I’ve always found something magical at hospitals during the break of morning. There is a stillness, a limit of movement, the sparse and necessary only. Silence reigns, punctuated only by the passing of clogs or the squeak of wheels. Voices are low, the cheesy music has run of the speaker system, and the hushed hospital seems to be waiting for the burst of activity precipitated by the morning staff. It resembles nothing more strongly than the piercing GLOSS of the gloaming. I love it — I’ve always loved it, from all my time in hospitals, as patient, as visitor, as student. There are not many things I will get up at 5am for, and this is one of them.
We get to listen to, if not meet, Dax Cowart today. When I finish my breakfast, I’m going to head over to the library and do some refreshing — I couldn’t find Jecker and Jonsen’s textbook with it as case example last night, the curses of not being unpacked. Still, details of the case will probably stay with me as long as my memory lasts. Dr.’s Jecker and Dudzinski both used this case in their courses, as well as the video “Please Let Me Die” that Sue opted not to show us last week. I remember that, with Dr. Jecker’s course, it was a class required of medical students, and most took it in their last year. One of the things that stuck with me was their reactions to the video; I didn’t know quite as much about medicine then, and I knew that if it was something that the to-be doc’s were shocked over, it was definitely an appropriate (as opposed to squeamish) response from me.
I’m really interested to hear what he has to say to us. I know he went on to get his law degree; what I wonder is what Lantos mentioned in his book, that I came across last night: people who survive the ICU most often say they would go through the experience again, even though they felt like they were being tortured. In fact, I should have brought the book, instead of leaving it on my bed, so I could reference the study he quoted, and ask Dax that with specifics and citations, should he not mention it himself. Is he grateful to be alive, blind and impaired, or would he have rather died? He suffered so greatly; I can’t even begin to imagine. Even at the depths of my despair and inability to move or get out of bed, shrieking pain raging through my body, I’m not sure a serious wish to die crossed my mind. Of course, maybe that’s part of Lantos’s point: I don’t recall it, but I know the people who cared for me do. Endorphins at that level are mysterious beasties, full of magical erasing power…
A group of medical students just walked in. Clumped together in an uncertain herd, starched and gleaming white coats, without any stains, standing out compared to the doc’s scattered here and there in the dining hall. They’re trying so hard not to make eye contact with anyone in scrubs or dingy grey long coats, and in return the people in the worn coats and rumpled scrubs are giving them long, knowing looks, and occasional kind smiles.
I don’t remember when I first realized that coat length could actually mean something, or how to spot the difference between a medical student and a resident, or what the hierarchy was in a hospital. Given how often I was in them as a kid, it was probably not a long time coming. I do, however, remember the first time I was with someone who was figuring the system out. I had been at a holiday party this past Christmas, and horsing around with a couple of the people I’d just finished teaching with. Despite the fact I was cold sober (and admittedly the only one), I managed to get drawn into duct taping a colleague to the floor — and kicked across the room for my effort. The long story short, I ended up in the ER about 6 hours later, admitting that my self-diagnosis appeared wrong. Mostly because I was in so much pain I couldn’t stand it; the intern nicely put me on a morphine drip the minute he heard my chronic pain history. A while later, when I wasn’t screaming and trying to physically harm anyone touching my wrist, the intern returned with his cadre — and my friend who’d accompanied me to the hospital, largely from guilt, as he was the one who’d caused the damage, jumped up and hovered over my bed protectively. He looked straight at the medical student in the group and told him, in no uncertain terms, to get out. The intern looked at me, while the med student turned white and didn’t even wait for my assent before he left. Seems that the two of them had taken a class together the previous year, and the med student was, in my friend’s terminology “a complete pothead loser” — and he didn’t want the student touching me or causing any more pain. Flattering, of course — but I felt a bit weird about it, too. After all, UW is a teaching hospital… A little later, when I was resting comfortably, sedated and full of enough morphine to hold up my end of a conversation, he told me he’d never realized that there are different white coat lengths.
I’ve had a lot of procedures done, and I do try to pull whatever charm I can to make sure the attending does as many as possible. My last nerve block, my attending sweetly asked if his star resident could do the procedure, and I consented… and had the terrifying experience of hearing my doc tell the resident to go further with the needle, and the resident saying “I can’t, I’m hitting her spine.” Nevermind the fact that, due to how I was positioned, I could see every detail on the fluoroscope (partially out of request — my doc’s always got a kick out of the fact that I wanted to understand what was going on). Not the most fun thing in the world to hear!
Still, even though it took him a dozen sticks, and I was bruised and sore for weeks, nothing truly bad came of it. I got my nerve block, the resident got his experience, and he got it on someone who was willing to tease him about it, rather than yell. Isn’t that the point?
And yet, the more I learn about medicine, the more inclined I am to find the best. The most experienced. The one who’ll cause the least pain while maximizing my own benefits. And I wonder if that’s fair? In a very short while, I’m going to be the one reading charts and weighing in on contentious issues. No matter how much experience I have analyzing case studies, doing four-boxes in my sleep, and running through practice exercises, it’s different in actual practice, and I’ll be a novice. A supervised novice, but a novice nonetheless. By coming to a teaching institution, people are implicitly, although I’d argue largely unknowingly, agreeing to be learned upon — and that learning is going to include my own. Shouldn’t I acknowledge that and offer myself as a learning agent when possible, as gratitude to those I’ll be learning on? Isn’t that the morally right thing to do, rather than see an intern and nicely ask to see the resident or attending, instead?