Better than Broadway: The Hospital's Opening Act

Odd as it sounds, sometimes in the flurry of signing orders, collecting vitals, making sure you can forget that most of medicine is "people-based".

In theory, medicine is a great job for the extroverted chatterbox - you know, the person who solemnly insists , "But really, I'm really shy, deep inside...I was the high school nerd...I still look at myself in the mirror and see an awkward teen with a big nose...," and then goes on to regale the crowd, entertain like a seasoned pro, and leave the party with a napkin practically dripping ink from all the phone numbers scrawled hopefully by infatuated admirers. (Seriously, folks. Let those of us who still surf the web for pocket-protector close-outs on Friday night or really have a big nose stake our claim to Nerd membership in peace. Get your own support group.)

Extrovert or otherwise, it is mostly true that medicine, you are going to be dealing with people all day. (Those of my classmates in medical school who balked at this reality - ahemfutureradiologistpathologistahem - decided that, even if unable to handle the Person in the living, breathing, demanding forme entiere, they could become desensitized by focusing on one digestible piece at a time: a thin-trichome-stained slice of biopsied lung here, perhaps, or an amorphous looking abdominal CT there.)

But just who makes up this cast of characters, you ask? (I'm flattered. You care!) We all know about the patients. But that's only the beginning. A brief sampling:

• Fellow interns, whom you now get to call "colleagues" for that extra elite-sounding punch (even if that "colleague" happens to be a fellow hapless intern who's standing behind you at the Pharmacy Reference Desk to look up the dose for Mylanta). NB: In the outside world, the casual toss of "Yeah, I'm a medical intern" might inspire a layperson's awe or even admiration. There is no such "casual toss" in the hospital. Rather, "I'm an intern" is usually a meek confession of sorts (i.e. "I'm wearing this white coat like I'm supposed to, but, um, I'm actually an intern,") , or alternatively used as an excuse (i.e. "Oops, I didn't mean to fax that X-ray requisition to the gift shop. Must have the wrong number. Sorry...I'm an intern.") Nicer hospital staff who learn that you are an intern usually offer their sympathies. (One nurse gave me a hug and said, "Bless your heart, honey, I'll keep you in my prayers.") An intern is commonly seen 1) trying to figure out where her pager is and how to turn it off as a cacophony of beeping erupts around her person 2) furtively sneaking graham crackers and bitter coffee from the nutrition kitchen 3) looking puzzled, scared, apologetic or confused.

• Residents, who are released from the shackles of the "intern" status, serving as official proof to the humane world that the hospital does not actually digest, process and recycle interns to become part of that suspiciously mosaic-speckled-tile hospital flooring. Yes, there may be battle scars - a few fine wrinkles, perhaps a double-chin or two, maybe an extra love handle or three (three love handles? I call that a hospital experiment gone wrong) - but on the whole, the resident is still intact, the triumphant victor in the battle of Intern vs. Hospital. The gloating period is short-lived, however, for the resident soon realizes that now, in her new role, her first task is to supervise and handle....not one, but two (or even three)...you got it, interns. (And all of their patients.) It's like Groundhog Day.

• Attendings and consultant/specialists - Fellow nerds: You know how in computer games there were those various little secrets and codes you could enter to "beat the game" and vanquish the evil monster "boss" who was holding the princess hostage? Well, attendings and consultants are like the Wise Elders of the hospital, having successfully learned all the codes and "beat the game" to vanquish the evil "boss" of residency. It's easy to identify them: the white coats of these realized souls swing crisply with the natural fit and pristine authority of a custom-made Armani ensemble, carrying nary a pen stain or overstuffed reference book. They don't need "books", for they have they have superpower ability to reference such details as the etiology of hypotonic euvolemic hyponatremia and the NEJM journal article last month that identified its optimal management....by just...thinking. (Really! No stealth googling, no panicked flipping through size-2-font pocketbook print, no running down to the librarian and begging for a lit-search. Isn't it amazing?)

• Nurses, who usually are united by the following qualities: 1) Access to all types of amazing food at all hours of the day, usually involving some type of baked good, and 2) Extremely cognizant of the unique superpower they wield- that is, the Power to Page Intern At Will. No matter how early they have to come into work, nurses usually sport neatly styled hair and pleasantly colored attire, have photos of their children/dog/cat within easy reach, and are always up for whipping together an aromatic casserole for the weekly floor potluck. From the intern's perspective, nurses usually fall into one of two categories: They Like You or They Hate You. Thus, the wise intern, when not working at her primary job of keeping patients safe from herself, focuses equally upon making sure that the nurses fall into the former category. After all, this is one excellent way to ensure endless free food (and access to the latest issues of Us Weekly.)



• Discharge planners and case managers, who quickly become your best friends in the hospital. They help you with that word that causes interns nationwide to break out into a cold sweat and run for cover: "Placement". "Placement" is why a patient who's been on your service for a month, who's so healthy he now routinely trumps 6'5" nurse "Rocky" in daily challenges of 1-on-1 pickup basketball, still wears a backless hospital gown and sleeps in bed 6789A. "Placement" is why 92-year old Mrs. X can't have that teflon-coated walker she needs to go home unless you fill out 2 sets of blue and green forms and stamp them on the lower-right-hand corner and then initial and date the top-left-corner of the third page before triple-hole-punching-and-faxing-and-filing. (And then being paged to come back and re-initial, date and time a stray pen-mark on page 4 that looks dangerously close to being forged.) But with a good discharge planner, suddenly you only have to fill out one form that takes care of everything, and your pseudo-pro basketball-player-grandma is going home tomorrow!



• The unit assistant: usually a commanding, authoritative female matriarch-figure who mans the front desk of each hospital floor and its environs, and is in charge of making sure charts are in order, patients are in the right rooms, and the orders scribbled by harried interns are scanned and processed. Rule #1: Never enroach on the sacrosanct territory of the Unit Assistant or Crowd Her Space. (As an ignorant newbie, I once made the mistake of meekly resting my water bottle on the side of the Unit Assitant's desk while pausing for a rare moment to breathe. Within seconds, the heat I felt coming from her menacing gaze nearly singed my split-ends. Never, never again.)



• The pharmacist, who is also your best friend, but also your Protector and Secret-Keeper. You see, within the first week of internship, as they read the prescriptions and orders you grandly authored with what you hoped was the flourish, experienced manner and carefully strategized unintelligible scrawl of a Doctor, they quickly realized just how little you knew. Yet, this realization remains unspoken as they continue to address you as "Doctor" (without the slightest trace of irony!), while valiantly protecting the patients from your advances. Thus, the phone call from Jorge at 4pm: "Doctor, I see an order for Vitamin K. There's no dose specified - was that 5 mg you wanted to start with?" I reply calmly, "Why, of course, Jorge - thanks for catching my oversight. We'll do 5 milligrams," as though it was a simple, universally known fact that 5 mg was the perfect pro-coagulation dose of Vitamin K for my septic, somnolent, febrile, super-complicated patient who gripped me in mortal fear with his comorbidities. As though I hadn't, uh, deliberately written a vague, open-ended "Vitamin K x 1 now" on the order sheet in the hope that an all-knowing pharmacist would call to fill me in on the right dose. All in a day's work.

So. There you have it: the cast and characters of hopsital times, in a nutshell. I did have a larger purpose with this entry, but as my mental juices have officially evaporated by way of the alcohol-hand-sanitizer-gel on my dehydrated hands, I'll have to attempt to retrieve it in a future entry...stay tuned.

And so with that dubious hook, time to go back to rehearsing my lines for Intern: Day #21.