V.A. Blues

by
R.C.Hampton

SAVE US from all the indifferent, or downright hostile, people working in the Veterans Affairs hospitals and clinics who love to treat us like annoying dirtbags who are something below welfare slugs and a drain on society; from people who don't like us and wish we would just be good enough to stay home and rot until we have the good grace to croak.

"The Best Health Care in the World" Collage © 2001 Robbo

you know, I get . . . cross . . . sometimes. So very fucking cross.

I got squashed by a wrecking ball while I was in the Army, so I'm in the VA health care system. To my frequent regret.

As it happens, the Veteran's Hospital here is the very first one they built. And it is about to go tits up. Well, they might not actually close it all the way down, but it is really only a clinic now. Any serious trouble and we veterans have to go to the facility in Omaha, a rather large hospital.

When I went through physical rehabilitation thirteen years ago it was, naturally, in a VA facility. That, along with the subsequent years of treatment at this clinic, has left me with some very strong feelings. I think that I was extremely lucky to have gone through rehab in the VA (Jefferson Barracks, Saint Louis). At that time, I think the VA was pretty cutting-edge when it came to spinal cord injury. Sadly, they didn't hold onto that edge. I am also convinced that the VA attracts the very best (and the very worst) in health care. They don't pay as much as the private sector does, and the benefits package for VA employees isn't all that great, so the staff is there because they have, for whatever personal reasons, a real commitment, a personal mission, to care for veterans. Either that, or they just can't get a job anywhere else in health care. When it became clear some years ago that the facility here was going to be scaled way back, the folks who had a young family to support, or didn't have enough years in to have a good shot at an early retirement before their department closed, were forced to jump ship so they could build a career elsewhere.

Actually, a lot of those people manage to make time to do volunteer work at the VA just so that they can be around the vets that they care so much about.

Now there are a bunch of people working at
the
hospital (oh, ahem . . . clinic) who really ought to be doing something better suited to their temperament, like selling used cars or doing the kind of phone solicitation that catches you at the very most annoying times.

I have a terrible time with some of those car-salesman-types, who seem to have found their way into key positions like scheduling, the pharmacy, records, and other clerical posts. These folks find themselves in a position to dick around with people. Rather than take the high road when a veteran calls or comes to their office or cubicle, agitated, angry, in pain or confused, and is perhaps tedious to deal with, they recognize that they can —kind of like a school yard bully—push that veteran around.

I live in Nebraska, which is a largely rural state. Together, the clinic here and the hospital in Omaha sixty miles away, serve guys from western Iowa, parts of Kansas and the whole eastern half of Nebraska. Many World War II vets are getting old and drifty . . . unsophisticated farmers who lag a little behind the leading edge of general technology. Very often they call scheduling to make sure of appointments before they drive hours to get here. I suspect that sometimes those callers are a little bit cranky after having to negotiate the Byzantine automated phone system ("Thank you for calling the eastern Iowa, greater Nebraska VA health care system {singsong lilt in the voice} Please select from the following Options . . if you know your party's extension you may dial it at any time. Press one for . . .").

By the time one of those old vets manages to get a warm body on the other end of the line they might be right testy. Instead of being polite, being kind, and answering questions as well as can be done, the pettycrats in scheduling often get their shriveled little rocks off by letting Grampa and Gramma Jones hire somebody to milk the cows on Tuesday morning so they can head out for Grampa's checkup here in Lincoln and the road trip that entails. And because that clerk in scheduling wasn't listening, wasn't treating each call as very important or was actively trying to be mean, Grampa gets to the check-in desk only to find out he has to come back in a couple of days because he has the wrong date. Scheduling won't show any adaptability, the clinic clerks don't want to accommodate anyone, and the reimbursement clerk ain't having any of it either (veterans who have to travel farther than a certain distance are compensated so much per mile).

And that's just the relatively benign stuff.

They have done a fairly decent job of tricking this clinic out with gizmos. Everybody has voicemail. They got rid of the medical transcriptionists and gave the docs swell LCD monitors with cool custom icons so that they can easily make their own notes. Everybody has pagers or cell phones, and as faulty as it is there is in place an automated 800 number for medications refills (some of which come from Kansas, for whatever reason). Having said that, the pharmacy is notorious for not answering their phones and for blocking their voicemail.

And as long as I'm rankin' on the pharmacy,
let me say
that they are my own personal cross to bear. I go out of my way to ingratiate myself to all of them, but like a great many other men who have need of what they dispense, they tweak me at every turn. Here's an example: My physician tells me over and over again that when the refills on my prescriptions run out (protocol dictates that scripts are usually written for about four refills), I shouldn't waste valuable clinic time by making an appointment to see him just to have them rewritten . . . just call them in. That's a little more complicated than it sounds, since he isn't, in this example, talking about the less-than-robust automated 800 number, so I'll explain.

This facility has closed its emergency room. They have farmed out that service to one of the for-profit public-sector hospitals in town. If you have an emergency that's big but not life-threatening like, say, a real high fever or maybe a broken leg, you get on the phone to the VA "Call Nurse" (as long as it's between 8-4, Monday through Friday). The "Call Nurse" will okay ambulance pickup and transport to a real ER. Without that okay you risk having to pay for the transport and ER visit yourself if your condition is judged to be non-emergent. Now, this Call Nurse has another job, one that she does an awful lot more of. She runs messages. So when I need scripts rewritten, I get on the phone to the Call Nurse and explain that I have X number of scripts that need to be renewed, and give her the numbers. In my case this invariably get complicated because I have several scripts for the same thing in different compounds.

The Call Nurse, when she is good and ready and if she is in good humor, takes this note to the doctor's clinic nurse or his clerk. If both of those people have their shit all in one sock and are doing their jobs right they will put the note in the doctor's "in box". When the doc has a free moment, either during a lull in the clinic traffic, at lunch time or at the end of the day, he will look at it and act on it, sending it by nurse to the pharmacy. Then their internal structure takes over. Now, even if everybody else has the very best of intentions, it only takes one person in that chain to have a case of the ass at somebody or something for it all to break down, and nobody ever wants to take responsibility for dropping the ball when somebody is checking up on things.

The pharmacy has a way of doing stuff that it likes real well, and it doesn't want to bend any. What it is happy with is patients always ordering their meds via the 800 number a couple of weeks before they are needed. They process and fill the prescriptions either here or in Kansas, and always mail them to me in the least effective and most costly way. That's just dandy until they need to be rewritten. Right now, for instance, I have two meds that are in limbo. I have been out of a muscle relaxant for a while now, and I'd like my legs to go back where they belong. I'll be out of one of my pain meds (the one I rely on most) today.

In theory, my doc is supposed to write for it this afternoon and I should be able to go out and pick it up. But! While he is a nice guy and genuinely concerned about me, he is also overworked and underpaid. He is likely to not get around to it until after clinic hours. That means that the little piece of paper won't make it into the machinery of the pharmacy until tomorrow. If they fill them here (and not in Kansas,let us pray) they might not make it out in the mail, so they won't get sent out until Monday. In spite of the fact that it can't be any more than seven miles away it will take two to four days to get to my mailbox. So, I might be without my best pain control for the better part of a week because some twit won't bother to look at the computer screen and see that I've taken this stuff for years and that in all likelihood my doc will rewrite this script. The twit won't show a little bit of adaptability, or, one might say show a little compassion and kick this bottle of pills out even though according to the computer, I should have had it two days ago! You can certainly argue that "rules are rules" and so on, but rules that aren't bent when good sense and expediency is served are worse than no regulation at all.

For several years now, by using some
alternative
therapies, I have been so fortunate as to get quite a bit of function return below my line of paralysis, and I have been enjoying some really impressive results in terms of pain control. I have gained insight about the nature of the general pain I have and, in particular, stuff that indicates incipient UTIs ((urinary tract infection for you that ain't hip to the jargon), because the very worst pain, which once overwhelmed both those other conditions and me, has been somewhat ameliorated. I go to a chiropractor three times a week to get my back snapped and to get acupuncture with a little bit of electrical induction.

While this has been wonderfully beneficial, it also costs a bunch. Since my doctor heartily approves, and since the VA claims to provide me, as a veteran, with all the care I need, and since they sometimes farm out stuff like neurology and other consultations for results quicker than they can get by putting a patient in the hospital in Omaha, I thought they might want to reimburse me for the cost of my chiropractor. Wrong answer. After I was denied, I wrote my Senator a letter. After all, I voted for him. Evidently his office made some calls, because the Chief of Staff wrote back to the good Senator's office, which forwarded a copy of the letter to me. Of course he (the Chief of Staff) claimed that he had no earthly idea who I was or what I was talking about, but if I would only file the right paperwork (filled out in quadruplicate) he would be willing to "consider" it even though it was not the VA's policy "in this region" to endorse chiropractic medicine.

But wait! It gets better! He goes on to tell the Senator's office that if I want to get treatment specifically for my SCI (spinal cord injury) I should really just move to Saint Louis. That's right, just get my lazy ass up and move to Saint Louis, and quit bugging him. I also was told right about then that the Chief of Staff was actually an accountant instead of a doctor. I can't tell you how much that bolsters my confidence in the integrity of the institution.

That's enough to give one pause.

I mean, how would you feel about having to take your taxes to an accounting office that was staffed by physicians? Just what exactly, do you figure the government was thinking?

While I am well compensated for my disability I am not compensated for being paralyzed. What I am paid for is "The loss of, or the loss of use of, both feet . . . and the loss of bowel and bladder control". They figure that somebody with my level of disability should be lying in bed all the time, having a nurse wiping his ass and generally, well . . . nursing him. Remember, the actuarial tables, or whatever the government uses to determine disability, were cooked up around World War II sometime. I am really torn when I think about that. I mean, in 1947 a paraplegic with a "complete" injury would have had the good grace, in most cases, to curl up and die in a relatively short while, and not be a long-term fiscal drain on his government (a "complete" injury refers to the complete severance of the spinal cord. An "incomplete" injury means that the severance is not complete and implies that there is a chance for considerable improvement).

Anyhow, they pay me enough so that I should be able to buy a house (a small house for two—myself and a live-in nurse, as per the standard of the 1940s). A squalid little cottage by today's standards. Also, I should, with my compensation, be able to pay somebody a decent wage to do all that ass wiping. To be sure, I do get incremental pay increases every so often, but the ratio remains the same— I get a little bit, and the nurse would get most of the dough. Personally, I have opted to wipe my own ass, live alone (if you ignore my service dog Ruby), and spend the rest of my compensation on myself and what, or whomever I want.

When I get to the point of utter frustration, where I am at my wits every-fucking-end, I begin to think that I should seek medical care in the private sector. There are, however, some very big practical problems with that idea. I have, on a couple of occasions, gone outside the VA system for consultations. I can't tell you how difficult it is to hunt for a physician, cold. Which medical school of thought do I look into? Internal medicine? Osteopathy? Family practice? General practitioner? "Is the doctor accepting new patients?" ("no" is very frequently the answer). "Has the doctor had any experience with spinal cord injury?" (again,"no" is overwhelmingly the answer). How do you go about finding a doctor you feel comfortable with? One you feel knows his or her art? I certainly can't just visit all of the physicians in the phone book, interviewing them on their thoughts about medication, various therapies, whether they are comfortable with a gay patient. At the average cost of around fifty bucks per office visit, and generally a two week lead time on appointments I would plow through a lot of money and time.

Then, of course, there is the business of duplication. A civilian doctor can't treat you. Well, they can't prescribe medications if a doctor in the VA system is already doing that. I suppose I could lie, but what kind of convoluted story would I be able to work out that would plausibly cover the thirteen years of my paralysis, during which I would appear to be the picture of blooming health, only to be wracked by pain and chronic insomnia now ? I'm not clever enough for that.

And I don't even need to tell you that health insurance is an absolutely impossible thing to acquire at this stage in my life. Not even an option. Hell, I can't even get a sizable life insurance policy now (and I'm still in pretty good health). If I were to seek medical treatment outside the VA system I would, first of all, have to pay for it out of my own pocket, which I am not sufficiently compensated to do, as I've mentioned. Not only would that be a big ol' bite outta my ass, but the VA's mission statement (along with the contract between a soldier and the military) makes it clear that they will take care of you for free if you get fucked up because of them. My feeling is, "By God, it was a deal! It was in my fucking contract!" They are supposed to give me, and other veterans like me, good quality free health care in a timely, efficient and courteous manner.

I often think that if the government decided to completely overhaul the system, things might radically improve. On the other hand, they might just decide that a 'plegic ought to be able to hold down a job, just like anybody else, and I certainly do enjoy not having to actually work (at anything other than what I want to) for a living. You see, my job skills involve things that I could only do if I were able-bodied. I also have health issues, not the least of which is chronic, exquisite pain that would certainly keep me from working a forty-hour week (no, SM-types, that is not a personal description of pain, but a medical one, sillies), so in all likelihood I would be really rather poor if I were trying to support myself.

Of course there is a mechanism in place so that funds are available to veterans who need to be trained in some field of endeavor where they can support themselves now that they can no longer do the work they once did when they were not disabled, but you know . . . I am not good with numbers or organization . . . fuck, I don't want to be something like, oh, an accountant or something. Some job that involves sitting at a desk. If I want to do that I will volunteer at one of the local gay and lesbian centers answering phones or something.

I'm entitled to my compensation check, and I want it. I want to spend my money and my time as I would like. It's the equitable payback for breaking my body and depriving me of being in control of the most intimate functions of my body . . . you know, not only the one's we don't like to think about, but the ones we gay men do like to think about. A lot. Like wet dreams. Like masturbation. Like getting lucky. Like being able to gracefully entertain your new friend when you do get lucky, and to enjoy the same payoff from those particular physical efforts that he does when his eyes roll back in his head, and after all the fricative tangle of limbs has run its course and you are exchanging social pleasantries and arranging to get together again for a repeat.

The VA "clinic" here farms out some stuff, as I mentioned above. Prosthetic services. The occasional neurological consultation. There is a neurology backlog of months at the hospital in Omaha. Likewise with the Pain Clinic. Hell, the two chief complaints I have had for the thirteen years of my crip career have been pain and sleeplessness. [An aside here for people unfamiliar with spinal cord injury: In many cases of SCI severe sleep disorders are endemic. The mind and body don't want to sack out at the same time. When the body is just fucking beat, the mind is running on overdrive and isn't about to slow for sleep. When the mind finally runs down, the body is too rested to be remotely comfortable laying around, so you wander around punchy and stupid. Most 'plegics so afflicted manage with a combination of weird hours and strong drugs.] Not all that long ago, about a year and a half, after I had investigated pain clinics in the private sector I found that there has been one all along in the VA hospital up in Omaha that, stunningly, none of the people involved with my health care knew about or had ever thought to fucking look for! The wait to get in was nine months. The Patient advocate then, a wonderful woman, yanked a string or two and got me in after about six months (to very good effect).

My point about the VA farming stuff out is that it might not be a bad idea if they just did that for everything. Give us vouchers and a list of approved physicians and physical therapists, shrinks and cardiologists, oncologists and proctologists and the doctors that work on ingrown toenails. Set up a system of clerkish types to dispense information and manage appointments and a few folks with some kind of diploma to counsel veterans in how to best use this new organization and to help them find what they need, and then sit back and watch the wheels spin. Let us get our prescriptions filled at the pharmacies of our choice with vouchers from the Feds. Save us from all the indifferent, or downright hostile, people working in the Veterans Affairs hospitals and clinics who love to treat us like annoying dirtbags who are something below welfare slugs and a drain on society; from people who don't like us and wish we would just be good enough to stay home and rot until we have the good grace to croak so that they don't have to hurry with any task, answer any unhandy question, cut short a coffee and Twinky break, or chip a nail. Follow those "Mission Statements" and "Value Statements" nailed up in pretty frames in the halls all over the place.

Gimme my good quality, timely and free health care like you promised me, and every other veteran out there, Damn it!

The foregoing diatribe has been an outline of my own personal story, and the lead-in to the central question—and indeed it is a question, not an answer— Should there be in the United States something like socialized medicine? Since I don't pretend to understand politics and the finer points of the economy, I don't feel qualified to begin to answer that question, only to bitch about it. I feel certain that my own personal struggle with disability and the medical structure in place for helping to treat it and to help me cope with it, is no less complicated than any other disabled man's, except by degrees. I don't think that any plan available to us as disabled gay men is, at this time, anything like equitable or efficient. While (largely heterosexual) families have things somewhat better in the short run, I wouldn't go on to say that the structure into which they might naturally expect to fit will be any better at helping them to survive the catastrophic changes that long-term disability or illness will bring to them.

I only hope that sometime soon someone far brighter and insightful than I can come up with something that will overhaul heath care in America. And because I am most enthusiastically interested in my own best interest and general ease, I hope that things get easier for me. And for all of you guys, my cousins in this condition of disability further marginalized by our queerness.

©2001 R.C.Hampton

.

 

R.C. Hampton,
former hustler, former dancer, former
dirt-bag street-creep, former entrepreneur X 3, former soldier, former bi-ped, lives in Nebraska, where he is settling into an early and tenuous geezerhood. This is his second article for BENT.

BENT: A Journal of CripGay Voices/May 2001