inhumane nights

Most of my time in residency has been spent at our county hospital, with a few months at our university hospital. I love the county and it's where I feel most at home. This month, working mostly night shifts, I've spent most of my nights at the university hospital, which I also enjoy, for different reasons. It is pretty amazing how different the two hospitals are, and I feel lucky to be able to experience both. Because of how different they are, everyone has strong feelings about which hospital they prefer. Thinking about the comparison makes me reconsider our definitions of misfortune and suffering, and our subsequent responses of empathy and connection.

There are definitely things about university patients that make them more readily relatable. For the most part, they are what people call "normal." They are generally employed, have supportive family, and can tell you a coherent story about their symptoms and their medical history. This is what people imagine when they imagine patients. And here, many of them have life threatening illnesses--advanced cancer, organ transplants, rare immune disorders. Many of them have had vibrant, successful, active lives, with strong professional and familial ties; people who write, research, travel; who have been doing pilates and karate and go camping. They are most often kind to us, and grateful for our care. So it is always very sad to see them face an acute change. All of the sudden, a man stops being able to swallow solid foods and is diagnosed with cancer of his throat. All of the sudden, a woman loses her memory over the course of a few months due to a rapidly progressive dementia. For these people, we relate to the people they were before their sickness, and can imagine the difficulty they face, and for me they are the ones that instill a familiar ache in the center of the chest, wherein resides what's closest to us.

This makes me re-frame the patients at the county hospital. They are often difficult to attain information from; they are usually less functional, less engaged in society, or engaged in a part of society that their providers have never lived in. We often think of their ailments as self-inflicted, such as drug and alcohol use that then predispose them to infections and withdrawals. It's difficult for us to see the people they were before these gradual, chronic conditions. Seeing the same patient over and over in the hospital for the same thing makes us more familiar with the illness but more distant from the person, as we consider futility in a way that is different than caring for a person with life-threatening cancer. And it would be dishonest not to acknowledge that some of these patients are less pleasant to us and often present behavioral difficulties, and are less able to see how hard you are trying to help, and less able to understand our own challenges as they are facing theirs. It takes real, hard work to take care of patients, and we are overworked, and when you are both overworked and feel like there might not be much purpose to your work, this fosters anger and resentment and ultimately distance.

I don't deny the differences, or deny that I respond differently to these situations. I do want to challenge myself to consider the similarities, to consider that so many of the things that make our lives physically and mentally challenging are beyond our control, and that somewhere in life we are very similar. Some people diverge from general commonality before others, and sometimes the source and timing of divergence interferes with our ability to relate to them. This is sad to me, the loss of a person's potential to become tied to the rest to the world. There are a lot of barriers to feeling this loss in the center of the chest the way we do with others; very real, understandable barriers like harsh words and violent motions and inconveniences to our own lives.

So I recognize the tangible differences and feel viscerally the differences in how I emotionally respond, intuitively. I do think that our intuition can be malleable, and that with thought, exposure, and practice we will come to intuitively relate to others' suffering as what could be our own, despite how much separates us. This isn't to say that I'm immune to the barriers; anyone close to me can tell you how unstable, distant, irritable and devoid of empathy working these hours has made me. And so in some ways as I advocate understanding for others I'm also asking for some myself, and maybe that's the way to stay connected to a circle of commonality.