Tuesday, January 27, 2009

The Russian Sanitarium

VA [Veterans Affairs] facilities have never been known for being warm, inviting medical centers teeming with well-trained doctors and solutions. In fact, they’re usually known for being horrid places – like hospitals for “the rest of us.” Those too poor to go to real medical care. That conviction was firmly driven home when I sat in the records office of a VA medical center one day As the man there took a break from hitting on me and telling me stories about misdiagnosed CODs [causes of death] all the time in the VA morgue, he leaned in and whispered, “I’ve been working here ten years. I wouldn’t take my DOG to get treated at this hospital.” His admission didn’t provide any reassurance that I was receiving quality medical care in the least.

While I can only speak for the part of the VA medical system I have seen, that hospital, at least aesthetically, is bloody awful. In what I presume was a massive attempt at improving their image in the community, the hospital underwent a thorough renovation of their main corridor – complete with friendly banners pointing you down the right halls, signs offering you helpful health tips, and even a nice little dining area with attached shop to buy veterans paraphernalia. (The one thing they didn’t sell was the one thing I would have purchased, though. A t-shirt that read, “Crazy, washed-up veteran.” I’d definitely wear that).

As a consequence of the renovations, the main corridor of the veterans hospital in question looked almost modern. But the cheery aura ended abruptly when you followed one of the signs into the bowels of the building. Until about six months ago, the corridors were painted a pale, awful, minty green. If I had to guess, they bought it as overstock from the Soviets when they realized they had no further need for Ukrainian Orphanage Green. But that was just the walls.

The sad, buzzing, flickering lights overhead illuminated similarly ghastly floor tiles – also bought from the Soviets: Russian Sanitarium Blue. The only thing missing was patients in ratty gowns sliding listlessly along the walls, or perhaps wheeling themselves along in 50s-era wheelchairs. And honestly, they had a few of those, but they somehow were allowed to “escape” into the main corridor. I’m sure it was bad for business. But hiding them was equally bad for business. It meant hiding the cost of war – and freedom.

I have certainly spent my fair share of time sitting in dank waiting rooms, wondering where on earth any sort of receptionist may be. For some reason, the VA will often schedule an appointment for me at high noon. I dutifully arrive 30 minutes early and check in, and am promptly informed by random passersby that nobody will be in the office from noon to 1PM. They’re on lunch, I’m told. So why was I told to be there at noon? Nobody could ever explain.

I will not comment on the professionalism of the medical staff there, since I’ve had equally unpleasant experiences in more mainstream facilities – doctors running into doorways, nurses unable to draw blood and routinely jabbing the needle all the way into my elbow joint – then panicking. I guess, in comparison, the VA docs aren’t any worse. So far, I haven’t seen any of them wearing googly eyes or a Patch Adams red nose. In fact, I’ve had a number of good dealings with VA staff.

In order to help reduce the traffic and burden at major VA facilities, and also to help accommodate the rapidly growing numbers of veterans entering the system, the VA began constructing a series of outpatient clinics throughout more local areas. They handle what they can, act as general practitioners, and screen any patients for more advanced care at the hospitals. Thankfully, I’m able to drive thirty less miles to one of these, and receive what I consider to be excellent care.

Since the building is new, an effort was made to improve the ambiance of the place from one of perpetual, eastern European depression to a cheery, inviting place to get your checkups and be done with it. And, they’re nice people.

Since I began using the facility in late 2007, I have been thoroughly pleased with the doctor there. In part because she has a smaller patient load and also because she’s just good at what she does, she actually remembers patients and their histories.

After I check in with the cordial ladies at the desk, I’ll sit in the waiting room and watch the handy flatscreen TV until I’m called back for some initial triage nonsense – with a friendly nurse. They record everything, determine that I’m not on the verge of death, type it all out at breakneck speed into the system, and then shuffle me into an examination room to wait on the doctor.

She’s always punctual, polite, and courteous. I find this particularly admirable because veterans, as a whole, are probably the single most self destructive patients a doctor can counsel. They tell us to do something, we promptly do the opposite. It may cause them to pry a little less into our behavior, but that’s probably so they don’t rip their hair out in frustration when they learn what we’ve been doing with (and to) ourselves.

When I was diagnosed a year ago with knee problems, the doctor prescribed me a PILE of painkillers, which I promptly put in a cabinet and did not take. I don’t want to take pills until I absolutely need them. When I came back some time later, she asked if I’d been taking them. I told her no, and received a very gentle scolding. She gave me good medical reasons to take it on certain occasions, and I conceded that she was correct. I left, and haven’t taken any still.

I recently scheduled an appointment for some other joint problems. That visit was supposed to be this morning. An hour before I was going to leave for the visit, I received a call saying that they strongly recommended that I not come in because of the ice and sleet on the road. I told the receptionist that I was sort of looking forward to going somewhere today.

“You can still go somewhere, but just don’t come here.”

I see. Rather dejectedly, I hung up. And then went to the appointment. Why? See the remark about veterans being stubborn. At any rate, they saw me anyway.

So, without consulting the records, the doctor reminded me that since I’d been prescribed so many painkillers a year ago, I should be taking it for the joint problems I have now. Again, I told her I had not. And again, the frown and gentle scolding, accompanied by a number of good reasons that I should listen to her advice.

Even the diagnosis amazed me, though. She remembered that I’d only recently returned from a lengthy motorcycle trip (from my last visit in December), and quickly determined that the problems I was now having were due to my body adjusting to inactivity, sitting on a motorcycle, and now suddenly starting to become active again. All this without looking at notes. In fact, the only time she looked at her notes at all was to confirm just how many painkillers I should take on any given day. Aside from that, it was all memory.

Since I highly doubt I’m an unusual patient at her facility (with the possible exception of my age), I assume she has the same sharp memory for all her patients, which is commendable. She gives the impression – most likely rooted in fact – that she actually cares about her patients. I like it, and her professional, caring attitude has greatly reduced the unease of going to see a doctor about anything at all.

She represents a turning point for the whole VA medical system. In the past, they were laughably inefficient, frustrating, and inclined to waste as much of your day as they possibly could. But that’s changing. Even our records are entirely digitized so any doctor at any facility will see the exact same diagnoses and treatments immediately. What’s more, this is now even available to US.

With little more than a few clicks of the mouse, we’re able to go online and access our own medical record and look at our own x-rays, MRIs, diagnoses and prescriptions. We can chart our own cholesterol levels, our own health, and even order new prescriptions without ever leaving the house and waiting in a long line of impatient vets eager to get their pills and escape the horrors of a VA hospital. According to an article I recently read, this new system is an attempt by the VA administration to set a trend in veteran care. And thus far, it seems to be a great system.

While many have undoubtedly complained about the VA healthcare system, my personal experiences have been relatively favorable. So much so, in fact, that I’m probably going to send a thank-you letter to the VA doctor and thank her for her outstanding treatment, professionalism, and care. And tell her that I’m still not taking my medication.

Copyright © 2009, Ben Shaw
All Rights Reserved


  1. Your doctor is either Indian, Pakistani, or Chinese.

  2. Oh, no, Benjamin. You ARE an unusual patient at her facility.

    I know several seniors who have developed great friendships with their doctors and their medical staff over the years. In fact, I am known as Sunshine to a variety of older patients we have at our clinic. I guess when folks get on in years and their world shrinks to doctor appointments, visiting sisters and writing commentaries, a friendly smile here and there can really brighten their day.

    Hope this brightens your day!

  3. Write your Doctor a thank you note. Letters of appreciation are rare these days.