Helping Veterans Reclaim Their Identity One Role at a Time
Dr. Shane McNamee of the Richmond VAMC talks about helping each veteran transform from a patient with complex injuries back to an individual with many roles — Marine, father, husband, son, athlete, artist ...
Medicine is funny in how it deals with people. Medicine tries to take very complicated patients and make them less complicated patients. Unfortunately people get stuck in those roles. What we try to do--and it's a big task--but we try to take less complicated patients and help them become very complicated people again--try to help them break out of this cycle of potentially disability and the patient role and the need for the physician or the medical team. We want them to be able to throw us off and to move on in life. To get a person there, you have to know who they are. You have to know what the roles in their life are. You take someone who's had a severe blast exposure event with a bad traumatic brain injury, with say musculoskeletal wounds and an amputation and physical wounds. The moment that that injury happens, they completely lose their person. They lose their identity as a Marine or a soldier or sailor, their identity as a father and as a husband and as a son. It markedly changes their identity as an athlete or a musician or an artist. All these different things that make us up all of a sudden quickly disappear, and they become a complicated patient laying in a bed. What we try to do is rebuild those roles one by one--keep their military identity there, because it's who they are very much so. Get their loved ones at the bedside and help rebuild that relationship not as caregiver and patient but hopefully as husband and wife. I can remember sitting out on the lawn and throwing a ball back and forth with a kid and his father. I caught the ball and handed it to his father who was half blind, and he was throwing it back to his son again. So that ability for dad and son to spend some time and for son to see dad and say, "He's going to be okay." I remember this specific case again, and we've known this family for a long time now, and I would consider them very good friends at this point. The son was having a lot of trouble in school, and this was years after dad got hurt, and his wife brought him in and and said, "Can you just talk to him for a little while?" It wasn't moments before or moments after I shut the door that this 11-year-old kid--tough kid--always calling me names and you name it. Moments after I closed the door he started weeping. "I'm afraid my Dad's going to die. Tell me my Dad's not going to die. Tell me everything's going to be okay." So to take that service member or patient or person or somebody who's outside of the VA and in the civilian life and to really help someone get better again, we have to make them people again. Being people is not easy. It's complicated. We go to work. We have headaches. We have inability to pay bills, and we challenge and we struggle. And we need to expect those same things from the people who have entrusted us their care. So in the VA, we preach and hopefully practice a holistic model of care meaning that it's not conveyor belt care. Everybody doesn't get the same thing at the same time. We really try to help get what's there to help people move forward. So you have to know them. Like I was mentioning to you earlier, we had a wedding at the hospital--2 of them now I guess. I walked the mother of the bride down the aisle in my white coat. She came over from Germany and didn't do it, but it was important for that service member to stabilize that relationship and to do it at that point, so what we can do to rebuild those roles with people, hopefully we will do.
Posted on BrainLine September 28, 2012.
Shane McNamee, MD serves as chief of Physical Medicine and Rehabilitation at the Richmond VAMC and has worked extensively on the development and implementation of the Polytrauma System of Care in the Veterans Health Administration.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.