Last Friday night, my patient with abdominal pain kept getting worse. The X-ray technician trying to get a study of his bowel called me down from the 5th floor to the basement twice. I finally called the hospitalist -- a real hospital-based doctor, kind of a Pretty Doctor but not quite a superhero -- who told me to call the general surgeon, who was at that time in surgery and to whom I relayed a message by way of one of the surgical nurses. The surgeon showed up an hour later, breezily told the patient he wanted to "open him up and see what's going on," and left. With the help of two other nurses, I got him ready for surgery in an hour. As he was being wheeled out by the transport orderly, the Pretty Doctor appeared to say good luck.
No brilliant diagnoses. Not even a good guess.
During all this -- which was not, in fact, an unusual shift; oncology patients are by definition unstable and the ones in the hospital tend to be quite sick -- three other nurses were caring for their own patients, all needy in completely different ways. A fourth nurse was filling in as our aide, helping with vital signs and blood sugars. A secretary answered the phone, directed visitors, put in computer orders and managed the charts. Transporters came and went. The IV therapy nurse appeared to help with a stubborn line. The physical therapy assistants exercised with a few people. A pharmacist prepared chemotherapy and dealt with the nurses' constant requests. A housekeeper hurried to clean the rooms left by two discharged patients, to make way for the next admission.
Meanwhile, the woman in Room 21 had sunk into unconsciousness. Her breathing was ragged and her legs swollen with fluid. I was in and out of the room frequently, turning her, checking the morphine drip, and mostly checking in with the husband, son and daughter, who kept a continual vigil by the bed. The chaplain visited for a while. Another nurse helped me position her and get her cleaned up once.
I dashed into the IV room, and the pharmacist told me a joke.
"There was this fisherman and he was up in Alaska, trolling for halibut, and here comes a wave and over he goes. Next thing he knows, he's in heaven. Man, everything is great! There's a big cafeteria and the buffet line has all of his favorite foods. So he's moving along with his tray when this guy in a white coat shoves him aside and cuts in.
"'Hey!' the guy says. 'Who do you think you are?' But St. Peter comes over and says, 'Ssh, that's God. Sometimes he likes to pretend he's a doctor.'"
The woman in Room 21 died at the end of my shift. No doctor had appeared. No doctor had even called.
The real message of medical shows is that brilliance goes hand in hand with emotional retardation. While this may be a debatable point, it has little to do with medicine as it is usually practiced. Most of the physicians I know are easy to work with -- oncologists, by default, tend to be at ease with teamwork. They are collaborative and respectful and although a few are quite handsome, they fall short of model status. (Wilson, House's oncologist friend, is played by Robert Sean Leonard. If only.) My biggest objection to medical shows is not that the doctors on television do their jobs brilliantly, but that they do everyone else's jobs, too. And my objection to doctors in the real world is a little like that. I sometimes wonder just how much doctors know about what goes on over the course of a day in their patients' difficult lives -- how many people are involved, how much we need each other.
I guess a lot of people are watching "Grey's Anatomy" now. Maybe I'm burned out, but another soap opera about surgeons just doesn't grab my attention. You have the gorgeousness, the sexy nurse, people bursting in on critical procedures ("How could you stand me up like that?" "Lidocaine, stat!"), the pop song ending over scenes of each stunted character staring out a window -- it just doesn't seem new at all.
The medical show I really like is "Scrubs." It's full of chaos, anger and fear, and no particular brilliance at all. Just struggle and good intentions and richly imagined fantasies of lust and revenge. Like my world.
I still watch "House" -- sometimes with a little amusement, a lot of frustration at others. Of course, we're supposed to understand that Dr. House is a lonely, bitter man with chronic pain and intimacy issues and blah, blah, blah. At the Not-So-Ordinary Hospital, I engage in an extraordinary task with the help of a lot of extraordinary people who never get to be the central characters in television shows. "Ray Power -- X-Ray Tech"? "Cases From the Central Venous Catheter Lab"? I don't think so -- not many rare diseases. "Chaplain Jones"? I can only wish.
Those are some great stories, but they aren't going to make it into a 50-minute show.
About the writer
Sallie Tisdale's most recent book is "Women of the Way: Discovering 2500 Years of Buddhist Wisdom" (Harper San Francisco, 2006). She contributes to magazines such as Harper's, Tricycle, and Antioch Review.
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