Davis, Charlotte BSN, RN, CCRN; Brothers, Kandie MSN, RN, CNL; Miller, Diane BSN, RN
As a member of the U.S. Army, 26-year-old Jessie had volunteered for all four deployments to volatile war zones. During Jessie's fourth tour, he was deployed to a high military conflict area where improvised explosive devices, or IEDs, were buried under the road. As Jessie's military jeep drove over the buried IED, a loud explosion was heard. Jessie awoke intermittently to immense pain over the next few days. He would later learn that the IED had severely damaged both of his legs, which were amputated within the first hour of the explosion to improve his chances of survival.
Although Jessie's dedication and sense of honor to his country never wavered, something within him changed. Newly diagnosed with posttraumatic stress disorder (PTSD), Jessie struggled with all social interactions. He found it difficult to go out in public after returning to civilian life. Although there had been no changes to his home since he left 6 months before, Jessie said he felt like a square peg trying to fit into a round hole. He was anxious and always looking over his shoulder. Nightmares prevented him from getting a full night's sleep. After spending so much time in a war zone, he had become vigilant 24/7 against a potential attack. Jessie knew that his fears were unrealistic, but he couldn't control them when he left his home. So he came up with the obvious solution: He would never leave his home except for necessary medical visits to the local hospital.
His youngest sister Amy was graduating from high school as valedictorian in 2 months and the entire family begged him to attend. Jessie said that normally he would've been over the moon with excitement at the thought of attending his sister's graduation, but things had changed. He was certain that something bad was going to happen if he left his home. He had taken medication and talked to therapists, but he wasn't improving—his nightmares were getting worse and he wasn't attending his physical therapy sessions to learn how to properly utilize his prosthetic legs, so he was limited to his wheelchair.
I first met Jessie at the Army hospital rehabilitation center. During our weekly case conference with the healthcare team, all the nurses began brainstorming about how we could get Jessie to come out of his shell. I had recently read an editorial on the benefits of a therapy dog for PTSD veterans like Jessie. The use of therapy dogs has been highly successful in reintroducing veterans back into society by shifting the veterans' focus from themselves to the dogs. Many veterans with PTSD who don't respond positively to medications or therapy often respond quickly to an external distraction. After the distractor has them routinely refocused, they become less and less fixated on their anxiety and unrealistic fears. After receiving the green light from Jessie's family, the healthcare team, and our administration, I contacted the VetDogs program to see if Jessie qualified for a service dog.
The representative from VetDogs indicated Jessie was the perfect candidate for a service animal. However, we had one more hurdle to jump: Jessie had to want the dog. Applications needed to be submitted and 4 weeks of on-site training was required—500 miles from Jessie's home. I asked the program director to send us pictures of the two dogs he felt would best meet Jessie's needs, and the entire healthcare team developed a game plan for the next session with Jessie.
Left alone with Jessie in the exam room, I remained visually fixated on my computer screen. Clearing my throat, I said, “Oh my goodness, aren't they adorable?” Jessie immediately wanted to see what I was looking at. “Oh, nothing,” I said, “It's just this new program we have that provides service dogs to our vets with PTSD.” Jessie quickly hopped off the exam table into his wheelchair and was immediately peering over my shoulder. He said, “I thought service dogs were just for veterans who are blind.” I replied, “No, we've been providing service dogs for combat vets with PTSD for the last 2 years.” I kept looking at the computer screen as I spoke with Jessie, “Oh my, they have a chocolate Lab and a golden retriever for adoption if they can find an eligible veteran. They're so beautiful!”
Jessie was moving his wheelchair back and forth behind me saying, “Let me see. I like Labs, let me see.” Trying not to smile, I moved aside so he could view the pictures of the two dogs. Jessie immediately locked his gaze on the chocolate Lab. He asked, “What's his name?” I clicked on the picture to enlarge it. “Sarge,” I said. Jessie exclaimed, “I want him. Seriously, I want that dog. I'm a combat vet right? I have PTSD right? I want that dog. Can I see more pictures of him?” We quickly browsed through all 20 photos of Sarge as I explained the VetDogs program to Jessie.
I informed him that he would have to travel to the training center for 4 weeks and caring for the dog would entail routine veterinarian visits and walks, which meant he would have to complete his physical therapy to utilize his prosthetic legs. Jessie said, “I can do that. I can do all of that. Look at him, he should be my dog. I think this dog was meant for me. My Sarge.” Jessie's PTSD had already taken an immediate backseat to Sarge.
Figure. A service do...Image Tools
I made my way to the exam room door and gave the signal to the physician and Jessie's family that it was okay to come in. As I turned back around to inform Jessie that his family and physician were returning, I noticed he had already dialed the phone number from the VetDogs website. By the time his physician and family walked the 20 steps to the room, Jessie was already providing them with the physician's fax number for the application to adopt Sarge.
When Jessie's mother entered the exam room, he immediately told her, “I'm getting a service dog. Look at this guy. His name is Sarge. I have to get a veterinarian for him. Hey doc, they're faxing an application to you for my service dog, Sarge. I need you to hop onto that right now. I have to go get my basic training for my dog. I may be gone up to 5 weeks.” The physician went over all the ins and outs of the program, they completed the application, and 48 hours later Jessie was on his way to receive his “basic training” for Sarge.
Three months later, the door opened and a smiling Jessie walked in. Yes, walked in on his new prosthetic legs! He was proudly holding Sarge and introduced him to all the office staff and every complete stranger in the room. Jessie told us about the journey he had traveled with Sarge and how after they were home, he completed his physical therapy and was now able to walk steadily with his prosthetic legs. He said that he had to complete the physical therapy so he could learn to walk Sarge around the neighborhood each morning and night because Sarge was much too handsome to be limited to the backyard. Every time Jessie felt anxious, Sarge would snuggle into Jessie's neck, demanding Jessie refocus his full attention on the dog.
Jessie's sister accompanied him on this visit. She said she was delivering her valedictorian speech when she noticed a side door open and to her amazement, her brother walked in with Sarge. She showed all the staff pictures of her graduation with the whole family present—Sarge included. She hugged all the nurses and said, “Thank you for bringing my brother back to us. You guys gave us Sarge and Sarge healed my brother's broken soul.” As we went over Jessie's medical needs, the decision was made to taper him completely off his anxiety medications.
Both Jessie and Sarge are doing well. Jessie has a job helping other vets transition back into civilian life, and each day Sarge accompanies him to work. Two years later, Jessie is still bringing in pictures that we look forward to viewing at each visit. The latest pictures were of his wedding. And, yes, Sarge was there, complete with a black bow tie!
As a nurse, I've learned that sometimes healing a patient's spirit begins with looking at solutions outside of the box. For each patient, we must find the unique key that unlocks his or her barriers.
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