If there is a word that means the opposite of a news hound, that would describe me. I get my news in small bits on my drive into work, but lately because I work at the VA, the news has been coming to me. People I barely know have been asking me with furrowed brows, real concern and almost prurient curiosity in their voices, “Sooo, how’s everything going at work?”
The funny thing for me is that not much has changed. I still listen to my patients’ stories and examine them with the same amount of care I always have. In fact, I would say, other than the comments I get from others because it is all over the news, there has not been much change in my practice. For everyone else I know that works at my facility, I would venture a guess that this is true for them as well. We are all doing the work we came here to do, despite news media reports, despite protestors, despite changes in leadership, despite insufficient staffing and budgetary concerns, because it must be done.
Coming from private practice, I will admit I had some trepidation about coming to work at the VA. As with any large hospital system, I was worried about fitting in after coming from a small community office. My fears were allayed on the first day of orientation. I knew very little about the military before coming to the VA even though my parents met on a US Army Base in Vietnam. I expected to get educated about rankings and how best to address people. In fact, none of this occurred. Instead the emphasis was put on serving veterans, those who have put their lives on the line for our freedom and our liberties. It didn’t matter where they served, in what capacity, what their rank had been, if they were a part of our military, they had in the (paraphrased) words I heard for the first time in orientation, “in effect, given the United States a blank check, payable up to and including their very lives.” Sobering, isn’t it? I have always admired those who were in the military, but after working here I have an even greater respect for them. As a PA, I owe my career to those who served in Vietnam and World War II. With the job market for PAs in its boom phase, I could get a job anywhere, so why do I work at the VA?
I work at the VA because:
1. There is nowhere else I’ve ever been where patriotism is not only seen everywhere, it is expected. I believe despite all the detractors, sarcastic comments, and negative reports, that this is still the greatest country in the world. There is a reason everyone still wants to come here, a reason why people risk their lives trying to cross borders and flee across seas filled with pirates and rapists to get to this country. Are there countries with less crime? Yes. Are there countries with better educational standards? Yes. Are there countries with less poverty? Yes. Is there any other country in the world, where we can have people protesting outside the gates of a hospital where we are taking care of our wounded warriors, and the only comment made by hospital administration is, please don’t stop to talk to the protestors as it will impede traffic through that gate. Why? Because these wounded of ours fought for our rights, including the right to free speech, even if it is to used to say they think you are wrong. As an immigrant, I am proud to call myself an American, and proud to serve our veterans.
2. I love working at the VA because I am surrounded by others who love taking care of veterans. I am blessed to work in a place where people are happy to be here. Many of them will be even happier once we get more providers to help take care of the many veterans who are signing up every day to be seen, but even despite being overworked, patients tell me everyday that they can sense how happy everyone is who works here. These patients talk about the smiles on the faces of workers here, the friendliness of all the people who stop to ask them if they need help. It is bred into the culture of this hospital, from the very first day of orientation, that it is our job to take care of all veterans, whether they are sitting in front of us in an examining room or wandering looking lost in the hallways. Many of the employees here are veterans themselves, so patients feel a kinship with them, bonding over stories of boot camp and battles.
3. History comes to life at the VA. From World War II veterans who endured the Battle of the Bulge to Gulf War veterans who were there when they pulled down the statue of Saddam Hussein, I’ve met so many people who were part of history from patients to administrators. Just walking through our hallways is a history lesson. Though we have our fair share of generic abstract hospital artwork, these are far-outweighed by the pictures of veterans, memorials and other landmarks that commemorate their accomplishments. And if you are willing to listen, there is nothing like hearing first-person accounts of what really happened behind the scenes by the men and women who had boots on the ground
4. The world becomes more global at the VA. Hearing their personal stories of exposures to radiation on Bikini Atoll, trudging through days of pouring rain during the monsoons in Vietnam, and life on board ships in the Pacific brings the world into my little office. Most veterans have been stationed in places I’ve never had the pleasure of going, and just asking them their favorite place to be stationed always yields surprising answers. I’ve learned about clear cockroaches on Marshall Island, hamlets in Germany found intact after the bombing ended, and blinding dust storms in Iraq.
5. Good quality health care is given here. When I worked in private practice, it was my responsibility to keep countless algorithms and guidelines for clinical practice in my head. A 65-year-old man with any history of smoking? I had to remember to schedule his abdominal aortic aneurysm screening, EKG, and cholesterol check. Here at the VA, electronic alerts for recommended screening pop up to remind us. Providers with years of experience are coming to the VA, tired of the same dwindling fee for service, pressure to succumb to the almighty dollar, and rising malpractice costs that are driving people away from and out of medicine in general. People forget that innovative research and groundbreaking discoveries were done first at the VA, including the first implantable cardiac pacemaker and the first successful liver transplant. In the wake of all the negative media attention, I’ve had countless veterans making a point to thank me (!) for helping them. Two of these veterans shared their stories of how their lung cancer and colon cancer was diagnosed early here, after coming from private practice, essentially saving them from much worse outcomes. Our hospital is a teaching hospital, like the one in Detroit where I did my internal medicine rotation, and the one in Ann Arbor where I did my first undergraduate research with the University of Michigan. Everyday, eager students from nursing, medicine, OT, PT, psychology and countless other disciplines come here to learn from people who are taking the time to teach others how best to care for our veterans.
6. The electronic medical records system here actually helps me to get my job done as opposed to impeding it. That is not to say that I love EMR, but being able to easily access records for a veteran who is sitting in front of me makes my life and the patient’s life a lot easier. I get alerts about patients’ labs, imaging, and consultations sent directly to my account on my desktop. This is more efficient than keeping a list in my head of all the patient results I needed to check on throughout the day. Veterans also can sign up for a program called MyHealtheVet which allows them to look at their own labs, notes, and reports through a secure gateway, enabling them to take charge of their own health.
7. And most importantly, I get to help heroes every day. In the grocery store, you and I might walk by these men and women without a second glance as we run in to pick up a gallon of milk. Every day I have the privilege of meeting, talking, and hearing from people who though most of them would not call themselves so, are heroes. They have saved lives, built bridges both literal and figurative, done acts of diplomacy under scrutiny in foreign countries, and done this for those of us who get to sleep peacefully in our beds. I look at the world very differently, realizing there is a story inside every one of us ordinary-looking people.
I know there will be many, and have been many who say this system is damaged. My answer to that is that all of medicine needs to be revamped, and if closer scrutiny is what it takes to make our healthcare system more efficient, then it is a good thing and I am thankful for it. This scrutiny involves recognizing what works and fostering this, especially so those who are doing the work don’t lose courage to keep fighting for good healthcare for our veterans. What does not help, and will never help, is negativity without action. And so, I ask all of you to share your stories of what works and what does not, and perhaps then we can use those pointing fingers to lift the burden instead of making it harder to bear for those of us doing the best we can.