Random thoughts about teaching hospitals

When you work at a teaching hospital, there is often a layer between you and hospitalized patients.  That layer of course is composed of residents.  They insulate us from many of the day to day tasks of caring for sick patients, but they also insulate us from the pleasure we get from interacting with (and sometimes actually helping) patients. For much of this week I have had no residents on my service, so have been seeing in patients on my own.  This morning after rounds I left Mount Sinai to follow up on a consult I had seen yesterday at Toronto Western Hospital.  This woman is the wife of  a prominent physician, and had become delirious on medications.  It was wonderful to see that she had almost recovered, and particularly impressive to see how fabulous her children were in staying at her side throughout the 48 hours of delirium to ensure that a familiar voice and face was always available during her period of confusion.  I followed this up with a family conference at Toronto General Hospital.  Once again meeting the daughter of a severely demented woman whom I had consulted on two days earlier, I was overwhelmed by how dedicated some caregivers are.  The daughter (herself a grandmother) knows that her mother never wanted to enter a nursing home, and has spared no physical effort or expense to help her mother stay in her own home (which is a few houses away from hers). I then returned to Mount Sinai, where I met a 91 year old retired nurse who lives by herself and still drives.  Unfortunately she tripped over a kitchen stool and had a fracture adjacent to her previous knee replacement.  She intended to return to her apartment and to continue driving after rehab.  I then met an indomitable 83 year old woman who had survived bladder cancer (ileal conduit in place), lung cancer (second hand smoke exposure from her husband), two hip replacements, and unstable angina.  She had tried to put something on a high shelf and instead of getting a step ladder, she stood on a rickety chair, and fell and broke her shoulder.  Her embarrassment was greater than her pain!  My sojourn on the orthopaedic ward ended with a delightful consult on a retired psychiatrist who tripped getting out of the shower (diabetic peripheral neuropathy) and broke his tibia.  He was an absolute delight to chat with. These type of direct interactions with patients are always special.  Community physicians have these types of interactions every day, and on days like today I envy them.  I see patients on my own in clinic all the time, but it is a different type of interaction (although still satisfying).  They are not in crisis when I see them in clinic, so the interaction is not as intense.  So for those of you who are thinking ‘If I only had residents’, think again.  Something is lost by having them around.  Enjoy the weekend, Barry Goldlist