High-Stakes Hippie Love-Fests: Doctor Edition!

I love this song. I love the almost unforgivably peppy bounciness of the thing, and I adore how the brashness of the ascending modulations near the end of the song just pulls my mood right up with them.

But I also enjoy (some of) the lyrics: “Stand in the place where you work…” and think about it for a minute. And “wonder why you haven’t before.”

I do that all the time, actually. As a writer, I’m a constant people-interacting-with-surroundings-watcher. And by all that is good and writerly, there is no more fascinating place to observe humanity than in a hospital.

I’m not even talking about the patients, or their families, though you will never see a more honest cross-section of humanity anywhere else.

I’m talking about the staff.

If you’ve worked in any kind of service profession, you know how much it sucks when one of your customers is having a bad day. They take it out on you, right? And it can completely ruin your day.

In my job, EVERY PERSON I INTERACT WITH is having one of the worst days of their entire life. They’ve just been told they have cancer. Their child may not live to see the sun rise in the morning. They haven’t slept in a real bed for days, months, or years, and they’ve been poisoning themselves with nothing but hospital food. They’ve been cut open and had a leg or a kidney or a section of their intestines removed from their body. They’re in pain, they’re scared, they’re lonely, they’re dying.

That’s baseline.

Now think about the people who are there every day. Who not only interact with patients and families in a pleasant and patient manner, but also are expected to work miracles, teach complex concepts, learn complex concepts, be scientifically brilliant as they make life-and-death decisions, and get along well with their co-workers. On 30-hour shifts. With a sometimes abusive patient load. In danger of catching hepatitis or HIV from a slip of the wrong needle.

Stand in the place where you work, indeed. In an environment like that, your very survival might depend on your team.

You’re exaggerating.

Well, yeah, maybe about the “very survival” part. (I always thought the “your very survival” was a silly grammatical construction, by the way. You can’t say it except in an overdramatic exaggeration.) But I’ve been on good medical teams and bad medical teams, and you wouldn’t believe the difference it can make.

If you’ve ever been in a hospital (at least, a teaching hospital), you’ve probably been the focus of an experience in which ENTIRELY TOO MANY PEOPLE IN WHITE COATS crowd around your bed near the beginning of the day (probably waking you up in the process), talk about stuff incomprehensibly, and leave. You might see those people individually over the course of the rest of the day, each breezing in and out with some random task or question. You probably have no idea what anyone’s name is.

That’s your medical team.

So here’s the basic structure of a medical team, at least at the teaching hospitals I’ve been working in. Try picking it apart next time the flock of white coats surrounds you while they round on you. Remember that there can be pretty much any combination of these roles on a typical team.

At the head you have the Attending Physician. The head honcho! The big cheese! That “here” whence the fabled “buck” doeth “stop”! (Is that a proper use of “whence”? I couldn’t decide, so I figured I’d just run with it.) The Attending is in charge of the service, and is ultimately responsible for the patient’s treatment. If there’s one relatively much older person in the group, that’s most likely the attending.

Sometimes a service will include a Fellow. (This can be a guy or a girl; it’s the name of a position in this case. Not replaceable with “feller”. Believe me.) The Fellow is a doctor who has completed medical school and residency, and is specializing further in their field: cardiovascular medicine, pulmonary critical care, endocrinology, or whatever else. I don’t know exactly how fellowships work; I’m not there yet. But I love having Fellows on the service; they are the most knowledgeable on the medical team (with the exception of the Attending), and they tend to be a little more accessible for questions. All of the Fellows I have been on service with have run very, very good teams.

Next on the ladder, we have the Resident(s). Residents are doctors who have completed medical school and are in their “apprenticeship” period. This is the time when they really learn how to practice medicine: decision-making, knowledge base, and leadership. The Resident on the team is usually responsible for the ultimate design of the treatment course (with the approval of the Attending and perhaps the assistance of the Fellow). The Resident is also in charge of managing the team that is taking care of his patient, and is responsible for making sure the day-to-day tasks of patient care are taken care of. The quality of a patient’s treatment really depends on the quality of the Resident. I’ve worked with fantastic Residents and awful Residents. They can really make or break a team.

And one step down are the Interns. This is actually the step I’m about to take. Internship is the first year of residency; Interns are full doctors for the first time. They are often the workhorses of the medical team. They are the patient managers. They are the hands that accomplish the tasks of patient care. They are often the ones who take calls from nurses, especially overnight. From everything I’ve heard, intern year is brutal. And the learning curve is steep. This is both exciting and terrifying to me.

In my experience, Interns tend to be the most cynical and angry people on a medical team. They work HARD, and it’s hard work. Under massive amounts of stress. For very little pay. Here’s a song that pretty much catches the general attitude of intern year, at least as I’ve seen people react to it. Note: I’m actually rather hesitant to post it, because it’s very patient-unfriendly…but it’s honest, even if it’s angry. And it’s very, very angry. Not safe for work.

Next (sometimes), you have Sub-Interns. These are fourth-year medical students. Like me. We try to act like Interns. But we have less ultimate responsibility, so ultimately less existential stress.

And then, the Medical Students. These can be either third- or fourth-year students, depending on the setup of the team.

I think this video pretty much says it all:

If you’re lucky, your team might have a Pharmacist and/or a Nurse Practitioner and/or a Physician’s Assistant on it. These people are freaking life-savers. For everyone, patients and staff alike.

People rotate in and out of the teams on a biweekly or monthly basis, depending on the service and on the schedules of the team members. So a medical team is in a state of constant flux. This can be a good thing or a bad thing; it breaks up bad teams after a while so you don’t have to work with malignant people forever, but it breaks up the good teams, too.

So where does the “high-stakes hippie love-fest” come in?

I love working on a medical team. For whatever reason, it just suits me. And I love it when the team really gels, even when it’s destined to break up at the end of the month.

I’ve been on teams where people practically ran down the hall, jostling good-naturedly for the privilege of holding the door for the rest of the team during rounds.

I’ve been on teams where, first thing after rounds, everyone descends on the post-call team member and asks to help with her work so she can go home sooner after she’s worked 30 hours… no matter how much work they have to do themselves.

I’ve also been on a team where the resident actively undermined his team members, not even always to make himself look good.

I really do prefer the functional teams. I guess I’m a little sensitive to group dynamics, and it just makes life easier when everyone supports each other, respects each other, and generally gets along.
Because the hospital environment can be physically and emotionally as dangerous as a world on the other side of a Stargate. And facing that kind of peril, it’s so much nicer to step through with people who have your back.

What is your work environment like (if you have a day job)?

Picture: http://www.shipbrook.com/jeff/raytrace/graphics/stargate.jpg