By Stephen Spotswood
FRESNO, CALIFORNIA—On the fourth floor of the Fresno VA Medical Center, patients suffering from a wide range of disease and injury converge on the Specialty Clinic. An outpatient surgery clinic, it offers specialty services in anesthesiology, general surgery, thoracic surgery, otorhinolaryngology /ENT, orthopedics, plastic surgery, podiatry, urology and vascular surgery.
Surgical nurse Doca Merdjanoska—recently named the VA Central California Health Care System Nurse of the Year—spends most of her time working with the ENT patients, though she might just as likely be found assisting with injections in the ortho clinic, taking vital signs, changing dressings in the podiatry clinic or providing wound care.
Merdjanoska never expected to find herself at the VA. Her story began on the other side of the world in the Republic of Macedonia in the heart of the Balkans.
“My life path [started] with these warm-hearted people with a vast history,” Merdjanoska explained. “One of the hallmarks of my heritage is to help someone in need, and that was blended into my upbringing as an ultimate value. It all started with a family member that influenced my choice by making me aware of the potential I have to help others.”
Merdjanoska took that guidance and signed up for nursing school in her home country. She spent six months interning at a hospital before being hired at an ENT specialty clinic in Macedonia. She spent three years there before moving to the United States, where she spent another seven years working at an assisted-living facility in Fresno before being hired at VA.
Her background of hospital experience, ENT specialty work and caring for older patients made her a perfect fit for the Fresno VAMC’s outpatient surgery clinic. “As somebody who was new to the healthcare system in the U.S., I was at first apprehensive about my performance. But with the help of a wonderful team, I am where I am today,” she said.
Her department is a nexus where patients with all manner of conditions arrive with a need for diagnostic surgery, such as endoscopies or biopsies, or more-invasive surgical procedures to treat infection, tumors or trauma. Her day starts with a daily meeting where clinic staff discuss current issues and opportunities. Then, nursing assignments are handed out for each specialty area. While the bulk of her day is spent on ENT clinic assignments, she can also be found assisting with biopsies, tending wounds, or removing sutures for any of the patients, regardless of what brought them to the clinic.
“It’s exhausting at times. Slow at times,” she said. “But there is no lack of challenge in rushing patients to unplanned surgery who need immediate attention and figuring things out on the way.”
From the outside, this might look like chaos. The entire hospital might seem that way to an outsider, Merdjanoska noted—a warren of departments and clinics, each concerned with their own patients, their own specialties.
“Yes, it could paint a picture of challenges in communication, management and merit,” she conceded. “But on the contrary, no matter how it looks from the outside it is actually a well-oiled machine. It brings results, and it is always in favor of the patients being treated. Yes, paperwork and administrative procedures are always a chore, but no patient is left behind.”
Those patients are what brings her the most joy in her job. They are also the source of the biggest burden.
“Knowing that somebody is in your care because they have given so much for their country and for society—that never leaves me without admiration. To be able to help somebody that helped make our country as it is and enabled a future for our children is awe-inspiring,” she declared. “The fact that the well-being of the patient is in our hands and that his or her comfort and happiness is now on our shoulders is a major responsibility—the burden to make your patient feel loved and cared for. The question of whether we have done enough is always a challenge for me. We strive not to let them feel like they are being taken for granted no matter who they are or what their condition may be.”
Merdjanoska admitted she’s a success-driven person and said she hopes to earn her RN degree. But at times she says she never wants to leave her current job. “The veterans’ hospital is the pinnacle of my career. And, as the old saying goes, do what you love and you won’t have to work a day in your life.”
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.