5 East and the Hunt for Rehabilitation
Apr 27 2011
By Patty Horan
In 2007 Capt. Pat Horan was shot in the head while serving in Iraq. This is the conclusion of a four-part series about his wife, Patty’s, journey as his full time caregiver following his injury. Patty is a member of MOAA’s 2010-2011 Currently Serving Spouse Advisory Council and serves on a caregiver focus group. She also contributed to the creation of the Department of Defense TBI caregiver manual. This is her story.
Part I – The Call
Part II – The First Day
Part III – The First Step
Once on 5 East Surgical Ward at National Naval Medical Center (NNMC), Pat was paired up with a 24 year-old army officer, who had also sustained a severe TBI. He had many visitors including his young wife who was nine months pregnant.
Thankfully most of the tubes, monitors and machines from the ICU were gone. A Navy Corpsman was assigned to monitor our room 24 hours a day. This was to prevent injury, incase either of them decided to try to get out of bed. The corpsman was also on guard, checking for any signs of distress or discomfort. Nurses were still in and out constantly doing checks, administering medicine and attending to their wounds.
Time and Therapy
It’s amazing how the effects of a penetrating head injury can be so different from patient to patient. Pat, who had a blow to the left side of his head was unable to speak, move the right side of his body and was only awake maybe 2 – 3 hours a day. While the other soldier, who had a right frontal injury, had full use of his body, was blinded, disoriented, combative, and could verbalize his thoughts. On our side of the room we spent hours trying to keep Pat engaged and awake. On the other side their goal was to keep the LT subdued. Over the course of three weeks on 5 east the men slowly recovered. Their wounds were healing, trachs came out, a baby girl was born, and they started occupational therapy , physical therapy and speech. Soon we all turned our sights to rehabilitation; it weighed heavily on all our minds.
Pat was in very bad shape. I knew our choice of rehab hospital was critical to his recovery. My goal was to find a place where Pat and I could feel comfortable, a place that had a brain injury program we could put our trust in. Our case manager at NNMC presented us with four options: Richmond, Tampa, Minneapolis or Palo Alto VA Polytrauma Centers. Oddly enough, the week we hit the 5th floor, The President’s Commission on Care for America’s Returning Wounded Warriors was published. Pat’s brother Richard brought it in to me in the hospital. In that draft we found Recommendation #3 it stated, “ DoD and VA must rapidly improve prevention, diagnosis and treatment of both PTSD and TBI.” This made me very nervous given the choices our case manager had presented.
Scouting Rehab
I felt, to make a sound decision, I had to go and see for myself, meet the staff and get a feel for several facilities. So, Pat’s sister Megan and I sat down and created a week’s agenda to visit six rehabilitation centers across the country. Jeanie our family liaison connected me with The Walter Reed Society who generously covered my travel expenses.
With my mother-in-law’s help, I made a list of questions to ask the admissions directors at each hospital.
- How many service members have you treated?
- Do you have private rooms?
- What is the average stay of in-patients?
- What sort of therapy do you offer? and how many hours a day?
- Do you specialize in TBI?
- What security do you have?
- What is the average age of patients?
- What assistance do you have for family members?
We also created a chart to help us compare and contrast all the programs.
The six rehabilitation hospitals I investigated were National Rehabilitation Hospital in DC, INOVA Mount Vernon in Alexandria, VA, Tampa Polytrauma VA in FL, University of Washington Medical Center in WA, Casa Colina Centers for Rehabilitation in CA, and The Rehabilitation Institute of Chicago in IL. Some we chose because they were close to home or Fort Lewis, others we found by reading stories of brain injury recovery on Caring Bridge web pages.
Picking a facility
After a week of interviews, travel and site visits I settled on RIC in Chicago. It had most everything I was looking for, a private room with a beautiful view of Lake Michigan, a locked down brain-injury unit with average age of patient being 35. They had experience with the army and TriCare. RIC also had a dedicated brain injury team, a huge assistive technology center. They offered music, recreational and dog therapy and had a cutting edge research lab on the top floor. There was also an underground tunnel to Northwestern, a renowned medical center. It was in a big city. I could stay in walking distance of Pat and have everything at my fingertips. To top it off we had a few friends around town as well.
Convincing the Case Manager
The next step was to convince the army it was the best place for Pat in hopes that RIC would accept him into their program. Our case manager was not happy with my decision and spent a week trying to talk me out of it. She warned me that it would be a mistake to leave the support of the army. She said it would be very hard to go out on my own to a private facility. She kept asking me why the VA wasn’t a better option. I held firm in my decision, our neurosurgeon supported us and she finally faxed Pat’s medical records over to RIC for approval.
In several days we heard back and Pat was in! Next a medivac was to be scheduled and in the meantime, Pat’s brother Chris, his mother and I closed out our non-medical attendant (NMA) orders with finance. We all filled out our DD 1351 Travel Vouchers and were quickly reimbursed for our stay at the Navy Lodge. We were also were allotted six weeks of per diem, which was about $68 a day back in 2007.
Once out of the acute stage, service members are only allowed one NMA so Chris and Mary Jo headed home and I was to remain as Pat’s primary NMA for the remainder of his recovery.
The scheduling of the medivac became very complicated. I am sure you can imagine, here you have a soldier in a navy hospital, dealing with army finance asking the air force to give us ride to a place they don’t usually go.
The Long Journey Begins
On the morning of August 23rd, Pat’s 35th birthday, I appeared with two suitcases in hand at Pat’s bedside at 4:00am. We were off to Chicago, ready to begin the long process of brain injury rehabilitation.
Patty Horan is a member of the 2010-2011 MOAA Currently Serving Spouse Advisory Council.
