Monday, April 04, 2005

A Trip to St. Elsewhere: Part I

Hospitals are mysterious places. They make everyone a bit uneasy, even doctors d'un certain age who have worked there so long they don't even faintly resemble the dark-haired patrician immortalized on their I.D. photo. The long corridors of hospitals echo with strange sounds, perhaps reminiscent of a cozy visit to the local penitentiary. I still sometimes get a chill while walking down a hallway past rooms with partially opened doors. I must resist the urge to turn my head and peek at a pair of bony legs resting on a narrow bed and wonder whether they will ever support their owner again. This is the place where Disease resides, sitting close to dear friends who smile wanly and wish it would jilt them. The smells found within hospitals are often inscrutable or nauseating - in either case they can snap one to attention within a second. Despite this doctors report to work here every day - and sometimes stay throughout the night.

Part of the reason hospitals appear esoteric is that they have forbidden zones such as the operating room, where I believe no medical oncologist in my city has ever set foot. This is the sanctum sanctorum for surgeons, and I imagine that if I ever sashayed in there without first donning green pajamas and reporting to the sergeant-at-arms I would be attacked by guard dogs and put in the stocks. With my fine motor skills, even if I were invited to assist in a routine procedure like a cholecystectomy the patient would probably turn off the gas, sit up and kick me out of the room. I therefore avoid the operating suite like the Three Stooges dodge a conference on quantum mechanics.

Hospitals are also scary places, especially for oncologists. We realize that when our patients are feeling well they enjoy the dog and newspaper in the comfort of home, and when complications of either cancer or its treatment strike they require admission to the ivory tower. Entering the hospital though can frighten both patients and doctors - them for obvious reasons and us because we no longer feel assured that our patient's care is under our control. There could be an unrecognized complication lurking about, or a test or medicine might be inadvertently forgotten. This stresses us out, so we work furiously writing scores of orders, scrutinizing radiographs of curlicued bowels, and generally cheering patients on until they are ready to be carted back to the happy bungalow - preferably in better shape than when they entered.

With time even the most timid oncologists will learn how to master the hospital routine and put a little spark in their step as they go about their rounds. There is one special place, however, that can unnerve even the most jaded practitioners - a place of unspeakable tension, where green-skinned zombies strain at the leather straps that bind them, where blood and vomit, sheets, tubes and rubber gloves amass into a tornado that sucks up nurses, doctors, even little old ladies in pink volunteer jackets into a writhing, screaming mass of chaos.

Goodness gracious - am I hallucinating? Is this a dagger which I see before me?

Of course not - I'm just describing the friendly confines of the elite suite where the injured meet - the emergency room.

Hoorah and congratulations to all those doctors who toil away in the place designated as the first line of defense, but for me I still get the heebie-jeebies whenever I press the metal plate that swooshes open the door to the E.R. The scene reminds me of a sci-fi film where victim number three is about to be dispatched off to his eternal reward as he enters the laboratory in search of the missing vial of antidote.

The emergency room is never a happy place for cancer patients either. In addition to feeling terrible, they must endure the interrogation and probing of professionals who work under a palpable time constraint. Emergency rooms are where patients are triaged, too and patients with metastatic cancer who show up there may not command the staff's attention as much as the fellow in the next room with a moray eel clamped to his leg.

Nevertheless, I go to the E.R. when needed and am happy to return there at any time to serve my patients. I can still visualize my last trip to that hotbed of activity. I stood in front of the dry-erase board trying to decipher the chief complaint codes that were written there: CP (canine psychosis? ), SOB (sick of belching?), UTI (unknown tomato intoxication?) and that all-time classic SSS-SAO (sick-sick-sick; sick-all-over). I found my patient lying on the ubiquitous gurney in a room lit up like a Vegas stage show. Fortunately she made it upstairs before the last bed in the house was commandeered, otherwise she was facing a night in the hallway, also known as the holding area. I think I would rather sing "Tip-toe Through the Tulips" at the American Idol finals wearing a pink tutu than spend another night in the E.R. - too many bad memories, as the song goes.

Hospitals are formidable places but even with all their flaws and quirks, to the men and women who walk through the doors each day with a fresh uniform on or a greasy stethoscope in their pocket it is a familiar place - a community where some of the most under-appreciated work in the world gets done.

Next: A Trip to St. Elsewhere: Part II - Radiology, the Cafeteria and the Parking Lot


At 10:39 PM, Blogger Lynne said...

I can relate to your description of the ER, I recently spent a night in one myself (University of Michigan to be exact, and believe me, it is one busy place!) I felt like I was in an episode of E.R.

I'm learning from you, Dr. Cheerful....

and I think I like you.

aka Funnigirl
aka Feisty (see

At 11:39 PM, Anonymous Anonymous said...

Funny, I've been thinking lately of being an ER doc...


At 1:31 PM, Anonymous Anonymous said...

The pernicious egomania of doctors must be unhealthy to themselves, let alone their patients.

Case in point: "a community where some of the most under-appreciated work in the world gets done."

What bizarre sself-absorbed elf-pity. UNDER_APPRECIATED? By whom? The medical profession is one of the best paid. We spend more than any other nation on medical care--on both an absolute and per capita basis. Nurses should be more respected, but doctors (despite the fact they kill 200K/year) are still worshipped in many locations.

What do you guys want--to be followed by chanting choristers singing your praises and throwing rose petals before you?

Give it break. Medicine is business. Everyone works hard.

At 1:59 PM, Blogger Dr. Craig Hildreth said...

To Anonymous Number 2:

1. I'm sure all the nurses, lab techs, paramedics, x-ray techs, transporters, security guards, cafeteria workers and custodians are grateful to you for reminding them of their "bizarre sself-absorbed elf-pity".

2. Egomaniacs make great doctors if they remember to include more in their philosophy of life than just the following platitude:
"Medicine is business."

At 2:31 PM, Anonymous Anonymous said...

1. Oddly, you did not mention in your bathos-drenched entry "nurses, lab techs, paramedics, x-ray techs, transporters, security guards, or cafeteria workers [do they work in ERs]" You mentioned DOCTORS. Which is probably a good indication of what you think is of true value (See my comments on egomania)

2. I want doctors to be businesses. Only markets keep people honest. Talk about "professionalism" is just that.

At 2:40 PM, Anonymous Anonymous said...

Oh-- amendment! In your primarily doctor-based entry, you did once mention "nurses . . . even little old ladies in pink volunteer jackets"

Hmmm.... Well, as I said nurses should get more respect--but in yr worldview, everyone else on the hospital staff is just a "little old lady."

Finally, your comment about egomaniacs making great doctors is evil. Scientists (if they are any good) are primarily humble in the face of their ignorance. (A good thing particularly for oncologists/oncological surgeons whose primary "tools" are mutiliation and poison, i.e. radition and chemo. and who really understand squat about the diseases they treat)

It is inconceivable to me that ego can play a helpful role in such pursuits.

At 4:04 PM, Blogger DrTony said...

Craig, a great post, again, of course. I find myself checking frequently for your posts. Of course, as an ER doc, I like your choice of first in the series.

You prompted me to document some of my own thoughts on this subject that have been floating in my mind: DrTony

At 5:07 PM, Blogger Joan said...

Yo, Doc -- hasn't anyone ever warned you against playing with trolls?

At 8:06 PM, Anonymous Maria said...

While I understand the apprehension that you (as an oncologist) may feel when you work in-house, have you forgotten the awe with which people (e.g. medical students, interns, residents, other docs, family members) look at you?

The oncologist is practically like a critical care doc. Patients with cancer, when severely ill, can become sick very quickly. And yet the oncologists consistently know what to watch for and how to treat it. And, God willing, maintain a graceful composure while supporting the patient, both medically and emotionally.

Maybe I've been lucky, but every single oncologist I've ever worked with in the hospital has been deeply empathic, insanely intelligent, and calm and collected. And for that reason, I still view them with great admiration.

At 8:45 PM, Anonymous Anonymous said...

Joan: Did the troller upset you? Does it pain you when doctors reveal themselves as arrogant hypocrites(by their own exhibibitionism in blog entiries as did Dr. Craig Hildreth no less)? Life is pain; I hope you recover.

Maria: Not surprisingly, this troll has had different experiences with oncologists--very different. But, I hope I don't cause you too much cognitive dissonance so that you will continue unmolested as a happy and content devotee in your oncologist-cult.

At 9:21 PM, Blogger Lisa said...

Why is everyone so anonymous around here? I know an ERMD. I had to pass this on. Too funny... SSS

At 9:29 PM, Blogger Lynne said...

Whoa.... touched a nerve with a couple of Anonymous posters. (not brave enough to share their names, apparently)

Like Maria, I have also had only positive experiences with oncologists.

At 2:34 PM, Blogger c1h2a3p4 said...

You write well. I'll check back to see your future posts.

At 5:38 PM, Anonymous Anonymous said...

Craig: Masterful again. Whether or not it's appreciated, I am glad to see the atmosphere transmitted to people who might not otherwise know. I can relate. Thanks!

At 5:40 PM, Blogger gemmak said...

Conversely I assumed you meant the nurses, lab. techs., cleaners, caterers etc. when you made mention of the 'under-appreciated.

At 8:45 PM, Anonymous Anonymous said...

I think anonymous is onto something. It's really revealing to see how defensive doctors become when someone suggests (or they suggest themselves as did Dr. Craig Hildreth) that they are so egotistical that their perceptions as well as their intellectual judgments are intrinsically skewed.

At 6:37 PM, Blogger Dreaming again said...

I've had 1 doctor that could not be put into the category having an ego.
I'd not send my worst enemy to him. He was the nicest guy in the world. But he was NOT a good doctor.

He didn't challenge the status quo. He wouldn't stand up to insurance companies that said no to necessary treatments.

My husband was getting very very sick, and he didn't even bother doing a digoxin level when I asked if he could be on too much.He said "Oh, Dr. M knew what he was doing, I wouldn't want to challenge him." (Dr. M had moved away 2 years before!)
I finally made my husband switch doctors, first thing the doctor told me was that my husband was probably going to die of respiratory failure, his scoliosis was in fact, suffocating him.
Then he ran tests, came back with an incredibly high digoxin level. Took him off 2/3 of the dose of digoxin AND reglan and within 2 weeks, my husband felt better than he had in a year and a half. The digoxin level, had been increased right before the egoless doctor took over, not once did he take a digoxin level, because he wasn't going to 'question' another doctor.

Do I want a doc that's an egomaniac and thinks he's god? NOO ...had a few of those I wouldn't wish on my worst enemy either ...

But enough of an ego to for them to think "I can save this guys life if I do my job right!"

Yea, I want a doctor with an ego ...

At 10:27 PM, Anonymous Rae said...

Thank you for another beautifully written post. I love to hear about these experiences I've had, from the opposite perspective. ERs are definitely mysterious and stressful.

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