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MILITARY
MEDICINE
“Tele called, said she was in V-tach. When we came to check between Wilford Hall and Brooke Army Medical Center.
on her she was unresponsive and cyanotic, so we started CPR.” When discussing my military time with others, what outsiders
“Anyone know why she was admitted,” I asked. seem to find most odd relates to the patient population. Yes, I did
“Alcohol and opiate withdrawal.” Her nurse skillfully stated care for several basic trainees and the occasional active duty mem-
with no interruption in chest compressions. ber, but on the whole, elderly retirees more reminiscent of a
Shortly thereafter the ICU team arrived and what followed was Medicare population made up the vast majority of my patients.
a well-orchestrated effort to save this patients life. Fortunately for Of course, this was in large part self-selection, as most active duty
her, three shocks and a dose of epinephrine later, that’s exactly personnel were fairly healthy and could readily be cared for in a
what happened. She quite literally came back to life and was scur- Family Practice setting. Regardless of the exact demographic,
ried off to the ICU for further monitoring. most of my patients shared several common traits, especially de-
With that crisis averted my team and I regrouped and labori- sirable from a physician’s perspective: stable social/living situa-
ously worked the long list of patients on this busy post-call day. tions, invested in their care, followed directions, reliable with
It was a smattering of the usual — gastrointestinal bleed, cellulitis, follow-up. To illustrate this point, when caring for patients in the
pneumonia, heart failure, COPD, alcohol withdrawal — most hospital, someone leaving “Against Medical Advice” was almost
with equally complex social situations to boot. Fortunately, unheard of during my time as a resident/staff.
though, the remainder of the day ran relatively seamless compared
to the morning endeavors. Having completed my active duty payback to the Air Force, I
This fall will mark four years of working at the Veterans Affairs was finally free to go my own way, but San Antonio had a hold
(VA) Hospital in San Antonio. Having grown up in San Diego, of me. Warm weather, good cost of living, I was already starting
Calif., I never thought I would end up in Texas. I had no family to call this home. Consequently, I took a job at the VA as a full-
or specific connections here, but as it goes with so many, this is time hospitalist, a natural transition for many a prior active duty
where my job took me. After completing medical school in Pitts- member.
burgh, I undertook an Internal Medicine residency at Wilford
Hall Medical Center, once the flagship of Air Force medicine. My Shortly after starting work at the VA, though, it was evident
training complete, I was fortunate enough to serve back my active this veteran population was different than the one I had become
duty commitment as a staff internist here in San Antonio, rotating so accustomed to in the military. Drug and alcohol abuse, often
running hand-in-hand with mental health issues, are dealt with
on a daily basis. All too often veterans have little to no social sup-
port or are presently homeless. I have become all too familiar with
the various homeless shelters and substance abuse treatment cen-
ters San Antonio has to offer. Not surprising, due to the afore-
mentioned issues, patient compliance with medications and
treatment plans is often sub-par at best. Of course, not all patients
I treat fall into this category. There are those “good” patients that
follow our instructions to the letter and have loving, supportive
families waiting to take them home. However, like in other av-
enues of life, it is often the more difficult situations that really
stand out.
My work at the VA has opened my eyes to a side of the veteran
population that I did not fully appreciate while on active duty.
This veteran group is ever growing and has a unique set of health
care needs. Each day is a challenge, but one which my colleagues
and myself gladly accept.
visit us at www.bcms.org 39
