Manchester V.A. Medical Center Town Hall: “Things Have Changed”
Pain is what brings someone into a hospital, typically. One could say, pain is the driver of the vehicle that is the healthcare industry. When one hears the word “pain” one thinks of physical pain, but many a visitor to a hospital carries along with them another passenger, it too called pain. That fellow traveler, psychic pain.
For veterans, it is one of the things that they carry with them, for a lifetime. It has many roots — surviving where one’s buddies did not. Serving in a war that half a century later most people still don’t understand the “Why” let alone “How” as in “How did things become FUBAR?”
The phenomenon that is the stepping into the role of soldier, sailor marine or airman when one signed on to the rolls of military personnel — either voluntarily or against one’s will in the days of the draft — means that somebody becomes somebody else. You’re never the same.
You’re never a civilian again, never quite “civilian” again, even when returned to the ranks of civil society. There is a veil drawn between you and those that haven’t served. You have been Beyond the Pale. Psychically, some part of you, some part of what some may call your soul, is forever serving Beyond the Pale, whether you recognize it, or not. Someday, that reckoning will come, when the burdens of the things that you carry bring you to a veterans hospital.
You are always on duty. Along with the memories, and the physical injuries, part of your “gift” of military service has been the conditioning of the soldier, sailor, marine or airman. There will always be part of you on active duty, long after your hitch in the service is over.
Pain is one thing. Suffering is another. Many veterans can handle the pain. But the suffering. That’s a bitch.
Things Change
I grew up on the West Side, which was in many parts and in many ways a French-speaking town inside the City of Manchester. I’ve met, at the Manchester V.A. Medical Center, self-described “Frogs” who were drafted out of “The Flats” to serve in the Asian war. Though in the place where they were shipped to, Francais parlez ici — as signs taped to the store front plate glass windows of many a business on the old West Side assured potential patrons in those days — the former French Indochina was very very far away from The Flats, a francophone neighborhood on the “wrong side” of the Bridge St. Bridge, located Beyond the Pale of Manchester proper.
Bulldozed in the name of urban development along with the old Modern Theatre, The Flats is a neighborhood that no longer exists. It once was a primary part of the once-beating heart of the Queen City’s le petit Canada. Little Canada, or “Frogtown” to the less enlightened and mischievous, was the birthplace of the first American credit union, a Quebecois institution brought south to the Lower 48 by “Frogs” crossing the very porous New England border looking for work. The “Frogs” couldn’t get credit from the Anglo-Saxons, so they pooled their own resources. And while the Anglo-Saxon institutions the savings and loan association and the old federally chartered savings banks offering 4.5% interest on every dollar beginning with the first on deposit went the way of the dodo bird, broken by scandal during the administration of the first Bush to be president, the French-Canadian credit union survives and thrives.
Anglophone America in the guise of a huge Texan with flapping ears as big as those of the beagles Him and Her he kept at the White House sent West Side Frogs to serve colonial duty in Indochina, a mission America took over from the departing French. The real French, an Empire that had been in decline since their defeat two hundred years earlier on the Plains of Abraham in Quebec City. In 1763, it had surrendered French America to the despised British, while in 1954, the French vamoosed from Vietnam after the disaster at Dien Bien Phu, a disaster nearly replicated by the “Anglo-Saxons” 14 years later at Khe Sahn. (“Plus ça change….)
I myself am part French-Canadian, though I didn’t find out until I was 18 years old. Just one of those things, eh? I took at least four years of French, never could speak it well if at all, could read French into my mid-20s. It was the language of an older generation and community I felt no connection with. (Plus c’est la même chose.”)
Many of the kids I grew up with were taught French, spoke French at home with their francophone parents, went to churches and parochial schools that were French. They could speak it, though they didn’t teach it to their own kids. Those were different times, and this was our time, and being bilingual was a thing of the past…. Such was the thoughts of the Baby Boomers. We’re Americans now. Nearly 50 years ago, the extensive system of parochial schools in America closed down, French as well as Irish — the other major ethnic group on the West Side who had their own churches and parochial schools coexisting alongside those of the French. The French-Canadian. The Frog. The word “Franco-American” wasn’t used on the West Side then, except for canned tins of spaghetti.
That world didn’t vanish, it merely went into eclipse, For there still are French Canadian francophones in and around, out and about Manchester. And the differences, the peculiarities if you will of that unique culture, that unique identity persist. And French is the language of many newer immigrants to Manchester, from the Caribbean and Africa, two areas in which American military personnel have served since the Asian War. History certainly is circular.
“Plus ça change, plus c’est la même chose.” The more things change, the more they stay the same.
That saying came to mind when I wrote this paragraph, the first paragraph I wrote for this piece, over 4,500 words ago:
“The Manchester Veterans Administration Medical Center held a town hall on Monday, July 8th, right on time, at 1730 hours. It was quite unlike the town halls that had been held before, since Al Montoya became MVAMC Director.”
Truthfully, there were things that were the same Monday as at that first town hall, which occurred in the wake of revelations of dysfunction and incompetence by The Boston Globe Spotlight Team that became a national scandal. The pain of the veterans was there. The suffering was there. But things were not the same. Things have changed.
Another aside: As I write, I hear Bob Dylan singing, “I used to care but/Things have changed.” I can’t think of any veteran who was more cynical than myself, when the scandal broke, when we found out that the pain and suffering we were going through during the previous MVAMC administration was greater than we could even think possible, though I’d hardly say we vets were surprised. We’d learned in the military that when one person is screwed in a certain way, it is a certainty that you and others will be screwed in that way, sooner or later. Still, it was appalling, the proof that the neglect was universal. It takes a lot to appall a veteran, particularly ones who’ve used V.A. hospitals dating back to the days of that Asian war.
All experience is subjective. One thing you learn in life is that no one, no one other person can really feel your own pain. It doesn’t matter if you’re a veteran or not. This is universal. No one other than yourself can feel your pain. They can try. I have met actual empaths at the MVAMC, one who saved my life. They can try, and some can come close. But no one can feel your own pain. Though god knows, you want them to. Because then they might understand….
This is not a condition unique to veterans hospitals. It is part of the human condition.
A Tale of Two Town Halls
Manchester, as in the Manchester VAMC, was not a community at the time of MVAMC Director Al Montoya’s — correction, Acting Director Al Montoya’s first town hall, held after all hell had broken lose and the previous director and her senior staffers reassigned. When The Globe blew the whistle, Manchester essentially was a bunch of individual vets, with similar gripes and experiences, but unlike a military unit, which has a life beyond its individual members — a unit is a living an breathing thing beyond the collective of individuals — there was no community in Manchester.
The difference between the two town halls was that the pain of the veterans, and their suffering, was being addressed and acted on. It’s a remarkable development. Things have changed.
MVAMC Director Al Montoya jokes that when he first met me at the first town hall, he thought I was going to hit him with my cane. Greeting me at Monday’s town hall, I told Al that I was wearing a back brace, so was a little out of sorts, as my back was out again. He said, “Since we gave it to you, I’m glad to know you’re wearing it.”
Things have changed. Things are not the same at the MVAMC. That conversation never could have happened in the past, in the pre-Al era.
When Congressman Chris Pappas asked me “Jon, how are things here?” I told him that I had been writing about veterans issues for manchesterinklink.com and that what I was writing has been positive. That pleased Congressman Pappas. I also told him about my back brace. The thing about Chris, he is so much a part of this community, he is the type of person you can talk about your back brace to, even if he is a Congressman. He actually listens.
Chris Pappas cares. And he cares about veterans. I have seen him several times at the MVAMC, seen his staffers there. I have been told he is very involved. There was a staffer from Annie Kuster’s office there, too. Congresswoman Kuster maintains a constant presence at these functions. Our senators have their hand in, too. As Carol Robidoux and I learned, when covering the rollout of the Mission Act, one of the reasons that the Manchester VAMC has been chosen to be the spearhead of the new reforms is the commitment of the New Hampshire Congressional delegation and other Granite State lawmakers to veterans and to veterans healthcare.
Chris made perhaps the shortest speech I have ever heard from a politician in the 39 years I have been covering politics, since interviewing Jerry Brown during the 1980 presidential primary. (This was the interview, in toto, shouted at him and back to me as he walked through a crush of reporters and supporters and standers-by: “What about the United Farmworkers Strike?” “I support them.”)
Chris spoke after remarks and a question and answer period with the top kick from the Veterans Administration New England Healthcare System/Integrated Services Network director Ryan Lilly, and remarks and observations by MVAMC Director Al Montoya. That in itself was unusual, a high ranking politician not taking pride of place during the gab sessions. What Chris wanted to get across to us was that he was committed to seeing we received first-rate medical care, the care that we earned and that was our right, and that he and his staff were listening to us and would help us. Congressman Pappas said he was committed to seeing the MVAMC improve its service to veterans as consumers of healthcare, mentioning that he knew how vital customer service was, being a restaurateur. One of the vets at the town hall quipped, “Why didn’t you bring some chicken tenders?”
Chris Pappas’ chicken tenders from The Puritan are not only the best in the universe, but have been the staple at many a function, be it political or charitable. His generosity is legendary. Chris smiled and pointed out that The Puritan was just down the road.
He was brief, as I said, introducing himself, telling of his commitment, and then staying to talk to the veterans after the town hall ended at 1830 (630pm to you civilians though the MVAMC does use “civilian” time reckoning). It was impressive, the commitment and concern on display at Monday’s town hall, of a congressman who serves on the House Veterans Committee, of the federal government and the Veterans Health Administration — a commitment to actually improve veterans healthcare. Things have changed, and for the better.
What did we veterans find out at the town hall meeting?
We found out we were getting a new Urgent Care facility, two stories high, with mental health units on the second floor. We found out we were getting a new parking garage (there were Huzzahs! all around — no more parking on the grass!). We found out many things that made we veterans, as cynical a community as there is, much less cynical. We found out that there were bee hives being constructed on the MVAMC campus, and Al Montoya told us how we could become a part of that.
The most important thing we found out is that we now were part of a community, a real community, that is growing at the Manchester VAMC. The Mission Act is engaging veterans hospitals with their local communities, by giving veterans access to community healthcare providers. More importantly, the Mission Act and the commitment and support of New Hampshire’s congressional delegation enables MVAMC Director Al Montoya and his staff and medical and support personnel to build bridges between veterans and veterans hospitals and the community at large. The latter is vitally important, as for far too long, the “Community at Large” has considered veterans and veterans hospitals as existing “Beyond the Pale.”
Beyond The Pale
The Pale, as many people of Irish descent and readers of Irish literature know, was the area that constituted Dublin, controlled by the English overlords for 700 years. “Beyond the Pale” referred to an outlaw territory outside of metropolitan Dublin, where English rule didn’t reach. Those living or traveling outside Dublin were “Beyond the Pale.” It was dangerous territory.
A quasi-religious metaphor often used with The Pale was that of a veil, a thin transparent fabric separating two worlds. One world could see the other through this imaginary veil, but the two worlds were as walled off as if it was the Great Wall of China separating them physically. There is a veil between the veterans and non-veteran. There are experiences that non-veterans cannot understand.
The psyche affects the physical body. Cognitive behavioral science has illuminated the link between the psyche and pain. At the Manchester VAMC, I learned Cognitive Behavioral Therapy skills to help control and lessen pain. Napoleon, who surely ranks with Alexander of Macedonia and Take Your Pick as one of the three greatest generals in all of human history, said the moral is to the physical as three is to one. He meant that soldiers perceiving themselves as fighters in a just cause are three times more effective than normal soldiers. It will take physical force three times greater to match them, let alone defeat them.
In veterans healthcare, the psychic pain suffered by veterans can be more overwhelming than the physical pain. That physical pain interacts with psychic pain, and vice versa, as it does in PTSD, makes things even more complicated. Most veterans don’t know what is going on, except that they are in pain, and that they need help, and it is hard to communicate this. Many don’t know that they’re suffering, let alone what they are suffering from. The failure to communicate can be catastrophic.
The experience of the combat veteran is something the non-combat veteran cannot really understand, let alone a civilian. James Jones, the author of From Here to Eternity, a combat vet who served on Guadalcanal, wrote in his book WWII that wartime military training and subsequent combat experience separates the soldier from the civilian, as it is akin to being enlisted in the rolls of the dead. Since a grunt or jarhead or pilot in combat could be dead at any second, the grunt and jarhead and pilot lives in a twilight world between the living and the dead, more akin to the dead in some ways than to that of the living. This is something that is impossible to understand, unless you are one of them. And then there is a problem of having lived Beyond the Pale, in this twilight world, and having to return to the Land of the Living, the land of civil society, the Community at Large. It itself is a perilous journey. Not every combat veteran who has returned to The States makes it “Home.”
I find it hard to communicate this, and wonder about the authenticity of what I have just written, as it is second-hand news. I am not a combat vet. The closest experience I had was listening in to let’s say “war games” held by the other side, and hearing men on the other side die. Like MVAMC Director Al Montoya, I was with signals intelligence and listened in on the Russians. It was it’s own education, an education in kind but not degree to the horrors of combat. (Now that I think of it, was Al Montoya SIGINT or COMINT? Acronyms abound in the military, and at the V.A. The next time I write “Community at Large,” I’m going to acronym it C.A.L.)
Al Montoya and I had had similar military experiences. I’m a disabled vet. Director Montoya was medically discharged after 10 and one-half years of military service. Like myself, he has hearing problems linked to his military service. We both served in signals intelligence (COMINT?) units, focused on Mother Russia. Me, in the Army, he in the “Chair Force.”
Al’s military service, even if it was in the Chair Force, is a plus in bringing him and the MVAMC closer to “us” — though without empathy and caring and commitment a person’s veterans status is meaningless. Al has suffered the loss of comrades in their post-service lives, which has made him extremely sensitive to the issue of veteran suicide. There are many MVAMC users who have Al’s phone numbers — all his phone numbers — on their cellphones. He has shown a real commitment to preventing veteran self-harm. Al truly is one of us.
It makes a difference.
“Plus ça change, plus c’est la même chose.” (The more things change, the more they stay the same.)
Body & Soul
“In a mad word, only the mad are sane.”
-Akira Kurosawa, Oscar-winning director of Rashomon
I’ve said pain is what brings someone into a hospital. And while Monday’s town hall was startlingly different, in one aspect, it was the same as that tumultuous first town hall under then acting-Director Al Montoya, where no one would have been surprised if a riot broke out (and nearly did). On Monday, veterans shared their pain. They shared their suffering.
The biggest issue that was brought up at Monday’s town hall had to do with the provision of mental health services at the Manchester VAMC. More than one veteran expressed the sentiment that while MVAMC staffers were polite and welcoming to those needing mental health services, the wait time for a veteran in crisis was too long. Al Montoya being Al Montoya, he immediately handled a situation for one veteran, and after the town hall, Al and his staffers went about helping others, while Congressman Pappas and congressional staffers talked to vets to find out their needs and help them.
At the first town hall I attended with Director Montoya, there was a group of individuals who were torn apart, in so many ways, in body and mind and spirit. There was no community, other than an impromptu parliament whose members aired foul grievances against The System, one after the other. At Monday’s town hall, I experienced the birth of a community.
Aside from constantly complaining about just about everything under the sun, the moon and the stars, bantering about the virtues or lack thereof of the different branches of military service is one of the many never-ending diversions of vets. I often think that veterans should officially be tattooed “BORN TO BITCH” on their left forearms on the day they are separated from military service. Now, I’m not “Navy,” but my father was a WWII disabled vet sailor, and he used to bitch about the difference between right arm and left arm rates, though I cannot remember which one was the more virtuous. His rating — abled bodied seaman — and the arm on which he wore his rating, left or right, was of course, the only virtuous one. Sailors who wore their rating on the wrong arm were bums. Explaining his own veteran status, Al Montoya told us just before the kickoff of Monday’s town hall that the real meeting was going to be the following day and for veteran airmen only. We all laughed, as we all got the joke. And the reality that underpins all humor, for a joke is only good if it is based in what is true. His experience was similar to ours, he was saying, but it was different. He understood that, and we understood.
This isn’t a joke. This isn’t “colorful material.” This is real, the differences between veterans, between themselves and their providers and support staff in their own community that is the Manchester VAMC. This phenomenon complicates things, particularly communications.
The philosophers explain that reality is socially defined. If we accept that, then one can see that there are different and differing realities one is part of, depending on the society we keep at a particular place and time. Reality is more fluid than stable, it seems. One’s past experiences are stable, in that they occurred, but while many veterans “live in the past” in the sense that those experiences define them and continue to affect their behavior — those experiences can be seared into the brain and actually continue to define a veteran’s behavior — we all, as human beings, live in the present, a dynamic and ever-changing environment.
Veterans are a culture that mirrors C.A.L. (the Community at Large). Just as the French Canadians of Manchester lived in their own world in their own neighborhoods with their own churches and schools and with newspapers printed in their own language and existed as unique community living inside the C.A.L. that was the Queen City/Manchester, New Hampshire and lived in the C.A.L. beyond Manchester that was the United States and its government and its demands, so too the veterans community deals with C.A.L. And not just C.A.L. the overall Community at Large that is the totality of American civil society, but with many other C.A.L.s, for there are many levels and layers of Community at Large in the glass onion that is a veteran’s life.
To individual vets and groups of vets whose experiences as say Marine riflemen or as combat engineers or Warthog pilots have given them their own unique culture and their own unique identities, the V.A. community at large is another version of C.A.L., part of the C.A.L. that is C.A.L. There are many C.A.L.s within the glass onion, and we can see each other, but can we hear? An individual veteran’s unique experiences define them. Those experiences create the reality in which they live their lives. And it is that reality and the peculiarities of that reality that drive their pain, the pain that drives them to a veterans hospital. They need to be understood, but where is the common language?
The lack of understanding of the unique and peculiar experiences of different veterans was an issue at Monday’s town hall, as suffering veterans unburdened themselves of their pain. Different branches, different specialties of combat arms, specialties within specialties — all have meaning to the individual veteran, meanings that complicate communication with Manchester VAMC providers and support personnel.
Les parasites
Both Al Montoya and myself were trained by the Defense Intelligence Agency to deal with communication systems. The first bridge being built to create a real community at the Manchester VAMC is one of communication. Since one cannot truly feel another’s person’s pain, since so few people can understand a combat vet’s experience, let alone their individual experience in individual units in unique and peculiar situations, communication between the healthcare provider and the veteran with unique and peculiar needs is negatively impacted by what Director Montoya and myself, coming from our military experience in signals intelligence, would call “Static.” In French, en francais, the word for static, be it on a radio or an old TV or in any system including the human body, is les parasite (plural). Le parasite is something that degrades a system, anything, not just a tapeworm sapping a human being’s bodily strength. Communications system static — les parasites — degrades communication and compromises the system. Static can lead to misunderstandings, which can be fatal during a military mission or in a hospital, any hospital.
The uniqueness of the veterans hospital and why it is essential that veterans hospitals continue to exist, is that the static that befouls communication is lower than in environments where veterans have to deal with “civilian” providers. The folks at veterans hospitals are better “receivers” of communications as they understand static and can dial it down. The staff and personnel at veterans hospitals — many of them veterans — can come closer to understanding the veterans experience, and come closer to understanding the uniqueness of the veterans pain.
Whether having served in the military or not, veterans hospital staff and personnel have greater experience in dealing with veterans, many of whom are afflicted with PTSD, both diagnosed or not, all of them affected by the condition of having served once physically and forever psychically Beyond the Pale. The new Mission Act paradigm being spearheaded here in New Hampshire represents a commitment to tearing down the wall between the two communities, that wall separating the veteran and veterans healthcare and the community at large (C.A.L.). It is dedicated to eliminating the dangerous territory that veterans hospitals became due to C.A.L.’s neglect.
Static in communications between the patient and the provider is universal. It’s not just at the V.A. but at every kind of hospital. Veterans at Monday’s town hall spoke of how civilian doctors, doctors outside the MVAMC, had a problem communicating with them, let alone understanding them. This was a problem with veterans being allowed to go out into the broader healthcare community to get care.
Responding to these revelation from veterans, V.A. New England Healthcare System/Integrated Services Network director Ryan Lilly said that doctors in the civilian healthcare system listen to their patient for only 11 seconds before interrupting them. Lilly said that the Veterans Healthcare Administration is dedicated to ensuring that the veteran patient in VHA medical facilities has all the time they need to communicate.
“Nobody said this was going to be easy,” is something I probably never heard outside of a John Wayne movie, though it seems that I should have heard it, must have heard it, while serving in the military.
Nobody said this was going to be easy. The Mission Act seeks to bind the two communities — the dedicated veterans healthcare community, which is the vital base of the provision of veteran healthcare — with the wider healthcare community. This could well be the most important development in the history of veterans healthcare since the launching of dedicated veterans hospitals in 1930.
This bridging of two communities, bridging the gap between veterans and the community at large, is a task as complicated as any undertaken by combat engineers. It is underway, and it is being done here in New Hampshire. There will be no more living Beyond the Pale, or at least, there will be a dedicated and concerned effort to rolling back the dangerous territory. The Mission Act is a commitment to helping the veteran come Home. And New Hampshire via the Manchester VAMC is a vital part of it.
What was the lesson of Monday’s town hall? For me, it was this: If this new-born community continues to thrive, if it grows up strong and healthy, the mission to strengthen veterans healthcare will succeed. This is a mission, a challenge, that New Hampshire veterans are uniquely equipped with handling. All’s it takes is leadership, and the leadership is there. Now is the time to muster the troops, and begin.
That this mission has been entrusted to Manchester, which so far has responded magnificently to the challenges, is something all of us, veterans and those who care about veterans, can be proud of it. This is a moral mission, and if General Napoleon’s insight was right, then the strength of the Manchester VAMC community is three times greater than any comparable C.A.L. And that is an awesome thought. Veterans are a great resource for all communities.
