I came to New York because I wanted to get my hands dirty. I choose this city (although, truth be told, it choose me) above the (however few) other options available because, I thought, it would garner me a kind of exposure, a particular perspective, I would have access to no where else. I based the decision and the formed the dialogue, to myself and others, on all of this; that I would come out of it having seen and done things I would not have had the opportunity to anywhere else. But the other part of the truth is that I would have been just as happy, if not more, to have gone to Stanford, to have stayed in Santa Cruz, to have maybe kept my hands just a tad bit cleaner.
The hospital where I am doing the bulk of my clinical training takes care of, by and large, the urban underserved areas that sprawl out around the pockets of wealth that glint like minerals in my small part of Brooklyn. My patients, its patients, the patients, rarely have regular doctors, those who do were lucky and got into the clinics. The hospital is a dreadful mess of limitless bureaucracy, social tension, and failing architecture. Nothing works. In order to go down the elevator you first must go up. The nurses walk around with buttons that say, "ask me if I washed my hands". There are no sinks. We stand in the hallways during rounds and watch--in shock? awe? amusement?--as a cockaroach climbs its way blissfully up the wall besides us. Someone snorts. Another makes a disparaging retort, we all roll our eyes as if to say, "only in _______ Hospital". But this is the lifeline to thousands of people. This place that we all despise so much for its filth and malfunctions and inefficiency is the only place these people know to go, can go, will go. They trust us so much, regardless of anything, enough to come here, to stay, to heed our words, our warnings, our castigations. They deserve more, certainly more than this.
At the nurses station we all gather around, in our dingy, uptight coats, our stethescopes, our reference books, our manuals and cryptic scribble. We invade the nurses only work space. There is no place else for us to go. We have one computer. One. On which to look up lab results for over 50 patients. This is the same computer that the nurses must enter in the lab requests after we put in the orders. Everyone's work is important. No one concedes to budge. Eye contact is to be strictly avoided because it may remind you that we are all in this together and part of the very forward momentum of this wretched place is acrimony and vitriol. The nurses hate all of us. All we do is make their life a living hell. They know who and only who they cannot f-with and this is, believe me, a very short list. All else are subject to be fired on at will. The residents hate the PA students and the PA students in turn hate the med students, whom the residents fawn on, and the NP students, for reasons I will never understand. The doctors generally abuse the residents, who in turn abuse all of us, the charge nurse speaks a language indecipherable to anyone not holding a degree in Speech Pathology and no one will help you. Because someone, at some point, really pissed them off and now you're going to have to pay for it.
All of this is without even beginning to dissect out the fragile, tempermental, sensitive subject of race, culture, ethnicity. Or education. Or social status. Or economics. The reality is that the nurses, the clerks, the aids, the receptionists, the secretaries and the therapsits are trashed. They are over worked and under paid and no one ever says thank you so they stopped trying. And it stops being about asking nurse A to get a blood sugar on patient x. Instead it becomes, that skinny little white girl with the big diamond her finger just told me what to do, oooh uh uh. Even though it was never about that. Ever. I don't think it is ever about that, no matter how arrogant the doctor or student or resident may be. It is only about getting the f-ing blood sugar on the patient, but suddenly, it's not. Because now she won't do it, for myriad and understandable and annoying and over-generalized reasons, but I still need it, that doesn't change or go away just because I'm white or she's not or I'm younger than her and she should be getting paid more. So when I really need it (during morning rounds) I will get yelled at by my attending and looked upon with pity by my peers because I couldn't even get a simple blood sugar. And somewhere behind me, she will be happy. And that's fine. Okay, whatever. But the thing is, patient x still needs his damn blood sugar checked. Maybe I was temporarily humiliated or embarrassed or frustrated and some small yet exquisite pleasure could be gotten from that in what will otherwise be a thankless day. But in the end, the person who suffers is patient x. Because he sat around with a blood sugar of 513 and did not get his insulin on time, increasing his length of stay and ever so minutely worsening his disease.
So this is what I do all day. I wait for hours to check lab results I should have been able to check during the first half hour of my day. I call for MRI reports, ECHO reports, CATH reports, surgery reports that are not in the computer, will never be in the computer, and am forced to try to translate the indistinguishable garble that I hear on the other end of a phone line by a person who is clearly speaking Russian. I cannot read the handwriting in 75% of the charts. It takes an expert in sanscrit to understand the orders. And while I am fighting the urge to jump out the window, the ones who suffer are laying in their beds, trusting. Trusting that we are getting it done. That we are on it. That it's understood and done. And they deserve that. If for no other reason than them we should be able to read the @#$%! medical records, access the reports, be made aware of additional charts from additional services. If for no other reason, we shouldn't be such a clusterfuck of chaos and anger and bitterness and incompetence.
I have seen much and not enough during my short time on every rotation. I have seen much of how I never want to practice medicine, hospital environments I hope I never have the circumstances to return into, toxic pits of personality disorders and disorganization like one would never believe. But I have not seen enough excellence, enough empathy, enough kindness, enough understanding, enough meticulous, uncompromising dedication to medicine, to patients, to learning, to care. I sometimes wonder how I will ever enter into a job with this as my only compass without being thrown out immediately. I have a vague optimism that somehow a place like New Hampshire will be different, better, less...dilapidated. And then I come to realize that I have changed from being here. My hands are dirty now and somewhere, deep and elsewhere, I am worried about the stains.
The hospital where I am doing the bulk of my clinical training takes care of, by and large, the urban underserved areas that sprawl out around the pockets of wealth that glint like minerals in my small part of Brooklyn. My patients, its patients, the patients, rarely have regular doctors, those who do were lucky and got into the clinics. The hospital is a dreadful mess of limitless bureaucracy, social tension, and failing architecture. Nothing works. In order to go down the elevator you first must go up. The nurses walk around with buttons that say, "ask me if I washed my hands". There are no sinks. We stand in the hallways during rounds and watch--in shock? awe? amusement?--as a cockaroach climbs its way blissfully up the wall besides us. Someone snorts. Another makes a disparaging retort, we all roll our eyes as if to say, "only in _______ Hospital". But this is the lifeline to thousands of people. This place that we all despise so much for its filth and malfunctions and inefficiency is the only place these people know to go, can go, will go. They trust us so much, regardless of anything, enough to come here, to stay, to heed our words, our warnings, our castigations. They deserve more, certainly more than this.
At the nurses station we all gather around, in our dingy, uptight coats, our stethescopes, our reference books, our manuals and cryptic scribble. We invade the nurses only work space. There is no place else for us to go. We have one computer. One. On which to look up lab results for over 50 patients. This is the same computer that the nurses must enter in the lab requests after we put in the orders. Everyone's work is important. No one concedes to budge. Eye contact is to be strictly avoided because it may remind you that we are all in this together and part of the very forward momentum of this wretched place is acrimony and vitriol. The nurses hate all of us. All we do is make their life a living hell. They know who and only who they cannot f-with and this is, believe me, a very short list. All else are subject to be fired on at will. The residents hate the PA students and the PA students in turn hate the med students, whom the residents fawn on, and the NP students, for reasons I will never understand. The doctors generally abuse the residents, who in turn abuse all of us, the charge nurse speaks a language indecipherable to anyone not holding a degree in Speech Pathology and no one will help you. Because someone, at some point, really pissed them off and now you're going to have to pay for it.
All of this is without even beginning to dissect out the fragile, tempermental, sensitive subject of race, culture, ethnicity. Or education. Or social status. Or economics. The reality is that the nurses, the clerks, the aids, the receptionists, the secretaries and the therapsits are trashed. They are over worked and under paid and no one ever says thank you so they stopped trying. And it stops being about asking nurse A to get a blood sugar on patient x. Instead it becomes, that skinny little white girl with the big diamond her finger just told me what to do, oooh uh uh. Even though it was never about that. Ever. I don't think it is ever about that, no matter how arrogant the doctor or student or resident may be. It is only about getting the f-ing blood sugar on the patient, but suddenly, it's not. Because now she won't do it, for myriad and understandable and annoying and over-generalized reasons, but I still need it, that doesn't change or go away just because I'm white or she's not or I'm younger than her and she should be getting paid more. So when I really need it (during morning rounds) I will get yelled at by my attending and looked upon with pity by my peers because I couldn't even get a simple blood sugar. And somewhere behind me, she will be happy. And that's fine. Okay, whatever. But the thing is, patient x still needs his damn blood sugar checked. Maybe I was temporarily humiliated or embarrassed or frustrated and some small yet exquisite pleasure could be gotten from that in what will otherwise be a thankless day. But in the end, the person who suffers is patient x. Because he sat around with a blood sugar of 513 and did not get his insulin on time, increasing his length of stay and ever so minutely worsening his disease.
So this is what I do all day. I wait for hours to check lab results I should have been able to check during the first half hour of my day. I call for MRI reports, ECHO reports, CATH reports, surgery reports that are not in the computer, will never be in the computer, and am forced to try to translate the indistinguishable garble that I hear on the other end of a phone line by a person who is clearly speaking Russian. I cannot read the handwriting in 75% of the charts. It takes an expert in sanscrit to understand the orders. And while I am fighting the urge to jump out the window, the ones who suffer are laying in their beds, trusting. Trusting that we are getting it done. That we are on it. That it's understood and done. And they deserve that. If for no other reason than them we should be able to read the @#$%! medical records, access the reports, be made aware of additional charts from additional services. If for no other reason, we shouldn't be such a clusterfuck of chaos and anger and bitterness and incompetence.
I have seen much and not enough during my short time on every rotation. I have seen much of how I never want to practice medicine, hospital environments I hope I never have the circumstances to return into, toxic pits of personality disorders and disorganization like one would never believe. But I have not seen enough excellence, enough empathy, enough kindness, enough understanding, enough meticulous, uncompromising dedication to medicine, to patients, to learning, to care. I sometimes wonder how I will ever enter into a job with this as my only compass without being thrown out immediately. I have a vague optimism that somehow a place like New Hampshire will be different, better, less...dilapidated. And then I come to realize that I have changed from being here. My hands are dirty now and somewhere, deep and elsewhere, I am worried about the stains.
