By Anthony McDonald, M.D.
Assistant professor of surgery
Five years have gone by in a heartbeat. Perhaps appropriately, I joined the general surgery staff at the Malcom Randall VA Medical Center the day after its most hallowed holiday, Memorial Day, in 2007. After 26 years of enjoyable and professionally gratifying private practice in Gainesville, I was ready for a change. My reasons for leaving were many. They included the opportunity to teach while assuming the liability protection of the federal government; escape from the burdens of overhead of a large private practice; and the prospect of dialing my work load back a bit with the hope of extending my career.
Having spent a considerable amount of time in the VA system during my training, as well as volunteering as a consultant on occasion through the ensuing years, I was well aware that I was entering a bureaucracy that could be ponderous and impenetrable. More than once, I was advised not to push the “big elephant” but to just “…get on and ride.” Likewise, I was aware that the system is encumbered by built-in bureaucratic and logistical inefficiencies that at times would make it necessary to manage and prioritize patient care issues differently than I had in private practice.
Other than being told that they are, by and large, a very grateful lot, I didn’t give much forethought to the veteran patient population that I would be serving. Other than the new venue, I assumed it would be practicing my craft as usual.
It wasn’t long before I realized that these men and women are unique and that our combat veterans fall into one of three broad groups of military service. There are the World War II veterans, now well into their 80’s and early 90’s, the last of the “Greatest Generation.” Most have a story to tell and bring with their surgical illnesses a whole host of the complexities of aging, complicating even the most straightforward of operative procedures. It was heart breaking to care for an elderly cardiac patient who served diligently in World War II, only to have him succumb to a heart attack days after his hernia repair. It is a great privilege to care for these stooped, wizened heroes who survived their tours flying bombers over Nazi Germany or landings on the beaches of North Africa and Normandy.
Many Viet Nam veterans are a less fortunate cadre. They were conscripted into a poorly conceived war in a faraway, inhospitable land where they were exposed to substance abuse and long periods of boredom punctuated by jungle terror inflicted by an unseen enemy. They returned to an ungrateful country in a bad economy with addictions and psychological scars that would burden them throughout their lives. Many were simply unable to get on with their lives. These are men of my generation and I am often reminded that there go I, except for a high draft number and a ticket to medical school. Their recovery from surgery is frequently complicated by the ravages of hepatitis C, smoking, alcohol abuse and all of their attendant co-morbidities, as well as a social infrastructure that offers little nurturing.
The veterans of the wars in Southwest Asia (Operation Enduring Freedom, Operation Iraqi Freedom and Afghanistan, in the VA vernacular) are more like the community surgery population I used to care for. They present with lumps and bumps, hernias and gallbladder disease, still relatively unscathed by the diseases of aging and self-abuse. They are busy with their lives, families and work, and often furthering their education with their veterans benefits to make their way through a tough economy. They seem so ordinary, until you stop and think about the hardships they endured during their tours overseas in brutal landscapes amidst hostile people from unwelcoming cultures.
Life is full of unintended consequences. Fortunately, some are pleasant surprises. The opportunity to care for our veterans in this system has been one such dividend that wasn’t part of the original calculation in making my career change. These men and women are everyday Americans whose lives were irrevocably affected in one way or another by their service to our country. We owe them a great deal, and, in spite of our debt to them, they are indeed a grateful bunch. We are proud to serve them. They earned it.
“In the Loupes” is an online column meant to give readers insight into what it is like to be a surgeon today. Faculty members and residents from the University of Florida College of Medicine’s department of surgery write the columns based on their experiences in academic surgery. Views expressed here are not necessarily those of the department of surgery, the College of Medicine or the University of Florida.