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John Simkin

Medical Treatment in your country

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Let me respond to John's original posting and say something about the situation in Sweden. But first let me extend my condolences to John's wife and John himself - I hope that you're both doing as well as can be expected …

Judith is suffering from bone cancer, acute kidney failure, pneumonia and septicaemia. Last week she also had a heart attack. Yesterday we had the first bit of good news. The kidneys have started to work again. The next couple of days are going to be very important for her survival.

Last year I earned about 350,000 SEK and paid about 108,000 SEK in direct taxation. My employer paid slightly less than I did in various types of payroll tax (the Swedish economy is doing very well at the moment, by the way).

We are subject to a co-pay of 150 SEK each time we visit a clinic (although people under the age of 18 pay nothing at all). That's about $25. There's a cap of 1800 SEK per annum on that co-pay, so anyone who has a chronic condition quickly gets up to the limit and then pays no more for the rest of the year.

If we're referred to a specialist, we pay between 80 SEK and 250 SEK, depending on what kind of specialist it is. That co-pay also counts towards the annual limit.

There's a similar 1800 SEK per annum limit on costs for medicines. The state-run Apotek (drugstore/chemists) has an obligation to substitute cheaper generic drugs for any brand-name drug a doctor might prescribe.

There's also something called 'guaranteed care', which says that you have to start receiving treatment from a specialist (if the condition warrants it) within 90 days. If your local health authority fails to meet this guarantee, you can seek treatment somewhere else in the country, or the world, and your local health authority is obliged to meet the bill.

The health care system is basically excellent, with modern hospitals and properly-trained staff, although the current Conservative government is trying to run it down. (We're electing a Conservative government about once every 15 years at the moment. They get one term to screw things up, and then we have to spend 10 years or so putting things right again.).

I was rather surprised by this. I always thought the Swedish system was like the NHS. Since Judith was diagnosed with bone cancer we have not had to pay for anything relating to her medical condition except parking the car at the hospital. Although there are prescription charges these are not paid by people with terminal illnesses or over retirement age (60 for women). No one pays for visits to doctors, clinics, hospitals or home visits (district nurses, GPs, etc.).

There are of course serious financial implications of being seriously ill. For example, people often have difficulty paying their mortgages when the main earner is suffering from a serious illness. To be fair to our government, they have recently introduced a scheme where someone who is terminally ill gets a very generous “disability pension”.

Overall I have been very impressed with the treatment that Judith has received. There are problems with the system (as I described earlier) but once you make it clear that you are going to hold them accountable for their actions, the treatment is excellent.

Judith has been moved to a kidney specialist unit. This includes specialist nurses and a team of doctors on site. Every day we have a meeting with the doctors who tell us about the condition of my wife and the treatments they are using. Our personal doctor (GP) phones me at home several times a week to discuss the latest developments.

The nurses are generally very good. About 75% of them are foreign immigrants but they clearly are well-trained and all except a German male nurse, can speak English fluently. There is a problem with bank (temporary) staff but none of these are employed in the specialist unit.

It seems to me that the government has done a successful job in improving our NHS.

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The co-pays in the Swedish system are designed to discourage people from calling the doctor for minor ailments they can sort out themselves. There's a very good medical advice line you usually call in the first instance (which costs one local call unit), and they'll either refer you to treatment you can carry out yourself, to a non-prescription medicine from the chemist's, or to a medical centre where you can get qualified medical advice. I've never heard of a case where someone has stayed away from the doctor's because they can't afford the co-pay (i.e. people are all rich enough here to afford it).

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The co-pays in the Swedish system are designed to discourage people from calling the doctor for minor ailments they can sort out themselves.

This is a problem in the UK. My wife used to work at a GP's surgery and the doctors clearly get very upset about seeing the same patients every week. They claim that there is nothing wrong with these people. All they want to do is to "talk to someone". They are usually very lonely people. Maybe the NHS should offer this as a service to its patients. Maybe it could be organized via the voluntary sector. Someone once said that the only difference between a person inside and outside a mental health institution is friends to talk to. Maybe forums like this play this role as well.

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The Swedish system has its flaws as well as its advantages. If you live in a bigger city like Gothenburg you might end up in a fairly long que - waiting to get a treatmet for whatever your problem might be. There is a priority of people with terminal sicknesses but no guarantee... This can cause problems and we read about them in our newspapers. Still its a system where everybody has the right to be treated - no matter income, background, personal problems, etc... and that's something I don't mind paying for through my taxes. Solidarity with our fellow humans seems to become more rare...

My own experiences of the Swedish system has so far been good. When I needed to see a doctor I would call them up and if the problem was accute I would get to see a doctor within some hours. Sitting in an emergency room is a diferent experience and there you can sometimes spend a whole day waiting which of course is very hard when you need someone right away. Cuts in the budgets of health care sure play a big role here. It even scares me more that ideas of more private health care has been on the new governments agenda. The dismantling of our old wealth fare state seems to continue.

I have also experienced health care in the US. As long as we were covered by a health insurance everything worked out great and we were always treated very well but one time I got the experience of not being covered... We had changed health insurance and our daughter got seriously sick. She had to spend one night at the emergency care but was released the next day (within 24 hours). This experience cost us over 4000 Dollars. Our noew insurance company had a policy of being with them for three months before you could use there "great service"... I know that it was of course our failure on finding out all these parts of the new contract but for some reason the insurance company also failed to mention it when we asked about our coverage. Fortunately we were in the position where we could pay but for me this was an important lesson (not only to read all the parts of the insurance policies) - if you have insurance, money enough, etc... the US system is great - if you don't you better not need any care.

Therefore I prefer the Swedish system.

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… and I'd like to add that I live in the county of Kalmar in Sweden which experienced a sizeable swing to the Social Democrats when much of the rest of the country swung away from them!

We've just topped the league for having excellent and responsive healthcare services (which are organised on a county basis here). Our local politicians now want to make the 90-day guarantee (of the maximum time it takes between going to the doctor and beginning specialist treatment, having been diagnosed) into a 45-day guarantee.

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The Swedish system has its flaws as well as its advantages. If you live in a bigger city like Gothenburg you might end up in a fairly long que - waiting to get a treatmet for whatever your problem might be. There is a priority of people with terminal sicknesses but no guarantee... This can cause problems and we read about them in our newspapers. Still its a system where everybody has the right to be treated - no matter income, background, personal problems, etc... and that's something I don't mind paying for through my taxes. Solidarity with our fellow humans seems to become more rare...

My own experiences of the Swedish system has so far been good. When I needed to see a doctor I would call them up and if the problem was accute I would get to see a doctor within some hours. Sitting in an emergency room is a diferent experience and there you can sometimes spend a whole day waiting which of course is very hard when you need someone right away. Cuts in the budgets of health care sure play a big role here. It even scares me more that ideas of more private health care has been on the new governments agenda. The dismantling of our old wealth fare state seems to continue.

I have also experienced health care in the US. As long as we were covered by a health insurance everything worked out great and we were always treated very well but one time I got the experience of not being covered... We had changed health insurance and our daughter got seriously sick. She had to spend one night at the emergency care but was released the next day (within 24 hours). This experience cost us over 4000 Dollars. Our noew insurance company had a policy of being with them for three months before you could use there "great service"... I know that it was of course our failure on finding out all these parts of the new contract but for some reason the insurance company also failed to mention it when we asked about our coverage. Fortunately we were in the position where we could pay but for me this was an important lesson (not only to read all the parts of the insurance policies) - if you have insurance, money enough, etc... the US system is great - if you don't you better not need any care.

Therefore I prefer the Swedish system.

In the US if you come to the emergency room you cannot be refused treatment simply because you cannot pay.

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http://talk.livedaily.com/showthread.php?t=609305

Woman waits in California hospital for a bed to open up here

Wednesday, January 02 - 11:30:00 AM

Lyle Fisher

VANCOUVER (NEWS1130) - A Surrey woman's holiday in California has turned into a healthcare nightmare. The 68-year old needed emergency surgery after her appendix burst, but now she can't come home due to a lack of hospital beds.

Arlene Meeks has been in a California hospital since December 17th. Her family has been trying to get her transferred back to the Lower Mainland for 2 weeks now but they haven't had any luck.

Stephen Harris with the South Fraser Health Region says the issue is a shortage of ventilated intensive care unit beds, which are highly specialized. He says over the holidays, it's not surprising to see those beds filled up.

Harris says as soon as a bed becomes available, Meeks will be transferred to a local hospital. Arlene's daughter Kim says her mom is 'frustrated as hell', and she just wants to come home.

NDP Health Critic Adrian Dix says the issue is one that's continued to plague the Lower Mainland and he's blaming Liberal government cuts to acute care beds. "The number of acute care beds in British Columbia was reduced by 1,300 in the first mandate of the government, and some of the new facilities being opened won't be adding to that number."

Dix says the Vancouver Coastal and Fraser Health authorities issued reports last fall indicating they are 650 acute care beds short right now.

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On Friday morning I received a phone call from Judith’s doctor that she had suffered a serious heart attack and that we had to get to hospital straight away. When Louise (my daughter) and I arrived we were not allowed to see my wife. Instead we were ushered to a side-room where we were told what had happened. Apparently, that morning her blood test showed that she had very high levels of potassium in her blood. This resulted in her heart beat slowing down. They quickly attempted to put her on dialysis. However, while they were doing this her heart stopped and the doctor carried out heart resuscitation and attached her to a mechanical resuscitator (an electric unit designed to breathe for the patient). Dialysis had reduced the potassium levels but the doctor was not convinced that she would be able to breathe alone. Nor did he know what impact the heart stopping had on her brain. The situation was further complicated by the fact that Judith had made a living will instructing her doctors not to resuscitate her. The doctor explained that he had done this instinctively because he felt there was a chance of saving her life.

I was then asked what I wanted the doctors to do next. I explained that they reason Judith had made a living will was because she feared being kept alive on a life-support machine after suffering brain damage as a result of a heart attack. The doctor was pessimistic about the damage caused to her brain and heart and suggested that he turned off the mechanical resuscitator. If he was wrong, Judith’s heart would take over and she would breathe on her own.

Louise and I were allowed to stand by the bed when they turned off the mechanical resuscitator. Much to everyone surprise, she carried on breathing. The optimism was short-lived when the doctor carried out a few tests that suggested that she was in some sort of coma.

That afternoon she began to show signs of life. By early evening we were able to converse with Judith. The senior doctor that runs the kidney unit was amazed by what had happened and even went as far as to describe it as a “miracle”. Judith had lost her short-term memory and had no recollection of Friday at all. We have been told that this is not uncommon in someone who has undergone such trauma.

By Sunday most of her short-term memory had returned. The main concern is that she is having trouble moving her legs. We are hoping this is a temporary problem. Of course still has the major problem of her kidneys not working. As a result, without constant dialysis, she will continue to have problems with potassium in the blood and other issues usually dealt with by functioning kidneys.

Judith appears to be in better shape than she was before her heart attack. On Thursday she was very depressed about her state of health and was saying that she did not want to go on. That she just wanted to sleep forever. Now she is much more positive and is showing much more interest in life.

At the same time as Judith’s heart stopped working my computer system crashed. What is more, my back-up external drive system also failed. Computer experts are currently trying to recover all my data. Let us hope they are as good as Judith’s doctors.

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On Friday morning I received a phone call from Judith’s doctor that she had suffered a serious heart attack and that we had to get to hospital straight away. When Louise (my daughter) and I arrived we were not allowed to see my wife. Instead we were ushered to a side-room where we were told what had happened. Apparently, that morning her blood test showed that she had very high levels of potassium in her blood. This resulted in her heart beat slowing down. They quickly attempted to put her on dialysis. However, while they were doing this her heart stopped and the doctor carried out heart resuscitation and attached her to a mechanical resuscitator (an electric unit designed to breathe for the patient). Dialysis had reduced the potassium levels but the doctor was not convinced that she would be able to breathe alone. Nor did he know what impact the heart stopping had on her brain. The situation was further complicated by the fact that Judith had made a living will instructing her doctors not to resuscitate her. The doctor explained that he had done this instinctively because he felt there was a chance of saving her life.

I was then asked what I wanted the doctors to do next. I explained that they reason Judith had made a living will was because she feared being kept alive on a life-support machine after suffering brain damage as a result of a heart attack. The doctor was pessimistic about the damage caused to her brain and heart and suggested that he turned off the mechanical resuscitator. If he was wrong, Judith’s heart would take over and she would breathe on her own.

Louise and I were allowed to stand by the bed when they turned off the mechanical resuscitator. Much to everyone surprise, she carried on breathing. The optimism was short-lived when the doctor carried out a few tests that suggested that she was in some sort of coma.

That afternoon she began to show signs of life. By early evening we were able to converse with Judith. The senior doctor that runs the kidney unit was amazed by what had happened and even went as far as to describe it as a “miracle”. Judith had lost her short-term memory and had no recollection of Friday at all. We have been told that this is not uncommon in someone who has undergone such trauma.

By Sunday most of her short-term memory had returned. The main concern is that she is having trouble moving her legs. We are hoping this is a temporary problem. Of course still has the major problem of her kidneys not working. As a result, without constant dialysis, she will continue to have problems with potassium in the blood and other issues usually dealt with by functioning kidneys.

Judith appears to be in better shape than she was before her heart attack. On Thursday she was very depressed about her state of health and was saying that she did not want to go on. That she just wanted to sleep forever. Now she is much more positive and is showing much more interest in life.

At the same time as Judith’s heart stopped working my computer system crashed. What is more, my back-up external drive system also failed. Computer experts are currently trying to recover all my data. Let us hope they are as good as Judith’s doctors.

Interesting, John. I wish I had met your wife when you were in Perth so that any well wishing would register if you passed it on. However having expressed my sympathies elsewhere and prayers are never far behind (I know you're an a-theist, but I'm not) I'll leave it at that. Nevertheless the revival of spirit, rallying et.c., albeit under continuing difficult circumstances, is great news.

________

On a more dispassionate level, your descriptions of the treatment sequences, living wills et.c. opens a lot of cans of worms.

examples:

My elderly mother had a slight localised blood clot in her brain that caused a loss of short term memory. Added to that her smashed up leg and shoulder from a car accident places her at her age in a precarious position. As there is a shortage of funds, peole like her are 'prioritised'. The fact that pre-accident (a year ago) she was (at 83) part of a troupe of belly/line dancers going around to old people homes showing that age does not equal disability, ie she is physically much younger than the average. However to get that through to the doctors is a problem.

Personally I was misdiagnosed for six odd years as I presented far too late and the doctor (ordinary GP) merely saw the symptoms and prescribed acordingly. In 'the good ole boy' doctor farternity, a doctor rarely questions another, so ignorantly I complied with this diagnosis which followed me around as I moved around. Only recently I've been fortunate to consult a specialist who had the courage to question the diagnosis, shift the class of medication and within 2 weeks remarkable signs of recovery started. So, suffering from side effects from unnecessary medication, one of which at one point led to a suicide attempt, six years later, fatter and older, hope and drive has returned. The specialist suffered from a backlash from the referring non-specialist who stopped sending him cases. However the specialists integrity and courage in the face of this entrenched systemic relationship between doctors + their diagnosis, I believe, will stand him in good stead in the long run.

Had I bindly 'followed doctors advice' and trusted in some kind of 'doctoral infallibility', who knows where one would be today. Which brings on (among others) subjects like living wills, euthanasia, hope and suicide.

edit : spelling

Edited by John Dolva

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24 Harrowing Hours Inside the ER

An Inside Look at One of America's Busiest Trauma Centers

By BILL WEIR, ABC News

Jan. 7, 2008

It is 7:18 a.m. at Parkland Hospital in Dallas, and dawn brings the day's first case of blunt-force trauma. The woman fell from a second story and now lies just down the hall from where President John F. Kennedy took his final breath more than 44 years ago.

An assassination may have put this Dallas hospital on the map, but its reputation is built on the sheer variety and volume of pain it treats. On average, a person walks or rolls into this ER every four minutes of every hour of every day.....

Full story: http://www.abcnews.go.com/WN/story?id=4098992&page=1

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On Friday morning I received a phone call from Judith’s doctor that she had suffered a serious heart attack and that we had to get to hospital straight away. When Louise (my daughter) and I arrived we were not allowed to see my wife. Instead we were ushered to a side-room where we were told what had happened. Apparently, that morning her blood test showed that she had very high levels of potassium in her blood. This resulted in her heart beat slowing down. They quickly attempted to put her on dialysis. However, while they were doing this her heart stopped and the doctor carried out heart resuscitation and attached her to a mechanical resuscitator (an electric unit designed to breathe for the patient). Dialysis had reduced the potassium levels but the doctor was not convinced that she would be able to breathe alone. Nor did he know what impact the heart stopping had on her brain. The situation was further complicated by the fact that Judith had made a living will instructing her doctors not to resuscitate her. The doctor explained that he had done this instinctively because he felt there was a chance of saving her life.

I was then asked what I wanted the doctors to do next. I explained that they reason Judith had made a living will was because she feared being kept alive on a life-support machine after suffering brain damage as a result of a heart attack. The doctor was pessimistic about the damage caused to her brain and heart and suggested that he turned off the mechanical resuscitator. If he was wrong, Judith’s heart would take over and she would breathe on her own.

Louise and I were allowed to stand by the bed when they turned off the mechanical resuscitator. Much to everyone surprise, she carried on breathing. The optimism was short-lived when the doctor carried out a few tests that suggested that she was in some sort of coma.

That afternoon she began to show signs of life. By early evening we were able to converse with Judith. The senior doctor that runs the kidney unit was amazed by what had happened and even went as far as to describe it as a “miracle”. Judith had lost her short-term memory and had no recollection of Friday at all. We have been told that this is not uncommon in someone who has undergone such trauma.

By Sunday most of her short-term memory had returned. The main concern is that she is having trouble moving her legs. We are hoping this is a temporary problem. Of course still has the major problem of her kidneys not working. As a result, without constant dialysis, she will continue to have problems with potassium in the blood and other issues usually dealt with by functioning kidneys.

Judith appears to be in better shape than she was before her heart attack. On Thursday she was very depressed about her state of health and was saying that she did not want to go on. That she just wanted to sleep forever. Now she is much more positive and is showing much more interest in life.

At the same time as Judith’s heart stopped working my computer system crashed. What is more, my back-up external drive system also failed. Computer experts are currently trying to recover all my data. Let us hope they are as good as Judith’s doctors.

I'm glad to hear of Judith's optimistic respite. I'd guess that surely puts things into perspective.

Three years ago my Mom was taken off of artificial respiration and passed away. That same day my brother committed suicide due to severe depression.

My family's and my best wishes going forward for you and yours. I Hope that Judith is as happy and comfortable as is possible under the circumstances.

The McKenna family

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On Friday morning I received a phone call from Judith’s doctor that she had suffered a serious heart attack and that we had to get to hospital straight away. When Louise (my daughter) and I arrived we were not allowed to see my wife. Instead we were ushered to a side-room where we were told what had happened. Apparently, that morning her blood test showed that she had very high levels of potassium in her blood. This resulted in her heart beat slowing down. They quickly attempted to put her on dialysis. However, while they were doing this her heart stopped and the doctor carried out heart resuscitation and attached her to a mechanical resuscitator (an electric unit designed to breathe for the patient). Dialysis had reduced the potassium levels but the doctor was not convinced that she would be able to breathe alone. Nor did he know what impact the heart stopping had on her brain. The situation was further complicated by the fact that Judith had made a living will instructing her doctors not to resuscitate her. The doctor explained that he had done this instinctively because he felt there was a chance of saving her life.

I was then asked what I wanted the doctors to do next. I explained that they reason Judith had made a living will was because she feared being kept alive on a life-support machine after suffering brain damage as a result of a heart attack. The doctor was pessimistic about the damage caused to her brain and heart and suggested that he turned off the mechanical resuscitator. If he was wrong, Judith’s heart would take over and she would breathe on her own.

Louise and I were allowed to stand by the bed when they turned off the mechanical resuscitator. Much to everyone surprise, she carried on breathing. The optimism was short-lived when the doctor carried out a few tests that suggested that she was in some sort of coma.

That afternoon she began to show signs of life. By early evening we were able to converse with Judith. The senior doctor that runs the kidney unit was amazed by what had happened and even went as far as to describe it as a “miracle”. Judith had lost her short-term memory and had no recollection of Friday at all. We have been told that this is not uncommon in someone who has undergone such trauma.

By Sunday most of her short-term memory had returned. The main concern is that she is having trouble moving her legs. We are hoping this is a temporary problem. Of course still has the major problem of her kidneys not working. As a result, without constant dialysis, she will continue to have problems with potassium in the blood and other issues usually dealt with by functioning kidneys.

Judith appears to be in better shape than she was before her heart attack. On Thursday she was very depressed about her state of health and was saying that she did not want to go on. That she just wanted to sleep forever. Now she is much more positive and is showing much more interest in life.

At the same time as Judith’s heart stopped working my computer system crashed. What is more, my back-up external drive system also failed. Computer experts are currently trying to recover all my data. Let us hope they are as good as Judith’s doctors.

Thank goodness, John.

You and your family are always in our thoughts.

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Hope things go well for you, John. I wish I could offer words to improve the situation, but they won't. We're all thinking of you and your family.

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Interesting, John. I wish I had met your wife when you were in Perth so that any well wishing would register if you passed it on. However having expressed my sympathies elsewhere and prayers are never far behind (I know you're an a-theist, but I'm not) I'll leave it at that. Nevertheless the revival of spirit, rallying et.c., albeit under continuing difficult circumstances, is great news.

Judith is also an atheist. My sister was a nurse and she says many people become very religious when they realize they are going to die. Judith was brought up as a staunch Roman Catholic and so I don’t suspect she will change. It takes a lot of psychological and emotional courage to abandon a faith that relies heavily on brainwashing. At the time she lost the approval of her mother, who she idolized. After that, there is no going back.

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Hope things go well for you, John. I wish I could offer words to improve the situation, but they won't. We're all thinking of you and your family.
My family's and my best wishes going forward for you and yours. I Hope that Judith is as happy and comfortable as is possible under the circumstances.
You and your family are always in our thoughts.

Thank you for your kind comments. I suppose some people will find it strange that I am willing to discuss such matters on the forum. However, I think the discussion can help us understand how we deal with such traumatic experiences.

The brain has difficulty dealing with such extreme situations. Your inner voice tells you to remain unemotional in order to deal with the situation. I suspect this is to a certain extent related to your idea of how a male reacts in such circumstances. However, my daughter, who is a very emotional person usually, also reacted in a similar way when we were told by the doctor that they expected Judith to die. We talked about it afterwards. It is as if you become an actor in a play. That it is not really happening to you. I have been told that the situation is similar to the way that soldiers behave in warfare. To see friends and colleagues die by your side is emotionally too difficult to deal with. So is killing the enemy. They therefore have to rigidly control their emotions. The problem with this is that it causes long-term psychological problems.

My father was killed in a car accident when I was eleven years old. We were very close and it must have been a tremendous psychological shock. My first words to my mother when she told me what had happened was: “Who is going to take me fishing and to football matches?” I suppose that shows just how selfish I was at the age. The answer was no one. It seems none of my parents’ friends and relatives were willing to play this role. It was not until I started work at fifteen that I found someone who wanted to become the role-model I so desperately needed. He also did not take me fishing or to football matches but he was a wonderful father. His own son had died at birth and clearly was looking to “adopt” a son.

It was about six months after my father’s death that I responded in an emotional way to the loss. It was triggered by a visit from my father’s brother. I have read that the delay is much longer amongst soldiers. Some have to wait until retirement until they become fully aware of what they have been through.

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