I was flat on my back staring in terror at the hall ceiling, like a turtle some malicious child had upended. I couldn’t move my arms or legs. My wife, Nancy, heard me cry out. She came running and saw me floundering at the foot of the stairs, where I had fallen midway through my morning exercises.
“Don’t panic! Don’t panic!” Nancy said in a panicked tone of voice. She frantically dialed 911. In a matter of moments, I heard a siren come to a high-pitched halt outside. Several black-clothed, heavy-booted first responders came stampeding up the stairs to our house. The one in charge leaned over me. His face hovered above mine like a harvest moon.
“Can you hear me?” he bellowed.
“Yes,” I said.
“Good! Don’t move a muscle,” he commanded.
He said something to his partner. She disappeared and returned with what looked like a large valise. I heard it click, a metallic clang, and next thing I knew my head was being screwed in place with what felt like a vice. They placed me on a stretcher. Although I could feel my body tipping from side to side as they navigated the landing and the stairs, my head remained absolutely fixed.
I found myself surprised at how cold the outside air felt. I heard the back of an ambulance open. The stretcher slid inside. Someone got in with me. Someone else slammed the doors shut. All I could hear were noises from a game playing on a cell phone. I remember staring at the ceiling wondering why the lights were so bright.
Such small thoughts for so large an event. I couldn’t focus on the big picture—that here I was, at the age of seventy-eight, a professor of linguistics at MIT, a jazz trombonist, a father and husband who was possibly staring at my very last moments on earth. I thought I might never see Nancy or my children again.
I certainly had no idea that I was about to be plunged into the heart of the nation’s medical industrial system, in which I would experience firsthand the downsides of some of the most highly regarded health care organizations in America, and the wondrous sides of one of the most pilloried, the Veterans Administration.
“Where do you want us to take him?” the driver asked.
“Mass General,” Nancy replied, referring to Harvard Medical School’s teaching hospital, Massachusetts General.
“Good choice,” he said.
The ambulance coasted to a stop, and the rear doors flew open. I was wheeled through to a brightly lit cubicle. Out of the corner of my eye I could see a doctor. I think his name was Liu. He told me he was a spinal cord injury doctor. He used the initials—SCI—and I couldn’t work out what they stood for. I was preoccupied with the wish that someone would put a bullet in my head. Another doctor was asking me a question.
“If you have a heart attack,” he said, “do you want us to try to resuscitate you?”
Why is he picking now to ask such a question?
“If you get pneumonia,” he pressed on, “do you want us to intubate you?”
Then it dawned on me. While I’m still alive, he wants to know how I want to die. My questioner had his reasons. After all, if it turned out that I lived but couldn’t answer questions, then Nancy would be stuck with a vegetable.
I have no recollection of what happened next. I woke up the following day in an intensive care unit. A casually dressed young man wearing no identification was waiting in the room. He introduced himself as Kris Kahle.
“You’re the neurosurgeon everyone genuflects to?” Nancy asked in a surprised voice.
“How old are you?” I asked.
“Thirty-seven,” he said, smiling.
Kris told us that he and his colleagues were debating whether to operate tomorrow or wait. In the end it was decided that I would go under the knife in two days.
I spent thirteen hours in the operating room for two operations. The first lasted nine and a half hours. It seems that for a very long time my spinal column had been abnormally narrowing from a kind of degenerative arthritis known as Forestier’s disease, or DISH (diffuse idiopathic skeletal hyperostosis). The ligaments connecting the cervical vertebrae in my neck were slowly becoming calcified. No one seems to know the exact cause, and there is no cure.
A normal spinal column is about fifteen millimeters in diameter; mine had shrunk to about seven or eight millimeters. In addition, my spine was riddled with bone spurs, and those at the top of the column had hammered my cord like tiny mallets when I fell. Kris Kahle said it was “the crappiest spinal column” he had ever seen.
The first operation involved exposing my spinal column from the base of my skull to about the middle of my shoulder blades. The surgeons shaved away as much as they could of the excess bone that had barnacled it, thereby relieving the pressure on my spinal cord. When they finished, they installed two rods to shore up what they had scaled down.
That the American health system is capable of such high-tech surgery is truly a wonder, and Mass General does it better than just about any hospital in the world. It’s also pretty remarkable that it’s not just the super-rich who have access to such miracles of modern medicine. Even though far too many Americans lack health insurance, most middle-class Americans, including a retired college professor like myself, have insurance that will pay for most of the cost of these procedures.
Yet as the rest of my story illustrates, even though my insurance covered a world-class surgical team at a world-
renowned hospital, it was nowhere near enough to guarantee that I would be able to sidestep a very real risk of being physically and financially ruined by the inadequacies of the American health care system. As it turned out, I was very lucky. I got the safe, coordinated, long-term care I desperately needed after my surgery from just about the last place I would have expected to find it: the VA. For most Americans, unfortunately, that’s just not an option.
My first operation went well, but I acquired an infection as a result of it. This is a big problem in the American health care system. About 150,000 Americans are infected by inpatient surgeries every year, according to the Centers for Disease Control. It’s apparently a bigger problem at Mass General than at other facilities. In 2015—the most recent year for which data is available—the hospital’s rate of surgical site infections was 73 percent worse than the national average.
The infection turned the area around my incision spongy. The surgeons went in to cut out the affected tissue, but then a further complication ensued. During the surgery, they discovered a tear in my meninges—the membrane that separates the skull from the brain. This had resulted in the leakage of cerebrospinal fluid, and the liquid itself had become infected. Had this gone on undetected, my brain would have sunk inside my skull. The tear was located close to bone, which meant that it was going to be very difficult to mend with sutures. After much debate, Kris and his colleagues decided to cover the tear with muscle fiber held in place with glue.
After my first operation at Mass General, a team of doctors—sundry members of the neurosurgical staff, residents, and fellows—streamed into my room every morning. It was comforting to see them all there, gazing down at me, intent on my well-being.
But not all my visitors were so welcome. One day a doctor I didn’t know came into the room, introduced himself, and, without preamble, told me that, while the operation was a success, I would never walk again.
Fuck you, I thought. Aloud, I said, “I’m sorry to hear that.”
“I know it isn’t what you want to hear,” he said in a consoling way. “But it’s best to be realistic in situations like yours.”
I have never understood why he felt the need to be “realistic.” I learned later that the nurse on duty had overheard the conversation and given him hell when he left the room.
While I was at Mass General, I was, for all intents and purposes, paralyzed. I couldn’t feed myself, and for a time I could not eat. I had to be force-fed with a tube that went up into my nose and down into my esophagus. My bladder wasn’t working, so I had to be catheterized. Pushing a foreign object—in this case the plastic tube of the catheter—into my bladder every six hours also creates a serious risk of infection, even if it’s done properly. Data shows that Mass General is 43 percent less likely to infect its patients by this means than the average American hospital—but that statistic didn’t mean I was spared. E. coli bacteria spread through my bladder.
At the time, I had no idea how dire my condition was. Nancy, who kept copious notes, told me later that my caregivers did not expect me to survive the bacterial onslaught I suffered after the first operation. She also told me about the pain I experienced. It was this account that surprised me the most, because I couldn’t recall it later. I spent my days floating in and out of opiate-induced dreams, and being shuttled back and forth between the intensive care unit and a regular room, depending on the state of the two infections. Thirty-three days later, after I finally recovered, the doctors pronounced that I was ready to be moved to Spaulding Rehabilitation Hospital, in Charlestown.
U.S. News & World Report ranks Spaulding as the fifth-best rehab hospital in the nation. Indeed, it is a marvel of modern hospital construction, light and airy, with lots of glass and shiny metal, gleaming floors, and murals of aquamarine abstracts meant to connect the interior with Boston Harbor, just outside. An atrium-like gymnasium with floor-to-ceiling windows contains state-of-the-art body-rebuilding equipment. I have never seen a hospital so invitingly designed.
Unbeknownst to my medical team, or to me, when I entered Spaulding my intestines were riddled with yet another hospital-acquired infection. This time it was Clostridium difficile, more familiarly known as C. diff. More than half a million hospital patients are infected with C. diff each year in the United States, and about 29,000 die within thirty days of initial diagnosis, according to the latest estimates from the Centers for Disease Control and Prevention. The bacterium lives in the gut and, in normal amounts, causes no problems. But when you have to take heavy-duty antibiotics after major surgery, they can knock out all the good bacteria in your gut that normally keep C. diff in check.
C. diff is very contagious and can spread like wildfire in a hospital. A patient is typically prescribed the antibiotic
Flagyl and quarantined for a month. Flagyl usually kills the C. diff bacteria but can also cause side effects, including the growth of a fungus in a condition called thrush. My tongue was coated with a thick milky-white substance that had the consistency of Greek yogurt, and I couldn’t stand the sight of food. I became so sick from my C. diff infection that for three weeks I was just taking up space instead of getting the kind of therapy Spaulding is famous for. I was so weak, I kept falling asleep in the middle of sessions, and I could only receive therapy in my room, using equipment that could be sterilized afterward.
The unfortunate consequence of all this was that by the time I had finally gotten the C. diff and thrush out of me, it was time for Spaulding to look seriously into the question of getting me out of Spaulding.
I had come face-to-face with one of the huge problems at the heart of the U.S. health care system: the “length of stay” issue. Most Americans don’t realize this, but neither Medicare nor most standard private insurance policies will cover the full cost of staying at a rehabilitation unit like Spaulding beyond twenty days, and won’t pay anything at all beyond 100 days. If you deplete your savings or have a very low income, you may meet the means test for Medicaid and find a nursing home that takes Medicaid patients. But quality nursing homes generally do not, and there is no entitlement for long-term support and services provided in the home.
This means that just about anyone of any age who has a need for long-term support and services—whether they’ve broken their back, fractured their hip, or suffered a traumatic brain injury, or have just become too frail or forgetful to manage at home without help—is left to dangle slowly in the wind. At the moment, some twelve million Americans are left dangling—44 percent of them under the age of sixty-five. Approximately half of all Americans age sixty-five and over will need long-term care before they leave this earth, and an estimated one in seven will face medical bills exceeding more than $250,000 for the cost of such care.
I didn’t yet know all that at the time, however. I thought I was basically alone in going through this experience, and my biggest worry was about being a burden to Nancy. I couldn’t see subjecting my wife to a regimen of bowel management for her husband that would turn her from a life partner into a caregiver. Although it was much too early, I began to contemplate drastic measures, like a colostomy bag. I knew virtually nothing about the operation, so when one of the ranking doctors came in, I asked him what he thought of a colostomy. “I think it’s a great idea,” he said unhesitatingly. “Shall I schedule you for an operation now?” He took a step toward the door, taking me by surprise. I had expected him to say something like “Why do you ask?” or “Let’s go over the pros and cons.” Instead, he did that quickstep toward the door.
After he left, I raised the question with two of the nurses who tended me, and both of them were adamant about it being much too early. They said I needed more time to see which way the wind was blowing. They spoke to me the way I had expected the doctor to. This was the moment when I first realized the importance of having a care coordinator. Shouldn’t someone who knew my case be raising questions instead of me?
Meanwhile, because I was so weak and helpless, I had to worry about another reality. Since I could barely move, let alone raise my voice, the call bell attached to my hospital bed was my only connection to the world outside my room. It was a long, beaded, bendable tube that looked a bit like an Indian peace pipe. When I blew into the mouthpiece, it sounded a bell at the nurses’ station. The device was fixed to the side of my bed with a clamp, its mouthpiece positioned close enough to my lips that I could reach it by lifting my head slightly. The problem was that as each night wore on, the pipe would gradually sink toward my chest and fall hopelessly out of reach.
One night around two a.m., I awoke to find my right hand jammed under my chin, the result of muscle spasms that come with spinal cord injuries. My wrist hurt like hell, and, to my horror, I found that the mouthpiece of the pipe had sunk onto my chest. The blanket imprisoned my arms, and I didn’t have the strength to free them, let alone grasp the pipe. I lay in bed for close to an hour, yelping for help, but the nurses’ desk was too far away. Finally, an orderly from the floor below happened by, heard me, and released my hand. The next day, my wife and son reported the incident to the head nurse, and both she and the director of planning appeared in my room, apologized profusely, and assured me that it would never happen again.
But it did, the very next night. This time it was my coccyx that hurt. Nurses typically turned me every two hours during the night to prevent bedsores. But my pain began before the two-hour period had passed. I blew into the pipe, and a nurse came in and started to reposition me. Just then an alarm sounded; someone had gone into cardiac arrest. The nurse ran to help and never came back. The emergency must have driven me out of his mind.
The third night I suffered the same coccyx pain. I blew into my pipe, a night aide showed up, repositioned me, and that was that.
The fourth night, the same pain appeared. I blew into the pipe. A night aide came, and she took the pipe away.
“What do you want?” she asked impatiently.
“Can you reposition me?” I asked. “It’s my coccyx again.”
“No!” she snapped. “You haven’t been lying on your back long enough.”
Without another word, she turned away, switched off the blinking alarm light, and left the room. She left the pipe out of reach.
As a result of my experience, Spaulding instituted hourly night rounds of each room. I welcomed the change, but it drove home the harsh reality of how vulnerable I had become.
Still, the therapy I did receive at Spaulding was excellent. I was exposed to devices that shocked the muscles of my hands into action and stimulated my legs to peddle a bicycle. There was a motorized plank that I was strapped onto, Frankenstein–like. The board slowly tipped me upright to acclimate my blood pressure after almost two months of lying flat. I was taught how to drive a wheelchair, and how to instruct someone to put a Hoyer lift harness around me.
But during the last two weeks of my stay at Spaulding, the focus shifted from rehabilitation to relocation. The level of care I received plummeted like the stock market on Black Monday. No more balancing acts on the mat or electrical stimulation of my immobile hands. No more teetering on tilt tables. Substitute therapists would come into my room and ask me what I felt like doing instead of telling me what I needed to be doing. I had become a lame-duck patient.
Fortunately, one person really came through for me. My case manager, LaChelle Capalla-Chery, who was charged with my relocation, discovered that fifty-two years before my accident I had spent three and a half years on active service in the Air Force during the Vietnam War. I never saw combat. I left the Air Force in 1965 and began a university career as an assistant professor at Brandeis University. By the time I ended up at MIT as head of the Department of Linguistics and Philosophy and then as associate provost, my Air Force career had receded in the rearview mirror.
As it turns out, the West Roxbury campus of the VA Boston Healthcare System has one of the best spinal cord injury rehabilitation centers in the country. And although my injury was not combat related, any vet with a spinal cord injury requiring 24/7 care was immediately moved to the front of the line.
But I still had to prove that I had served, and like a lot of vets I had no idea where my discharge papers were. Nancy discovered that military discharge records are kept in the National Archives, but also learned that requests for paperwork can take much longer than the insurance coverage I had left at Spaulding. She and I immediately thought of David Ferriero, the 10th Archivist of the United States and a good friend. Nancy emailed him on a Thursday, and by the following Monday at three p.m. the relevant documents were in her hands.
So on the morning of my seventy-ninth birthday, July 7, 2014, I took another ambulance ride, strapped into the familiar metal box like a magician’s assistant. I heard an engine start up, and the electronic gurgles of instruments. I was on my way to the West Roxbury VA.
Within a few days of admission I was assigned my primary care physician, Dr. Vidya Jayawardena, and she declared ownership of my rehabilitation. Every Wednesday afternoon I sat in my wheelchair at the head of a horseshoe-shaped table. Dr. Jayawardena would begin with a report on my physical progress. Representatives from each specialty—occupational, physical, and recreational therapists, along with nurses, a social worker, a case manager, and a psychologist—joined us and would describe how I was doing and what I needed to work on. My family was always welcome to attend.
I didn’t know it at the time, but it turned out that these meetings were part of an innovative model the VA uses to coordinate patient care. It centers on so-called patient-aligned care teams, or “PACTs.” All PACT members meet regularly with the patient and his or her family to plan visits, conduct exams, process tests, and do any necessary follow-up care. They collaborate closely to integrate mind and body care in a way that, as I’ve since learned, is seldom found in the U.S. health care system.
The PACT system is very labor intensive compared to how medicine is typically practiced outside the VA. Primary care doctors in the private sector, for example, are responsible for an average of 2,300 patients, and often more. So they must move quickly from patient to patient, with each visit lasting only ten to fifteen minutes. At the VA, by contrast, primary care physicians and their PACT team are responsible for only about half that number of patients. And as studies show, this allows them to provide safer and more effective care.
Dr. Jayawardena was a superb doctor, proactive but careful. If, for instance, I showed the slightest signs of a urinary tract infection—something anyone using a catheter was particularly susceptible to—she immediately prescribed an appropriate antibiotic, but she was always careful not to overdo it. She is not alone at the VA in her attention to patient safety and evidence-based care. According to a recent study published in the Journal of the American Medical Association, VA hospitals outperform non-VA hospitals on six out of nine standard indicators of patient safety, including vastly superior performance in preventing postoperative infections, and do as well on the remaining three indicators.
A few days into my stay at the VA, I was jolted awake at one a.m. by all the lights blazing in my hospital room and people shouting, “What’s your name?” A ninety-three-year-old veteran had been admitted because he had become dehydrated to the point of complete confusion. He was unable to reply, and the nurses and doctors in the room were obviously very worried. It took four days to bring him back. By then he was fully conscious and able to answer questions sensibly—as long as they were shouted at him; apparently he was very hard of hearing. It seems that no one at his private nursing care facility had been making sure he drank enough water. He was sent back as hydrated as a freshly used sponge. The staff was elated, and I could not help but think, There but for the grace of God go I—if I hadn’t qualified for Roxbury.
This kind of focus on the patient was something I noticed when I first came to West Roxbury. There was something ineffable in the air, a sense of solidarity that we were in this together. Staff I didn’t know would nod and smile at me as if they were assigned to my ward. Workmen would thank me for my service. Patients with complete spinal cord injuries who would never walk again often cheered on patients who were struggling to regain some semblance of ambulation. I mentioned this to one of my nurses. She understood immediately. “Once you come into the VA, you are part of our family,” she said. “We never say goodbye.”
Many of my friends were curious about the other patients on my ward—perhaps expecting mostly IED victims from Iraq or Afghanistan. They anticipated political fights about what those wars were really about. That never happened. Everyone—nurses, patients, doctors, therapists—conscientiously avoided the usual taboo topics, religion and politics. In any case, the average age of the population in the ward, at least during my stay there, was somewhere around seventy. My fellow patients’ war was most likely mine, Vietnam, although, again like me, many of them were admitted because of non-service-related accidents.
The VA is unique among U.S. health care providers in that it has nearly a lifetime relationship with its patients. It starts when they leave the military, typically in young adulthood, and often extends to long-term nursing home care near the end of life. This gives the VA an institutional incentive—often missing in the rest of the health care system—to keep its patients well. But it’s more than that. About a third of VA employees are veterans themselves. In my experience, most are strongly motivated by a strong sense of mission, of wanting to give back, as opposed to being in it just to make a living.
The spirit at the VA probably goes a long way toward explaining why the VA does so well in objective measures of quality. Over the last few years, problems at specific VA facilities have been widely publicized, so the public reputation of the VA system has suffered accordingly. Yet study after study continues to show that, as a recent report by the RAND Corporation put it, “the quality of care delivered by VA is generally equal to or better than care delivered in the private sector.” The Journal of the American Medical Association reported that men with heart failure, heart attacks, or pneumonia were less likely to die if treated at a VA hospital than at a non-VA hospital. Research shows the VA exceeding the rest of the U.S. health care system in the treatment of many other specific conditions, including mental illness.
This certainly comports with my personal experience.
On my first day with my physical and occupational therapists I had asked if I could incorporate trombone playing into my therapy. My accident had reduced my lung capacity by 25 percent, and the trombone required me to breathe from my diaphragm and to move my right arm as I pushed the slide of the horn in and out. My therapists thought it was a no-brainer.
A friend loaned me his apple-green pBone, a plastic trombone that has a surprisingly good sound. The biggest advantage for me was its weight, just under two pounds. Even so, it was too heavy. My therapists had to hold the horn on my shoulder while I brought my lips up to the mouthpiece. Those first notes sounded like a Paris taxi rounding the Arc de Triomphe. It was as if I had never played before.
I practiced several times a week. As a kind of reward after I had gone through a regular therapy session, I could play the pBone in the hospital gym. As with everything else, each week I got a little stronger. After a while I was able to hold the horn, even if I could not move the slide.
I also worked every day with my primary physical therapists, Jess and Barbara. On the first day they sat me on the edge of a mat two feet above the floor and told me to plant my feet firmly on the ground and try to balance for one minute. After a few seconds, I would begin to list to one side. Both therapists would grab me before I fell over. This went on for a month, until one day it was as if a switch had flipped inside me. I could balance for as long as I wanted. I could lift my arms off the mat and still stay upright. My therapists could leave to go to the bathroom or the water fountain. My recovery was like that: long periods of nothing followed by something. One morning I surprised myself when I pushed the start button of my electric toothbrush and it began to whir. Watching myself improve felt like watching grass grow.
One March day, Barbara and Jess wrapped a harness around me tethered to the ceiling track, handed me a walker, and told me to walk. The first time it was one step. The second time, twenty-five steps. The third, fifty steps. The fourth, 100 steps. Then, on the last day of June, when I went into the gym for my usual therapy, I pushed my heels into the floor and slowly rose up out of my wheelchair, transferring my hands from the armrests to the walker. No strap connected me to the overhead track, and no safety harness was around my chest. For a brief instant I felt like Wile E. Coyote in a Road Runner cartoon, one where he runs over a cliff and remains suspended in midair until he realizes where he is and then plunges to the desert floor below.
“I’m not tethered,” I said, startled.
Jess was smiling. “I know.”
An important obstacle to walking had been removed. But now I had to learn how to transfer from my wheelchair to my bed and back.
“I don’t think I can do it,” I said, wavering.
“I think you can,” Barbara retorted. “Now stand up.”
That was the major breakthrough toward normalcy. I could move between my bed and my wheelchair or commode on my own. A major obstacle to leaving infancy behind me had been removed. It had taken a year and a half.
As I readied to leave the VA, there were many changes to make, including trading my car in for a wheelchair-accessible van. My ward mate Pete had already been through the drill and referred us to a firm that had a special arrangement with the VA under which we could get the van for a discounted price and the special accessibility equipment I needed for free. We got caught up in red tape when it came time for the VA to pay the dealer; the whole thing was finally straightened out, but it took a toll in needless stress.
The VA combines high-quality care with a bureaucracy that can sometimes infuriate. In another instance, the VA agreed to pay for two superb caregivers to look after me at home—something I could never have gotten from Medicare or from a private insurance plan at a price I could afford. (Standard private health insurance typically does not cover nonmedical expenses beyond short-term rehabilitation care.) Everything was going along swimmingly until one day the head of the home care agency called and said that they had not been paid for three months, and that unless the VA paid them, they would have to discontinue care. They said they had called the requisite person in the VA hierarchy numerous times, but she wasn’t returning their calls. So I called her.
I asked her what I could do to unlock the logjam. She said, “I’m very sorry, but I cannot talk to you about your case.”
“Why not?” I asked.
“It isn’t appropriate,” she snapped. “I have four hundred other cases to deal with. I can’t single you out for special treatment.”
In the end it was resolved. I learned from these experiences that the quality of care the patient received at the VA hospital was directly proportional to the distance between the patient and the hands of the caregiver. As soon as I had to deal with someone who couldn’t pick me out of a lineup, my experience was not always smooth. But, of course, anyone who has ever had to deal with the bureaucracies of private insurance companies is likely to have had many of the same experiences.
I still receive all of my meds and my bed and bathroom supplies as needed. The VA provided me with custom shoes, and maintains the $7,000 wheelchair I was given. It also supplies other necessary equipment, like an overhead hoist, a hospital bed, and walkers. I still go to the VA gym as an outpatient for therapy whenever I need it. My VA doctors see me once a year for a full-scale medical checkup, and whenever a medical problem arises, I can schedule an appointment, be seen at the Spinal Cord Injury Clinic, or go to the hospital’s emergency room. I’ve never had to wait for any of these appointments.
That, too, turns out to be typical, despite all the political grandstanding you may have heard. Although there are some VA facilities where wait times have been a problem, a recent study by the RAND Corporation found that “VA wait times do not seem to be substantially worse than non-VA waits, based on the limited available evidence.”
During the 2016 campaign, Donald Trump repeatedly criticized the VA as “the most corrupt” and promised to outsource much of the care it provides to the private sector. As I write this, his secretary of veterans affairs, David Shulkin, has announced plans to downsize the VA’s workforce in anticipation of the closing of VA hospitals and clinics that he thinks won’t be needed as more and more vets get their care “in the community.”
I’m a linguist, not a health care expert, but I think my personal story should be considered by those making decisions about the future of the VA and of the American health care system generally. If someone were to ask me what my story is really about, I would say that it isn’t just the story of an individual who faced a catastrophe like none other. Nor is it about a remarkable wife and supportive children and the army of caring health care professionals who stood by him in his darkest hour and helped him on the long journey back to normalcy. It is the story of how wrong we all can be in what we think we know about health care, and about just how deeply at risk we all are until the American health care system becomes, like the VA, much more driven by public purpose and less by money.