Monday, April 26, 2010

Fort Carson, Warrior Transition Units, the News, and the Ugly Truth

By now, several people have emailed me the various newswire reports of the goings on at Fort Carson.
  • Synopsis: Soldiers in the WTU are strung out on pain pills, heroin, and booze. The chain of command is harsh and uncaring. The doctors are clueless pill pushers. The troops aren't getting the help they need, and are getting lost in the system, and family members are incapable of getting them help.
  • Opinion:  The Times article was definitely slanted, and agendized.   Of the soldiers and family members in the WTU, there were no success stories.  There were no heroes, only poor, sad victims and ignorant, harsh leaders.  It pisses me off beyond belief that the default view of warriors is muscle dragging, booger-eating savages, and the default view of the wounded is helpless, pitiable cripples, and the default view of their spouses, in either case, is of miserable, pitiable people who must be cared for.
Analysis: I'm going to caveat this by saying that the NYT isn't exactly my favorite birdccage liner. As a matter of fact, it's the last place I would look for facts about anything military.

There is no "fix" for PTS or Traumatic Brain Injury.  It's hard to diagnose, and even harder to treat.  What works wonders for one is like giving tic-tacs to another.  (Same thing happens when I take Ambien.)  The docs are issuing brain candy to remedy everything, because brain candy is like the spackle that fills in the cracks of the depression.  It doesn't make you any happier, but it makes you care less about not being happy.  The brain candy makes you think different.
Soldiers take the pain/brain meds, and make sometimes really bad decisions.  (Guess, what?  Some Soldiers make bad decisions when they aren't taking really strong drugs.)  They mix booze and pills, a REALLY bad decision (I do so very rarely, admittedly, but not with the really strong pills, and only after a very long time learning the effects of the pills that I take.)  Left to their own devices, some Soldiers will readily make a bad choice over a good one if it seems like a good idea at the time.  I admit, I've gone down that road (bad decisions) a few times myself.
The Docs aren't necessarily doing much to get them off the addicting and brain-chemistry-altering drugs and narcotics--like putting them on methadone, which has all of the analgesic qualities, without the "high."  There are, believe it or not, several good reasons for this.  Sometimes, meds take time to work, and uptake varies by medication, and  by person.  Meds react differently in people.  Whereas some people can have a shot of morphine and sail away on memory bliss, I can get hits of morphine until my breathing stops, but still be in pain (been there, done that, not really fun.)  Also, people can have drastic reactions when they come off of meds--especially the brain-chemistry-altering kind.  Detoxing is one of my least favorite things.  All things considered, I'd rather have a full-body skin graft that detox from opiates again. Last time, the Mrs. was so scared she hid all the guns in the house, because she was afraid I'd suck start a pistol because I was so utterly miserable.  The thing to remember is that the doctors really truly do want the Solders to get well--but they don't have a magic bullet, magic pill, or one size fits all treatment.  It's a process, and a long one at that.
The chain of command can only do so much--especially if the soldiers aren't living in barracks.  Spouses are woefully untrained and uninformed in how to deal with their service members, and who to call for help.  Spouses of wounded troops are sent off with a bag of pills, a box of bandages, creams, ointments, potions, tape, and tubing, shown how to change bandages on their "patient," how to help with physical therapy, and handed a card for Army OneSource.  They are then asked to be part nurse practitioner, part medical assistant, part therapist, and full-time spouse.  Their soldier just want to be well, be strong, be the person they were before.  In some ways, it's worse when the spouse "helps."  They are trying to be SO careful, because they don't want to hurt their wounded Soldier.  The Soldier is trying to put up a brave facade, but it's friggin' frustrating.  Strife, not hilarity, ensues.
The chain of command has to instill discipline and military order.  It. has. to.  Sometimes the drill sergeant is exactly what Soldiers need to remind them they are Soldiers.  Other times require more gentle approaches.  Although the WTU must account for every soldier by first call (usually 0600), there are ways to do that without having a formation.  (Back in the dark ages of Wounded Warrior Care, 2005, they had all of us cripples stand (or sit, if you were in a wheelchair) at 0800 at Walter Reed.  I did that once.  After the "Platoon Sergeant" failed to show up, I dismissed the formation, and told them there would be no more formations.  Asshattery ensued, but in the end, there were no more formations.)  An in-ranks formation at noon would serve the same purpose, or even a "physical check in" with the training room/1SG by noon would also serve that purpose.  Even better if their leaders have a list of appointments they need to make, and can ensure they have transportation (I relied on the wife network, but a phone call would have had someone from my unit picking me up post-haste.)  Better still, their leader looks them in the eye, asks them how they are doing, and listens to them, every single day.  The leader then takes responsibility for fixing any problems the soldier mentions.  Even better, the leader meets, calls, or other wise engages with that servicemembers' spouse to get the unvarnished truth about how the soldier is doing.
As far as pulling duty goes,  Soldiers in the WTU pulling CQ or Staff duty is bullshit, and should NOT be happening, especially if even one of their meds "may cause drowsiness."  Have the Cadre run staff duty, make the floor checks, and handle issues--it's one of the reasons they get the extra pay.  However, having no responsibility but "get well" isn't always beneficial to the soldier's mental health.  It's a delicate balance between what the soldier can do, and what the soldier should do.  We all want to "do," even when we can't.
THE WTUs need to have an on-call cadre of shrinks, too.  People who work directly for the WTU, not people who see any other patients. 
If illicit drugs are a problem, UCMJ is the answer.  WTUs are there to help soldiers.  Find the dealers, find the users, and toss them in jail, then out on their ass.  Illegal drugs have NO place in the Army, and their use along with prescription drugs is deadly.  It sounds harsh, but none of these guys is so mentally incapacitated by their scripts that they seek out heroin, too.  Heroin is being given to them, to string them along, and then sold, to string them out. No one is sticking a needle in their arm, they do that themselves.
Finally, if the soldier wants out, right now, then accommodate him, but make him aware that it may result in his benefits taking LONGER to kick in.  If the soldier wants to get back to his unit, back to work, then have the docs check him out, and if they say yes, let them.  If they say no, or "not sure" or not ready," they owe it to the soldier to give them goals, and a time line.  If the answer is "never," they owe them that as well.

I've never commanded a WTU, never even been in one (they came to be after I'd left Walter Reed.)  The challenges the leaders face are different than the challenges in any other unit.  I find it laughable that a kid with a camera and a journalism degree has the gall to question how the leadership commands that kind (or for that matter, any kind) of unit.

I'm not a shrink, nor am I a therapist.  I'm just a simple soldier who loves what I do, and loves those with whom I serve.  I want to see them well and healthy, and if I can't have that, I want to see them well cared for.  I am not alone in the Army, the commanders of WTUs all want the same thing.  These people are selected, not assigned.  They are not put in the job because they've failed elsewhere.  Their mission, and the mission of their charges, is to get well, get better, get back to work, and above all, live the Army values and Warrior ethos.


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