An Ailing Enterprise

Webster’s dictionary defines Hospitals as “institutions where sick or injured are given medical or surgical care”. This definition truly falls short in many respects, especially when viewed from the perspective of the medical fraternity. We, who spend most of our waking hours in one or more of these “institutions” come to look upon them as this, and much more. They are our teachers for the best part, there are times when they are our friends, our shelter, and of course there are occasions when we can barely wait to get out of there. Hospitals are in a number of ways like living, breathing entities. They are born when they start functioning, they grow over years as they develop with the changes happening in the world of medicine and in some occasions, for different reasons, they one day cease to operate, or die.

I have been associated with a hospital that is, unfortunately in such a situation, where it is fighting to stay alive and to put it bluntly, the prognosis doesn’t look too good. In such circumstances, it is natural for all the people associated with the institute to be very worried, and the instinct for self preservation takes over. Perhaps we should take some time out and give a little thought to the hospital itself. Having been around for over a hundred years, having been over a thousand bedded facility in its heyday, having been a premier center for health care and research, for the institution to see this day, to be, metaphorically speaking, on its knees, having stood tall not too long back, is indeed a sad, sad story.

These, however, are also signs of the changing times, when we realize that a hospital is not merely what the lexicon defines it as, but are also financial concerns, with medicine and health care being the multi billion dollar industry it is today, and we also must unfortunately accept that if it is not financially viable for an organization to keep running, it must shut down. If we take a moment though, to reflect on the parallel I attempted to draw between humans and hospitals, I wonder how the hospital would feel at the state of affairs, having witnessed many events in its time. It has seen glorious discoveries, it has trained fresh moldable minds into competent physicians, many of whom are at the forefront in their chosen fields. It has served the changing community for over a century. It has been a part of their joys at the birth of their children and the recovery of their sick. It has been a source of strength in their times of weakness, and a silent sympathetic spectator to their grief. In short, it has done its part and a whole lot more.

Everywhere you go in the premises of the hospital at this point in time, you come across snippets of conversation about the impending fate, and while most of these circulate around how it is going to affect the lives of those associated with the organization, there are underlying emotions which are quite perceptible. There are those who feel angry and frustrated, partly because of the concern for their own futures and careers, but also because they can do little to help the hospital, their home away from home, in its time of need. There are those who feel despair and disgust at the way their workplace is being snatched away from them by financial reasons and constraints that they don’t even comprehend, and there are some who still feel pride at having been associated with an institution that in its day shone like the sun in the world of medicine, leading the way in research and clinical practice. If I may speak on behalf of my fellow workers, it is largely a combination of all these emotions that most of us feel.

Many of the employees, past and present, have been associated with the hospital for a large part of their careers, and declare with pride, “I will go down with this ship”. It is this attitude, perhaps that also reflects what the hospital would feel at this time in its life. Pride, at having accomplished so much, and the will to continue to fight, no matter how dire the circumstances. As for the employees, patrons and other people associated with the hospital, life will carry on, here or elsewhere, but I hope that the mixed feelings of anger and despair will eventually give way to a feeling of pride. Pride, in staying in the fight and not throwing down their arms, pride at performing their duties to the optimum even under the most strained circumstances, and pride, for coming through testing situations which are being witnessed far too often in the American health care system today.

(Written in tribute to Michael Reese Hospital, Chicago)

The Code

Suddenly it was all over
And everyone looked at me
As I looked at my watch,
Said “time of death - 4:53”

After all the frenetic activity
A squalid pall had descended
For, on ICU bed 3
A code had just ended.

(also a piece deemed unworthy by the Annals)

Life, death and that post call feeling

The last 4 months have been a bit of a blur. The last 3 weeks even more so. Since moving to Cleveland in June, lifes been either ridiculously busy or ridiculously dull. No real in-between moments. The last 3 weeks I've been in the Neuro ICU, (One more week to go, and its been really, really tiring!) which if one has the time is the kind of experience that will make one reflect on life, on death, on dying, and also on that incredible thing we call the post call feeling.

It will make one realize how fragile life is, as indeed many of our daily experiences do, and how a small blood vessel popping somewhere in a persons head can bring an end to what might have been a long and happy life. It will reiterate the belief that dying might actually be a lot harder on the loved ones of the patients rather than the patients themselves. It will bring a relative, in some cases an absolute lack of emotion dealing with death and dying, which is unfortunately, and in an ironic extreme, a part of life.

Coming to that amazing post call feeling, I'm not sure if there is any non-medical parallel I can draw for the more fortunate folks amongst us who were smart enough not to go to med school. I could liken it to running a marathon, somehow getting through it, and then seeing the finish line, the home stretch, but then I dont know too many marathon runners either.

You spend almost 30 hours at a stretch, working like the devil, getting almost no sleep. Somewhere about 20 hours or so into the call, it really hits you hard, but you keep going and around 24 hours into the call you get a second wind, which is the beginning of the post call feeling, even though you're technically and physically still there, still answering questions, presenting cases, and sometimes unknown to the ACGME, doing procedures, you bask in the knowledge of having successfully completed a call, in anticipation of the comfortable bed and undisturbed sleep that await you at home. Trust me, it is almost euphoric, as is the feeling of actually hearing those hospital doors slide shut behind you and the half asleep drive back home.

I still have over half a year of calls every 3rd or 4th day and I expect that like everything else this too shall pass. At least on every call day I have the post call feeling to look forward to.

The "Graduates"

Michael Reese Hospital celebrated the graduation of its last ever class yesterday. It was a great occasion. A happy one. A sad one. A proud one. A beautiful one.

As part of the outgoing intern class, I was perhaps amongst the people with the briefest association with MRH at the graduation party last night. The gamut of emotion that many were going through was very palpable to me nevertheless, the open bar not withstanding.

As all of us leave Michael Reese, we all take with us a small part of the institute, a small part of each other, the people we worked with, and the people who were friends, practically family for the last 1 year. We also as a corollary, leave behind a small part of ourselves with this place and with these people.

Its been pretty much a roller coaster ride during my internship - I apologize for using such a cliche. There've been times of joy, times of sorrow; Times of sheer frustration and agony, somewhat outnumbering the times of ecstasy (its a residency - thats about par for the course); Times of nerve wracking stress (I never, ever want to hear the words 'business' and 'lunch' used together again.) and times of complete relaxation (the last couple of months have been pretty easy).

As the party came to a hesitant end last night, after all the music and dancing (yours truly danced as well - most people who know me well know that happens even less often than a sighting of the Halley comet - to underline how special the occasion was) one could tell that many of us were reminiscing on such moments (the open bar was a help this time around). Everybody looking back on the time they spent here, with each other, lasting memories they would have of each other, of themselves, of the hospital. The education they received here, which would of course serve as the foundation for most of their careers. The relationships they forged. The laughter they shared. The quarrels they had. The things they shouldn't have said but did, the things they should have but didn't. (I know thats what I was doing, at the very least.)

Now that the serum alcohol levels are tending towards zero, I can think clearly and realize that I was thinking pretty clearly last night anyways. In about a week, all of us will move on to our lives at other programs and hospitals. The hospital, too, doesn't have too much long left in terms of operation. At this point in time I would just like to thank everyone I've had the pleasure of working with over the last year and wish them the very best of luck.

If any of you guys are ever in Cleveland, give me a shout out. It'll be great to catch up.