The price of freedom is visible here

“The Price of Freedom Is Visible Here.” So reads the sign in the entryway of the Veterans Affairs (VA) hospital, providing both a warning and a tribute. Given the terrorist attacks and the war our nation is currently in, I have been thinking a lot about people paying the price of freedom. If our previous wars are any indication, the lucky military survivors from the war against terrorism will surely end up here, at the VA medical center. In my third year of medical school, a fair amount of my training takes place at the VA hospital. It is a different kind of hospital—and not just because it provides low-cost care. Having been both a patient and a volunteer at a county hospital, I've experienced the “bottom of the health care barrel.” The VA is appreciably different. For one thing, it has its own culture. At the VA hospital, you feel like you've stepped back in time—or to a different country, one less developed and less modernized than the one we are used to. Most patients and visitors enter and leave the VA hospital confused, disoriented, and lost. Being lost at the VA hospital is common because there is no apparent design to the layers of old buildings, each forced together at odd intersections. Just like the patients, the buildings are chopped up, amputated, and anastamosed. As if to make the overall uncoordinated nature of the complex more apparent, signs point out these defects to everyone. Leaving Building 128, a sign tells you that you are entering Building 122. Building 122 connects to Building 8, which connects to Building 1, which, of course, connects to Tower. The main entrnace is not called the main entrance; it's the South Entrance. The older wings of the hospital, housing the operating room and the surgical intensive care unit, remind me of my grammar school in Wisconsin, and were likely built in the same era, with the same linoleum, windowpanes, plaster walls, low ceilings, and narrow tiled hallways. The hospital accoutrements, modern and familiar, are startling in comparison. Into this dated setting, the patients themselves seem out of place, monitored and maintained as they are on multiple intravenous pumps, ventilators, and telemetry readouts. The thoroughfares are filled primarily with men who are remarkably friendly. They will frequently ask me if I am lost, a common occurrence and one they seem to enjoy pointing out. One gentleman stopped me, told me my coat was buttoned wrong, and then yelled out, “The sergeant would tell you to drop and give me 20, young lady!” I half believed that he was going to make me do it, but we parted with a chuckle, albeit a nervous one on my part. The VA hospital is a self-contained colony for veterans. Who would have guessed that this complex holds a barbershop, a retail store (tax-free), a rehabilitation center (with a jewelry-making laboratory), a bowling alley, a swimming pool, a mailroom, a library, a theater, a golf course, a patients' vegetable garden, and a ham radio association that uses the VA antenna. The hospital must have the only psychiatric ward where people really are broadcasting from the basement. Like all nations and cultures, the VA hospital seems to have its own relationship with time, and people actually speak of “VA time.” Sort of like in Italy where, to do business, you must first engage in the niceties of social exchange. Likewise, at the VA hospital, if you want something, you have to be willing to say, “Hey, what's up? How are you? Oh, really?” with lots of teasing and smiling. Then and only then will you get the medical record, see the computer, or be able to send a patient off to surgery scheduling. Unlike the rest of hasty America, and usually contrary to the wishes of an intern, here manners matter more than efficiency. Things move slowly for other reasons, too; for wheelchair- or stretcher-bound patients and visitors, elevators move at a snail's pace, stopping at each floor with programmed times for opening and closing. Before September 11, the patriotism at the VA hospital also struck me as old-fashioned, even sentimental, like a Norman Rockwell painting. The hallways leading to the canteen are covered with WWII photos of bombers and wartime propaganda posters. Flags are visible everywhere, and long before the terrorist attacks, the retail store sold T-shirts that say “Proud to Be an American.” Now it seems no different from any other place in America, festooned with red, white, and blue nosegays and flags hanging from every vehicle and body. The war, and the sense that Americans are under siege, has brought my own feelings of national identity closer to the surface. It seems entirely appropriate to be working at the VA hospital now, surrounded by veterans. In the day-to-day bureaucratic torpor and medical inefficiencies, I had lost sight of the fact that the patients are the men and women who bravely defended us in the past. Their strange and random hospital complex, running on its own time and rules, is above all a secure, hard-won place of peace.