All In a Day's Work

36 hours awake now- and still writing. Well, I actually snuck in a nap around 2am (19 hours ago) when my ICU patient was as tucked as we could get him for the night (or morning- they tend to blend together these days). But don't worry, this isn't a woe-is-me opportunity to elicit sympathy from non doctors and "been there" from those in medicine. In fact I'm enjoying the quiet.

Hospitals are not quiet places. In fact, I am bombarded by more pagers, beeps, buzzers, alarms, overhead alerts, ambulance sounds (if I step outside for one second), elevator door dings and other noises than I ever expected. This is among the things one doesn't know when they sign up for the life of a doctor: The noises are always present and reliably annoying. Once, a few years ago, I was senior resident on a medical team and we were all in an elevator and I blurted out "Do you hear that?" And everyone listened intently- until I added, "that's the rare sound of silence," which was met with knowing smiles. The med student asked, "Do you guys get headaches a lot around here?" I had never really thought about it. I had indeed had a slew of headaches since medical school, maybe one or two a month which was new for me- and then I started to realize that almost every nurse I knew carried Tylenol in their bag, and that almost every colleague of mine was asking for Tylenol from a nurse at some point. I had never drawn the conclusion that all of those noises took off from their respective machine, only to make a turbulent landing somewhere between my inner ear and the part of my brain that is supposed to make sense of such sounds- and the result was not pretty. In fact, by the end of a shift, doctors, nurses, techs and other who work the halls of the hospital aren't in the best shape. We have bloodshot eyes, and we are often irritable. It is commonplace for folks to lose the most basic communication skills and small arguments between nurses and docs, docs and docs, nurses and nurses, anyone and a complaining patient are not uncommon, especially as the day wears on. This article is interesting and skims the surface of what has now been widely recognized: Hospitals are WAY behind on creating a business environment in which people respect some basic rules of working together (oh, and I happily disclose that I have no affiliation with the company):

http://www.lftinc.com/content/about-our-company/newsletter/detail.jsp/q/id/15

And this MSNBC article, while a tad sensational for my taste, is really interesting and touches on what is happening to change the hospital environment:

http://www.msnbc.msn.com/id/25594124/

In all fairness to myself and my overworked, underpaid colleagues (I'll touch on trainee payment and how much debt I'm in another day), hospitals are also stressful places. Where else, in a day, do you come across the sick and dying on almost every floor. Commonplace are sights that are frightening- tubes coming out of places that shouldn't have tubes, blood, people the color of Big Bird, or Oscar The Grouch, as yellow and green as yellow and green get. I always wonder, when I see people bring their children to the hospital, what nightmares they might have from an afternoon in those halls where I have spent every day for years. This is not a place for people unprepared for the truth about the human body: It breaks down. It is as frail as a leaf. It isn't built to last forever.

So I suppose this is all sort of somber (OK, downright depressing) this evening. And in order to remind myself, and you, why anyone would do this, I will leave you with this:

A mother of a mentally retarded man sat on his bed with me yesterday and asked me if I would mind explaining to him what he was doing in the hospital and where he was heading next (a rehabilitation center). I began to speak with him (which I had done daily in her presence) and he nodded as I spoke about his condition and his treatment and that he was improving and would return to his mother's home soon and play checkers again and play with his dog again and watch Baywatch DVDs and live happily. As I reminded him of the things that he loved in life- all of which he shared with me in these past weeks, all of which peppered the walls of his room in the photos that his mother brought and posted- he smiled broadly. When I was done there was silence. The mother dried a tear from her eye. This has been a terrible week for her. She has been living in a hotel next to the hospital since their home is hours away. She has come every day and kept a log of what we say and had to meet well over 50 doctors caring for him in these weeks and seen team after team press on his belly and seen the looks of kindness and compassion and sometimes awkwardness on the faces of his caretakers who want to connect with him but somehow can't. She dried that tear and probably hoped that for an instant he might forget this terrible month-long admission and remember fresh air and sky and fun. She hoped. And in that silence and his smile I knew that he had made this connection. And he pointed to the wall and said "My dog!! I'm gonna see my dog!"