America’s Service Men and Women
From October 2017 until September 2018, I was the massage therapist at the USAF’s Pain Management Clinic at Joint Base Elmendorf-Richardson (JBER, pronounced jay-bear) on the northern edge of Anchorage, Alaska. The Air Force is new to Pain Management, and JBER is their first and only pain clinic. I was the only massage therapist working for the USAF in the world.
Needless to say, this was quite an honor, opportunity, and challenge. It was an honor representing my profession and serving Active Duty and US Air Force, Army, Marine Corps, Navy, and Coast Guard as well as the Royal Canadian Air Force. And National Guard members, too. The JBER Hospital is the largest and best-equipped military medical facility In Alaska and draws patients from around the state. Filled with art and less than 20 years old, it’s a dazzling facility by almost any standard, most likely owing in good part to our late Senator Ted Stevens’ tenure as Chair of the Senate Appropriation Committee.
For those not familiar with JBER, civilian Anchorage occupies the southern half of the Anchorage Bowl, the wedge of relatively flat land at the head of Cook Inlet, bounded on the east by the Chugach Mountains, on the south by Turnagain Arm, and by Knik Arm on the north. JBER occupies the northern half of that wedge and contains most of what’s left of the Bowl’s undeveloped land. As US military installations go, JBER probably ranks in the top 2% of the most scenic and desirable posts--assuming one is not allergic to cold, dark, bears, moose, and mosquitos. In other words, patients either love it and are planning to retire there or hate it and are desperate to leave.
The ever-present Military Police make JBER a relative haven from Anchorage’s crazy drivers and opioid epidemic. During lunchtime walks from the clinic, while the world’s most advanced aircraft roared overhead, I might see moose, fox, coyotes, bald eagles, black bear, or grizzlies. A given commute might feature the Chugach Range silhouetted against dawn’s early light, platoons out for a 7 AM run, a flight of F-22s taxiing into position for full-afterburner take-off, or a brief interruption: All traffic halts, wherever it may be when the national anthem is broadcast at 5 PM. Most drivers don’t even bother to use their flashers.
The Pain Clinic shares an extension off the Hospital’s Lynx wing with the Traumatic Brain Injury Clinic. Admission to our clinic begins with a referral from the service member’s primary care physician, after other attempts to reduce or eliminate the pain prove fruitless, and ends with an examination and interview with our medical doctor or physician’s assistant. Patients have a say about whether they would like an exclusively medical or alternative approach or some combination. The doctor produces a treatment plan based on the patient’s history, goals, labs, x-rays, and MRIs. Needless to say, demand far exceeds the number of appointment slots available. Patients often waited months for a first appointment and might get transferred to another base before their turns ever arrived.
Medical treatment consists of various procedures, such as nerve blocks and steroidal injections to calm down the nervous system in the hopes that this will allow healing. Our Complimentary and Alternative Medicine (CAM) treatments consisted mostly of acupuncture and manual therapy, with some counseling which was mostly screening, yoga, and meditation.
Pain is a complex and mysterious beast, varying greatly with the individual. Therefore, some people whom one might think should be in excruciating pain are relatively symptom-free, while others who seem to have no obvious reason to be in any pain whatsoever are virtually incapacitated. Every individual is… well, individual.
My job was to use manual therapy to reduce patients' pain. While massage can help reduce pain, CranioSacral Therapy, Visceral Manipulation, and Myofascial Release generally are more likely to find and treat the cause of the pain, thereby eliminating it which was always my goal. I had several other goals. In addition to trying to discover common patterns, with the hope of improving patient care and preventing injuries and illness, I was determined to provide patients whatever tools they needed to heal, to return to duty, and stay healthy.
Of all the personnel patients encounter during the military service, I was probably the best positioned to attain those goals. My treatments ran 45 minutes—3-4 times longer than other treatments, and I am licensed to touch. The combination of hands-on and face-time made for an unequaled opportunity to build trust, intimacy, and collaboration. This often translated into progress.
Therapeutic bodywork has another advantage, namely that while our stories are in our head, our history is largely in our tissues. When we find that history and revisit it, the passage of time often allows us to see it in a new light, and better positions us to write new, healthier endings. We are also better positioned to make healthier choices in the future. Indeed, after several treatments, some of my patients were able to envision a future they could look forward to where before they could not. This was one of the most exciting and rewarding aspects of my time at JBER.
The challenges were multiple. For starters, many of our patients had very complex histories. Their pain often stemmed from multiple injuries and emotional traumas extending back years. Dysfunctional families, adverse childhood experiences, sports injuries, and the indiscretions of youth, often compounded or resurrected by one or more accidents in the service, often untreated or misdiagnosed, so that more damage was done and the pain pathways in the nervous system were wider, deeper, and more persistent.
We’ve all heard of the Peter Principle. Military life presents it on steroids. In addition to the usual opportunities for injuries associated with everyday life, military service provides almost infinite possibilities multiplied by many factors largely beyond the control of the injured person.
I’m not referring to the hazards associated with combat. Instead, I’m referring to arbitrary, capricious, and sometimes punitive quotas, deadlines, customs, and procedures all compounded by the lack of freedom to question orders and superiors, let alone actively disobey them. In other words, much of what we treated could have been foreseen and should have been prevented, which isn’t all that different from what shows up in a civilian emergency room. The main difference is the many tasks unique to the operation and repair of military equipment. They’re working on it, but technology always produces unforeseen consequences.
Much of the pain we treated stemmed from back injuries from too much lifting and carrying or operating too much heavy equipment. At our clinic, the US Army Airborne personnel seemed to have it the worst. There are so many, many ways to injure oneself jumping out of aircraft. Then strap an extra hundred pounds of gear on the body. You can get sucked out of the aircraft when not prepared or knocked unconscious on exiting or on landing. Chutes may fail to open. In addition to the peer pressure associated with all units, in the Airborne, it’s jump or hit the road. Jump at least once a month, even with herniated discs or vertebral fractures. No jump? No jumpers’ pay. No jump? Enjoy civilian life, soldier. Too often, those are the only options. What would you do?
Most of us would rather get a magic bullet from the doctor or numb out rather than look under the hood and confront our deepest wounds and revisit our worst moments and poorest choices. Often, the exhaustion of medical options is what drives civilians to my office. The same is roughly true for service men and women. In many ways, the Pain Clinic is the last best hope of avoiding a medical discharge for those who want to stay in the service.
The bravery of military personnel is legendary. Their sacrifices in training and combat for their country and companions are well known. It takes no less courage to look within and heal. Perhaps even more so for military personnel who have been trained to ignore pain, be stoic, and sweep insults, injustices, and injuries under the rug. Whiners need not apply.
One of my most important jobs is to create the safety and space my patients need to do their work. I’m humbled by the courage my patients showed me every day. I’m deeply grateful to have been a small part of that for them. My only regret is that I couldn’t have helped more of them.