Exeter hospice doctor again serves veterans at the end of life
By JASON SCHREIBER
Union Leader Correspondent | November 11. 2012 9:51PM
Nearly a half century has passed since 58,000 Americans were killed and more than 300,000 injured in the Vietnam War, and Clary is still caring for veterans.
Only now, it's at the end of life.
A certified hospice and palliative care doctor and the medical director of Rockingham VNA's Hospice in Exeter, Clary helped start a specialized program in which veterans volunteer with dying veterans.
"Vets recognize the Vietnam Service Ribbon I wear in my lapel. Even if they fought in a different war, they know I speak their language," said Clary, who will speak about end-of-life care and read from his book of poetry, "Dying For Beginners," at the Water Street Book Store in Exeter on Tuesday in celebration of National Hospice Month.
Clary, who became involved with hospice care shortly after he arrived in New Hampshire in 1986, helped start a veterans volunteer group at Rockingham VNA two years ago.
Veteran volunteers meet regularly with Clary, Ray Caron, an RVNA Hospice nurse and Marine veteran, along with volunteer coordinator Martha Chandler, to plan outreach to underserved veterans and help those already cared for by the hospice agency.
"The volunteers are a very important part of hospice. This is the most gratifying work I've ever done," said Clary, who worked as a primary care doctor before pursuing hospice work.
As many as a quarter of the dying in New Hampshire are veterans, Clary said, and being veterans themselves helps the veteran hospice volunteers understand their special problems.
"Nearing death may trigger latent Post Traumatic Stress Disorder in veterans," Clary said. "PTSD can look like psychosis or anxiety, yet effective treatment requires a different approach, and starting with trust can only help."
Nearly a third of male combat veterans may suffer from PTSD, he said.
"Because of the frequency of sexual assault against women in the military, an even higher percentage of women veterans are susceptible to this disorder, even if they never were exposed directly to enemy fire," he said.
A thorough military history is now part of each veteran's admission to their hospice, helping clinicians gauge the likelihood of PTSD-related symptoms.
Clary pointed to medical studies that show PTSD-related symptoms are second only to pain in causing suffering among veterans.
"We have a pain management plan for every patient we admit to hospice, and now we plan PTSD management for our vets as well," he said.
The Veterans Administration now has a mandate to provide good end-of-life care as a "basic benefit," Clary said.
"Service-connected disability is not required for the VA to step up. They've become leaders in hospice care nationally. They have an inpatient palliative care unit in Manchester as a Plan B for many New Hampshire vets who otherwise might end their days in a hospital or a nursing home," he said.
Many serious illnesses have become recognized as service-connected, with additional support available from the VA, he said. They include illnesses such as Lou Gehrig's Disease - ten-fold more common in veterans than those who never served.
Many forms of cancer as well as heart disease are now recognized as service connected for Vietnam veterans because of the toxicity of Agent Orange, used widely as a defoliant in that conflict. Veterans with these illnesses may be eligible for disability payments and their survivors can get benefits as well.
"I'm proud that I served my country in a difficult time," Clary said. "I'm even more proud to be serving veterans as they face death once again."