Viewpoint FROM THE CHIEF MEDICAL EDITOR

Paul S. Koch, M.D.

Memories of the VA

The first time I got into a lot of trouble in my medical career (the first time I got caught, anyway) was during my third year of medical school. Three classmates and I had no interest in our gynecology rotation, so we arranged it that after lunch one of us would stay behind to cover things and the rest of us would go to the Lincoln Park beach. That lasted only until the smell of coconut oil exposed our return.

The next time was during my internship at a VA hospital, when I made the serious blunder of discharging a patient on a Saturday. The administrator nearly took my head off on Monday. "If they’re well enough to go home, they’re well enough to stay until Monday," he screamed inches from my face. I didn’t know that the hospital received funding based on beds occupied and that, thanks to me, this bed stayed empty for two nights.

Recent stories from Washington about inadequate military medical services brought back memories of when I worked in, ahem, a different sort of hospital.

I remember the man who arrived at our VA hospital in extremis and drifted into a coma. One puzzled resident wrote that he wanted an autopsy after the patient passed. Thirteen years later the man was still in an acute care bed, waiting to die.

And who among us can forget walking past the bathroom and seeing a dozen veterans in wheelchairs sharing stories and smoking through their tracheostomies?

Most of my patients fought in World War II. My most memorable veterans were the ones who arrived in the late fall and stayed for the winter. Every few weeks they described a new symptom so they could be transferred from one service to another. Once spring came they "felt better" and headed home. Until then, they looked forward to being tested, probed, prodded and incised by every manner of student, intern and resident. It gave them something to do during the cold months.

An Extension of Service

They weren’t cannon fodder anymore; now they volunteered to be intern fodder. "No matter what you do, it’s impossible to kill a veteran who drinks," we amazedly whispered among ourselves. It wasn’t completely true, of course, but most of them did outlast many years of bumbling house officers. Through their patience and graciousness they helped us learn, continuing their lifetime of service to America until the end.

Pau