Last year, more than 200 Penn medical students and 600 of its residents trained at PVAMC. For more than 25 years, Penn has provided PVAMC with resources and personnel, leading to a mutually beneficial relationship. It is one of 107 medical schools and 55 dental schools across the country affiliated with a VA facility. More than half of the physicians practicing in the United States had some of their professional education in the VA health care system.  Yet many say that the size, depth, and extent of the Penn-Philadelphia VA affiliation are unique. Many Penn doctors maintain offices and see patients at PVAMC, or as they call it, “across the street.”

Ask the trainees what’s so important about the time they spend at the much smaller center, and most will tell you about the VA’s extensive data and its expertise in specific areas of research and clinical care. Listen longer and you’ll often hear about something less tangible but in many ways even more powerful.

Residents speak feelingly about African-American World War II veterans who risked their lives for a country where they were banned from lunch counters, Vietnam veterans ravaged from lives spent on the street, and Iraq veterans as young as they are who are scarred by stress disorders and trying to function without limbs. The stories abound. In today’s world of fast-paced, cost-driven medicine, what’s perhaps most remarkable is that these novice doctors have time to hear the stories. With all the talk about incorporating “humanism” in medical school curriculums, this is how the real education happens.

Dr. Karen Warburton, medicine residency director, says that she always tells new residents about a World War II veteran she met when she was training at PVAMC 10 years ago. While many of the patients, especially the older ones, treated female interns with skepticism and often outright chauvinism, this man was a “gentleman.” She earned his trust and quickly developed a good relationship with him. Yet it took more than a year for her to find out that this small, humble 85-year-old man had once been a fighter pilot decorated for his service. “He brought me this article one day,” she says. “He was a real hero. I had known him for more than a year, and he never even mentioned it. I always keep that article in my office and show it to residents.”

Humility and service are values you hear about a lot at the VA. Residents talk about how appreciative the veterans and their families are, something Dr. Neil Fernandes, a first year resident, attributes to the “kind of personality and selflessness it takes to serve your country.”

The students and residents who do best at the VA seem to share some of that selflessness, or at least are not, as one physician says, “prima donnas.” There are few frills here. Getting a full-size refrigerator and microwave to improve on-call meal options for residents was significant enough to warrant mention in the 2008 Annual Report. Prior to that, Warburton says, residents working overnight had to head to a dungeon-like storage area for often less-than-appetizing options. “You learn to laugh,” she adds. While part of that comes from being the kind of person who makes the best of things, it is something the medical trainees also learn from the veterans. It is hard to complain about a bad dinner when someone your own age, who could be facing a lifetime of crippling back problems from wearing 50 pounds of body armor in the Iraqi heat, isn’t complaining.

“They all have colorful and perhaps more meaningful stories and experiences than most of us will ever have,” says Warburton. “We often see them at their worst and see what disease has done,” she adds quietly.

PVAMC trainees not only work closely with their attending physicians on diagnosis and treatment decisions but also gain experience from counseling patients and families. Because the facility is smaller and has fewer support personnel than a large academic medical center such as the Hospital of the University of Pennsylvania, they say, the pace is a little slower, which allows more time for such conversations.

“[Trainees] can spend two hours talking to a patient about diabetes—what it means, how to take care of yourself,” says Warburton. “Patients often have a number of physical and social issues. It’s like a crash course in internal medicine.” Residents see firsthand how social-economic factors such as education and income affect physical health.

“One of the things we recognize is poverty as a cause of illness,” says Dr. David Asch GM’87 WG’89, executive director of the Leonard Davis Institute of Health Care Management and Economics and the Eilers Professor of Health Care Management and Economics. Patients often present with chronic diseases in much more advanced stages than at other facilities. “We often catch people who have fallen through the cracks,” says Asch. “The VA does a good job of taking care of the veterans who walk through its doors, but by the time they get here it may be late.”

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FEATURE:
Crossing the Street By Randy Mintz-Presant
Photography by Candace diCarlo

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Below: William Heggs and Mrs. Frances Lloyd are among the thousands of veterans who receive care each year at PVAMC; Theresa V. Liggett (behind Mrs. Lloyd) works there.