September 20, 2012
“On May 25, 2004, my son, Army Specialist Rory Dunn, was on escort duty for a civil service team just outside Fallujah, when a daisy-chained IED hidden in a tree overhanging the road on which he was traveling was detonated by remote control as his Humvee passed underneath. The devastating shrapnel tore through the canvas top of the unarmored Humvee killing two soldiers and critically wounding Rory and another soldier. Rory was wearing a helmet, but the blast crushed his right cheek, forehead, and frontal skull from ear to ear; destroyed his right eye and right eye orbit completely; blew his other eye out of his head; and deafened him immediately in both ears. With no eyesight or hearing and with massive head injuries, Rory attempted to search the back of the Humvee to see if anyone else was still there, but then collapsed across one of the seats where he had been sitting. Rory was so grievously wounded that the medic, upon arriving, passed over him to assist another soldier who he thought had a better chance of survival. However, a Marine holding my son in his arms asked what he could do for Rory, as Rory was still clutching his weapon and asking about his buddies. Rory struggled against the three soldiers who tried to get him to the ground and on a stretcher. Rory finally lost consciousness as he was airlifted to a field hospital in Baghdad. His traumatic brain injuries (TBI) were so devastating that upon arrival at the hospital emergency unit, the triage doctor’s diagnosis/prognosis was that there was nothing that could be done for him. My son was set aside to die. It was his 22nd birthday.”
Excerpt from “My Son Went to War”
Rory Dunn nearly died that day in Fallujah. Afterward, the Army shipped his tattered body first to Baghdad, where they literally glued him back together and placed him in a medically-induced coma, then to Germany where his parents had been flown to say goodbye, and finally to Walter Reed Army Hospital stateside. Doctors gave him no hope of recovery, and only scant hope of survival. For six weeks he lay unconscious, and when he was finally brought out of it, his world was dark and silent. “It was horrible those first few months out of the coma,” recounts his mother, Cynthia Lefever, “He couldn’t speak, hear, or see. He had to just lie in bed without knowing what was going on. Gradually, we discovered that he had slight hearing in one ear, so I would get close to him and literally shout in his ear every day ‘This is Mom. You’re in the hospital. You are safe.’ Each day I’d give him a little more information.”
Dunn’s gradual return
In time, Dunn began rudimentary communication with his mother and stepfather — for instance, by tracing a question mark in his hand and then pointing to his eyes. Lefever told him he was bandaged because his eyes needed medicine — knowing that the truth —that one eye was gone, an empty socket in its place, the other attached with glue — was more than he could handle at that point. Making matters worse, his doctors insisted that Dunn would likely live out his days in a nursing home, in a vegetative state. “I knew Rory was in there,” says Lefever, “He would wiggle his toes when he wanted a foot rub; he was trying to reach out.” One day, frustrated and desperate to prove to doctors at Walter Reed that Rory was aware, Lefever grabbed a white board and a magic marker and thrust it into Rory’s hand. “He knew it was a pen,” she says, “And I got down in his ear and shouted ‘Soldier, write your name!’” In a childish scrawl he wrote R. Dunn. Lefever finally had the proof she needed; Rory was in there. His doctors were amazed.
All told, it was a year before he would be released, only to face countless challenges — surgeries, battles with the VA over benefits — as well as some victories. A corneal transplant, coupled with a hard contact, has returned the vision in his left eye. While still profoundly deaf in his left ear, a hearing aid has given him back sound in his right ear.
A Call To Action
Five years ago, when Dr. Theresa Cheng first read the horrific account of Rory Dunn’s injuries in The Seattle Times — and his subsequent disputes over care with the VA — she knew she had to find a way to help. Cheng and her staff had volunteered in their community for years, helping out at Baby Corner, building houses for those in need with Habitat for Humanity, and volunteering at other community events. And, while she saw the good in what they were doing, she and her staff had been looking for something new, and were immediately drawn to Dunn’s story. Dr. Cheng elaborates, “I was really moved by the article – he was essentially left for dead, and his mother was called out to to say goodbye to her child, only to stay with him for a year, advocating on his behalf, fighting bureaucracy, and helping nurse her son back to life from the brink of death. When I read the article, I couldn’t believe what the Veterans and their families had to go through. I assumed that Rory would have dental coverage through the VA, but I worried about his mom and her dental care — would she need our help? So initially, my goal was to provide dental care for the families of the Veterans – figuring that the Vet’s needs were provided for by the VA.”
Planning the event
Excited by the prospect of reaching out and helping Veterans’ families, Cheng began to plan out an event — a day of free dental care for Veterans’ spouses or significant others. Timing was going to be crucial – the article had been published in September, and Cheng traditionally holds the event on the day before Thanksgiving every year. She worried there wouldn’t be enough time to pull it off.
Cheng and staff rallied and started making calls to the VA to see if they could find families in need of dental care, only to be asked why she wasn’t instead offering aid to soldiers. It was then that she learned of the byzantine regulations and criteria Veterans have to meet to receive dental care after their discharge — and that most don’t meet the criteria. She explains, saying, “It’s very complex, and I’ve tried to talk with the VA about it — but they acknowledge that the ‘service disabled’ standard is very complicated. For example, one of the people we treated he had an implant done by the VA because he had lost the tooth in combat. However, they would not do cleanings, fillings and other work because they were not directly service related.” Because of convoluted criteria, most Veterans do not qualify for dental care past the 90 days the government provides for all discharged service men and women.
Through another reporter at The Seattle Times, Cheng was able to establish contact with Dunn and his mother. “She not only wanted to extend dental services to deserving Veterans and their families,” Lefever said, “But wanted to know how to better serve Veterans both in and out of the dental chair. She wanted her staff and others to understand PTSD, its triggers, and how to deal with potential PTSD episodes/behavior in the dental office and dental chair. As a health provider, she wanted to know how to not only serve and support Veterans in her community but to help others in the dental community understand the potential special needs of Veterans who had experienced combat and returned home with PTSD, TBI (traumatic brain injury), and other disabilities.”
Lefever, who has fought ferociously for her son since his return from Fallujah, declined Cheng’s offer of dental care for herself because she had dental insurance, but accepted the offer to bring her son in for an appointment. Cheng and her staff took easily to Dunn’s outgoing personality and eventually “adopted” him into their practice, and have provided his dental care in the years since. In Dunn, and servicemen and women like him, they’d found a new way to give back to their community. But Cheng and her staff did more than provide dental care, Lefever says, “Dr. Cheng treated Rory with dignity and respect. She wanted to hear Rory’s story, and understand PTSD. She thanked him for his service to the country, and made Rory feel appreciated.” Just asking for help can be a monumental obstacle for Veterans, who often feel shunned or forgotten upon their return. Randi Jensen, director of The Soldiers Project NW, a referral service for mental health counseling for returning Veterans, agrees. Jensen says, “It is very difficult for these men and women to ask for help — they’re ashamed that they have to reach out for free services.”
Getting the word out
That first year, contacts at the VA allowed Cheng to post flyers in the VA dental clinic, which helped them nearly fill the books. The following year, however, VA officials informed her that allowing the flyers had been a breach of protocol — that it implied an endorsement, which isn’t permitted without a long, formal process. So, while Cheng had been warned that offering free care to Veterans would leave her inundated, she found nearly the opposite to be true, saying “It’s very difficult to get the word out – I thought I would just call the VA and they would let the Veterans know, but they don’t have a way to reach these people. I went to other community and Veteran support groups with people from Vietnam, and believe it or not, one of the biggest problems they have is reaching their audience. It was an interesting education for me — it’s harder to get the word out than you would think.”
After the first year, Cheng forged an alliance with social workers at the VA — they had patients who needed dental work, and they could help spread the word to those in need. That, along with word of mouth, has helped make the day a success for the last five years — she and her associate Dr. Sul Hong see about 30 Veterans between them on the day before Thanksgiving. And, her close relationship with the social workers means that they call on Cheng throughout the year if they find a Veteran in need. Cheng relates, “They occasionally call us with a special case during the year. One of the Vets even got an implant – Nobel donated the implant, the lab donated their work, the prosthodontist donated the dental work – it was very cool.” And while some might worry that working with Veterans could be difficult, Cheng eschews the notion, saying, There are some things to learn that are specific to Veterans who have been in combat and may be suffering from PTSD,” she says, “but they’re simple guidelines which are easy to learn and follow, and the benefits far outweigh any issues.” Cheng learned much from Dunn and his mom — that Veterans can be jumpy, you can’t just tip them back in the chair without telling them first; they’ve been trained to react quickly to surprises. Lefever adds, “It took a long time for Rory to be able to sit in a dental chair with his back to the door. They’re told never to do that, and it becomes ingrained in them.” Dr. Barry Feder agrees — he’s been an enthusiastic supporter of Cheng’s program for years. Feder, himself a Veteran, sees three or four Veterans in his office a year, noting that there is a huge need to deliver care to this disenfranchised population. Most of the dentistry he provides is standard, including cleanings, fillings and crowns. The Vets, he says, are great patients, easy to work with, and grateful for the care they receive.
Today, Cheng is looking to expand her program further, and she needs your help. She’s looking for additional dentists, and she’s looking for people with ties to the Veteran community to help get those in need into a chair. It’s equally important to her that the families of Veterans are looked after, too. Cheng would like to be the lead contact for Veterans and their families needing care, saying, “They can come to me and we’ll clean, screen, and set up a treatment plan, then pass some along to other dentists in the community-at-large willing to complete their care.” And, while Cheng has typically set aside the day before Thanksgiving as her personal tribute day, she sees no reason why dentists couldn’t opt to see patients any time their schedule permits. “Ultimately, I’d like to find people willing to adopt Veterans and provide ongoing care — whether it is provided free or not — but if people want to participate to a lessor extent, that’s fine, too. The idea is to find them a dental home in the community. It’s easier for the Veterans to get to their appointments, and doctors can see the Veterans in the comfort of their own office.”
If you would like to learn more about Dr. Theresa Cheng’s program, please contact her at firstname.lastname@example.org.
Editor's note: Dr. Cheng would like to thank the many dentists who have participated in the event over the years:
Dr. Eugene Hsu, Dr. Scott Okino, Dr. Susan Robins, Dr. Willis Gabel, Dr. Ryan Duval, Dr. Jerome Yamada, Dr. Timothy Butson, Dr. Warren Libman, Dr. Kelly Garwood, Dr. Kristi Donley, Dr. Paul Chilton, Dr. Roger Chin, Dr. Eric Hagman, Dr. Kelley Fisher, Dr. James Ma, Dr. Virginia Lee, Dr. Robert L Odegard, Dr. Mark Nelson, Dr. Martin Scott, Dr. Lisa Kajimura, Dr. Raymond K. Chan, Dr. Merle Herbison, Dr. Blake Herbison, Dr. Boyd Munson, Dr. Tom Rude , Dr. Randy Lake, Dr. Aaron Cooley, Dr. Brandon Cooley , Dr. Chris Manley, Dr. Ellen Reh, Dr. Helen Youm , Dr. Andrew Lewis , Dr. Greg Mortensen , Dr. John Berude, Dr. Steven Kwan, Dr. Edmund Kwan , Dr. Emily Kuo , Dr. Warner Young , Dr. Gary Folkman , Dr. Mike Scoles , Dr. Pete Nathe , Dr. Don Pratten, Dr. Ryan Wynne , Dr. Theodore Baer, Dr. Kerry Bailey, Dr. Daniel Topper, Dr. Baptista Kwok