April 2021

With a crisp gesture, sharp as the crack of a whip, the nurse sends the curtain rings skittering along the track, separating the bed on one side of the room from the other. The doctor does it more sedately, pulling the curtain along as if walking an aging dog, chatting to calm an anxious patient as she does. Either way, the object seems to be patient privacy.

Even when the curtains are drawn tightly enough to prevent a sliver of a glimpse of the person within, the task inevitably fails. There can be no real privacy when a few squares of linoleum and a few yards of fabric separate one bed from its neighbor. Without distance or density to muffle sounds, a discrete murmur directed to one patient easily reaches another.

As someone who has spent a few nights in a hospital bed, am I dismayed or outraged that patient privacy is a polite illusion? In theory, perhaps. In reality: Hell no.

The tedium of confinement sharpens the appetite for distraction, and hospital stories can be particularly tasty. I’ve heard police question a woman about how she landed one bed over from me. Turns out, a would-be boyfriend, spurned and angry,

I treat a lot of patients with multiple disabilities, like cerebral palsy and epilepsy, so things get complicated when they are admitted to the hospital. The parents have to deal with multiple rounding teams who come into the room at unpredictable times.

One such parent told me how she had solved the problem of dealing with surgeons who would not answer her questions. Her child’s surgeons often rounded at an ungodly hour in the early morning when no one was awake, spent a few minutes in the room and then moved on. By the time the mother was awake, the surgeons had left.

So, she figured out a strategy. Once the surgeons came into the room, she closed the door and stood in front of it. The surgeons could not leave until she let them out, and she would not let them out until they had answered all of her questions.

I have often recommended that strategy to other parents. By the way, it also works with rounding teams from other specialties.

David L. Coulter
Natick, Massachusetts

My patient walked into the exam room, expressionless, her shoulders hunched. Her last blood pressure reading had been high.  

I gently closed the door. “Good morning,” I said. “My name is Esther, and I am an RN. How are you today?”

“I am OK, I guess.” 

“You are here for a BP check. May I check it?” 

“Sure, why not.” 

When the ambulance doors shut, a fertile silence is wrought as patient and paramedic situate into the tight, mobile quarters. The patient, strapped backwards on the gurney like a carnival ride, stares upward at bright lights and cabinetry chock-full of colorful medication boxes. As the ambulance takes off toward the hospital, the paramedic begins an ataxic dance, hopping and twisting over blood pressure cords, pulse oximetry, heart monitor leads and IV tubing.

Patients may not be as forthcoming around large numbers of family, bystanders or medical personnel, but the atmosphere in the back of the ambulance is made for intimacy and truthful candor. I make sure they’re comfortable as can be, and then I continue the interview. Chief complaint, SAMPLE history, secondary issues, reassessing everything. Once it’s just the two of us on what can best be described as an awkward first date, we both open book and overshare.

Some joke or express their deepest pain and fears. Anxiety, stresses, regrets. The alcohol and pills they imbibed. The nagging injuries, traumas and diseases. I stay nonjudgmental.

COVID patients speak about the shame and small mistakes they made to contract it. One man on high-flow oxygen being transferred to the ICU

During my fifteen years as a health educator and project manager for a large HMO, I met frequently with the physicians, managers and medical staff in their offices. Sometimes these were formal meetings, and sometimes I just dropped by to run through an idea or check out a procedure. Perhaps we met to work on a new outreach program. Or perhaps I gave an in-service about the databases we used to track patients with chronic conditions. Even though the doors between the waiting areas and the offices and exam rooms were locked, many of the receptionists recognized me and buzzed me in when I waved to them.

I loved my job and the camaraderie.

Upon retirement, one of the most difficult adjustments was the loss of that sense of belonging, of being an integral part of the medical community. Nowadays, when I go to the clinic for a visit with my physician, I am just one of the hundreds of anonymous patients passing through each day, restricted to the patient side of the waiting room doors, no longer allowed access to the inner sanctum of offices and exam rooms unless accompanied by the medical assistant.

To combat this loss, I

Something doesn’t feel quite right these days. I’m in-between, hanging in the wind, waiting for the next set of closed doors to open, for what lies behind those doors to emerge. The earth moved from winter through solstice into spring, yet temperatures still dip. Which jacket and shoes to wear? How many blankets are needed at night? We just sprang the clock ahead, but I haven’t yet adjusted and my sleep is off. A big birthday lies ahead and I want to get into celebratory mode, but I still dwell in this decade, which was capped off by a trying and tumultuous year. Least exciting of all, I’m in that liminal phase dubbed perimenopause by Western medicine.

“Façade,” a song in “Jekyll and Hyde,” one of my favorite musicals, describes how so many of us, myself included, live our lives. “There’s a face that we wear/In the cold light of day–/It’s society’s mask,/It’s society’s way,/And the truth is/That it’s all a façade!” Behind my façade—the one that shows a smiling person answering “fine” to the socially-accepted question, “How are you?”, lives a person who believes that every online photo-shopped image is real and that only I endure a life of darkness and despair behind closed doors.