

Similarly, my story and those I’ve shared on this site, relate to this ethical confusion.  Mission-centered rather than person- or patient- or client-centered.  Denying care to save on costs, driving down disability ratings justified in ways most civilian professionals would find laughable if not for the deep anger they feel, sending medically unfit personnel to the front, and ignoring clear cries for help to keep this man at his post.  Our government and Army leadership will always place the mission first.  Though they are very rarely personally affected by their principled decisions and actions.  The questions are, how long do they believe we’ll tolerate this, and don’t they realize that long-term this approach is more costly?  Not just in terms of treasure, but in terms of losing our souls, individually and nationally.

My manner of resolving this is simple: Dismantle military professional classes.  Legislation and rule-making probably won’t work.  Those in power have a tendency to play fast and loose with the rules, knowing there’s little chance they’ll be busted for it.  These professionals, either purposefully or by ignoring the importance of an informed client, tend not to share relevant information.  Their subordinates won’t risk reprisal, and their superiors have an interest in keeping things as they are.  These combined with military mores of not complaining or criticizing, even in instances in which both are warranted, and there’s no real chance for positive change.  No, it’s time for a more radical solution.  This stone kills many birds.  It reduces the conflict of interest, allows for patients or clients to tell their providers where to go when they sense mistakes are being made, and holds individuals in these positions to the same standards as everyone else.

Addendum

The officers appointed over this soldier used the same bullshit tactic those appointed over me have used.  “We aren’t doctors, and we don’t question the correctness of their opinions” is the gist of it.  One doesn’t have to be a doctor to understand certain things.  Sometimes those not pinned down by a particular method tend to think more clearly and objectively.  They base their opinions on results rather than what is expected given a certain approach.  I’ve been to many a doctorate granting ceremony.  I promise you, God doesn’t descend on a cloud girded and praised by choirs of angels to hand the keys to the Kingdom and the universe to doc grads.  An MD or a DO or a PhD or a PsyD or a JD or whatever doesn’t, contrary to popular opinion, make one infallible.  Even in her/his own field of expertise.  It doesn’t mean they’re more intelligent than you.  It doesn’t mean they understand the specifics of your situation better than you and those around you do.  This horseshit, accompanied by what I’m betting is a well-rehearsed lament, is just another cog in this dysfunctional and immoral machine.  A cog designed to give the appearance that those appointed over us, while responsible by vocation, aren’t responsible for what happens and doesn’t happen to us.

My wife scolded me today.  “You’re really down on yourself in your writing lately.”  I hadn’t noticed a difference.

She said I could have gone to the zoo if I really wanted to.  If one calls ahead one can reserve a cripple scooter.  Sweet.  Depending on the model, maybe I could pick up sufficient speed to jump the rail to the lion exhibit.

My mother in-law is in town.  That’s a good thing.  We get on well together.  She’s here to celebrate my step-daughter’s birthday, and to have a visit with the rest of us.

Mom, Sarah, and Paige are at the Toledo Zoo.  I really wanted to go.  They have great primates.  But I did some house work yesterday, and a bit more this morning in prep to entertain a visitor.  Maybe an hour or so of total work time divided up between a day and a half.  I’m really paying for it.  I had a little accident this morning.  Yeah, that kind of accident.  I figured it was best that I stay behind.

Today, more than ever before, I realized that I’m the family cripple.  I’ve felt this before, but something’s different about today.  It’s hit me pretty hard.  I was hoping after the surgery I’d be a bit better.  Not what I was, of course.  Some pain and a distinguished limp, both of which justify satisfying my childhood wants for a cool 70s pimp cane.  But one must not hope to be more than one can be.  That’s not mine.  I read it somewhere.  But it fits.  Life as the crippled turd in the family punchbowl is going to take some getting used to.