Welcome to the eighth edition of The Fourteener, the official newsletter for the Veterans of VA ECHCS.

We are proud to serve you!

Greetings Veterans – Since our last edition of The Fourteener, we have been through some tough times together. As the world entered into an unprecedented global pandemic in early 2020, we at VA Eastern Colorado Health Care System (VA ECHCS) have been working to navigate a safe path forward while continuing to provide you with seamless access to quality care in a new reality with the coronavirus. Thank you for your collaboration and understanding in recent months. While VA has long been an innovative leader in delivering high-quality virtual care, the pandemic has proved our capability to reach and serve Veterans across Eastern Colorado in rural and mountain communities. Despite these challenging times, we’ve already reached important milestones and victories this year. In June, we opened our brand-new Fisher House that will serve as a home away from home for 16 families while their loved ones receive care on the Rocky Mountain Regional VA Medical Center campus. In July, VA ECHCS was also recognized as ‘Most Improved in Patient Experience’ for Inpatient VA Survey of Healthcare Experiences of Patients (SHEP) scores between Fiscal Year 2019 Quarter 1 (62) and Quarter 4 (76)! Even though COVID-19 has delayed some plans to meet you in person out in the community, I always want to learn how we can serve you better and will gladly share meaningful conversations with you about our way forward with your care. In this issue, you’ll learn about how we’ve adjusted to COVID-19 and how the community has supported us along the way. You’ll read about how we are fulfilling VA’s Fourth Mission and what we are doing to keep you safe when you come to see us. I look forward to meeting you and hearing your story. As we move forward together, please remember to take care of yourselves and loved ones! ~Michael T. Kilmer

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Navigating a pandemic, counting the victories

Without a doubt, 2020 has challenged us all to adapt. We've been faced with an unprecedented global pandemic surrounding the coronavirus, known as COVID-19. Our lives may never be the same, but we carry lessons from the past and count victories along the way.

Air Force Veteran and Pastor Terrance 'Big T' Hughes reunites with his wife, Rachel, on May 6, 2020 after a nearly two-month long stay at the Rocky Mountain Regional VA Medical Center while fighting COVID-19. Hughes was VA ECHCS' first and longest hospitalized COVID patient admitted on March 9, 2020.

Hundreds of nurses, doctors, frontline health care workers, friends, family and supporters lined Wheeling Street outside the Rocky Mountain Regional VA Medical Center (RMR VAMC) on May 6, 2020, in anticipation of Air Force Veteran Rev. Terrance 'Big T' Hughes' release. After being admitted to the medical center on March 9, Hughes spent nearly seven weeks on and off a ventilator while fighting COVID-19. When he was finally wheeled out of RMR, he rose his staff high as the crowd cheered on. The moment shined a light on what everyone was hoping for--a reason to celebrate.

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Challenging times, committed service

By Terri Rorke, Public Affairs Specialist

Staff stand outside Rocky Mountain Regional VA Medical Center on May 6, 2020 in anticipation of Air Force Veteran 'Big T' Hughes' release after a nearly two month-long stay while fighting COVID-19.
'Swab Squad' at Rocky Mountain Regional VA Medical Center

Tough times, tough team

Since the beginning days of the pandemic, VA Eastern Colorado Health Care System team members rose to the occasion of meeting a variety of challenges.

The COVID-19 drive-thru testing site at PFC Floyd K. Lindstrom VA Clinic in Colorado Springs (pictured on cover) was one of the first VA clinics in the country to set up a testing site and has served as a model for other VA's to learn from.

During the height of the pandemic between March and May, the Rocky Mountain Regional VA Medical Center (RMR VAMC) also activated a mobile 'Swab Squad' (pictured above) and a drive-thru testing site at both the Emergency Department and outside the north entrance of RMR VAMC to serve our Veterans.

We've made several adjustments to our operations and set up a variety of safeguards to protect our Veterans and staff.

We set up a variety of safeguards at all VA Eastern Colorado Health Care System sites of care to protect our Veterans and staff.

Veterans, if you come to see us for a medically necessary appointment or for urgent and emergent needs, you’ll find that we've implemented a variety of safeguards throughout our medical center, emergency room and clinics to keep you safe during your visit:

- Plexiglass guards installed at information desks

- Hand sanitizer stations available throughout facilities

- Frequent cleaning and sanitizing methods throughout facilities

- Physical distancing cues in waiting areas and elevators

- Respaced chairs and tables in waiting rooms and at the Canteen to ensure physical distancing

To keep you and our staff safe, we maintain mandatory screening upon entry and ask for all persons to wear a provided earloop procedure mask (surgical mask) for the duration of your visit.

While you always have the option to connect with your provider through virtual and phone visits, please do not delay care if you are in medical need. We are here for you.

Adjusting to COVID-19 Operations

By Brandy Morrison, Public Affairs Officer

When the entire world is facing a global pandemic, life changes. Some changes are gradual and go unnoticed while others happen rapidly. The Rocky Mountain Regional (RMR) VA Medical Center has made life-changing modifications to their Emergency Department (ED) operations.

On April 3, 2020, RMR stood up a drive-thru ED triage and acuity level routing processes. Before a Veteran ever steps foot into the facility, they are met by a nurse in personal protective equipment (PPE) and triaged from their car. Today, that nurse was Eliza Russell, an 18-year veteran of nursing who has been on the front lines of the RMR ED.

As a key contributor to the development and implementation of the new ED routing process at the time, Russell stressed the importance of those measures, by stating, “We need to keep respiratory symptoms separated so that we are not unintentionally infecting people with COVID.” From the point of triage, Veteran patients can get routed through one of three ways; COVID-19 testing, drive-thru ED triage for acuity levels 3, 4 or 5, or the Emergency Department.

Mark Phillips, ED Chief Nurse, expressed how impressed he was with his team that took this idea and brought it to life, sharing that this operation “eases tension in the ED.” Phillips echoed the sentiments of Russell in the overall need for this process stating, “This helps eliminate our people walking into an area with COVID-19 and reduces their exposure.”

When asked to describe the team of nurses and providers through the set up and implementation of the new emergent care process, Russell said, “In one word, solidarity.” She did not pause or hesitate, she was instead definitive and direct, “solidarity.” RMR has a team of true professionals who have united with a common interest – to keep each other safe and keep our Veterans safe.

Safety is the goal here—to mitigate and minimize risk to both Veterans and staff. VA Eastern Colorado Health Care System (ECHCS) has taken many steps to safeguard both of these populations. During the early months of the pandemic, ECHCS canceled all non-emergent surgical and procedural cases, closed down many face-to-face outpatient sites of care and has implemented screening protocols for COVID-19 symptoms for all staff and patients.

Solidarity has stretched across the health care system as Licensed Independent Practitioners (LIP) and nurses were realigned to assist with the surge. Melissa Munkwitz, an Orthopedic Physician Assistant, who supported the drive-thru ED triage as a treating LIP said, “This is awesome … We are doing this for the organization and the Veterans. This is teamwork.”

Tyree Morrison, a home-based Primary Care Nurse Practitioner who usually supports the Pueblo region during normal operations, went to Aurora to work side-by-side with Munkwitz. Morrison said, “This (pointing at the drive-thru operations) is how we do COVID responsibly.”

Since ECHCS had their first COVID-19 patient on March 9, 2020, they watched as the acuity level of their COVID patients increased. This is no longer a travel concern but is based on community spread. In Colorado, the COVID pandemic was projected to surge between April 17 and April 20 and VA ECHCS took every necessary step to be ahead of the surge.

If you are a VA ECHCS patient in need of urgent or emergent care, please be patient and kind as this has not been our normal operations. Every change that has been put in place is there for the safety of the community.

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Furry employee offers comfort during COVID

By Khristie Barker, Public Affairs Specialist

Tootsie, VA ECHCS Facility dog

One thing is certain, during the COVID-19 pandemic, the Rocky Mountain Regional VA Medical Center looks vastly different. There are no groups of Veterans sharing stories, the waiting rooms are empty, tents are set up outside for various triage stations and much of our staff were temporarily reassigned to the labor pool to assist with the impending battle. Through all of these changes, one thing has remained the same. Tootsie, the facility therapy dog, is still making her rounds with her handler, Clinical Psychologist Dr. Elizabeth Holman.

As freezing rain turned to snow on a blistering cold Colorado day, a call came into the Critical Incident Response Team (CIRT) from Dr. Javier Perez, Emergency Department (ED) Chief. Perez’s team had been outside in the elements, testing Veterans for COVID-19. They were cold, tired and needed an uplifting moment.

The CIRT team consists of three psychologists, a chaplain and Tootsie, who when needed, always answer the call.

On this particular day, they ventured off to the ED to offer whatever support they could. During a time when we are instructed to keep our physical distance, Tootsie shows us “how hungry people are for touch right now, for contact. Being with Tootsie allows people a moment of joy in a day of stress and a time that is really scary,” said Dr. Holman.

VA Eastern Colorado Health Care System was the first VA to have an acute inpatient therapy dog. Tootsie, our second therapy dog, takes her job very seriously by offering warmth and comfort to all who come in contact. Dr. Holman stated, “when we are with animals, we are in our hearts. In this setting and time, we guard our hearts and Tootsie gives us a chance to connect with the sweetness that’s inside of them.”

So, what are Tootsie’s plans as we ride out this health care crisis? As long as she can continue to support the employees, she will be available to staff. In her time off, she looks forward to lots of walks and a few playdates (with physical distancing in mind, of course) to make sure she isn’t over stressed and her batteries are recharged.

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VA Police salute health care heroes in procession

By Terri Rorke, Public Affairs Specialist

"... we wanted to use this small gesture to say thank you to everyone working in the emergency departments and wards. Each and every one of them are heroes.” - VA ECHCS Police Chief Daniel Clark (photos by Scott Arnold, SRA).

As a show of support for front line health care heroes in the community fighting COVID-19, police officers from the VA Eastern Colorado Health Care System (VA ECHCS) at the Rocky Mountain Regional (RMR) VA Medical Center joined area police and fire departments and other law enforcement officials in a procession around the University of Colorado Anschutz Medical Campus.

The motorcade was organized by University of Colorado Police Department as a way to salute hospital staff, displaying lights and sirens that could be seen and heard from the windows of all three hospitals. One helicopter crew from Children’s Hospital Colorado flew multiple laps around the campus, showcasing their appreciation for our health care workers.

"From the blue line and the red line to the front line, the men and women of the VA police, CU police, Aurora police and Aurora Fire Department salute all of you."

As the motorcade approached RMR, VA police announced from their vehicles, “From the blue line and the red line to the front line, the men and women of the VA police, CU police, Aurora police and Aurora Fire Department salute all of you. Thank you to all of our medical staff during this COVID pandemic who are treating our Veterans.”

VA ECHCS Police Chief Daniel Clark, officers Loren Will, William Kain and Kriss Espedal participated in the procession.

When asked about the April 23 event, Clark said his team was honored to participate in an outward display of gratitude and support for medical staff who are “truly fighting on the front lines with a rapidly changing environment.”

“It is far too often we see processions to honor fallen first responders,” Clark added. “For the first time in our generation, we are faced with a pandemic event that has brought clarity to our lines and we wanted to use this small gesture to say thank you to everyone working in the emergency departments and wards. Each and every one of them are heroes.”

VA ECHCS would like to thank our Anschutz partners for organizing this event honoring all the health care workers.

Community members lined the Aurora medical campuses in support of area first responders saluting local health care heroes on April 23, 2020.

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RMR VA hosts community blood drives

By Terri Rorke, Public Affairs Specialist

To help fight the nationwide shortage of blood caused by COVID-19, VA employees have been donating blood to help their neighbors today. Together we can make a difference.

With thousands of canceled blood drives across the country in recent months due to the coronavirus disease known as COVID-19, VA Eastern Colorado Health Care System (ECHCS) has partnered with community blood center, Vitalant, to host blood drives at the Rocky Mountain Regional (RMR) VA Medical Center in Aurora.

On May 20, 2020, the medical center’s first blood drive during the pandemic was coordinated by the ECHCS Emergency Management team as a pilot event to assess donor response and to accommodate the facility’s limited visitor policy. The blood drive was a success, resulting in all 46 appointment slots filled—28 of those were first time donors. This drive alone will go on to help 138 patients, according to Michelle Lowry from Vitalant.

“By taking an hour out of your day, you will be able to save up to three lives and help out our community and our Veterans.”

“We thoroughly enjoyed our time at [RMR]. Everyone was super friendly and so appreciative of the drive being hosted on site,” Lowry said.

Like many VA facilities across the country, ECHCS is leveraging community resources that stem the shortage of vital blood and blood products. These blood drives exercise VA’s “Fourth Mission” that provide back-up health services to the nation in times of disaster. This joint effort helps VA and the community better prepare for and support Veterans who may need blood or blood products in the near term.

“This partnership with Vitalant is so important right now. Especially with all the current events, blood supply is critically low,” said Eva Gergely, ECHCS Voluntary Services Chief. “By taking an hour out of your day, you will be able to save up to three lives and help out our community and our Veterans.”

ECHCS Voluntary Services plans to coordinate regular blood drives at RMR in the future. To schedule, visit Vitalant's website at https://donors.vitalant.org or call 303.363.2300. RMR Site Code is ‘5720.’

* Courtney Graham with VA ECHCS Voluntary Services (left) donates blood at the facility's first blood drive during the pandemic on May 20, 2020. If you are healthy, giving blood is safe and you can donate even if your community is under a stay-at-home order.

Donated meals fuel health care heroes

By Terri Rorke, Public Affairs Specialist

Community organizations have united in recent months to support both restaurant workers and health care heroes. VA Eastern Colorado Health Care System has received more than 15,000 donated meals to date from local eateries.

It wasn’t long after Colorado Gov. Jared Polis issued a statewide stay-at-home order when VA Eastern Colorado Health Care System (VA ECHCS) received its first bulk meal donation from nearby café, Etai’s, on March 30, 2020. Since then, food began pouring in from countless restaurants and has totaled more than 15,000 meals delivered to date.

While several restaurants have struggled to stay in business recently, essential workers have been challenged to find healthy meals between working long shifts. What used to be a simple trip to the grocery store has quickly become a complicated endeavor to navigate through the coronavirus disease known as COVID-19.

Despite lean times in the community, organizations like Frontline Foods and Feeding Colorado Heroes have united with a variety of vendors to support both restaurant workers and health care heroes. "It has been refreshing to see the community come together during such a difficult time," said Gretchen TeBockhorst, co-founder of Feeding Colorado Heroes.

"The restaurants with which we've partnered were thrilled to support the VA hospital team. Knowing that their nourishing meals were feeding such important people helped to make difficult times a little better," TeBockhorst added. Feeding Colorado Heroes donated 800 meals to VA ECHCS and more than 4,500 in total to the state's health care community.

“This program is such in important piece to fighting this COVID battle; providing these meals has been such a gift to these front line employees so they are able to take care of themselves in order to take care of our Veterans,” according to Eva Gergely, VA ECHCS Voluntary Services Chief.

Gergely and her Voluntary Services team have often been the first point of contact for the delivery of the thousands of meals donated to VA ECHCS recently. On any given day in recent months, you could spot the team, along with Employee Engagement Officer Kristen Luevanos, wheeling carts packed with snacks and treats throughout the Rocky Mountain Regional VA Medical Center (RMR VAMC) or driving to outlying clinics to serve piping hot meals to staff.

Since March, everything from pasta, sandwiches, tacos, salad, donuts and coffee have fueled VA ECHCS essential workers across the medical center and outlying clinics.

“It has been such a delight delivering these meals to the different departments and seeing the faces on the staff,” Gergely added. “Many of them were in aww or disbelief that someone was thinking about them, and so they really appreciated the meals.”

Along with Gergely, several VA ECHCS staff members are excited to now have a list of restaurants they’ve been able to enjoy through these donations so they can pay it forward in the future.

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While many restaurants and businesses are now open, it's still important to follow safe practices when you’re out and about. Remember the "3 Ws": Wear a mask. Wash your hands frequently. Wait 6 feet apart away from others.

The Art of Medicine from an Old Country Doc

By Terri Rorke, Public Affairs Specialist

Before physicians had science, they relied on the art of medicine, which according to Hippocrates consists of three things: the disease, the patient and the physician.

Former Denver VA Outpatient Physician, Dr. Stuart Smith, expanded this concept into a model he calls the Hippocratic Tripod representing the doctor-patient-illness relationship upheld by the Hippocratic Oath, research, practice and teaching. Through this model, Smith shares his message about the meaning of medicine, which he says has everything to do with community and clinical trust.

“I present to the patient, offering whole mind and body,” Smith said. “Medicine is human-to-human care.”

Smith knew he’d one day become a ‘country doctor’ after receiving great care by the one he knew while growing up in a Western Massachusetts town of 400 hundred people.

Years later, Smith deployed to Europe with the U.S. Army during the height of World War II where the experience of caring for the ‘comrade-in-arms’ to his left and his right affirmed his path in life.

When he returned home, Smith went to medical school using his GI Bill benefits and conducted an internship in Meeker, Colorado, where he took care of pioneers and cowboys.

“We all drank from the same river; everyone knew everyone. They taught me how to be a doctor really,” Smith said.

In his 1987 book, Doctor Patient Knows Best, Smith chronicled his time as a small-town doctor in Meeker during the 1960s, sharing how he knew patients as people—“their jobs, future hopes, home and family circumstances, and accepted the fact that these personal matters affect the outcomes of care in ways not always described in textbooks. This is part of care which needs preserving though, and record sharing does it, even in the face of an ever more impersonal technology.”

Smith’s patient-centered practice was affirmed by two of his teachers and friends, the late Dr. Ward Darley of the University of Colorado and Dr. Lawrence Weed of the University of Vermont. Both Darley and Weed laid down important groundwork in the medical field that is still used today in both VA and non-VA health care settings.

Darley and Weed’s work was fundamental during the demobilization of World War II—a time when the country was facing a challenge to care for all the returning servicemembers.

“There were about 1,000 civil service VA career doctors for 100,000 disabled war heroes gaming the Veterans hospitals to the wind sills,” Smith wrote.

On January 3, 1946, President Harry Truman signed a law uniting medical schools with VA hospitals across the nation, forming a pivotal partnership that solved a crisis for returning sick and disabled Veterans and a move that initiated our present federal residency training program for American medical specialists.

As president of the Association of American Medical Colleges, Darley stewarded the surge of student enrollment in the 1950s with the new VA-medical school partnership. Meanwhile Weed introduced a system for organizing patient data and was the first to computerize patient records.

“Because they conceived ways of delivering understandable technology to all patients, these two are among the 20th Century’s most important and perhaps least acclaimed clinicians and teachers,” Smith said.

Today more than 40 different health professions are represented by affiliations with more than 1,800 unique colleges and universities, according to VA: “Whether you receive medical care at a Department of Veterans Affairs (VA) facility or with a private provider, odds are your doctor has trained with VA at some point. In fact, almost 70 percent of United States-trained physicians have received training at a VA medical center or clinic…”

But at 95, Smith believes there’s still more work to do. He continues to share the lessons he’s gathered in research, practice and teaching as he wraps up his latest book called Wives and Mothers Sharing Tools of Primary Care.

When he’s not working on his book, you may find him at Golden VA Outpatient Clinic where he said, “I’m fortunate to be a patient here. I can check on things from time to time.”

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Created with an image by LuAnn Hunt - "This local sheriff took about 30 minutes out of his busy day to donate a pint of blood at the local Red Cross blood drive. One pint of blood will save up to three lives!"