Saturday, March 3, 2012

The Lowdown On Being An Outpatient

I read emails and comments from people who have walked this path previously, but Derek commented that he felt they were exaggerating as to how intense it was.  Let me set the record straight.  This is not an exaggeration.  This is the down and dirty truth about the start of the journey as an outpatient.

Of course, this is our experience and the way that I have seen things, thus far.  I have heard from others that they had similar experiences.  I spoke at length to a mother and fiancee on Friday who gave me their experiences, and, so far, it feels the same as what we are experiencing.  Depending on your Warrior's level of functioning, both mentally and physically, your experience could be quite different.  The important thing to remember is that you are finally on the next leg of this journey.  Also, you have one month to complete the Warrior In-Processing, and you need to relax and take your time.

While an inpatient, the Warrior goes to the Matc for a few hours (generally two - an hour of OT and an hour of PT) and then can "relax" in the hospital room for the rest of the day.  Of course, there isn't much rest in the hospital with the revolving door, but you do not have to go anywhere.  As an outpatient, you leave your room in the morning and for six to seven hours, you are on the go.  It strains the nerves and drains the stamina.  Derek was quite overwhelmed his first day, as were we all.

When your Warrior is first released from the hospital, the WTB and the Squad Leader are supposed to help you not only remove all items from the hospital room, but make sure that all of your belongings are removed from the Navy Lodge or Fisher House or wherever else you might have been staying.  Although the Squad Leader was quite helpful getting the items removed from Derek's room, we received no help removing our belongings from the Fisher House.  Actually, I was harassed during one of Derek's appointments to get my things out immediately, after I had been previously told I had the weekend.  I could not leave Derek's appointment at that time, so we had to wait until his appointments were completed at 1515 (3:15 p.m.).  We were offered a van, but only until 1500 (before the end of Derek's appointments), but not offered bodies, that we really needed to help us remove our things.  In the pouring rain, Krystina, my Dad, and I removed all of the items from the Fisher House.  It was a lot.  Over the past seven months, people gave us a lot of stuff.  We both arrived with two small bags.  We were then brought down winter clothing by our families.  We also received clothing, blankets, bags, games, etc. from visitors and care packages.

The day you are actually released, you first meet with the Squad Leader who briefs you on what is expected of you as an outpatient and gives you forms to complete.  Please remember that you have one month to complete everything, and you need to go at your pace.  If the squad leader or anyone else rushes you, tell him/her to take a chill pill and relax.  Tell him/her that you will get it done, but that your Warrior's well being is paramount.  Sometimes the people with whom you are working forget that.  Sometimes they are wonderful, but sometimes....

First of all, accountability is very important, as it was in the regular military before the injury. Your Warrior is expected to call the Squad Leader every morning before 0730 to let him/her know that he is still alive and well.  You may make the call for him.
Your Warrior is also expected to attend formation.

Formation for the Marines is every morning, in uniform, at I believe 0800 or 0730.  The Army has formation on Monday and Friday at 0830 and on Wednesday at 0900, at least Battle Company does.  There are three companies for the Army - HHC, Able and Battle.  HHC is for inpatients and those in transition for the first month.  Of course, appointments take precedence, unless otherwise advised, so if there is a scheduled appointment, formation may be missed.  If it is a manatory formation, appointments must be rescheduled.

Your Warrior is most likely already scheduled to attend the Matc for OT and PT every day.  As an inpatient they were more lenient with missed appointments.  Not so much as an outpatient.  Also, as an outpatient, your Warrior is now expected to spend more time in the Matc working out on his own.  During this time, you might be able to escape for a little while, since it is not always necessary to hold his hand while he works out.

Your Warrior is required to attend several appointments in the first month and obtain signatures after the appointment or briefing.  There are about 27 signatures required.  Those signatures include the Warrior Clinic, 24 hour risk assessment by the social worker, 3 day risk assessment by the social worker, mail room, dental, nurse case manager, finance, solder assistance center, unit billeting, tricare, AW2, OT, etc.  Some of these can be completed before discharge, but that information was not provided to us.  Some of the signatures can be obtained in the New Warrior Briefing on Friday mornings at 0745.  The New Warrior Briefing should take care of 9 signatures.  The Briefing takes about two hours and must be attended during the first month.

In the first twenty-four hours, you must go to the Warrior Clinic, see the nurse case manager and squad leader, and have a 24 hour risk assessment.  In addition, you are expected to make your appointments at the Matc.

Thereafter, your Warrior is scheduled for appointments with the various medical teams involved in his care, such as Ortho, Endrocrinology, TBI, etc., in addition to the appointments required to obtain the needed signatures.  These appointments are made by the nurse case manager (NCM), who will work with you.  If your Warrior is not up to more than one or two appointments in addition to the Matc, tell the NCM and he/she should be accomodating.  Capt Bowser certainly is working with Derek.

An additional appointment that might be necessary and is not part of the check list is with DEERS to renew the ID card and the AKO.  Without an active ID card, many of the appointments cannot occur.  We are going on Monday, hopefully, since our day was a little too busy Friday. We also hope to get to the mail room and obtain not only the required signature, but a PO Box.  Also on Monday we have the Matc and the three day risk assessment with the social worker.  Another long day.

The meeting at the Warrior Clinic is with the new PCM (Primary Care Manager).  As an outpatient, your Warrior has almost all new doctors.  Some of the doctors in various services might stay the same, such as ortho, but for the most part, a new team takes over the outpatient care.  Thankfully, Derek will still be followed by Dr. West, the only doctor who has been a member of Derek's team since the beginning.

As an outpatient, your Warrior no longer sits in the hospital room and has labs, x-rays and doctor appointments at bedside.  You must now go to them.  Derek is going to be seen at wound care, Matc, Warrior Clinic, Wheelchair Clinic, Amputee Clinic (PM&R), TBI, Neuropsyche, Endocrinology, Ortho (for ongoing treatment on his hand), social worker, and any other service determined by his NCM and PCM.  Each Warrior has different services that he must see.

The NMA is expected to attend all appointments.  This makes it quite time consuming and stressful on the NMA.  Many of the warriors have diffculty with memory, whether it be from TBI, PTSD, anxiety, or the medications, so the NMA is an invaluable asset.  The purpose of the NMA is to assist in keeping appointments, attend to the daily needs that your Warrior cannot do himself, etc.  Some of the NMAs have more responsibility than others, due to the level of care the Warrior requires.  Basically, the NMA is agreeing to put aside his/her own life for the period of time that the Warrior requires care.  A job, schooling, etc. is not possible when he/she is required to accompany the Warrior to all appointments, and make sure all needs are met.  This is why the NMA is entitled to a daily allowance.  NMA orders are issued on a thirty day basis.  The NMA can be alternated so that one does not become too overwhelmed, and to allow the NMA to travel home, see family, attend to his/her own needs, etc.

On the plus side for NMAs, there are a lot of caregiver events and benefits that the SFAC, Yellow Ribbon Fund, and NMA Caregiver Support Group, as well as others, offer.  These include spa days, movies, dinners, lunches, etc.  One thing that the NMA must insure before attending, though, is that the Warrior's needs are met and he will not be in danger while he/she is away.

We have spent one full day as an outpatient, and it was overwhelming.  We have 5 of the 27 signatures we need, but we also have four weeks to obtain them all.  We almost had another one, but Derek's ID card is not working, so we have to go to DEERS on Monday (hopefully).   Just one more stop to make.
Friday, Derek went to wound care, OT, PT, Dr. West, the Warrior Clinic, and met with the pharmacist to input all of his medications.  We left the room at 0900 and returned at 1700, after completing all appointments and emptying the Fisher House.  To say we were all tired on Friday night is an understatement.

This weekend, we are relaxing, unpacking, organizing, and recouping for a busy week ahead.  We all got to sleep in this morning.  Derek and Krystina had a relaxing weekend on Derek's first overnight pass last weekend, but since I was at another hospital with Ryan, this morning was the first morning I was able to sleep in since Derek was injured.  It was heavenly.

Now a look at the accomodations of Building 62.  The Warrior is given a two bedroom apartment.  There is a full kitchen, a living room, two bedrooms and two bathrooms.  One bedroom has a double bed and the other has a single bed.  The beds are lower than regular beds to allow them to be more easily accessible to those in wheelchairs.  There is a TV, computer and printer in each bedroom.  Each bedroom has a large, walk-in closet and a bathroom with a large shower. 

The living room area has a reclining chair, couch, TV, DVD player, and a small table with two chairs.  There are also lamps, side tables, and an alarm clock in each bedroom and the living room, as well as a landline telephone in the living room. 

The kitchen contains the following:  microwave, dishwasher, refrigerator, six pots/pans (all on the smaller side), and four each - bowls, plates, mugs, small plates, knives, forks, spoons.  There are also two towels, two washclothes, and two hand towels, as well as one set of sheets for each bed.  The checklist we were given listed 10 oz and 14 oz tumblers, but our apartment does not have them.  The SFAC has some cleaning supplies that you can get, and there is a vacuum cleaner at the front desk that may be signed for when needed.

o set up the apartment, you will need to get paper products (toilet paper, paper towels, etc.), food, towels, laundry detergent, dishwashing liquid, etc., since all of these things are necessary but not provided.  Many people also get additional items for the kitchen, such as mixing bowls, serving spoons, carving knives, crock pot, toaster or toaster oven, coffee pot, etc.

The Warrior Cafe is downstairs where the Warrior can eat for free with his meal card, but sometimes it is just nice to have a home cooked meal.

That's the story, morning glory.  I've tried to give a comprehensive look at the first stage of outpatient, and the apartment.  Hope this helps those of you coming behind us to know what to anticipate, and to know what you need to buy to set up the apartment.  If I've forgotten anything or if there is a particular question that you have, leave a comment and I will do my best to address it!

Thank you for continuing this long journey with us!  We are closer to the top than ever before.  Climb to glory!  All the way!  To the top!  I'll meet you there with a cold drink and a big smile.


  1. mama mia! that's quite a schedule!! hope you get to sleep in again sunday morning. congratulations on outpatient status -- it sure would be nice if everything were less of a challenge at this point. i hope at least someone helps you get the stuff all the groceries and other supplies you need. (or am i dreaming...??)

  2. Praying for you all as you take this huge next step... For peace and provision...

  3. Wow, you've made it to the next leg of the journey. Congratulations! I was so glad that you explained where you are staying and what it's like. When you mentioned that you and Krystina had to move all of your things out of Fisher House, I started to wonder where you were going. I'm glad to hear that the 3 of you are all together!

  4. Continuing to pray so very hard!
    Psalms 28:1-2 Unto thee will I cry, O LORD my rock; be not silent to me: lest, if thou be silent to me, I become like them that go down into the pit. Hear the voice of my supplications, when I cry unto thee, when I lift up my hands toward thy holy oracle.

  5. Went through this experience with the VA at Vanderbilt a couple of yrs ago with my uncle. Do you have any family close? That makes things much easier. Would carry meals up there daily and do their grocery shopping for them. He had AML, and then my aunt ( his caretaker) had her rotator cuff fixed so I ended up living in the apartment with them and caring for them both. Was tough bit well worth it. Wouldn't trade the time I got with my uncle that summer before he passed. Make sure you are taking good care of you too so you can take good care of your warrior. Will keep you all in my prayers. May God bless you and keep you in his arms during this long journey.