Stand up straight

You know how, when you squint at a colorful tree, the borders disappear, and all the leaves merge together into one big mass of green? Turn that inside out, and you have my relationship with The Hospital. At times--especially difficult times--all the departments and interests and people in that place start to merge. Their demands and rules start to become one entity's demands and rules, and their borders disappear. I have to squint hard to separate the strands that come together to form the rope around my neck.

My friend Jack was in a terrible accident last week. I heard about it the evening it happened. After emergent surgery, he was rushed to the intensive care unit, where his chances of surviving the night were estimated at 50/50.

That night, I dreamt that when I went to visit Jack in the morning, he had done so well that he had been transferred to a non-critical floor. I smiled as I walked down crepuscular hallways, looking for his name on the lavender-colored room doors inside my head.

I woke up early to see him, and when I swiped my badge at the entry into the unit, he was still there. I waited outside his room--after all, I am his friend, not his doctor--and when his nurse came out, I asked if I could see him. She frothed at me: I could not see him. I should have entered the unit as a visitor rather than with my badge, since I was coming as a friend and not a provider. I would have to come back. And no, she could not tell me how he was doing.

I did not ask her why, if I was a visitor, I was being chewed out as though I were merely a resident. I instead burst into tears and left.

I stood in front of the window outside the unit, watching the early morning creep into the parking deck across the street. Downstairs, my own work--in a different intensive care unit, with different patients--was to take care of patients exactly like Jack. I knew exactly what we whispered to each other about people with his injuries, and I wished now that someone would tell me that it was all lies.

That afternoon, I was pulled aside by a superior and told that something I had said had caused a patient's family member to raise an eyebrow. A few days prior, I had been post-call--awake for 30 hours--and on rounds, I had mumbled, "God, I'm so tired I can barely stand up." This, he said, had been seen as unprofessional.

I turned to face him and marveled at the strange blur before me. No eyes, no ears, no chin--just a building with a big, flapping mouth for a door and an inconvenient parking structure tacked awkwardly onto the back. Flap, flap, flap went that mouth.

Here is the message the hospital was giving to me: I am expected to maintain firm boundaries, refrain from complaining; and provide to patients' families exactly what they want, whether it's reasonable or not. However, I should not expect that when I am the loved one of a patient, I can demand any of the indulgences that families can demand of me--not kindness, not time for my own grief and anger, not a sensation of loss of control. I am a pillar of professionalism at all times, and even when I snap in two, both halves need to stand up straight.

I squinted, trying to pick out details, perhaps an element of misunderstanding, or spaces where I could come clean about my sadness. But I was too tired, and whatever it was I was seeking was hidden behind that blurred facade.

Sure, there are faces in that building that express compassion--it's just not compassion for me.


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Hang in there, Signout! I hope your friend Jack is doing well - fingers crossed.

By Ctenotrish (not verified) on 13 Aug 2008 #permalink

To my mind, this is a by-product of the mentality that views patients as "customers". You? Why, you're just the help.

Very nice post, Dr. Signout! I am sorry about your friend.

The sort of compartmentalization you describe between "professionalism" and "compassion" is very typical of professions in which one owes a special duty to someone else, such as medicine and law. It does serve a useful purpose, but also has unfortunate side effects, as you point out so eloquently.

Your concern for your injured friend and your dismay at the misguided professional environment emanate pain and compassion. We wish for your friend's successful recovery, and are appalled at the way you were treated by your peers. You may not be able to change the world today. But knowing that you can see and guide a way for change, we know there is hope for all of us.

I send my best wishes to you, Jack, and Jack's family.

I forgot how beautifully your write. Welcome back.

The day we allow physicians show their humanity is the day medicine will take a giant step forward.

I'm so sorry to hear about your friend, and about your hospital situation. How dehumanizing. *hug*

mdiehl - while that's an interesting link, I really don't think it has anything to do with the situation that Signout's describing. A resident trying to visit an ill friend or commenting on how tired they are is certainly not the same as a surgeon throwing scissors at someone.

I am so sad for you, and so sorry for your friend Jack, and I hope he will get better. I hope they don't grind that compassion out of you. Wish I could come by for a cup of tea and just to give you a hug.

And damn, I wish I could write like you! I'm sorry you have such a heartbreaking story to tell, but you tell it so very well.

mdiehl, I read a similar article in another paper recently, and I don't think "humanity" is exactly the right word for throwing things, swearing, and put-downs. Those things might be human, but they're not humane. I don't think Signout is making an argument here for that sort of arrogance or temper, and I'm guessing Abel Pharmboy didn't intend to, either. It isn't so much a matter of "too much" humanity as of what KIND. No work environment benefits from the presence of violent, condescending blowhards. They blow up because of the stress? Puh-lease. What about the anxiety they create in everyone around them? And what about all the people who manage, every day, to do so much better?

Signout, I've been missing you. Sending all my love, and very best wishes for Jack.

You are all far too kind. Thanks for the warm welcomes back! If Jack weren't intubated, I'll bet he'd thank you for your kind thoughts, too.

Brian, you're right on. I'll probably discuss that mentality in a later post. There's a fine line between providing care that meets peoples' needs and providing customer satisfaction, and it's not always clear which side I'm on.

Ophir, are you the Ophir I know? If so, hooray! If not, just hooray, without the extra punctuation.

MDiehl, I am going to stab you in the eye with these scissors. Kidding! Thanks for sharing.

Ctenotrish, you are always so encouraging. Thank you.

Heather, I miss you, too, and your always-thoughtful words. I want to come to the prairie and eat your cooking.

And to my fantastic Scibs: if I hadn't met (or re-met) all of you last weekend, I'm pretty sure I'd have already sent in my letter of withdrawal from SB. Thanks for reminding me what a great place this is.

Any surgeon who would ever throw a pair of scissors at someone must be a lone wacko. That kind of behavior couldn't possibly reflect anything in general about the medical profession, because the medical profession has been completely expunged of all paternalistic, patriarchal, and/or arrogant attitudes on the part of physicians and surgeons towards patients and/or other participants in the medical enterprise.

PP, I am going to hack off your junk with a wooden tongue depressor--not because I am threatened by your notion that patients and physicians should be equal parts in medical decision-making, but because I HATE YOU.

Big love,

I know I'm late to this thread, which is a pet peeve of mine, but I can't help crap, your posts always make me write my own, so I'll finish my thought over there.

Oh, and if you perform a successful orchiectomy on PP with only a tongue blade, I'm pretty sure there's a Lasker prize waiting for you.

I think a lot of visits are more for the parents than for the kids. You identified what her real concern was, which is not as easy as it sounds. Nicely done.

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