From Wikki: Moral Injury
"...a natural response to an unnatural...
"....but finds that not to be the case, or when the soldier is sent to war with an impossible mandate rendering him powerless in the face of human suffering, the soldier can experience moral injury.
[3] Those who have seen and experienced death, mayhem, destruction, and violence and have had their worldviews shattered – the sanctity of life, safety, love, health, peace, etc.

            06 Aug 2015 @ 1625
           
       by       PRINE,JANYCE ANNE;  MSW MHD Social Worker
                    
 MENTAL HEALTH OUTPATIENT NOTE                   
66 yo, transgender male to female, white, Navy; NSC; Vietnam Era, clean, appropriately dressed, and groomed. 
Speech clear, articulate and coherent, 
mood: 
distressed affect full range, TP&C normal, focused; Denies SI/HI; appears 
oriented x5; concentration: WNL; Memory good; 
Fund of Knowledge: average; 
Intelligence average based on vocabulary and fund of knowledge; Judgment and Insight: good

Medical complication USPECIFIED complications of medical care
Procedure performed: Psychotherapy Only
Length of time with patient during this visit in minutes: 60
Focus of session: moral injury

Ms. Parkison  processed recent challenges she has had at the VA, thus triggering… 
 As she processed this past week she shared of a vision she had that incorporated memories of her church. She was reminded of sadness, fear and wrong doing specifically linked to how she was treated here at the VA recently >SNIP< These memories as reviewed with Ms. Parkison appear to be potentially a form of moral injury based on her religious views >SNIP<distrust and potentially personal/self-humiliation she has received at the VA regarding their lack of trust and willingness to move forward to assist her in addressing her medical problems she presents.

      17 Oct 2017 @ 1327
              PSYCHOLOGY NOTE
               VA Roseburg Health Care System
              RODRIGUEZ,STEPHANIE R
MENTAL STATUS EXAM:
APPEARANCE: dressed in milieu appropriate clothing
SPEECH: normal rate/rhythm, talkative
LANGUAGE: intact
ORIENTATION: Alert and Oriented x 4
MOOD/AFFECT: labile
THOUGHT CONTENT: WNL
THOUGHT PROCESS: normal, coherent, linear, logical, goal-directed
PERCEPTION: No issues observed
MEMORY: Not formally assessed, intact
INSIGHT: awareness of struggles and a desire to make changes
JUDGEMENT: no issues observed in session

 Discussed with Veteran how she has been the part of supportive networks throughout her life (Cub Scouts and 
military) which worked well and efficiently. 
She expects the same level of efficiency (which in itself is not an unreasonable request) with her healthcare, 
which appears to have led to frequent and high levels of distress in interacting with her care team. 
This works as a barrier to her care because the high emotion may interfere with her ability to efficiently communicate, has lasting somatic symptoms, and impacts her comfort level with different VA facilities. She is 
aware of how in the past efficiency and effectiveness was tied to life or death situations (e.g., military, health issues). It is possible a pattern is emerging 
in which Veteran continuously seeks contact with the VA in hopes for an improved experience, and disappointments build up on each other, and in turn are response to with the emotional intensity associated with a life and death situation, 
which impacts her effectiveness. 
Encouraged Veteran to start noticing her wise mind to move towards a middle path in regards to how to proceed with her health plan.

MENTAL STATUS EXAM:
APPEARANCE: dressed in milieu appropriate clothing
SPEECH: normal rate/rhythm, talkative
LANGUAGE: intact
ORIENTATION: Alert and Oriented x 4
MOOD/AFFECT: labile
THOUGHT CONTENT: WNL
THOUGHT PROCESS: normal, coherent, linear, logical, goal-directed
PERCEPTION: No issues observed
MEMORY: Not formally assessed, intact
INSIGHT: awareness of struggles and a desire to make changes
JUDGEMENT: no issues observed in session

* Moral Injury/Adrenal Fatigue/CLL


July 21
Sarah is having a difficult morning. her BP spiked to 176 106 72 over the course of a couple of hours (0545-0715). after talking out some emotional subjects (VA issues again) it was down to 153 82 71 (0745). then after ingesting Mj  down to 124 75 68 (0808). we will check it again after she eats and naps. the episode includes pain in her left inner thigh, left shoulder blade and along the left rib cage. that pain has persisted though the pressure is down. Episodes like this are infrequent, somewhat predictable (VA interactions) but frightening. We are waiting for J. Otterstrom, lcsw  to connect Sarah with another provider.  questions; at what point to we go into urgent or emergent care? should she take an aspirin?  what else should i look for, symptomatically speaking? what kind of damage is being done during these spikes? 
		Karen Hill, spouse

cc to J. Otterstrom

post food/nap 152 82 69 0900
                         94 64 74 0930 *
                       111 67 65 1021 *


notes:

stress induced
history of intense somatic issues
reg doc not available


Hopefully, this Record of my TELEHEALTH AFTER HOURS call 14 Dec 2021 @ 0734
will be SOON Corrected:
STATUS: COMPLETED it says in the Record.     
Actually; No it is not.
Type of call: DTN SYMPTOM.MSN-ED, RN     What does this mean?
“…as if Veteran having worsening s/s,         What does this mean?
“… his s/s can be assessed. …”            What does this mean?
“etc.”                            What is “etc.”
Caller Response: OTHER                ?OTHER?
Chief Complaint: Not applicable to call.…         Please explain
Length: 11 minutes

Comments:
“Veteran starts off by asking is this writer familiar with Moral injury
and Adrenal fatigue?”
This is true.
Also true;

Now for the, “Length: 11 minutes” of “etc.”, “Not applicable to call.…”
Please be mindful that, as per my recollection of that 11 minutes:
As proved to be true, it seemed immediately clear, this Provider was not
versed in or going to be helpful with my
Chief Complaint:
Moral injury and the recent recurrence of Adrenal Fatigue Characteristics;
often precursor to another VA Induced ER Episode, & more VA Induced
Stress, ANXIETY Depression Despair … facing the wholly unsupported
Caretaker.
= a waste of Tax$  and the Provider’s time at best.
As per my recollection,
Provider chose to instead, vigorously’ in my view, perpetuate the
Suicidal Ideation
perpetually perpetrated instead of confronting the
Chief Complaint: Moral Injury/Adrenal Fatigue perpetrated by this very
VA Paradigm.

Re “?…thoughts about suicide…” i answered as i have for a decade now,
the evidently unacceptable “we’re talking about it aren’t we!?.
Both, “MHTC) Social Worker || Prine, Janyce Anne || PHONE:53088 ||
PAGER:*41 3521
[in 2015] and Roseburg Clinical Psychologist Dr Rodreguez [in 2018]
have stated,
*Moral Injury; more info needed*

Furthermore, “Without Commander in chief Biden’s Rescue $$$, i would be
Dead”
i asserted, because i would not have been able to Purchase the Indicated
Military Grade Health Care from the naturopathic private sector.

By now i was attempting to exit the Call.
Four ER Visits, numerous Lab Test, my bodily sensations & hostile
language suggest;
this Paradigm is again triggering the Adrenal Fatigue and exacerbating
the CLL.

Enough said.
Sarah Patient