Category: Nonfiction

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Education Medicine Nonfiction Observations Systems

Who Works at a Hospital?

Who works at a hospital? (Again, just indulge me for now.)

Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical students and other trainees (the army of white coats tromping through the hallways). Instead, you’ll see lone attending physicians.

Nurses. Nurses play vital roles in patient care; without them, hospitals simply would not work. Nurses arguably spend the most time with patients. They monitor and observe patients around the clock. As a result, they’re often the first to realize that something has changed and thus have the responsibility to do something about it.

There are different kinds of nurses, such as registered nurses, licensed practical nurses, and certified nursing assistants. Their roles differ in terms of their training, skill sets, and responsibilities, but they all serve to observe and monitor patients and their conditions.

Therapists. Not the talky kind. There are respiratory therapists, speech therapists, physical therapists, and occupational therapists. They focus on skills and function: How can we help this patient walk? How can we help this patient talk with less difficulty? How can we retrain the muscles in this patient’s hand so he can write again?

Technicians. Radiology technicians, pharmacy technicians, surgical technicians, electroencephalogram technicians, patient care technicians… the list is long. They assist other professionals in the hospital in their duties and may have more contact with patients that the professionals themselves.

Consider an ultrasound technician. A physician may order the ultrasound, but it is the technician who will explain to the patient what an ultrasound is and perform the procedure. A radiologist will interpret the results.

A special note about patient care technicians (PCTs): These individuals often spend the most time with patients and are often a treasure trove of data for nurses and physicians. If you are a physician working in a hospital, make a point of talking with the PCTs. They’re the ones who will know if the patient slept, went to a procedure, has a change in mental status, etc.

Janitorial staff. These individuals have one of the most important jobs in the hospital: They help with hospital-wide infection control. They help prevent people from getting more sick. If you work in a hospital, thank a janitor today for what they do.

Clerical staff. This includes the clerks who serve as receptionists for the hospital units (not an easy job: imagine juggling phone calls from patients, managing the anxiety of family members of patients, paging physicians multiple times because they don’t call back…), hospital operators, all the people working in medical records, and the staff who work with the hospital administrators. Hospitals generate a lot of data. Someone has to help manage and organize all that data.

Information technology staff. Electronic health records now hold patient information. The networks fails. The mouse doesn’t work. There aren’t enough terminals. Someone can’t remember their password. The radiology images aren’t showing up. The orders didn’t go through. The IT department gets a lot of pressure to get it all right.

Food services staff. There are all the people who cook hospital meals, transport and deliver the meals to each patient, and wash the leftover dishes. These people also prepare the food in the hospital cafeteria, which feeds the rest of us who are well enough to get it on our own.

People want to eat and they want to eat food that tastes good. In the hospital it is hard to please all of the people all of the time.

Environmental services staff. These are the plumbers, electricians, HVAC experts, etc. who make sure that the electricity stays on, that there are backup generators available, that the water temperatures are satisfactory, that the ambient temperatures are within a certain range, that the windows seal tight, etc. If the building doesn’t “work”, then the hospital doesn’t work.

Pharmacy staff. I don’t know how many thousands of medications are available, but the pharmacy takes care of all of them. Whether they are amazing antibiotics that will drip through an IV or cartons of chicken soup (yes, doctors can order chicken soup), the pharmacy takes all of those orders and fills them. They ensure that medications are available in every single hospital unit and prepare medications for patients to take with them when they leave the hospital. And they have to make sure that they fill the right drug at the right dose at the right time for the right person.

There are many more people who work in hospitals; I do not omit them willfully. We often take for granted all the people who make a hospital work.

If you are a patient (or someone visiting a patient) in a hospital, I encourage you to thank all the people who have helped you. Hospital staff appreciate hearing that and want to know that their actions made a difference.

If you work in a hospital (especially physicians), I encourage you to thank your colleagues, particularly those who have a completely different job from yours. They are doing something to help you do your work. Let them know that you appreciate it.

Next time: The “rules” of the hospital.

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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.

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Nonfiction Observations

Boundaries.

A bus approached the curb and I looked up from my book. It took me a few seconds to realize that he was talking to me.

“Dr. Chang? No, Dr. Wang. It’s Dr. Wang, right?” he called. He slowed the pace of his walk. In one hand he clutched a plastic bag filled with loose papers. A backpack bounced against his shoulders. Though it was a crisp autumn day, he wore only a tee shirt one size too large for his frame and had tied the arms of a jacket around his waist. The hems of his jeans were frayed.

“Hi,” I greeted, trying to recall his name. I hadn’t seen him in nearly six months. He stopped and extended his hand to shake mine. His skin was softer than I had anticipated.

“Dr. Wang, I don’t like how they’re treating me at The Clinic,” he began. “They don’t know what they’re doing and I’m done with them. I think they’re working with the FBI, Dr. Wang, but I can’t do anything about that. I don’t feel safe in my apartment and they know this. They’re bugging my apartment. I don’t know what the FBI is looking for, but would you want to live somewhere that is bugged? I don’t. I’m done with The Clinic, Dr. Wang, I really am. What do you think I should do?”

He stood still, waiting for an answer.

Pedestrians filed past. Buses roared along the street. An occasional yellow-orange leaf fluttered to the ground. A dozen people looked down the avenue, looking for their bus to whisk them away.

I opened my mouth, still uncertain of what to say—

“I’m sorry,” he interjected. “You’re not here to provide psychological help right now.”

Before I could reply, he began to turn his body away from me.

“I’m sorry, Dr. Wang.”

He began to walk away as the bus I wanted approached the curb. Before stepping towards my bus, I looked back at him.

“Have a good day, Dr. Wang!” he called, waving at me. I waved back.

As I boarded the bus he looked back as he continued to walk forward. Over the heads of the people between us he shouted: “Thank you, Dr. Wang! THANK YOU!”

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Lessons Medicine Nonfiction Reflection

A Dream.

A few days before I learned what happened, I had a dream about you. When I awoke, my heart felt like a bird flapping its wings inside the cage of my ribs.

The details had vanished. Only anxiety remained.

I gasped when I learned what happened. I suddenly remembered the little details, the things that never made it into the clinical notes: You liked your coffee black. You read the Wall Street Journal. You missed driving your sports car.

Where did you kill yourself? Did you get a motel room? Were you outside? What time of day was it?

You certainly planned this. When did you make the final decision? Did you waver? Did you want to waver?

They say that there are two kinds of psychiatrists: The kind who have never had a patient commit suicide, and the kind who have had patients kill themselves.

I now belong to the second group. We all join the second group at some point.

I wish you hadn’t killed yourself.

I thank you for what you have taught me, both in life and in death.

I wish you had the peace in life that you thought was only available in death.

May peace be with you now.

Categories
Medicine Nonfiction Observations

I Remember.

I remember when we dragged ourselves to the large lecture hall every morning, backpacks slung over our shoulders and cups of coffee in our hands. Six to eight hours of lectures awaited us.

I remember where we all sat in that lecture hall. I remember the future ophthalmologist who sat behind me and made snarky comments while certain professors gave their lectures facing the chalkboard. I remember students sitting six rows behind me who told me after class, “We saw you falling asleep today. If you sit in the back, it won’t be as obvious.”

I remember the guys throwing around a fluorescent Nerf football between classes. Some of them would take off their shirts (and one would look around to see if women were watching) and relive their days of playing college sports.

I remember when we wore shorts, tee shirts, sandals, tattered jeans, dangling earrings, and tank tops.

I remember going to parties and watching people drink wine and beer out of those red plastic cups.

I remember when we received the short white coats. I remember how stiff they were, how awkward we looked in them, and how annoyed we were that we had to buy “nice clothes” in preparation of training in the hospitals.

I remember that we exchanged ideas of where to find “nice clothes” for “cheap”.

I remember how tired and haggard we looked after we took call. I remember when our scrubs were wrinkled, our hair was unkempt, and our hygiene was suboptimal.

I remember when we wondered how we would ever survive our intern year.

I remember when we contaminated sterile fields and didn’t know what size sterile gloves we needed. I remember certain nurses rolling their eyes and yelling at us for our ignorance. I remember when we would see each other in the hallways and stairwells, holding order sheets for signatures, carrying baskets filled with gauze and tape, and trailing behind the medical team that was into its third hour of rounding.

I remember when we tried not to cry when attending and resident physicians said unkind things. I remember when we shared strategies about how to manage certain doctors. I remember how much we said, “I don’t know.”

I now see current photos of my classmates from medical school and, to my surprise, they actually look like doctors. They have wrinkles around their eyes. The men wear white collared shirts, mild neckties, and dark business jackets. The women wear conservative jewelry and shirts with modest necklines. The long white coats fit their frames. Their smiles radiate confidence.

They look mature.

And old.

Which means I must look that way, too.