Quacks: Two years as a patient in a Veterans Administration nursing home
Noun: quacks kwaks
1. Charlatans who pretend to have medical expertise.
Verb:
1. The harsh sounds of a duck.
2. To act or do business as a quack.
by Fred Dungan
May 9, 2009
3749 Myers Street
Riverside, CA 92503
(951) 688-1396
fdungan@fdungan.com
Dedicated to the memory of my parents, Chief Russel Alonzo Dungan, U.S.N. (Retired) and Blanche Marie Dungan, whose selfless, God-fearing, caring natures were not lost on their son. Although you no longer walk this earth, your footsteps remain, suspended by good deeds in the sands of time. May your descendents continue to display these social attributes for innumerable generations to come.
Preface
Dr. Reipzig slid the x-ray of my right knee out of the large manila envelope and slapped it onto the backlit screen that hung on the examination room wall. Scowling at the negative, he pronounced the verdict: “kaput,” which pretty much summed up its condition. Bone on bone, no cartilage left, it was time for me to get an operation.
Artificial knees usually last twenty years or more. When they wear out, they are relatively easy to replace. How do I know? It says so in the pamphlet the VA gave me to read.
The clerk at the front desk scheduled a pre-op appointment for me with the VA hospital’s orthopedic surgeon. I drove home, wrote the pertinent information on a wall calendar, and gave the matter no more thought. Three months later, I received a phone call from a robot phone calling machine reminding me of it.
Chapter 1
Pre-op
After taking my temperature and blood pressure, the nurse directed me to one of the 50 or so identical examination rooms in 3NW Ortho and told me to sit down on a stainless steel piano stool. I waited for what seemed like eternity and it crossed my mind that they might have forgotten about me. I was about to stand up when the door opened and in stepped a flaxen haired young fellow in khaki trousers and a polo shirt. He looked as if he belonged on the 18th green. All that was missing was his titanium putter. I thought a white lab coat and stethoscope were de rigueur for Veterans Administration doctors. But this wasn’t just any old doctor. Surgeons tended to be prima donnas. They comprised the top echelon of the VA medical hierarchy and were pretty much free to say and do what they pleased.
“Hi, I’m Dr. Harold Gustafson. I’ll be leading the surgical team that is going to replace your—he paused to scroll up and down a file on a flat screen monitor—right knee.”
The creamy white right hand that he extended to me was frighteningly pale—as if it was regularly kept tucked away and had only been brought out now because manly tradition demanded it. Obviously, it was a hand adverse to physical labor—no calluses here—with carefully manicured nails and cuticles. For a nanosecond I searched in vain for a trace of clear nail polish, but none was to be found. At least he’s not gay, I thought.
My grizzled right paw took hold of his cold, clammy hand and pumped it up and down as if to wring out the excess moisture. No question about it, this guy had the grasp of a dead fish and I was sorely tempted to squeeze some life back into it when it occurred to me that this was the hand of a skilled surgeon who would shortly be cutting apart my knee with a glorified saber saw. Best to keep on his good side.
Then I noticed the Rolex on his wrist. It too was limp. Strange, why would someone buy an expensive watch and not have the metal band adjusted? Perhaps it wasn’t his watch after all. Or maybe he had lifted it from a corpse after an unsuccessful operation. It took me back 30 years to a distant jungle where I used my bayonet to mine gold nuggets from the teeth of the enemy dead. It certainly wasn’t anything I was proud of. But my sergeant was doing it and I desperately needed the money to get drunk enough to forget what I had become—a predator who was loathe to let morals and ethics interfere with the instinct to survive. Having pumped the limp appendage dry, I released it, half-expecting it to fall off the body and flop around on the floor. But then those kind of things almost never happen in real life. Kind of a shame, isn’t it?
But I digress. My right knee was a real mess. For 10 years I had been walking stiff-legged with a knee that would not bend. The cartilage had worn away and calcification had fused what remained of the knee cap to the upper and lower leg bones. Bone on bone is about as painful as it gets—stabbing pain that wouldn’t go away even when I wasn’t walking. I was getting two to three hours sleep at night and popping far too many pills.
“So, how do you go about giving me a stainless steel knee,” I asked.
“It’s titanium,” he corrected. “We use titanium because it is stronger than steel and weighs less than aluminum. They normally cost $50,000, but the VA gets a good price on them by purchasing in bulk. Your new prosthetic will last 20 years or more. And it will be easy to replace because it’s crenellated.”
“What’s ‘crenellated?’” I interrupted.
“It’s like the battlements atop a castle wall. We will notch your leg bones to mesh snugly with the ridges of the prosthetic, much like the gears in a transmission. After a while, you won’t even notice that it’s there.”
Dr. Gustafson smiled a bit too smugly for my tastes. Did I really want to put my life in his hands? The answer was a resounding no, but I couldn’t come up with any other option. A private surgeon would cost more than I could afford. Besides, the VA was going to do it for free plus pay me a monthly check until I completely recovered. What could go wrong? Knee replacement was commonplace. It was so safe that the VA didn’t hesitate to replace the bum knees of World War II vets who weren’t in the best of health. The government was offering me an outright gift and it didn’t seem right to dig too deeply into the details. I didn’t want to appear ungrateful, however, there were a few questions for which I lacked answers. Seeing as how there is no time like the present . . .
“What’s your rate of success? I mean, does anything ever go wrong?”
His eyes narrowed and he wet his lips. Unwittingly, I seemed to have struck a nerve, but it only took a moment for the smug smile to return.
“My team has the best statistics at this facility or any other VA hospital in this region,” he bragged. “More than 99 out of 100 knee and hip surgeries are successful. I’m very good, in fact, I’m the best.”
That was exactly what I wanted to hear. In my youth I had been a boxer. Statistics made sense to me. You are either a winner or a loser. I had seen enough winners to know that they oozed confidence from every pore. If you’re going under the knife, the last thing you want is to have a loser perform the operation. I nodded my head up and down in approval.
Dr. Gustafson seemed relieved. He checked his surgery schedule and tentatively penciled me in for the first of three operations he would be doing on a Thursday three weeks from now. His assistant would provide the details. Like a fool, I signed a VA form authorizing surgery without bothering to read it. One more perfunctory handshake and I went out the door. Total face time with the man who would be sawing me apart had been less than five minutes.
Instead of shoehorning myself into a crowded elevator, I went down the stairs to the main lobby and exited the hospital through a side door. On my way back to my truck, I stopped to gather my thoughts at the manmade duck pond which encircles the facility in much the same manner as a moat encircles a castle.
This was elective surgery. Nobody was putting a gun to my head. Other options were available to me. Loma Linda Medical wasn’t the only VA hospital in Southern California. I could have said “no” and went elsewhere. There were VA hospitals in Long Beach, Los Angeles, and San Diego—all of which had skilled orthopedic surgical teams that had put artificial knees and hips in thousands of veterans. That was exactly what bothered me the most. No matter where you went in the VA system you ended up getting factory-style surgery. Gone was the close relationship between doctor and patient that was standard in private practice. I really didn’t trust that limp hand to wield a scalpel.
So why had I signed the authorization form? As I was watching a pair of snowy egrets stand stiff-legged at the edge of the pond, the answer came to me. It was a piece of philosophy that had kept me sane when Uncle Sam snatched my conscientious objecting teenaged ass out of the University of California at Irvine and thrust me into the role of a shotgun toting, .45 caliber semi-automatic pistol equipped United States Army Military Policeman some 35 years earlier: “Oh well, what the hell?”
Chapter 2
Op
Just because I signed the authorization form, did not necessarily mean I was going to have an operation to remove my frozen right knee and replace it with an artificial factory-built gizmo that was guaranteed by Johnson & Johnson (the baby wipes people?) to last twenty years. But what if it broke down before that? Was I supposed to unzip my skin, rip out the bloody thing and send it via Federal Express overnight delivery to their plant in Dearborn, Michigan (or wherever—if you have seen one dilapidated Rust Belt city, you’ve seen them all).
Before the VA would pay the $50,000 plus surgical cost, I would have to prove that I was worth that much. After all, if I dropped dead during surgery, the government would lose a bundle of money. I mean, no matter how good the guarantee was, one could hardly expect a manufacturer to restock an artificial knee that had been salvaged from my decomposing corpse. Not that my corpse would be any different from any other veteran’s corpse in the identical graves that flow row upon row like some horrendous crop that war has grown in our national cemeteries. No, it is simply that once you drive it off the lot, that knee is only worth a fraction of its original value. Think of it as a new car after it has lost that new car smell.
Everybody got a piece of me. There were EKG’s to perform, blood tests to be taken, urine to be sampled, and countless forms to fill out in triplicate (had Congress met in secret and repealed the Paperwork Reduction Act while we weren’t looking?). Somewhere there is a set of rules and regulations that govern the VA. Veterans aren’t permitted to see it, but we are nevertheless expected to abide by it. We refer to it as the VA Bible. In Genesis, it says that “an appointment begets another appointment which begets yet another appointment” and so on until there are enough appointments to give everyone in its bloated bureaucracy full employment with no danger of layoffs. And, should the budget shrink, benefits to the veterans are cut while medical personnel continue to enjoy their Garden of Eden lifestyle. Veterans function as guinea pigs unnecessarily sent to specialist after specialist with little or nothing ever coming from it. The primary purpose of an appointment is to schedule the next appointment. Frequently the physician is overloaded with patients to the point where there is hardly time for anything else. On busy days doctors are rushed to the point where they diagnose patients with diseases and ailments they do not have and for which they are prescribed drugs they would probably be better off not taking. Veterans are regularly kept busy running in circles with little or nothing to show for it. Most instinctively know better than to attempt to change the VA bureaucracy‘s attitude that they are dispensing a charity, rather than providing an entitlement. Besides, an overworked physician soon learns that it is easier to prescribe “feel good” pills than to determine the actual source of an ailment. It should not surprise anyone that even the most idealistic physicians eventually succumb to the regimen of a system of public healthcare that is substandard to that of private practice. This phenomenon is by no means limited to the Veterans Administration. Even in Honoré de Balzac’s day, government employees who valued their jobs learned to go with the flow and got along to get along. The primary difference between then and now is one of degree in that the more money that the public pumps into the VA in an effort to help injured vets, the more bloated the VA becomes. Top VA administrators want nothing more than to add to the size of their fiefdom in order to aggrandize their personal standing. The objective is to further the image of the VA and thereby perpetuate the bureaucracy. All else, including healthcare is secondary. Thus, the construction and maintenance of buildings and grounds receives priority over healthcare for veterans. This can assume ridiculous proportions, e.g. at the Jerry L. Pettis Memorial VA Hospital in Loma Linda, California, disabled vets bide their time waiting for a walker or a wheelchair while duck ponds, valet parking, and state-of-the-art, motion-sensing self-flushing toilets receive priority. Or as the veterans say, it’s all show and no go, with the emphasis placed on what VIP’s see when they tour the place.
The ideal situation would be to have the VA run by veterans for veterans. If it was staffed with veterans, the agency would be sensitive to the needs of veterans. Most of the medical personnel were recruited from overseas countries such as South Korea and the Philippines ostensibly because immigrants will work larger caseloads for lower wages. No matter that many of them have a hard time learning English and/or tend to stick to themselves—to the detriment of veterans. There is nothing in this world as rude and disheartening as going to the VA clinic for a checkup and having a couple of Filipino nurses discuss your condition in their native language, Tagalog, in front of you. Why are they being so secretive? Could it be that they know something that you don’t—like maybe you have leprosy or AIDS? It’s just plain bad manners to talk about someone who is present in the room as if they are too dumb to understand what you are saying. If they must hire their employees from the dregs of foreign cultures, the Veterans Administration should at the very least give them an idea of how they are expected to act. There is a lot more to being a good nurse than processing the maximum number of patients in the shortest time.
Forgive me for going off on a tangent, but I’m an old man and I tend to ramble. That’s the only nice thing about getting old—people make allowances for your age, so I can get away with quirky behavior. When you are young and poor and you do outlandish things, people call you crazy. But as you get older and acquire some wealth, they either shut their mouth or refer to you as eccentric. You are the same person behaving just as badly as before, but somehow your age and money makes a big difference.
As I said earlier, I had to have my blood tested and my urine analyzed. That takes place at the Laboratory where you have to take a number and wait. A cylindrical device on a stand spit a scrap of paper with the numbers 069 at me. There was row after row of government issue dingy orange fiberglass bucket chairs in the waiting room and each chair was bolted to the others in the row by means of a heavy metal bar. Evidently they were afraid that the veterans were going to steal their ugly beat-up chairs. I tried to picture myself going down the stairs with a chair under each arm and a VA police officer closing in on my tail while shouting “halt or I‘ll shoot,” but it was overly melodramatic and ridiculous; no such thing had ever taken place and none ever would. On the far wall an electronic board flashed the number 003. That meant there were 66 people ahead of me. Sixty-six people waiting to be checked in by one of the clerks at the front counter. And after that I would have to wait to have my blood drawn by a technician. Long waits are commonplace at the VA. I might as well get used to it because it is the only healthcare I have. Anything is better than nothing.
After waiting for what seemed like forever, my number came up. Oh, happy day! There is a God and he has heard my plea and delivered me from suffering the humiliation and pain of this accursed ergonometric bucket seat. My butt had gone numb and my back throbbed. I was stiff all over. Because my right knee could not move, I had to rock back and forth to stand up. Meanwhile, the clerk at the counter had seen nobody coming and had gone on to number 070. A beer belly fellow in a white “I LOVE NY” t-shirt had handed over number 070 just as I got to the counter. Brazenly reaching around in front of him, I placed number 069 on top of the pile of numbers on the counter and said “I believe I come first.” I realize now that Miss Manners might not have endorsed my boarding house reach, but I had been waiting for almost four hours and I wasn’t about to start over again. I had pushed Number 070 and was about to find out what happened when you shoved a plug-ugly Marine out of the way. He wasn’t about to take crap from the likes of me and said it so loudly that a VA policeman was summoned. The officer stood between us as a phlebotomist drew a tube of blood from each of us and he subsequently escorted us to the parking lot. He had given us a break, but somehow neither of us was feeling grateful. Nobody should have to wait four hours to have their blood drawn. There is nothing like wasting a half day in line at the VA to bring out the righteous indignation in a well-meaning, God-fearing veteran. Standing in line waiting for the government to begrudgingly give you something is a socialist disorder that has no place in the United States. In the Soviet Union people had to stand in line for a roll of toilet paper. We won the Cold War, didn’t we? Then why are our veterans standing in line? I see no reason why the Veterans Administration cannot function in an organized and efficient manner. One blood test that took less than five minutes to perform was made to kill an entire day of my time. If such an inefficient rate is deemed desirable, why not go back to making house calls? The technician’s time is valuable, but so is everybody else’s.
The following morning I returned to the hospital for an electrocardiogram. This time there was no waiting. My dear departed mother couldn’t have treated me better. I had no sooner checked in then the cardiology technician called my name. I was done in a few heartbeats. Afterwards, she had me hand carry the test results to the surgeon’s office to make sure the paperwork couldn’t get lost in the interoffice mail. Why couldn‘t the Lab be like this? It’s not that difficult to do the job right. Was it a morale problem? The clerk at the Lab simply went through the motions without even bothering to look up. 069, 070, it was all the same to him. Three hours to Miller time, two more days till payday. What happened to the poor unfortunate patients wasn’t his concern. After all, things were looking up. Only two hours and fifty minutes to Miller time. He could close his eyes and feel the cold beer massaging his throat as it went down. Two hours and forty-seven minutes to go. God willing, he will choke on his beer and the next time I come to the VA hospital for a blood test, the slacker that used to work at the counter will be toasting his tootsies in Hell.
The next stop was the Radiology department where I was scheduled to get some x-rays of my right knee. They had me strip and put on a gown. Then they wanted me to climb up on a cold slippery stainless steel table that stood three feet off the floor. Ever try to jump on a table without bending your knee? It simply cannot be done. Besides which I am flatfooted and don’t have an arch from which to spring. Nevertheless, the radiologist encouraged me to do it. Of course, the two people on duty could have helped me up, but then where is the fun in that? Much better to comment on how I didn‘t seem to be trying hard enough. They were being paid by the hour and could afford to wait all day if necessary. Eventually, they tired of their sport and took the x-rays with an older model (old enough to have been used by Madame Curie) vertical axis machine. They weren’t happy with the results, but hustled me off anyway. Having an x-ray done with black and white film is about as close as I will ever get to film noir. Did James Cagney have a bad knee or was it George Raft? Call me a gimp, but I’m in good company.
I don’t mean to belittle x-rays. Far from it. If it weren’t for x-rays, doctors would be in the dark. However, it wasn’t so very long ago that children’s shoe stores used x-ray machines to convince mothers that their child had been properly fitted with shoes. You put your feet under a vertical box while your mother observed an x-ray image in bright green and black through a metal stereoscope on the top of the box. Lord only knows how much dosage we got.
The runaround is almost over. All of the specialists on the checklist that Orthopedics gave me have examined me and declared me fit for surgery. I guess that means I’m 100 percent USDA—or VA—Grade A choice beef. Oh happy day! I’m good enough to butcher. Surely, I am truly blessed.
A week later, the mail carrier delivers a letter from Ortho informing me that I am going to undergo surgery. I will be the second of three veterans who will be fitted with an artificial knee on the appointed day. I should come an hour early and deposit my valuables with the clerk. No eating after midnight the night before the operation. Nothing to drink on the day of the operation. No smoking. However, nary a word about sex. Although the instructions didn’t say it, I gathered that the thing to do was to shack up the night before so that if they slipped up and slashed me to death with a scalpel, I would at least die happy. Be prepared for the worst case scenario. That way you will be pleasantly surprised when you don’t end up on a cold slab of stone with a tag on your big toe and embalming fluid in your veins.
The medical profession would like for us to believe that operations are routine; there is no need to worry. Make no mistake about it, being cut open is always a big deal. If you don’t die on the table, there is still a risk of infection. There are no guarantees. Getting a second opinion should be mandatory. For all you know, you might be getting an operation so that the surgeon can make the next payment on his boat. Never trust someone who wears deck shoes to cut on you.
Why am I so wary? A year ago quackery (the unrestrained business of medicine) had been responsible for murdering my father, a retired United States Navy quartermaster, who had survived numerous World War II landings in North Africa and Europe, only to be brought down by a two-faced heart specialist who made more money by treating him with pills for ten years than he would have if he had referred him to a surgeon to get the heart bypass he needed. In the end, my father, who was covered by three different health plans (Champus, Pacific Care, and Medicare) was sent to a county hospital to die because the HMO’s were being run by administrators who argued over how much of the bill each should pay. After the funeral, I went to Pacific Care’s offices to complain. They could have cared less. I had to pound my fist into his keyboard to get the administrator’s attention. Accountants aren’t qualified to make medical decisions. Why wasn’t there a physician in charge? Profits take priority over patients’ lives. No wonder we are plagued with assisted suicide and late term abortion. When religion, morals, and ethics are brushed aside, there is nothing left to hold society together. Our forebears had the courage of their convictions. How far must we fall before we are willing to take a stand? Nobody gives anyone anything. The price of liberty is eternal vigilance.
Nor am I ungrateful for the services that taxpayers are providing me. I am simply mindful that bureaucracies often have hidden agendas. This is not a modern phenomenon, nor is it peculiar to our form of government. In the early 19th century, Honoré de Balzac wrote that in dealing with bureaucracies “you cannot prevent the buying and selling of influence, the collusions of self-interest.” Has my surgeon accepted gifts from a prosthesis manufacturer or drug company? Surveys show that healthcare professionals who don’t are an exception rather than the rule. Corruption is rampant and pervasive. Don’t be naïve; your chances of surviving surgery could be influenced by such factors. The Hippocratic Oath is not what it used to be. When the American Medical Association conducted an in-house investigation, they found that of the medical schools that were still administering some form of the oath to their graduates, only 43 percent had them vow to be accountable for their actions. How pathetic! Moreover, a mere three percent prohibited sexual contact with patients.
We pay more for healthcare than anyone else. In 2006 the United States paid 15.7 percent of its Gross National Product to the medical industry, which is over five times the amount we spent in 1950. In the last eight years alone, insurance rates have doubled. Something is definitely amiss.
The day I am to have knee replacement surgery finally arrives. There is nothing left but to do it. Before I leave, I say goodbye to my faithful dog, Speedo. Although neither of us are aware of it, we will not see each other again for two years. I will miss a lot of things, but I will not miss anything as much as I miss him.
I walked into the VA hospital under my own power. That is important because I came out in a wheelchair two years later, worse off than when I went in. The Hippocratic Oath says “above all, do no harm.” Society has a right to protect itself; no oath, no license. I have no use for abortion and assisted suicide. Margaret Mead wrote that “throughout the primitive world, the doctor and the sorcerer tended to be the same person.” Surely, we have evolved beyond that. We need to rid ourselves of the rotten apples who give medicine a bad name.
We cannot expect doctors to be perfect. Anyone can make a mistake, but mistakes have to be acknowledged and corrected. Otherwise, they will no doubt be repeated.
The nurse asked me to undress and put on a hospital gown. It had evidently been designed for double-jointed patients because it tied in the back. Besides which it was far too flimsy to provide any protection from the cold. Breathing cold, stale, processed air makes people sick. They need to turn off the air conditioning, open the windows, and get some fresh air in here.
The two orderlies who are wheeling me on a gurney towards the operating room think I’m joking. Goosebumps aren’t funny. If the sheet wasn‘t tucked in all the way around me like a mummy, I would scream “Airborne” and hit the ground running (or stumbling in a rapid manner).
The double doors of the operating room slam shut behind me, signifying that there can be no turning back. Ahead lies the brightly lit faces of the sardonically smiling surgical team.
Stainless steel instruments are being arranged on stainless steel trays. The surgeon takes a ballpoint pen from his pocket, clicks it open, and draws a line down the center of my right knee. A nurse asks me to remove my dental bridge and eyeglasses. I hand them to her and she puts them on a tray. Down comes a rubber mask that covers my mouth and nose. I am instructed to breathe deeply and count backwards from ten. Ten, nine, eight . . . .
Chapter 3
ICU
The anesthesia wore off slowly. I was drifting in and out of consciousness. When I finally opened my eyes, I found myself in a white windowless room with tubes and wires coming out of my body, feeling terribly alone.
But I wasn’t alone. There was a rather muscular fellow standing nearby who was wearing a wide black elastic contoured back support belt like those worn on the job by stevedores, warehousemen, and other workers who routinely do heavy lifting. How strange, I thought, what’s there to lift in here?
The mystery man turned out to be Stan, a physical therapist assigned the mission of being there when a patient first woke up following surgery.
“Get up,” he ordered after introducing himself.
“No can do,” I said, gesticulating towards the tubes and wires attached to my body.
“You either get up now or your knee will freeze up,” Stan asserted with an air of authority that set off a drill-sergeant alarm in my head. “Take a couple of steps and you can go back to bed.”
Could I trust him to keep his word? I sincerely doubted it. Nonetheless, it seemed futile to resist.
It took me a while to inch to the edge of the bed. My new knee felt like it was on fire. The pain was unbearable. I tried and failed to stand up. More than anything else, I wanted Stan to go away. However, it was his job to start me walking. He suggested I transfer to a chair by sliding down a wide plank he referred to as a transfer board. Since the slope was steep, it should have worked. Only it didn’t. Perhaps I can’t slide because I don’t weigh enough, or maybe my skinny butt acts like a suction cup. Who knows? I sat at the top of the board and probably would be there still if Stan had not grabbed me in one hand (like King Kong did to Faye Raye) and dropped me on the seat. One thing is for sure. I now know what the belt is for.
It took awhile, but Stan eventually tired of bullying me and wandered off to torment some other poor veteran. I thought I was rid of him, but Stan returned fifteen minutes later with a vigor that told me he had made short work of his victim. Fortunately for me, Stan’s shift was nearly over. I imagined him hurrying home to beat his wife and kick the dog. Perhaps that didn’t happen, but I wouldn’t be surprised if it did.
Later that night, I cajoled a nurse’s aide into getting me a PVC potty chair on wheels from an empty room down the hall where she had seen it on her rounds. Anything is better than a cold metal bedpan. She helped me to get down off the bed and walk a couple of steps to where she had it parked. Somehow a few encouraging words from her accomplished a lot more than a litany of unspoken expletives from Stan.
Despite spending more than two years as an inpatient at the VA hospital, I never saw Stan again. But I often heard about him. Since there isn’t all that much an inmate (excuse me, I mean inpatient) can do (especially when confined to bed), gossip and rumors are rampant. Although there were more than a dozen physical therapists, none of them even came close to matching the chutzpah of Stan. But I’m not worried. Guys like Stan usually end up as a notch on someone else’s belt.
The Intensive Care Unit (ICU) resembles solitary confinement. I was in a room by myself tethered to a glucose intravenous drip and several monitors. No doubt it was necessary for the first few days, but I ended up stayed in ICU for three weeks solely because the nursing home on the first floor was full and, according to them, they had no other place to put me.
I used the phone on the nightstand beside my bed to make a few inquiries. What they said was true, but they didn’t bother to say why. It was painfully clear that more veterans were admitted than discharged. The surgeons were performing more knee and hip replacements than the recovery and rehabilitation system could absorb. Unlike private hospitals, the VA hospitals preferred to do this with inpatients (perhaps because much of their rehabilitation resulted from war wounds). The process was lengthy and effective, albeit extremely slow. Pack too many patients into the wards and the risk of spreading disease and infection goes up. But the surgeons weren’t concerned. Surgeons cut and stitch and call it a day. Dealing with the aftereffects isn’t what they like to do. In a private hospital the doctor who admits you closely monitors your progress throughout your stay. Perhaps the VA hospitals could learn something from them. Nobody wants assembly line surgery. Chickens are butchered in that manner. I’m not meat. I demand to be treated with dignity. Whether a human being lives or dies should be a matter of importance to everyone, including the surgeon. Quacks don’t care what happens to their patients. No matter how skilled the surgeon, he’s a quack if his sole reason for doing his job is the money.
During my three week stay in the intensive care unit, my intravenous drip was being laced with morphine by a machine that injected the drug whenever I pressed a button. However, it would only do so once every ten minutes. It worked perfectly in the ICU but would later malfunction, resulting in me becoming severely addicted to morphine. How could the VA fail to notice that a malfunctioning machine had been injecting far too much morphine for more than a year? Morphine is a controlled substance. Are VA records kept so sloppily that no one takes notice of how much morphine is being dispensed? Although it could happen conceivably under combat conditions, such negligence should never be allowed to happen in a domestic hospital administered by an agency of the United States government.
At least I’m in good company. I read somewhere that Hermann Goering, the Nazi founder of the Gestapo, was also addicted to morphine. Do birds of a feather really flock together? Since Hermann Goering died three years before I was born, I guess we can only speculate.
I don’t particularly like alcohol; I don’t even drink coffee. I stayed away from drugs in my youth. Now, here I am, at 61, addicted to morphine. My long, curly hair hasn’t been cut in five years and I’m stuck in a wheelchair. Once I was a Military Policeman. You might say I was a role model. Then the VA covered up by telling my son, a Major in the U.S. Army, that I addicted myself to morphine and that led to me losing his respect. I’m surprised that they could pull it off. You can’t buy morphine on the street. Only the VA and the military have morphine in significant quantities.
Nothing could be further from the truth. But I have no recourse because veterans can’t sue the VA. I sincerely hope that the people who read this book will strive to make changes in the system. I believe that the good citizens of the United States cheerfully pay for the VA, thinking that the money is well spent on caring for veterans. They deserve to know what’s really going on: quackery, waste, and corruption.
Since morphine isn‘t very common, I probably should say a little more about it. Morphine is derived from giant poppies whose sap is collected and dried to make opium. Processing opium farther produces morphine which with farther processing produces heroin. It’s sort of like refining sugar:
Sugarcane - molasses - raw sugar - granular white sugar
Opium poppies - opium - morphine - heroinWhat is it like to be on morphine? First, let’s get something straight. Morphine pills mess up your stomach and won’t get you a good high. In order to get high on morphine, it must either be injected or administered intravenously. Within minutes all pain vanishes and the patient feels comfortably numb. An increase in dosage may make the patient a bit queasy. With time, constipation ensues, but that can be corrected by drinking milk of magnesia or taking a laxative.
How many patients in ICU are on morphine? Automatic injection machines are pervasive. Morphine (at least at the VA) is fast becoming the "feel good" drug of choice. Keep them high on morphine and they won’t cause trouble. Happy patients are not constantly ringing for a nurse and consequently require less care. So what if they are temporarily vegetables? If they survive, they can be taken off drugs before leaving the hospital. And, if they die, at least they die happy. What’s wrong with that? What is wrong is me and guys like me who continue to crave morphine long after we get off of it. I don’t just like morphine, I LOVE it. Thank God it isn’t available on the street because I cannot remember a time I felt better than when I was on morphine. Administrators who addict veterans in order to save money should be fired. Instead, they are promoted.
For 66 consecutive Sundays, a group called the Veterans Revolution has protested outside the Los Angeles Medical Facility at Wilshire Boulevard. They are demanding that the VA administrators quit making policy about what is best for veterans and start asking veterans what they want. This is the United States of America. Because we fought for you, you are free to do as you choose. It is only fair for veterans to demand freedom, too. Get rid of the administrators and let the physicians and veterans determine policy. Dr. Feel Good can go take a flying leap. I want to walk. I want to drive. I want to live as well as everybody else. If an administrator needs someone to take morphine and be a gimp, he is welcome to have my wheelchair. There is nothing wrong with me that cannot be fixed. All I need is surgery minus the quackery.
Enough negativity. From what you have read or heard about the VA, you may have gotten the mistaken idea that the VA is rotten and corrupt. Though that may be the case for a few bad apples, the vast majority of VA employees (including healthcare professionals) go out of their way to assist disabled veterans. If they are off the clock and they see a veteran in a wheelchair struggling to open a door or not being able to reach something, they drop what they are doing and cheerfully come to his assistance. I have found this to be true of almost everyone both in the VA and the public at large. Taxpayers provide a generous pension to service-connected disabled veterans like myself along with free medical care and benefits.
I am extremely grateful to the public for all they have done for me. I went to school on the G.I. Bill. Later, I enrolled in the veterans’ writing project which gave me an award for one of my short stories. Overall, the VA has been very helpful. My primary purpose in writing Quacks is to expose the inefficiency, waste, negligence, and redundancy which plague the VA, so as to improve performance and assist the accomplishment of mandated objectives. Constructive criticism is an essential part of the feedback process which government uses to determine how well it is doing its job. Quacks is intended to function like a report card; nothing less, nothing more. I apologize in advance for any connotations that are perceived to be destructive.
Etched into the entrance of the Department of Veterans Affairs (VA) in Washington D.C. is a phrase from Abraham Lincoln's Second Inaugural Speech: “To care for him who shall have borne the battle, and for his widow, and his orphan.” President Lincoln obligated the nation to care for the men and women who have honorably served this country. More than 140 years later that promise still stands. My father and my mother served as President and Vice-President of the Fleet Reserve Association, Long Beach, for more than two decades. As a youth, I watched them visit disabled veterans in VA hospitals, comforting those who needed it. I was born at the VA hospital in Long Beach, California, in 1948 when it was a Navy facility. Of course, I had no idea then that I would come to depend on this and other VA hospitals for my healthcare. My parents were selfless role models of whom I’m justly proud. To the extent possible, I have followed in their footsteps in my support of veterans and enlisted military personnel. What my parents used to do on an individual basis, I now do online and in books so as to reach a far greater number of people.
Since ICU is akin to solitary confinement, it should never be used as interim warehousing of recovered patients awaiting further processing. The cost is enormous; my extended stay in ICU cost almost a thousand dollars a day. If the decision maker had to pay for it out of his own pocket, this wouldn’t be happening. But he is paying for it out of your pocket and the pockets of everyone else who pays taxes. A few seconds of thought might have solved the dilemma. Administrators are paid to think. Those who cannot need to be transferred to menial positions commensurate with their skills and abilities.
The ICU physicians and nurses gave me drugs to suppress my immune system to keep my body from rejecting the artificial knee. Consequently, I was more susceptible to infections and similar disorders. The housekeeping staff did an outstanding job of combating germs, mopping the floor with disinfectant three or four times a day. But the sheets were changed on an infrequent basis and I have been told that they are laundered at a central facility that fails to ensure that the water temperature meets or exceeds 180 degrees for one rinse cycle so as to eliminate staphylococcus.
The Government Accounting Office should investigate and determine the rate of infection in VA hospitals and whether taxpayers are getting enough bang for their bucks. Is the rate of infection higher than in private for-profit hospitals? If it proves higher, the VA must be made to improve its standards and procedures. Care and treatment for veterans should not be permitted to slip to slipshod substandard quality. When the Inspector General finds out that something is amiss in the standard operating procedure of the Department of Defense and/or its hospitals, heads begin to roll. This should also be the case with the VA. Regular examination of VA hospital statistics needs to be undertaken by the GAO and compliance with standards strictly enforced.
Jerry L. Pettis Veterans Administration Memorial Medical Center, Loma Linda, California, featuring the duck pond, nursing home, emergency room, eye care facility, dental, and 4 floor hospital
11201 Benton Street, Loma Linda, California 92357
Toll free phone: 1-800-741-8387
(photograph courtesy of Jerry L. Pettis VA Memorial Hospital, Loma Linda, California)Got a nasty habit? You can’t get by for two weeks in ICU without a stiff drink and a pack of Camel cigarettes? Anything can be had for the right price. Usually, a patient or a nurse will offer to serve as a go between. Smuggling liquor and cigarettes into hospital wards is a time-honored VA tradition. Formerly, manufacturers gave away cigarettes to veterans in VA hospitals. Currently, smoking has gone out of style, but at one time field rations came with cigarettes and matches. If I remember the ads correctly “more doctors smoke Camels than any other brand of cigarette” because “there isn’t a cough in a carload.” The Surgeon General can put that in his pipe and smoke it.
Give the guys in ICU a big one finger salute and be glad that you aren’t them. Who wants to be tethered to an IV and/or a catheter? Want to piss in a bag that hangs from the side of your wheelchair? Hell no! The best care is prevention. Don’t wash down your viagra with a shot of tequila, don’t flavor your beans with bacon grease, and keep out of unlit brothels and dark alleys. Believe me, ICU in a VA hospital isn’t for you. Your elected officials get to go to Water Reed. You get Loma Linda. They’re smart and you aren’t. But don’t worry about it. If you fail to survive, the VA will bury you for free and mark the site with a solid brass plaque, commemorating your military service. That’s right, you get to rot along with your military buddies. There is no finer way to go. A copy of your DD214 form gets you a deed to eternity.
I was born in a VA hospital and someday they will bury me in a VA cemetery. How about that? I am getting cradle to grave coverage and I am a confirmed capitalist. Oh happy day!
If you are going to be admitted to ICU, take everything you will need with you. Take your laptop along and it is liable to get stolen. Besides, you won’t be able to get on the internet with anything other than a Blackberry. The structural steel in the walls interferes with cell phones and the VA has yet to discover Broadband. The food is atrocious. Bring cash with which to bribe the kitchen staff into providing you with edible fare. Otherwise, a taste bud transplant should be scheduled with your surgery. Ever try toasted cardboard? Bon appetit gastronome.
When you find yourself feeling far too frisky for an ethical man in his golden years, when your spirit surges and overflows its banks, when life’s cornucopia threatens to overwhelm you, a short stay in ICU might just be the reality check you need. Watching other veterans space out on mind-numbing drugs, watching people die before their time due to quackery, negligence and incompetence, and listening to the whir, beeps, and clicks of monitors that mostly monitor the best time to pull the plug, will certainly bring you back to your senses. Nothing is more illustrative of the human condition than pain and suffering.
Chapter 4
1 Southeast (1SE)The vast majority of patients are discharged from the hospital when they finish ICU. But I chose to complete the six month physical therapy rehabilitation program so as to gain full use of my titanium prosthesis. Dr. Gustafson had told me that I was not likely to get more than 70 percent usage. However, the physical therapists thought otherwise. Their bonuses were based on performance. They said that if I worked hard enough, I could be restored to 100 percent. I wanted to be a whole man, not a pitiful gimp in a wheelchair. A ray of hope was all I needed.
There are three nursing homes on the first floor of the VA Loma Linda hospital. We don’t talk about them. They are tucked away beyond the “employees only” kitchen and can best be reached via a passageway between the eye clinic building and the main hospital. Please refrain from calling 1 South, 1 Southeast, and 1 Southwest the funny farm or the cuckoo’s nest because someday you might end up there, too, vegetating through marathon reruns of Jerry Springer and Maury Povich. Feel like killing your wife? Fancy a career as a rapist or a serial killer? Does Osama bin Laden ring your bell? If you answered yes to any of these questions, then you are a candidate for 1 Southwest where they test the latest tranquilizers and hallucinogens on veteran guinea pigs. My neighbor came back from Vietnam with all sorts of flashbacks. The Emergency Room admitted him for observation and subsequently wheeled him past the double security doors into a fantasy world called 1 Southwest where they shot him full of happy juice and strapped him to a gurney. He emerged from there as a different man, totally devoid of will. His family now has to lead him around by the hand because the VA gave him the chemical equivalent of a frontal lobotomy.
This poor veteran also got a heavy dose of Agent Orange while fighting in Vietnam. Dow Chemical could care less. They should be held responsible for the effects of their dioxins. Hundreds of children in Vietnam and the United States have been born with birth defects. God rendered a rainforest which Dow Chemical tore asunder. There is no justification for defoliation. Why has the World Court at the Hague in Holland failed to adjudge this a war crime?
1SE is the entry port for the nursing home. It is primarily for rehabilitation and recovery, the average stay being four months. They admitted me for six months of physical therapy, but I caught a staphylococcal infection and wound up spending two years there. Infections have always run rampant in hospitals. If you don’t want to get sick, don’t go to a hospital. Put diseased people together with patients with suppressed immune systems and you have a prescription for disaster. It is not in the patients’ best interest to conduct healthcare from a central facility. Far better to have doctors make house calls. Black bags are back in style among médecins compétents. Long term doctor/client relationships don’t just happen, they have to be developed. Recluse physicians are a thing of the past. Today’s doctors are built to last. They are part of the communities in which they live. Thus, they cut down on stress and anxiety. Responsible physicians do not accept gratuities from drug manufacturers and insurance companies. They sell their services, but not themselves. A true professional has character and integrity. By bringing back the Hippocratic Oath, doctors will regain respect by the public for the medical profession. One spots a quack by how it mucks around. Stop mucking and do the job right. God grants the physician the power of life and death, do not abuse it.
My respite in 1SE was organized and disciplined. At 7 AM, five days a week, the nurse at the front desk handed me a computer printout with my schedule on it. I was required to go to everything on the printout. Here’s a typical schedule:
8 - 11 AM Physical Therapy
11 - 12 Noon Recreational Therapy
1 - 3 PM Physical Therapy
3 - 5 PM Audiology
Our cafeteria serves lunch at noon. Each patient had a tray that came from a compartment in one of the two stainless steel slop wagons that the orderlies wheeled in at mealtime. No matter what is served, it is lukewarm, including the salad and ice cream. Everything tastes the same; no salt, no pepper, no seasonings whatsoever. Cardboard is king. The food is so bland that the rats refuse to eat it. Here, try my strawberry rhubarb fruit cup. The VA buys it from Vietnam. I guess it’s payback for waging war against them. The Marines splatter it on the wall when the nurses aren’t watching. The spots and stains closely resemble the fly specks found in real military mess halls. Our two obese nutritionists claim that the food is good for us, but you won’t see them eating it. Once a week, I pay one of them to bring me a cold bottle of Pepsi from the PX. I treasure it because it is my last link with civilization. If Margaret Mead was still alive, she would most likely do an anthropological study on it. But she is long dead. Nobody cares. What is needed is a sign at the entrance similar to the inscription Dante saw on the seven gates of hell: “Abandon hope, all ye who enter here!” As in Hades, many enter, but few return. Disease, infection, and negligence take their toll.
I can honestly say that the food that is served in VA nursing homes is worse than the food served in military mess halls. Patients who had money and weren’t bedridden bought their meals at the food court on the second floor. It wasn’t just that the food wasn’t seasoned, it wasn’t prepared properly. Many of the processed food items were offbeat and ended up in the trash can. Anybody for strawberry rhubarb fruit cup? Of course not. Why it constantly came up on the menu is beyond me. Evidently, the nutritionists know what is best and are determined to give it to us whether we can stomach it or not.
With such atrocious conditions prevailing, one must wonder why a veteran would want to enter a VA nursing home. Most have no other option. Some are dumped by their families. A select few view it as a way to hornswoggle an assisted suicide complete with burial and flag. If you are bound and determined to go, you might as well go for free like Sol Roth in the 1973 science fiction classic, Soylent Green, who was given a comfortable bed prior to having been prescribed a lethal dose of opiates and happy juice. Thank you, VA. People’s Temple leader Jim Jones could have learned a thing or two from you.
And, Josie, the reservist Staff Sergeant head nurse of 1SE is uniquely qualified to teach it. Every morning she bumped against my sore right knee as she made her rounds. “Oh, did I hurt you? I’m so sorry,” she feigned while savoring my excruciatingly painful involuntary reaction. Make no mistake, Josie is by no means a sadist. Rather, she believes it is her job as head nurse to maintain order and discipline in the unit. Although I made no overt effort to challenge her authority, she had heard me interpreting regulations for others, the gist of which she feared because she did not understand. Supervisors are promoted to the level of their incompetence. Torture is an ineffective tool whose use cannot be excused. No doubt the fires of hell burn in eternal vengeance for those who knowingly tormented their fellow men.
Having been designed in the early 1970’s, the double occupancy rooms are quite spacious and have all of the amenities found in private facilities including a handicapped bathroom with a sliding door that is shared with the room next door (knock before entering). Rumor has it that it came into being as a result of the Sylmar earthquake in which 35 people were killed when two wings of a VA hospital collapsed. But please do not worry as there is not much chance of it happening again. Loma Linda VA hospital was built of steel reinforced concrete. However, if by some weird quirk of fate, it pancakes in an earthquake, the worst place to be is at the rear of the ground floor where the nursing home is located.
Most patients eventually succumb to infection. The infection begins as a small yellow dot that when left untreated expands into a pressure sore. If the sore is discovered and treated, it goes away. Otherwise, it becomes infected. Shifting bedridden patients helps to prevent bedsores. In fact, there are hospital beds available that automatically turn the patient as he or she sleeps. But the VA has yet to authorize the upgrade. Could it be that a burial plot in a national cemetery costs less than a decent bed? Sol Roth had it better. I suspect this also explains why unsuspecting wheelchair bound veterans get foam egg crates to sit on rather than thick gel cushions. What it doesn’t explain is why physicians permit this to happen. I recall a young Air Force veteran, a well-respected and well liked long-term resident of the nursing home who over the course of several decades received a number of skin grafts for pressure sores on his rear. Following each procedure, he had to lie on his stomach until he healed. Obviously, it wasn’t a joy for him, the VA, or the plastic surgeon. But this is what happens when medical schools teach by rote. Physicians who can’t think are incompetent. Far too many doctors fall into this category. Next time you are in a medical school, watch an instructor and his students walk single file down a hallway with the teacher in the lead. This works fine for a mother duck, but a system based on privilege can’t teach a physician to think. Those grueling 24 hour shifts that interns are forced to work do little to stimulate their brains. Zombies don’t think and zombies are prone to make mistakes. Zombies don’t belong in the medical profession.
The last hour of a nurse’s shift is devoted to handwritten reports, none of which makes its way into patients’ digital records. During this time, the ongoing shift is supposed to cover for them, but in my experience it rarely happens. I know of patients who have waited over an hour for assistance after pressing an emergency alarm. What’s wrong is that the alarms are visual rather than audible and can consequently be ignored. Most nurses have come to regard the last hour of the shift as “their time.” Once the reports are written, they sit in the nurses’ lounge and gossip. How do I know? Like President Bill Clinton, they occasionally leave the door open.
In addition there are potlucks, sports pools, and other events, most of which take place on paid time and all of which serve to distract nursing personnel from taking care of patients. I got the distinct impression that the sale of handicrafts and jewelry provided a substantial source of income for many of the nurses. Patients were largely an inconvenience that they would rather do without. The solution is to give them drugs and tranquilizers so you don’t have to deal with their problems. As far as much of the staff is concerned, the sooner they can pull the plug on you, the better.
Think I exaggerate? The turnover is so fast that names are written on masking tape before being placed on a room’s door. Here today, gone tomorrow. How sad. Veterans don’t rate a label maker. A former Command Sergeant Major (E-9) in 1 Southeast wrote a history of his service (numerous tours in Vietnam, etcetera) and attached it to his room’s door. Most of us thought it added a humanistic aspect, but the administrators were afraid it was going to get out of hand. They eventually evicted him. The last time I heard, the Sergeant Major was living on the street in his truck. During a robbery, he was hit over the head, suffered a severe concussion, and the surgeon put a metal plate in his skull. It seems to have affected his balance as he now walks using a hand carved staff. Anyway, it made me wonder. How many combat tours does it take to gain the respect of VA administrators?
Doctors sometimes provide referrals to private specialists with the implication, spoken or unspoken, that the for profit specialist does a better job than the one that the VA provides. Are there kickbacks involved? This is something that needs to be looked into by the VA’s Inspector General.
In VA healthcare veterans are assigned a general practice doctor who acts as a gatekeeper, deciding when a specialist is needed. The only way anyone can get an appointment with a specialist is through his primary physician. Patients in the nursing homes are not assigned a primary physician. The only way they can see a specialist is if the director of the nursing home refers them. In practice this rarely happens. In other words, nursing home inpatients living on the first floor of the VA hospital have a harder time seeing a specialist than they would if they were outpatients living at home. When, following an infection, my artificial knee was removed, I was constantly trying to obtain an appointment with the surgeon, but couldn’t get one. In fact, I wasn’t able to see him until after I went home. What good does it do to live in a VA hospital nursing home if you cannot be seen by a specialist when you need one?
I should mention that all of the rooms are exactly the same. Once you’ve seen one, you’ve seen them all. I confess that Stalinist construction does not appeal to me, nor do Daly City and federal housing projects. Just because something is egalitarian does not mean it has to be monotonous. In my opinion, long term residents should be encouraged to redecorate as long as it doesn’t interfere with the staff’s routine. For instance one of my roommates was a World War II Marine with a Purple Heart who had a large family. During visiting hours, our small room was packed with his relatives, most of whom had to stand because there is a rule against taking chairs from other rooms, even when they are vacant for a long period of time.
The three nursing homes on the ground floor of the VA hospital share a large rehab center between them that is stocked with exercise machines, weights, mats and other gymnasium items. It is staffed by upwards of ten full and parttime rehabilitation technicians. Upstairs, on the second floor, there is an almost identical rehab center for outpatients. The 2nd floor rehab center also seems to be responsible for testing to make certain that the claims of the other center are not being fudged, which, together with the intensity of the rehab program, makes me think that rehabilitation technicians’ pay is to a great degree based on how well their patients progress. In most cases this is a great idea, but it should not be done without the aid of a doctor monitoring the patient’s overall condition. My rehabilitation technician worked hard on improving the arc of motion in my artificial right knee to the exclusion of everything else. Eventually, my calcified left ankle collapsed, erupting in a staph infection that spread like wildfire throughout the hospital and did not come under control until they sent me home to die. I didn’t ask for the role of Typhoid Mary. It could (and should) have been prevented. Now, the surgeons won’t fix me because they are scared to have me back in the hospital. I cannot walk or stand. Although I’m not to blame, they condemned me to spend the rest of my life in a wheelchair.
Rehabilitation was an arduous, albeit necessary, process in which atrophied muscles were toned and made to function. Rehab technicians chart your progress from the first faltering step to (ideally) full and complete recovery. My relapse was an anomaly. Rehabilitation is successful more often than not. I say this in all honesty; I am the exception that proves the rule.
Anyone who receives an artificial knee goes to rehabilitation. At private hospitals rehab is recommended but not required. At VA hospitals, however, there are no exceptions. Either one takes rehab on the second floor as an outpatient or on the ground floor as an inpatient. Because the taxpayers are paying approximately $50,000 for the operation, the VA makes certain that you do your part, i.e. rehabilitation, to make the outcome a success. It is either arranged as a package deal (artificial knee operation and rehabilitation) or it isn’t done. At least in theory, there isn’t any room for failure. I am living proof, however, that nothing is foolproof. Mistakes occur. Physicians are not immune from bad judgment. Surgeons must acknowledge and correct their errors. Attempted suppression only serves to exasperate the problem.
As previously stated, a patient’s day is scheduled by computer printout. An individual can have up to four hours of rehabilitation in two hour accruements interspersed with arts and crafts, recreational therapy, aerobics, work therapy, and a litany of assorted subject matter that the staff have devised over the years, much of it of questionable relevance. Schedules come down from on high with absolutely no patient input. The attitude is "we know what is best for you." While that may be true for a few slackers who do not want to be bothered by the details of their treatment, the majority are offended by the VA’s inflexible dictums. They appear to have been promulgated by an educator familiar with intermediate and high school scheduling in some bygone era when students automatically accepted the judgment of administrators in determining career choices. Why an adult veteran cannot be trusted to have a voice in his/her own treatment is beyond me. Big Brother has gone far enough. It’s high time for change.
At the time of being admitted to a VA nursing home, the patient is asked to fill out a form showing whether or not he/she wants extraordinary means utilized to maintain life should a life threatening situation arise. What comes to mind is pulling the plug on someone who is brain dead and comatose. What doesn’t come to mind is temporary dialysis, chemo and radiation treatments and an entire gamut of procedures that can be construed as artificially maintaining life. A roommate in 1 South became bloated and died because he had elected not to receive extraordinary treatment. Temporary dialysis might have taken the strain off his kidneys, but now we will never know. To my way of thinking, he deserved the chance he didn’t get. God alone should determine when we die. Who wants the VA to play God?
If you would rather not have the government make life and death decisions for you, check the extraordinary measures block when you fill out the form. You can still change it later. It simply keeps the government from pulling the plug against your family’s wishes. Don’t ever authorize the VA to determine when the physicians should give up on you. There are enough conflicts of interest going on at the VA without you adding to them.
Remember the old roach motel commercials, “roaches check in but they don’t check out.” That is how it is with a VA nursing home. I term it the Hotel California syndrome. Private nursing homes are populated by patients who check in and check out at will. Once you are admitted to a VA nursing home, you must stay until they discharge you. Remember, when it comes to decisions regarding your health, Big Brother knows what is best. Born with an independent streak? Then VA healthcare might not be for you. You call the shots for only so long as you pay the bills. Once the VA becomes involved, you no longer run the show, so think carefully about it before calling on the government to help you out. And don’t be surprised if they ask you to disclose your finances. You may have fought for freedom and capitalism, but now you are stuck with charity and socialism. It is best to stay with private healthcare if you can possibly afford it.
The chokepoint is at the front desk. Nurses determine at what point a specialist will be (or will not be summoned) for patients. Patients whose families ask about their condition and visit them regularly tend to receive better treatment. Moaning and groaning won’t get you anything more than a tranquilizer and some pain medication. Feeling queasy? You are not the only one. Between midnight and 6 AM there is a semicircle of wheelchairs behind the front desk of patients who cannot sleep for one reason or another. Don’t ask for a sleeping pill because you aren’t going to get one.
Recreational therapy has a few things to offer. Wheelchair bowling, however, isn’t one of them. Using ramps to play gutterball isn’t much fun. Much better to accept a dinner offer from a fraternal order such as The Elks or the VFW. I have gone to some that were prime rib affairs with baked potato and decent beverages. It doesn’t cost a cent. These guys will show you a good time. They genuinely care about disabled veterans. If nothing else, it’s a break from the nursing home grind. Recreational therapy also has books on cassettes with walkman style recorders. It kept me from joining the wheelchair semicircle in back of the front desk at night. When I couldn’t get to sleep, I listened to a John Grisham novel about evil corrupt lawyers and Wall Street Go-getters. Audio books kept me sane.
The packaged peanut butter and grape jelly sandwiches with no crust are nourishing. With luck you can subsist on them for days. Avoid brands other than Smuckers. Put 20 or 30 in the meds refrigerator near the front desk and you can get a snack late at night. Microwave popcorn is another good idea. Heat it for 15 seconds longer than it says on the packet. Get kettle corn or buttery flavor. Stash it with your socks or underwear and never do it while a nurse is around. Nurses are good for smuggling alcohol and cigarettes and little else. They are all look and don’t touch. Pontius Pilate didn’t wash his hands half as much as they do.
Want to leave for a while? Good luck. Your family must sign you out on a pass. Ask your son to give the front desk a number at which you can be reached. Be punctual or the nurse won’t ever give you another pass. It’s just like the military, only better. Remember to take a shower before you go because you will have to pass inspection by the nurse in charge at the front desk. Sick and tired of rules? Isn’t that just too bad? Without the VA, you would probably be pushing a shopping cart loaded with your belongings down the sidewalk. Try to be grateful.
I’m going to give you an idea of what your day will be like. At 4:30 AM a nurse shows up to administer my meds. She wakes me and my room mate from a deep sleep by turning on the bright overhead lights. She is positively bubbling over and couldn’t wait until we have something in our stomachs to absorb it. Ducosate on an empty tummy will trigger an acid reaction. You are permitted to wonder how this ditzy drug pusher airhead made it through nursing school, but please have the courtesy not to ask. When it is 6:30 AM, we shuffle to the cafeteria for breakfast. Oh boy, it’s strawberry rhubarb fruit cup for the fourth day in a row. And a great big helping of mush. Bet that will act like a catalyst on the Ducosate and the other meds the nurse made me take at 4:30 in the morning. Time to go to the restroom and get ready for the 7:30 AM lineup at the front desk. I even have time to go outside and feed the ducks the hard roll they gave me at breakfast. Last week the Director complained that our bread crumbs were making the pond turbid. That’s too bad because I don’t have a quarter to put in the gumball machine that dispenses duck food. Administrators who don’t like it can eat cake. Down with the Bastille and up with the ducks in the moat. Revolution is brewing albeit remote.
A revolution is the farthest thing from the mind of a per diem medical professional. Try to imagine these people in Cuba making $45 per month. They are dedicated to accumulating a sizable bank account and little else. Sin vergüenza. My ex-wife became a money hungry registered nurse. Only a money grubbing nurse would abandon her son. May she choke on someone else's sausage.
Ever had a turkey hot dog? Dry with a plastic skin. Almost inedible. The nutritionists like them, but you won’t. No matter how they are cooked, they taste like cardboard. Yum yum in your tummy. These things must be close to 90 percent fiber. The turkeys may have died of old age, but you won’t. Too much of this kind of food will most likely give you a colon or gastro-intestinal disorder. No more granola for you. Wouldn’t you rather have a shot of 200 proof rum and a crack whore? It’s only a matter of money. When you get rated at 100 percent, it’s like a cardinal’s robe in that it will bring out the best veal when you go out to dine in Los Angeles and/or Las Vegas.
Do you need a bed bath? Only student nurses give bed baths. The riper you get, the better the chance of disease and infection. Hello, I thought this was a hospital. I’ve seen cleaner kennels. These people need a bath or a shower. Please, give them one. What’s wrong with the night shift? The handicapped showers sit empty at night. Get on the ball. Where is the DAV and the VFW when you need them? This place is nasty. They claimed I got infected with staph by not washing my hands. My hands aren’t the only things dirty. Please, get rid of the filth and corruption.
Once a baby is born, you cannot reinsert it into the mother’s womb. The same maybe true of the elderly and disabled. Once you enter a nursing home, you will never reenter society in the capacity in which you left. You have become a marked man. Sooner or later disease is going to take you down. Pills and alcohol cannot solve the problem. Get a new lease on life by developing a raison de vivre.
If you are off balance and/or unsteady on your feet, the nurse is supposed to put a wireless perimeter alarm on your bed at night, but it never seems to get done. The nurse could care less if you fall because that would mean one less patient. Stan, my roommate died at night and fell on my missing knee, causing me to scream and wake up the other patients. That’s too bad. When you complain about waking up to witness a compatriot’s passing, you will probably pass without a whisper too because you have foretold your own death by being a magnificently insensitive jerk.
They used to have colonies of lepers, where people dare not venture. Am I diagnosed with a leprous disease? Or is it simply that nobody wants to come and visit me? It is Christmas and everyone else is having a feast. Here I am in a VA nursing home dining on coagulated macaroni and cheese. When I was in the Army, I did much better than this. The cook tried hard to cook us a hot ham Christmas dinner. The Holidays were full of cheer, why can’t it happen here? Scrooge must be in charge of Veterans Affairs and scrimping on the food as if it was being paid out of his own pocket. I barely weigh 116 pounds. I am emaciated and my ribs show through my skin. Is it too much for me to ask for a hot Christmas dinner?
Wheelchairs these days are made of plastic, one size fits all. But I had to lean over to grab the rim and brakes of a 20 inch wide wheelchair. Needless to say, I almost never got to go anywhere. In fact, it barely fit through the doorway in the bathroom. Worse yet, I couldn’t get into the meditation room of the chapel. Must I die for my sins before my time? Let me linger a little longer. I may yet surprise everyone by doing something stupendous with my life.
Ever had a catheter? You are in for a treat. A masochist will ram a tube up your penis. Your job is to scream. No Vaseline for you because you are a macho Marine. Look on the bright side; your male nurse is gay and he enjoyed every minute of it. Isn’t that a swell plastic bag? Please don’t spill it. Have yourself a Big Gulp and then you can fill it.
Do you like shoes? Are you aware that some kinky people have a fetish for them? I guess this explains why the VA has us wear green wool socks with black tread on the bottom. Socks without shoes makes a fashion statement. The VA asks you to wear the socks once and then throw them away. Don’t wash socks, Beau Brummell would never stoop to washing socks. Taxpayers have money to burn.
Aren’t you cute? You are wearing a flimsy gown. The ties are in the back to keep you from undoing them. Now you can squat to urinate. Isn’t that wonderful? The VA gave you a gender change without you asking for it.
Bibliography
Pool, Bob, “Veterans with a Gripe Upend Stars and Stripes,” Los Angeles Times, June 27, 2009, A8.
(to be continued)