I was an In-Patient in a Major Teaching Hospital 

James d'Acier
Issue CLVI - May 24, 2008
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A sample image “Hello Mr. d’Acier.  My name’s John.  I’m a fifth-year medical student and intern here.  I’ll be assisting when Dr. Smith performs your operation.”  John exhibited a calm, confident, friendly, professional manner, and seemed quite relaxed and experienced.  Yet still there seemed a small element of hesitancy in his approach.  “In fact, for some steps in the procedure, if Dr. Smith approves, I’ll be undertaking them – under his direct and immediate supervision, of course.  It’s a part of my training.”
“I see, John.  And may I ask in how many of these have you personally participated previously?”
“About one hundred.”  He smiled, relaxing, clearly confident.  Any disquiet he’d exhibited a moment before was clearly from his uncertainty over my reaction, not the task ahead.
“That will be great, John.  I look forward to having this procedure done.”  I was the pre-op room in a world-renowned university teaching hospital and medical center waiting for a routine surgery; routine, but not minor.  After several years of struggling with chronic arthritis, the consequence of a condition with which I’d been born, I’d decided it was time to have it repaired.
The operation itself went particularly smoothly and quickly.  Dr. Smith, a truly world-famous surgeon, did it entirely himself; apparently it did not present sufficient challenges to make it worthwhile for the interns to do more than watch a master at work, or so I was later told.  I awoke in recovery, feeling surprisingly alert and chipper, perhaps a delusional feeling induced by the anesthesia, but a good feeling nevertheless.  After about two hours I was moved to my hospital room.  I was immediately assisted by a squad of nurses, aides, and the like, checking my condition, giving me advice on pain management, and gathering data – blood pressure, temperature, blood oxygen saturation, etc.  My impression was of a thoughtfully organized, carefully coordinated, smoothly run team.  And then, around 5:00 PM, Jill arrived.
“Hello Mr. d’Acier, I’m Jill Roberts.  I’m a master’s student here at the university.  I’d like to know if you’d be willing to participate in a survey that will collect data on in-patient hospital experiences.  These data will be used in my master’s thesis, and – we hope – in developing changes that will result in more comfortable hospital stays for our patients. 
She was lovely, enchanting.  I found myself eager to please.  “Count me in, Jill.  This sounds like a good idea.”
From her attaché she drew a clipboard with several sheets of paper.  “I’ll just run through these with you, if you are up to it now.  This is usually the simplest way to do it, and will only take a few minutes.”
“Fire away, Jill.”
“OK, first question.  On a scale of 1 to 10, with 10 being best and 1 being worst, how would you rate our hospital gowns in terms of fit, compared with other hospitals you’ve visited?”
My first reaction, which I kept to myself, was “hospital gowns have ‘fit?’”  “Well,” I said, wanting to be agreeable but still helpful, “they’re pretty good, but I suppose they could be improved.  Six, maybe?  Seven?  If anything that understates it, but I suppose I’ll go with seven.”  I realized the gown was falling off my shoulders,, twisted around my body so that the back opening appeared in front about halfway down, and the whole thing hiked up to an extent that were it not for the bedsheets, my exposure would have been rather embarrassing.  But Jill seemed so very nice, and I didn’t want to inject a note of negativity.  “Yes, seven.”
“Great, Mr. d’Acier.  Next question.  I notice you are wearing our pale green plaid gown.  On a scale of 1 to 10, how would you rate the importance of switching to a gown of light tan plaid, light pink stripe, or plain blue?”
“Umm.”  I thought for a minute.  “To tell the truth, I’ve never given it much thought.  I suppose it isn’t extremely important to me.  I guess three.”  I thought about charming Jill and her thesis.  Was I being helpful?  “Although I’d like to add a caveat that if a bright gold and black check pattern were available, I’d go at least eight or nine.”
“Good, good, I’ll make note of that.”  She was enthusiastic.  “Now, if a hospital gown in floral prints were available, what kind of flower would you choose?”
And so it went for fifty questions, exploring the finer points of gown design, from i-pod pockets and pencil holders, to alternative materials such as chiffon and mylar, etc.  When we finished, she thanked me, and again assured me my cooperation was making a valuable contribution to medical science.
“You’re certainly welcome, Jill, but may I ask, which part of the medical school are you studying in?”
“Oh, I’m not with the medical school.  I’m with the School of Design and Fashion.”
“Really!  That’s something of a surprise.  I assumed that a teaching hospital would be devoted entirely to the medical school.  But I guess it would be an asset for many non-medical fields as well.”
“Oh yes, we have hundreds of different majors and fields here, and I don’t think there’s one that doesn’t make some use of the hospital.”
And so it was I met the students of SOC HLTH-101.
It was the day after my surgery, midmorning.   I always had the nurses keep my door open; it makes the space seem roomier and puts me at ease.  I first recognized something a bit out of the ordinary was occurring because of the commotion down the hall.  I could hear a sizable group in the distance, slowly moving towards me.  They weren’t overly noisy, but there was the continual chatter of many simultaneous conversations, all conducted faux sotto voce, as if the speakers wanted to be quiet but didn’t know how.  Occasionally a louder male voice rose above the individual conversations.  I couldn’t make out what he said, but he spoke to the group, almost sounding like a tour guide.
In only a few moments the group was outside my room.  At this point in the hallway, several wings converge into a sort of lobby area, a natural place for a group to stop and get its bearings.  I could see from my bed a large number – one hundred or so – of what appeared to be freshmen students, led by a professor in his late fifties with bushy gray hair and beard.  He was saying something about “cross-cultural implications of socially constructed public expectations,” or something like this.  Suddenly a head popped in my door.
“Hey, man, what are you in here for?”  The head was ruddy, with red tousled hair and a quick friendly grin.
“I’m James.”
“Hey, James, I’m Boomer.”
“Come on in, Boomer.”
He was a solidly built kid, wearing blue jeans, a university t shirt, and old running shoes.  “Cool.  Can my friend come in too?”
He stuck his head out the door and motioned.  “C’mon in Derek.  Yeah, it’s OK, we’re invited.”  He was joined by a thin tall kid with dark hair.  “This is my friend, Derek.”
“Hey Derek.”
“Hey, how’s it going?”
“I’m OK.  I just has surgery…hurts a little, but no big deal.”
“What was it for?”
“I had a new hip put in.”
“No way!  That’s wild.  And it doesn’t hurt?  Don’t they have to saw through the bone for that?”
“Yes, they do.  And I guess it does hurt some, but they’re giving me some pretty strong stuff for it.”
Boomer and Derek asked me a few more questions about my operation.   They were quite agreeable, fun to talk with, and genuinely interested in my experience.  Finally it was my turn.  “So what group are you guys here with?”
“This is ‘Social Health 101’ … ‘Our Friend the Hospital.’”  They sniggered a little.  “Actually that’s only this section of the course.  It’s actually called ‘Exploring the Mysteries of the Health Care System.’  It satisfies our Health and Human Development core requirement.  Easy ‘A’ and field trips!”
I mulled this over.  “Sounds kind of ridiculous to me.  ‘Our Friend the Hospital?’  What kind of a course is that?”
“It’s a bone-headed one,” Derek replied.  “It’s mostly stupid.  But you should see how stupid some of our fellow students are.  ‘This is a hospital, this is a doctor, this is a nurse…’ and they act like they’ve never seen anything like this before.”
Boomer broke in.  “And the professor, he’ll tell us the simplest stuff as if it is some sort of deep revelation.  ‘People stay here to be treated.  It’s expensive, and usually paid for by insurance.’  Plus there’s his own political b.s.”
“Well, I suppose people have to learn this stuff somewhere,” I replied.  “After all…”
The professor stuck his head in the doorway.  “What are you two doing here?”
Before anyone could respond, three girls stuck there head in as well.  “Ooh, look!  Is this a patient?”  “A patient, oh cool!”  “Can I touch him?”  “Can I feed him something?”
“Keep your distance, ladies,” the professor warned.  “Yes, they look harmless enough, but they can carry disease.”
“Oh, but he’s so cute!  Can I pet him a little?”
I was thinking the same about her… including the part about carrying disease.
“Hi prof!” I said.  “I was just chatting with Boomer and Derek a bit.”
He stroked his bushy beard, and peered at me through his heavy horn-rimmed glasses.  “You know, this is a teaching hospital within a university system, and we use it to develop young minds for future service to society.   I’m Professor Smedley Smudgeon, Department of Sociology, and I’m teaching a course that introduces students to the intricacies of the modern medical system.”
“Our friend the hospital?”
“Precisely!  The fourth rubric in the course, after ‘What is a Doctor?’ and immediately before ‘Why You Will Never be Able to Afford Private Health Insurance.’  Very deep material.”  There was a slightly pompous tone in his voice.  He seemed to think it sounded very learned.  “But let me ask you.  I wonder if you would mind participating as a subject for my class?”
“Why, I’d be delighted, professor.  Anything for learning.”
He left, and quickly returned, followed by quite a number of students, who wedged themselves into my small room.  There were maybe fifty, with that many again crowded outside my door listening.
“Students,” he began, “here we have a specimen of the American patient.  Note carefully his pitiful plight.  He is no doubt in extreme pain and despair, torn from the supportive ties of traditional tribal-village culture and thrust into the cold, antiseptic, money-driven, impersonal and unsupportive modern world of the wage laborer.  Alienated from himself and his fellow humans, he sits alone, suffering, his only hope of cure resting in the number of dollars he’s been able to eek from his exploited condition.  His fate is a sad one.  Cut off from a natural bucolic existence, his life will be shortened.  He will no doubt be bankrupted, as hospital administrators and insurance corporations present him with bill upon bill.  As his coverage runs out, he will be turned out on his own, unwhole, broken, and will find himself on a path to ruin, homelessness, and early death.”
“Well, actually, professor, it’s really not like that at all,” I interrupted.  “I was born with a minor flaw in my hip that eventually, given enough years, led to severe arthritis.  But in a traditional society I doubt this would have happened, because I’d probably not have survived that attack of appendicitis when I was 14.  Still, through the miracle of modern medical technology, I can get a new hip to restore me fully, no more pain and limping, thanks to titanium, polythelene, and human ingenuity.   And the people here have been great: extremely professional, extremely caring and friendly.  I’m glad that they can earn a good living doing this, so that they can specialize and concentrate on being so caring and competent.  And I’m not really abandoned.  Family and friends are visiting all the time, and on a daily basis I’ve been calling my worried mother several states away to reassure her I’m fine.  Try doing that without modern technology.”
I took a sip of water.  The professor stared silently, his eyes wide, eyebrows dramatically arched like shocked caterpillars.  I continued.  “Now frankly, I agree this isn’t cheap, and besides my insurance and medical savings accounts it’ll likely necessitate raiding my checking account for deductibles and such, but let’s face it.  Thirty or forty years ago I’d have been looking forward to the remainder of my life on crutches.  But today, my doc tells me that once I’ve recuperated, I can return to running and the like.  So it’s not cheap, until you consider the alternatives.  And then it seems like a pretty good deal.”
Professor Smudgeon adjusted his glasses, turned to the class, cleared his throat, lifted his nose and began.  “Note carefully, students, the effects of the artificial painkilling compounds on this poor soul, warping his judgment.   One cannot even begin to follow what this unfortunate man says.  If instead he had been given gentle natural organic herbal remedies, gathered locally by happy worker collectives in a sustainable fashion, he would be totally pain-free and lucid.  So in fact, you’ll note that he is truly a victim of the current system in every way.  My proposal for a Comprehensive National Health Care Czar is really the only way in which this unfortunate victim could have been saved.”  He dismissed the class and led them out of the room.
Boomer leaned over to me.  “He’s written ‘Health Czar’ proposals for every major presidential candidate.  He’s pushing to be appointed health czar himself.  We all think he’s nuts.”
The girl who had wanted to pet me came back into the room.  “A real live patient!  Can I touch him?”
“He speaks English,” said Boomer.
“Go ahead,” I said.
She reached out tentatively, touched me on the tip of my nose, and drew her hand back.  “A real live patient!  And what’s that in the jar by your bed?”
“My hip bone.  They took it out, and I’m saving it.”
“Eeeeeeee!”  She ran from the room.
James d’Acier is an economist and writer who currently lives in the Midwest.  He recently underwent surgery in a major university teaching hospital, and wrote this story while hospitalized.  He assures us that despite some elements of truth, it contains far more fantasy than fact.


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