FOUR LESSONS

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FOUR LESSONS

We all know it.

Today's health care model is a mess. When I was a fresh Intern, I met an ornery patient I came to adore, and not only because I saw him on a near-monthly basis. The first day I met him, he was being admitted from his dialysis clinic because his blood pressure was too high. Upon entering his room, he grinned and said,

"I get a lady doctor this time round, coo-wee! I tell you, as soon as I get out, I turn right 'round and be back here again! That's fine, tho,' that's fine." He leaned in with a wink and continued. "This time, tho,' they fuh shore better tattoo a big ol' barcode on me. Instead of wasting everyone's time, you could just scan me with one of them fancy machines. Beep! Everything done! And maybe, just maybe, they'd bag me for free when I finally check out."

He was a good-natured black man born in the 1930s, somewhere in the bayou along Houma, Louisiana. He wasn't sure of his real birth date or his actual place of birth (aside being born inside the house his father built with his own hands). He loved to talk and I was easily captivated by his agile, river-rapid accent. It was sandy with touches of gravel, yet unmarred by his lifelong love of hand-rolled cigarettes. He would say "Nawlans" instead of 'New Orleans,' among other fascinating, drawn-out bayou words that were unfamiliar, if not outright comedic. Yet, he'd lived above the Mason-Dixon line just long enough that I manged to understand him most the time, even if I had to file some of his vocabulary to be figured out later (it took me forever to figure out what a beignet was).

He could still speak old-school Louisiana French (when he cared to) and I knew his traditional Cajun was a dialect that would fade away within my lifetime. To this day, I deeply regret my lack of courage. Each time his name appeared on my schedule or rounding list, I swore I'd ask if I could record his voice. Yet, doctoring always got in the way and I inevitably justified my hurried rush to the next patient by assuring myself I'd ask next time.

Sadly, "next time" never arrived. One night he arrived suddenly, too ill to speak or even recognize his doctor. He was taken to the ICU where he succumbed to sepsis within hours. Despite nearly three years of continuous care, I never got that recording. It would have been given to me gladly. More than anything, he loved to talk and have someone around to listen. Had I taken the time to appreciate his brief - but life-altering - gift within my too-preoccupied life I could honor him today by listening to him now and sharing his stories with my children. 

It never feels good to realize you've started to look like a cog in the machine. I had mistaken myself, the Doctor, as the "Person of Consequence" while relegating patients to "things." Patients were overbooked appointments; lists of diagnoses; time-sinking pain seekers; additional paperwork; more billing; and worst of all, they were "next times."

I was wrong. How did I stray so far from altruistic girl who just wanted to help people? How did I become this insensitive asshole? That was Lesson One:

Patients are people and they are valuable because of their own merits. I must never take that for granted again.

For three years, he was my regular patient. He had no remaining family - his strongest relationships consisted of his neighbor, a cat, and me - a doctor still learning the ropes. I never understood what that kind of isolation was like for him. I never once thought to go to his home and care for him there. I assumed he'd tick along on dialysis forever. That is, until he arrived in the ER that night and I received the admission call. One look at him and I knew the inevitable was coming, but no one else was. There was no one for me to call, no one to provide a preferred funeral home...no one but me. So I pulled up a chair and sat next to him, watching his heart monitor slowly space out until only a flat line remained.

When he died, his black, weather-worn hand was held in mine, white and bland. Yet, our palms were nearly the same color, creating the illusion that our skin blended into each other's. That was Lesson Two:

The only ideas that create separations between doctors and patients are the ones they create themselves.

Eventually, I left his ICU room to write his death summary. It took so long to complete that transport personnel finally wheeled him out, covered by a black sheet. And that was Lesson Three:

Medicine does bag you in the end, and it sure as hell wasn't free.

I never forgot the many injustices he should not have faced. His chronic illness; his poverty; his insurance; his race; his age - these were used against him by corporate medicine, turning a kind man's complex and fascinating life into a demographic and later, a discharge summary I was yelled at for not completing on time.

Leaving residency and joining a Hospitalist group did nothing to assuage the many grievances I carried from my medical education. In fact, I continued to accumulate anger on behalf of those who had less power over their care or their management: patients, nurses, and other vital care providers. Be it clinic or inpatient, nothing changed: patients and doctors had little time together; care was expensive and insurance was a mess; patients couldn't understand their medical bills because of intentionally-complicated forms; physicians were pressured to meet daily patient quotas; nurses were abandoned by busy physicians to manage end-of-life care without help; and always, always, medical providers were intentionally understaffed. By far, nurses were treated worst, despite being the hardest working employees in any care facility. As an Attending who could finally put the entire sham into focus, I came to learn Lesson Four:

 If you lead a health care team - which works best when all are treated as equal partners - you will feel ashamed because the "system" you're supposed to support is taking advantage of those receiving smaller paychecks, despite being the legs you stand on.

These four lessons changed who I was inside. I know myself well enough to know I will never again return to corporate medicine. There is a better way of doctoring, and I'm stubborn enough to figure it out.

Fuh shore.

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