For the Record
Serving those who serve
By Stephen P. Spielberg, M.D., Ph.D.
Medical school deans spend a lot of time in airports. I must admit that I find airport downtime less enjoyable than I did in the past. While it occasionally offers a welcome chance to catch up on my reading, more often I find myself consumed with anxieties about missed connections, missing luggage, late arrivals, poor or no food, and so on. Recently, however, a different sort of airport experience led me to reflect on much more important matters.
I was scheduled to fly from Manchester, N.H., to Philadelphia, and my fellow passengers and I were waiting for the arrival of our plane. As the jet taxied up to the gate, I noticed a Marine sergeant in dress uniform walk out onto the tarmac. I soon realized what was about to happen but was amazed at how the event unfolded.
Coffin: The plane pulled up to the jetway, the passengers disembarked, and their luggage was unloaded. Then seven more Marines appeared and approached a conveyor belt that led into the plane's hold. A van pulled up, then a hearse flying two American flags. A few minutes later, a flag-draped coffin emerged on the conveyor belt. Six of the Marines approached the coffin, while the other two went over to the van and accompanied the members of a grieving family over to the coffin. The honor guard then carried the coffin to the hearse, loaded it in, and closed the rear doors.
The whole event was over in a matter of just a few minutes, but what was really remarkable was the response within the airport. There was utter silence in the waiting rooms. Everyone rose to their feet—passengers, crew, and airport staff alike—in silent tribute to a fallen soldier. There was no more rushing to gates, complaining about late departures, or munching on snacks; the day-to-day activities of the airport were suspended in time. Politics became irrelevant. This was about one human being and his or her family.
Perspective: My fellow passengers and I boarded our flight, still in near total silence. A few people made cell-phone calls before we pulled away from the gate, but the content of all the calls I overheard was the same—no business arrangements, simply personal calls relating what had just happened. During the safety demonstration, the flight attendants showed enormous grace and insight, validating everyone's sense that we had witnessed a very sad event—but one that put everything else in our lives into perspective.
Northern New England has traditionally contributed disproportionately to the nation's armed forces and to the associated costs of military service. The airport incident highlighted the debt that the rest of us owe to those who serve. And it also reminded me, once again, of the debt that DMS and DHMC owe to the White River Junction, Vt., Veterans Affairs Medical Center. Our VA—one of the component institutions of Dartmouth-Hitchcock Medical Center—is a remarkable place. It not only provides care to the veterans of our region, but it also provides considerable teaching to Dartmouth medical students and contributes to the creation of new knowledge through its extensive research activities.
The White River VA has consistently received recognition for excellence. It houses no less than three national VA centers—for post-traumatic stress disorder (PTSD), for patient safety, and for the VA system's quality scholars program. And the research that takes place there runs the gamut from nervecell repair, heart disease, and vaccine development to health-care decision-making, depression in the elderly, and health economics.
Within just the last two years, the White River VA has been granted the Secretary of Veterans Affairs' Robert W. Carey Trophy for Organizational Excellence (the highest VA award for quality); the Robert W. Carey Circle of Excellence Award (eligibility for which is limited to previous Carey Trophy recipients); and not just one but two Malcolm Baldrige National Quality Award site visits—the first Baldrige site visits ever made to a federal facility.
Value: The White River VA also contributes in a major way to the Medical School's educational efforts—from providing mentors for our On Doctoring course in Years 1 and 2 to supervising many clinical rotations in Years 3 and 4. Our medical students greatly value their experiences at the VA: the excellence and dedication of the faculty, as well as their relationships with the patients. Students all comment that there is something very special about their experiences there, serving those who have served the nation.
And DMS isn't the only medical school that benefits from a relationship with a VA hospital. In fact, the VA system oversees the largest medical education and health-profession training program in the U.S.; 107 of the nation's 125 medical schools are affiliated with a VA. The VA accounts for approximately 9% of all residency training in the country, supporting more than 8,800 full-time residency positions. More than half of the nation's physicians received some part of their medical training in a VA hospital, and over 28,000 residents and nearly 17,000 medical students rotate through one VA or another each year. In total, approximately 83,000 health professionals from more than 1,200 colleges and universities train each year at a VA facility. In addition, the VA system nationwide supports more than 5,100 researchers—76% of whom are practicing clinicians who also provide direct patient care to veterans.
In these difficult times, setting politics aside, we need to recognize those who serve—and those who help those who serve.
"For the Record" offers timely commentary from the dean of Dartmouth Medical School. Spielberg, a pediatrician and a pharmacologist, is in his third year as DMS's dean.
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