Old Geezers Out to Lunch

Old Geezers Out to Lunch
The Geezers Emeritus through history: The Mathematician™, Dr. Golf™, The Professor™, and Mercurious™

Wednesday, February 6, 2013

A Look into the VA system.

As my father-in-law has been going through the process of being diagnosed then treated for a heart attack, we've spent quite a lot of time at the Minneapolis VA hospital system over the last three weeks, and it has been quite an eye-opener.

First of all, there is the paradox of the VA system itself. On the one hand, the physical hospital itself, and all the incumbent technology and facilities, are quite state-of-the-art. I have been in private hospitals with very lofty reputations in which the facility itself has been pretty old-fashioned and out-of-date. Not so with the VA, where the hospital building features bright, wide hallways, enormous waiting rooms for families, and intensive care units that really appear to have all the bells and whistles that modern technology can offer.

But managing this finely tuned  race car of a hospital is a managerial system that is positively medieval in its clumsiness and inefficiency. When my father-in-law had his heart attack, he was initially brought to the University of Minnesota, a world-renowned research hospital where the very first open-heart surgeries were pioneered. It's the place where Christian Barnard, the surgeon who performed the first heart transplant, was trained. Today, it is still a world-renowned hospital that is absolutely cutting-edge when it comes to heart treatment. So this is the facility that did the initial work-up on this 87-year old veteran, the hospital that told us precisely what was going on.

But the old guy is part of the VA insurance program, so we needed to then transition to that system for the actual care. The VA, in its infinite wisdom, simply could not or would not accept any of the reports or information offered by one of the world's best hospitals, so it started over from scratch performing the same tests and workups that had already been done (presumably at significant taxpayer expense), and then announced exactly the same findings we already had from two weeks earlier.

As a result, my father in law finally got his by-pass surgery yesterday, a full three-weeks after his initial heart attack. Not within a few days, as you would rightfully expect. A friend of mine, a younger veteran from Vietnam, smiled ruefully when I told him this story, and said this is pretty much the same story as with the American military itself—great, space age equipment, but an administrative system that is utterly feudal in its processes and logic.

Ironically enough, once you get into the system, you then rise above the administrative nightmare at the VA.  The actual teams doing heart surgeries for the VA are the same top-notch teams from the University of Minnesota, who come over a couple of days each week to bang out these heart surgeries like nobody's business. The heart ICU units and all the doctors and nurses there are consumate professionals, and we couldn't be more pleased with what we've seen, once we made it about the first-floor administrative offices. Within six hours of having his chest split wide open, his heart stopped and replumbed and then jolted back to life, the old guy was awake, alert, and asking when he'd be able to fish again.

I've spent quite a lot of time at the VA cafeteria recently, and this, too, is an interesting study. The clientele is divided into two rough groups these days. There is an older segment that includes veterans and families from the era of Vietnam through WW2, and a much younger segment populated by the folks from the various gulf and afghanistan conflicts.

It was a little startling for me at first to see that the Vietnam and WW2 vets seem like part of the same club, now. In my own head, of course, since Vietnam was the war of my own youth, I think of these guys as being far, far younger than WW2 vets. But these groups look much more like each other now than they do to the younger vets, and that makes sense when you think about it. Vietnam started in the mid 60s, less than 20 years after WW2 ended, and the older Vietnam vets are approaching 70 years of age, some of them. On the timeline of history, these groups are quite close together when compared to the youngsters fighting in Afghanistan today.

While there is a similarity of appearance between the Vietnam vets in their mid to late 60s and the 80-year olds from WW2, with their grey hair and gimpy knees, it's interesting to see how the Vietnam vets set themselves apart. There is a kind of uniform you see among those vets seeking treatment at the VA. Many of them wear caps, for example. Rarely are these armed forces caps; baseball teams, farm implement companies, fishing tackle manufacturers,; all these are advertised on the caps worn by so many Vietnam vets. You also see quite a few of the soft "bush" caps that resemble the soft fishing hats sometimes worn by fly fishermen. In the winter, it's pretty common to see these vets dress in hooded sweatshirts under heavy plaid flannel overshirts. It's so common as to be something of a stereotype. Vietnam was a pretty working class group, by and large, since so many of the college boys deferred in those days of the draft.

The WW2 vets, aside from being notably older when you look closer, seem to be prouder of their heritage, as they are more likely to wear clothing that is marked with quiet references to the armed forces branch or even the ships or divisions in which they served. Other than this, though, there is little to distinguish them from retired school teachers or hardware clerks.

But the larger group now are the veterans from the Gulf and Afghanistan, with very young families including toddlers and infants. It's a little shocking to see 26-year old fathers without legs bouncing infant children on their laps as they sit in wheelchairs waiting to see their doctors. And there are so many of them: so many young men with missing limbs or heavily bandaged legs that are being salvaged.  Minneapolis serves the needs of five full midwestern states, and so many of the worst injuries come here for treatment.

As difficult as life was for the Vietnam era vets, I fear it will be worse for this group. Three separate wars spread over a long, long historical period means that are many, many of these veterans who will come to depend on the VA system as they grow older. And because battlefield treatment is so much better these days, there are great many very seriously injured soldiers who might not have survived the same injuries had they been incurred in 1968.

In a few years, the plight of this veterans group could well be worse than that experienced by my own contemporaries from the Vietnam period. And it seems to be already starting, as a newpaper story this morning reported that veterans are committing suicide at the rate of 22 each day.


  1. Excellent post. I can add something from my own experience with the Dallas VA hospital. As you point out, the physical facility and equipment are state-of-the-art, and the major procedures are done by doctors...professors in may cases....from the UT Med School in Dallas.

    My wife (a 10-year Navy veteran from the '90's) was there around 5 1/2 years ago for breast cancer (she was between jobs/health insurance coverage) and the treatment she received was excellent. This was a relief as we had heard all the horror stories about the VA of old. Obviously major upgrades had transpired since. While we didn't have any private care/VA care stories to compare, I don't doubt for a minute that their management is antiquated. That's government inefficiency for you.

    Hope your FIL enjoys a full recovery. FYI, wife is doing just fine today. Thank you VA. :)


  2. You point out one of the great paradoxes of this time we live in - Wounds are treated better, so sufferers of more horrific injuries survive. Far be it from me to say with certainty that it would be better to be dead in some cases, but that's my first sad thought. God bless them all, in any case, and if the amazing advances continue (such as the double arm transplant which recently took place here in Boston, on a vet who had lost all four limbs) then perhaps there is more hope than not.

  3. We can hope that perhaps VA administrative procedures will catch up with both the battlefield emergency care and subsequent medical delivery. Some of our wounded warriors likely face a life time of VA engagement.