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It was late at night, and as the neurosurgery resident on call, I was alone in the hospital, wishing that I could lie down, or even just slow down, in the midst of a busy shift.

I sat for a moment, awaiting the inevitable next phone call or text. Predictably, my phone rang within minutes. It was the trauma-team resident.

The team needed a consult for “Trauma Uniform” (a frequently used pseudonym in our hospital)—a patient suffering from a common neurosurgical issue. This type of trauma typically did not require surgery; just close attention from our team, in conjunction with the trauma and ICU teams.

“I’m on my way down,” I said. “What’s the room? And the patient’s name?”

“Trauma Uniform,” repeated the resident.

“No, his real name,” I said.

“It’s a VIP,” the resident said, then murmured the name of a high-ranking government official.

I felt a fleeting but significant wave of adrenaline.

We weren’t taught how to treat VIPs in medical school—at least, not the one I attended. To most medical students, “VIP” stands for “vasoactive intestinal peptide” (watery diarrhea), and the man’s consult notes made no mention of that. This was clearly the other kind of VIP: a Very Important Patient.

It’s still the same history, the same physical exam and the same plan for a common diagnosis, no matter who has it. Business as usual, I reassured myself as I flew down the stairs to the emergency department.

And, I reminded myself, this isn’t your first experience with VIPs.

I’d initially heard about VIPs when I started as an intern at this hospital, which, unlike my medical school, serves some of Washington’s elite. Almost every year since then, we’ve had a handful come through the neurosurgery service. They get special blankets—the “non-itchy” kind, as I called them.

I remembered once getting a heads-up that a “Tier 3” VIP would likely end up on our service.

“I’m not sure if that’s high or low, but I’ll do my best regardless,” I replied, as a voice in my head grumbled: Who in the hospital is ranking these people, and why? This goes against one of the basic pillars of medicine, which is justice. In fact, it’s a basic pillar of our country: “Liberty and JUSTICE for all.” Fair and appropriate allocation of resources….

Every time I heard the term “VIP” in the hospital, I shuddered a little bit harder—and the voice grew louder: Are we supposed to give more effort for certain people? I assumed that we’re always trying our hardest!

Now, arriving at the VIP’s room in the ED, I was surprised by the number of people in attendance. Suits and ties—hospital suits and government suits—had replaced the usual sea of scrubs and patient gowns.

A scene from the prior night’s shift came to mind: I’d gone to the ED waiting room to escort a patient’s mother into the ED, because countless procedural and bureaucratic obstacles had prevented her from coming in to see her son, who’d been shot in the head.

None of the people in the VIP’s room were family members, yet they’d somehow made it to his bedside before me. Usually, an ED patient would be attended by one nurse, one trauma resident and one ED resident. For this VIP, on the other hand, numerous attending physicians were doing tasks typically delegated to residents—taking a history, doing a full neurological exam, getting collateral information from the suits.

I had reviewed his imaging already in the solitude of my call room, and found myself wading through a crowd to examine him. I determined that he was not in imminent danger, but did require ICU-level care. I discussed this fairly routine conclusion with several attendings who, after very careful consideration, approved it. It felt odd to have so many doctors involved in making a decision that my fellow residents and I would have made as a matter of course.

Meanwhile, a piece of my mind was focused elsewhere, wrestling with the implications inherent in the VIP designation.

Tagging some people as Very Important Patients does imply, after all, that there are patients who don’t require, or deserve, this kind of attention, I reflected. If there are Very Important Patients, maybe we should also start identifying the Somewhat Important Patients and the Hardly Important Patients—and even the Not Important Patients. Who are these SIPs, HIPs and, dare I say it, NIPs?

After dozens of physicians had declared themselves part of the VIP’s care team and concurred that he should go to the ICU, the most spacious room in ICU 6 was cleaned, and he was swiftly moved there for further care.

As I later discovered, this room had had to be cleaned because, until that moment, it had been occupied by another patient. That patient, also one of mine, had had a large metastatic tumor removed from her brain that morning.

Consider the optics for a moment, and the headline opportunities: A Black woman recovering from brain surgery was moved to a different room, in the middle of the night, to make room for a white male politician. In our nation’s capital. In this century.

I must have traveled back in time somehow, I thought in disbelief. Is everyone aware of this? Clearly, people outside of the little hospital bubble would not put up with this.

If I’d known about the game of musical chairs that was being played here, I would have wanted to ask them to find a different room.

Move somebody else, or find an empty regular room, I thought. But don’t disturb Ms. Jones, who is trying to rest after having cancer excised from the organ that makes her Ms. Jones.

Every morning, I drive to the hospital before the sun comes up. Crossing the Theodore Roosevelt Bridge, I see the monuments to Washington, Lincoln and, further off by the Tidal Basin, Jefferson. They’re spotlit at night to make sure that they and their legacies won’t be forgotten—so goes the conventional wisdom. But I can’t help feeling that perhaps some of us need a reminder.

A reminder that, a short two-mile walk from the hospital, engraved in the Jefferson Memorial, are the truths we uphold as Americans—the ones that are supposedly self-evident. We are created equal, with unalienable rights to life, liberty and the pursuit of happiness, whatever form that may take, including the non-itchy blankets that can comfort and warm us during a hospital stay.

Mulling this over, I recalled how once, as a medical student, I was in the operating room with a senior neurosurgery resident. In the middle of discussing the case, he asked if I knew who the patient on the table was.

Confused and nervous, I told him the patient’s name, why he was here and all of the other relevant medical information—or so I thought.

“This is my dad,” he responded.

It wasn’t his dad, of course, but I grasped his meaning: As a physician, you should treat everyone as if they were your family. You give everyone the same care you would give your family members, because everyone is someone’s family.

 And that makes everyone a Very Important Patient.

Max Fleisher is a fifth-year neurosurgery resident in Washington, DC. “Writing allows me to better express my thoughts and also process day-to-day experiences that would otherwise be internalized or forgotten. I enjoy both scientific and creative writing and look for opportunities where they intertwine.”


13 thoughts on “The VIP”

  1. Esther Pottoore,RN

    Beautifully written! Reminds me of the book Animal Farm by George Orwell. I quote, “All animals are equal but some animals are more equal than others.”
    The truth is that depending on your status and who you know or connection to someone high up in administration, the approach and treatment differs. It is unfair but common practice especially within the health care system.

    I have used my “connections” in the hospital to help our VOP (Very Ordinary Patients) from disadvantaged backgrounds to get through the ED and or an admission! My philosophy is every one is a VIP regardless of their background!

  2. So glad that someone like you is writing this. Gives me hope for our profession. The fact that you were disturbed and cared about your patient with a brain tumor being moved is so encouraging! Please take as many students and residents as you can so they can see a role model such as yourself.

  3. Thank you for your moving writing. I hope you keep writing throughout your career. I believe I did an ER rotation as a medical student at your institution and was amused to see a line of women with twisted ankles, wearing ball gowns waiting to be seen the night of the inaugural balls. Now you are young and not too jaded. But soon you will be powerful and have to ability to influence policy. Please stay angry and righteous.

  4. This is so sad but goes on every day in this country. I am not shocked by this story, only saddened. There is so much conscious and unconscious bias in healthcare. The systematic racism in healthcare is real. I hope the other patient that had to be moved because of the VIP is okay.

  5. So eloquent and elegant. Truly represents what Our Nation is all about. Dr. Max Fleisher has been that way ever since the moment I first met him.

  6. There is also something I think of as the VIP malpractice syndrome where VIPs get “special care” to their detriment because they demand it. ( think Michael Jackson). Once as a junior captain doing a pre-operative physical on a very senior military officer, I was reprimanded for asking for detail of his alcohol intake and advising him fairly mildly that it was considered high and he might want to cut back and recording the number of oz he was imbibing in his record.

  7. The tales we tell ourselves about equality and justice in this country are so flimsy. Thank you for being a truth teller. Fortunately for them, your patients will be “seen” by you. This shouldn’t be exceptional, but perhaps it is.

  8. Thank you for writing this! It made me angry to be reminded how some people are “worth” more than others! I applaud your candor.

  9. Sara Ann Conkling

    I’m so happy to see a physician comment about this. As someone who couldn’t purchase insurance in this country for seventeen long years (genetically-based cancer), I was an NIP in our health care system. Not Insured and also Not Important. Specialists I needed refused to see me. I remember overhearing my primary care doc (a good guy, and generally very calm and pleasant) screaming into the phone to a urologist “If you don’t see her, you will never get another referral from my practice!” Our health care system is broken. And this story is important. I wish I had been with you; I would have blocked the door of that ICU room so the black post-surgical patient would not have been moved. I would have made people think about their desire to oust her. I would have shamed them for their racism. No one should get demoted from VIP because a white male politician comes to the ER.

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