Family Medicine: The Service and the Addicts

This week I'm on the inpatient service at the hospital, and boy is it different from the clinic. I arrived at 7 AM in the hospital cafeteria for morning sign outs... the cafeteria was abuzz with people of all different species; the loud scrubs with a sleepless night etched under their eyes, the manicured hairstyles who got up an hour early just to look pretty, the confused medical students who accidentally turned off the alarm instead of hitting sleep in the morning and therefore have flyaway hair... wait, that's me! Dammit. Amidst the ruckus, I found my group tucked away in a quiet corner going over complicated sheets covered with observations, lab values, and treatment plans. The goal was to cut through the din and simultaneously to make sense of the chaos on the sheet. We got to work with intense focus. I feel that in the hospital environment, that's 3/4 of the battle on a regular basis.

The hospital is a whir of activity, sometimes enough to confuse you to oblivion, at other times enough to literally make me feel nauseated. Five hours in the hospital seeing only 3 patients is significantly more draining than five hours in the clinic seeing 10 patients, and that's just the nature of the beast. Imagine, then, what it's like to be a patient. You come in, by car or ambulance, and you're placed in a stretcher. You're admitted and wheeled through a crowded hallway where dozens of people are walking past you at breakneck speed, into an elevator, and up to a room that you will share with someone's smelly grandfather (unless you are someone's smelly grandfather... then you're the lucky winner of a room shared with the lovely young MS patient with a devastating pulmonary embolism). Your wife, or husband, or daughter, or son, gets to sit on a vinyl-lined seat next to the bed, and place her/his handbag on the table at the foot of your bed... all of which (bed, seat, and table) are generously covered in MRSA. You wait. Sometimes for hours at a time. Your wife/husband/daugther/son grows tired and can't lie down. You freeze in the tiny hospital gown. People in scrubs and white coats come in and out of the room, but you haven't quite gotten the hang of figuring out which ones are doctors, which ones are nurses, which ones are techs... which ones are medical students (we're the ones in the short white coats, by the way... and why the heck am I giving that away??? it must be really late at night). Sometimes they explain something complicated to you, but you're embarassed to asked for clarification. They come and sedate you and then shock your chest so that you squeal in pain and writhe in the bed (by the way, I actually saw this today... it's called cardioversion).

Anyway, the point I'm trying to make is that all that touchy feely stuff is not strictly bullshit. I now know firsthand-- this weekend, I brought a friend into the hospital and witnessed for myself how important patient comfort, communication, and amenities for relatives/friends can be! At 1 AM, after waiting in the ER for 5 hours, I found out exactly how welcome a cot for the companion could be. I reflected on how our children's hospital is so ridiculously proud of its pediatric floors, with their special sections in each room where parents can sleep. It's no wonder that studies have shown: when the loved ones are also cared for, the patient is also healed faster.

After treating a couple more patients in the ER and scarfing dinner, I attended a meeting of what's equivalent to AA for former jail inmates. I listened to these stories with total compassion but a helpless feeling of greenness; there was no way I could ever comprehend what it is like for these people, with this disease of addiction, to walk down the street... to wake up each day and fight the urge to use. I've never been there. A young lady, V, spoke up, saying that the evening group meeting time is difficult for her because walking home, she has to walk the night gauntlet of her addictions, passing every dealer on her street in her neighborhood to make it to the safety of her house. I can't even imagine what it would be like for each day to be a struggle against myself; not a struggle for anything more than just to stay away from heroin, or alcohol, or cocaine... for just one more day...

I drove V home to her grandfather's place on the outskirts of the city and dropped her off at her front stoop, where 4 people were in the process of getting high. I gave her a hug and went back into town, where I contemplated my long day over a draught at the local brewery...