Friday, February 21, 2014

A Terrible Day at the VA

Oh. My. Gosh. What a day.

For our Patient-Centered Medicine course, we are paired with a physician and an M3 student mentor, both of whom we have to shadow a couple of times over this semester. Since my wife is due in April, I figured it’d be best to get those out of the way now. So, today, I shadowed my M3 mentor. He was on an inpatient psych rotation at the VA hospital near Loyola. Which is probably the most terrible place in the world (ok, not really, but the events of today have left me rather ill-disposed towards it at the moment…).

After navigating my way to the main entrance, where I was supposed to meet my mentor, I discovered that, as it turns out, there are actually two main entrances. On opposite sides of the freaking building. So, I continued to navigate my way into the bowels of the VA and eventually found where I was supposed to be. I met up with my mentor, and he took me to a little psych consult room where a couple of other junior/senior medical students were working on stuff. After reviewing the past history of the patient we were about to go interview, we went and found the psychiatrist (whom we’ll call Dr. J) my mentor was working with and my mentor introduced me to him. He seemed nice enough, perhaps a little eccentric. We started walking back through the maze of hallways while talking about the next case. Dr. J asked if I had been here before, and I said no. They both smirked – in a friendly, yet knowing way – and said, almost in unison, “Welcome to the VA.”


As we were nearing the elevators, Dr. J turned back to me and said, “You’re welcome to take the elevators, but we take the stairs. We’re going to the 8th floor.”

Of course you are.

I went along with it though, like a good little medical student. After we huffed and puffed our way up to the 8th floor (I really need to do more cardio…) we stopped at the nurse’s station. “We always catch our breath before going into a patient’s room,” Dr. J said, in between breaths.

After recovering there for a bit, we finally knocked on the patient’s room. He was a male in his mid-thirties who was, at the end of the day, a pretty normal guy. He had had a tough few years, though, with family members dying, a divorce, and some tough luck. He had apparently had some chest pain recently (which he had experienced before) and presented to the VA seeking help. They had started to rule out a cardiac etiology, though they still wanted to do a stress test. Dr. J was here to investigate the possibility of generalized anxiety disorder and/or panic attacks causing his symptoms.

In the emergency department, where I worked for two years before medical school, a “long” interview was maybe 15-20 minutes. Today, though, we spent almost an hour interviewing and talking about the patient, which my mentor said was fairly average. We sorted out how best to get him some help in the form of outpatient counseling and a little Ativan for the odd anxiety attack, and went on our way to check on another patient, who was on the second floor. This time, mercifully, we took the elevator. This patient was in surgical ICU while recovering from abdominal surgery. He had apparently been a bit delirious, mostly at night. Last night, he had ripped out his ostomy bag, making a mess. He also apparently was telling people that he was actually dead and didn’t know how he was talking to them.

Today, though, he seemed mostly normal. Mostly. In talking to him, you could tell all of his oars weren’t in the water, so to speak, but he had apparently decided that he was in fact alive now. That’s good. But we’ll keep you here just a little longer. And give you something to sleep at night.

After that, I headed out. I had a bunch of stuff on my plate to do that afternoon, mostly in the form of actual school work I needed to get through. Before I left the VA campus, though, I wanted to pick up my ID card that had taken forever to sort out. Back when we first started, we had to fill out an hours-long set of forms online for a background check and then get fingerprinted (which took hours and hours of waiting in line at the ever-so-efficient VA HR department) so we could get a government-issued ID for our rotations at the VA hospital in third year.

Turns out, though, the person in charge of handling the paperwork for my entire class left the VA while it was processing, and somehow all of our applications were forgotten about. And after sitting in some electronic holding vat for too long, the VA system terminated some of ours, depending on how long they had been sitting there. Those of us who had gotten them done early, for example. Like me.  And, by the time they told us, our original fingerprints had expired. Lovely.

So I had gone back to HR a few weeks ago to get my fingerprints redone, and tried to figure out what was going on with the online forms. Someone took my name and said they’d figure it out and get back to me.

Which never happened.

I ended up calling the person in charge of “endorsing” us for our badges, who said don’t worry about it, we really didn't need that form anyway (so we spent hours filling it out then because…?). Your fingerprints are all you need for the background check. Go get your card.

Awesome. So, finally having a free moment from school, I thought that I’d run over to the ID card office and pick it up real quick. Hahahahahaha……

Turns out the office is in the middle of a seemingly mile-long building that stretches across the entire VA campus. And looks like it’s abandoned. And only has one entrance (that I could find) labeled “Suite C.”  I needed Suite E. I couldn't tell where along the mile-long expanse to park, so I called the office number and asked them for some type of landmark. “We’re in building 1.”

Yeah, I got that.

“Oh, we’re at the north side of the building.” Great. So I drove to the north side of the campus/building…no entrance. The frick.

Drove back to Suite C. Parked. Went in. Was told to walk up a long hallway to Suite E. So I did, and finally found the office. Then I found out I wasn’t actually going to be able to pick up my badge, I actually needed to start the process. Which means more fingerprints and pictures. Buuuut the fingerprint machine wasn’t working – its server is busy. Can you use the extensive fingerprinting that I had completed at HR? No, our systems aren’t connected like that. Fine. Let’s try again. And again. And again. Let’s wait and see if the system suddenly becomes not busy. I did some Anki while waiting. Try again. Wait again. More Anki. Try again. Wait again. Try again. Oh, let’s change this parameter – great, it’s fixed (an hour and a half later). Oh, remember those online forms you were told you didn't need? You actually do need it. We can’t give you a badge. Sorry.


So I walked back out of the building, toyed with going home and just doing the stuff I needed to get done, but decided that I’d better just go over to HR and sort out the online forms thing now and save myself a trip back to this dreadful place. So I walked over to HR, and actually ended up speaking to a lady there who was actually very helpful, which was a nice change of pace. She even stayed a little over her shift to sort things out, revived my forms from their electronic grave, dug some of my old paper forms that I had signed months ago out of some stack in a corner so I didn't have to go through them again, and got things moving again. I should be able to finally get my ID card in a few days.

I hope.