Rewriting the Stories of Our Wounded Warriors: Dr. Madison on UCLA Operation Mend and Healing the Invisible Wounds of War

Transcript auto-generated from the episode audio; formatting has been cleaned up, but wording is verbatim.

I. Truly have the best career. Operation Mend provides life changing, holistic care for our nation's wounded warriors and their care givers, helping them recover from severe physical injuries and the invisible wounds of war. We're treating the whole person. Do you see even your your quietest, most reserved warrior sparking and interest in something. That I'm to see this person on day one and then two weeks later to have become something different? I'm Cynthia Marks, and I head up the Holistic Psychoanalysis Foundation, established by my late husband, the fabulous doctor Bernard Bail. Welcome back to.

And Now Love. You know that we spend a lot of time exploring what it takes to heal our deepest emotional wounds and break free from the past imprints that keep us small. We talk about the hard work of piecing ourselves back together. Today we are looking at a very inspiring, real world example of that exact kind of profound healing. And we're talking with Doctor Madison, who is making giant headway with her organization. We are honored to have Madison here with us today. Madison is an exceptional occupational therapist working with an organization whose mission is very close to my heart. UCLA Health Operation Mend.

For those who don't know. Operation Mend provides life changing, holistic care for our nation's wounded warriors and their care givers, helping them recover from severe physical injuries and the invisible wounds of war like brain trauma and PTSD. Madison works right on the front lines of this recovery in their brain intensive treatment program. What I love about her approach is that she doesn't just look at healing as a medical checklist. For example, she works with veterans and their families in a kitchen that they literally call a classroom for the brain. Using simple things like nutrition, routine, and lifestyle changes to help them reclaim their independence and reconnect with their communities.

That's just one of the things they do. She is helping these incredible heroes rewrite their stories and remember who they are underneath the trauma. We're so honored. Thank you for taking the time out. I know how busy you are, and rightfully so. You're doing these great things. Thank you for having me, Cynthia. It's so great to be here and to be able to talk about our program with you today. So let's do that. So just give us a little briefing on how Operation Mend came about and really what Operation Mend does in terms of the big umbrella. Yeah. So Operation Mend is a program that's housed under UCLA health, and we work to provide intensive treatment programing to US service members, both active duty and retired service members, as well as their caregivers.

As you mentioned, in the great part about Operation Mend is that this care is provided at no cost to the warrior or their caregiver. So there's not the financial barrier to accessing care. When people come to our program and we have this really amazing multidisciplinary team that really treats the patient and their caregiver from many different angles. And so. We're treating the whole person through evidence based intervention that's provided during a two week intensive treatment program. And it's been really fantastic to see the impact of that on both the invisible and visible wounds of war. So let's talk about that two week intensive program.

So yeah, so a warrior will come to you and visit UCLA every day for two weeks. Yeah. So we have a couple of different tracks in our program. And so one option is our surgical track where warriors may be brought out for surgical evaluation. That's actually where our program began back in 2007. Ron and Maddie cats were interested in partnering with UCLA health. They were UCLA alumni, and they saw this mission to support warriors who were returning with severe burn injuries. And so they really wanted to make a difference in their lives. And so. Was it because they were seeing that these individuals weren't able to be served or couldn't maneuver a system?

Yeah, I think the system was was challenging and they needed these higher level of specialty care surgeons that were available at UCLA, and they saw a way to help support these warriors in accessing that care. And so they partnered with UCLA and Brooks Army Medical Center to really build the foundation of what Operation Mend was as that surgical program. And in 2015, the Wounded Warrior Project recognized our program as a national program and asked us to partner with them to build out the mental health and traumatic brain injury treatment side of our program. So we were able to partner with them.

And in 2016, that program came to life, and we've been able to focus on the mental health side of the warrior care as well. That's fabulous. So these warriors and their caregivers find their way to you also at no cost. Yes. So that brings us back to what the different tracks look like. There is a surgical track where we'll bring warriors out for a surgical evaluation, and if we can provide the surgeries that are required or needed for them, we will provide those as well, at no cost. When they come to us, the housing, the care is all covered for them in a caregiver on site. We also have a one week evaluation week where warriors come out for the mental health side of our programing.

It's an evaluation and treatment week. We do. They see up to ten providers in that week and receive different diagnoses or help with medication, different supports that we can send them back to their community to seek different specialties. And then they could be invited back for either the traumatic brain injury arm of our program or the PTSD side of our program, and some warriors come back for both. And if you discover that there are resources in their own communities that can assist. Is that something that's covered too, in terms of the finances? So that's not something operation meant will help cover.

But we have case managers and VA liaisons who help ensure that those warriors are able to connect to those resources in their local community to help with the continuity of care when they return home. That's great. And I would think that a lot of individuals who need these services wouldn't be able to access similar services through the military hospitalization system, because they can't afford to get themselves there. As you and I spoke earlier, it may be that the amount of time required to even get a treatment in place is extensive, and there may be going back and forth. That is close to impossible for many people.

Yeah, I think health care systems in general can be pretty complicated to navigate. And having the resources, the family members, the caregiver support to be able to do that is helpful for certain warriors. But it's still a huge lift. Our we see a lot of caregivers who have become case managers for their loved ones. Having to try to navigate systems that are are challenging, make sure their their loved one gets access to care. And so having Operation Mend as a resource, being able to come to our site for two weeks of programing where we house them and we help support meals and we help provide all the programing and then transition them home, our team helps to to build those connections in their community.

So they do get a little bit of extra support with that continuity of care after after seeing us. I see, and you mentioned a few minutes ago that when someone comes in for an initial evaluation or a study, that they may see up to ten different experts. What are some of the differences? Expert to expert. Yeah. So our team is very comprehensive. Comprehensive. We have neuropsychologist, occupational therapists psychologist, psychiatrist neurology. We also have lifestyle medicines. We have someone who does acupressure qigong. We have a lot of variety on our team. So when a warrior comes for their initial week of diagnostics and treatment, they will receive cognitive testing.

And they may receive imaging, they may receive labs, they may receive record reviews. We review records for all of our patients, actually. But to really ensure that we're able to streamline care for them and give them the best quality of care that they deserve. I see. So then obviously at the end of that process, you know that this warrior needs to be set up with, you know, person A in person. And those are the connections that are required in order to help this people, these individuals overcome their issues or deal with their issues. Yeah. And our team works really closely in having those conversations together.

We're always communicating with one another about what might be best for a warrior, or if we need to engage in advocacy on the warriors behalf. We're always trying to provide the best care to them while they're here as an entire treatment team. So there's lots of open lines of communication. Well, it seems like this is overarching question, but that, you know, you your organization started from these two individuals who are very passionate about finding help for these warriors. And it's really blossomed into, you know, this sort of industry of compassion and that you've been able to establish a program that's so organized and thoughtful and such a team with so much communication is kind of a model for a lot of us in terms of being able to help those individuals who need help.

What is it that you think your organization is doing really to to do more than just hold itself together, but sort of propel itself as the world becomes something different day by day? Yeah, I think there are a few factors that play into making that really successful for us. One of them is being part of Wounded Warrior Projects Warrior Care Network, which is for academic sites that have programs similar to ours, and we all partner together to build the programing out to make sure that the Warriors that come to any of our sites are receiving quality, evidence based care. Being a part of an academic institution really insinuates that we need to have that evidence based treatment that we're providing to our warriors and really gives us the advantage to be rooted in that evidence based care.

But the Warrior Care Network and having other sites to collaborate with, to conduct research with, to build programing with is really made our program that much stronger. So an individual could go to your site or perhaps to another academic site. So they can go to all of all four if they see the value in attending all four programs. All four programs offer something slightly different, and so there is value to exploring which one might be the right fit or the right fit at the time that you're exploring the opportunity. And then for us at Operation Mend, we do have warriors who come back years later for additional programing.

Again, they've been through different life events or they've experienced different challenges, or they're ready to process a new part of their trauma and they come back and seek repeat programing from us. I see. To share a little bit about the differences between those, those four sites and what we offer offer. Operation Mend were the only site that offers care to caregivers, and so that's something unique to to our site in the Warrior Care Network. And that's huge. We're finding in many of our conversations that the caregivers are often overlooked. And the trauma that they share and support, because they're dealing with someone who's suffering is kind of left by the wayside.

So kind of bring acknowledgment to that is is a giant gift both to the caregiver and the person being cared for. How do you help caregivers acknowledge that they need attention to. This feels like an ongoing conversation in both our our team dynamic and in individual sessions that I run with these caregivers every single week, is helping them acknowledge that their care is important to. I mentioned earlier, they they really do tend to take on this role of case manager and have bigger roles in the home. And so there needs to be this recalibration between the family unit of how is the caregivers role going to exist, and how is the warrior going to exist in the space, and who's capable and able to provide different responsibilities in the home?

Part of that is empowering, maybe the warrior side to take on more responsibility or to establish more of a role in a home where, during deployments and other times in their careers, they may not have had as much of a role, and then working with the caregivers to relinquish some of that leadership that they have in the home, they've maybe had to run the home during those deployments, or during times where their spouse or loved one was out of the home. And how can we recalibrate the system to benefit both parties? That's that's tough. That's hard work. I recall being a kid. My father was in the military and he would be away for a year at a time sometimes, and I remember him coming back when I was very small.

Maybe I think it was in the kindergarten, in kindergarten, first grade, and not even knowing what kind of place he held in our family anymore, and being very confused about why all of a sudden, this man came into our lives and was part of the parenting system because I had only been dealing with my mom, it took a long time to let him fit back in. Anecdotally, I hear that so often the transition into the house and out of the house and then into retirement is is so jarring for everyone in the family unit involved. And I think that's why, since the foundation of our program, incorporating caregivers has been so important, 80% of our patients come from out of state, out of California, and so some even come from abroad.

It's important to include the caregiver in that care, so that the warrior feels like they have someone there supporting them as they go through what was originally our surgical intervention. Most of our surgeries were outpatient, and so having someone to stay with them, having someone to take in the education, the information that was being provided to them while they were here so that that could successfully transition home. And then another thing we found through that process was the education piece to both the warrior and the caregiver was so significantly important. If you look at people who maybe have addiction and go to a treatment center for a period of time, they're receiving a lot of education and skill building and life changing strategies, and then they try to reintegrate back into the everyday world.

But family, friends, those who are surrounding them may not understand all of those strategies that they were taught during their treatment. And so it makes it harder for them to reintegrate back into what they need to establish as their new lifestyle. And so with operation meant, the goal is that we're providing education to both the warrior and their caregiver to eliminate that conflict that might arise when one is working or trying to educate the other. We work with both of them to do that recalibration so it transitions better. Home. That is interesting. I, I think that deserves a lot of attention in that we expect people to kind of step up and take care of themselves and do it on their own when they're part of a family.

And to have been, you know, in this position of being a warrior, whether you're in war or not, the stress of that, and to hold it in, to hold it as your own, I would think, is really impossible, even though you may think it isn't. That sort of leads me to my next point of this idea that we believe those people serving in the military are to just sort of be very stoic and strong, and that there is weakness associated with any sort of invisible pain, sometimes even weakness associated with physical pain. How do you go against the system that you know is providing you your livelihood and sort of be crumbling inside?

I think it's such a challenge for all of our warriors to navigate that, that struggle of having visible or invisible injuries and to report or not report so many, so much of the culture in the military is performance based, both mental and physical health. And it's so important for them to always be performing at their peak. And so reporting an injury or reporting of vulnerability may impact their ability for promotions, for opportunities in their career, for ability to reach the level they want to reach on their career track. And so there's this culture of underreporting to be able to perform, to be perceived as performing at their top caliber.

And so when they transition out of the military, that culture tends to follow them. They're not necessarily skilled in reporting or sharing that vulnerability, because there hasn't maybe been space or opportunity to do that previously. And I do a lot of work with collegiate and professional athletes, and we hear a lot of the same things in that population as well, this fear of reporting or fear of documentation of certain things, because in that population as well, their career rides on their physical and mental health being optimal at all times. Yes. And at Operation Mend. What do you think we as civilians can do to sort of stop working from that stereotype?

Yeah, I from the reporting of our warriors, I'm not sure there's a feeling that it's coming from the civilian population towards them. I think it's the culture that they're they're brought in up in. Something that we could do on the civilian side is if, you know, a warrior or you have a friend or a neighbor or someone who, you know, has served engaging with them in conversation about healthcare and seeking support and normalizing it from your experience may be helpful to them so that they feel encouraged. Or maybe learn from your experience about the support you received in your care that might open the door for them to receive that support as well.

I see maybe it's what I see, but I feel like even in the civilian world, it's hard to be a person that comes from a military background. There's so many different opinions about what the military means. I feel like there's some amount of unnecessary shame that individuals may feel, but maybe that's just based on my own experience. Yeah, I think so. I've been a part of Operation Mend now for almost nine years, and I think culturally, war in the military has looked a lot different over the last 25 years. It's ebbed and flowed in our conflicts, the way that the media and the news has reported on conflicts has ebbed and flowed.

And so I think that might be contributing to where we're at now and the feeling around military at the moment. We just received your in our conflict with Iran, and we just received our first applicant from the Iranian conflict, who will be coming to Operation Mend. So we continue to serve those who are post nine, 11 US service members in that journey. And how did that individual find you? Most people tend to find us through word of mouth. That's a big spread for us. So we see a lot of individuals coming from the same pockets or the same areas, because they've heard a friend or a colleague has has told them about our program.

And then Wounded Warrior Project is a huge referral source for us as well. Can you share a little bit with us about the Wounded Warrior Project? Kind of what that is in a nutshell. Yeah. So when were your project is a wonderful organization that provides a lot of resources to the Warriors. So some of the favorite ones that I like to talk about. When did Warrior Project does so much, but the ones that I get to talk about with Warriors every day are more activity based. As an occupational therapist, I try to engage our warriors and as much physical activity activities of daily living activity as possible.

And so one of their favorites is a program called Soldier Ride, which is an opportunity where Wounded Warrior Project flies warriors and sometimes their caregivers out for a 3 to 4 day experience of cycling through major cities. And so they have sites in Chicago and in Nashville, New York. And they take these warriors on adaptive three day bike rides. The mileage varies, but they make sure that every warrior is able to participate with whatever adaptive equipment they need. And they have so many different programs like that. They have peer support systems, they have funded activity opportunities.

They have chapters all across the US and even outside the US, where they're able to provide that support to warriors. And it sounds like then that that's an agency that is familiar to most people who have served. Most of the Warriors I've worked with are connected to Wounded Warrior Project because of our affiliation with Wounded Warrior Project, but it seems like a very robust organization, and they have so much to offer that for those who haven't heard, I would encourage you to explore what that might look like for you, because there's so many different opportunities within their organization.

And in that organization, or even in yours. Are there opportunities for people to volunteer? Yeah. So in our organization here in LA, we have a buddy program. And so whenever warriors come out for programing, they have the option to be matched with a buddy. And buddies are volunteers in the LA area who want to help support Operation Mend. And these buddies are matched based on extensive profiles that are buddy coordinator Claire puts together. And they're matched for the two weeks that they're here for programing, and if they return for other opportunities within operation meant they generally get matched with the same buddy again, and that buddy is there to provide really a social connectedness while the Warriors are here again, 80% of them come from outside of California.

So while they're in LA, they don't know anyone here. And so it really is meant to be that social anchor for them while they're here. And buddies take our warriors to events in LA, or to meals or to sightsee or just provide that that support after a long day of taking them to dinner in Westwood, right next to UCLA campus. But even something like that is so meaningful to the Warriors. I hear the best stories from their buddy experiences. I would imagine, because that's putting a positive light on this warrior, a light that that warrior can see and feel. Yeah. And I think it provides the warrior an opportunity to put into practice all the things that we're working on in our program.

We talk about skills all day and all of our treatment sessions, and then they get to go out and practice that social connectedness or, or practice a skill that they were were talking about with a provider earlier that day in a real world setting, which helps with that translation of skill building while they're here before they even return home. So, for example, what what would one of those scenarios be? I've been working with Operation Mend all day and now I'm going out to dinner. What am I going to be thinking about at dinner that I might not have thought about seven days before? There are so many.

And from my own personal programing, one of the groups I run is a social and leisure group, and so we spend an entire hour talking about resources that are available to warriors to help with socialization. Getting out of the house. Many are funded opportunities. There are so many opportunities across the US for fishing trips or hunting trips or experiences that these warriors can have, and so we will spend that our talking about it. And by the end, you see even your your quietest, most reserved warrior sparking an interest in something that we talked about in that our group. And so maybe that evening they're going out to the place they need to Uber to, instead of the place that they can walk to because they're feeling a little more motivated to engage in that social connectedness and go meet their their buddy out somewhere that is a little less familiar than the immediate Westwood area, where they're able to walk and familiarize themselves.

So then, is it a common scenario in terms of trauma that a warrior would be traumatized enough or in some fashion to not want to communicate with the world generally, to just want to stay put, to be, say, afraid of going out the front door or not even interested in going out the front door. And when that is the case. How do you even approach someone to say there's another way, when they're just sort of settled into that? I think from our standpoint here, we often find that people are so burdened by their trauma without really knowing that it's something that can be kind of undone or addressed, that they don't.

And on the other hand, when people discover that, wait a minute. Maybe I don't have to be made up by this trauma that I carry. It's still what they know. It's still whether it feels good or bad or indifferent. It's still what they know. What happens when I don't have that anymore? The rest of that is alien. That seems like such a big thing to help someone contend with. Yeah, it's it's definitely still a challenge in helping people feel open enough to access care in the first place, and then to feel open to taking in the information provided during that care treatment program, which is why we do offer the opportunity for return warriors, because they may be in different spaces in their lives where they're able to work on or process different things.

But we spoke on kind of the culture around service earlier, and we're still seeing that it takes people up to 10 to 12 years to seek medical support or mental health support following their time in service, which is similar to what the statistics were back in Vietnam era. And so anecdotally, we're seeing maybe that word of mouth helping when people find programs like ours, maybe getting them into access care earlier. But so many warriors are coming to us for their first line of care for their first time seeking care. And so where the that front line for them in helping to open the door for them to explore processing that trauma and and what they might need to do to support themselves or or what opportunities might lay out in front of them after going through a program like ours.

A lot of what we do is rebuild trust in their own abilities. These are highly capable individuals who maybe didn't see, or weren't able to find the translate ability of their skills from the military world to the civilian world. And it's our job operation to help them find that trust and that confidence in themselves. Again, to to reengage in meaningful activities. Thank you for doing that. It's it's huge. How do you help the warriors who are really alone, who say, don't even have loving individuals around them who support them, especially during this maybe difficult time of say, ten years where the warrior isn't aware of something about his or herself that needs to be addressed, but yet the family around them is aware or there is no family around them.

Yeah, those those cases are challenging. They're they're so hard to navigate. And we do our absolute best to provide them with the on going care and support during and after our program. So we check in with the Warriors before they come, after they leave. And then at three months, six months and 12 months post-treatment. So they have contact with us that entire time and they can always reach back out for extra contact after that. But the warriors who maybe navigating or going through it alone. It's it's definitely extra challenging for them. The ones that do come to Operation Mend have that initial motivation to seek treatment because they have to apply to come to our program.

So there's something in them that is ready to explore the idea. Of. I see getting treatment. However they got. Their however they got there. And then I spoke briefly about that one week diagnostic treatment week that we start with. And the amount of warriors I see come in to that week. So hesitant about being there in the first place, hesitant that we're going to be able to do anything to change their course. And then they leave and we're showered in these compliments about how confident they feel that we can do something for them, and how quickly can they come back, and how much programing can they come back for, because they feel the culture that we've created at Operation Mend, and it's so individualized to the warrior that I think they feel comfortable or trusting that we can make that difference for them.

Well, you you certainly created a place where they can feel held and heard and respected, and it sounds like there's nothing but grace associated with all that you're doing. And something that might help to some extent is when warriors come to us, all of their medical records stay at UCLA in our system, unless they give consent for them to be sent to whatever health care system they are part of back home. And so to some extent, back to our vulnerability conversation. There may be more openness to reporting situations, histories, things that they maybe didn't feel comfortable reporting previously.

The people that come to you and discover, you know, that there's more help than they imagined. Are they also sometimes coming to you saying to themselves, you know, I'm not sure this is right. I'm thank God I'm, you know, I'm still alive and my comrades lost their lives or their ability to be mobile or whatever it might be. Are there a large group of people who just feel like they don't deserve. But the survivors guilt, or that returning home guilt is it's definitely discussed in our in our sessions, maybe even more so on the PTSD side, which I mostly work in the traumatic brain injury side. And even there, I still hear warriors bringing up those conversations and so many of them have or are transitioning into the mindset of wanting to live.

For those people who were were lost, wanting to help themselves, or being ready to be at a a place where they're able to do what they can with their life because they still have the opportunity to do so. A good number of the warriors coming through our program, or involved in nonprofits or different organizations that do give back, or if they're not already, but they express the want, I help connect them to those nonprofits to make sure that they're able to engage in that active service that's so ingrained culturally in them by giving back to the to the warrior community. And sometimes those our our world's best helpers, people who have struggled with whatever it is the individual they're attempting to help is struggling with.

And it's so easy to hear that person and respect that person because they're coming from something, you know? Yeah, that they bring such a sense of relate ability. In my conversations with our warriors, a lot of conversations with our warriors are around identity, transition and finding that new role, that new purpose in life after the military, after retirement. And for some, that is finding another full time career. It's being integrated into the civilian workplace. And for some, it's finding those volunteer opportunities or finding those roles where they just get to give acts of service to other people that maybe they in the past have taken from that same pot, or feel this empowerment from being able to to give that to others.

How do you think we can help those warriors who are on our streets, who are unhoused, who, you know, clearly have some either physical or unseen issue? I feel like there are so many of those people in our communities, and I'm not sure they know how to reach out to an agency that can help, or if they feel entitled to the help or if they're not so sort of internally hurt that they even know they can do such a thing. I think awareness around traumatic brain injury and post-traumatic stress disorder, the awareness in the civilian and the warrior population as a whole is so important. Traumatic brain injury wasn't recognized until recently.

Or concussion related injuries in the military. That's a more recent recognition. And recently even more recently, the last year, two years, we've been talking a lot about blast injury exposure in our warriors. And so I think keeping the conversation going and making sure that we have support in the research field to be able to better understand PTSD, sleep disturbances, mental health challenges, traumatic brain injury, concussion injuries in our warriors is is so important. We need to have the research to develop evidence based care, to be able to provide treatment to those, and to have an entire civilization awareness around these problems so those people can get support.

And there's more people there to offer that support to the people who need it. Yes. And so many of these people who are ignored or unable to to know how to get help are those individuals who have, you know, given everything of themselves for this larger community that somehow isn't able to support them. It's it's tragic and it's a big thing we need to overcome. So I'd love to talk about more more about what you do. So so tell us about your part in Operation Mend. Yes. So I, I'm an occupational therapist. And so a lot of what I focus on is rebuilding the identity, the roles and the routines of our warriors during their programing here.

And so in the one week program, I get to meet with each warrior and each caregiver individually and assess what goals or things they want to work on in their lives. And that's very exciting and unique to me because I get to have the conversation with the caregiver. That is the what do you want to be doing right now conversation, not a how are you going to help care for this person conversation. And so I get to explore their goals and their wants to. So during the one week I get to do those individual sessions, as well as lead education groups on both exercise and sleep. And then when the Warriors come back for the two week program, I mostly work in the traumatic brain injury track.

My background is in concussion management. And what qualifies as a traumatic brain injury. So it could be anywhere from a mile to a severe traumatic brain injury warriors could have experienced during their time in service. And it doesn't necessarily mean in combat. Doesn't necessarily mean combat. Yeah. So warriors can come back for the traumatic brain injury portion of the program. And in that program, I do four exercise groups with warriors and caregivers. So we do adaptive exercise. We do for cooking groups together, which are my absolute favorite groups to run. We do for education groups covering topics like social and leisure, sensory integration, sleep and change in roles to open the the room for the discussion of that changing role and identity.

And then I get to do for individual sessions with each person as well. I see so that seems like a lot. And I guess the connection is that the people that are coming to you only come to you from some sort of motivation. They're already at a place where they're saying this, whatever this is that I'm doing isn't working, and these people are offering me some help. And so I'm on board, but they may come to you timidly and over a bit of time, discover that there is respect for their situation, whatever it is, and they engage. And you see that progression over the two weeks, and especially because I get to run such activity based groups, I get to see the social dynamics between the Warriors evolve over the two weeks that they're here.

And so that first lunch is usually on Tuesdays, and we we make a mediterranean pasta salad together. Everyone helps to prepare ingredients. We lay them out buffet style. Everyone can make their own plate of whatever ingredients they want. And then we sit around a table and enjoy our meal together and then do community cleanup. And in that first cooking group, there's starts of conversations, some politeness going on. And then by the fourth cooking group, which is the end of the second week, conversation is going seven different directions. You just see the social connectedness that cooking in the community kitchen brings.

And I actually get to, in real time, watch these warriors blossom, both in their their socialization, their connectedness with others, their ability to share stories that maybe wouldn't have been shared in a clinical setting or with a one on one provider. And I get the opportunity to learn so many unique things about these individuals through those cooking groups. It continues to be ever so evident how important our connections with other people are. There's so much that we can learn from each other and so much growth that we can have by sharing our experiences and the purpose of that, the the lunch and the community there is to help individuals who have been unengaged or afraid to engage, for whatever reason, feel safe.

Yeah, back to that confidence piece and helping these individuals feel like they're capable of doing their daily life tasks, engaging in the things that they need to engage in. When we plan the the meals, we try to plan things that are easy, use low cost ingredients, and can be meal prepped so that there's maybe one day of cooking for 3 to 4 days of meals for the week, and we talk about conservation and creating those meals. So do you do chopping in the morning and actually prepare the meal in the evening? So there's energy conservation strategies built into preparing that meal. How do you source ingredients if you live in a rural area and things might not stay good for the two week period where you don't go grocery shopping, and then how can we prepare healthy meals at a lower affordable cost that are easy and tasty, and use a variety of ingredients that are nutrient rich and have brain health benefits?

So there are some specific goals around a food oriented program. But then as the idea to that the principles learned there are the feelings had there roll over into other aspects of one's life. The hope is that it initiates this confidence in something they maybe weren't interested in, or didn't feel like they were good at, or capable of doing at home. And now they see that they're able to engage in this task and engage in it. Well, I always say that I like my goals and occupational therapy to start very, very small. And I like my patients to always feel small successes because if they feel successful, they will be motivated to engage in the next thing that will help them feel successful.

And then those goals seem to grow exponentially, just like you were alluding to. And that very small goal where we started has become this entire day of engaging in activities. Or this I'm now cooking Thanksgiving dinner for my family or whatever it is. But if we have repetitive, small successes, we see that translate into other areas of their life. I guess even just on the simplest level, an individual could be saying to themselves, you know, it's a super hot day. I've got this giant yard, I have to mow the grass. I don't know when I'm going to find that chunk of time to do the entire yard, but they could come at it a different way.

Now. I see when I was cooking this meal, I did some of these things early on because I could, and that didn't sort of ruin the freshness of whatever that was. Maybe I spread mowing the lawn out now, and I don't have to, like, pressure myself to get it all done at once and just take it in steps. Yeah. And then on to bigger and bigger things. Exactly. And one of my favorite things to do with patients is to create what I call the brain dump list. So the brain dump list is all of the tasks that you need to do, big and small. And it's just a sheet of paper that sits on your counter every week, and you write down whatever comes to mind, but then you pull from that list to make your daily to do list.

So what can I reasonably accomplish in the time and energy and bandwidth that I have today? And it might not be mow the lawn, but it might be mow by the front door. Or it might be chop vegetables that I bought at the store yesterday, but not prepare any meals today. I don't have the bandwidth for that. And then they put that on their to do list, and then they're able to cross off that item from their to do list and feel that success. How do you make that big list not be something you want to slam the book on? It's hard. And we practice while they're here. So for the two weeks that they're here, they write down their homework on that list.

They write down the things that they might need to do for their family back home, or to stay on top of work or whatever it is while they're here. So we practice using that strategy. As an occupational therapist. The people that come to you are coming for a specific service. So can you kind of describe a an individual who you've watched, have success, like how they came to you sort of with what what were they struggling with? How did you offer them some help? How did they take the help? How? How did their life change? Yeah. So there's there's one case specifically that comes to mind. And it was a warrior and his caregiver, and they were living in a suburban town that wasn't much outside of a big city, but there wasn't a ton of access to things like public transportation.

And this specific warrior really wanted to be involved in a lot of things, but had a lot of chronic pain. Used forearm crutches to ambush late, and had just a really hard time navigating the community. This individual is able to drive but didn't like driving because traffic was a trigger. Would try to access public transportation to get the places he needed to go. But there were triggers in that environment as well. And then his caregiver, who was his wife, was working full time but had to adjust hours to offset for his doctor's appointments and things like that. So she worked very challenging hours for her own well-being and sleep schedule.

And so they came to our programing. We did a lot of talk about how we were going to make the world more accessible for him, or how we were going to create some openness to exploring ways to navigate the community. And the first session or two, there was resistance. There was this is never going to work. I I've tried all these things. I don't think this is going to happen. And by the time I did my post check in after they left treatment, he had involved himself in several sports organizations that provided adaptive sports to warriors. He was already going to compete with them as part of the team.

The wife had adjusted her hours to be more tailored to her own needs, so that they were able to still have her income, and this was within a couple weeks of leaving our program, and I looked back to see progress. And looks like he also came back for our surgical program and has experienced a significant decrease in his overall pain. And so it looks like his his outcome has been pretty, pretty significant so far. That's awesome. Thank you for sharing that. And I don't think that's atypical I think that's why you still exist because you have all of these success stories. Yeah I think there's so, so many different cases I could talk about where I saw them come to our program unsure, resistant, feeling like there was no other opportunity left for them and leaving and just finding an entirely new lifestyle, a new career, a new job, finding a way to go back to school.

And those stories are really what makes the effects of our program so significant. Yeah, and so rewarding for all of you that are helping. I would imagine that a lot of people come to or maybe again, this would just be me and hear about this idea of a cooking class and like, what is that going to do for me? I don't think so. Yeah, I the cooking class is hit or miss day one of how interested people are in engaging with me, but they're committed to trying and by the end they love it. They have a really good time. And I think the most reported change I hear in my post sessions with these warriors is I made that recipe you taught me, and I loved it, and I taught my family about it.

And I'm just one part of the traumatic brain injury program. My colleagues do amazing things with these warriors to liking them in acupressure, in art therapy and mindfulness practices. They get cognitive training every single day with a one on one cognitive trainer. They see neurology, they see psychiatry while they're here. So they really get such a well-rounded experience. And I'm just one small piece of that experience. And we all together as a cohesive bunch, really do make the impact. For Operation Mend. You do it again. It seems like the whole person is being treated, but the amount of funding required for this is huge.

How do you how are you funded? We're 100% philanthropy based, funded. And so how do civilians find you? So there's a website that you can visit that has a donate button. Or you can learn more information about our program, Operation Mend. And if you wanted to learn more about our Warrior Care Network as a whole, there's also a website for that to where you can learn about the other sites that are part of our Warrior Care Network. And do you have events? We do host events, so we host golf tournaments across the country where those seem to be great fundraising events. People like to get involved in a day of golfing.

And some people active. That one is. It's so attractive. We always have a really great turnout, and those seem to be good fundraising events for us. And then we have one event that's my personal favorite event in New York every year. Every year our team goes to New York and we bring a couple of participants from our program, and we walk with them in the Veterans Day parade in New York. And while we're there, we have other events. Sometimes we'll have dinners or we'll have auctions or things while we're in New York to help raise money for our program. That's terrific. So what do you see happening going forward, or is it just that you hope your services expand and you're able to reach more people, help more people?

Are there new arms of this that perhaps we even get to know what those arms are that could be explored? I think we're always talking about the big dreams that we have for the program, about how we can include more warriors, how we can expand our services to other populations that maybe can benefit from the services that we offer. And like you alluded to, new treatment arms that we can explore and provide an extra layer of of treatment and extra treatment approach to these warriors, all things that we talk about and we hope to to develop as the program continues. And you personally, what do you love about what you do?

I love seeing the change in the warrior from the start of our program until when they leave. My part of the treatment, whether that be over the course of a year because they did some other programing in between. But you really just see the growth in these, in these warriors. And if I was to pick a specific moment, I know I talked about the Teaching Kitchen so much, but I think I did because that is my absolute favorite place to watch. These relationships and personalities evolve in our program. It's kind of a super clear example, and to see this person on day one and then two weeks later to have become something different.

Yeah. In terms of a social experience. Have goals you never thought that they would have goals about or hear that something you talked about in one of your groups really left an impact and is something they're going to implement and change when they get home or get involved in when they get home. I hear about it from my colleagues sessions too. They'll be like, oh, and Cog training. We talked about this and I never thought about that, and I've already implemented it. And I texted my wife, and my wife has it on the whiteboard now. And you just it really these skills really resonate with them in our environment.

And that intensive treatment environment, which sometimes isn't accessible, other places where the cadence of groups or treatment might be every other week or every month, where the adherence to engaging in that programing is harder because real life comes up, whereas we have the ability to do so much in an intensive two week program. Well, it just completely speaks to what we need across the world, and that is respect. Patients love community. And look how how you can see people thriving and people coming from such deep trauma. You know, just to see that it's it must be so uplifting. I truly have the best career.

Well, thank you for doing what you do. And thank you for sharing with us what you do and what Operation Mend does. And we will, like I said, post so people can see where they can help fund your project. Thank you so much for having me. It was so great to share all about Operation Mend today. Thank you for being here. It's an honor to have you and we look forward to hearing more. It sounds like there are 15 other people we can talk to that can share some good insight as well. Please follow, rate and share our podcast and pass this episode along to someone who might need it. This is and now love.

Listen to your heart, live from your dreams and you can always say to someone who's been in service, thank you for your service.