The happy village

"I'm going to hug you," said the patient. We did hug, and I realized that it had been a good week as the hospitalist, looking after patients who don't have family doctors. It's like a little village. I feel like the mayor, ushering in new villagers and bidding others farewell. While they're in my town, I take care of them as best I can. Sometimes it's tough. Too many villagers! Too many other mayors calling me because their villages are overrun. Too many sick villagers. Not enough resources for my villagers. But this was a good week. What made it good? Well, that hug was special. We had spent some time talking about non-medical issues, including culture and the arts. I got to know two patients a bit more as people and not only as problem lists. That's the advantage of hospitalist over emergency medicine, that anything beyond hello doesn't feel forbidden. I had a code on the weekend that I managed without hesitation. I told Criticall, our critical transfer service, "Yes. This is a life or limb case." Or, as I prefer to congratulate myself afterward, "Another life saved." I felt energized. This is why I do medicine! Saving lives and limbs! "I'm so happy with everything. The doctors, the nurses, everyone has taken such good care of me," said one patient. "That's wonderful." It's like when people tell you they enjoy the book you wrote. You take the compliment, but as author and publishing guru Mark Leslie Lefebvre taught me, you have to make sure the right people hear it. You're supposed to encourage them to leave a review online. "I know it sounds funny, but if you're able to send a compliment, they count our compliments during accreditation, and it's good for the hospital." "I don't know how to use a computer." I laughed. "A pen and paper will do, if you like." To my surprise, I was clearing charts away later in the week, and he'd written his compliments on a piece of paper that was sitting on the charts cart. Another patient was extremely pleased as well, and a third said, "I like you. I can tell that you cared and that you tried hard and did your best to find out what was wrong with me." So I had really nice (and perceptive!) villagers this week. The nurses made sure all the day-to-day work was done and made suggestions of how to improve care or make things more efficient. For example, the hospital has two sets of vital signs, with a lower O2 saturation threshold for the emphysema patients, and if no doctor orders them, they end up with more charting. I've gotten to be a better mayor, too. "It's better if I do all the orders right at the beginning, instead of doing them throughout the day as I chart," I told my husband. "Otherwise, when I finish and drive away, they might have a stack of orders, and they have to call me to clarify. This way, they ask me a question while I'm still there." I keep my ears open. One nurse commented to another that one patient was keeping the other roommate awake at night, so I increased both their sleeping medications. I have to keep my census as "clean" as possible. Meaning that as soon as people feel better, I start making arrangements for them to go home, making room for my next villagers. If patients are too sick, I need to ship them out. And I was rewarded in that I didn't get woken up once during my seven days. Totally shut out. It's not as financially rewarding per hour as the ER, but it's not as tiring either. I can go home during daylight and walk my dog. I can usher my children on and off the bus. It's more like a clinic, concentrated with sick patients, and I have the advantage of checking on them the next day if something goes wrong.

The happy village

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