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Unofficial Prognosis

Unofficial Prognosis


Perceptions and prescriptions of a medical student
Unofficial Prognosis Home

Because I work in a hospital, I can’t help you

The views expressed are those of the author and are not necessarily those of Scientific American.


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Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.

She was 99 years old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, I’ve never had surgery before. Yes, I have sleep apnea. Just gonna place your IV! It’s a highly controlled, organized process. Nurses, anesthesiologists, surgeons come with specific tasks to be done: forms to be signed, equipment to be placed. Once each box is checked and the operating room is prepared, we can roll you back.

She was not my patient. I did not even know her name. But I knew she was upset. Anyone within earshot could know that.

I’m in pain! she yelled. I’m in pain!

If you don’t help me, I’m going to scream!

Then, fulfilling her promise, she screamed. And kept screaming. Around the corner, I and some others identically outfitted in blue scrubs and blue surgical caps stood around and continued our business. We stood there and wrote medication orders, sent emails, and checked pagers, while a few feet away a 99 year old human being cried for help.

She wasn’t our patient.

“I hope I never live to be that old,” a set of blue scrubs standing next to me said, the only acknowledgement of what was happening.

*

Working in a hospital, I am immersed in human misery on a daily basis. I’ve assisted in surgeries to amputate limbs and remove tumors the size of babies. I’ve wheeled beds down hallways while the patients lying in them groggily awakened from anesthesia, confused and in tears. I watched the reaction of a mother and father told the four worst imaginable words about their child – “he didn’t make it” – and I’ve seen cardiac arrests that ended in flat lines. A man once begged me to “take the whole thing off” while I was stitching a foot-long gash in his leg, his pain so excruciating.

Often on the way to do these things, I pass misery I know less intimately. I see my patient in hospital bed B, walking past bed A where a person is moaning into her pillow. I see a consult in the emergency room and on the way there pass ten others. Some might be yelling. Some might be crying. Some might be writhing in pain. I have seen human suffering I cannot un-see, heard things I cannot un-hear. I have seen acute traumas that immediately steal a person’s well-being, chronic illnesses that gradually chip away at human dignity, and in between.

I brush past most of it. At any given time, I am on a certain medical team, meaning I have a panel of patients who are mine. I see those patients for whom I am responsible, and I don’t see those patients on other medical teams. I know they have care here; they have their own doctors, nurses, medical students, social workers, and others looking after them. That is the system. We play very defined roles in a complex and intricate health-providing system. Veering from those parts could at worst harm patients or at best get us in trouble.

Contrast that with, say, one block over. The odd realization was that had I met any one of these people outside the hospital walls – with me outside the confines of my white coat and them outside the confines of “not my patient” – I could do more. Without fear of crossing boundaries, breaking rules and, interfering with care, I could actually intervene. I wouldn’t perform care I was not equipped to do, of course. But I could talk to strangers, listen to their problems. In the hospital, my role is defined and limited. As a concerned citizen, it has the freedom to be considerably broader.

That’s not to say the system is fundamentally flawed. It’s what coordinated care looks like, and it makes sense. There are extremely good reasons for organizing care and delegating responsibilities. Something as simple as giving a patient a glass of water is not something you want to interfere with if he isn’t someone you are directly caring for; maybe he is on nothing-by-mouth restrictions because risk of aspiration into his lungs, or maybe he is preparing for an urgent surgery. Certain doctors take care of certain subsets of patients and report to certain higher-ups, and it’s for quality of care reasons that it is arranged this way. It would be chaos otherwise. All would suffer as a result.

But I can’t escape the irony that in a place devoted to helping, all the times I can’t help, and I can see why a perspective of doctors as distant exists. I think of what we look like on rounds: white coats walking in packs, walking (often rushing) toward some destination, ignoring everything we pass along the way. The image of a person in a hallway calling for help and a group of doctors – doctors of all people! – walking by without a second glance.

No, I am not desensitized to what I am passing. It’s not my fault! I want to say. I wear a white coat and ID badge that says I work here, and I have a role, and that keeps me from getting close. I remember the words they told us at orientation, “Your job is to direct them to the next point of care.” Here is how you press your nurse button. Down that hallway is where orthopedics is. I direct them to the next point of care.

Then I hurry off.

*

Your patient, M, is calling for help, I say to a nurse, and she goes over. I overhear “how can I help you, hun?” as my resident whisks me away into the operating room, for the surgery we are about to do, for my own patient whom I am supposed to be there for at that moment.

Had I met her anywhere but the hospital, I would have gone over.

It’s a cold realization: In my job aimed at relieving suffering, I experience most of it as a passive bystander, from afar.

Ilana Yurkiewicz About the Author: Ilana Yurkiewicz is a fourth-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was an AAAS Mass Media Fellow, and her work has appeared in the New England Journal of Medicine, Aeon Magazine, Science Progress, The News & Observer, and The Best Science Writing Online 2013. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues. She is also interested in general internal medicine and quality and systems improvement. Follow on Twitter @ilanayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. ttheobald 8:06 am 10/9/2013

    That sucks. I see why it is set up that way, but that really sucks.

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  2. 2. BillR 8:53 am 10/9/2013

    As an engineer, I understand the need for order and organization. But I do not think I could handle that kind of job. I would become an emotional basket case within a day. But I do appreciate being able to see this from your perspective. It is so easy to blame the doctors and nurses as being unfeeling when in reality they cannot allow themselves to feel to much or they would no longer be able to do what is needed. A hard life to live.

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  3. 3. Marina1 9:36 am 10/9/2013

    You are showing the classical signs of desensitization as i observed from your bio that you are a third year medical student. I suspect by 5 years into your career you will be just like the other doctors you see around you. It is unfortunate the way the medical system is set up as you noted “assisting the patient in pain may cause more harm then good” as you would not be familiar with her medical problems.

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  4. 4. RSchmidt 2:51 pm 10/9/2013

    From what I understand, one of the differences between the Canadian and American systems of nursing is how patients are allocated. For example, in Canada a nurse might be assigned a few patients one that requires a great deal of care and others not so demanding. Whereas in the states the nurse with seniority gets the light load and the ones with less seniority get all the demanding patients. A friend who moved to the states told me that it was a common sight that more senior nurses would be sitting around doing nothing while the newer nurses would be running around trying to see everyone. Perhaps this is why there are patients screaming for help. This is of course a second hand anecdote.

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  5. 5. rockjohny 6:13 pm 10/9/2013

    It’s a good thing there are those wired to deal with that pressure; where would we be without them? I’m sure a field full of wounded Civil War soldiers would have still been moaning and screaming if they were getting help – better than being left there to die ‘moaning and screaming’ which was the case many times.

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  6. 6. StevedeBurque 8:51 am 02/18/2014

    I note with endorsement the response of Marina, “You are showing the classical signs of desensitization..I suspect by 5 years into your career you will be just like the other doctors you see around you. It is unfortunate the way the medical system is set up as you noted “assisting the patient in pain may cause more harm then good” as you would not be familiar with her medical problems.”
    In a culture where deviation from the mean is alarming, to break from rounds to attend to a suffering patient is abnormal, and abnormal is bad. Since young students are trained to be enthusiastically mediocre, independent behavior raises alarm in the herd; and nobody who alarms the herd goes unpunished, in the unwritten law of medical training. If that counts as “desensitization,” perhaps it is. More truly, it reforms the suffering patient from a compassionate person to a threat, in medical culture.

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