Invisible Heroes

Navy Safe Harbor’s Judith Carlisle wants everyone to know that Sailors, Coast Guardsmen, and veterans with brain injury and post-traumatic stress disorder should be cared for and treated as the heroes that they are.

If Judith Carlisle had her druthers, every Sailor, Coast Guardsman, or veteran who has sustained a traumatic brain injury or post-traumatic stress disorder would have a small scar on his forehead like Harry Potter’s — a scar that would light up when he was angry, anxious, or afraid, making his invisible and sometimes misunderstood injury visible. “The Harry Potter scar would speak for the person, ‘This is my battle injury, the reason I act this way sometimes. Please don’t judge me’,” says Judith, who for the last four years has worked as a non-medical care manager at Navy Safe Harbor.

Dream job

Judith Carlisle is one of those people who oozes passion — passion for the work she believes she was born to do. Before joining Navy Safe Harbor in 2008, Judith had worked for many years for the foreign service doing health education. While her daughter was growing up, the single mother went back to school for “a couple of masters,” but she knew she wanted to work for the Navy and help wounded warriors. “Sometimes the energy you put out in the world comes back around to you,” she says. Rather out of the blue, she got a call about working as one of the first non-medical care managers at Navy Safe Harbor — the Navy’s lead organization for coordinating non-medical care of seriously ill, wounded, and injured Sailors, Coast Guardsmen, and their families. With her career background, education, and the fact that she had volunteered and advocated for years for veterans’ rights, she was hired on the phone.

“I have never worn a uniform, but the minute I started training as a non-medical care manager for Navy Safe Harbor, I thought: now I have the chance to give back,” says Judith. “Our mission is to help wounded, ill, and injured warriors and their families get the best care available through the entire spectrum of recovery, rehabilitation, and reintegration … basically, for the rest of their lives when and if they need it.”

Judith says she feels the intense immediacy of the job, especially when it comes to the service members with mild traumatic brain injury or post-traumatic stress disorder. “There are some very, very sick warriors out there with visible and invisible wounds who need help, and they need it today, not tomorrow,” she says.

Coordinating a wounded warrior or veteran’s non-medical care can include arranging travel for the family to arrive at National Naval Medical Center in Bethesda, MD (now the Walter Reed National Military Medical Center) before their injured loved one returns stateside; setting up housing or childcare for the family; helping Sailors, veterans, or their family members enroll in online classes or internships; and planning individually focused job training for warriors retiring from the Navy or Coast Guard. She has helped coordinate assistance with résumé writing, found funding for accessible housing and renovations, and helped veterans obtain service dogs, which can make a significant difference in quality of life.

“Every minute is such a blessing to work with these people, “says Judith. “As I pull on base every morning as a civilian, I feel so lucky. I’m like the mom to all these guys. I mean, they’re letting me work with these heroes and their families. It’s incredible.”

For the first two years, Judith didn’t have an office. No one did. Navy Safe Harbor consisted of two care managers working in a coffee shop and a few folks at headquarters. Now, the organization has a full staff at headquarters and non-medical care managers at all the major military treatment facilities across the country. This, of course, includes Bethesda — which is now “two officers and a mom.” They recently moved to Building 62 at the new Walter Reed National Military Medical Center, complete with barracks for wounded warriors and their families. “We have three offices and a Navy Safe Harbor sign on our door,” she says. “We’re a one-stop shop, the lead organization of its kind for the Navy and Coast Guard, and while we mainly enroll the seriously injured, we never say no to assisting a Sailor or Coast Guardsman who may have a few needs or who is just having a hard time adjusting to life post-deployment.”

Seeing the invisible injury

Judith is especially driven to help those who have sustained a traumatic brain injury — and to raise awareness about this often invisible and misunderstood injury. “One of the biggest challenges ahead for this country, even after the wars end, is helping the thousands of returning service members who have mild traumatic brain injury and/or post-traumatic stress disorder,” she says. “I mean, these are young men and women — sometimes as young as 19 and 20 — who may need life-long care. Who is going to take care of the tens of thousands of heroes from age 19 to 90-plus?

“Most service members would trade a limb in a second for their brain injury. There hasn’t been one person who hasn’t brought up the subject,” she says. They tell her that no one can see what’s wrong with them, no one recognizes their service or sacrifice because no one knows they’re hurt. If they act out, people just think they’re crazy, drunk, or lazy.

Mild TBIs sustained in combat may not be documented, especially if the service member does not lose consciousness or is not evaluated at the time. There may be no medical record to show later when the person is acting out of character that there is an actual medical reason for their behavior.

“There are vets who are withdrawing from their wives, losing their jobs, or sinking into substance abuse because they have not been diagnosed.” says Judith. “They can’t get the treatment they need if they are not diagnosed. A Sailor or Coast Guardsman in combat is less apt to notice that he’s irritable, depressed, angry, or over-vigilant than when he is back home with his family or at his job. There, he realizes things are off.”

This situation can be more pressing for reservists since after six months post-demobilization, their medical care and insurance changes.

“The epidemic of warriors still under-diagnosed, untreated, and even suicidal is escalating,” she says. “We had one Sailor who was depressed, hopeless, belligerent. Nothing was helping. He was burning bridges left and right, totally out of control,” Judith says. “Later we found out he’d seen some bad, bad times in combat. He was retested and diagnosed with TBI and PTSD. He finally received the treatment he needed to recover. There are so many men and women like him who are probably slipping through the cracks right now. He was one of the lucky ones.” Her whole heart, she says, is out there for these men and women with brain injury.

What Judith hears from many of the men and women with TBI with whom she works is that they feel as if no one can truly understand them except others with TBI. Not even their loved ones no matter how hard they try. “They’ve told me that having a retreat four or five times a year for a couple of days with other veterans with TBI would help,” says Judith. “A place and a time, they’ve said, where they can let down their guard, share ideas, feel understood — fully, no shame.”

All hands on deck

Navy Safe Harbor works hand-in-hand with the medical team overseeing the care of Sailors, Coast Guardsmen, and veterans. They share information and resources and they collaborate with the doctors, nurses, social workers, and case managers to make sure no one — or no needed step for best care — falls through the cracks.

Non-medical care managers, like Judith, work with other organizations and are always seeking more ways to collaborate to help Sailors, Coast Guardsmen, and vets recover and find their way back into service or back into life in their communities. For example, there are programs like Fleet and Family Support, and others like VITAL, which provide wounded warriors with internships during their recuperation time, and education as well, so that access to federal civil service jobs and educational advancement opportunities is maximized outside the service.

Many of these programs were created in response to the 2008 Wounded Warrior Act. The program prepares service members for jobs in several fields including information assurance specialists, network operators, network engineers, software engineers, system administrators, and application testers.

Judith has also encouraged many of “her warriors” to get involved in the Warrior Games or the Paralympics. “Participating in sports and competition can be life-changing for these men and women and their families,” she says. “They may be seriously ill, have lost a limb … or two or three, they have PTSD or mild TBI but their resilience and determination are intact. We help them focus on what they can do now, this day, this minute. Having a goal helps them beat their depression, pull themselves up and work hard to return to their best selves.” Warriors’ participation in these athletic programs is also instrumental for the recovery of the family. A good race or increased confidence from training can change the mood of a while family.

“We learn more from these service members than they could ever learn from us,” she says. “These guys — and girls — in the Navy and Coast Guard are the most gracious people I have ever met … selfless, dedicated, resilient, and incredibly committed to their country. The first thing most of the wounded warriors do when they open their eyes is ask how their buddy is or when they can get back to their unit or vessel.”

All systems go

One Sailor Judith worked with had been medevaced to the psych ward at Bethesda. Along with his physical injuries, he had been diagnosed with adjustment disorder. “He was a basket case,” says Judith. One day, he broke down and said, “Who would want to hire me?” During their conversation, Judith found out that he had sustained two TBIs in combat and had received a Purple Heart but had been too sick and listless to relay any of this to his doctors. When he finished recovering from his physical wounds, he enrolled in the Navy Safe Harbor Anchor Program — a program that matches a Sailor or Coast Guardsman returning to his local community with mentor volunteers who provide local support and assistance. With this peer support, he started kayaking again, something he had always loved. He began to feel better, more hopeful; his self-esteem returned. He now has his own business advocating for wounded warriors.

“That kid is an example of how the system can work. He was saved from becoming another statistic. By helping him talk through some of his non-medical issues, we found out he had mild traumatic brain injury, which requires specific treatment, present and future,” says Judith. “If only he’d had a Harry Potter scar, we would have been able to help him more quickly.”