Rehabilitating Time: Multiple Temporalities among Military Clinicians and Patients

Abstract

In this article I explore the different orientations to time experienced by clinicians and patients in the US Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center in Washington DC. In structuring, describing, and working with patients, clinicians rely on a rehabilitative program that is embedded in a narrative notion of time. This approach seeks to embed the grievous wounds patients have sustained along a trajectory of injured to well. Patients are often eager to adopt this approach to their injury but in many cases find that the linear flow of time, upon which this clinical approach relies, is not matched by their experience. Instead the past, the present, and the future can flow together so that patients are simultaneously experiencing these three time orientations. This can create the potential for misunderstanding and conflict between clinicians over adherence and the meaning of a good rehabilitative outcome.

Key Words:

• experience
• limb loss
• military
• rehabilitation
• time
• trauma

ACKNOWLEDGMENTS

This research at Walter Reed was sponsored by the Department of the US Army under Award Number W81XWH-06-2-0073 to the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. Thank you to Matthew Wolf-Meyer and Karen-Sue Taussig for editing this special issue, and to Tracy Pilar Johnson.

Notes

http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm, accessed August 25, 2009.

The military has two other amputee rehabilitation programs. One is located at Brooks Army Medical Center in San Antonio, Texas. The other is located at Naval Medical Center in San Diego, California.

All the names have been altered to two letter initials that are themselves pseudonyms. This was a requirement of the Department of Clinical Investigation at Walter Reed Army Medical Center, although many therapists and patients in the Amputee Patient Care Program have become public figures as a result of the media attention devoted to the program.

Rates of acceptance and use of upper and lower extremity prosthetic limbs fluctuated based on cause of limb loss, length of residual limb, presence of knee joint, and a host of more specifically social issues such as age and gender (Biddiss and Chau 2007a, 2007b). Individuals with above-knee or hip disarticulation limb loss were less likely to use prosthetic legs than those with below-knee or ankle disarticulation amputations. These generalizations are complicated by both multiple limb loss and comorbidities associated with blast injuries—the primary mechanism of limb loss among US service members.

Patients are also transferred from the National Naval Medical Center in Bethesda, Maryland, and from other military treatment facilities in the United States.

There were also problems about my interacting with patients at this point in their involvement with the program because they would not, at these early moments, be able to provide consent. Thus, aside from introducing myself, I limited my interactions to the therapists rather than the patients during these encounters.

Among the more than 850 service members with limb loss, less than 20 are women.

Additional information

Notes on contributors

Seth D. Messinger

SETH D. MESSINGER is Assistant Professor in the Department of Sociology and Anthropology at the University of Maryland, Baltimore County. His research focuses on recovery from traumatic injury, trauma and memory, and the social organization of clinical settings.