More VA antics

So the VA is like a little military base, which is not a foreign concept to me, but still very odd when you're not expecting to be on a military base. The cafeteria is called the canteen; there is a retail store that sells not only convenience store items, but also electronics and a small assortment of clothing, much like a PX or NEX -- all tax-free, just like on a military base, too! In medicine, we usually use military time to prevent any confusion in orders or progress notes, but the whole VA hospital posts everything in military time; thus, the canteen is open from 0700 to 1400 daily.

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Yesterday, I went down to the canteen to get a sub made. The menu offered New York-named subs -- things like "The Big Apple" or "Fifth Avenue" -- with various deli meats and cheeses. The woman in front of me in line ordered a tuna sandwich and I heard the man behind the counter (MBC) offer her a variety of wraps or a wheat or white roll. She took the white roll. Then it was my turn:

Me: I'd like a roast beef sandwich on a wheat roll, please.
MBC: I'm sorry, but we're out of wheat rolls, and you can't get roast beef by itself [gesturing to the bins of meats behind the glass, which I couldn't see into since they were covered with sheets of wax paper].
Me, in my head: But I heard you offer a wheat roll to that woman, and she didn't take it, so she couldn't have taken the last one. And what are you trying to gesture to, because I can't see what's under that wax paper, and what does "roast beef by itself" mean?
Me: That's OK; a white roll will be fine. What do you mean, I can't get "roast beef by itself"? [I'm seriously picturing that they have some sort of special roast beef, like specially flavored, in the way you can't take the peppers out of pepper jack cheese or something]
MBC: Well [continuing to point to what I can only assume are meats under the wax paper that I can't see], you can get ham by itself, or turkey by itself, or our Big Apple is ham and turkey, or we have the Fifth Avenue, which is ham, roast beef, and turkey.
Me: [Pause. MBC continues to look at me in all seriousness. I decide to just go with it.] Turkey and pepper jack cheese, please, then.

Then I turned to the guy behind me in line, who happened to be my resident, and we exchanged incredulous looks. "That's classic VA for you," my resident said. And that pretty much sums up my thoughts, too. No wonder people are so hesitant to allow the government to take over our health care system (yes, I'm conceding this point to you); providing ham, turkey, and roast beef sandwiches, but not allowing people to get "roast beef by itself" is pretty much classic government-ness.

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I enter the VA building from the basement level, and to get on the elevator, you walk past the security office. Next to the main entrance to the security office is a door that remains closed, and the sign next to it reads:

Authorized
Personnel
"Only"

Sigh. Enough said on that subject, I'm afraid.

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Remember Ms. G, my female vet patient who served at Normandy? Well, here's how unusual it is to have a female patient at the VA. We requested a GI consult for her, and the GI fellow came and saw her, then wrote his note in the computer system (everything is computerized at the VA), which read [explanations of abbreviations in brackets]:

"HPI [history of present illness]: 84 y.o. [year-old] man with hx [history] of DM [diabetes mellitus], was admitted with N/V [nausea and vomiting] 1/4/08. CT [CT scan / "cat" scan] abd [abdomen] concerning for thickened dilated esophagus, possible colitis and possible chronic pancreatitis."

He writes a nice long consult note, and signs off on it.

Later, he makes this addendum to the note:

"Correction: Pt [patient] is easily noted to be a woman, not a man, as stated in HPI."

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There's a patient in the hospital right now who has been there for a while. He's not on our service, and I'm not sure why he's there (he's 90 years old, so there are many possibilities) but our attending told us an interesting story about him today. He has hemophilia, and he has a strong family history of hemophilia. When he entered the army during WWII, they gave him a full medical checkup. The army knew about his family history of hemophilia, and they knew for sure that he had hemophilia. So instead of giving him a nice, safe desk job, you know what they did? They sent him to the front lines. And of course, he got shot. Good thinking, people. Luckily he survived, and he's now 90 years old and admitted to the VA. I'll refrain from commenting on which fate I might have chosen.

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There are four general medicine teams at the VA -- white, red, green, and purple. I'm on the white team. We have our own team room with desks, chairs, and computers, and we do all of our work from our team room. Unfortunately, whenever someone in our room answers the phone, they say, "White medicine." It's funny and disturbing at the same time.

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Last weekend on my first call night at the VA, we engaged in some antics of our own. Our team room had a very large, government-issue, gray metal bookcase that took up a lot of space, wasn't used for holding anything, and was pretty ugly. It bore a yellow post-it that read, "To A-601" (our room number), so at some point in the past, it was somewhere else and the post-it directed it to our room. So late that night, we went around to the other team rooms, trying to figure out where we could move the ugly bookcase to. We found a spot occupied by a smaller bookcase in another room, but we were pretty sure the other team would notice. But maybe not. It was worth a shot. So we did some rearrangement, dragging this 8-foot-tall gray behemoth through the hallway into the other team room and taking their bookcase back to our room. It opened our room up nicely, I must say. The finishing touch? I found another post-it, wrote "To A-603" on it, and stuck it on the bookcase in the new team's room. That's all it took to make it official-looking. Ha.