Friday, March 17, 2017

Fear and Loathing in French Camp


Hello My Beautiful Reader,

I hope you are well. I feel like we should just hug each other next time I see you. As you probably heard from my incessant whining and complaining- Steven and I are doing part of our surgery rotation in Stockton. We live in a shitty building with no hot water and there are spiders. Spiders. Ugh.

But it is important for me to tell you more about what this county hospital--built on an alpaca farm--on the outskirts of one of California’s most dangerous cities, is like.

Recently I bonded with Dean Henderson over the use of paper charts—something this hospital still uses. In the mornings, before rounds, the med students have to get there several hours early to run around and write down all of the vitals from the paper charts overnight for the residents—something Henderson himself remembers doing when he was in med school—like 30 years ago. I’m not bitter…not bitter at all. But paper charts are dangerous and they waste everyone’s time. I know EMR has its problems but its 2017 people. Get with the times. You cannot check medication interactions on paper and I can’t read your god damn handwriting.

Another absurdity that takes place here is the design of the hospital building itself. Let’s just say it puts the east wing of UCD to shame. There are two buildings, the newer part and then an older building called the towers- a medieval looking building made of stone bricks. Interestingly enough if you are standing on the third floor of the new building and then walk across the completely flat breezeway to the towers—you would find yourself on the 4th floor—without actually going up a floor. It’s a relic of how the floors were numbered and its super weird. Steven likes to tell me where to go in the hospital by using words like, “north”  and “south.” These words mean nothing to me Steven. Nothing.

Amidst this rather shitty building, with its shit system of patient record keeping and stupid layout, there are some really sick folks.

This morning when I was walking through the ER waiting room, the inscription of the Statue of Liberty came into my mind.

"Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door!"

I know it sounds a little saccharine, but the people sitting in the ER waiting room, in Stockton at 4am—well they look pretty tempest tossed to me. The hospital is full of people whom society has forsaken and forgotten about. One of the features that was advertised to us at the start of our time in Stockton was that the pathologies of patients were “really good.” And of course by really good, they mean really bad. Disease so advanced we might only expect to see it in other, underdeveloped nations. And yet here they are, right in our own backyard. We see patients so in the grips of poverty or mental illness or drug use or victims of violence and tragedy of tremendous proportions.

We often visit the room of a recent trauma patient we saw. We peak our heads in and see family and friends visiting, leaving pictures and notes and whispering words of love and encouragement. We look up recent labs and imaging and physician notes—anything that might give us a glimmer of hope that things won’t end terribly for this family. Sometimes we glance in the direction of the room and shake our heads or ring our hands.

Stockton is a place of paradoxes. In spite of limping along with paper charts and poor design, this hospital catches our most vulnerable and for the many victims of violence in Stockton has often been the only thing between those people and death. Our trauma patient is getting good care. People who come to this hospital get help—although its often not nearly as much as we hoped. I think the woman who delivered her baby on the floor of the ER waiting room might attest to this. It’s a miracle-- but its messy and not anything like we thought it would be.

We only have a week left in French Camp, and while I can’t wait to get back to Davis, I am reluctantly grateful for my time here. While I will continue to fly into a rage about the copious amount of carpeting in the hospital (who does that?) and the fact that I spend my day tracking down charts, I have nothing but respect for the men and women who show up everyday to an imperfect building, with an imperfect system, in city rife with problems, to help people with no where else to go.


Thursday, March 9, 2017

Admit


I have often wondered what it feels like to be a patient in the hospital.

My personal experiences as a patient have been limited to the occasional clinic visit, having my wisdom teeth removed and a brief visit to the ED when I was 17, after cutting my foot open while backpacking in Point Reyes.

For all intents and purposes I stay securely and safely on the provider side of things. We get to keep our clothes on, we can for the most part eat what we like, drink what we like and unless you happen to be retracting in the OR for hours on end, we can use the bathroom when we want to.

Sure it can be a little uncomfortable and down right exhausting to be working in the hospital taking care of patients. I’ve started to refer to all the walking and rounding and standing we do as ‘slogging in my clogs,’ and I know you know the feeling. But when it comes to actually being a patient, no less one who is acutely ill, we don’t know the feeling—at least not most of us anyway. So we are left to imagine what it might be like.  

The other day I was helping an intern pack a horrendous and impossibly deep abscess and as we pulled miles of blood soaked curlex out of the wound I got to wondering what that must feel like. Vomit started to well up in the back of my mouth.

I don’t really want to be sick or hurt. Because who the hell does? But I do want to understand just a little bit better the loss of control patients must feel, the fear, the embarrassment and the sleepless noisy nights and rude early morning wake up calls.

Back in the day it used to be a fairly common practice to admit medical students to the hospital under a pseudonym and a fake (albeit mild) diagnosis, in order to allow them to experience the hospital as a patient. The Long Beach Medical Center still has a program like this—the only one left in the country started by an Australian Family Medicine physician, Dr. Stephen Brunton. You can read more about that program here. 

Programs like this one are insanely difficult to do. Hospital resources are stretched so thin these days, they aren’t about to waste them just so trainees can try on a hospital gown for the evening. But I maintain that the lessons the participants learn from a brief time in the hospital is immensely valuable. And if hospitals care about patient satisfaction the way they claim, then I’d like to see programs like this become common place.

So I started sending emails out to hospital CEOs and CMOs, ER directors and the like, asking if I could spend a night in their hospital. The answer was a swift and resounding absolutely not. Even the task of having the IT department create a fake EMR for me was too great a task for most hospitals to manage. Additionally, I think that hospitals also feared that real harm might come to me. And perhaps they are right to be concerned, after all medical mistakes result in thousands of deaths across the country each year.

For now, I have been attempting to experience patient life in other ways. For one, I tried patient coffee the other day. No—not the coffee in the cafeteria, but the brown liquid served up in miniscule Styrofoam cups. I don’t know what it was, but it sure as hell wasn’t coffee. I also let my friend Millie put me in an MRI machine for two and half hours to study my brain for her PhD. It was okay I guess, a little loud for my liking, but at least now I have confirmation that my headache isn’t a brain tumor. And finally, I am feebly attempting to live my life as a diabetic—a diagnosis I do not really have. I have tried to write down my carbs and test my blood sugar, but after bleeding like a stuck pig all over our kitchen after repeatedly stabbing my finger with a lancet I am taking a bit of a break. Because being diabetic sucks and I can’t do it.


I hope you never actually get to be a patient in the hospital. And unless we are actually facing illness or injury our experience will always be limited. But let’s challenge ourselves to experience more of what it might be like. Try laying on one of the gurneys to see how it feels. Let someone practice starting an IV on you so you can know how badly it hurts. Try on a Philadelphia collar (literally the most uncomfortable neck brace ever). 
And if in doubt about where to start to get to know hospital life, talk to your patients, ask them more, drink the coffee—I dare you.