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