This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
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.
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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.