It is a doctor’s duty to take care of patients as has been our job since the first physician quoted the Hippocratic Oath. However, what happens if this distinction becomes somewhat blurred? What does it mean to be a doctor and a patient?
An experiment I inadvertently took on after feeling sick the night prior to my last day of wards. In my most resilient form I pushed forward with the day because, hey, sickness is for patients! While listening to a patient presentation on rounds I began to feel the color drain from my face and the prodrome of impending doom fill my thoughts. Within seconds the shades over my eyes closed and I quickly became the sickest patient on our service.
My wards team which consisted of your basic attending, two interns, and array of medical students quickly arrived to my aid. The blood pressure cuff read 80/40 and I could hear over the loud speaker: “rapid response physician lounge.” Could there be anything more embarrassing on the planet I thought as I faded in and out of consciousness. The decision was made to admit me to the emergency room for further evaluation.
My intern with two months of medicine under her belt herds me into the hospital wheelchair and swiftly wheels me down the corridor of 10 west — the tails of my white coat flapping gracefully in the wind, I’m sure! We get on the elevator next to a man and wife likely leaving from visiting a sick loved one on 10 tower. They both turn toward me with a curious look on their faces – is that a doctor? I can only insinuate from their unified eyebrows at upmost attention. There is no time to explain myself before we arrive at the nursing station of the emergency room. My greenish complexion now begins to resolve to a bashful flushed red as many of the emergency room residents and attendings I have discussed patient care matters with pass me awkwardly as if they have seen a ghost.
“Is this our rapid response? Take her to room 20,” a voice from beyond the hurried mass yells.
Quickly my intern wheels me with undoubtedly some ironic pleasure to the vacant room 20. Right outside the door the nurse stops us in our tracks and hands me the dreaded screwtop cup.
“You know what to do with this,” he says. “You think you could be pregnant?” he asks.
“Well, I dunno. I guess I could …” I muster the energy to reply.
Now convinced I was pregnant by the mere question alone, I weakly attempted to stand for the first time in what felt like ages and transition into the restroom stall — a feat I would have patted myself on the back for had this pat not likely resulted in a fall and likely emergent CT head. Once alone in the stall I felt the life fade from my face once again and thoughts of being found by a sea of known physicians passed out next to the toilet with my pants around my ankles and urine cup in hand filled my oxygen deficient mind.
If this must be the case, I thought, let this be the end! I undoubtedly had done some good in the past because God took pity on me at that moment and I was quickly shuffled from the stall onto the bed in room 20. The bed was haphazardly covered in fresh linens that masked the scent of cleaning products emerging from the firm mattress. Like a pit crew they got to work—nurses with hurried introductions begin poking and prodding my arms. Why so many sticks? Why so much blood? I thought to myself. Are they taking blood cultures? Am I that sick? Where is the doctor? It seemed my sense of medical knowledge had vanished as I lie there as helpless as any other patient. Pulse oximeter applied and monitor connected the jolting sound of an inflating blood pressure cuff that I hadn’t even noticed was placed began to silence the room.
“Please put on this gown,” a nurse said.
“Why can’t I stay in my scrubs?” I said.
Gowns are for patients! I thought to myself. After realizing my hesitancy was merely delaying the inevitable I changed into the unflattering gown that managed to hang off my shoulder like a bad 80’s workout video. Just like a well oiled machine, the pit crew disassembles and the room is quiet. I sit there in silence. The puttering conclusion of the next blood pressure reading ends and the alarm begins to sound. I quickly turn to see what could be so alarming … I feel okay. The screen reads blood pressure “85/40” and flashing prominently oxygen saturation “86”. I look around to see if anyone notices but there is no one to be found. I start second guessing myself—am I breathing okay? I take some deep breaths to validate my own claims which appeared to be on trial. However, my internal monologue is interrupted as the ER attending quickly walks in the room.
“What happened today?” he says.
I explain my side of the story — much of which was spend passed out with my head on a desk. He seems dissatisfied with this information.
“You say you were sick before?” he said.
”Yes, I felt ill last night and I threw up some,” I said.
“Some?” he said.
“Well, once or twice,” I said.
“Only once or twice?” he said.
“Well, yes I believe only once or twice,” I said. Not good enough? I think to myself, Should I have sold it more?
“You say yesterday you felt ill and that your stomach hurt, can you be any more specific?” he said.
I felt his prodding for a better description and my uselessness to provide this. I do this for a living! I think to myself, what would I write on my own history of present illness? The words didn’t seem to be coming out right.
“Yeah, it just kinda hurt, more like an ache, kind of like a churning really, don’t know if I would say actually use the word hurt,” I said.
I felt his eyes transcend to the ceiling as the look of “this conversation is going nowhere” came across his face. I know this was the look because it is a look I am familiar with giving when struggling with a difficult patient history. Patient is a poor historian–I can see it already splattered across my chart.
“Last question, do you think you could you be pregnant?” he asked.
The topic of the day it seemed.
“I don’t know, I guess I could be,” I answered (On par with all the other informative, decisive answers I had given thus far.)
“We are going to run some tests and we will let you know,” he said as he left the room.
Wow, glad that is over I thought. Tests are good I suppose, I felt some degree of satisfaction and relief at the concept of “tests.” Just as what I felt was a revolving door into room 20 began to slow, a secretary looking person entered the room.
“I am with registration,” she states. She verifies my name and birthdate by the identification bracelet on my wrist. “What kind of insurance do you have and how will you be paying for this visit?” she states while taking vigilant notes on her red clipboard.
This visit I thought. Our conversation was interrupted by the incessant sound of the inflating blood pressure cuff that I could feel squeezing the life out of my arm that had been just recently ransacked by the nursing pit crew. I focused my attention back on the lady standing at the foot of the bed.
“Paying for this?” I said. “Well I was working 30 minutes ago, I didn’t really have any plans of being admitted to the ER today. I hadn’t really thought about it.”
“Well we will need your copay and insurance information,” she said.
Finally the situation sunk in as talk of money has a tendency of expediting. I am a patient in my own hospital! I thought. An agreement was made that I would contact them tomorrow. Luckily they knew where I worked and could find me– finally a break I thought to myself. Who plans for these things? I wasn’t prepared to have an emergency today. Satisfied with my lack of organization and planning she leaves the room as a nurse quickly enters to hang a bag of saline.
“We are going to give you some fluids,” he says quickly. “Keep your arm straight so it will flow better.” Great I think—between the squeezing, noisy blood pressure cuff on my left arm and now temporary paralysis of my right how will I spend my time. By this time my phone has been dinging nonstop as news has begun to spread among my comrades in the hospital. Many stop by to witness the sight. Like a framed piece of art in an amateur art show many of my fellow residents and attendings came to see the sight.
“Hello Becca,” they would say “heard you passed out. Hope you’re alright.” Once they verified it with their own eyes they would quickly slip away as if my exhibit wasn’t the most entertaining at the gallery today.
I waited patiently. The ER attending doctor returned.
“We’ll you are not pregnant” he said. Sorry to disappoint I thought to myself.
“Everything checks out okay on your bloodwork, you should be able to go soon. Lets see how you do after a snack,” he says.
Without missing a beat, a new attendant enters the room with a very, precisely packed container labeled “Snack Pack: Low Sodium.” Low sodium diet? I thought, What have I done to deserve this! Inside the box: a suspicious looking turkey sandwich on rye bread, a pack of SunChips (low sodium, of course!) and a diet sierra mist. Snack? I thought to myself. The thought of a full meal made my stomach churn, yet I managed to eat most of the sunchips much to my new overseer’s dismay.
“You need to eat the sandwich too!” he barked.
“But … I’m nauseated you see. I don’t feel like eating a sandwich,” I said.
To me I had already satisfied the mental checkbox of “patient can tolerate PO intake” I had many times used with my own patients. Somewhere in this transition from doctor to patient it seems I had overshot it and had assumed the role of the “difficult patient.” I could tell he had given up on his attempt for me to finish the entire “snack pack” and now began focusing his efforts on me walking the hallway. He signaled for me to stand and move toward the door.
“In this gown?” I said “but I’m not even fully clothed!”
He sighs as I present yet another road block in his checklist of discharge criteria. Sure I’ve asked patients to do this without second thought, but this was different. This was me. He settles for me transitioning back to my hospital scrubs with some delay in the scheduled process.
“Grab all your things,” he says. “We have a burn victim coming in that needs your bed. You can take a seat in the waiting area and someone will be by to recheck your vital signs after you walk.”
I stagger down the bustling ER hallway, of course passing everyone I knew whom I didn’t pass on my initial grand entrance. I took my seat at the next available chair next to two other “phased out” emergency room patients. I clutched my white coat in my left hand—the woman next to me noticing its symbolism began to laugh.
At first I assumed it was at the humor of the situation of a doctor seated next to her. As we interacted, I found her laughter was more one of comfort. My hair was noticeably disheveled, my arms sore and already beginning to bruise at the venipuncture sites, my peripheral IV line still in place and frequently catching on my shirt causing awkward, terrible pain.
I felt exhausted by the whirlwind experience, yet I had made it through just as she had. I like to think she saw me differently now — as a doctor and as patient. It’s every doctor’s nightmare to be admitted to their own hospital’s ER, but it gave me a new insight on what it means to deliver patient care. Next time I ask a patient to ambulate the halls, maybe pants aren’t too much for them to ask.
Rebecca Crow is an internal medicine resident.