The New York Times
Monday 24 March 2008
How much more can this country keep demanding of Justin Bunce, Daniel Verbeke and Michael McMichael?
The men - a marine, a sailor and a National Guardsman - went to Iraq to fight as ordered, served honorably and suffered grave injuries. When they came home another struggle began, to find the care to make them whole again.
At a recent hearing in Washington before the Senate Veterans' Affairs Committee, the men's families told anguished tales of trips through bureaucratic hell in the transition between the Defense Department and the Department of Veterans Affairs. That terrain is notorious for its paperwork mountains and tripwires of red tape, but especially treacherous for those with traumatic brain injuries, the signature affliction of this five-year-old war.
Mr. Bunce lost an eye in a roadside bomb blast that also thrust shrapnel into his frontal lobe. His father, Peter, said his care was so "stovepiped," with nobody knowing what anyone else was doing, that doctors working on his head ignored his broken leg. Technicians nearly did an M.R.I. on his brain, not realizing - because scans had not been done - the danger from the metal in his skull. Nobody tried to coordinate his many medications.
Time and again his parents had to cross the country looking for the right therapies and treatment. Whatever expertise they found they stumbled on; there was no one but them to manage his case. The V.A. relied on the brain-damaged young corporal to evaluate his own mental state, and once sent him a letter threatening to cut off benefits because he could not manage his affairs.
Mr. Verbeke's injuries, in a shipboard accident, were catastrophic. He cannot speak or control his limbs, though he can laugh and smile. His father, Robert, told of years of battling with the V.A. over treatment, tests, prescriptions and plans for therapy and assistance at home. "They can't plan or execute," he said. "The only logical conclusion is that they just don't care."
The bomb blasts that crushed Mr. McMichael's vertebrae and damaged his brain did not take his life, at least not all at once. When he came home he seemed intact, but it soon became clear that his psyche was in shreds. His behavior put him in constant danger of losing his independence, his composure and dignity, his home, his family.
His wife, Jackie, has refused to let that happen. As a National Guard spouse not immersed in military life, she had to rely on doggedness and patience and large measures of self-tutoring. It took her a year and a half, on her own, to assemble a support network for her husband.
That forced self-reliance is the most difficult and baffling part of these veterans' struggles. Had they lost arms or legs, the process would have been much easier. But the quest for care for psychic injuries takes place on a landscape without maps. All three families said that doctors and therapists were constantly handing out business cards, friendly advice and vague offers of help, but that it was nearly impossible to find firm guidance and quick, flexible, responsive care.
At the hearing, representatives of the Pentagon and V.A. played to type, laying down a bewildering fog of acronyms and promises. Their central point was that things were moving now, that the two departments were "in the process of implementing more than 400 recommendations of five major studies."
One involved hiring eight "recovery coordinators" to oversee care for 46 people. That's a droplet of care in an ocean of need: about 3,000 veterans have sustained traumatic injuries, by some rough estimates, and untold thousands of others are afflicted by post-traumatic stress disorder.
The U.S. Naval Institute reported last month on the staggering immensity of paperwork that veterans confront. Defense Department records are on paper and often incomplete; the V.A.'s are electronic. Service members have to carry records between departments, never knowing what might be missing.
The three families in this article were unusually, perhaps stunningly, well equipped to overcome those hurdles. Robert Verbeke is a corporate executive. So is Peter Bunce, who worked at the Pentagon as the Air Force's liaison to the House of Representatives. His wife, Patty, is an occupational therapist. Jackie McMichael has a master's degree in counseling, and practically grew up at the V.A. hospital in Durham, N.C., where her mother worked.
As Ms. McMichael testified, Michael sat behind her, his back straight, hands gripping a cane and shaking so hard they looked as if they were plugged into something. Peace has not arrived for him, and may not come anytime soon.
He is lucky in many ways: he has two young children and a wife who loves him and has sacrificed so much to travel the bureaucratic labyrinth for him. It is more than anyone could ask, but far less than any wounded soldier deserves.
"I am educated, tenacious and resourceful," Ms. McMichael said of her work as a self-taught case manager. "And I was completely lost."