Veterans' Psychiatrist Puts Duty Before Departure

Long Beach VA Medical Center staff often go the extra mile in their service to 45,000 patients yearly. But when retiring psychiatrist Dr. Epifania Casino listened to a woebegone former GI she's seen for 13 years, she was compelled to go an extra three months.

She'd planned to retire in September. Then came the patient's visit. He sat in her tiny plain office near the corner of 7th and P.C.H., in the familiar blue naugahyde chair. When he heard the news, it was devastating, Casino could see.

""He is a very sad, lonely man, about 60, never married. He has no family,  friends, no pet," she recalled. "He came to us severely depressed and then made satisfactory progress with the medications and therapy we prescribed. Now, however, he has begun facing major medical problems and his depression has become serious again."

She remembers his four simple words, before he started to cry: "'You're all I've got.'"

Psychiatry is a challenging field for practitioners because patients suffer brutally;
its causes are are simple to define, yet the problem is almost always difficult and time-consuming to alleviate or cure. Causes are overwhelming physical or emotional trauma, or a malfunction in the chemistry of the brain.

Post Traumatic Stress Disorder or PTSD among returning war veterans is the most common current example, statistics show, but it is not confined to service personnel.

Stricken by her depressed patient's grief at losing her, Casino, a grandmother, re-thought her retirement plans.

Her name, Epifania, is Spanish fror "epiphany," a sudden realization of mercy, hope and comfort, drawn from the Bible.

She had one.

"What if my patient had come to his appointment to find a stranger at my desk? How many other patients might I have who would be expecting me and then hear: 'Oh, she's retired. She's gone.' How would they feel?"

"I assured him that I would reccomend a new doctor who would be just right for him, who would understand him just as I have," she said.

"And after he left, I called upstairs to personnel to ask if I could extend my retirement date three months later, to the end of December, " Dr. Casino said.  "I knew by his reaction that I must see as many of my patients as possible for one last time, to properly say goodbye and to wish them well."

Those farewells drew to a close last week. One of her final official acts, on Friday, involved signing this reporter's request to be excused from jury duty.

She has treated many of her patients for years, not simply as a therapist but more broadly as their case supervisor; those over-arching responsibilities often mirror a motherly role. She monitors and sometimes alters their medications, asks about family--if any--their feelings, work or job search, questions sleep, appetite, anxiety levels, fears, hopes and other matters. She is the mother some never had.

"I wanted to be a pediatrician," says the graduate of the Phillipines' prestigious University of Santo Tomas, "but changes happen."

The daughter of a Filipina mother and a successful Chinese businessman, she came to the U.S., after marrying Leon Casino, to enroll at Michigan State University. She completed residency in adult and child psychiatry at MSU's Fairlawn Center facility, and went to work at a Michigan VA hospital. A friend urged her to apply at Long Beach. 

Once established here in 1989, she was also recruited by the Los Angeles County Department of  Child and  Adolescent Mental Health Services and its Asian/Pacific Islanders Family Mental Health Program. She is continuing as a consultant there after retiring from the VA.

She notes Asians have long been reluctant about any perceived need for mental health care because of their ancient cultural stigma carrying shame for a family with a member so afflicted.

But, she says, Long Beach's large Cambodian population is far more accepting where care is needed. Many suffered cruelly under the Pol Pot communist regime, losing entire families to murder, torture and starvation in forced labor camps. Some of the younger Cambodians are also still struggling to assimilate here.

She's worked with tough, sometimes gruff old American GI  combat veterans dating from Vietnam 40 years ago, and now young men who could be grandsons just back from present warfare abroad. And, she's worked with the mentally afflicted young. Her observations?

"Children are the most challenging. It is hard to reach children," Dr. Casino explains. "There is always a set of symptoms, but children do not have the language to express themselves. And of course the origins of their traumas differ."

Retirement for Dr, Casino and her husband, who live in Fullerton, will mean longer trips home to the Phillipines and more time with their four children and five grandchildren here. Leon is retired from property title research in the realty and banking industry.

"We've been all over the world, but there are still so many beautiful places in America to see, we are anxious to get started," says Dr. Casino. 

She remembers many patients quite fondly, especially two who now live far away, but insisted on remaining in the Long Beach VA outpatient psychiatry program for devotion to her, rather than transfer to a VA facility nearer their present homes.

One patient lives out of state, but has kept his 90-day followup conferences with her four times a year, bringing his whole family along at least once annually for a California vacation.

The other lives in another country, but has continued to fly to Long Beach for those scheduled appointments, rather than give up his favorite "shrink." He may lose frequent flier miles now, but of course, he's losing so much more.