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It’ s Never All in Our Heads
by Mary Barry, MD
At long last, the CDC has in October finally recognized Gulf War Illness as a separate, stand-alone medical condition. It has been assigned a diagnostic code in the ICD-10 realm, T75.830-( the- stands for the last character which describes the type of encounter, for instance A for Initial).
More than three decades ago, these veterans were exposed to toxins released, for example, when Iraqi chemical weapons depots were demolished.
“ Veterans have been told it was in their heads. The medical establishment cannot do this anymore, now we have this code. This is an official illness,” said Ronald Brown, an Army veteran and toxic wounds specialist, as reported by Linda Hersey in the Oct. 6 Stars and Stripes. Formerly, the VA called this group of symptoms“ chronic fatigue,”“ fibromyalgia,”“ undiagnosed illness” or“ medically unexplained chronic multisymptom illness,” she reported.
As of November, however, the VA has yet to grant disability benefits based primarily on this diagnosis. Veterans’ groups will continue to lobby – they’ ve come this far – they won’ t give up now.
I have taken care of veterans as a nurse, a medical student, a resident and an internist, and it was always a privilege and nearly always a pleasure. The youngest veterans were the saddest. They had brain tumors at 24, for instance, or AIDS back when we could do nothing except palliative care. They had head wounds which had left them talking only gibberish. Their psychic scars had sent them spiraling into drinking and drugs. They had nightmares that no civilian could truly imagine. We have empathy to spare, but we will never be members of this club.
My guys at the Atlanta VA were from rural Georgia. In the main
32 LOUISVILLE MEDICINE they were reluctant to discuss combat experiences with a“ lady,” which is what a lot of them called me.
“ Hey Lady! You got my medicine?”
“ No Hank, I prescribe the medicine and the nurses bring it. I’ m your intern, Dr. Barry.”
“ We on a first name basis?”
“ Sure – you can call me Dr. Mary.”( This always made them smile, because they could make fun of my rhyming. The ones with education would immediately call me Beriberi.)
They were Southerners of a different generation and having a female doctor was simply too foreign for many to accept. They’ d be like,“ Where’ s the boss?”
And I’ d be like,“ I’ m in charge of your team. Of course, Dr. Hardison is the Big Chief – I’ m the team chief.”
“ You the little chief.”
“ I ain’ t tall, but I’ m the one who can keep you here or send you home.”
“ Oooh, you threatening me.”“ Going home is a threat? Not a treat?”
For lots of them, being with their buds was a treat. They all complained endlessly about everything, in true human patient fashion: the food, the waits, the lack of movies, the lack of alcohol, the creaky old wooden wheelchairs, the necessity of physical therapy, the quality of the canteen.
The VA in the 1980s was not paid by capacity, or for care delivered. The VA budgets were fixed by standard appropriations. Veterans’ care was solely based on historical expenditures until the 1990s. Sometimes,
OPINION