The Guardian speaks with Buyannemekh Tsogtbaator, a student veteran who received disappointing healthcare services at the VA Hospital over a dragged-out period of six months and three surgeries.

Starting anew in college is difficult enough for most students, but add to that the stress of transitioning to civilian life, and the equation shifts quite a bit. Campus resources specifically catering to student veterans at UC San Diego include the Veterans Affairs Hospital and Student Veterans Resource Center (SVRC), but seemingly, they aren’t enough.

The Guardian sat down with John Muir College junior Buyannemekh Tsogtbaator (who goes by Nemekh), to discuss his recent ordeal at the VA Hospital. Nemekh, a transfer student, described the surgeries for his torn pectoral muscle injury — a painfully protracted process that has dragged on from May to December, and even then remains unresolved.

“Even though I have UC [Student Health Insurance Plan], I figured I’d go to the VA because I don’t have to pay the co-pay. It took about a month to actually see them, almost a month, three weeks,” said Nemekh. When the surgery was finally performed in late June, Nemekh was in a sling for eight weeks, and then during physical therapy, everything was healing well. However, he had to return to the hospital after the area had become infected.

“I started to experience a lot of pain, tightness, and swelling around the area,” Nemekh explained. “Eventually, the swelling got to the point where the tissue around the surgery site got soft and then busted open.”

After initially denying that this was an infection at all, the surgeon and physician assistant went further to dispute the possibility that Nemekh had caught the infection from the hospital itself, and actually blamed Nemekh for causing it.

“They told me, it’s one of those things where [I] irritated [my] shoulder through the physical therapy or I actually lifted weights. That’s what they told me,” said Nemekh incredulously. “And I hadn’t lifted any weights by then!”

This blame was further insinuated when the hospital told him to let it close on its own by not using his left arm or shoulder. “And I didn’t. It didn’t go away. I came back a week and a half later.”

“She [had] heard the horror stories; it’s not a secret for the VA to do stuff like this,” Nemekh told the UCSD Guardian.

Nemekh was prescribed antibiotics. When that did not work, he was given a stronger one, which was ineffective yet again. The whole time, he had only seen the PA, and the surgeon hadn’t even done a proper physical evaluation.

“He just looked at it and said, ‘OK. Try these antibiotics. See where it gets you,’” said Nemekh. “For me, I didn’t like that. How can you just throw a bunch of antibiotics at me, thinking that it will just go away on its own?” After almost a month of constantly coming back to the hospital and arguing with the doctor about the nature of the infection, he insisted on getting a culture done, but even that hadn’t helped.

“No improvements. I got this big gaping hole in my shoulder now,” said Nemekh. After waiting for three weeks for lab results, the hospital still did not know the cause, and suggested another surgery to figure it out. At that point, it was November, and right in the middle of Week 8 midterms. This made the decision even harder and more confusing for Nemekh to take, the balance being even more skewed than usual for student veterans. So he decided to hold off. “Finals [were] coming up. I would have to drop all my classes and pay the VA back the money I received for my school benefits.”

Eventually, Nemekh decided to take another route and see someone from Student Health Services (SHS). The doctor and nurse practitioner were immediately helpful and figured out the cause of the infection to be due to some anaerobic bacteria. Unfortunately, the antibiotics they prescribed were a disappointment once again, and the VA kept insisting on surgery. Then, Nemekh tried, with the help of the doctor at SHS, to get an appointment through UC SHIP at UCSD’s orthopedic department, but after endless postponing and excuses on their part, even that track did not work.

“They kept saying, ‘We don’t want to take responsibility for your current condition because initial surgery was done by the VA,’” explained Nemekh. “I was kinda taken aback by it because I have health insurance with UC SHIP. I should at least be able to get an appointment with ortho and get their opinion on what’s happening with my health.”

At the end of November, with an open wound that was still draining, another MRI at the VA Hospital brought concerns of a bone infection and the necessity of another surgery had increased, so it was scheduled in December — during finals week. Fortunately, Nemekh had understanding professors that quarter. “I had to miss two finals, but my physiology and political science professors were super cool about it and worked it out with me.”

But even then, shockingly, the ordeal was not over. After waking up from anesthesia, the doctors neglected to give Nemekh any follow-up instructions, and performed a shabby follow-up procedure a week later. Two weeks later, Nemekh found a suture poking out of his wound.

“I was like, ‘What the hell? Why is it left there?’” related Nemekh. “The next day, I [saw another] one sticking out. I was like, ‘what?’ so I tried to pull it out. I couldn’t pull it out because it was snagging on something in there.”

As the week progressed, he started noticing multiple areas where non-dissolvable sutures had just been left in there. Unsurprisingly, the VA Hospital brushed it off, telling him, “We don’t know [the reason]. As long as it’s not causing any problems right now, leave it in there.” And that’s the situation he is still in today, after almost three drawn-out surgeries, with a wound that is still not perfectly healed.

“My biggest gripe with VA would be how they handled the infection after the surgery. Incompetence on their PA’s part and instructions I’ve gotten from my surgeon,” said Nemekh.

The stress that this situation placed on Nemekh, one that was easily six months long, is unfair on the part of UCSD’s orthopedic department and especially the VA. Being pre-med at UCSD is an especially difficult path, considering the competition and top grades it requires, and to deal with so much pain and difficulty while taking upper-division exams at the same time was no easy feat.

“It really set me back academically because I could have been using that time to study for my classes or doing something other than sitting at the VA for an hour or two to been seen for my appointment.” And even then, the appointments were never taken at the scheduled time, and neither was the responsibility for the delay. “Their response was, ‘We have a lot of patients.’ Well, OK,” said Nemekh sarcastically. “I guess I don’t have anything better to than this.”

Along with the couple of health care professionals that did try to help him, Nemekh also credits the Student Veterans Resource Center at UCSD (SVRC). When he had to make the difficult decision of taking a quarter off to deal with the injury, the coordinator at SVRC advised him to stay in my classes, a decision he is grateful for being encouraged to take. “[In the end], I had actually had gotten through all my classes and took all my finals and everything worked out.” The coordinator, however, was not completely surprised by Nemekh’s experiences.

“She [had] heard the horror stories; it’s not a secret for the VA to do stuff like this,” Nemekh told the UCSD Guardian.

One of his friends had gotten an MRSA infection after surgery for her foot at the VA, due to a bone infection, and had to stay two weeks on antibiotics after the surgery. Nemekh also met an elderly gentleman who had a surgery around the same time and had gotten an infection that wasn’t resolved until three months after June. “He actually ended up getting sepsis, full on sepsis, and had to stay in ICU,” said Nemekh.

Still, he credits UCSD for the help he got from the SVRC while transferring, and the other student veterans he met there and formed study groups with.

“Yeah, it was a big change. Academically, it was challenging in the beginning. But we’re used to committing time into things we want to do, being a veteran. Working hard is not a problem. In the beginning, it was hard to actually know which resources are available to you, especially like tutoring centers, office hours, discussion sections, and things like that.”

Nemekh’s ‘work-hard’ mindset certainly derives from his training from being in the Marines, but so does his desire to be a doctor. “I was a combat medic. I worked with a lot of physicians and physician assistants and I saw how much a difference they were making every single day. I wanted to make that difference too,” declared Nemekh. “I feel that’s one of the unique things I’ve seen that I want to help those people that are in need.”

This admirable goal that Nemekh has, and the aspirations of all other student veterans at UCSD, should be encouraged. With the graduation rates of student veterans already lower on average than civilian students, it is clear that adjusting and dealing with college life after years away from formal education is extremely challenging, and they should get the full benefits of the resources promised. The VA’s behavior disappointed Nemekh, because the priority should be to help a patient, not to be so scared of the consequences and not even try.

“For some reason, the VA was very hesitant on culturing what I had. I almost felt like [they didn’t want to take the blame for the infection], so I didn’t like that. I mean, what’s the point of having UC SHIP if you can’t get your needs met, right?” said Nemekh.

Nemekh hopes that UCSD will increase its awareness of these problems and try to focus on improving the problems.

“I almost felt like UCSD didn’t want to take any part of it. They maybe felt that I could potentially sue them in the long run if something goes wrong. They were basically trying to stay clear of it so that they don’t have to have responsibility.”

Art by David Juarez.