I first walked through the doors of a VA hospital as a brand new intern in 1997, thinking I was there to learn medicine. But what I came to understand — though I would not appreciate it until much later — was that I was really getting a firsthand lesson in American history.
My patients were as different as Americans can be, from what Tom Brokaw has called the “Greatest Generation” to the young men and women recently returned from Iraq and Afghanistan. To provide each of them with committed and comprehensive care, I had to learn about and appreciate the immense diversity of their injuries and experiences.
The VA, or the Department of Veterans Affairs as it is officially known, is the branch of the US government responsible for serving those who have served our nation in the armed forces. In that role, it’s one of the largest health care providers in the nation. Despite all of its challenges, the VA represents our collective commitment to providing the care due to those who have served our nation. It is also a living reflection of our history.
When I started working at the VA, the hospital wards were full of mostly men, and a few women, from the Greatest Generation. They were a cross-section of America of the 1930s and 1940s, carrying themselves with quiet pride and unmatched stoicism. They had served in World War II, storming the beaches of Normandy and fighting in the bloody battles of Iwo Jima. They were welcomed home as heroes and still had pride in their stories of fighting the Nazis, the Japanese, and other Axis forces. As I took care of them, I began to learn firsthand what our country and the world had gone through a half century before.
I left the VA after I finished my residency. I returned in 2004 to find that it had changed. Across the country, veterans of World War II and the Korean War were dying at the rate of nearly 1,000 a day. By the mid-2000s, the hospital wards were filled with men and (now more often) women of the Vietnam era. Their stories of service shared many elements with those of the Greatest Generation. But something was different — their wounds of war were more evident, and medical recognition of trauma was growing.
Like the Greatest Generation, Vietnam veterans had answered a call, but from a country ambivalent about the war in Southeast Asia. These men and women returned with similar physical, mental, and emotional wounds, but to a country that often shunned them. Many suffered in solitude, but the effects of their experiences couldn’t be hidden.
While a majority of Vietnam-era veterans returned to their lives and became leaders, for far too many of them the ravages of war showed up decades later as post-traumatic stress disorder and mental health issues. Encountering these veterans in the hospital, I was reminded that their suffering was a direct manifestation of our country’s collective failure to honor its commitment to their care.
A few weeks ago, I was standing in the wards of the VA hospital in West Roxbury, Mass., talking with a young Iraq War veteran about his post-traumatic stress disorder. He was a third-generation Marine, having served in Fallujah where he had lost a friend to a roadside bomb. We talked about his war and the wars of his father and his grandfather.
Today’s generation of veterans looks different from previous ones. There are more women and minorities, mirroring today’s America. And they are more engaged in their care, insisting on greater mental health services and the kind of patient-centered, responsive care that they have earned.
While many Americans think about veterans as a single group, I have learned that each generation of veterans is different: The impact of their service is different, and the way we as a country treat them has shaped them in different ways.
This Veterans Day, I urge everyone to take a moment to remember those we have lost. But let’s also celebrate the veterans who are still with us. They embody important parts of our history, a history accessible to all of us. You can seek it out by volunteering.
In my hometown of Boston, the Home Base program — an initiative by the Boston Red Sox Foundation and Massachusetts General Hospital — helps veterans and their families recover from the “invisible wounds” of war, including traumatic brain injury and post-traumatic stress disorder, by providing world-class care, education, and support. Volunteers can help with the Run to Home Base and other events. There are similar programs across the country.
Or you can simply volunteer at your local VA facility and spend some time giving a little bit back to the men and women who have given us so much. And in the process, you’ll get a history lesson you’d never get from reading a book.
Ashish Jha, MD, is a general internist at the VA, a professor of health policy at the Harvard T.H. Chan School of Public Health, and director of the Harvard Global Health Institute.
