Wednesday, May 21, 2008

Dancing With The Morons

The hospital, when flowing smoothly, is beautiful to watch. The elegance with which teams of doctors, nurses, pharmacists, techs, and other staff work together is something so remarkable, so coordinated, so intricate, that is so closely resembles…a dance. Yes, just as B and C list celebrities have proven time and time again, a well-orchestrated dance is simply magical, especially when you are paired with a half-naked dancing goddess in heels. And just like in those dances, the hospital carries with it a unique array of dances, some dazzling, some romatic, all strangely metro. So please, learn these moves, dazzle your family, friends, and lovers, and just be careful. After all, wouldn’t want you breaking anything, because before you know it you’ll have me dancing around you…and as anyone who was at my bar-mitzvah can attest to, it ain’t pretty.

The Icky Shuffle

With apologies to the original Ickey Shuffle, a fond form of entertainment from my youth, this one is starkly different and, in my opinion, vastly more challenging. Your partner in this case is an ED exam room covered in blood, vomit and feces, all deposited by the charming young alcoholic in the center of the room. You must briskly hop, skip, and jump across these assorted piles of excrement, urine, and lord knows what else, for if you slip that is not only a ten point deduction, but also a memory no amount of showers will wash away.

By the way, those extra blue dots in the corner aren’t just for a hopping sequence involving your left foot – those are just tears. Lots and lots of tears. Lets move on.

The Intern Code Special

For this dance, you (in blue) are the intern on the ICU Code Blue team, paired with a high-powered group of medical professionals. At any moment an overhead page will holler “Code Blue [location]”, repeating over and over again. One second you’re trying to stay awake during noon conference, the next second that voice emerges from the monotony – you, along with the other members of the code team, bolt from your chairs and charge towards the crashing patient at full speed. Hilarity ensues, at your clueless, dumb-ass expense. This may or may not be based on a true story…I’ll let you decide.

The There Is No Way In Hell I’m Getting Anywhere Near That Guy

There is something about drug seeking behavior and body odor that makes for a very intimate, albeit distant tango of passion. And by passion I mean a foulness that would burn the inside of your nose much like the cocaine burning the nose of this guy right now!

The Shadow

Paired with a ballroom trainee (in green), otherwise known as a medical student, watch as she follows your every move. Literally. The only thing more annoying is that Hello Kitty pen she carries with her as she scribbles down every worthless thing you say.

Hey, you. Ya, you. Med student. How about instead of following me into the bathroom you do a literature search on staying away from my balls? Thanks a bunch.

The Eye Pass

The most seductive of dances, this one involves the lowly intern, downtrodden but still yearning for the higher echelons of care, catching the glimpse of the Hot Nurse, she who bestows upon the lucky housestaff an image of perfection behind her oddly form-fitting scrubs. He makes a pass, then walks away, then another pass, and another. He knows she dances for him, that their connection is true. She, on the other hand, knows he’s a douchebag. And one who makes less than she does.

Higher Power

As a medical student during your clinical years, you are generally expected to take a lot of time to get to you’re your patients intimately, to spend long amounts of time with them, to truly know them. After all, on most rotations you are generally only assigned one to three patients at a time, so there is often ample time to give them the attention they, in most cases, deserve. So much of healing seems to revolve around the simple act of sitting down next to a patient at the bedside and listening (although a squirt of antibiotics or a snip of an appendix can help from time to time as well).

Which makes it all the more ironic that perhaps the greatest challenge in the transition from medical student to intern (or resident, or attending for that matter), is that the precious element of time is taken away from you and you have to deal with it without compromising patient care. What started as a 30 minute to one hour encounter progressively shrinks, to the point that at peak efficiency any self-respecting intern can probably limit actual face-time encounters with a patient to less than one minute and still extract enough information (along with the time you spend getting labs, vitals, etc.) to guide the course of therapy and interventions for the day.

I bring this up because over the course of intern year, one thing has become alarmingly clear: namely, that an increasingly large number of patients are distrustful, antagonistic, doubtful, and angry with health care providers. I can rattle off a lengthy list of patient encounters that involved stacks of (often false) information patients printed out from the Internet, the patient angrily shaking the papers in the doctor’s hands when what the doctor says does not agree with whatever crap some quack on the Internet typed up. Then there are patients that repeatedly insist on seeing only specialists and/or attendings even though they know they are at a teaching hospital and have absolutely no choice about whether the putz intern or medical student rounds on them every day (unless the patient happens to be a prince from any number of middle-eastern countries needing a transplant of one organ or another…but that’s for another day). And I think a lot of these encounters can be easily fixed, but the system no longer allows us to spend the time necessary to do so, and as a result this contributes to the declining respect for physicians in our society.

I have not thought much about this until today, because until today I really had nothing to compare it to. However, this afternoon I met a very pleasant and exceedingly tragic young man who is dying from cancer. Stoic and occasionally tearful, he ended up in our hospital after vomiting blood at the airport shortly after arriving from his home country of India on a business trip. My encounter with him was somewhat standard; yet, it was my encounter with his mother, who hopped on the first plane to America upon hearing her son was in the intensive care unit (likely at some obscene financial cost, no less), that was so remarkably unusual. After discussing the case with the patient and his mom, the mother started talking about her concerns regarding his health, repeatedly invoking the notion that God will help her son, that God will cure his cancer, that God will ease his pain. After a few minutes of this monologue, she turned to me and said, “And honestly, we both know that God is too busy to meddle in the day to day health of all the souls on this Earth. That is why you are here…you are the hand of God, to do his bidding…you are God.” She grabbed my hand and repeated, “You are God.”

I smiled, held her hand for a few moments, and after a brief discourse walked outside of the room and took a deep breath. I instantly remember thinking that that had to be one of the most, if not the most, awkward patient encounter I experienced in my budding career, more frustrating than drug addict who called me a “pain medicine Nazi” (just a note to all you pain seekers out there: most things probably don’t rile doctors up, but before you call someone a Nazi, make sure they aren’t Jewish and descendants of Holocaust survivors, because when you say things like that you don’t get your pain medicine…just a tip), more embarrassing than the prostitute that screamed through the halls of the emergency room, “You can’t handle my pussy with your peppercorn dick!” (seriously, how did she know?).

I’ve spent most of the year being reminded by patients of how idiotic I am, how incompetent the hospital staff has become, and how incomprehensible the system shall ever be, and here I am being proclaimed a God so matter-of-factly, so nonchalantly, by someone who held her oncologist from India in the same regard and also does not appear to understand that neither one of us was going to be able to cure anything her unfortunate son had anyways.

At first, after walking back to the resident room, I recall thinking, “Well it’s about damn time someone appreciated what I do all day!” It was so refreshing to be put on that pedestal, because, obviously, there is no other pedestal that quite matches up to the one God is on. But it was only a few moments later that I started feeling extremely uncomfortable. Would a physician prefer the current state of medicine in our society, one rife with distrust, conflict, and frustrations, or would a physician prefer to return to the extremely paternalistic state, one in which the physician was king, immediately trust-worthy, the ultimate arbiter of life and death?

At first the answer may seem obvious to those of us currently operating under the current mode of existence. Frankly, the next time a patient comes in with a stack of information printed out from some quack website, questioning my every move and shoving those pieces of paper in my face, I may simply say, “Fine, if you want to take the Internet’s advice over mine, that’s OK; just never come to see a doctor or go to a hospital ever again.” (Right before I take their stack of papers and throw them down the hall.) Fortunately we don’t have to imagine what that might be like, we have the vast majority of modern medicine to guide us. After all, the Tuskegee Experiment and the Nazi medical crimes were both done under the guise of the all-knowing, all-powerful physician. Yet, those are admittedly extreme examples that are perhaps more a reflection of the stunning depths of humanity and not a particular aspect of paternalistic medicine itself. At a much smaller but more practical level, it is important for me to express the intense discomfort that soon swept over me shortly after that patient and family encounter. Yes, I was initially feeling pretty proud of myself, but I shortly started feeling rather uncomfortable. Because before I became a doctor, I went through an incredible series of silly hoops, whether they were exams, activities, or hours upon hours with incredibly obnoxious interactions with awful people. In fact, I think I’ve made it pretty clear that my education over the last four years does not exactly prepare one for…well…much of anything, as it turns out. And I feel very confident in saying that nothing I went through actually amounts to any true higher stature, and surely no true higher power.

Most importantly, however, I learned that it is far better to be humiliated, scorned, and untrustworthy in the current medical system than to be falsely idolized in the older model. So much of this past year has been accepting failure, whether it manifests in the cancer-ridden body of a previously healthy 40 year old with a wife and two young kids, or in the glazed eyes of the same crack addict with a habit I will never break. In the wake of these perpetual failures, the notion that physicians are somehow elevated in society holds no ground, and I think it is silly for any physician to attempt to embrace this role. This is something medical students are now taught to varying degrees, but my hunch is these lessons last as long as it takes for most newly minted doctors to find themselves in a similar position to that I just experienced, weighed down by a year’s worth of sometimes literally being shit on only to be elevated to God-like status by some kind (if misguided) patients, and enjoying the latter role far more than the former. The attitude starts there, and only grows.

Where to go from here? As with most things, moderation seems like the key. I think most doctors would willingly give up a fair amount of the hero-worship they currently enjoy from the minority in exchange for a little more appreciation and respect, along with a large disposal of the unwarranted distrust that is currently sweeping through this country, from the majority. It doesn’t seem like much to ask to me.

And what of the family I spoke about? Sadly, the patient quickly succumbed to his disease two days after I met him, no miracle cure to save him from the terminal cancer he was suffering from. Yet, I was told he died in peace, without pain and with family at his side. Something God would be proud of, no doubt.