Down East 2013 ©
Photograph Courtesy Togus V.A. Medical Center/Jim Doherty
The first time I drove up the long, tree-lined approach to the Veterans Affairs Medical Center in Augusta — known around Maine by its historical name, Togus — I experienced an odd sense of homecoming, even a sort of nostalgia. Such feelings were, on the face of it, wholly unwarranted: I’d never seen Togus before, seldom taken much interest in veterans’ affairs, and not worn a military uniform for almost twenty years. My visit was, you might say, economically motivated — I’d lost my regular health insurance and signed up online for the V.A. medical plan. Today I was scheduled to meet my new “primary care provider.”
I knew virtually nothing then about the place. I didn’t know that it is the oldest veterans’ facility in the nation, founded in 1866 in the painful aftermath of the Civil War. I didn’t know that the vast complex — more than five hundred acres of mostly pristine woods and wetland — contains a national cemetery, the final resting place of 5,373 veterans of conflicts going back to the War of 1812. I didn’t know that with some 1,050 staffers, it ranks as one of the largest employers in the state, nor that one in twenty adult Mainers is enrolled in its health plan. If I had any preconceived notions about the place at all, they’d been formed by news reports of shrinking V.A. budgets, long waiting lines, and national embarrassments like the Walter Reed Army Medical Center in Washington.
So there I was on a warm late-summer morning, rolling at the prescribed twenty miles per hour (having been warned against speeding up this drive by a fellow vet at the local diner) past an allée of ancient, lichen-covered pines, across a well-behaved creek, and into the open, immaculately tended main grounds. That’s when the sense of homecoming hit me.
Togus staffers refer to their sprawling facility as the “campus,” but it felt to me more like the Base. Not any particular base, rather, an archetypal one — a large military complex that has stood long enough for its specimen trees to loom tall above the closely shorn grass, for its oft-repainted buildings to acquire a spruced-up
gentility, for its flag to be hoisted so many times up the pole (set here among weathered boulders near a small pond) that a mere glimpse of it, waving against the blue sky, triggers a Joplin-esque mental soundtrack. Cumulatively — as any former service member can attest — these things make you feel you’re on familiar turf. The institutional buildings around you take on a benign character. You are enfolded in a well-ordered world where your needs have been foreseen and will be attended to.
Okay, maybe some of that was just a mood. But I’ve since made the drive out to Togus dozens of times, under changing circumstances, at all seasons of the year, and this distinct sense of being welcomed and cared-for has never dissipated.
As to my experience that first day, I can distill it to this: My primary care person was a cheerful young woman who likes to be called Bethany. She is married to a jazz pianist and competed hard to get this job. Over the next couple of hours, I repeated the last four digits of my social security number roughly one thousand times. I walked a great distance down secret hallways that connect everything to everything else. All the people I met seemed friendly. There would be follow-up consultations with specialists elsewhere on campus. I was in the system now. But I still had a lot to learn.
Now, here is the main thing to know about Togus: It is not now, nor has it ever been, quite what you would expect. I mean for better or worse — and the place has seen plenty of both.
Just for starters: There it sits, a huge and sophisticated medical complex occupying nearly a square mile of real estate within the city limits of the state capital. Yet for most people zooming by on Route 17, it is a total mystery, completely hidden from the road and indeed from the outside world. And this is no accident — Togus was meant from the start to be a tranquil, secluded place, a world unto itself, because in its earliest incarnation it was a private health resort.
One Horace Beals of Rockland, a successful granite merchant, bought the property in the late 1850s, spending some two hundred thousand dollars of his personal fortune on a hotel, a bath house, riding stables, a racetrack, a bowling alley, and other amenities, roughly along the lines of then-fashionable Saratoga Springs. Beals called it Togus Springs, a name derived (according to the official history) from a Native American word, worromongtogus, meaning mineral water.
History intervened: the Civil War broke out and Beals went bankrupt. The government acquired the property in 1865 for the bargain price of fifty thousand dollars and transformed it into the Eastern Branch of the National Home for Disabled Volunteer Soldiers. (Thus began a tradition of awkward official names for Togus that continues to the present day.) The new Home welcomed its first veteran in November of 1866, nosing out by a few months both the Western Branch in Milwaukee and the Central Branch in Dayton. It expanded rapidly, and, by 1870, housed some three thousand veterans, many of them badly injured. Patients wore army-style uniforms and lived mostly in barracks. There was a hundred-bed hospital, but medical services were of the most rudimentary sort. The atmosphere cannot, I suspect, have been very cheerful.
And yet the grounds were still lovely, as they remain today. Electric trolley service from Augusta proper was established in 1890, and Togus became a popular destination for weekend excursions. It boasted regular band concerts, a hotel, a theater, and even a small zoo.
The national cemetery, on the western end of the property, took shape at about the same time. Major Cutler, then Togus’ chief, conceived and directed the project, but the actual work was done almost entirely by the “inmates” themselves, including a former marble worker who designed the original Memorial Monument in 1889. In true Maine fashion, almost everything connected with the project — design, landscape work, building, and stone-carving — was done on site by the veterans. Headstones came from quarries in Augusta and Hallowell.
The population of veterans was meanwhile changing in character and even in color. Civil War vets were dying off, their places filled by survivors of the Indian Wars and the opening of the West, including Buffalo Soldiers, African-Americans who had served in special units known as the U.S. Colored Troops. To Major Cutler, such matters as skin color, religion, or military rank were neither here nor there. Veterans lived side-by-side in the Home and were buried side-by-side in the cemetery.
Precious little of that earlier Togus can be seen today. The facility fell into disrepair in the early decades of the twentieth century, as budgets dried up and the needs of aging veterans faded from public consciousness. By the 1920s, the situation at Togus and elsewhere had grown dire, as a dilapidated system was overwhelmed by a fresh wave of injured and ailing veterans from the First World War. Slowly the public mood began to change.
The year 1930 marked the start of a decade of radical renewal, sparked by the merger of several small agencies to form the Veterans Administration. This was followed by FDR’s New Deal and its ambitious program of public works. By the eve of World War II, most of the present-day campus at Togus was in place. A veteran whisked forward seventy years from 1939 would have no trouble finding his way around.
We have much to be grateful for in this regard. It’s easy to spend a lot of federal money quickly with shabby results. That didn’t happen at Togus, in large measure because the dominant architectural styles of the day — American modernism in the vein of Frank Lloyd Wright, and what we now call art deco — were quite successful in giving rise to public buildings that are functional, pleasant, gracefully proportioned, and even occasionally beautiful. The major buildings at Togus have none of the dispiriting, soulless character they might have been saddled with had they been built a couple of decades later. Indeed, when you move through the
complex, you’re struck by the unity and harmony of the place — only marred, inevitably, by overflowing parking lots. It impresses you as a triumph of the can-do, in-it-together spirit of the Roosevelt era.
Yet the cold facts of history reveal that this impression is misleading. The impetus to rebuild Togus came principally from Maine Congressman John E. Nelson (Republican), an Augusta native who, in January 1930, three years before Roosevelt, introduced legislation — today we would call it an earmark — to build a new, 250-bed hospital for a cost of $750,000. President Hoover opposed the plan, but Nelson kept pushing, and within months the project gained full congressional approval. Henry Coombs, of Lewiston, was named the lead architect, and the new hospital, soaring a full nine stories, opened in May 1933. Other buildings followed in short order, as Togus was rapidly transformed (as one contemporary account had it) from a “village of wood to a modern city of brick and steel.”
Of course, the story didn’t end there. In a way it repeated itself, two or three times over. The basic narrative has a tidal quality, a seemingly irresistible ebb and flow. Wars are fought and then ended; budgets are raised and then slashed; facilities are improved and then allowed to decay.
At this writing, we’re in a “flow” phase. The V.A. (rechristened the Department of Veterans Affairs) has been bumped up to Cabinet level; its budget rose $7 billion in the last funding cycle; Maine’s own Representative Mike Michaud (Democrat) chairs the House Veterans Affairs Health Subcommittee. So far, $12 million has been spent on facility improvements at Togus, twenty new physicians have been hired, and a satellite center has been opened in Bangor, with more planned elsewhere around the state. Togus Director Brian Stiller, himself a navy vet, has been on the job only about a year-and-a-half but seems like an energetic and personable guy. (If you dial the main switchboard, it’s Stiller himself who greets you on voice mail.) Staff morale, from what I can tell, is good. People seem happy to be working there, and patients seem pleased with the quality of care they’re receiving.
That’s all to the good, because the V.A. is only just starting to feel the impact of Iraq and Afghanistan. About three thousand veterans of those conflicts have enrolled at Togus to date, out of nearly forty thousand vets who regularly use the system. Those numbers are rising, and should continue to rise for many years, but for the time being, they’re more than offset by the number of WWII survivors who are still, so to speak, rolling off. Other limiting factors are in play. Many Iraq War vets are still on active duty, hence getting medical care from their respective services. Others are reservists with health insurance through their civilian employers. And, as with the population at large, younger vets don’t need or use health services to the extent that older people do. For all these reasons, most Togus users are of the Vietnam-era cohort or older. There’s a good-sized contingent from the first Gulf War and a smattering of others — like me — who had the good fortune to serve in peacetime.
Which brings us to a noteworthy point. Togus is no longer, as in its early days, primarily a “Home” for people with crippling, service-related disabilities. (Of the Iraq and Afghan vets, only about 1 percent — thirty-three at last count — suffer serious war-connected injury or illness.) Togus today is a large comprehensive medical center that provides lifelong, full-spectrum, managed care to Mainers who, medically and demographically, look pretty much like their neighbors.
To the extent that it succeeds, it provides a useful and interesting model for the health-care system at large. And a growing number of observers feel it’s succeeding pretty well.
At the risk of pushing anecdotal reporting to an extreme, let me relate one personal experience. I was at Togus a few months ago for a routine appointment in cardiology. That’s in the main building, the one finished in 1933, though from the inside you’d think it was much newer. After the usual round of tests, I had a few questions that the technician couldn’t answer, so the poor woman (a Maine native who’s worked at Togus for many years) made two separate trips to a physician’s office down the hall. She was perfectly cheerful about it, but I felt guilty, so I muttered an apology for making her run all over the place. She smiled at me and said, in the most unaffected way, “Thanks to men like you, I’m a free and happy American.”
Now, that is a rather corny story, I suppose, but it’s not the first time I’ve had a similar experience at Togus — it’s not even the first time this kind of thing has happened to me in cardiology alone. Togus really is a place unto itself. Which brings me all the way back around to that odd feeling I had on that summer morning when I first drove onto the grounds: I felt curiously at home, I felt welcomed, I felt my needs would be attended to.
This is more than just a personal subject, “A Vet’s Own Story.” This is, increasingly, a national subject, or so I
believe it ought to be. We as a nation are grappling with the great question of how to guarantee decent health care for everyone who needs it. The history of the V.A., which begins at Togus, has many things to teach us, good things as well as bad. There are lessons here about how government can do things right — driving a hard bargain for a piece of land, encouraging self-reliance and a spirit of community, doing big things on a not-so-big budget — as well as lessons about how it can screw things up. In the latter category, the chief venial sins are
incompetence, poor planning, and willingness to tolerate decay. The one mortal sin is a failure of compassion.
On the whole, for all its ups and downs, the story of Togus is an affirmative one. It reflects honorably upon our community and upon many individual Mainers. And that’s a good place to go forward from.