When she worked on a trauma floor in a city hospital, Patty Kotora saw a lot of long-term patients who had to overcome significant physical and emotional damage. “If they didn’t have insurance, they would remain on the trauma floor for rehabilitation,” she explained. “We would be their primary support people until they were well enough to go home and live on their own.”
This kind of care, while unusual in many hospital settings, prepared Patty well for her role as a Combat Casualty Assistance visiting nurse with the Navy-Marine Corps Relief Society. This year marks her 10th year in the position. Patty joined the Society while her husband, a Navy doctor, was stationed at Marine Corps Base Camp Lejeune in North Carolina. “My husband was deployed, and I was going a little stir crazy,” she recalled. “My neighbor mentioned the visiting nurse position with the Society, and I applied. I had a two-year-old and an eight-month-old at home, but I found someone to take care of them. I really wanted to get back into nursing and I thought it was the perfect job for me – helping young Marines who had been injured get back on track.” Working as a Society visiting nurse also helped Patty to get to know the Marine Corps culture
The Combat Casualty Assistance visiting nursing program was new program when Patty first joined NMCRS. She was responsible for CCA clients in North Carolina and continued to work with them when her husband received orders to Naval Hospital Portsmouth, Virginia. There were no CCA nurses in Portsmouth at the time, so Patty expanded her coverage area. She now covers New Jersey—her home state—Ohio, and North Carolina. Patty and her family have returned to MCB Camp Lejeune – courtesy of the USN.
“When I started with the Society, most of our clients were recently injured Marines who were still recovering. But today, most of my CCA clients are medically retired or veterans who were injured quite a while ago. Some have continuing medical issues that have long-term effects which they’ve been managing for several years. But often they have medical issues that have never been addressed or dealt with before they got connected with me. I provide support while also dealing with major issues when they arise.”
“Marines who haven’t addressed their medical issues for more that 10 years have a significant learning curve – for the service member and their family. I help them break down all of the services available to them and help them take this transition to recovery step by step so they can and make and reach attainable goals. That can be a long process. One of the great things about our program is that I can take the time needed to do gain their trust and help them. If they trust me, they’re more likely to trust a service officer who can help them with their VA rating or a counselor who can help them with their PTSD treatment. Developing a trusting relationship with a Society visiting nurse can translate into getting better care or even getting care at all.”
Often, when combat-served veterans have not received proper treatment over several years, their relationships with family and friends deteriorate. “Their families have adjusted to their moods and behavior, and they help the service member manage, but it can take a toll on relationships and some eventually fall apart. If the family unit down, maybe the veteran will begin showing up late to work because he no longer has someone helping him get up on time, then his relationship with his employer breaks down. These things can spiral downward many years after an initial injury.”
At the same time, Patty finds she is able to help many service members just by providing resources at the right time. One such example is a client who came to the Society for emergency travel assistance when his father died. The caseworker realized the client’s medical issues were causing financial strain on the family and connected the client with Patty. Working with the client, Patty discovered that combat-related injuries were exacerbated by untreated dental issues because he couldn’t take the time off work to get proper dental care. This was contributing to mental health issues. Once he received financial assistance to get dental work—he had to have all of his teeth removed and get a full set of dentures—he was able to take time off and get treatment for a variety of physical problems. “Now we’ve seen significant improvement in every area—his dental pain, mental health, back pain, and his financial health. He’s not having to work himself into the ground to pay the bills.”
When the CCA visiting nurse program was created, conventional wisdom in the medical community was to allow individuals with traumatic brain injuries (TBI) to rest. While that’s still true to some extent, Patty and her colleagues now understand the importance of helping clients develop and stick to routines, challenge their minds, do exercises to improve memory, and actively address headaches and other TBI side effects. “If your symptoms are adding up and you’re having depression and sleep issues, you’re not going to want to leave the house, and then you won’t feel positive about yourself or like you’re making a contribution,” Patty explained.
No matter what clients are struggling with, however, Patty makes sure they know she will listen to them and provide assistance without judgment. “We’re not going to be angry. They don’t have to feel ashamed. We’re here to support them in whatever decision they make for their care. I’m very honest. I’m going to tell them if I don’t agree with a decision or if I think it will be harmful, but the ultimate decision is up to them. A lot of veterans don’t have anyone who they trust to be honest. Being that person who’s not going to judge them but just give them as much information as I have to offer and guide them to a decision is a really big deal.”
It is frustrating to Patty to know there are always more clients out there who she or one of her colleagues could help, but who aren’t connected with a NMCRS CCA visiting nurse. “We all do our best and have large caseloads, and I wouldn’t trade it for the world, but I know there are more we could help. I know in my heart there are Marines who are alive today because of the work we do. I know our program literally saves – all the time.”
Thank you for your 10 years of dedicated service, Patty!
By Betsy Rosenblatt Rosso