When Joseph Vitti first meets a veteran to whom he will provide the comfort care of hospice, he usually begins by saying, “Thank you for your service.” But for those who served in Vietnam, he begins with words that have long eluded them: “Thank you and welcome home.”
Vietnam is very much in the national conversation now, with the recent debut of Ken Burns and Lynn Novick’s landmark documentary series marking the 50th anniversary of the war’s escalation. Among the powerful legacies that the series brings to life is the toll that the war’s brutality and divisiveness still exacts on those Americans who fought and returned. My colleagues in the Visiting Nurse Service of New York’s Hospice and Palliative Care program who are caring for veterans at the end of their lives find that the silence common to many veterans on the subject of war is compounded in Vietnam veterans by the lack of support—and even enmity—they experienced when they came back home.
End of life is the last chance to change the equation—to build bridges of communication to family members and loved ones, to other generations—and even to oneself. VNSNY’s special hospice program tailored to military veterans helps do just that. Our veterans hospice team of physicians, nurses, social workers, spiritual care counselors and home health aides is specially trained to provide care for not only the physical illness at hand, but also conditions such as PTSD, survivor’s guilt, depression, and substance abuse. We help connect veterans and their families with community resources and veteran-specific benefits, and hold bedside recognition ceremonies that honor their military service. VNSNY’s hospice initiative also benefits greatly from our participation in “We Honor Veterans,” a program created by the National Hospice and Palliative Care Organization in collaboration with the Department of Veteran Affairs, to address the unique physical, emotional and logistical needs of veterans and their families at end of life.
This specialized hospice care includes prompting and listening to stories. “End of life is a time—for anyone—to look back on one’s life and reflect on what mark they have left,” says Joseph, who is VNSNY Hospice’s veterans liaison, and is also a veteran himself. “For veterans, we work to create an environment that lets them understand it’s okay to talk, to share stories. It’s not that they don’t want to—it’s that they don’t know who to tell the stories to, or how to tell them.”
So conversations typically begin slowly, with Joseph or a colleague asking straightforward questions: What was your branch of service? Where did you serve? For how long? “Then,” says Joseph, “we take one small step forward: ‘Tell me about your friends.’ That’s where the stories are.” Joseph further supports the veterans in sharing their experiences by explaining to them that their stories could help him help other veterans and families. “Veterans are very selfless. Helping others is something they certainly want to do.”
Joseph describes what happens once the stories begin to come. With a Vietnam veteran living on Staten Island, a former machine gunner referred to our service by the Veteran’s Administration, Joseph began with his standard greeting: “From one soldier to another, Welcome home.”
“He broke down in tears,” Joseph recalls. “An instant bond formed between us, and a visit that was supposed to be about connecting his family with benefits became about connecting in a whole different way. It opened the floodgates. He talked about things he’d never talked about before, and said that there wasn’t a day that went by that he didn’t think about them.”
Another veteran, a deeply religious Catholic who was in the final stages of cancer thought to be caused by his exposure to Agent Orange during the war, felt that his life, and now his war-related terminal illness, were a form of purgatory for what he did during the war—namely, survive when friends around him were killed. Joseph helped him reframe the narrative and achieve a measure of closure. “Did you ever think that this wasn’t your purgatory,” he said, “but that you survived because you had another mission—to be a husband to your wife and a father to your children?”
The veteran embraced the conversation, talking as he never had before. “These veterans don’t want to be forgotten, and don’t want their stories or their friends to be forgotten,” says Joseph. “They just don’t know how to begin. So we say, ‘Tell us. We want to know about your experience. We need to know.’”
For those who are unable to share their stories, such as the Queens veteran in the final stages of amyotrophic lateral sclerosis (ALS), families can learn their loved one’s history from military discharge papers, which the hospice team will help track down, along with any medals the veteran might have received. The Queens soldier’s discharge paper detailed the circumstances behind his Silver Star, the military’s third-highest honor—a story the family had never heard. The only one in his eight-man team to survive an attack during the Tet Offensive, he kept firing even after he was shot and wounded—saving the lives of countless Americans ahead of him on the battlefield. When Joe shared the papers and the story with the family, including a young grandson, everyone was in tears, hugging the patriarch and hailing him as a hero. “They were a close family, but this brought them even closer,” Joseph notes. “That, the family’s support, is the ultimate medication and therapy.”
Joseph sees this time and again with veterans of all wars, but it is most pronounced with Vietnam veterans—who, after keeping their stories bottled up for decades, take the leap of faith in opening up to their families and find grace where they expected judgment, and honor where they expected contempt. “Imagine, your father afraid to tell his stories, maybe because he accidently killed innocent civilians and he thinks he’s going to hell,” Joseph explains, citing a composite father built out of many fathers he’s worked with. “And then imagine that, instead, he hears from his children: ‘We love you, we’re proud of you. You’re not going to hell. You are a hero.’”
Joseph has been watching the Burns/Novick documentary with his wife, who asked, “Have you heard stories like this?” Indeed he has, and he believes that this is just the beginning. “I hope this opens up a national conversation, and encourages people—especially a younger generation—to engage these veterans and hear their stories,” he says. “Ask a friend, a neighbor, a loved one. Comfort care doesn’t begin with hospice. Many of these veterans have emotional and physical scars that go deep, and we owe it to them to listen.”