I walked into the Veterans Affairs (VA) hospital where I have primary care clinic. I hadn’t been there for a few weeks between vacation and working in the ICU (critical care unit) at a different hospital. Yet, I’d heard about the budget cuts and other residents had shared murmurs of uncertainty related to what was to come for our patients. Entering the VA hospital for the first time since the budget cuts started to take effect, I was immediately struck by how gross the floors looked. And, as I was processing the dullness of the floors and their peeling finish, I heard a woman next to me comment on the floors too.

I used to joke to my spouse about how frequently they refinished the floors at the VA hospital. Over the past 2 years it seemed that every time I worked nights or left late, they were refinishing the floors. These efforts resulted in a floor as shiny as the shoes of the sentinels at the Tomb of the Unknown Soldier in Arlington Cemetery. And, until the floors looked dull, I’d never thought about their symbolism.

Every patient seen at the VA hospital is a veteran. Some of them wouldn’t have access to healthcare if it weren’t for the VA. Most of them wouldn’t have access to some of the most critical medical resources that our veterans need for good health without the VA. Mental health care is one example of such a resource.

I settled into my day at the clinic. A patient I hadn’t seen before was among my first patients. “I’d like to be screened for PTSD,” he said.

“Okay, why?” I asked. PTSD stands for “post-traumatic stress disorder.” It’s a condition that can occur when people experience things that are mentally traumatic. It can include flashbacks to the event(s) that disrupt life, nightmares that prevent sleep, and mood challenges that make it difficult to function in daily life.

“My daughter thinks I have it,” he said.

“Do you have nightmares?” I asked.

“No. But I think about things that happened. I just push the thoughts out of my head though. You know, I saw people die in Vietnam,” he said.

“How often do you have those thoughts?” I asked.

“Multiple times a day,” he said.

“How long has that been going on?” I asked.

“Years. I also get angry really easily,” he said.

“Do you get angry over things that other people don’t?” I asked.

“Yeah, all the time. I just get angry fast,” he said.

“Any thoughts of hurting yourself?” I asked.

“Hasn’t come to that,” he said.

“What about thoughts of hurting others?” I asked.

“All the time, but I don’t act on it,” he said.

The conversation unfolded. From my assessment he easily met criteria for PTSD. “Well, I think your daughter’s right that you have PTSD. Do you want treatment for it?” I said.

“Yes,” he said.

We discussed our options for treatment. I was grateful that we had options. How awful it was to think he’d potentially lived for 50 years with thoughts of the people he saw die in Vietnam haunting him multiple times daily.

Mental health is a huge part of health for all people and an especially common challenge for veterans. It has taken years of population education and eradication of misinformation to create an environment where veterans feel comfortable asking medical providers for help with their mental health. In my experience younger veterans are more comfortable discussing things like depression and PTSD than older veterans. But it’s an important issue for all veterans. To put it in perspective, about 18 veterans across the US die by suicide daily.

The VA offers more mental health services than any other healthcare system I have encountered. People using civilian healthcare often wait months to be seen by a therapist and longer to see a psychiatrist. When working at the VA, I can ensure my patients’ mental health is supported as soon as I learn it is a challenge for them thanks to the VA’s dedication to the mental health of our veterans. The VA’s effort to help manage mental health challenges among veterans matters. For example, suicides among veterans diagnosed with PTSD decreased by 32% been 2001 and 2022.

What makes medicine different from most other industries is that we don’t deal in money, property, or things. We deal in lives saved, lives lost, and human suffering. What does the shine of the VA hospital floor say about the future of our veterans’ healthcare? Time will tell. Yet, looking at the landscape of US federal budget cuts and executive mandates, people’s access to healthcare in this country is declining. I suspect that it’s only a matter of time before the health effects are felt broadly. Of course, these federal healthcare budget cuts and restrictions are concurrent with cuts in federal funding for research. As a result, we probably won’t be able to quantify the impact politics today had in terms of lives lost and population health deterioration. Perhaps the symbolism of a floor, which one walks all over for their personal benefit, is fitting symbolism for the value current political figures place on the health of others.

References:

1. VA releases 2024 National Veteran Suicide Prevention Annual Report: https://news.va.gov/137221/va-2024-suicide-prevention-annual-report/