Author: Maria Yang, MD

Categories
NYC

The Great City.

With iron mined from the earth, they built lumbering machines that crushed trees, dredged holes, and flattened hills. They used their ingenuity and strength to excavate limestone and granite from the mountains. After carving these boulders into blocks, they stacked them into buildings that reached for the heavens. Using the soil and silt beneath their feet, they changed the courses of rivers and increased the area of the island. It was a great city.

From miles away, the skyscrapers were visible, forming a jagged contour that jutted up from the arc of the horizon. They marveled at their achievement.

They also leveled hills, uprooted trees, pulled out grass, shaped new hills, replanted trees, and added flowers. They filled in ponds and constructed new lakes. The result was a beautiful park. It beckoned the citizens out of the grid of the great city onto its manufactured grounds for respite. Tall buildings cast long shadows over its expanse.

No matter the direction of their gaze, they saw their wonderful creations: The skyscrapers. The city grid. The subway system. The works of art. The green spaces. The fashion. The cuisine. There was nothing that they could not do. Everything in the great city was man-made, a product of their brilliance, efforts, and ambition.

In their pride they overlooked the creations of Nature. Some mountains reached heights such that they were frosted with snow throughout the year. Tides splashing over the billions of grains of sand along the oceans’ edges succumbed to the pull of the moon. Though trees were naked in winter, by spring they were dressed in lush leaves that captured the energy of the sun.

They forgot that Nature provided the materials to build the great city. They forgot that there was something greater than them.

Categories
Uncategorized

Tact.

The clerk in front of them put another stack of papers into a folder.

“You know the George Washington Bridge, right?” the police officer said. The orderly nodded.

“Lemme tell you how strict the policy was. I used to work over there. One precinct covers the area north of the bridge, another covers south of the bridge. If someone jumped off of it—like a suicide—all of us from both precincts would watch the body hit the water.”

“Oh jeez.”

“We’d wait to see which way the tide carried the body. If the body went the other direction, we’d pat the other officers’ shoulders and say, ‘All right, that’s yours.’ Crazy, huh?”

The people sitting in the chairs against the wall were dressed in hospital gowns. They watched the police officer chuckle. The clerk’s phone began to ring.

“Psychiatric emergency room,” she said into the receiver.

Categories
Education

Termination (III).

Her phone began to ring as she was putting socks into her luggage. It was him.

“Hey,” she greeted.

“So I can’t take you to the airport. Something came up.” He sounded distracted.

“Oh.” She paused, waiting for him to elaborate. He said nothing. “Can we still meet for lunch?”

“No, something came up last minute. I actually gotta go soon—”

“But I was hoping that we could spend some time together before I move. You know, to say good-bye.”

“Yeah, so was I, but this thing came up and I just can’t. I’m sorry.”

She frowned.

“Look, I gotta go,” he said. “I’m sorry about this, but I’ll call you in a few days to make sure everything went okay.”

“I don’t know when we’ll see each other again. Is there—”

“I really gotta go. I’ll call you. Have a safe flight!”

She heard a click, then silence.

Malan (p. 220) remarks:

[One] pattern is that when the therapist starts talking about termination the patient announces that he doesn’t want to come any more. [A]lthough the patient suffers by losing even more therapeutic time, he gains by retaining control of the situation and turning the tables on his therapist by leaving rather than being left.

Sometimes patients don’t attend their final appointments with their therapists (or good-bye parties, graduations, etc.) so they can avoid feeling emotions—”positive” or “negative”—associated with termination. If you don’t have to talk about it, that means you don’t have to think or feel anything about it. In this way, avoidance as a coping strategy works.

If you never say hello, you will never have to say good-bye. That also means, though, that your experience of the world—and of yourself—is limited. Some people want that. Many people don’t.

(Read more about termination in part one and part two.)

Categories
Uncategorized

East vs. West: Hospital Fashion.

You’ve decided to dine at an upscale restaurant in New York City. You and your date walk through the entrance and the maitre’d looks up from his podium. He’s wearing a dark suit, a white shirt, and a conservative necktie.

The corners of his mouth turn up slightly as he greets you. “Good evening. Welcome to The Hoity Toity. Would you like to check your coats?”

A young lady with a dark dress wrapped around her slender figure appears. She helps you both out of your coats and, after draping them over her arm, she gives you a small ticket with a large number printed on it.

As your evening progresses, you notice the cavalcade of people providing the dinner service:

Black Shirts. These men wear black dress shirts, black slacks, and black shoes. They ensure that your glasses of water—”tap, filtered, or bottled?”—are never empty. They also clear away your plates between courses.

Striped Neckties. These men wear blue shirts, no jackets, and identical neckties with bold, diagonal stripes. They take your order and replace your silverware after each course. (After the third set of clean silverware is placed on your table, you begin to wonder just how many pieces of silverware the restaurant owns and if a human or a machine is washing them.)

Gold Vests. These men wear white dress shirts, black pants, and muted gold vests. They place baskets of bread on the table and bring out the dishes from the kitchen. When they place the plates in front of you, your Striped Necktie appears and identifies the items on your plate.

Black Shirts, Striped Neckties, and Gold Vests swirl around you throughout dinner. The maitre’d periodically walks around the restaurant, scanning the tables and customers, but says nothing. Coat Check Girl perches on a small stool by the door, smiling at entering and exiting patrons.

You’ve worked in several medical centers on the West Coast and now work in a few hospitals in New York City. While visiting patients in different wards, you notice the cavalcade of people providing medical services:

Tan Scrubs. These are the patient care technicians, the people who are rarely thanked for changing bed linens, assisting patients to the bathroom, and wiping vomit off of beds.

Pink Scrubs. These are specialty technicians, the people who record electrocardiograms, shoot X-rays, etc.

White Scrubs. These are the nurses, the people who often know more about patients—their health concerns, their personal histories—than the treating physicians.

Blue Scrubs. The doctors and doctors in training.

In all the medical centers I trained in while on the West Coast (Sacramento—how about that Delta Breeze?—and Seattle), all hospital staff wore the same colored scrubs. It mattered not what your title or position was. This uniformity fostered equality: Since everyone looked the same, everyone greeted each other with respect. (Add a white coat and things change.)

Perhaps the system of color-coded scrubs in certain hospitals in New York is a “patient centered” strategy. Patients can quickly recognize who is best suited to help them at any moment.

However, this color-coding system, at its worst, could lead to disrespectful behaviors and stereotypes that appear in social hierarchies. Those wearing tan scrubs can disappear; no one acknowledges them or their work. People may feel awe for those wearing blue scrubs, even though their behavior may not warrant reverence.

Apparel communicates information about social status, wealth, and culture. That fashion—colored scrubs—is incorporated into hospital policy is one way medicine in New York is more formal. However, I do not believe that this is a foible of medicine in New York. The hospital fashion, rather, reflects the fashion (and implicit messages about social status) of the city. And that is the subject of a whole other post.

Categories
Nonfiction NYC

East vs. West: So Serious!

When I was a medical student in California, many of my classmates expressed relief that we weren’t in a medical school on the East Coast.

“Everyone is so serious over there,” they said.

The stories we heard about medicine back East!

  • “The medical students have to give all of their patient presentations from memory during rounds!”
  • “You have to wear a coat and jacket all the time! It doesn’t matter if you are on call! You change into scrubs after 9:00pm and then, before rounds in the morning, you clean up and put your suit back on! The attendings never see medical students or residents in scrubs!”
  • “If attendings ask you a question you can’t answer, they throw you out of (rounds, the operating room, the cafeteria)! They scream things like, ‘DON’T COME BACK UNTIL YOU KNOW THE ANSWER!!!’”
  • “They have to keep their white coats buttoned all the time! ALL THE TIME!”

These stories must have trickled down from the interns and residents who attended medical schools on the East Coast. Funny, though: I did not hear these tales directly from them.

During my surgery rotation, one of my residents attended a medical school in New York City. This surgery resident had olive skin, dark brown hair, and manicured fingernails. He smiled only once during the month-long rotation.

“Medical students don’t have any respect for the attendings here,” he once complained to the chief resident. The chief was a young man who was almost bald, had grey-purple bags under his eyes, and always carried a travel mug full of coffee.

“Back where I went to medical school,” the resident continued, “everyone called the attending surgeon ‘sir’. We all stood up when an attending walked into the room. If the attending asked us a question, we always finished our sentences with ‘sir’. You only spoke when you were spoken to. And our white coats were always buttoned.”

My classmates and I shot knowing glances at each other.

We then shoved our presentation notes for rounds into the pockets of our short white coats that were hanging open over our green scrubs.

During my time in New York City, I rotated through three different hospitals as a fellow. I visited many wards as the roving consult psychiatrist: I noticed the internists rounding in the hallway, saw the obstetricians rushing to labor and delivery, observed the surgeons dashing down the stairs, peeked at the radiologists staring at films on computer screens, spotted the pediatricians cooing at toddlers, and glanced at the internists still rounding two hours later.

From my observations at these three hospitals in New York City, I can say the following with confidence:

  • The medical students do not give presentations from memory. They read from their notes. Their voices are infused with anxiety and self-doubt. They are just as nervous as medical students out West.
  • I never saw any medical student, intern, or resident wearing a suit. If they were post-call, they were wandering around in their wrinkled scrubs and sneakers. If they were not on call, many men did not wear neckties! The occasional attending would wear a suit to work, but that was an uncommon sight.
  • Though I saw many floundering medical students, I never witnessed an attending throw a student out of rounds or the cafeteria. (I can’t comment about the operating room.)
  • Many physicians, regardless of their position in the hierarchy, did not button their white coats.

Nonetheless, I do believe medical training and medicine is more formal on the East Coast. More to follow.