Monday, July 18, 2016

UC Davis Island

I was promised a “psych-ation.” You know, like the chillest, easiest rotation of all. I was expecting to wake up at a reasonable hour, have coffee, walk to the hospital, have more coffee, pretend to be a doctor, look busy typing on a computer and then leave for the day (also at a reasonable hour). Psych is supposed to be the Hawaiian vacation of rotations and after internal medicine I was looking for a break.

The trouble is, I wasn’t expecting the patients to have such complex social problems and for Sacramento to have so few resources. How can a hospital function when there is nowhere to send people. What’s a hospital to do with people who become stranded here. Survivors who have some how made it through the doors and past triage should no doubt be received into the arms of some kind of safety net, or options or something.

I know you know. I know you recognize that we don’t do enough in this country to help those who need it most. So I’ll spare you a boring paragraph about the budget, our politicians and our priorities.

Its just so hard to help people and I didn’t think it would be like that. Maybe that’s why I’m so tired at the end of the day. Not because I walked 10,000 steps because the psych work room is in the farthest possible reaches of the basement, but because I’m so defeated at notion that we are not going to be able to fix everything. Not because we can’t, but because we won’t.

I can come around to the fact that people have medical problems we can’t cure. I get that. People get sick sometimes and there is nothing we can do. But when there is a solution and we do nothing…well then now we have a problem.

I find myself running around the hospital getting people juice and crackers. Finding them a book or a DVD, offering patients in the ED showers or a phone or fetching clean clothes from upstairs.

You don’t have to do that,” an intern said to me, my hands full of graham crackers for our patient who has been in the ED for 6 days. 

But the thing is, that I feel compelled to bring people the little things we can do, because I know the big things, like finding them housing or getting them into a rehab center are much harder, next to impossible tasks. And honestly, sometimes we just discharge people to the street. There just aren’t places to send people and we can’t keep them. Its like catch and release. Treat em and street em.

I didn’t know psych-cation would be like this.

President Obama said it best on Seinfeld’s Comedians in Cars Getting Coffee, “bad stuff and stupid stuff is happening everyday.”

Truer words indeed Mr. President.

I think this is part of the reason doctors burn out. Who can stand working in a broken system for years on end? I bet it gets to you.

I suppose the only saving grace is that sometimes things go right. In spite of a complicated, stretched thin network of resources. People are helped. Its never as shiny and beautiful as I imagined. It’s a bus pass, or a train ticket, or some food. One patient who came in looking for help is now off drugs and has a sober living community to go to. Its a miracle, but not even close to how I thought those things are supposed to go. 

Anne Lamott, who's work was recently featured on Orange is the new Black says, “I wish grace and healing were more abracadabra kind of things. Also, that delicate silver bells would ring to announce grace's arrival. But no, it's clog and slog and scootch, on the floor, in the silence, in the dark.” 

I wish it was easier. I wish helping people took as much effort as raising a fruity drink with a tiny umbrella in it to my lips.

I know psych-ation isn’t real. But that's okay. What we're doing is real, and its hard and messy and complicated, but its honest and it means something.

And I bet you're already getting ready to it again tomorrow.

Sweet dreams friend.