Reverberations From War Complicate Vietnam Veterans’ End-Of-Life Care

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Many of Ron Fleming’s fellow soldiers have spent the past five decades trying to forget what they saw — and did — in Vietnam.

But Fleming, now 74, has spent most of that time trying to hold on to it. He’s never been as proud as he was when he was 21.

Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive of 1968, sometimes for 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching a bullet himself.

“At 21, you’re bulletproof,” he said, as he sat on the edge of his hospital bed at the San Francisco VA Medical Center. “Dying wasn’t on the agenda.”

Now it is. Fleming has congestive heart failure and arthritis, and his asthma attacks often land him in the hospital. Ten years ago, he was diagnosed with post-traumatic stress disorder (PTSD), which makes him quick to anger and hypervigilant, as if he’s still in that helicopter.

Fleming’s physical and mental health symptoms, combined with his military history, are a challenge to the VA’s palliative care team, which is coordinating his care as his health deteriorates. It is a challenge they are facing more often as Vietnam veterans age and develop life-threatening illnesses.