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Teaching and Learning Moments

The Many Faces of the Hospital

Foote, Michael Bonner

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doi: 10.1097/ACM.0000000000000825
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After my first clinical rotation as a medical student, how the hospital worked was a mystery to me. Simple mouse clicks summoned vacuum tubes full of dosed medications. Pyxis machines once empty were miraculously sorted and full the next day. Faceless specters completed tasks behind the scenes, guided only by the occasional, “Do you have Ms. …?”

To uncover the truth behind these mysteries, I enrolled in a new clerkship at my medical school called “The Hospital.” I shadowed different health care practitioners and gained a new perspective on providing multidisciplinary care.

During my first shift shadowing nurses, I experienced firsthand the agony of Q1H vitals, charting again and again heart rates, pressures, and diaper loads. One hour after the labs were drawn, the order came for another vial. “Please package your orders!” my exasperated preceptor implored. Tasks poured in helter-skelter throughout the day; many had mistakes or were unintentional repeats. The result was a dizzying maelstrom of multitasking by the nursing staff. The experience convinced me of the importance of coordinating physician goals with, not against, nursing staff plans.

Shadowing nurses taught me more than logistics. I changed a dying patient’s bed sheets, told her how I missed the South, and laughed at her mother’s impressions of relatives I hadn’t met. It was uncomfortable at times (especially when the portable toilet came out), but living as a nurse gave me a sense of the deep intimacy of experiencing another’s vulnerability, a perspective I had experienced only on the fringes of medical school. Nurses weren’t just the means to a lab result; they pulled together different teams, comforted sobbing toddlers, and advocated for their patients’ right to “get off the damn liquid diet!”

While shadowing a respiratory therapist, I was terrified to approach the attending’s ivory tower with respirator advice that contradicted his plan. My fellow technicians and he were all equal members of the team, yet I could sense that they did not want to challenge the attending’s perceived authority. Although he cheerfully acquiesced to my request, I, for the first time, experienced how powerless different colored scrubs could make one feel.

Soon after, I helped to facilitate a terminal extubation with the palliative care team. It wasn’t like a scene from a movie—quiet somnolence and background music. Tears and final assurances were punctuated by ringtone interruptions, jokes about how grandpa would have wanted a certain show (The Jacksons) on the TV, and stammered attempts at saying the perfect goodbye. Peace lingered, binding the circle of friends, family, and supportive staff. In the end, we all were there for the same moment.

The hospital forces us to confront that which we would rather avoid: ugly, soiled bed sheets, stoned grandfathers, and toddlers with limp, cold wrists. I now know that sad stories are never experienced alone. The hospital is a super-organism of collective activity, thousands of people each carrying out different yet intersecting jobs. My travels along these crossroads gave me an intimate sense of the challenges and needs of the different stakeholders in patient care and an understanding of how to best unify seemingly conflicting priorities. Most important, this clerkship unmasked the hidden faces of the hospital, revealing a beautiful collection of diverse perspectives, experiences, and personalities all oriented towards the patient. Now, in moments of tension, pain, and death, I know I can lean backwards into the comfortable arms of my colleagues and breathe deeply into a circle of peace, disappearing inside the soft blinking lights and sparked-silver floors of our hospital.

Acknowledgments: The author would like to acknowledge Dr. Sujay Pathak and Dr. Peter Pronovost for their administration of “The Hospital” clerkship and for their support for this essay.

Michael Bonner Foote

M.B. Foote is a fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland; e-mail: [email protected]

© 2015 by the Association of American Medical Colleges