Last Wednesday I was rounding on the hospitalist service and I got into one of those time-wasting gripe-fests with one of the general surgeons. He was beefing about an incentive spirometer he'd ordered for a patient the day before, which never materialized, and I told him I'd had to transfer a patient to Macy's in order to get an echocardiogram over the weekend, and then we both shook our heads and talked about how Gimbels was falling apart. This is the kind of conversation you have when you've decided to leave a job.
Then the surgeon left the room to see his patients, and I was left alone with the osteopathic medical student who has been running around with us these days. I don't know how much internal medicine she's learning, but she knows a hell of a lot more about the economics of staffing a hospital than I ever learned in med school. Anyway, I've been ranting and raving too much in her presence, so I said aloud: "OK, today I'm not going to start one of my tirades. I'm not going to do it. We all know about the echo disaster, we all know you can't get a PICC line here at Gimbels, so I'm not going to go on and on about it." I took a deep breath in and smiled at her, then looked down at the orders I was trying to write. "The stupid thing is," I said, still looking down, "I don't really want to go. I don't really want to leave this place." And then I started to cry.
It's always a bad sign in a hospital when the attending physician is reduced to tears at 9:30 in the morning. It means discharges will be late, and core measures will not be met, and the morale in the hospital will lapse before the first wave of busyness hits the Emergency Room. So most of us internalize our little griefs and get on with the work, but on Wednesday, I hit my internal limit and I cried in public.
I don't know when, but somewhere during my adult life I fell in love with hospitals. I've been working in hospital buildings since I was twenty-three years old, and I suppose the bad ventilation in the buildings has addled my brain, because I tend to develop these Baroque affairs with any hospital I work in regularly. Sick, but true.
What is there to love about a hospital? Lots of things. I love the way the lights stay on twenty-four hours a day. I love the collections of newspapers clippings and memos which accumulate on any spare wall space on a hospital unit. I love the personal photos nurses tape to their lockers, and I love knowing where they hide the emergency stash of Hershey's miniatures. I love the clutter and disarray of a charting room: the collection of old coffee cups and bits of confetti from punching holes in lab results littering the floor, a textbook left open on the counter and shoved aside, the rabbit-like multiplication of paper clips which gather in any drawer.
I love the way the housekeepers patrol the hallways, with looks of mixed dread and affection for the state of our worn linoleum floors. I love the quirky equipment, such as the office chair which always tilts forward and threatens to eject its occupant into the next room, or the IV pump which beeps no matter how many times you tap the air out of the line or adjust the volume to be infused. I love the sight of the meal cart being rolled down the hallway as I exit a patient's room, because I know the patient is hungry and there is something coming for him to eat. I love the fact that, even if the food is not very good, it is made with a great deal of pride and care. I also love the awkward moment when the laundry cart makes its way down the hall and has to be maneuvered by its handlers around the meal cart, laundry hampers, and vital sign machines we can never quite stow away properly. I love the cheap, thin linens hospitals stock, so thin but so plentiful, you can grab an armful of towels and never worry about running out.
I love our volunteer's gift shop. They sell Burt's Bees products and locally-made chocolate bars, and Moleskine notebooks. Every week they sneak out a box of Sees candies to Med Surg for the nurses, gift-wrapped no less, and I love the way we can demolish that box of candy within an hour.
I love knowing where all the coffee makers are, and which units stock Coke and which stock Pepsi. I love sneaking into the cafeteria at night and raiding the ice cream freezer. I love the way wooden tongue depressors can be used as cream cheese spreaders. I love the way unit clerks collect the little plastic tops that come off of medicine ampules. These fill dozens of mason jars in a number of local homes, I am told, to one day become a craft project. I have a jar of them myself.
I love listening to the nurses problem-solving in the background, even though I wish fewer of their solutions involved asking me questions. I love the way our pharmacists make rounds and nudge me good-naturedly to renew my TPN before the sun goes down each day.
I love watching the staff executing the same, tedious, time-consuming process of taking in their patients, getting to know their problems, their personalities, their individual quirks and universal challenges. I love the way most of them manage to create an individual healing experience for so many different kinds of people. I love the way even a ward clerk, who has no medical training, can answer a patient's call bell with the expectation, the hope, of doing a good thing. I think a hospital is a unique setting for that set of expectations, far different from a corporate office, and closer to a church than you might imagine.
I will probably come to love another hospital as much as I love Gimbels, but knowing this doesn't make the leaving any easier. Neither did the discovery, upon my return from the restroom where I bawled my eyes out for ten minutes, of a fresh box of Kleenex left at my desk, its cardboard opening carefully torn out and illustrated with a Sharpie-drawn valentine.
I just graduated nursing school and loved reading this post. Doing my preceptorship and spending much time in a hospital setting, I have come across many dr's who seem to be robotic and have no emotions! I am loving the details you collect and the passion you bring to the table. Thanks for the refreshing post!
Posted by: Marcela | June 30, 2009 at 02:39 AM
Beautifully written and very inspiring. Thank you for sharing!
Posted by: l33t MD | June 17, 2009 at 03:45 AM
I wonder, should they take a moment between sorting the beans and counting them. Would they understand 1 word of what you wrote?
Well said and much apprecated.
Posted by: William | June 16, 2009 at 08:05 AM
Dr. Chan,
Thank you for a wonderful post. I feel for you. Few people realize what this work takes out of us sometimes. Can't offer much comfort...but if I could give you a Kleenex box valentine I would. Good luck next shift.
PA Moore
Posted by: Mike Moore | June 15, 2009 at 10:14 PM