Night Shift
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As my residency director walked out of the examining room his face was beet red, just like his hair and beard, as if he was about to explode. After he closed the door he erupted in laughter. “You won’t believe what that mother just said,” he told the crowd of residents gathering in the hallway. “Her 12-year-old daughter has belly pain,” he began explaining. “I asked her about everything possible, but nothing was coming up positive. Finally in desperation I asked her ‘Do you think it’s possible that your daughter has ever had sexual intercourse.’ Do you want to know what she said?”
“Whaal,” he said imitating her back woods accent. “Ah don’t know ‘bout anythang like that. But if you thank she needs it. You go raht ahead and geeve it to her. Cuz we got the health card and it’ll pay fer it.”

I was just a resident when that happened. Little did I know at the time, that I would come to expect that kind of ignorance and almost comical sense of entitlement throughout my career from so many of my patients. The ignorance I could deal with. I am a patient educator. But being a slave to a sense of entitlement has been a struggle for me.

***********

“Don’t forget that we have an appointment with the accountant after you get home from you shift tomorrow,” my wife said cheerily as I headed out the door in my scrubs. It was year end and time to get the ‘good news, bad news’ speech from the accountant.

“It looks like you have had a very good year,” the accountant said brightly as I slumped at one end of the oversized mahogany conference table. “You are a very lucky man.”

“I know,” I said gloomily. Despite still having my scrubs and lab coat on, I felt like I was sitting in a cold examining room wearing a paper exam gown about to get a freezing sigmoidoscope.

“You know what that means?” he said looking over his spectacles.

“I know,” I repeated sighing deeply.

“Even though you’ve paid a lot already, you’re still going to owe a bundle on this years taxes.” I just shook my head.
 
“I saw an EZ IRS short form the other day,” I recounted numbly. “It just had two lines.  ‘Line 1 - Total earnings for 2007’. Line 2 said ‘Send it in.’”

“That’s pretty funny,” he chuckled.

“Yeah, if it wasn’t true. And you know the hard part about this?” I sat up starting to bristle. “I see where all this money is going. It’s going to pay for all the bogus medical problems that I see every night.”

“Well at least it’s coming back to you,” he said philosophically.

“Let’s see if this works,” I said wide awake now. “First I have to work all night and see every person who shows up regardless whether they pay. Then I pay an accountant God knows what, no offense, to figure out how much I owe the government.” I caught my wife scowling out of the corner of my eye. “Then I have to argue with the pinheads at the IRS about whether it’s the right amount. Then the Congress has the gall to decide what tiny fraction of my money they will give back to me for working all night to see all the patients they say I must. Somethin’ ain’t right about that,” I said imitating my old grandpa.

“He’s tired,” my wife said, smiling wanly at the accountant. ‘We’ll talk about this later’ she mouthed to me.

“It’s not like I don’t want to help those poor ignorant souls that I see every night,” I protested to my wife as we walked to the car after the appointment. “I do. But I hate it that they act like I owe it to them. What happened to the ‘good ole days’ when the doc would say to the poor farmer ‘Just pay me when you can’. Or maybe, ‘I know you’re on hard times now, so don’t worry about paying me. Consider this visit a gift. Even if they couldn’t pay, at least they knew they owed something for their care. Now they act like I owe them! Health care is not a ‘right’!”

“Calm down,” she chided me. “It’s not like all your patients are narcissistic ignoramuses. Besides, are you ranting because the taxes are too high or a few of your patients don’t show enough gratitude?”

Her analysis gave me pause for thought. “It’s both,” I said, now more in control. “Don’t you see how they are related? When patients have a ‘right’ to have someone else take care of their every need, somebody has to pay for it. Then the government steps in and offers to ‘pays for everything’,” I was exaggerating each phrase for dramatic effect. “But then where do they go to get the money to pay for all their benevolence? Me!”

“Everyone should be as oppressed as we are.” She stopped the conversation with a little signal that she used frequently. It was her index finger rubbing back and forth across her thumb. I made the mistake once, in the middle of an argument, of asking what she was doing. ‘I’m playing on the world’s smallest violin, My Heart Bleeds for You.’

I went home and finally got to sleep but dreamed fitfully all day of poor farmers bringing me chickens saying ‘Thank you doctor, you saved my life. I couldn’t pay you, but I brought you this chicken.’ In my dream there were thousands of chickens, sitting everywhere, clucking and crapping on everything. It was horrible.

And wouldn’t you know it, the whole weekend, everyone around me was always saying ‘thank you’ for the slightest courtesy. I was beginning to feel like I was a spoiled brat. When it came time to go to church at the Naval Academy chapel on Sunday, I was ready to repent of my sinful attitude and get right with God. That was until the chaplain got up to speak.

“Don’t do your good deeds so people will see you and praise you. You’ll have your reward. Do your good deeds in secret, then your father in heaven will see and reward you.”

“Hey,” I whispered to my wife with a suspicious squint. “Is he saying I shouldn’t be looking for people to say thanks?”

“Shh,” she could see I was starting to get agitated again. “We can talk about this after church.”

“Oh, I get it,” I said louder. “I can see what this is all about.” People started to glance my way as my wife began to glare. “He’s telling me to just do my job and shut up about being thanked for it.”

“That’s right,” she scowled, “shut up!”

“Jesus said,” the chaplain continued, ‘If someone wants to sue you and take your tunic, let him have your cloak as well.”

“Now he’s using Jesus to justify the IRS using and abusing me. That’s just not right.”

As we filed out of the church my wife tried to ignore my continuing rant. “I wish I could stand by the door after every shift and have everyone thank me.”

Approaching the smiling chaplain I stuck out my hand, “All I want to know is, did the IRS tell you to preach that sermon?”

Totally bewildered he looked to my wife. “He’s been working nights, and he’s a little tired,” she said pulling me out the door.

“A lot of good church did you today,” she said softly while taking my arm.

“I know,” I said, worn down and finally getting it. “Let’s go get some lunch.

“How does chicken sound?”

Dr. Plaster practices emergency medicine in Baltimore.
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Comments   

# Peggy 2008-01-08 03:31
In every walk of life you see it, from the rich and from the poor -- people are infantilized. By the culture? I think so. (Only infants are entitled to total loving care, whatever they need, regardless of anyone else's need, just because.) I'm pretty sick of it, too. They do indeed all look like ignoramuses. Thank you for this wonderful blog, Dr. Plaster!
Reply
# rlbates 2008-01-08 17:32
Wonderful post!
Reply
# Perhaps it's timeAdi Nadimpalli 2008-01-09 03:09
If you're not happy with ER life, perhaps it's time that you seek other ventures in life. It seems that the demands of ER work are not fun/rewarding and that you're not able to communicate with some patients on a personal level. It's not a self-slight that you may be in this place, but you should question whether you even want to practice medicine in this environment. On the other hand, there are plenty of places across the world that physicians are necessary and rewarded plenty in non-financial ways. Perhaps trying them for a bit may re-kindle your work enjoyment. Perhaps Doctors Without Borders for 6 months?
Reply
# "Conspiracy Theory"Rita Iverson 2008-01-10 17:27
Dr.Plaster,

as a RN, who worked ER for 6 years and married to an ER doc, I totally agree with your article. We in America take health care for granted. I work in the 3rd world now and people are grateful for every little help they receive. Very seldom did I feel a patient in the ER, who received free care, was grateful. So many would only complain.

I read "Night Shift" every month and love it.

Years ago one of our docs ask a female patient if she was sexually active. Her answer:"No, I just lay there."
Reply
# Dr. Paul for President!bryan 2008-01-10 18:27
Government is just a big middleman who interferes with the Doctor-patient relationship and takes a cut for himself.

To make healthcare affordable, we need less government regulation and more competition.
Reply
# http://emshaiku.blog-city.comRevMedic 2008-01-10 19:19
"I went home and finally got to sleep but dreamed fitfully all day of poor farmers bringing me chickens saying ‘Thank you doctor, you saved my life. I couldn’t pay you, but I brought you this chicken.’ In my dream there were thousands of chickens, sitting everywhere, clucking and crapping on everything. It was horrible."

You're not hiding any Bird Flu phobias, are you?
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