Take 3: In the Service of Fellow Veterans

 From the 11/6/2020 newsletter

Take 3: In the Service of Fellow Veterans

Dr. Jeffrey Jackson shares his insights about being a retired Army officer and serving veterans at the Clement J Zablocki VA Medical Center in Milwaukee.
 

Jeffry L. Jackson, MD MPH 

 

 

1. Some people have observed that there is an esprit de corps within the VA, especially between the patients.  How do you explain that?

 

The VA purposefully instills a strong sense of mission.  Ask nearly any VA employee and they can recite the mission statement, “to care for those who shall have borne the battle,” initially uttered by Abraham Lincoln.  From the initial orientation to daily meetings, VA employees are constantly reminded of their duty to serve veterans.  

 
This esprit de corps is also present among veterans.  The purpose of boot camp in the military is to indoctrinate a sense of belonging, that the person standing beside you is responsible for keeping you alive in combat, an obligation that is mutual.  A significant portion of veterans have seen combat in WWII, Korea, Vietnam and now in the Middle East.  Nothing creates a sense of comradeship like going into harm’s way. Unfortunately, nearly everyone who deployed into a combat theatre saw a friend die or be severely injured.  This strong sense of purpose and sacrifice leaves an indelible mark.

 

 

2. What is the best advice you could give to students and residents who provide care for veterans?  What key insights could make their care for veterans better?

 

Veterans are no different than nonveterans in what they want from their providers.  If the patient believes you have their welfare at heart, if they trust that you are motivated to do your best for them, they will respond to you. Communication is at the heart.  Be open and honest and human. Admit when you don’t know something. Seek out their underlying motivation for the visit, and as best you can, honestly deal with it.  Do not judge veterans, many have physical and psychological scars, and some have made bad choices.  Listen to their stories.
 

 
3. Tell us about a moment during your service in the Army that you are most proud of (or that contributed to your development as a caring physician)?

 

I spent most of my military career at Walter Reed Army Medical Center.  I was a senior resident and was working in the ER when we gathered around the television to hear George Bush announce that the United States was going to repel Iraq’s invasion of Kuwait.  The United States he said, but he really meant the United States’ military forces - young men and women.  Nearly all the military casualties made their way back to Walter Reed. I witnessed the impact of combat on soldiers and their families; a family at the bedside of a soldier with a horrific brain injury, clinging desperately to hope and misinterpreting every minimal sign of responsiveness.  I avoided elevator bank 4 because that’s where the amputees would gather in their wheelchairs, coming back from our amputee center.  It broke my heart to see so many being pushed by their mothers or their 18-year-old girlfriends.  They barely looked old enough to shave. 

Old men make the decision to go to war, young men and women pay the price.  

I once made the trip out to Dover to watch the dead being returned home.  Each flag-draped coffin was moved from the plane to the mortuary, solemnly accompanied by an honor detail.  On my visit, family members and several high-ranking officials were in attendance.  I only made the trip once and cannot imagine the resilience it must take to be assigned this duty.  I attended several funerals at Arlington Cemetery.   On one occasion, President Bush was in attendance.  I was proud to serve a Commander in Chief who was openly weeping. 

I spent 21 years in the Army.  What I am most proud of was the sense of purpose, honor and sacrifice that I witnessed.

 
 

Jeffrey Jackson, MD MPH is a Professor in the Department of Medicine at MCW. His practice is at the Zablocki VA Medical Center. 

 

Editor: Kathleen Fletcher, MD MA

 

Veteran’s Day Reflection

 From the 11/6/2020 newsletter

Perspective 
 
Veteran’s Day Reflection
 
 
Kenneth Lee, MD – Department of Physical Medicine and Rehabilitation
 
 
Dr. Lee, a retired Army Colonel, shares his perspective on how we all learn to serve our military veterans …
 
 

“Thank you for taking care of my patients.”  These words meant something to me when I addressed nurses, therapists, dieticians, pharmacists, and many other disciplines at the Zablocki Veterans Affairs Medical Center (VAMC), especially when Veteran’s Day came around. 
 
 But now, I no longer say these words.  Why?  Let’s see……
 
I have been a physician in the VA system since 1997 and my whole medical career has been at the VAMC. I retired from the military after twenty-seven years of service in 2013.  I spent 27 years in the National Guard with one active duty deployment. Now, I am a retired military veteran. I have seen leaderships change, colleagues move around, and viewpoints challenged and accepted over the years.  The one thing that has stayed consistent in my life: The veterans.  
 
I interact with different generations of veterans on a daily basis.  Some are sick.  Some are healthy. Some are disabled.  Some are athletes.  And, some are just friends.  They are all serviced by the VA.  So how are we doing on that front?
 
Some time ago, a second-year medical student approached me to help create an introductory curriculum on veteran care to be taken BEFORE medical students start their rotations at the VA.  Without much thought, I agreed to be her mentor.  Three years later, this is a fully formed, elective inter-professional educational curriculum created in partnership between MCW’s schools of medicine and pharmacy. This curriculum covers the life of military service member during peacetime and war, the structures of the DOD and VA systems, the development of interviewing skills with veterans, and much more.  You can see the eagerness of the students in the classroom as they absorb the information the teachers and veterans share with them.
 
During this COVID-19 pandemic, there have been countless gestures by the community, despite the suffering, to provide comfort needed by the veterans. Boxed lunches for VA staff during the height of COVID -19 surge, generous donation of PPEs so we can continue to be safe during the care of the veterans, and many words and notes of encouragement.  
 
 It seems that during the worst of times, the veterans are never forgotten. 
 
What else? You can tell your stories.  You have them.
 
So, why do I no longer say the words, “Thank you for taking care of my patients”?  I always thought of the veterans as my brothers and sisters. I never had second thoughts. But it was just one of those things that was part of the military/veteran culture.  Just accepted it.  But recently, I find myself truly belonging to this family.  So, I now say….
 
“Thank you for taking care of my fellow veterans.”
 
 

Kenneth Lee, MD is an Associate Professor of Physical Medicine and Rehabilitation at MCW who works and teaches at the Zablocki VA Medical Center in Milwaukee. He served as the Commander of the Army’s Company B, 118th Area Support Medical Battalion in Iraq. 
 
You can read more of his personal story and motivation for caring for veterans here.

Opinion: Trump's baseless claim that doctors are profiting from coronavirus has consequences

From the 11/2/2020 Milwaukee Journal Sentinel 

Faculty Op/Ed essay 

Opinion: Trump's baseless claim that doctors are profiting from coronavirus has consequences

Jayshil (Jay) Patel, MD - Pulmonary and Critical Care physician

As the COVID-19 pandemic rages in Wisconsin, doctors stand on the front lines, caring for critically ill patients infected by the coronavirus.

But, according to President Donald Trump, doctors are inflating the death toll for financial gain.

Just like veterans shouldn’t have to defend serving their country, I never thought I’d have to defend doctors caring for sick patients, especially after hundreds have died fighting the battle. But here I am.

Doctors must provide clear documentation when billing for their care. Misreporting medical conditions is a crime and violates ethical principles our profession considers sacrosanct. No financial incentive replaces lost family time and the compounded threat to our well-being.

The truth is, health care workers have taken pay cuts while continuing to care for the sick. Hospitals and outpatient clinics have closed, resulting in the loss of an estimated $200 billion and communities losing access to care.

When the president points his finger, there are consequences.

Last March, he pointed to the calendar and said the virus would go away by Easter. It didn’t, and 230,000 have died.

Then, he turned his criticism toward our nation's leading infectious disease expert, Anthony Fauci. Chants to "Fire Fauci" echoed across his rallies as if he were a contestant on "The Apprentice," the reality TV show Trump once hosted.

Now, while doctors stand on the front lines, a line the president has never walked let alone seen, his hot finger points at us. Despite the scorching light cast on us, we will continue to do our job, even if the president doesn't do his.




Jayshil (Jay) Patel, MD, is an Associate Professor of Medicine (Pulmonary & Critical Care Medicine) at MCW. He is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.



Link to the essay: 
https://www.jsonline.com/story/news/solutions/2020/11/02/trump-claim-doctors-profit-coronavirus-baseless-hurtful/6131051002/

Advocating for Safe Voting in Milwaukee – It’s Tough Sledding Out There

 From the 10/30/2020 newsletter

Perspective

 

 

Advocating for Safe Voting in Milwaukee – It’s Tough Sledding Out There

 

 

Christopher S. Davis, MD MPH

 

 

Dr. Davis reflects on some of the important lessons and frustrations as MCW’s Save Voting Taskforce pushed to empower voters and educate the community in safe voting practices during the pandemic …

 

 

The publication of this week’s Transformational Times heralds an opportunity for me to pen a reflection on the efforts of MCW’s Safe Voting Taskforce which I co-chair with Dr. Megan Schultz. Mostly a medical student- and resident-led endeavor, our efforts indeed generated some meaningful successes; however, our victories and defeats were, at the same time, both enlightening and infuriating. If we could have had our cake and eaten it too, we would have actively registered hospital and clinic patients, provided the entire community with safe voting information, and created a highly visible media messaging campaign. However, largely due to the politicization of voter registration (and even mask-wearing--really?), we couldn’t bring home the gold. Nonetheless, I believe that we will still find ourselves on the medal stand, if only for dutifully fulfilling our civic responsibilities of promoting health and voting.

 

 

Our Successes

 

As Dr. Kalet underscores in her Director’s Corner this week, those of us in healthcare must get our houses in order by casting ballots. To that end, we worked diligently with MCW’s deans, center directors, chairs, and the Office of Graduate Medical Education to emphasize both the importance of voting and MCW’s support for these efforts.

 

In an event hosted by the Kern Institute, Alister Martin (from the national VoteER campaign), educated us and fielded questions about engaging hospital leadership to support patient voter registration. As was discussed by Megan Quamme (the engine of the Safe Voting Taskforce) in a recent Transformational Times essay, this effort led to direct patient engagement in both Children’s and Froedtert’s Emergency Departments. Our student-led efforts even extended to Wausau, where Hayden Swartz (MS-3) encouraged North Central Health Care and Ascension’s local hospital systems to adapt the VoteER model to engage their patients to vote and vote safely.

 

Concurrently, our Safe Voting Taskforce sought to engage a much broader audience. In order to avoid any appearance of “taking sides” in the process, MCW’s Office of Government and Community Relations introduced us to Eric Ostermann and Jaime Michael at Badger Bay Management Company. In order to bypass partisanship, Mr. Ostermann suggested we reach out to the Wisconsin Public Health Association (WPHA) to take the lead for a statewide coalition of major health-related groups. WPHA’s board quickly voted in favor of this and on October 8, we held the kick off of “Vote Safe Wisconsin 2020.” Keynoted by Dr. Susan Polan (Associate Executive Director, Public Affairs and Advocacy, American Public Health Association), the event helped secure pledges from numerous organizations in Wisconsin to support our efforts of ensuring that the public had the information it needed to vote safely. In addition to WPHA, the Wisconsin Medical Society, the Wisconsin Chapter of the American College of Emergency Physicians, and United Way of Wisconsin were engaged. By directly reaching at least 15,000 professionals across Wisconsin, MCW and WPHA has led a public health campaign to assure Wisconsin’s citizens that they can vote and vote safely despite the surge in COVID-19 cases.

 

Lastly, MCW and the Kern Institute have continued to actively engage with our partners from MaskUpMKE who launched MaskUp2Vote. This work combines the long-standing public health message of MaskUpMKE with information that voters might find useful in terms of where in Milwaukee to find free masks and the basics of voting safely during a pandemic. MaskUp2Vote also generated an animated public service announcement which features Bango (the mascot of the Milwaukee Bucks) and highlights the ongoing civic engagement and public support from the Milwaukee Bucks organization.

 

Our Failures

 

I am constantly reminded that the work of community engagement and uplifting our patients can be a slow and arduous task. Sometimes, the hurdles appear too numerous or too high. Other times, the resources are too scarce, the time in a day too short, and the willingness of others to do the morally obvious thing too non-existent. For these ailments, I wish I could offer a cure that wasn’t solely based on dogged persistence. Unfortunately, this is the stark reality, particularly in a time when our elected officials have left us in – what the editorial board of the New England Journal of Medicine calls – a “leadership vacuum.” There are now nearly 230,000 deaths from COVID-19 with no end in sight.

 

In Milwaukee County, the key pandemic safety indicators have rapidly changed from green to yellow to red while, at the same time, homicides in 2020 have surpassed the previous record of 174 set in 1993, and are projected to reach 220 by the end of the year. Structural racism is rampant, and, as I mentioned previously, the infant mortality rate in Milwaukee is among the worst in the nation. And as if that is not enough, MCW has lost another medical student – one of our immediate family. We can’t even protect ourselves, and if this doesn’t give us all pause and insight into our failures, it is entirely unclear to me what will.

 

We clearly need a curriculum and culture dedicated to medical student and clinician well-being, public health, advocacy, legislation, and community engagement so we can train tomorrow’s doctors to work within these spheres and remain healthy while doing so.

 

 

Pertaining to MCW’s Safe Voting Taskforce, I believe we fell short in three main ways.

• ·   First, we hit logistical roadblocks at our own institutions. We could not achieve a plan at Froedtert Hospital (and to a lesser extent at Children’s) to actively approach patients to register to vote, cast their ballots, and do so safely. Much of the allowable activities were mostly relegated to signage restricted to the Emergency Department, whereas other hospital systems across the country begin voter registration activities during registration and continue the conversations during the patient-provider interactions.
• ·   Second, we never arrived at a single local, regional, or statewide governmental partner that would embrace concise guidelines for a successful and safe election cycle. There were too many cooks in the kitchen and too many distracting partisan agendas. Indeed, attempts to engage with many elected officials or groups, such as VoteSafe Wisconsin, went unanswered. It quickly became clear that pushing for access to voting and safety protocols during a raging pandemic was not a priority for some people.
• ·   Third, we never achieved a widespread media coverage or public service announcement campaign. I strongly believe that this and other medical student/resident activities were undercut when the Milwaukee Election Commission, fearing a lawsuit, ruled out using the Fiserv Forum and Miller Park for voter registration/balloting sites.

 

There should not have existed the need for us,  as a grassroots group at a medical school, to take on the task of widespread and concise public health messaging about voter safety and empowerment. Yet, as the pandemic rages on and in the midst of a leadership vacuum, we did what we could. We are proud of our efforts, have learned from them, and will continue to work tirelessly with this growing knowledge for the betterment of those in our communities.

 

  

Christopher Davis, MD MPH is an Assistant Professor of Surgery (Trauma and Acute Care Surgery). He is a faculty member of the Community and Institutional Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.