It's common wisdom that surgeries are better done at high-volume centers. Specialists should do what they're best at - this reduces errors.
By analogy, medical schools should do what they're best at. Different medical schools are (I speculate) better at educating different types of doctors: NYU might be better at training primary care physicians, while Columbia (to pluck a name out of the air) might be better at training future cardiologists.
So why can't medical schools specialize? Why not telescope the long and tiresome haul of medical school-residency-fellowship into a single training program?
We know "physician" is a variegated profession. Why must all doctors be trained the same? Wouldn't it make sense for a medical school to be able to choose an area of specialty, rather than trying (fruitlessly) to be all things to all possible future doctors?
Showing posts with label medical students. Show all posts
Showing posts with label medical students. Show all posts
12/1/05
No longer confused, not yet overwhelmed
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
6/9/05
MEDICINE MENSCH
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
5/12/05
Public and Private
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
3/31/05
Lost and Found in the Call Room
Medicine Mensch 5 is here, so you can continue your vicarious medical-school education. (Study hard, there'll be a test later.)
Update: 4, not 5. You haven't missed one.
At long last: I'm posting the whole thing below (I had to ask my Forward folks if it was okay first), and I'll post my other Medicine Mensch articles on my blog over the next couple of days.
MEDICINE MENSCH: Has Anyone Seen a Wedding Ring?
By Zackary Sholem Berger
April 1, 2005
In between patients, each room in the hospital has a life of its own: The operating theater is prepped for another run; the delivery room is ready for another baby to come down the pike. Everything's sterilized and rearranged. While the attendants and residents wolf down their cheeseburgers, a medical student (that's me) retreats to the residents' call room to make quick work of his dependable cheese sandwiches and raisins. ("Oh!" a resident says admiringly. "You're so healthy!" "No," I respond. "I'm kosher.")
The call room is a place that many patients wouldn't want to see, since its workaday normality might disappoint those who expect their doctors to be something other than run of the mill. Imagine your break room at work, but without the stern hand and refrigerator-clearing punctiliousness of an office manager. This room is furnished with chairs that also have served as footstools and as impromptu beds; a refrigerator higgledy-piggledy with old lunches, and a TV talking to itself. Off the main call room is the back room, with a bunk bed; piles of white medical jackets, coats and other clothing, and a box of shoes that hasn't been touched since the Ford administration. Project onto this backdrop the rhythms of any workday: petty frustrations and jealousies, hot- and cold-running gossip, and unavoidable tedium, and you can understand why "ER" never could be called "Call Room."
Last week I lost my wedding ring in the back room. It's probably still there.
It happened like this. I had a week of observing surgical procedures. Surgery, like a symphony orchestra, is fascinating in the abstract but puts me to sleep after the first 30 minutes. I strain to keep my eyes open; I think of chapters from the textbooks I'm studying; I say Psalms under my breath; I eat a good lunch and sleep right; all to no avail. Luckily, my head jerked up with a start just as I was about to fall, face first, into the instrument tray.
Observing procedures is a lot less boring when your hands are allowed into the surgical field. "This is the aorta," a surgeon said during one procedure, and I said to myself, "Put it away before something happens to it!" Nothing untoward happened, even though I was only 18 inches away — partially because I wasn't allowed near any of the knives. My job was to retract, to pull apart the edges of the incision to allow the surgeons to see as much as possible.
Even for this minimal participation I had to get ready like the high priest entering the Holy of Holies. Before I donned the surgical gown and the surgical nurse held open the gloves so that I could stick my hands down into them, I scrubbed up just so. First fingernails, then sides of fingers, then fingers, palms, backs of hands and arms. I was cleaner than I'd ever been in my life. This reminds me of washing hands before breaking bread, which is similarly governed by precise detail but for a very different purpose: not cleanliness, but sanctification through the remembrance of Temple purity. In both sorts of washing, extraneous objects must be removed from the hands (although, relying on some fairly obscure leniencies, I don't take off my ring before washing for bread). I took off my watch and stuck it in the pocket of my scrubs. The first time I ever scrubbed in to a surgery (a long three weeks ago), I forgot to take off my wedding ring. As I stuck my left hand through the sleeve of the surgery gown, ready to meet the glove midair, the nurse raised her eyebrows as she glimpsed the band on my finger. "Uh-unh," she said. I retreated to the sink and started over.
Before long, I had come up with a place to store my wedding ring before scrubbing up — my Palm Pilot case — and had congratulated myself on my cleverness. Last week I was getting my things together after a long and frustrating day. I had gotten up at 3:15 a.m., arrived at the hospital at 4:30 a.m. to write notes on patients' progress after their surgery, and stood at drowsy inattention during a six-hour procedure at which I did not fall over onto the patient. I was standing in the back call room — the one with the bunk bed, piles of clothing, a box of neglected shoes and a general air of summer-camp disorder — ready to restore myself to everyday life, complete with wedding band, and go home. I opened up the Palm Pilot case, and, with a happy clink, the ring sprang free to find a new home. I haven't seen it since then.
Of course I got upset, like any normal person. But it's hard to stay annoyed about things you've lost when among the patients you see the next morning is Dolores, a woman who had a hysterectomy as a treatment for uterine cancer and (as a bonus) some of her very large stomach removed to make the operation easier. At 6 in the morning, awakened by a medical student's awkward questions, she was hardly even put out, and very happy with the belly button reconstructed for her by the surgeon. Here's to her new navel, and here's to whoever finds my wedding ring. May you use it on happy occasions.
Zackary Sholem Berger is a medical student, but someday (he hopes) he'll be a doctor. This series of columns traces his metamorphosis from one into the other. Send comments, complaints and lost-and-found notices to doctor at forward dot com. No medical advice given.
Medicine Mensch 5 is here, so you can continue your vicarious medical-school education. (Study hard, there'll be a test later.)
Update: 4, not 5. You haven't missed one.
At long last: I'm posting the whole thing below (I had to ask my Forward folks if it was okay first), and I'll post my other Medicine Mensch articles on my blog over the next couple of days.
MEDICINE MENSCH: Has Anyone Seen a Wedding Ring?
By Zackary Sholem Berger
April 1, 2005
In between patients, each room in the hospital has a life of its own: The operating theater is prepped for another run; the delivery room is ready for another baby to come down the pike. Everything's sterilized and rearranged. While the attendants and residents wolf down their cheeseburgers, a medical student (that's me) retreats to the residents' call room to make quick work of his dependable cheese sandwiches and raisins. ("Oh!" a resident says admiringly. "You're so healthy!" "No," I respond. "I'm kosher.")
The call room is a place that many patients wouldn't want to see, since its workaday normality might disappoint those who expect their doctors to be something other than run of the mill. Imagine your break room at work, but without the stern hand and refrigerator-clearing punctiliousness of an office manager. This room is furnished with chairs that also have served as footstools and as impromptu beds; a refrigerator higgledy-piggledy with old lunches, and a TV talking to itself. Off the main call room is the back room, with a bunk bed; piles of white medical jackets, coats and other clothing, and a box of shoes that hasn't been touched since the Ford administration. Project onto this backdrop the rhythms of any workday: petty frustrations and jealousies, hot- and cold-running gossip, and unavoidable tedium, and you can understand why "ER" never could be called "Call Room."
Last week I lost my wedding ring in the back room. It's probably still there.
It happened like this. I had a week of observing surgical procedures. Surgery, like a symphony orchestra, is fascinating in the abstract but puts me to sleep after the first 30 minutes. I strain to keep my eyes open; I think of chapters from the textbooks I'm studying; I say Psalms under my breath; I eat a good lunch and sleep right; all to no avail. Luckily, my head jerked up with a start just as I was about to fall, face first, into the instrument tray.
Observing procedures is a lot less boring when your hands are allowed into the surgical field. "This is the aorta," a surgeon said during one procedure, and I said to myself, "Put it away before something happens to it!" Nothing untoward happened, even though I was only 18 inches away — partially because I wasn't allowed near any of the knives. My job was to retract, to pull apart the edges of the incision to allow the surgeons to see as much as possible.
Even for this minimal participation I had to get ready like the high priest entering the Holy of Holies. Before I donned the surgical gown and the surgical nurse held open the gloves so that I could stick my hands down into them, I scrubbed up just so. First fingernails, then sides of fingers, then fingers, palms, backs of hands and arms. I was cleaner than I'd ever been in my life. This reminds me of washing hands before breaking bread, which is similarly governed by precise detail but for a very different purpose: not cleanliness, but sanctification through the remembrance of Temple purity. In both sorts of washing, extraneous objects must be removed from the hands (although, relying on some fairly obscure leniencies, I don't take off my ring before washing for bread). I took off my watch and stuck it in the pocket of my scrubs. The first time I ever scrubbed in to a surgery (a long three weeks ago), I forgot to take off my wedding ring. As I stuck my left hand through the sleeve of the surgery gown, ready to meet the glove midair, the nurse raised her eyebrows as she glimpsed the band on my finger. "Uh-unh," she said. I retreated to the sink and started over.
Before long, I had come up with a place to store my wedding ring before scrubbing up — my Palm Pilot case — and had congratulated myself on my cleverness. Last week I was getting my things together after a long and frustrating day. I had gotten up at 3:15 a.m., arrived at the hospital at 4:30 a.m. to write notes on patients' progress after their surgery, and stood at drowsy inattention during a six-hour procedure at which I did not fall over onto the patient. I was standing in the back call room — the one with the bunk bed, piles of clothing, a box of neglected shoes and a general air of summer-camp disorder — ready to restore myself to everyday life, complete with wedding band, and go home. I opened up the Palm Pilot case, and, with a happy clink, the ring sprang free to find a new home. I haven't seen it since then.
Of course I got upset, like any normal person. But it's hard to stay annoyed about things you've lost when among the patients you see the next morning is Dolores, a woman who had a hysterectomy as a treatment for uterine cancer and (as a bonus) some of her very large stomach removed to make the operation easier. At 6 in the morning, awakened by a medical student's awkward questions, she was hardly even put out, and very happy with the belly button reconstructed for her by the surgeon. Here's to her new navel, and here's to whoever finds my wedding ring. May you use it on happy occasions.
Zackary Sholem Berger is a medical student, but someday (he hopes) he'll be a doctor. This series of columns traces his metamorphosis from one into the other. Send comments, complaints and lost-and-found notices to doctor at forward dot com. No medical advice given.
3/4/05
Newborn medical students
And other miraculous beginnings.
My new Medicine Mensch article, written between deliveries.
And here it is in full:
MEDICINE MENSCH: Bringing Up Baby — and Doctor
March 4, 2005
Even God needs help when making miracles. He sent a wind to split the Red Sea rather than doing it directly; Moses took intensive elocution lessons before he could shout the Ten Commandments down to the Israelites, and the walls of Jericho could well have been jerry-built by history's first unscrupulous contractors. Add to this list the Miracle of Birth, which requires a number of gadgets that whir, beep and gargle to help doctors coax new life into the world. As I begin my rotation in obstetrics and gynecology (OB/GYN), I know to treat these machines with wary respect, stepping aside as the all-powerful nurses set them up, then copying down their flickering readings with equal parts diligence and ignorance. One new mother attached to a monitor wanted to know whether her blood pressure readings were good or bad. "They went up, and now they're coming down," I answered lamely, to her silent dissatisfaction.
A few days ago, for instance, I participated in the delivery of an ultra-Orthodox woman's baby. Most such women, though young, already have a number of kids, and respond to my questions either in blasé fashion or with outright impatience, aware that they know their own physiology better than I ever will — after all, it's served them for the past four or five children. Their next birth will be fine, God willing, and, in any case, they've got an experienced obstetrician waiting in the wings to help make sure the miracle proceeds as planned.
When I say "participated in the delivery," I mean that at first I stood in the corner, paralyzed with fear, hoping that if I were asked to catch the baby, it wouldn't slip out of my hands like a wet trout. (Newborn babies should come with grippable surfaces, as do basketballs or pistols.) As it turned out, I did leave the corner, when invited by the attending physician to help support the mother's body and the baby's emerging head in a way that made me think I was helping. (This is an essential part of teaching: making the student think he or she can be of service even when it's not the case.) I put three fingers on that warm, black-haired dome and, together with the doctor, gave a gentle pull. The newborn flopped out purply with a healthy cry, caught by the doctor, or — more important to my terrified self — someone other than me. I didn't drop anything! The baby was transferred carefully, but with great speed, to a couple of waiting pediatricians.
This is the point when the father swung into action with his own piece of equipment. As the pediatricians hovered around and above the child (I thought doctors and father were going to butt heads, but, by another miracle, they did not), Dad held his cell phone up to the squalling bundle, broadcasting its cries to a grandmother in Brooklyn. The father returned the phone to his ear, said "Mazel tov" and burst into tears. (He had been in the room the whole time, learning Torah, carefully training his eyes on the monitor or out the window when the mother-to-be, his wife, was convulsed in another epic round of pushing.) His wife asked him, in Yiddish, "Host yeder gekolt?" ("Did you call everyone?")
Off in the corner where I stood, another birth was taking place, helped by nature and by medical school, if not quite by God. A new medical student — me — was coming into the world. Sure, this is my second rotation, but the first, though fascinating, was the decidedly nonstrenuous 9-to-5 Psychiatry rotation. The first couple weeks of OB/GYN has you working from 4 in the morning till 7 in the evening. The unit in which I'm stationed delivers around a hundred babies a week. Here, what's miraculous is the transformation of the act of birth from the breathtaking to the manageable. "This is not normal," one new mother said, smiling through tears, trying to describe her feelings as she watched her baby being cleaned and monitored by the pediatricians. "Every delivery is different," the doctor responded, friendly but underwhelmed, as he sewed up an incision.
A miracle becomes everyday through systematization. The people were stunned by their first exposure to the divine voice, and refused to listen to God after his first words, but Moses had done it a thousand times; for him, it was already routine. When I see a pregnant woman, as ripe as a watermelon, warily approaching the secretary to say that she's here to give birth, I realize that this might be the first time she's ever said those words, while it's maybe the millionth time they've been uttered on this floor. Miraculous acts are not available to the medical student, but a short interview and physical exam, performed in the service of routine medical evaluation, can make sure that the abnormal and the wonderful give rise only to results that can be treated and managed. At least in the medical realm. As for raising the children themselves, that's an even more slippery fish to catch.
Zackary Sholem Berger received his doctorate in epidemiology in January from New York University. Now he's becoming that mythical figure, the Jewish Doctor. His OB/GYN rotation lasts until Purim, when he will not deliver any babies while drunk — or sober, for that matter. Questions and comments can be sent to doctor@forward.com; no medical advice given.
And other miraculous beginnings.
My new Medicine Mensch article, written between deliveries.
And here it is in full:
MEDICINE MENSCH: Bringing Up Baby — and Doctor
March 4, 2005
Even God needs help when making miracles. He sent a wind to split the Red Sea rather than doing it directly; Moses took intensive elocution lessons before he could shout the Ten Commandments down to the Israelites, and the walls of Jericho could well have been jerry-built by history's first unscrupulous contractors. Add to this list the Miracle of Birth, which requires a number of gadgets that whir, beep and gargle to help doctors coax new life into the world. As I begin my rotation in obstetrics and gynecology (OB/GYN), I know to treat these machines with wary respect, stepping aside as the all-powerful nurses set them up, then copying down their flickering readings with equal parts diligence and ignorance. One new mother attached to a monitor wanted to know whether her blood pressure readings were good or bad. "They went up, and now they're coming down," I answered lamely, to her silent dissatisfaction.
A few days ago, for instance, I participated in the delivery of an ultra-Orthodox woman's baby. Most such women, though young, already have a number of kids, and respond to my questions either in blasé fashion or with outright impatience, aware that they know their own physiology better than I ever will — after all, it's served them for the past four or five children. Their next birth will be fine, God willing, and, in any case, they've got an experienced obstetrician waiting in the wings to help make sure the miracle proceeds as planned.
When I say "participated in the delivery," I mean that at first I stood in the corner, paralyzed with fear, hoping that if I were asked to catch the baby, it wouldn't slip out of my hands like a wet trout. (Newborn babies should come with grippable surfaces, as do basketballs or pistols.) As it turned out, I did leave the corner, when invited by the attending physician to help support the mother's body and the baby's emerging head in a way that made me think I was helping. (This is an essential part of teaching: making the student think he or she can be of service even when it's not the case.) I put three fingers on that warm, black-haired dome and, together with the doctor, gave a gentle pull. The newborn flopped out purply with a healthy cry, caught by the doctor, or — more important to my terrified self — someone other than me. I didn't drop anything! The baby was transferred carefully, but with great speed, to a couple of waiting pediatricians.
This is the point when the father swung into action with his own piece of equipment. As the pediatricians hovered around and above the child (I thought doctors and father were going to butt heads, but, by another miracle, they did not), Dad held his cell phone up to the squalling bundle, broadcasting its cries to a grandmother in Brooklyn. The father returned the phone to his ear, said "Mazel tov" and burst into tears. (He had been in the room the whole time, learning Torah, carefully training his eyes on the monitor or out the window when the mother-to-be, his wife, was convulsed in another epic round of pushing.) His wife asked him, in Yiddish, "Host yeder gekolt?" ("Did you call everyone?")
Off in the corner where I stood, another birth was taking place, helped by nature and by medical school, if not quite by God. A new medical student — me — was coming into the world. Sure, this is my second rotation, but the first, though fascinating, was the decidedly nonstrenuous 9-to-5 Psychiatry rotation. The first couple weeks of OB/GYN has you working from 4 in the morning till 7 in the evening. The unit in which I'm stationed delivers around a hundred babies a week. Here, what's miraculous is the transformation of the act of birth from the breathtaking to the manageable. "This is not normal," one new mother said, smiling through tears, trying to describe her feelings as she watched her baby being cleaned and monitored by the pediatricians. "Every delivery is different," the doctor responded, friendly but underwhelmed, as he sewed up an incision.
A miracle becomes everyday through systematization. The people were stunned by their first exposure to the divine voice, and refused to listen to God after his first words, but Moses had done it a thousand times; for him, it was already routine. When I see a pregnant woman, as ripe as a watermelon, warily approaching the secretary to say that she's here to give birth, I realize that this might be the first time she's ever said those words, while it's maybe the millionth time they've been uttered on this floor. Miraculous acts are not available to the medical student, but a short interview and physical exam, performed in the service of routine medical evaluation, can make sure that the abnormal and the wonderful give rise only to results that can be treated and managed. At least in the medical realm. As for raising the children themselves, that's an even more slippery fish to catch.
Zackary Sholem Berger received his doctorate in epidemiology in January from New York University. Now he's becoming that mythical figure, the Jewish Doctor. His OB/GYN rotation lasts until Purim, when he will not deliver any babies while drunk — or sober, for that matter. Questions and comments can be sent to doctor@forward.com; no medical advice given.
2/3/05
Shampoo, soap, and psychiatry
Feigning Sanity at Bellevue, my second article in the Medicine Mensch series.
And here it is in full:
MEDICINE MENSCH: Feigning Sanity at Bellevue
By Zackary Sholem Berger
February 4, 2005
My first rotation as a medical student is psychiatry, that branch of medicine that patrols the border between sane and insane. But as is well known to any observer of human behavior, the sane are sane up until the point when you start looking at them with an analytic eye. Then everyone seems to need treatment, doctors and students included.
At 9:15 every morning, our psychiatry ward has a "community meeting," a chance for everyone — patients, doctors and staff (the "community") — to thrash out problems that are relevant to life on our unit. A sociologist would have a wonderful time here. Everyone sits in large, colorful, uncomfortable plastic chairs, like booster seats for grownups. We're reminded daily that at the meeting, personal issues are out of bounds. But without fail, one of the patients always starts with the question, "When do I get out of here?" Or, "Quiero irme ya." ("I want to leave right now.") (The meetings are translated into Spanish.) "That's a personal issue," a staff member always answers, "but we can try to discuss it generally. We're only talking about community issues now."
(On the other hand, our staff meeting is a freewheeling chance to bitch and moan in the most personal of terms. Without coming to blows and, miraculously, without psychotropic medication, the issues are somehow solved, helped by the powerful motivation of getting enough work done by lunchtime.)
But let's get back to the first meeting. What does the "community" complain about? Someone gets tea instead of coffee at lunch, or vice versa. The meeting room (normally the patient lounge) hasn't had its floor washed in days. One of the patients won't take showers. "Hey, where's the shampoo?" Men are using women's bathrooms. And so on. If this list of problems sounds familiar, it's because they show up at all stages of life whenever people stay in close proximity: in the suburban home, summer camp, resort, homeless shelter or Elderhostel. We all have the same problems when staying three to a room.
Even in an emergency, the sickest mental patients have more in common with us than we might like to admit. A couple of weeks ago, I spent midnight to7 a.m. at Bellevue Hospital's Comprehensive Psychiatry Emergency Program — the psychiatric emergency room. The orientation packet emphasizes a number of safety precautions: Never be alone in a room with a patient; always have an exit route in mind; don't promise a patient, even in the name of politeness, anything that you can't deliver. From these caveats, I imagined a cross between a cellblock at Alcatraz and a chaotic thrill ride of the insane. (Never mind the prime rule of medical-student safety, on any ward, psychiatric or not: Get out of the way as fast as you can; someone larger than you knows exactly what to do in this situation.)
I saw five or six patients, and of those, only one needed urgent psychiatric care. Why did the others come to CPEP that night? It was rough outside, rainy and cold, with a brisk wind off the East River — not a good time to be kicked out by your mother because you've had a fight with her new husband. It also wasn't the best night (from another patient's point of view) to have taken a bus to New York from Michigan to "hang out with some friends" who turned out not to be so hospitable.
The attending physician on call that night decided that none of these other cases could be admitted. There were those who didn't have psychiatric problems at all, and just wanted a warm bed for the night. Others were indeed mentally ill, but not sick enough to stay in the hospital. Some fell into both categories. It's not trivializing the plight of the mentally ill to say that the daily lives of the sane are also ruled by institutions that cannot admit just anyone; the problem of limited resources is a general one. (Have you ever tried to find an apartment in the city, or get your kid into school, or find a job?) Even so, I kept asking myself the question: Shouldn't there be an institution that is ready to help these people, no matter what the cost? And here's the answer: Yes, and you're working in it. But you still can't do everything.
The next morning at 9:15 I did my little bit, filling in as a Spanish translator because a couple of people were out sick. Among other things, I helped make sure everyone understood an important fact: how packets of sweetener are distributed at lunch and why. Life on the wards, like life outside, is measured in shampoo and sugar.
Feigning Sanity at Bellevue, my second article in the Medicine Mensch series.
And here it is in full:
MEDICINE MENSCH: Feigning Sanity at Bellevue
By Zackary Sholem Berger
February 4, 2005
My first rotation as a medical student is psychiatry, that branch of medicine that patrols the border between sane and insane. But as is well known to any observer of human behavior, the sane are sane up until the point when you start looking at them with an analytic eye. Then everyone seems to need treatment, doctors and students included.
At 9:15 every morning, our psychiatry ward has a "community meeting," a chance for everyone — patients, doctors and staff (the "community") — to thrash out problems that are relevant to life on our unit. A sociologist would have a wonderful time here. Everyone sits in large, colorful, uncomfortable plastic chairs, like booster seats for grownups. We're reminded daily that at the meeting, personal issues are out of bounds. But without fail, one of the patients always starts with the question, "When do I get out of here?" Or, "Quiero irme ya." ("I want to leave right now.") (The meetings are translated into Spanish.) "That's a personal issue," a staff member always answers, "but we can try to discuss it generally. We're only talking about community issues now."
(On the other hand, our staff meeting is a freewheeling chance to bitch and moan in the most personal of terms. Without coming to blows and, miraculously, without psychotropic medication, the issues are somehow solved, helped by the powerful motivation of getting enough work done by lunchtime.)
But let's get back to the first meeting. What does the "community" complain about? Someone gets tea instead of coffee at lunch, or vice versa. The meeting room (normally the patient lounge) hasn't had its floor washed in days. One of the patients won't take showers. "Hey, where's the shampoo?" Men are using women's bathrooms. And so on. If this list of problems sounds familiar, it's because they show up at all stages of life whenever people stay in close proximity: in the suburban home, summer camp, resort, homeless shelter or Elderhostel. We all have the same problems when staying three to a room.
Even in an emergency, the sickest mental patients have more in common with us than we might like to admit. A couple of weeks ago, I spent midnight to7 a.m. at Bellevue Hospital's Comprehensive Psychiatry Emergency Program — the psychiatric emergency room. The orientation packet emphasizes a number of safety precautions: Never be alone in a room with a patient; always have an exit route in mind; don't promise a patient, even in the name of politeness, anything that you can't deliver. From these caveats, I imagined a cross between a cellblock at Alcatraz and a chaotic thrill ride of the insane. (Never mind the prime rule of medical-student safety, on any ward, psychiatric or not: Get out of the way as fast as you can; someone larger than you knows exactly what to do in this situation.)
I saw five or six patients, and of those, only one needed urgent psychiatric care. Why did the others come to CPEP that night? It was rough outside, rainy and cold, with a brisk wind off the East River — not a good time to be kicked out by your mother because you've had a fight with her new husband. It also wasn't the best night (from another patient's point of view) to have taken a bus to New York from Michigan to "hang out with some friends" who turned out not to be so hospitable.
The attending physician on call that night decided that none of these other cases could be admitted. There were those who didn't have psychiatric problems at all, and just wanted a warm bed for the night. Others were indeed mentally ill, but not sick enough to stay in the hospital. Some fell into both categories. It's not trivializing the plight of the mentally ill to say that the daily lives of the sane are also ruled by institutions that cannot admit just anyone; the problem of limited resources is a general one. (Have you ever tried to find an apartment in the city, or get your kid into school, or find a job?) Even so, I kept asking myself the question: Shouldn't there be an institution that is ready to help these people, no matter what the cost? And here's the answer: Yes, and you're working in it. But you still can't do everything.
The next morning at 9:15 I did my little bit, filling in as a Spanish translator because a couple of people were out sick. Among other things, I helped make sure everyone understood an important fact: how packets of sweetener are distributed at lunch and why. Life on the wards, like life outside, is measured in shampoo and sugar.
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