“Hit me like a like a ton of bricks,” Vietnam Marine Corps Veteran Robert Hall, 67, told his primary care (PC) physician Dr. Sabrina Felson. He was explaining how he felt recently hearing from his oncologist there was a bad prognosis for his gastrointestinal cancer.
Dr. Felson said no one can know exactly how long a patient has to live. She reminded Hall he would be meeting with members of the Palliative Care team in upcoming weeks and that the goal now was to make every day the best day possible and to maintain his control in shaping what time he did have left here.
He is clear about his main priority, which is quality time with his family, particularly Jayden, his 11-month old curious and spirited grandson. His daughter, Monique, says that when Jayden sees his grandfather, he is “all gums, he’s so excited.” Jayden is also soothed by Hall’s calm voice and Monique says appreciatively, “Jayden is a handful, but when my dad lies down next to him Jayden just falls asleep.”
Daughter and grandson have recently moved in to stay with and tend to Hall during his illness. “Somehow, he caught on to calling me Bobbie,” said Hall, sharing photos of his dimpled grandson with Dr. Felson, who has been his PC physician for 10 years.
“Make every day the best day possible.”
Navy Veteran Penelope Bennett-Kone, Primary Care Program Support Assistant, is very protective of Hall and enjoys talking with him on his frequent visits.
Hall says, “I remember a lot of things about Vietnam.” He held up his hand and flicked his fingers, to describe the “star shells,” flares that were set off at the airstrip where the new troops’ plane landed. “To welcome you to war,” said Dr. Felson. Stories about “Wet Socks and Rain”
He kept a lot of war details private according to his daughter, who does remember hearing stories about “wet socks, and rain, and bullets flying over your head.” Hall was injured by mortar friendly fire and medivacked to naval hospitals, first in Vietnam and then to Japan before returning to the States. He has 100 percent service connected disability status.
When asked what she admires about her father, Monique says “Everything! I admire anyone who can protect people and put other lives first. That’s an unselfish person.”
Hall, like many of his fellow Vietnam Veterans, struggled with drugs and alcohol when he returned home. It was the unexpected and tragic death of his son at age 13 that pulled him back into the fold of his family. And into the welcoming arms of the church he’d grown up in, where he now serves as Deacon and sings in the choir.
Monique says, “You can’t walk the streets of Harlem with him cause he stops to talk to everyone. Everybody knows him. You run outside for five minutes and it takes three hours.” On a recent morning Hall said he was “Feeling OK, a little up, a little down.” He had been busy all morning answering phone calls, from VA, some people in the church and his daughter. By noon, he had to prop his swollen legs up and take a little nap.
Dr. Felson says that for Hall, like many of the Vietnam Veterans she sees, “Their grandchildren are so important. That is their legacy.”
The hope is that Jayden will walk the streets of Harlem with the same love and respect that his grandfather garners with his patience, bravery and kindness.
When Linda Fraunfelter heard about the VA Medical Foster Home program she contacted Ruby Rideout, Medical Foster Home Coordinator at the Prescott VA Medical Center in Arizona. Two months later, after application, reference checking, training and multiple VA home inspections, Linda took in her first Veteran, Betty Dodd, 91.
Medical Foster Home is an alternative to a nursing home in a personal home setting, for eligible Veterans who are no longer able to safely live independently.
The Prescott VA implemented the Medical Foster Home Program in March 2012 and today has four homes in the community serving six Veterans. VA’s Home Based Primary Care (HBPC) team is an integral component of the Medical Foster Home program, and staff from HBPC makes visits to provide home assessment, caregiver support and education.
Direct patient care and oversight for the medically complex Veterans placed in homes is a vital aspect of the program.
Linda describes herself as a natural caregiver and has worked in various settings as a caregiver over the years. She decided to give Medical Foster Home a try so she could be at home for her parents more and also to provide her mother with companionship.
Able to Offer Personalized Care
She identifies with the Medical Foster Home concept because it limits the number of people being cared for to three, allowing her to offer personalized care. “You have to have a big heart to do this work – a smile, kindness, gentleness and patience to bring joy into their life.
Betty Dodd served in the Marines during the Korean War. When asked what she likes best about being in the Medical Foster Home, Betty replied, “It’s sincerity. I feel comfortable. I think I belong here.”
Linda is especially appreciative of the support she gets from the VA Home Based Primary Care Team and the Medical Foster Home Coordinator. “I always get a response from the team in adequate time. We are provided with a training course every six months which is very helpful.
The team is very caring, willing to go the extra mile to help the caregiver and the support is always there for you and I love it. I have a sense of purpose every morning when I wake up.”
“They make you feel at home.”
Another couple taking care of Veterans in their home are Robbin and Mike Dohm in the rural community of Chino Valley.
When Robbin and Mike learned about the VA Medical Foster Home program at the Prescott VA, Mike contacted Ruby Rideout.
Veteran Mike Brown and his second place prize at the Yavapai County Fair
The first Veteran Robbin took in was Mike Brown, 69, who served in the Army during the Vietnam War. Mike likes the security of where he lives: “It’s a place where they make you feel at home. They include you in their activities.”
“The support is always there for you.”
He appreciates that he has the freedom to move about the home and to take walks down the lane. Since moving into the Medical Foster Home, Mike says, “I think my health has improved.” Robbin hosts a second Veteran, a 96-year-old WWII Army Veteran who believes: “The VA is the greatest organization. They have been helpful to me. Robbin is a good caregiver. I give God credit. He saw me through a depression and a war. He’s taken care of me.”
A Medical Foster Home can serve as an alternative to a nursing home. It may be appropriate for Veterans who require nursing home care but prefer a non-institutional setting with fewer residents.
VA has an exceptionally talented team of outstanding employees. We would like you to meet them, starting with our dedicated staff of doctors. We will be introducing an eminent doctor in a continuing feature: VA’s Top Doctors.
We continue our series with Dr. James Michelson, associate chief of primary care at VA San Diego.
Simple Things Make a Great Doctor
When Air Force Veteran Jack Rathburn thinks about excellent health care, little things set good doctors apart from great doctors.
“So many doctors now are in a rush and I love a doctor who’s not,” he said. “I want someone who’s easy going and great to talk to and has a great bedside manner.”
For him, that doctor is Dr. James Michelson, the associate chief of primary care at VA San Diego Healthcare System. Rathburn has seen Michelsen since enrolling for VA health care in 2007 and the secret to this longstanding relationship is in the doctor’s demeanor.
ldquo;Dr. Michelson reminds me of those doctors from 50 years ago where they sit down and talk to you and are like your best friend and take care of everything,” Rathburn said. “And, he always gets back to you in a timely manner, even on a Saturday.”
“I think very much about what I would want as a patient.”
According to Michelsen, timeliness is the key to quality health care and it’s been something he’s focused on since joining the VA as a physician in 2000. He worked at other local private hospitals prior to his current position but he finds his work with Veterans to be the most comforting and rewarding.
“I love working with those who served our country. It’s one of the main reasons for my coming to the VA,” he said. “My mother also served as a career nurse for VA, so it’s very familiar to me and also where I’m most comfortable working with patients.”
Over the years, one of Michelsen’s priorities has been to focus on the things Veterans care about the most: improving the patient experience which includes expanding clinical access and improving coordination with interdisciplinary primary care teams, known as PACT. While PACT meets patients’ needs, patient access to care rises to the top for Michelsen.
“I think very much about what I would want as a patient and I try to bring that experience to the Veterans I serve,” he says. “I also think about what VA’s needs are and what my needs are as a doctor regarding outcomes. You have to find that fine line where you can satisfy all three areas and one of the keys to that is to make sure you spend time with patients and answer all of their questions.”
Dr. Michelsen examines a patient during a medical examination in July
With every appointment, there’s a limited time providers can spend with patients, but part of the trick according to Michelsen is to be efficient with your time as a doctor.
“If I have a half an hour during a typical appointment, I will spend a majority of that time with my patient and I will try to involve them with some of my work as well to be as efficient as I can,” Michelsen says. “Beyond that, we get many phone calls and emails from our Veterans and we’ll always try to respond to them in a timely manner outside of appointment times. We have time built in for that but we’ll also spend the extra time outside of work to answer their questions outside of visits. Many of our patients enjoy that, especially if they have to drive long distances for appointments and have to fight traffic and search for parking.”
“You can win awards and be published in medical journals, but as a doctor, you can’t forget what makes all the difference,” said Dr. Robert Smith, chief of staff and acting director at San Diego. “The great care you provide to your patients is what ultimately matters.”
While there have been many notable accomplishments during his career, it’s these little things that resonate most between Dr. Michelsen and his patients.
VA has an exceptionally talented team of outstanding employees. We would like you to meet them, continuing this week with our dedicated staff of nurses. We will be introducing our remarkable nurses in a continuing feature: VA’s Top Nurses.
Drema Bratton, RN, of Flatwoods, Ky., began her VA nursing career 37 years ago at the Huntington VA Medical Center (VAMC). She has always worked the midnight shift on an inpatient unit.
She was recently presented with the VAMC’s Nurse of the Year award in recognition of her excellent nursing skills and compassionate care for her Veteran patients.
“I had to take a pay cut but it was where I wanted to be.”
After finishing nursing school at Marshall University, Drema worked at a community hospital for about seven years, but she always wanted to take care of Veterans. “I called every day to try to get a job at the VA. When I finally did get hired, I had to take a pay cut but it was where I wanted to be. I was amazed at what was offered to our Veterans. They get wonderful care and services here,” she said.
“Drema is a true example of the devotion of our nursing staff,” said Dr. Mike Skeens, Chief of Medical Service. “Not only is she an excellent, long-serving nurse at this medical center, she intervened last year to save her husband’s life. She sensed something was wrong and drove him to the Emergency Room where he arrested multiple times. He had an extended hospital stay with multi-organ issues and she now does home dialysis for him. “
Drema Bratton, RN.
Missed her award caring for her husband
Drema’s husband, Gary Bratton, is an Air Force Veteran. When he fell ill last July, he spent two weeks on a ventilator and about a month as an inpatient. Drema trained to give him dialysis when he was finally able to return home. Now, each morning after she finishes up her midnight shift at the VAMC, she hurries home and begins the dialysis process. “It takes about four hours from set up to finish,” she said. “We are hopeful that eventually he can get on the transplant list for a kidney.”
Drema missed the VA nursing awards ceremony on May 11, because she was caring for her husband. She was presented with the award the next morning at the end of her shift.
“My husband and I have been married 44 years, and when he found out about my award he was tickled for me,” Drema said. “It is truly an honor.”