Above all else, the TBI doctors and therapists at the US Department of Veterans Affairs listen. They learn what makes each injured person — and his family — tick, so they can help put them back together and return them to a full life. "This is about getting to know the person and his family, his support team ... this is individualized care, it's not conveyor-belt care."
[♫Music♫] [Shane McNamee, MD] When someone's laying in bed with their hospital gown on, and we see them come in here for the first time, they've been reduced. Their roles have been taken away from them. They can't hold their children. They don't necessarily have the same relationship with their spouse. Their parents have a tendency at times, wonderfully, to step in and support, and they've got a tremendous medical team around them, but their roles have kind of melted away, and they've become this one singular being, which is not who they are. So what we try to do is, hopefully, listen to what they have to say. Listen to what the problems that they're having in their own voice and listen before you speak and address the problems that they have, so you can gain their trust and their faith and really get to the heart of things. Then we begin to slowly rebuild their roles. [Mark Bender, Ph.D. - Neurophychologist] Everybody in our program has a brain injury. We definitely have individuals who are common injured and then those that were injured stateside, and that could be from a variety of reasons. Motor vehicle accidents are one of the most common. [Michael Clark, M.D.] In Afghanistan and Iraq, we have people with very severe, typically, head injuries or polytrauma, multiple kind of damage, very severe damage who are admitted as inpatients typically in our polytrauma units, and pain is almost universally part of their problem. The other group are those people who are not wounded as severely or may actually lack evidence of the tissue wound, but come back from deployment with evidence of a mild TBI and may have a number of other complaints, most typically headaches. [♫Music♫] [Major Kevin Farrell-Military Liason] I've never seen a treatment or prosthetic device denied if the member would benefit medically from it. I think he's young. He had the kind of injury that he can continue to recover from over long periods of time, and I would never say that there's a definite cut off. [Spanish interpreter] You have family members who are in denial. They're really having a tough time accepting the new reality of the condition of their loved one, in most cases. Most of our guys are young, and they're often accompanied by their mothers or the fathers, and I can't tell you how many times that I can see the sigh of relief when they get off the plane at the airport, and you see the look of relief on the family members face when they see that uniform marine officer standing there to greet them. We meet them at the airplane. We put them on the ambulance. Often times, we'll bring the family members in our government vehicle back here to the hospital, and we're with them from the time they land until the service member is in the hospital in their bed, in their room. It's a rollercoaster ride. [Marta Riquelme, RN] Families are one of our key elements in our rehabilitation comprehensive program because family is the base of the emotional-social-psyc aspect of our therapeutic approach. So we want to integrate the families in any way possible, and families are usually part of everything that we do here. When somebody is injured significantly, it's not only they that are injured, their loved ones and caregivers and whole family supports are injured as well. We're blessed that when people come down to our facility that we're able to not just accomodate family members, care givers, and loved ones, but we're really able to integrate them into what we do. They can stay on campus here with us. They're encouraged to participate in the therapies. They're really encouraged to be part of the team. Jay, Jay, talk with me here, okay? Are we doing blinks these days? Blinks. Hard blink for yes. No blink for no. Yes is a pretty firm blink. Give me a yes. So as individuals get admitted to our polytrauma unit, Is your pain here? we develop the treatment relationship and the treatment plan. We always try to communicate with people early on that this is individualized, that the recovery plan and rehabilitation and the medical issues and the things that we're going to address are really individualized to every specific person. I always say this isn't conveyor belt therapy. To be able to use that relationship and set that relationship of one of trust and to really help gently lead people through these issues. You know--we hear about how modern healthcare is so rushed and it's such a challenge. Well, in rehabilitation medicine, your job is to actually get to know this person and as many aspects of them as you can as well their family and their support teams and their employer and their coworkers and all that and to really understand what makes this person tick, so that you can put them back together because it isn't just a single pill or an exercise or an injection or x-ray that's getting these people back together. It never works like that. What you need is someone who can really facilitate all these things coming together, and to do that you've got to get to know the person, and that's what I just totally love. This is going to feel funny, okay? You'll feel like your brain is buzzing. Not too bad. Nothing dangerous. The guys with the craniectomies with a piece of skull missing from their brain-- they get very nervous about going to a barber. Barbers get nervous because the skull isn't there, so it gives you an opportunity to actually sit and talk to them. And when you talk, you don't always talk about medicine and you don't always talk about their issues or their symptoms. You talk to them as people. Where do you want the fade to start? They usually brought it up like 2 fingers above the ear. So the approach that we take is relationship-based medicine. It's not a medical care team that is outside of patients lives and only see them briefly during periods of the day, but it's about getting to know them, knowing what their strengths are, knowing what their current struggles are, knowing what their goals in life are and what motivates them. I don't really believe in miracles. I think they happen one day at a time. But I could see why people would call some of these things miracles, just from the point A to point B has been unbelievable. The steps in between are the ones people don't see, but I can understand why they'd say that because it truly is miraculous to see the recovery that some of these folks have been making. Every time I see someone who has a significant disability, to me it's just seeing the little things that you and I often take for granted. It is to me the biggest thing that our patients have to do all the time. [♫Music♫] It's food for the soul to see these guys recover and accept the reality of their new life and not give up. They never say die.
Posted on BrainLine November 23, 2011.
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.
Excerpted from the United States Department of Veterans Affairs. Used with permission. www.va.gov.