This post originally appears in The Intima: a journal of narrative medicine Crossroads blog
No matter how many years we spend studying textbooks of medicine, nothing can prepare us for the clinical world.
On my very first rotation, a patient said he had a question for me while I was pre-rounding at 7 am. I was nervous, thinking I wouldn’t know enough about his medical condition to answer any questions. He asked me if he would be able to get a pair of pants to wear during his physical therapy session. He explained that yesterday he wore only a gown and felt “well, rather exposed.” I will never forget my feeling of bewilderment at hearing that: How come no one had thought to give him a pair of pants before he walked the hallways?
Nothing prepares us for the indignities of the hospital—batteries of tests, the gowns designed to allow frequent physical exams, the narrow hallways. It scarcely allows privacy, a sense of control, or a patient’s say in the daily routine.
In “The Choice” Keenan Whitesides describes this dynamic beautifully. He asks a patient whether she would like to get out of bed:
Do you mean I have a choice?” she asked. Her voice was barely above a whisper and her eyes danced with hope as she searched my face for an answer. I nodded my head and we were suspended for a moment in time, as she savored the luxury of choice, something she had longed for so greatly in her time in the hospital but so rarely received.
This piece is a sorrowful, lovely reminder of how powerless the hospital can make patients feel, at the mercy of decision makers that make up the treatment team.
It is often the new students, with only one foot in the clinical world, who are most attuned to this loss.
In “Double Black Doors,” Moragi struggles with keeping a patient with suicidal ideation on a locked psychiatric floor. This haunting and honest piece explores the medical student’s complicity in taking away freedom in the dubious pursuit of health.
Like an aggressive cancer, her depression only ever came back, worse than the time before. And now, we sat around at morning rounds, scratching our heads. What else was there to do? The answer, really, was nothing. There was nothing to do. Nothing to do except the right thing to do. To free her. To give her the freedom she begged for every day.
As trainees in medicine, we are caught off guard during initial clinical rotations, as we learn the hospital feels like a prison for so many patients. On psychiatry rotations, we see how the mind can be another kind of prison. We are shocked, even ashamed of our team’s power over our patient’s daily freedoms. It was a pandemic and sudden changes in daily life that led me to ponder the confinement I describe in my piece “Confined,” but as these authors clearly illustrate, confinement has always defined the hospital.