Behind every staffing vacancy in VA’s spinal cord injury centers lies a veteran at risk of receiving inadequate care
Solitary confinement is a form of punishment and sometimes torture, and regardless of why it’s used, it can have severe negative psychological effects.
Debates are ongoing about the ethics and legality of solitary confinement, but I believe most people will agree that it’s cruel. So, why do we do it to ourselves?
Because sometimes we just need a break from the kids. After spending the day with my two daughters, I look forward to some “me time” after they go to bed. I need that daily dose of solitude to maintain my sanity, but sometimes too much solitude can lead us into some pretty dark places.
In 1991, I was in the intensive care unit (ICU) at Balboa Naval Hospital in San Diego. I had just broken my neck in a parachuting accident, and I couldn’t feel or move anything below my chest. My head and neck were immobilized with something only Dr. Frankenstein or Pulitzer Prize-winning cartoonist and inventor Rube Goldberg could create.
I had cranial tongs affixed to my skull with pointed screws and some kind of cervical traction device that relied on a system of pulleys and weights hanging behind my head. I certainly wasn’t going anywhere anytime soon. I was confined to my bed and surrounded by curtains.
The curtains provided a sense of privacy, although they did nothing to buffer the incessant clamor of a hectic ICU. The noise was inescapable. I don’t remember what kind of pain medications I was given, but I do remember my imagination ran wild. I could hear the conversations among the clinical staff, even though their medical jargon was foreign to me. I remember hearing a woman crying and expressing grief when the patient in the neighboring bed passed away. Cell phones and Wi-fi didn’t exist back then, so I had no contact with the outside world. I asked myself, “Does my family know that I’m here?”
An overwhelming sense of isolation began to take root, followed by paranoia. I began to question my treatment and wondered why my doctor had condemned me to solitary confinement. A state of fight-or-flight was emerging, which conjured up uninvited memories of some training I had gone through while in the military.
Just a few months earlier, I had attended the Navy’s Survival, Evasion, Resistance and Escape (SERE) training program. Perhaps the most memorable part of SERE was the so-called “POW (prisoner of war) camp experience.” It simulated captivity and the psychological challenges of being held against one’s will.
A hood was placed over my head, and I was jammed into a 3-by-3 foot box made of concrete blocks. Confined to such a tiny space while wearing the hood, I was unable move or see. To make matters worse, a recording of a screaming baby was played incessantly, all while I was deprived of food, water, sleep and human interaction.
By the following day, I had convinced myself that I didn’t like being confined to little boxes, so I schemed a plan to escape. However, before I could carry out my great escape, the training came to an end, and I was rewarded with a peanut butter and jelly sandwich.
That training was supposed to prepare me in the event I was captured and held captive by an enemy. But what if I was being held captive in a hospital?
Well, with that in mind, I schemed a plan to escape from Balboa Naval Hospital. First, I had to disconnect myself from that medieval contraption around my head and neck; second, jump out of bed; third, bust through those flimsy curtains; and lastly, rendezvous with my friends at McP’s Irish Pub and brag about my brilliant escape while enjoying a peanut butter sandwich.
The first part of my planned escape went well, but the second part proved to be more problematic. Who knew getting out of bed with a broken neck could be so difficult? The sound of the weights hitting the floor alerted the nurses, so any hope of celebrating with my friends that night was lost.
Not to be deterred, a second attempt was made the following day with the same results. It was determined that I was not being compliant and needed to be restrained for the duration. Fearing being left alone with my hands tied to the side bed rails, I tried to negotiate with them. I promised to cease all attempts to escape my cell, as long as a nurse was at my bedside 24/7. Needless to say, I was restrained.
After four weeks of captivity and two surgeries, I was transferred to the Department of Veterans Affairs’ spinal cord injury (SCI) center located just a few miles away to begin my rehabilitation.
I was placed in a large room flooded with sunlight coming through a wall of windows. It sure beat the light from the florescent tubes above my bed in the ICU. And my new digs included an en suite bathroom with a shower — something that had eluded me during the previous four weeks.
There were three other patients assigned to my room who were willing to share their experiences, and volunteers visited from the local chapter of Paralyzed Veterans of America. Sure, there were curtains for privacy, but they were rarely utilized. Despite the constant flow of people, the noise levels were negligible, and nobody was having a near-death crisis.
The new vibe was positive, and my arrival at the SCI center brought an end to the monthlong saga of isolation and all the crazy stuff that came with it. It had been a long time since I had felt that optimistic about anything.
It’s embarrassing to put all these crazy memories in writing, but I have to admit it’s been good therapy. During those first four weeks of being a quad, my emotional state was very unstable as a result of the isolation. My behavior in the ICU might be considered by some as irrational or silly, but when it was happening in real time, it was absolutely frightening.
No doctor would recommend isolation as a means to heal or rehabilitate. Post-traumatic stress disorder (PTSD) symptoms are common among those of us with a traumatic SCI. PTSD symptoms can lead to social isolation, which in turn worsen PTSD symptoms; we’re inadvertently creating a self-reinforcing loop.
Nowadays, when I see my fellow patients hide behind their curtains, I try not to judge. I’m guessing it’s their way of coping with excessive worry. But that isolation can also lead to serious and unintended consequences.
I know there can be many reasons why patients choose not to venture beyond their curtains. I just hope someone is paying attention.
As always, please let me know your thoughts at al@pvamag.com.
