American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, May 1, 2012

Life at Grady: What you see

"Excuse me, doctor. I hate to bother you."

That's what this woman said to me one evening as I made my way out of the hospital. My stride was brisk; it signaled that I was on my way somewhere and that I wasn't exactly looking to be stopped. But on this day, I can't say that I was exactly in a hurry. My husband was picking up the children and taking them for haircuts that day so there wasn't any hard deadline I needed to make.

But still. It had been a long and mentally tough day. I was ready to go. For real.

I abruptly stopped in the hallway and gave her my attention. "Ma'am?"

Even though I stopped, I know that my body language was still communicating otherwise. Rocking side to side on my feet, hand on the strap of my tote bag, cell phone in my hand just waiting to be used. Sure, she had the floor for a moment--but only a moment.

"I hate to bother you, but I was just wondering if you might be able to give me some money to get something to eat. I don't never ask people things like this but when I saw you I thought I would just see what you said."

Now. Let me be honest. This? This is not an unusual thing to encounter at a place like Grady Hospital. Just ask anyone who has worked at Bellevue in NYC or Jackson Memorial in Miami or Parkland in Dallas or Cook County in Chicago or Charity in New Orleans. This is bound to happen to you at least once in a public hospital. Maybe even more than once. As for Grady, we're the safety-net hospital serving metropolitan Atlanta and all of its surrounding counties. Our patient population ranges from elders on fixed incomes who marched shoulder to shoulder with Dr. King to the newly uninsured to undocumented immigrants to our large population of homeless or unstably housed folks who are doing what Stevie Wonder called "living just enough for the city." So that means that getting asked for spare change or a few spare bills while inside of the hospital is common enough to leave your feathers unruffled.

(Click "more" below to keep reading.)

Some days, I just reach into my pocket and give whatever I have. I don't allow myself to think about what the person is going to do with the money or whether or not they are telling the truth. Almost always I find myself wondering whether or not I did the right thing. Asking myself things like, "Did I just buy someone a hit of crack cocaine?" Then I shake my head and tell myself that I did my part and the rest is up to someone far bigger and greater than me.

Then there are the days that I feel more critical and nitpicky. It's almost always after a rough week on the wards with lots of wretched social issues crippling my ability to care for my patients. Those are the days where I drive home fuming about how much I hate crack cocaine or any other kind of highly addictive illicit drug. My mind declares a war of sorts that manifests as mini-battles taken up with any and everything suspicious for drug involvement.

This was one of those days.

"You're hungry?"

This was a simple enough question. Nitpicky, yes, but still a simple question. No, I wasn't trying to be passive-aggressive either. This was just a piece of information that I needed before deciding what I'd do next.

"Yes, ma'am," she replied.

I looked at her carefully and then nodded my head. "Alright. Let's go upstairs to the cafeteria. I'll buy you something to eat right now. Let's go." I waved my hand and prepared to walk toward the cafe.

"Uuuhh, see I'm at Gradys 'cause my daughter she in the hospital here. I want to go to visit her before the visiting hours is up, you know doc? So, you see what I'm sayin', I 'preciate you being willing to go get me something but what I was hoping you could do is just give me the money so I could get it a little bit later."

That whole convoluted answer immediately made me feel tired. I rubbed the side of my neck and craned it sideways. My eyes narrowed as I listened to her and my pulse quickened. "But I thought you said you were hungry? Listen, it's only five-something. You have a bunch of time before visiting hours is up."

I stopped there and immediately felt bad for assuming the worst. I tried to clean it up. "I'm sorry to hear about your daughter."

You know--the one that's in the hospital. 

I pressed my fingers into my neck again.

"Oh, my daughter? Uh, yes ma'am. She okay. She just had a baby tha'as all. But, you know, I'm really just trying to get up there, you know what I'm sayin', before it get too late. So I was gon' go to the McDonalds or something after I saw her. So I mean, if you willing, you could just give me the money and I could take care of it. You ain't got to go all up to the cafeteria and all that."

She was talking fast and shifting from side to side nervously. The urgency in her voice didn't sound like that of a person who was simply hungry and that's it. She also looked to be somewhere in her mid-forties so it was certainly plausible that she could have a daughter somewhere in the hospital.

So I'll just go ahead and say what I was thinking. I was staring at this woman who stopped me in the lobby for some money and trying to discern whether this was an unfortunate plot by a person who was anxiously seeking a hit of something. And it feels terrible to admit that but it's true.

"I hear you," I finally said, "but listen, I'll walk you up to the cafeteria and buy you something to eat right now if you are hungry. I won't give you money, though."

She started laughing out loud and smiling when I said that. It was odd considering nothing I had said seemed to warrant such a thing. She continued with her jittery movements and side-stepping. "But doc, ain't you got a lot to do? You look like you on a mission, see what I'm sayin', so even if it's just something like one or two dollars, you know, I could jus--"

"Ms.. . . tell me your name?"

"My name Kathy."

"Okay, Ms. Kathy. So listen. You're right, I do have to go. But I have some time to go to the cafeteria. I'll get you a hot meal and you can save it or eat it right then and there. Okay?"

So I sort of marched off in the direction of the stairwell near the cafeteria. And now that I am replaying that interaction, I am slightly ashamed of the way that I did. It was almost begrudgingly.

But it had been one of those weeks.

Ms. Kathy followed me up those two flights of stairs. We entered the turn stall leading inside the cafeteria and instead of hitting the hot line, she went toward the sandwiches. She picked up two tuna sandwiches and a bag of potato chips. She also grabbed two Coca Colas.

"You don't want anything hot?"

"No'm. This good. This what I want."

I didn't say much more after that. I paid for her items and handed them all to her.

"I sure 'preciate you," she said while shoveling the sandwiches, chips and sodas into a plastic bag near the check out.

"No problem. Nice meeting you, Ms. Kathy. And congratulations."

She looked at me with a puzzled expression.

"On your daughter. And the baby."

"Oh, yeah . . yeah. Thank you, hear?"

And just like that she scurried down the hallway with that same pressured urgency.

I stood in the doorway of the cafeteria for a few moments thinking. Thinking about what Ms. Kathy had selected to eat, thinking about her behavior and thinking about all of the patients I'd seen that week with some kind of drug addiction. All that thinking in these situations is mostly futile, but nonetheless I still stood there thinking. And just like that,  I felt like I'd been duped.

Damn. What if she wants to just sell the food? Or trade it for a rock? Damn.

Like always, I did my best to remember those Bible stories that tell of God approaching people in different forms asking for help. This was the only thing that would make me feel like I hadn't been hoodwinked and bamboozled.

Instead of taking the stairs back down I strolled over to the main elevators. And there she was--Ms. Kathy. Standing and waiting along with several others. She held up the bag and smiled big and wide in my direction. I gave her a nod and leaned against a wall several feet away from her. This was my way of telling her that she didn't need to thank me any more. Then again, I probably just didn't want to think about it anymore.

Even though I was on the other side of the hallway I kept watching her. Offering people that same overzealous laugh and watching their awkward responses. Tapping her feet and bopping around like some sort of windup doll. I sighed silently and this time clasped both of my hands behind my neck. A picture of Nancy Reagan on those anti-drug campaigns from my school days popped into my head: Just say no.

The more I watched Ms. Kathy, the more I wished I had. Said no, that is.

It was one of those days, see. One of those weeks even, so this was where I was. Frustrated with drugs and poverty and strongholds and all of it. I was two beats away from going right up to Ms. Kathy and flat out asking her about all of this. Like whether or not she really was hungry and if she had actually made as much of a fool out of me as I was feeling she had.

Fortunately the elevator opened up before I could.

Everyone filed into the elevator and one nice man pushed the ground floor button. I stuck my hands down into my white coat pockets and faced forward. Just as the doors began to shut, I noticed fidgety Ms. Kathy still standing outside. I pulled my hand from my pocket and thrust it between the door before they could close. An alarm went off and the doors instantly parted again.

"Ms. Kathy?" I called out to her, "You coming on the elevator?"

With her right hand she pointed upward which lifted the bag again since the straps were around her wrist. Then she said, "Y'all going down. The mother-baby unit on the fourth floor, remember?"

Oh right. That.

She leaned in so I could see her face as the doors were closing. Still appreciative and smiling. And perhaps, still nothing more than hungry and  low on funds. My face grew warm as I replayed her voice in my head:

"The mother-baby unit on the fourth floor, remember?"

My bad, Ms. Kathy.  It sure is.


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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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