Dr. Peryakoil, thanks so much for highlighting some of the variables that can be present when caring for Veterans in general and particularly when the Veteran and their family support systems. It is important for a colleagues outside of the VA to be aware that when it comes to hospice approximately 96% of Veterans get their Palliative and EOL care in the community at large. We who interact with Veterans and their families are aware of the special needs they may have and through education and experience have developed skills and a companion empathy that is necessary if we are to be successful in facilitating our Veterans the opportunity to express those issues that may be related to the experience of guilt and/or shame when following order was in conflict to their personal sense of doing the right thing. Your emphasis on the intra-professional team approach and adaptations needed to meet the bio psychosocial needs has a potentially strong influence on pain and symptom management beyond opioid and anxiolytics which can have potentially positive influence on reconciling moral injuries that can profoundly affect the quality of life and the peacefulness of death.
Developing trust is the first step to potentiating a positive clinical and personal experience in eliciting those military historical events that may be impacting the Veterans current state of health. Questions like: Did you serve in the Military? Which branch of the armed forces did you serve with? Was/Is there any particular event or experience that affected you then or now that you would like to share? And once you have presented the question or questions do the next right thing …be silent and patient to allow the Veteran to determine if you are safe enough to share those experiences.
Each of the wars has created both common and unique experiences: The Greatest generation of World War II, the forgotten warriors of Korea (who were left with a cease fire agreement) or the much maligned Vietnam Veteran who did not win the thanks of a grateful Nation for nearly half a century. We do not know yet how our Gulf War and Iraq/Afghanistan Veterans who frame their experiences overtime. Gratitude is an action word. It is enough to say “thank you for your service” or to apply a sticker to your bumper that says “support our troops”. It is much more inconvenient to translate those catchy phrases into clinical acumen and skill in treating and attending to those that have born the wounds of battle and their survivors. Thanks once more Dr. VJ for your unflinching support of our Veterans in both word and deed.
Charlie Antoni, LCSW, ACHP-SW
Palliative Care Coordinator
OVAMC