City Matters: Little sleep for Vietnam vetMARK HAYWARD
New Hampshire Union Leader
August 06. 2014 7:14PM
SLEEP, WE all know, restores. And Warren Fisher certainly needs some restoration.
The 62-year-old, who lives in a campground just outside Manchester, has struggled with anger issues, depression and suicidal thoughts.
His truck-driving jobs have come and gone, petering off when work dries up or when he tells off his boss. His relationships are as steady as his work; he’s been divorced four times, and his last romance ended in April with a restraining order.
You could say these last couple of years have been a nightmare, one that the Vietnam veteran hopes to vanquish with a good night’s sleep.
Fisher said he’s been waiting 19 months — since December 2012 — for the Veterans Administration Medical Center in Manchester to provide him with a Continuous Positive Airway Pressure machine.
The machine, about the size of a boom box, opens airways for people with sleep apnea. After all sorts of distractions and lost faxes, Fisher got his CPAP on Monday.
Fisher tells a story that jibes with tales of VA incompetence we’ve heard this year, stories about people dying while waiting for care, about the resignation of the Veterans Affairs secretary, and about something so bad that it prompted an unworkable Congress to actually do something and pass reform legislation.
His tale — most of which is verified in his medical record — contradicts the rosy findings of a June audit of VA regional facilities. The audit found short wait times at the Manchester facility for first-time appointments and nearly all patients seeing a doctor within 30 days.
In Fisher’s case, the long wait wasn’t for a doctor. It was for his sleep machine.
“That’s my medicine, and I scream for medicine,” Fisher, who goes by the nickname Fish, said this week during an interview at Lake Massabesic park. He spoke on Monday, hours after the VA finally provided the machine he had asked for 1 1/2 years ago.
He first got a CPAP in 2008, when prescribed by a sleep doctor in Florida. A New Hampshire native, he returned here two years ago. He visited the VA that December to say his CPAP machine had broken, and he wanted a new one.
Since then, Fisher said, he has gotten by on three or four hours of sleep a night. Not three or four hours straight, but three or four hours interrupted by sudden breathlessness.
“Your emotions go up and down,” he said. “It affects your mood. When you’re tired, everything pisses you off; when you’re super-tired, you’re pissed off even more.
“It’s not just anger. You start crying,” he said.
Fisher served in the Coast Guard in Vietnam. He said his gunboat often shelled enemy positions, and another problem includes hearing loss.
To review Fisher’s medical file is to understand the complex cases the VA deals with.
His most recent printout lists 23 specific health problems. He takes more than a dozen medications for ailments that include diabetes, hypertension and cholesterol.
Recent records show three or four visits to the VA each month for the past two years.
His record includes the Dec. 17, 2012, request that the VA made to his Florida doctor for results from a 2008 sleep study. Fisher said the Manchester VA sleep doctor would not give him a new CPAP without the sleep study results from the Florida doctor.
Handwritten notes show the Florida doctor twice sent the paperwork to the VA, the more recent in May 2013. Still, no CPAP.
“There could have been a breakdown in communication. We’re not saying it did (happen), we’re not saying it didn’t,” said Will Gagne, staff assistant to the director of the Manchester VA. Gagne said he could not speak about a specific patient, but he spoke in hypotheticals and generalities.
He said it’s not uncommon for the VA to receive a fax with little information, other than a patient’s name.
The medical information on the fax is entered into a patient’s file, but sometimes there’s no indication why the information was needed, Gagne said.
(Fisher insisted his VA sleep doctor said the VA wouldn’t pay for a new sleep study. The VA’s Gagne said he’d be surprised if the VA would want a 4-year-old sleep study rather than just order a new one.)
Meanwhile, Fisher went through a difficult time.
In November 2013, he was brought to the VA after he got fired and said he wanted to die. The following April, he had suicidal thoughts when his girlfriend left him.
During other visits, he asked the VA for stronger sleeping pills. According to his record, he made no inquiries about the CPAP machine until July 2014.
“I was concerned about other (health) problems,” Fisher said. “I kept on waiting (for the CPAP machine).”
He said his lack of sleep is to blame for his recent problems, and he thinks sleep problems contributed to earlier problems in his life, which include feelings of depression and hopelessness.
Although Fisher visits the VA a lot, he does not come across as someone who over-doctors and doesn’t take charge of his health. In the last two years, he’s lost nearly 80 pounds, and at 6-foot, 2-inches, he’s a muscular 210 pounds.
He doesn’t smoke, and his VA record shows no problems with alcohol or drug abuse.
His life may be turning for the better.
A stepdaughter has moved to New Hampshire with her children to be close to him. He’s taking an anger management course at the VA. He went back to work recently. And on Tuesday night, he slept four to five hours — a little longer than usual, although he said the sleep was erratic.
The machine will need some adjustments, as will he.
“People at the VA, in their defense, they’re overwhelmed. It’s all about money, budget cuts,” Fisher said. And the country has changed from the late 1960s, he said, when gas was cheap and everyone pitched in to help each other.
“My belief in God is more than my belief in my country now,” he said, “It’s sad because I went to Vietnam and fought for my country.”
Mark Hayward’s City Matters appears Thursday in the New Hampshire Union Leader and UnionLeader.com. He can be reached at firstname.lastname@example.org.