You Can't Make This Stuff Up

The end of my VA saga of stories that shouldn't die with me.

In my previous two VA articles, I chronicled an unbelievable journey through the VA healthcare system. In this, the final article of my year-long saga, you can’t make this stuff up. Reality beats fiction every time.

When we left off, I was heading to my daughters for just over a week to await my operation at the Salt Lake VA. The staff didn’t teach my daughter how to care for my bags, tubes, and paraphernalia, but she’s resourceful, so we dealt with it. I did get my Loritab and needed it every four hours. We managed well until Sunday that week.

Mid-afternoon, my catheter fell out. Not to worry, Dr. Doogie gave my wife his private number with instructions to call if there were any problems. She called, and she did—for two hours, and he never answered. Then she called the urology floor at the VA to no avail. My daughter called a friend whose husband was an Air Force paramedic stationed at the nearby Hill Air Force Base. The paramedic promptly came over with a new catheter and replaced it. Problem solved.

Tuesday came, and bright and early, I was finally in the operating room, undergoing surgery for both kidneys. An hour after awakening following surgery, Dr. Doggie entered my room to check on me. He explained the surgery, and it went well, but he continued, “Mr. Kugler, the operation went well, but I have to inform you that you have cancer on your right kidney.” I didn’t expect that, but what to do?

I was sent home, actually to my daughters, an hour north of the hospital, for three weeks to heal from the surgery and come back to decide on my options. Fortunately, first, Doogie found the cancer, and second, it was located on the bottom of the kidney, and major surgery wouldn’t be required.

The three weeks weren’t without problems, as infections followed and issues with urinating. That led to more tests and surprises. They discovered I had a large cyst encasing my bladder. That would extend matters even further, as surgery would be required. The next three months were consumed with two surgeries. A week after the bladder surgery, I looked forward to being released and having a welcome trip home to Montana.

When the Doctor came in to discuss my release, he informed me I would have to visit the walk-in PTSD Clinic to secure my release. To say I was shocked would be a gross understatement. I realized the Doctor delivering the news was just the messenger, but I was pissed. I had previously written a letter that my daughter typed and printed for me to leave with the Administrator documenting my travails since arriving at the hospital. With the letter in hand, I set out to find the Administrator, deliver it personally now, and ask why I had to go to the head clinic to be released.

The VA complex was enormous, and I had no idea where the administration might be. I asked nurses, who all said they had no idea. I wandered around and found a janitor, who gave it up and told me where to go. I walked up, and a professional lady stood guard as the gatekeeper outside the Administrator’s office. I approached, still in my hospital gown, and explained why I was there. I requested a short audience with the main man I could see sitting at his desk.

She politely explained why that wasn’t going to happen and suggested I leave the letter in my hand to her, she would see he received it. I insisted I wanted to personally deliver it after the shit show I’d been through. She called security as I walked into the Administrator's office, where I introduced myself and handed him my letter. He did not comment as I was escorted into the hallway and back to my room.

Being a quick study, I knew that the visit solidified my spot at the PTSD clinic, so I dressed, got my papers and directions, and my wife and I headed off to find the Clinic. We were told it was in Building T-22. The buildings were all A, B, C, etc, so what is up with T-22? My wife was driving as we wound through the VA campus looking for T-22. I was pissed, but I wanted to be thoroughly pissed when I arrived. I have never been able to stand radio host Sean Hannity. I said to my wife, “Get Hannity on the radio. He will piss me!”

We wound around the grounds, and there it was, a big T-22 on four office trailers assembled amidst the vintage old buildings in all their ugliness. The paint was peeling off the sides; it was a disgrace. We parked and walked up to the building, which had a rickety deck with more peeling paint wrapping around the entrance. The entrance faced a nice new brick building, and in between was a garden by the front door.

I said to my wife, “Get a picture of this bullshit”. Before entering the door, I noticed a plaque inscribed, ‘PTSD Healing Garden’. I kid you not … every plant in it was dead—a nod and another picture. If you know anything about PTSD, having someone behind you is not a good thing. Once inside, we could see the place was packed, and a vet covered every wall with his back to the wall. The seats in the middle were placed facing one another, so close that when you sat down, your knees were four inches from the person across you.

As I walked up to the young, chipper receptionist, I knew it had better be a walk-in clinic because I wasn’t sitting behind all these folks. Facing the desk, I heard a wholesome young lady say with a smile, “And why are we here today, Sir?” I looked at here and said, “They sent me over from the medical center. They said I am fucking crazy”. Shocked, she stood and quickly retrieved a therapist. I wouldn’t be waiting in line.

Once, when I was in the office for my fifty-minute hour, the young lady said, “Well, tell me your story.” The last thing I wanted to do was repeat my hospital saga. I said, “Ma’m, if you don’t mind me asking, how old are you?” She told me, “26, Sir.” I asked if she was a psychologist. She explained, “No, she was a social worker.” I said, “Ma, I'm letting you know, and I apologize up front, that anything I say to you is not meant for you. It is my frustration with a system that would one, place you in this position, and two, would put vets in a shit hole of a place like this.”

She was a sharp young lady and a trooper, and I shared my ups and downs, tossing the Doctors from my room, and ‘English is my second language’. She nodded through fifty minutes and, without a word, picked up the phone, called, and had a discussion. Holding her hand over the phone's mouthpiece, she turned to me and said, “Would Tuesday or Wednesday work for you?” Keep in mind it was Tuesday as this was taking place.

She repeated, “Sir, would Tuesday or Wednesday be better for you?” I asked, “Would Tuesday or Wednesday be better for what?” I would now find out she was talking about Tuesday or Wednesday next week. Meaning I wouldn’t be released until then. She explained I would have to come back and talk to someone who could prescribe me medication. My red rage was no longer hanging in the wings; it flew right in. I said, “Ma’am, seriously, who is fucking crazier here? Me or you?” With that, she promptly hung up the phone, and I had her attention.

Shortly thereafter, a psychiatrist stepped in. We had a chat, and I was released with the prescribed medication. After a night at my daughter's, we headed home to Montana. I would shortly receive a letter from the VA directing me to visit a shrink in Helena at the Fort Harrison VA facility. My wife and I made the four-hour drive over for my appointment. And I reiterate … you can’t make this stuff up.

The gentleman I was meeting was old. I don’t know how old he was, but he was well seasoned, disheveled, and beyond prime. I sat down as he was perusing my paperwork. He noted, “So you were a Marine sniper in Vietnam.” I said, “Yes, two years actually.” He sat there for the longest time and asked, “Did you ever see anyone killed?” I thought he was shitting me. I said, “Sir, I was a sniper. I killed people.” He never said a word. He stared at my papers and asked a series of questions, and would fall asleep as I answered. I would wake him by raising my voice loudly when responding. It lasted maybe twenty minutes. I never heard another word about my PTSD.

Three months in Montana and it was time to return to Salt Lake for follow up on my surgeries and bladder problems. Driving to Salt Lake, I rubbed my right temple with my finger and discovered a tiny knot, like the point of a pencil, under the skin. I mentioned it to my wife, and she said, “You’re being paranoid now.” I thought maybe, but that little thing shouldn’t be there.

One thing about the VA system is that it is binary. If you are seeing them for X, don’t ask about Y. By now, I knew my way around the system well and knew it was fruitless to ask the Doctors I was seeing about my discovery. When I finished my appointments, I walked down to the ER and told them of my discovery. After a short wait, a young, one-year intern examined me.

He said, “I don’t think it is anything, but I am inexperienced. We have a seasoned Doctor here with me; let me ask him.” He left and returned with a white-haired, no-nonsense Doctor who looked over my charts and then examined me. He said, “Sir, it is probably nothing, but since you’ve recently had cancer, we owe it to you to check it out. I will order a biopsy for tomorrow.” That is the way it should work.

The next day, I show up to an oncology intern, a jovial, welcoming, light-hearted guy. He examined me and wasn’t convinced it was worth a biopsy. I convinced him to give it a shot, after all, I’m here from Montana. He agreed and called down a Doctor who would perform the procedure. The Doctor came in, felt my little knot, and said he wouldn’t biopsy something that small.

I said, “Sir, I don’t know if it is or isn’t anything serious. (reaching for my temple) But my Mother always told me that if I were to get hit with a baseball, it would kill me. So, there must be a lot of important shit running through that part of my head.” He laughed and performed the biopsy. We stayed at my daughter's just in case, and the next afternoon, I received a call from VA Oncology requesting my presence for a meeting the next morning and telling me to bring my family. That gets your attention.

The next morning, my wife and two daughters dutifully went to our meeting. In a nutshell, they informed me it was lymphoma, quite serious, and needed immediate treatment. The VA Oncologist was short, to the point, and not open to much discussion. What would turn out to be the best news was that they were referring me to Huntsman Cancer Center, a couple of blocks down the street. That referral would prove to be a lifesaver.

Huntsman Cancer Center was and is incredible. They assigned nurses, doctors, and specialists to a team. At our first meeting, the oncologist announced, “You have single-cell plasma cytoma. It is the precursor to multiple myeloma. You have one node. If you had two, it would be multiple myeloma.” I was impressed with everything except that the VA oncologist said I had lymphoma.

I pointed that out to the Huntsman Oncologist, who stood for a moment and said, “Sir, I don’t know what to tell you about that. But I can assure you that you have a single-cell plasma cytoma. It is rare; we see maybe one or two cases a year. We know what it is and how to treat it.” He later told me privately that while he did not know why the VA diagnosed it as they did, pointing out the two cancers are very different, but he knew that multiple myeloma is classified as possibly caused by Agent Orange, and lymphoma is not. Who knows?

I would spend December of that year in a motel near Huntsman and receive radiation treatment daily for thirty days. I’m cancer-free from both the kidney and the little knot on the side of my head. As for all those kidney stones, I took Doc Christensen’s advice to drink tons of water daily to flush them when they’re small, and I’ve never had another one.

The Doctor at Huntsman, also a VP at the University of Utah Medical Center, still emails and checks on me. I reached out to him when a friend of mine received bad cancer news, and he made arrangements for him to be admitted to Huntsman.

Some systems work and some don’t, unfortunately. And some things you can’t make up.