Editorial

A numbered day in the life

Abstract

Abstract

A story of Jim, a man who begins to habituate himself to hospital culture as that outsider known as the patient. Journal of Hospital Medicine 2009;4:326–327. © 2009 Society of Hospital Medicine

Copyright © 2009 Society of Hospital Medicine

It seemed like years had passed since he was told he had cancer. While he basked in the cool white ambiance of the examination room, Jim mentally traced his many steps up and down the nearby hospital hallways. From this room to that, he had shuffled through most of the rooms on this hospital ward. Jim had read every outdated Time and National Geographic magazine, and all of the kids' books. From sitting in waiting rooms, he had even developed a deep appreciation for Thomas the Tank Engine. As he sat there, he realized that he had only spent 8 days in this hospital ward. But in here, 8 days might as well be 11 years. Time doesn't so much pass in hospital wards as it stands perfectly still on your chest. The total isolation for those who must stay is startling. Jim had begun judging time by the movements of those lucky enough to go home. Instead of Mondays, Tuesdays, and Wednesdays, he was also measuring time by food. Days of the week had become known as Styrofoam meatloaf, highly suspect lasagna, and inedible beef Wellington; all had become units of time measurement.

When he was told about his cancerthe doctor told him it was a type of hematological neo‐something‐or‐otherJim felt strangely aroused by the news. He felt energy racing through his body as he geared for battle. His immediate response was to think about how he would volunteer for the harshest, meanest, nastiest treatment he could get the doctor to agree with. Poke him full of holes, pour poison straight in his veins, run him on treadmills while doing all of thatit didn't matter. There was nothing he would not do to beat this thing. The doctor had finished telling Jim about all those options at the very minute Jim was ready to hear them. Whatever, whatever, Doc, let's get going with this, was his response.

Then, he had gradually noticed that the pace of medicine was something a little less urgent than he had thought. On TV the doctors run everywhere, but here they walked with a brisk but awkward gait, as if afraid of falling on the floor by going too fast. While waiting for his appointments, Jim noticed that everything was about waitingwaiting for everything. Nothing happens in the hospital. There are people walking everywhere with some projected sense of purpose but it all seems so meaningless when there's a hundred people in hospital uniforms walking past a whole room of patients.

Finally, the door to the examination room burst open and in walked Dr. Day. Standing slightly less than 6 feet tall, Docas Jim called himwas one of those well‐preserved 50‐year‐olds who could be found wind‐surfing his way back to his convertible sports car during his off‐hours. Jim imagined that Doc had been the star student, the handsome rover, the jock. Age had started to claw at his youthful looks, but vanity had led the charge against age for Doc. His behavior and choices worked against his clock, and he was not going quietly into that dark night. Doc's athletic stride made it seem like his feet never touched the floor, and he wafted deep into the room before the doors had even fully opened. Doc never looked forward, but always studied the charts in front of him. He was intense; it was as if he had to truly concentrate sometimes to keep pace with his own mind. Doc was talking, but it was unclear to whom. Finally, he looked up with an expectant pause, and Jim, battered with indifference, nodded in affirmationto what, he didn't care. Doc then gave Jim the thumbs‐up, turned on his heel and headed toward the door; he spun around on the spot and looked back, Yeah, you'll need to change into a robe with nothing on underneath it. He gestured to the one wall where a shelf held neatly folded paper‐thin gowns. Jim put one on and could barely believe how sheer it was. It had the density of a paper napkin, he thought. Then again, this was hardly a cause for modesty. The cancer, he had learned, was actually lymphoma, and it had settled in his groin. At first, Jim was ashamed to have doctors and nurses poke and prod his nether regions, but after a while he became quite causal about it with the usual array of doctors and nurses who populated his monotonous life in this shiny new white palace. After the requisite 15 minutes of unexplained absence, Dr. Day returned through the doors. There was something different about him now, and in a world so dominated by sameness, predictability, and routine, change was a dark storm cloud and sudden wind in Jim's mind.

Lie down on that table please, Doc said in his usual my hand may be making a tactile map of your groin, but my mind is in Bermuda manner. As Jim hopped up on the table and shifted his diseased area closer to the end, the Doc seemed to brighten up, Stay right there, he said as he moved quickly from the room once again. Jim pondered the instruction. As opposed to going where? Jim groaned. He would go somewhere, but his treatment, eventually, would happen here. If he left, he didn't know if would ever come back.

In through the door, one more time, came Dr. Day, but this time he seemed to be leading some kind of tour. Trailing behind him in different states of interest and alertness was a team of young people, all in the little training smocks they give them that look just like the big‐boy coat that Dr. Day wore. Their smocks were more wrinkled and more ivory colored, but they still looked official. Dr. Day hardly looked toward the patient as he smoothly rolled into the side of the table nearest Jim's now‐exposed groin.

Jim looked up between his upstretched knees to see them, all of them, standing around trying to decide if they should be looking at the Doc or looking at the affected area. Jim was embarrassed. Jim was mad. Jim was embarrassed again. He tried to make eye contact with every single visitor in the room, and all he could see were eyes looking straight down under the flap of his hospital gown. Doc had broken into his whole song and dance when he stopped short and looked to Jim, almost apologetically, You're alright with this, right? These are first‐year residents and I wanted them to see this kind of tumor up close. Doc hardly took a full breath and he had turned and was back into his blather about mito, crypto, this, that, and some other bullshit. Jim felt like if he rested his head back maybe no one would ever know that he was the real fleshy cadaver that they stared at that day. He might never see any of these students again, and even if he did, none of them could bring themselves to look him anywhere near the eye anyway. Not much danger that any of them could pick him out of a police lineup, even if he did it without any pants on.

It's important to palpate the region, each of you need to feel what this is like, starting with you. Jim heard this particular instruction and snapped his head up to see exactly where the students were now headed to see and feel the thing they just had to touch. Imagine his dismay when he saw that all of them were still there, still transfixed on whatever they had found to look at studiously during this whole period of time. Doc had motioned to the smallest, frailest, most out‐of‐her‐element young woman he had ever seen. She visibly swallowed hard at the news that she would be first. Her eyes, previously fixed without distraction on some point on Jim's leg, now began to frantically search the eyes of others, possibly looking for some permission to run away. Her eyes met Jim's quite by accident, and she shared with him a look of total and complete shame. He took out his annoyance on her by fixing her with a murderous stare, while he watched as her hand inched ever closer to his leg. In a continuous, but painfully slow motion, she reached under the robe and Jim felt the slightest touch of what he assumed was her finger come to rest on the lowest part of his abdomen. She held her finger there, motionless, and then drew it away quickly while nodding to the Doc. No, no, no, you have to really feel it! Doc chided. He reached down and poked the area firmly, but with a certainty and comfort that comes only from unspoken familiarity. Doc then grabbed the poor girl's hand and guided it and proceeded, with his hand holding her wrist, to make the poking motion with her hand. She was clearly horrified and would have rather been poking through the exposed abdomen of a cadaver at that point. Jim's mood became even more annoyed at her response. It was okay to be embarrassed, but she was now acting like his groin was Elephant‐Man‐esque in its hideousness. He wondered if Doc would set up a barker stand and call to the passers‐by to see the bulbous freak, 50 cents for a viewing! Don't forget about our snack tents! Nobody should go home without candy, everybody loves candy!

After the young resident had endured all that the Doc thought she should, he motioned to the next one and repeated the same process; one after another, after another. The students instinctively formed a line that snaked around the table and spilled out through the room. Jim became callous at this point and began chatting up the students while they stood, quietly waiting their turn for the guided poking, to make them feel even more uncomfortable and intimidated. Jim spied one extremely uncomfortable‐looking male student. You know, if you like this, it doesn't make you gay, Jim shared in an almost caring tone. As the target of his comments shuffled forward, eyes never leaving the floor, Jim targeted another victim with his comments, and then another, and then another. Jim became a sniper of sarcasm, picking off helpless young residents as they stood helplessly in his aim. Doc finally reacted to Jim and shot him a scolding look. Doc leaned into Jim's ear, Fun is fun, but let's just take it easy now, ok? Jim grunted in disagreement, but complied. There was no anger left to vent, and really no need to vent it. Residents weren't the problem, but it was easy to treat them that way. Besides, Jim figured there was many more days for him to make it up to them by being a nicer patient. Today was today, but there were probably 20 more tomorrows for him here.

Finally, the last student had his moment. Jim noticed that the region was now sore from the guiding probing, and Doc had his back to him while addressing the students about what they had seen there today. Jim hopped off the table and proceeded to change back into his clothes while Doc carried on talking. Then, Doc was gone; he sped from the room with his entourage in close pursuit. Jim finished dressing and shuffled down the hallway to his room. Jim sighed under the weight of monotony. Every day was the same, and only the torturous delight he enjoyed at the expense of those residents made the day unique. It was, for the most part, emotion that broke the routine. Emotion was the only thing that Jim controlled at this point, and occasionally, selfishly, he would let it loose on the unsuspecting, simply to bookmark his day. Cancer was not killing Jim, but boredom quite possibly could. As Jim passed the drink machine around the corner from his ward, he saw nurse Janet coming in to work with her neon pink lunch kit slung over her shoulder. She smiled at Jim and asked him how he was feeling. Jim smiled, told her all was getting better, and then made his way back to his room. Janet's arrival meant it was almost supper time, and today was lasagna.

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