Disclaimer: The primary characters in this story belong to Janet Evanovich. I make no money for this work.
A/N: This will be a multi-chapter AU story. It will be a realistic look at the problems that plague veterans, particularly newly discharged veterans, and the VA system. As always, it is a Babe story. Joe will probably not be featured at all. I'm hoping to post at least weekly. I hope you enjoy it.
I was late again. My boss hates me and he makes it his business to hang around in the area of my office until I show up. I jumped out of my car and took off running for the building. Several vets were outside smoking and waved and called out greetings.
One, whom I had known for several years said "I saw you drive in on two wheels so I had Oscar go and hold the elevator for you." I smiled at the man in the wheelchair and said, "You're the best, Isaac." He grinned back and said, "Anything for you Ms. Plum." I ran for the elevator and thanked Oscar as well. Thank God I had worn tennis shoes today.
I finally made it to the acute psych unit and went through the first set of locked doors and entered a hallway of several offices. Mine was the second on the right marked "Unit Social Worker." As I approached the office, I noticed that my door was open and my boss was sitting in my chair. Stepping in, I took a deep breath and said "Good Morning Derek. Happy Monday."
He glared up at me and said, "Stephanie. I was beginning to think you weren't going to come in to work at all. You're 20 minutes late. Again. Would you care to explain why it is so impossible for you to make it to work on time?" I took another deep breath to keep from choking the little hobbit and said, "Well, it could be exhaustion from the 20 extra hours I worked without pay last week, or the outreach event I organized and worked yesterday."
Derek's nostrils flared and he retorted, "Regardless of your extra duties, you are expected to be at work at 8:00 sharp. One more incident of tardiness and you will receive an official letter in your personnel file indicating disciplinary action."
With that ominous statement, the hobbit stood up and vacated my office, shutting the door behind him. I sank down into my chair, my elbows on the desk and my head in my hands. Why did this asshole have it in for me? Before I could follow that question to it's obvious answer, there was a soft knock on my door.
My friend Cheryl, the unit RN, stepped inside and said, "Is Mighty Mouse giving you trouble again?" I laughed at our nickname for Derek, who was all of 5'2. "Yeah, he was waiting for me when I came in." Cheryl opened her mouth to launch into a diatribe against Derek and I cut her off. "Forget about it, Cheryl. What have we got today?"
Cheryl handed me a file. "Only one new admission. Cal Roberts. Dr. White wants to meet with him as a team this afternoon."
"Good. That will give me time to look over his history and meet with him first." I said. Cheryl stepped out and I started looking through the file. Mr. Roberts was 30 years old and had never been treated in the VA system before now. He was a Navy SEAL and had been discharged about 18 months prior. He had quite a list of honors and metals and had done two tours in Afghanistan and three in Iraq. He now works as some type of security expert for a company called RangeMan, LLC. He was apparently involved in apprehending an intruder and the incident triggered memories of something that had happened while he was in the military.
After the incident at work, Mr. Roberts began experiencing classic PTSD symptoms: lack of sleep, loss of appetite, extreme anxiety, hyperawareness, etc. His employer had apparently convinced him to seek treatment.
I logged into my computer and checked my email. I also logged into the electronic record to check out how Mr. Roberts had been doing since he was admitted on Saturday night. His picture popped up and he appeared to have a huge tattoo of a flaming skull on his head. Like a lot of OEF/OIF*** veterans, he looked very intense. Not someone you would want to meet in a dark alley.
Looking through the nurse's notes, I saw that Mr. Roberts had not been a behavior problem over the weekend. Instead, he had completely isolated himself from his peers, remaining in his room except for meal times. He was also only eating about 25% of his meals. Hospital food is certainly not the best in the world, but this is a big guy and he would lose too much weight and muscle mass eating that light. I made a note to have the dietician do a consult with him as well.
I looked through the records to check on how my other patients had done through the weekend. There were no major problems, so I got my things together and went to the unit to meet Mr. Roberts.
I used my key card to step through the second set of locked doors and waved at the nursing staff as I made my way to Mr. Roberts' room. I stopped on the way to speak with several veterans and listen to complaints and concerns.
I approached Mr. Roberts' room and was surprised to find Willie, one of the PSA's, sitting in a chair outside his door. "Hey, Willie, is he on one-to-one?" *** I asked.
"No, he's just very jumpy and he's such a big guy that we were afraid there would be trouble if one of the other patients wandered into his room by accident. I'll go in with you, Steph."
I shook my head and said, "No, that's okay. We'll be fine." Willie looked doubtful, but said, "I'll be right here. Yell if you need anything." I nodded and knocked on the door. I cracked the door opened and called, "Mr. Roberts?"
I stepped in and looked around. It was a private room and very typical of an acute unit. The room had been stripped of any material or furnishings that could be harmful to the veteran or staff. There was no glass or mirrors. No curtains that could be used as a hanging device, no ceiling tiles that could be removed, no sharp edges on the furniture, no lamps or heavy framed pictures on the walls. Also, there was no door to the bathroom. Instead, there was a special, lightweight vinyl curtain that was incapable of holding any weight.
I called "Mr. Roberts?" again and he stepped from behind the bathroom curtain and stood and stared at me. Geez, he's huge. He is about 6'5 and very broad. He was lightly tanned with brown eyes and a bald head. The flaming skull tattoo was brightly colored and extremely prominent. He was barefoot and wearing green hospital scrubs. He looked scary as hell, but I made myself smile and said, "Mr. Roberts, my name is Stephanie Plum and I'll be your social worker while you're here." I reached out to shake his hand and he stared at me for a long moment before he took my hand and shook it gently.
"Can we sit down and talk for a few minutes?" I asked. He gave me a brief nod and sat on the edge of his bed, leaving the only chair in the room for me. "Mr. Roberts, as I said before, I'll be your social worker while you are here. Part of my job is to meet with you a complete what's called a Psychosocial Assessment. This assessment helps your treatment team look at your particular circumstances and determine the best course of action for your treatment. However, the best information comes from you. You are the most important part of your treatment. We will complete your treatment plan with you and the final course of action is always up to you. We meet with you to provide you with options and to discuss those options and answer any questions you may have. Before we go any further, do you have any questions so far?"
He lowered his head and seemed to be lost in thought for a moment before he looked up and said, "Do I have to stay here?" I gave him a small smile and said, "No, you're not a prisoner and you're not under an Order of Commitment. You do not have to stay. However, we may be able to help you if you do choose to stay. I know it's hard to be here. Everything is taken away from you and you're behind locked doors. The doors are necessary for the patients who wander or are a danger to themselves or others. We do want to help you and I believe we can."
Mr. Roberts gave a brief nod and said, "My boss thinks this will be helpful, but it's making me awful jumpy to be locked in here. I can't see what's going on around me and I can't stand that."
I nodded and said, "That's certainly understandable. I wouldn't like it either. It's sort of like driving through a dark tunnel and seeing things fly by you, but you can't make out who or what those things are."
He looked up at me then and said, "Exactly. I feel out of control. With the type of work I do, that's unacceptable. I could end up hurting someone if I'm out of control."
"Is that why your employer convinced you to check yourself in, he was afraid you would hurt yourself or someone else?"
Mr. Roberts nodded and said, "Yeah, that's part of it. But we all live in the same building, so there's no hiding what's going on. They see that I'm not sleeping or eating like I usually do." I nodded and said, "That's part of what I'm here to talk about, the situation that caused you to admit yourself to the hospital. First, though, your treatment team meeting is scheduled for this afternoon. Is there anyone you would like me to ask to come, maybe a friend or family member?"
He shook his head and said, "No, I would rather my family not know that I'm here. My boss could come, though." I nodded and looked down at his file again, "Is that the person you listed as next of kin, a Carlos Manoso?"
He nodded and I assured him that I would call Mr. Manoso and invite him to the meeting.
"Mr. Roberts…" He interrupted to say, "Please call me Cal." I nodded and we proceeded to go through his history, from childhood to the military. He had not had any major problems until about 6 months before his discharge. He was in Iraq and his SEAL team was assisting in capturing a high value target in Baghdad. The intelligence was faulty and the team was caught by a roadside bomb. The bomb killed two members of his five-member team instantly. A third was badly wounded and he had walked two miles with that team member on his back, only to find that he was dead when they arrived at a medical unit.
At the end of the story, Cal said, "If I had moved faster, if I had had the sense to spot that bomb, my team wouldn't have been decimated. I live with that everyday." Cal went on to explain what had happened at work to trigger the memories and symptoms. "The company I work for provides security to private and corporate clients. We also apprehend local, state and federal fugitives. One of the guys we were after had spotted a tail when one of the guys was following him. He didn't know who it was, but set a bomb at his front door. When we went to the door to pick the lock, the bomb exploded. It wasn't a very big bomb and no one was injured, but I heard the loud sound and all I could see was what had happened in Iraq. I freaked out. I grabbed my partner and threw him over my shoulder and took off running. I didn't stop for two miles. He was screaming the entire time for me to put him down. I thought he was injured. I was trying to get him to safety. Some of the guys must have understood what was happening, because they cut me off with a vehicle and the boss came towards me with his hands held in the air in front of him. I remember seeing his lips move, but I couldn't tell you what he was saying. I noticed him nod at someone and the next thing I knew, I was out for the count. He had the company medic give me a sedative from behind."
He took a deep breath and I waited patiently for him to continue. "That was about three weeks ago. Since that night, I can't settle down. I can't sleep. I can't eat. I pace all night. Any loud noises startle me. The boss pulled me off of field duty and I've been watching monitors and taking care of the cars. It's quieter that way, but with the amount of men we've got in the building, something is always going on. There are always loud noises and people coming and going at all hours. I don't know what else to do."
I offered him a smile and said, "What you've just explained sounds like classic Post Traumatic Stress Disorder symptoms." Cal looked alarmed and I held up my hand to stop him. "Don't be alarmed by the medical term. This is very common in combat veterans, particularly within the first few years after discharge. It is terrifying mostly because of the loss of control, but you can get past it. You can learn to control your reactions and feel like yourself again."
Cal looked hopeful for a moment, but then said, "I don't understand why this didn't happen why I was still in Iraq. Why now?"
I explained, "You didn't notice a difference in Iraq because in combat situations you're supposed to be hyper-alert and hyper-aware. During a long tour of duty it becomes normal to you. Some experts believe that PTSD is the body and minds way of returning to the state you were in while in combat. While it certainly feels like a loss of control to you, it's a defense mechanism that is activated when you feel threatened."
We sat there for a few minutes and I waited him out. Finally, he said, "What can you do to help me?" As scary as this man looked, he was clearly terrified about what he was going through. I felt a surge of sympathy for him and said, "Well, there are several options, though first, the psychiatrist, Dr. White, will probably want to put you on medication." He looked ready to argue and I continued, "The medication does not have to be long term, but it will help you start sleeping again and feel a little more in control, so that other options can be explored as well. Don't worry, we'll go over all of this at your treatment team meeting this afternoon." He nodded and I said, "Unless you've got any more questions, I'll let you get some rest. I'll contact Mr. Manoso to invite him to the meeting."
Cal stood and walked to the door with me, "Thank you, Ms. Plum." I smiled and shook his hand again and said, "Call me Steph. I'll see you in a few hours."
I walked back to my office and got ready to type up his assessment. I pulled out his next of kin information and called his employer. I sat and played with my curly hair while waiting on him to answer.
A/N: I've listed a few definitions below, just for clarity. Please read and review.
OEF/OIF – Operation Enduring Freedom and Operation Iraqi Freedom. This is how veteran's who fight in each war are classified.
One-to-one – One staff member per patient. In psychiatric units, a patient is put on one-to-one if they are deemed to be a danger to themselves or others.