Hospital Hostility or Hospitality

Ever since I embarked on this journey in the world of medicine, I have had the opportunity to observe countless different personalities, varying levels of authority, and numerous methods of dealing with difficult situations. I have found that certain subspecialties within the field of medicine seem to breed hostility, while other areas tend to cultivate kindness. Many times, I have encountered doctors who have reached the pinnacle of their professional training and yet have resorted to elementary ways (e.g. throwing fits and shouting obscenities) in dealing with stress.

The field of General Surgery is often pinpointed as an area of medicine in which physicians are rude, crass, obscene, and disrespectful. As a third-year medical student at a local county hospital, I remember being intimidated and aghast at some surgeons who barked orders at their scrub techs or pimped a fellow student until she nearly melted away in embarrassment. I always wondered, what possesses these people to lose their sense of chivalry and to let such uncouth habits loose in their work setting?

These are the conclusions that I reached (but as I am not a general surgeon you can take all my comments with a grain of salt):

1. Emergencies and urgencies and stress. Many times when people are faced with stressful situations, they tend to have a shorter fuse. The world of general surgery is constantly approached with difficult emergency situations in which things need to happen quickly (“STAT”). If the traumatic aortic rupture patient is not taken to the operating room NOW, he WILL die. In dealing with some of these crazy life and death situations, health care workers tend to regress back to a primitive paradigm of performance – they shout and scream for things to get done, they ignore the wife or husband at bedside who is brimming with questions, they have one focus in mind – to operate on the patient in order to save his life. By being bombarded with stressors on a day-to-day basis, physicians often forget how to take a step back from their emergent situation or how to ask for things in a nicer way or how to work on those relationship skills.

2. Lack of sleep. It is common knowledge that a person ideally needs eight hours of restful sleep to function at his or her maximum capacity. Surgeons are often sleep-deprived, being forced to awaken at ungodly hours in the middle of the night to repair a strangulated hernia or perforated appendix. Plus, surgery is the one rotation in which you have to get up at 4 am every morning, since surgeons have to round before they go into surgery.

3. Long and difficult residency. Of all the residency programs, general surgery has to be one of the most demanding. In order to become a general surgeon in the United States, one has to endure five years of residency after medical school. Deciding to specialize in vascular surgery or cardiothoracic surgery would add several years on top of that! By the time one finishes residency, surgeons have endured so much that they are often disheartened and cynical.

4. Food chain. During my third year of medical school, I noticed that there was an undeniable level of hierarchy in the hospital. I was obviously at the bottom of the totem pole, then the interns, then the residents, then the attending physicians. This food chain was especially evident during my General Surgery rotation, when the actual order in which we walked indicated who was at the top and who was at the bottom. Interestingly enough, when the attendings would give the residents a hard time, the residents would give the interns a hard time, and the students would get the brunt of it all.

5. Environment. The hostile attitude that is cultivated also dissipates into the other health care workers as well. Trauma bay nurses can be especially unfriendly. My first day on surgery call as a medical student, the intercom overhead announced, “Level A Trauma! Level A Trauma!” Our whole team ran down five flights of stairs to the ER, and my job was to record all the history, vital signs, and physical findings that the paramedics, residents, and nurses shouted out. Everything was chaos. I could barely hear what was going on. So I turned to a young nurse who was also documenting similar findings, and I asked her about the findings I had missed. Suddenly an older nurse began screaming at me, “This is YOUR JOB! You need to LISTEN and record this for YOURSELF! You ARE the medical student, aren’t you???!!!” I was so taken aback I could not even muster up a response. I simply stepped away and continued to record my findings. About half an hour later the younger nurse approached me and apologized for the way the older nurse had exploded. I said, “No, that’s okay. It’s just that it was my first day on call on surgery, and I wasn’t familiar with what I was supposed to do.” Ever since that moment, I knew that life inside a hospital was definitely different from life outside the hospital. Since then, I have encountered many unfriendly nurses and physicians, all experiences that have made me think and have led me to write this blog.

6. Lack of God. It is my observation that when people are extremely busy, stressed, and sleep-deprived, they tend to forget about God. Personal devotional time is the first thing to go. Prayer time is limited to brief periods in the car or before meals. However, it is at this time when it is most necessary to have a strong relationship with God.

Of course I must at this point make the disclaimer that all of these generalizations do not apply to each and every General Surgeon out there. I have a few friends who are in general surgery residency who are among the sweetest, most mellow guys that I know (e.g. Jukes Namm, Geoffrey Lam). Nonetheless, I had to blog my thoughts simply because I have just finished a week of Trauma surgery, and I have been forced to think about all these points lately.

A few days ago, my co-intern Darin asked me with great consternation, “Are you okay? How has general surgery been treating you?” I automatically replied, “Oh, it’s been fine,…why?” He answered, “You just seem…different…more stressed or something. You always used to smile before, but now…you seem a lot more stressed.”

It was at that moment that it hit me. During the few days I had been exposed to the culture of general surgery – the fast-paced, uptight, down-to-business, no-nonsense culture – I had metamorphosed into a different person. I was no longer sweet, gentle, kind, caring, and understanding. Because of the stress of the rotation I had become uptight, no-nonsense, business-minded and short with patients, students, and fellow residents almost overnight! The reality hit me, and I was again taken aback – this time not because of the shock of someone yelling at me, but because I realized I had let my surroundings influence my character instead of letting God lead my life and consume my character completely.

I breathed a prayer of repentance to my Father, and I determined in my heart to steer clear of the temptation to follow the instincts of my carnal heart. Please pray for me – that I may keep my eyes focused on Him even during this trying rotation and that He can use me as a vessel to influence others for His Kingdom.