November 9, 2016

On the wall in the lobby of the VA Portland Hospital, above the insignias of all of our U.S. Armed Forces, is a quote in golden letters: "The price of freedom is visible here."

Every morning, the foyer fills with veterans who have borne the strain of serving our country. Some are making do without a limb, others are getting around by wheelchair or motorized cart, some sport bandages or an oxygen hook-up to ease their breathing.

There are spouses and family members, too, offering a steadying arm, navigating the wheelchair into the elevator, or sitting by their loved one's side, sharing the news of the day.

There's also a lot of fellowship.The coffee bar is a social hub and the VA offers ice cream and other treats on special days. Many of the staff and volunteers at the VA are also veterans and swapping stories with the patients is part of the warmth here.

And everywhere in this room is a sense of pride – from the Vietnam Veteran caps pulled down over graying hair to the bright red Semper Fi T-shirts of the U.S. Marine Corps.

OHSU and the VA Portland Health Care System are inextricably linked. In 1926, the University of Oregon Medical School (the precursor to OHSU School of Medicine) donated the land on Marquam Hill for the earliest VA buildings and soon began collaborating on patient care. Today, the two institutions are connected by a sky-bridge and a sharing of expertise and knowledge to benefit today's and tomorrow's veterans.

"Facilitating a collaboration between OHSU and the Portland VA Hospital is incredibly rewarding," said Jeffrey Kirsch, M.D., associate dean for veterans and clinical affairs, OHSU School of Medicine. "The partnerships that exist in the areas of clinical care, education/teaching and research are very deep and meaningful to both organizations. So many veterans gave to our country, now I get to give back to them."

OHSU and the VA collaborate across missions

Medical students and trainees rotate to the VA and gain practical skills as well as first-hand knowledge of the health care needs of veterans. Researchers work together across multiple scientific areas, including behavioral neuroscience, neurology, otolaryngology and many others. More than 200 VA physicians and scientists hold joint appointments in School of Medicine departments.

One area of collaboration is Parkinson's disease research. Charles Meshul, Ph.D., research scientist, VA Portland Health Care System, said he's published multiple papers with OHSU scientists, resulting in "a win-win situation for both sides," and noted how interaction between the VA Parkinson's Disease Research, Education and Clinical Centers (PADRECC) and the OHSU Parkinson's Disease and Movement Disorder Program has led to expansion of clinical services related to Parkinson's disease.

"Carrying out research at the VA is absolutely wonderful. We have a very supportive VA research service, headed by Drs. Michael Davey and Archie Bouwer," said Dr. Meshul, who is also professor of behavioral neuroscience in the OHSU School of Medicine. "Having been at the VA for over 32 years, I can't think of a better job or a better place to carry out my research on Parkinson's disease." 

The close proximity of the two organizations also leads to a more robust clinical mission.

Civilian lessons

Grace Chien, M.D., a staff anesthesiologist at the VA Portland Health Care System, has witnessed how the connection between the VA and academic medicine serves veterans in her 28 years of federal service, including one year in postgraduate training. "I believe veterans across Oregon, Southwest Washington, VISN20 [the VA's Northwest network] and beyond, benefit from our facility's success in large part due to the partnership between OHSU and VA Portland Health Care System," she said.

Yet Dr. Chien calls the lessons learned as a civilian working in the VA the most important opportunity of all.

"Veterans are very special people because they have made sacrifices on behalf of our country," said Dr. Chien, who is also professor of anesthesiology and perioperative medicine in the OHSU School of Medicine. Being at the VA allows me to "remember that working in health care in general involves sacrifice and a focus on service, and to carry forward these lessons both professionally and personally."

Evan Foulke brings a unique perspective to patient care at the VA. In addition to being a second-year medical student, he was a Green Beret medical sergeant with the U.S. Army Special Forces and goes to the VA for primary care.

"It is interesting to participate in a provider-patient encounter as both a student/provider and as the patient," Foulke said. "It provides a lot of insight into what we talk about in classes about communication and treating patients with respect. Personally, I love working with veterans and consider it a great honor to have the opportunity to work with them."

Shared appreciation

Many veterans share that sense of appreciation.

Jim Nicholas served from 1958 to 1961 as a military policeman in Berlin, investigating traffic accidents that involved American servicemen in all four sectors of that then-divided city.

He traveled from Hubbard on Wednesday with his wife, Dolores Nicholas, to see about a painful condition in his right arm. He was impressed by his provider who fashioned a temporary plastic splint on the spot that was already easing his pain.

Nicholas said he values the partnership between the VA and OHSU because of the exchange of technology and resources across the two institutions. And even though he's not necessarily feeling his best when he comes to the VA, the experience is almost always pleasant.

"People here are so good and gracious," he said, while waiting for an X-ray. "They've just been darn good at working with me."

Pictured (top to bottom):

• Jim and Dolores Nicholas
• On a recent day, a rainbow appeared to drop into the VA Portland Hospital
  
• Dr. Grace Chien
• Evan Foulke, second-year M.D. student