It’s getting very difficult to remember what it felt like not to be completely at home in a hospital. Only the most tragic of our patients have spent more than a week or two here, certainly not all at once. For their families, it’s probably one of the most stressful occasions of their lives: Momma’s in the hospital, they don’t know what’s wrong with her, they’re doing all these tests and no one can tell us the results, sometimes she’s not in her room when we come to see her, she has all of these medicines running into her, so she must be really sick, she has a monitor that has bright green lines, like the actors on tv right before they die, and it beeps all the time, and she has to wear oxygen to breathe, and she doesn’t look like herself at all. . . And no matter how routine the eventual diagnosis is to us, to them it’s still a shocking illness, a tremendous surprise. Even the smallest surgery – lap chole [surgeon-speak for laparoscopic cholecystectomy, if that enlightens you at all – taking out the gallbladder with small incisions and a camera] – is still an invasion that will cause pain for weeks to come, a total upheaval in the daily routine, two days spent in the hospital even if there are no complications.

I can see it on their faces, but I can’t really understand anymore, because for me the hospital is home. I spend most of my waking hours there. Someone mentioned the hospital smell. I honestly don’t know what that is; it smells like excitement and work and life to me. I know what all the different uniforms mean: who’s an OR nurse, who’s an L&D nurse, who’s a surgical floor nurse, who’s a medical floor nurse, who’s an ICU nurse, who’s a dietary worker, who’s a janitor; who are the surgery attendings, who are the psych attendings (they don’t wear white coats, because it would scare their patients, I guess), who are the medicine attendings (some of them take surgery interns seriously). I know where the water fountains and the bathrooms are, three different ways to get to the cafeteria, and three secret snack locations, and almost all of the main exits. I even know where the mailbox is. I know all the best kinds of cafeteria food, and which ones will give you nausea even if you didn’t have it before.

To a lot of our patients, especially at a tertiary care center, where you get transferred to when you’re really sick, this is one of the scariest events of their lives – certainly one of the most painful. And to us, it’s just another day: a consult from the ICU, two consults from the floor, another consult from neurosurgery (why does our service get all the PEG tubes?).

We discharge people happily to “rehab facilities” – which for our elderly patients is probably their biggest fear come true. No matter how much we reassure them that they’ll leave in a week or two, they don’t quite believe us; they know we’re putting them away. And for some of them, unfortunately, that will be how it turns out. But to an intern, it means one less complicated patient to see in the morning.

(I have to observe: medicine residents make me laugh – not bitterly, just ironically. They spend all day seeing 4-5 patients as interns, maybe 10-12 as seniors, and think they’re busy. I see, and write notes on, sixteen patients between 4:15 and 6:15am, and spend the rest of the day chasing labs, consults, results, and discharges on them. That’s just hilarious.)

Which brings up another point: my patients are so nice. At least on this service, they’re almost all “real” people: they have families, they have/had jobs, and their illnesses are not primarily their fault. They are so patient with me waking them up at unearthly hours of the morning. Some of them even answer my inquiries by asking how I’m feeling. A couple have asked what time it is, or what time I woke up, but they’re agreeable when I explain the logistics. One of them says, “Hang on a minute, honey,” and shakes her head a couple of times to wake up, and then starts chattering as agreeably as if it’s the middle of the day. (And just to excuse my disrupting their rest: there are ivs going off, vitals to be measured, and labs to be drawn, at the same time I’m rounding, so my attempts to get going early in order to avoid an eruption from the attendings are not solely responsible for breaking up their sleep.)

One sweet little old lady thinks I saved her life (more like I stood by while another doctor whom she hasn’t seen since saved it), and she always lights up when I walk into the room. The chief and the attending think it’s funny, because they don’t know what she thinks; all they can see is that she’s picked me as her favorite member of the team. She has a beautiful warm blanket, and when I complimented her foresight in bringing it, she told me it was her husband’s, in the Marines in the Pacific during World War 2. Then she told me about a secret code she and her husband had worked out before he left, to circumvent the censors. They had a list of scores of popular old songs, and using a phrase or title from one of them would indicate a particular situation or location. Thus, she told me, she knew exactly which island her husband had landed on the day she had their first child, from a phrase about blue eyes in the next letter he sent. I can only imagine the number of subversive secrets like this that her generation are carrying to their graves.