3rd Floor ICU, XX University Hospital, August 2022
I’ve noticed recently that the Korean doctors at my hospital like to give their Korean patients more time during their physical exams; they’re a bit more thorough with the touching, and more sensitive with the wording. There aren’t that many Koreans at our hospital, however, and in the fluorescent dawn of early-morning rounds, I follow my Korean attending around the hospital as she prods patients one-by-one in silence. At each room, she looks down at her patients in the bed with her tired, strained eyes—almost as weary as the patient’s at 4:30 am—and double checks the name on her sheet as if her looking is going to change it. The name doesn’t end in an –un or –ohn; sadly not one of the nice, boxy Korean surnames that she’s looking for, so she sadly gets to work, and begins her physical exam.
I watch her work from my spot behind the narrow vitals machine at the foot of the bed, where each time I try to squeeze my body into two dimensions and disappear from sight. She’s told me to take a more active role in rounds last semester; they’re hell-bent on getting me to test out my first-year medical knowledge on these poor patients. But much to their dismay, and I’ve been brought to the chief of medicine’s office not a small number of times now for this, I stay silent, allowing the weight of the world—room 3801 at the moment—to speak for me.
Most of the time I manage this quite successfully, and as far as I’m concerned, I am able to vanish from the room almost entirely. Not a word you’ll hear from me. Often, and if I’m lucky, they’ll forget I was ever there, and the doctor will leave the room, sometimes even the hospital floor, without me, the fact that he or she is responsible for a young medical student exiting their mind completely. So much for an education, I suppose. But once I’m able to make myself invisible, believe it or not, and the medical interview unfolds before my ghost, I am quite an apt and engaged learner. Without anyone to watch, I set fast to my work: from my coat pocket stuffed with gauze and tinctures and creams, I pull out my little spiral notebook, and begin to dictate almost everything: nothing goes unnoticed. To me, even the smallest gesture has something of value to offer.
The whole thing is quite an odd meeting if you think about it—picture the scenario: here we have a healthy young lady, fresh out of medical school and years of grueling education, and if we’re lucky, still under the impression that she can do good by someone, interviewing a homeless man who was not 36 hours prior pulled off the asphalt, one leg almost fully-digested by gangrenous bacteria and the other on its way. The lady begins to undress the man, and ask him a series of increasingly personal and inane questions: Who are his living relatives and where are they now? What are your sexual practices, and with whom? When was the last meal that you ate; what was it? And not only are these questions expected to be answered in fullest possible detail from this half-deranged man, but are expected to be returned with a certain graciousness, almost as if the lady herself derives pleasure from their wringing. Each time, I can tell that she stops herself just before she probes too deep (just as I know modern-day physicians all wish that their ancestry traced back to the psychoanalysts), but just long enough to properly establish a sense of superiority over the man.
If this meeting wasn’t already so hard to believe, imagine our lady now endowed with a long, brilliantly white overcoat (and I use this term with the least amount of endearment possible), and the man wearing hardly anything more than a patterned napkin. It occurs to me that this intersection of status, of which the gradient of social class and health between the two being so unbearably steep, occurs at very few, if not no other places in our society today, other than among the beggar and the pedestrian. But let us not bother ourselves thinking about the context of their meeting too much, I would much rather spend time taking note of its content.
Summarizing for the patient is a very fundamental tool we are taught in medical school to make sure everyone is on the same page. In other words, when our long-winded speeches to patients fail to leave them in a proper enough stupor, we like to beat it into them with a repeat or three until they are. That being said, let us now recap. I am now in room 3802, on the surgical intensive care unit of XX University Hospital, standing behind the vitals machine of bed two, and still actively trying to thin myself out into a silhouette in order to fit behind it. My Korean doctor, thirty seconds since entering the room, has just finished her exam. She’s pushed on all four quadrants of our patient’s stomach without extending a singular greeting, and is almost on her way out the door. (Two things. One, it seems as if we are always splitting up body parts into quadrants just to torture poor medical students like me, and two, I am not sure who is tortured the most here, us, the doctors, or the patients). With each push she asks if it hurts, and each time he responds yes. Worst pain I’ve ever felt, he says. On her phone, she enters his pain into the chart, “diffusely tender,” and along with its cure, a fourth order of oxycodone since yesterday, she extends her condolences, consisting of a quick sorrowful glance and a ‘take care’, and we move on to the next one. Sorry that was short, I’m quite possibly as disappointed as you are. Most of our visits are like that in the mornings—but don’t worry, I’ve checked the chart, and our next patient, 3311, last name ending in -ohn, is Korean—we’re in for a treat, you and me both.
Walking into the room is a radically different experience. The interaction looks exactly like what they teach you it should look like in medical school with the standardized patients—involved discussion, and meaningful, actual questions (or at least that’s what I presume is going on, I don’t speak the least bit of Korean). The physical exam too, is more involved—it seems like she’s actually trying to gather information. Each touch has a purpose, direction, and magnitude. Nothing is done too hard or too soft, and you can tell that the patient feels listened to. As odd as it may seem, patients really do like being touched by doctors if its done right—makes them feel like we’re doing something about their illness, even if we’re really not. Plus, there’s a lot of chatting in-between maneuvers. If you can suspend your sense of disbelief for a few minutes, forget the beeping machinery, the white capes, the napkins, the conversation feels almost like a real one that you’d have with a friend (I don’t know what kinds of conversations you have with friends, but hopefully they don’t take place in a hospital). When my doctor walks out, they look satisfied, finally, like they just walked out of a wine tasting, or a run in with an old friend (once again, I can only imagine that some people are supposed to enjoy run-ins like these). I don’t know if it’s Korean specifically that makes these encounters so different; maybe it’s the language, or maybe it’s the commissary of being stuck in a foreign hospital. Whatever it is, they continue down the hallway afterwards with a newfound lightness, hardly caring about the sickness around them, or even better, me.
I used to think that that these kinds of brief interactions changed people for the better—that maybe the doctors would be able to carry it on their shoulders for a while. Unfortunately for them and us, I think, it’s not the case, and over the weeks here, I’ve noticed that they’ll usually only make it about halfway down the hall before it’s stolen back from them. I think it’s the walls that soak it back up; nothing explains it otherwise. Within a few minutes, the Korean-speaking memory is all gone—and not that they aren’t trying to hold onto it either, but rather that it’s being forcibly evicted. There’s only so much real estate a thought is allowed in someone’s head, and sadly, we don’t get much say in which ones get to occupy it.
I can tell precisely the moment that it happens too. From my position walking behind them, in the clunky and submissive way that medical students are expected to do, I notice the doctor’s arms begin to swing less gently at their sides, or when they start taking slightly wider, more awkward strides—there’s a couple of good tells really, but mainly, it’s always about noticing a subtle but distinct change in their motion. Hard to pick up on at first, but if you want to know when not to disturb a doctor walking down the hall with a question (not that I ask questions anyway), one who’s probably relishing the last taste of self-fulfillment that they’ll get all week, I suggest you learn how to spot it fast. There they are, walking down the hallway and mulling over the encounter in their heads, probably entirely in Korean, reimagining it from every angle. Suddenly, at some point a couple of doors down, the English-speaking thoughts of their next patient find their way back into the spotlight.
The room right after that happens is always the worst: still, remnants of the talk with –ohn linger, and as if my doctor were ripped out of a dream, she has a very dazed look on her face, it being the look of someone who’s just realized they’ve been headed in the wrong direction for a very long time. This realization then being shifted onto the patient, lying there in the hospital bed, they face the brutality from entire years of wasted life, and the misery of the doctors that wasted them. Trust me, us medical students get the brunt of it too—the frustrations that they don’t take out on us trickles down to the patients. The other day in the operating room, for example, a surgeon almost took my head off with a retractor she flung across the room at me. Sadly, it missed my right carotid by about two inches, so I had to stay in for the rest of the surgery, but you get the point. I didn’t even say anything to her either, she must’ve just been mad my square knot came undone as I cinched it.
Honestly, I wasn’t too beat up about it. It takes a lot of others’ suffering to actually affect me. Everything else aside, sometimes I think that’s why I’m in medicine after all. But the thing is, I almost always look I’m on the verge of tears, and I guess she felt guilty for almost decapitating me, or maybe she thought I would sue, so she pulled me out of rounds the next day to apologize to my face. She admitted that she was utterly miserable, and not knowing what to do at this point in her life, took out her frustration on me instead. It was particularly sad not because she was just trying to cover her tracks, which she most certainly was, but because underneath it all, I could tell that it was a genuine apology. She had lost her family and friends to the profession, and despite how hard she tried, she couldn’t at this point even get her patients to like her. After a while, I started to wonder if she was trying to get me to somehow apologize to her. But why she felt that I was the only person that she could express her frustrations to, I don’t know. Really, it would’ve been much easier for the both of us if she had just told me to practice my knot tying. Tell it to my lawyer, I thought to myself. You’ll be seeing him soon enough.
Anyway, lets get back to room. The patient, another ‘diffusely tender abdomen’, doesn’t know what’s about to hit them. Not only does the doctor not want to be here (baseline), but on top of that, the patient has unknowingly just ruined the doctor’s day by not speaking Korean, and the doctor isn’t about to let them forget it. It’s often hard for me to walk into these rooms; sometimes I can’t believe this is all happening to me (or the patient, for that matter). But eventually, by some ungodly amount of willpower and instinct for self-preservation, I manage to make my way in.
The whole interview around two minutes give or take, if that. A couple of taps here and there, and a rub and a listen on the back if you’re lucky. Hardly any words exchanged. The words that the doctor does manage to say have no meaning—they’re more for formality’s sake than anything. That being said, each word drops as much weight on the patient as a quilted blanket, and from my space in the corner, I can see their expectations crumpled before my eyes—any comfort or reassurance that they expected (as one presumably does at one’s sickest and lowest) evaporates, and I can almost see their chests physically deflate with each passing sentence. Occasionally the patient will open their mouth to ask something, but before anything comes out, their parched lips fuse back shut, knowing already that their words will fall on deaf ears.
I see this exact same phenomenon with the Indian doctors here, and the Spanish-speaking ones too. Or for example, last week I was following an almost exclusively Russian-speaking doctor. The communication with his patients consisted almost exclusively of the same three-word sentence: “Did you poop?” Although in his Russian accent, it was closer to “Dyid you pyoop?” For an entire week, my patient visits consisted solely of asking patients this one question, and then walking out. If they did in fact pyoop, he would nod his head briefly before leaving. If they didn’t, he would shake his head angrily on his way out, but not before sending in a resident to further question them on the status of their pyooping (or lack there of). But the second he walked into a room with a Russian-speaking patient, his grim, jowly face lit up in a way that I had never seen before, and from the way that they were speaking to each other, which consisted of mostly loud laughs and exaggerated hand motions, I thought that the two were going to try to restart the Soviet Union and go annex the second floor.
My problem is that I don’t speak Korean or Russian, nor do I even particularly like speaking in English. I enjoy talking with the patients that no one else bothers to—the intubated, the comatose, the anesthetized. Even the anesthesiologists don’t talk to them, and they’re the ones who put them under in the first place. If you don’t really know what anesthesiologists do, or if you’ve only heard a little bit about them, they’re the ones who put you to sleep before surgery. Most people haven’t heard so much about them, I mean if my job consisted entirely of drugging people within an inch of their life, I’d probably want to keep it a secret too.
You might think that the anesthesiologists would talk to you before they drug you, or even after they drug you, really; it’s a nerve wracking thing getting put under—one, you’ve got to trust this strange skinny man to forcibly remove yourself from your body, and then miraculously put it back into your body three to five hours later (by the way, anesthesiologists are always rail thin, and surgeons quite fat, I have no idea why this is), and two, if you wake up, who knows you’ll even wake up the same person? The whole thing reminds me of a kid being put to bed by his parents against his will. It’s a very stressful experience for everyone involved. So in everyone’s’ best interest, you’d think that there’d be a fair amount of communication going on, but the other day I was working with the anesthesia docs, and I listened to them compare house-sizes for two hours while the patient was lying wide awake on the operating table before the surgeon got there. For starters, why it always takes the surgeons an extra hour to get into the operating room is beyond me. If they had more to say to their patients than “dyid you pyoop,” I’d be more than happy to give them the benefit of the doubt; maybe they were caught up in a conversation with a patient or a family. But having worked with the surgeons for a couple of weeks now, I’m not nearly as willing to. Secondly, these anesthesiologists couldn’t stop comparing salaries for the life of them—again, if I weren’t forced to work with these people, I would’ve walked out. Sadly, the patient and I were forced to listen, (him shivering on the ice-cold table, bare-naked aside from his gown, and me with my notepad, trying to stay as quiet as possible), and the last thing he heard before going under was probably the two anesthesiologists debating whose wife had the nicer car. But if anything, he was the lucky one—at least he got to sleep after a while; I had to be tortured for another hour and a half.
If I were under the knife, I’d still want someone to be talking to me. Just because the patients can’t talk back doesn’t mean they’re not there at all. Most doctors think of them as just heavy sleepers. But to me, they’re more like people who’ve blacked out after a night of drinking. I mean it’s the same concept after all, we’ve just replaced alcohol for propofol, and a pullout couch for an operating table; the only reason why they can’t ramble on like drunkards do is because we’ve paralyzed all their muscles, including their vocal cords. The anesthesiologists always like to justify themselves by noting the patients don’t remember anything when they wake up, which is an argument I doubt would hold up in any other context. No one would ever let me practice incision making on a blackout drunk—just because they don’t remember it, doesn’t mean they didn’t go through it.
That’s why I like to talk to these patients in their hospital rooms whenever I have the chance. There’s a patient on the fifth floor right now with a rare neuromuscular disease that causes all her muscles to contract constantly—she’s lies in her bed with her eyes bulging out of her head, jaw hanging wide open, and all of her limbs constrained to the most unnatural and painful-looking angles. She can’t speak, and I haven’t seen a single doctor talk to her since she got here. Every day they come into her room and do their exam in silence, as if she were made of plastic, unable to hear or see anything. Why we assume anyone who can’t speak is dead, I don’t know. We assume that communication has to be bidirectional in order to be successful.
My silent patient on the fifth floor may not be able to respond, but someone is no doubt in there, thirsty and starved for a single word intended for her. It’s amazing how long we think we can go without being spoken to, and even more unbelievable how quickly we realize we were mistaken. So after rounds, I come back into the room, and helping the nurses change gauzes, dressings, or lines, I speak to her gently, speaking about my day, or asking her about hers. Expecting responses from her might seem as pointless to as expecting them from the bed she’s lying on, but nevertheless, I try to read her bulging, bloodshot eyes for an answer. And while most of the time I can’t glean an answer, what I can get from them each time is that just from my asking, she is grateful. For most people, a call is nothing without a response, a cry nothing without its shoulder to fall on. It’s why the Russian and Korean doctors act how they act here, and honestly, I don’t blame them. It’s not easy to try and expect communication from patients in hospitals—at a their very lowest, often they aren’t able to. So after trying in vain, day-in and day-out, there has to be a point where we stop expecting responses at all. It’s why after a while, the only thing we expect from patients is to be able to answer yes-or-no questions about their feces. But words are much more than the responses that they evoke. Even to someone who is unable to answer, the meaning and attention that our words carry is the very essence of our profession. Often, we fail to recognize that patients are identical to us in their desires—and in denying them of our voices, something as simple as a gentle goodbye, it only blinds both parties to the light that’s possible between two people in the hospital. It’s rare to be found around here, but it’s still present, bright as ever, shining when the needy call out and are lent a hand in response.