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Education Medicine Observations Systems

What is a Hospital?

So what is a hospital? (Just work with me here.)

Hospitals are physical structures. They are buildings that have rooms and beds. People, who become “patients”, are “admitted” into a hospital and assigned a bed. Because patients receive a bed, there is an assumption that they will be in the hospital for at least one night. This is called an “inpatient” admission, because the patient is “in” the hospital. (Contrast this to a visit to a clinic, which is called an “outpatient” encounter.)

Hospitals provide acute health care. “Acute” can mean “intense” (like cutting someone open to remove an organ or the delivery of a baby in a mother who has major medical problems) or “fast” (like giving a patient antibiotics through a vein to fight an infection or using a machine to help filter blood when a patient’s kidneys suddenly stop working).

Because most hospitals offer services from nearly every medical specialty, patients can experience “one stop shopping” for acute health care issues. Patients might see four different kinds of doctors, have numerous tubes of blood drawn, undergo five imaging studies, receive education from dieticians, undergo strength training with physical therapists, and talk with pharmacists about their medications.

Hospitals permit around-the-clock observation of patients. This is directly related to the previous point and is arguably the primary reason why people are in hospitals. If someone does not require frequent and regular observation, then she doesn’t need to be in the hospital. All that staffing and equipment in the hospital serve to monitor patients and their health (heart function, breathing, infection, etc.). If medical staff observe an acute change, they can then deliver an acute intervention.

Hospitals are businesses. Hospitals, like hotels, want a low vacancy rate, as this is how they make money. Sometimes patients are ushered out of the hospital sooner than expected because other patients are waiting for open beds. (I’ve worked in hospitals where, in the morning, the operators announced over the intercom a “code” about bed status. This was a discreet message to hospital staff about the census. If the census was high, then we were to try to discharge patients if we could.) Sometimes patients are welcome to stay in the hospital for another night because the census is low. This is not actually a good thing. (The longer someone stays in the hospital, he is at higher risk of developing an infection from the hospital. This is bad because infections that originate in the hospital are often resistant to available antibiotics. Furthermore, patients often get “deconditioned” because they aren’t moving around as they usually do. As muscles, stamina, and endurance weaken, that can cause problems with mobility and function.)

Hospitals are not places of rest. While it is true that people can recover in hospitals, that doesn’t mean that people recover in peace. Hospitals are often noisy places with frequent, unexpected intrusions because of all the observation, testing, and services that occur there.

Now that we have a general sense of what hospitals are, we’ll talk next about all the people who work in hospitals.

Categories
Education Lessons Medicine Nonfiction Observations Reflection

Cancer.

As a fourth year medical student I did my “sub-internship” in oncology. I hoped that this rotation would help me choose what specialty to pursue: internal medicine or psychiatry.

One of “my” patients was a woman with breast cancer that had spread to her liver and lungs. Fluffy brown hair fell to her shoulders. Wrinkles surrounded her puffy eyes that held jade green irises. Though she was in pain, she was patient and kind.

On the evening of her second day in the hospital, I came to her room and asked if there was anything else we could help with that day. Her pale, thin lips stretched into a sad smile.

“No, thank you,” she answered. “Have a good night.”

“I’ll see you tomorrow,” I said.

She was sleeping when I saw her the next morning, though awoke without a startle when I said her name. She kept her eyes closed as I placed the cool, metal diaphragm of the stethoscope on her chest and back. She murmured her thanks before I left her room.

As the attending oncologist, resident, intern, nurse, fellow medical student, and I approached her room later for formal rounds, she called to us.

“I can’t see!” she gasped. “I can’t see!”

We surrounded her bed and the attending began to ask her questions. He waved fingers in front of her face. He directed the beam from his penlight into her eyes.

“I can’t see! No, I can’t see!”

“But you could see yesterday, right?” he asked. She turned her head as if she was looking around at us, but her gaze was over our heads.

“Yes… but I can’t see now. Does this mean that I will never see my husband and daughters again? Is this permanent?”

I tried not to cry. The other medical student and the intern also looked away, their eyes welling with tears.


We learned later that the cancer had metastasized to her occipital lobe, the part of the brain that controls vision. Though her eyes were in good working order, the part of her brain that interpreted the electrochemical signals from her optic nerves was not. The cancer had stolen her sight.


You learn a lot of things in medical school: anatomy, physiology, pharmacology, and other concrete facts about human function. You also learn about human relations, communicating with people with different agendas, the system of health care, and other topics that fall under the “informal curriculum“.

You also learn how tenuous life is. You see women give birth to dead babies. You see children succumbing to cancer. Healthy adults get hit by stray bullets and drunk drivers. Heart attacks and strokes steal time and life away without making a sound.

You begin to recognize the blessings that you previously overlooked: I can eat all the cookies I want and I don’t have to take insulin. I don’t need a walker to get around. My fingertips and toes can feel the soft fur of a cat, the hot water coming out of the shower, and the zing of static electricity. I can breathe without difficulty and without having to lug an oxygen tank around. My arms and legs move when I want them to. My balance is intact.

You also realize, with some dread, that all of that can change in an instant. So you better enjoy the blessings while you got ’em.


My mother was sent to the hospital with urgency the day I returned to California to visit my parents. She was subsequently diagnosed with metastatic lung cancer.


I am grateful that I could advocate for my mother while she was in the hospital. I am also thankful that I could translate what was happening—not just from English to Chinese, but also from medical jargon to plain English—to my parents.

I was struck by the degree of confusion and uncertainty throughout her hospitalization. Things that I knew as a physician were not at all obvious to my parents. Things that I knew as a concerned family member were not at all obvious to the physicians.

I was and remain humbled.


As a consequence of this, upcoming posts will focus on how health care in hospitals work, what hospitals can do differently to help patients understand what is happening, and things that both medical staff and patients can do to make the hospital experience better for everyone.