Community Essay : In Defense of the VA Hospitals : Caring and camaraderie among veterans, doctors and staff make a clunky bureaucracy work at Veterans Administration facilities.

I am a surgery resident. As part of my training, I work at the Veterans Administration hospital in West L.A. It is popular among medical residents to bad-mouth the VA. The facilities are old. The staff can be government-style surly. It is hard to get things done. But while my work rotates me through all sorts of hospitals, my job is never quite as rewarding as when I am at the VA.

I’m not really sure what makes the VA unlike any other kind of hospital. Maybe it’s the patients, who are among the most grateful around. When I am weary at the end of a 36-hour shift, I always seem to run into a vet who looks at me and says, “Thanks, Doc.”

The patients stick together. The VA is understaffed, so often it is the doctor’s responsibility to transport patients around the hospital for various tests and procedures. If I’m too busy to wheel a patient down to radiology to get a study, I find a healthier patient in the next room, introduce him to my patient and ask him to give the guy a hand. Before I leave the room, they are swapping old Army stories.

Once I had a patient take a severe turn for the worse during the night. I was at home when I got the call. It took me 10 minutes to get the hospital. When I arrived, the room was filled with people: two doctors, a medical student, three nurses, a respiratory therapist--and four other vets. They heard the commotion in the next room and came to lend a hand. They gathered supplies and called the people we needed called. You would not see that in the average community hospital.

Maybe the VA’s uniqueness comes from the people who work there. The VA where I work is staffed by old-time VA doctors, some veterans themselves, of Vietnam, Korea, World War II. These are no-nonsense doctors, out to make their patients well and teach some young colleagues along the way. Every Friday morning, they gather the residents in a room to discuss cases. No esoteric talk of new-fangled technology or techniques, no slides on a screen in a darkened room, no handouts of obscure journal articles. I learned more about taking care of my patients during those sessions than from all of my other didactic and clinical lectures. Common sense medicine taught by common sense doctors.

Maybe the VA’s secret is its culture. I was on duty on Veteran’s Day last year. There was a party at the hospital, an old style USO show. There was coffee and cake, a “top banana” comedian, singers and the Raider football team cheerleaders. It seemed like every patient in the hospital was in that crowded basement auditorium. Some were young, some were old. Some were white, some were black, some were Latino. Some were in wheelchairs. And they all loved the show.

Make no mistake. The VA is a government institution. The paperwork is staggering. Important things often seem impossible to get done. There are committees of every sort. Memos abound. There are rules for how to do things, how not to do things and how to administer the rules. My patients might have landed on Normandy beach to win World War II, but I have won my own share of battles. I once got a patient an MRI scan on a Saturday night.

Oddly enough, part of the VA’s strength is its bureaucratic maze. We who work there share a common mission to help our patients. Doctors, nurses and staff must jump hurdles and massage the system to get that done. It becomes a game. We give nicknames to the forms we must fill out. Shortages of supplies force us to be creative and pool our problem-solving skills to get the patient what he needs. We know that X-rays will surely be lost in the file room if not read immediately, so we read them immediately. The adversity of the system unifies us and gives us a small sense of the esprit de corps that our patients shared on the battlefield long ago.

The VA system faces terrible challenges these days. There are movements to cut health-care spending and government spending. That makes VA hospitals a double target. But the VA will survive. When these men were in uniform, their mission was to defend their country. Now their mission, as VA staff, is to help their fellow vets. And they do it well.