To Help Keep Veterans Healthy, VA Wants To Hear Their Life Stories

Apr 12, 2016

An initiative at several veterans hospitals adds something new to patients' medical records: their life stories.

The pace of modern medicine can make patients feel like they're little more than a row of symptoms on a check-off list. A new VA program, though, is giving doctors a chance to get to know their patients better.

It's doing that by putting stories about veterans' lives into their medical records for doctors, nurses and therapists to read. It's called "My Life, My Story," and it started at the Department of Veterans Affairs medical center in Madison, Wisconsin. It expanded last year as a pilot program to six more VA medical centers around the country, including the Charles George VA Medical Center in Asheville, N.C.

Now, half a dozen more VA hospitals are planning their own versions.

One of the Asheville patients who participated, Dorothy Managan, 93, of Hendersonville, N.C., already knew the value of taking the time to build relationships between patients and their doctors and nurses.

Dorothy Managan, 93, served as an Army nurse in Tacoma, Wa. after World War II. She recently added her life story to her medical record at the Asheville, N.C. VA Medical Center.
Credit Jay Price / American Homefront

Managan was chief nurse on a hospital ward at Fort Lewis in Tacoma, Washington when former American POWs began arriving. They had just been released from Japanese prison camps. Some had amputations, were malnourished or had experienced psychological trauma.

"Our nursing instruction was listening and being with them at the bedside," Managan said. "It was a good time for the exchange of sharing some of their concerns, what their family situation was or where they just needed something extra. Someone to listen to them."

But as a civilian nurse after the war, and now as an occasional patient, Managan watched as medicine changed, speeded up, and lost much of that personal connection with the patients.

"There's so much more paperwork that seems to be going on," Managan said. "I mean, we had records to keep and all of that. But you did that afterwards."

"Our profession has lost its soul"

Now, Managan's doctors at the Asheville VA are trying to at least partly restore that personal connection … by listening to those stories from 70 years ago.

Melanie McConnell, a former Associated Press reporter, interviews veterans, writes up their stories, and puts them in their medical records. The veterans also get copies.

The idea comes from a growing movement called "narrative medicine." It's part of efforts by the VA - in the wake of its wait-time scandal - to pay more attention to what patients want and need.

"It's part of a larger VA initiative to enhance person-centered care, and try to bring relationships back more to the forefront than they historically have been." said Dr. Bruce Kelly, who oversees the story program at the Asheville VA.

"I think among those of us, especially those of us who have been around for a while, I think you'd find very little disagreement that our profession has lost its soul," he said. "And I think the big reason for that is I think we've really lost the sense of how important relationships are."

As an example, Kelly mentioned one of his patients who is a Korean War veteran.

"He is actually is a very quiet man, very unassuming, and he was wounded four times in the span of three months," Kelly said. "He had never mentioned that to me despite having had several opportunities."

Often, he said, older veterans come in with several immediate medical problems that need to be addressed and are focused on that.

"They want those taken care of in the time that we have, and there doesn't tend to be a lot of time left for them to really tell us about what their experiences have been," Kelly said. "This is a way to try to recapture it."

Thor Ringler, the project's writer at the Madison VA, helped pioneer the program. He said the medical benefit is an "increased sense of connection" between patients and doctors.

"That definitely yields a different kind of relationship with your provider, a more trusting relationship," he said. "And I would say I think that's more likely to result in better care."

Now Ringler helps other VA hospitals plan versions of the program that work for them.

"We work closely with sites that are thinking about implementing it or are in the midst of implementing it and try to work with them to come up with a model that suits their site best and suits their population and what they're interested in using the program for," Ringer said.

Stories of war ... and life

The participating hospitals approach the project differently. Some, like Asheville, hire professional writers.

Edwin Cottrell holds an illustration of the fighter plane he flew in World War II.
Credit Jay Price / WUNC

Others rely on volunteers or a mix. And several are focusing on different kinds patients, at least initially. One hospital in New York City is collecting the stories of women veterans. Others target inpatients.

The Asheville VA decided to focus on the remaining World War II vets. The idea, said Kelly, was to get their stories before it was too late.

Stories like Edwin Cottrell's.

Cottrell, a genteel former college professor and golf coach, also lives in Hendersonville. In World War II, he piloted a P47-Thunderbolt fighter for 65 missions over Europe.

The central war tale in his medical records wasn't about glory and victory, but an act of mercy:

"As we came up off the deck and as we were starting to climb to gain altitude, a [ME] 109 [German fighter plane] came in from the right, shooting at my commander. I yelled to him, and then I turned toward the 109 who turned toward me and I saw the 20 millimeter canon blink, and the next thing I knew I heard a big explosion. I was hit where my wing joined the fuselage and knocked out eight cylinders, which I found out later; I didn't know how many at the time. The plane still flew, but I thought I was going to have to bail out. I told my squadron commander I was hit and he said to head west, so I started heading toward the bomb line. About three or four minutes out, the fighting was still going on and I looked out to my right and there was an ME 109. I looked to my left and there was an ME 109. They crisscrossed behind me, throttled back, came up and escorted me on to the bomb line. I had all this black smoke coming out and oil all over my plane. We got to the bomb line and they saluted me, and then they peeled off and went back to Germany. I continued on to my airfield, A-92, and as my wheels touched down, the engine froze, so I coasted in. I wish I could have met them or got to know them and thank them. People ask me what I would have done in that situation, and I say, well, I don't think I would ever shoot somebody down that's crippled. I don't think I would take advantage of a crippled plane. That's just the upbringing that I had."

Some of the World War II veterans talk about combat, some don't. But the point, McConnell said, isn't so much war stories, as it is capturing the things that helped shape their lives and their health, mental and physical.

That can mean stories like Managan's, about receiving second-hand the horrors of being a prisoner of war. It's clear that at least some of the stories have led to changes that improved patients' lives.

"When they're talking to me, they will tell me things they don't tell their primary care physicians," McConnell said. "I had one man who had been in the Marines and he had gone blind, and he's an artist. And he was sitting with his wife and she says to me that he's looking for more reasons to live."

The veteran was depressed because he couldn't do the thing - art - that once made him happy. So she hooked him up with with the VA's voluntary services.

"I said, 'Well, you need to be volunteering here," McConnell said.  "He has this great background and other things that I thought would benefit him and the VA."

"Thank you" notes from 70 years ago

There haven't been deep studies into the effects of the program, but Ringler says there are enough stories now - nearly a thousand at his hospital alone - that the project has begun planning research into outcomes. Research elsewhere has shown that narrative medicine can reduce stress, strengthen immune response, and improve health in other ways.

That's something the patients and caregivers 70 years ago at Fort Lewis seemed to understand. Even without research.

Dorothy Managan still keeps a collection of notes from patients she cared for at Fort Lewis after World War II. Some are written with crayons because that's all the patients had.
Credit Jay Price / WUNC

In her retirement-center apartment, Managan keeps a collection of hand-written notes from a group of shattered troops whom she helped heal as an Army nurse just after World War II.

When former POWs were about to transferred to hospitals closer to their homes, many would write the nurses thank you notes, and even poems. Often all they had were crayons and prescription pads for these 1945 versions of patient satisfaction surveys.

"We of the various wards, especially number 22, are very grateful and appreciative," says one note that Managan kept. "It really makes us feel as if we have come to a new world, or have found a new life full of real beauty and happiness."

Another was scrawled a diagnosis for the nurses: "A broken heart from losing 56 wonderful patients."

And yet another said: "God bless all Army nurses. Take it from men who know, Ward 22."

Hear more of Dorothy Managan's stories of caring for POWs after World War II.

Hear more about the lifelong lessons that Edwin Cottrell learned in combat.