By Kendra Deja, LCSW, MSN, GNP-BC, ACHPN
Jim was a 67-year-old Vietnam Veteran with stage IV lung cancer who was admitted to the hospital for difficulty breathing. I was a palliative care social worker sitting at his bedside, tasked with helping him “make a plan” in the absence of any close family or friends. Jim had a weathered face and embodied the “rough-around-the-edges” toughness and bravery that I encountered from many veterans during my career in the VA. Jim had had a hard life, made more difficult by substance abuse and homelessness after Vietnam.
I can’t do this. I can’t die, do you understand?
As I sat there next to Jim, watching his chest rise and fall with each labored breath, I discussed some of the options for care as he faced the imminent end of his life. In the midst of this conversation, Jim slowly sat up and reached for my hand. I offered him my outstretched hand in return, which he gripped with veracity. Looking straight into my eyes, Jim’s own eyes filled with terror as he said, “I can’t do this. I can’t die, do you understand? You don’t know the things I did over there, the things I did in Vietnam. I don’t know what’s going to happen to my soul.”
Veterans possess some of the best qualities that define human nature: sacrifice, loyalty, bravery, duty, respect, and love of country. Every veteran, no matter where or how they served, sacrificed their own time and freedom to serve in the United States military. In my 10 years of working in the VA system, first as a palliative care social worker and then a palliative care nurse practitioner, I found that there was no great privilege than serving those who served.
I also learned quickly that some veterans’ experience of war creates trauma that impacts the way that these veterans approach their own impending deaths. Many combat veterans, like Jim, were deeply affected by their experiences of war and fearful of their own death. The experience of taking another’s person’s life in combat weighed heavily on them as they faced their own mortality.
However other veterans were like Thomas, a Marine Corps veteran who had a different perspective on his experience in Vietnam….
Thomas was a 58-year-old man who came to the VA for medical care related to his newly-diagnosed ALS. The VA had determined that Thomas’ ALS was caused by exposure to Agent Orange in Vietnam, and thus, was eligible for VA care for the rest of his life.
As the palliative care nurse practitioner, I met Thomas after one of his neurology appointments to discuss new challenges that he was having with swallowing solid food. Talking about his trouble swallowing led to an important discussion about how, at some point due to the progression of the ALS, Thomas would lose the ability to swallow food and fluids. We discussed how some patients with ALS opt for a feeding tube at this point in order to prolong their life for months or even years.
I’m ready. I’m not afraid to die.
With a raspy, but strong voice, Thomas looked at me and said, “Here’s what you need to know about me – if we’re going to work together on a plan. I’m not afraid to die. My platoon leader sat us down within an hour of arriving in Vietnam and told us that half of us would not make it out of Vietnam alive. He was right. In my time there, I saw people being killed all around me. What you need to understand is that I thought that I was going to die in Vietnam, so every day since then as felt like a gift. I’ve had much more time than I expected. I’m ready. I’m not afraid to die.”
Every veteran is unique in how their military experiences affect their lives. Jim and Thomas had very different stories about how combat influenced their coping and functioning long after they left Vietnam. However, because of the presence of palliative care at the end of their lives, Jim and Thomas’ stories both ended with a comfortable and dignified death on their own, very different terms.
Whether you are a staff member at the VA, or work in a community health care organization that cares for veterans, all health care professionals can benefit from education about how palliative care can reduce suffering and improve quality of life for veterans like Jim, Thomas, and countless others.
The CSU Shiley Institute for Palliative Care offers many different courses on palliative care with topics ranging from the clinical provision of palliative care to self-care practices for health care professionals. All of the Institute for Palliative Care’s courses aim to enhance the practice of physicians, nurses, nurse practitioners, physician assistants, social workers, chaplains, case managers, and mental health counselors who are working with both veterans and non-veterans alike to deliver palliative care across diverse health care settings.
Please check out our courses at https://csupalliativecare.org/programs/or call our office at 760-750-4006 if you would like more information about how palliative care can improve the lives and the care of veterans that you care for.
Learn more about Kendra here.