The VA - A Book Reading in the Operating Room and a Few Memories
I was honored to read stories and share writing insights with my friends and colleagues in the OR at the Zablocki VA Medical Center today. Thanks for the warm reception!
I did my first rotation at the VA in July 1980 as a brand new PGY1. Many of the people I spoke to today had not yet been born then, of course. The VA has changed quite a bit but not nearly as much as our other campuses. Here are a few things that I remember from 1980 that no longer hold true:
We routinely had thirty patients on the ENT Service, many of whom stayed in the hosptial for months. It was common to admit someone in the fall when the weather turned cold and discharge them in the spring. Some would be hospitalized for their entire course of radiation therapy. I remember one veteran who was on our service for at least two years, hoping to heal his wounds after a laryngectomy.
There was a sixteen-bed open ward on our floor (5A South). Making rounds was simple and we moved from one bed to the next. The vets would rat each other out if someone had refused medications, was still smoking when they assured us that they had quit, or wasn't complying with physical therapy.
There was no such thing as outpatient surgery. Everyone was admitted the night before and stayed at least one night after. No one could be admitted for an elective procedure over the weekend, so patients undergoing surgery on Monday had to be admitted on Friday, then sent out on a pass until Sunday evening.
Our section chief insisted that the pathology report be back before a patient was discharged (apparently in response to a missed report at some point in the past), so a patient undergoing a direct laryngoscopy (now an in-and-out procedure) would be admitted on Friday, have the procedure on Monday, and go home after the pathology report came back on Thursday.
Patients who were at risk for alcohol withdrawl could have beer from the refrigerator in the nursing station. As I recall, it was not very good beer.
The cafeteria closed at 2:30 for the day, so if I was on call wanted to eat anything between 2:30 pm and 7:00 am, I had to bring an entire meal from home. Or have nothing to eat.
Smoking was permitted anywhere in the building. The VA had the cheapest cigarettes in town because there was no state tax. It was common to see patients pushing wheelchairs full of cigarette cartons to their cars after clinic visits. Ironically, the VA was the first Milwaukee-area hosptial to ban all smoking in the building, although there was pushback from the VFW and the American Legion. The VA built heavily utilized smoking shelters and initially put them right outside the front door. Not a good look.
The operating room was on the second floor but the ICU was on the seventh floor. Waiting for elevators and navigating long corridors while moving very sick patients to the ICU from the OR was sometimes terrifying.
As surgical trainees, we had frighteningly little supervision in the operating room and none at all in clinic. There was a coding system for faculty involvement in surgery ranging from 1 ("faculty surgeon scrubbed in and performing the case") to 5 ("faculty surgeon in town and available by telephone"). We did a lot of surgery as residents that would have been 3s and 4s. That never happens these days; the staff won't bring a patient into the OR unless the faculty member is present, in scrubs, and ready to go. Somehow, the lack of having faculty present seemed "normal" back then. It was wrong.
The hosptial was built on the grounds of the Milwaukee Soldiers Home, an institution created in 1867. The current building was erected in 1966. When I was in training, it was the Wood VA Hospital. It was renamed the Clement J Zablocki VA Medical Center in 1984 after the powerful US Congressman in whose district the medical center sat. For years, there was a full-size recreation of Zablocki's office preserved as a museum piece near one of the entrances.
Two of the most important employees at the VA were the men who worked in the radiology department file room. Back in the days when all xrays were on film and needed to be sorted and filed, they had an uncanny ability to find any film at any time.
There were always a few employees that inexplicably kept their jobs despite assidiously accomplishing nothing while at work. As residents, we quickly learned who would help us and who would passively agressively make our lives harder. Maybe that is still true.
Early on, I was always struck that the VA was a small town that just happened to have some incidental healthcare functions. There was a post office, a barber shop, a nursing home, a police department that could make traffic stops and write tickets, a store and cafe ("the canteen"), a bowling alley, a house on the grounds for the center director, its own zip code, a cemetery, a motor pool, libraries, and plenty of signs telling you that this-or-that was prohibited. There was a row of bars across National Avenue that were patronized by hospital patients, some in VA pajamas and pushing IV poles.
Here is what hasn't changed, though. I began working there caring for a few WWI vets and mostly WWII vets. I actually met a hundred-year-old veteran of the Spanish American War (the era of which ended in 1902!). Now, most of the people I see with head and neck cancer are from the Vietnam War or Gulf War eras. No matter when they served, it has been an honor to be part of their care.