In the dust of humility

It's surprising how many people there are, that even when the lives of their loved ones are in the hands of their doctors will still put on airs of entitlement and superiority. Oftentimes these are the so called "VIPs" that pass through our clinical service. "Very important person," as some might say. Does this mean their lives are more important, their conditions more critical, or their outcomes more significant than any other patient on the list? No, of course not. But their pocketbooks may be heavier, and their clout more weighty, than the poor Latino family one room over who are putting everything they have, including shreds of their dignity, into a homemade contribution box by the bedside of their comatose son to help pay for his ICU stay (saddest thing I've seen this week).

The irony is that these VIPs oftentimes receive the most questionable care. A battery of unnecessary tests are ordered to exclude the rare and as we call them "zebras" on the differential diagnosis, to leave no stone unturned amidst a landslide of unlikely boulders. These are the patients that ask that the attendings do the procedures that would normally go to the residents such as placing central venous catheters or ventriculostomies, procedures that some of attendings may not have performed in months if not years. I've seen the chair of liver transplantation doing a neuro exam and commenting on a patient's neurologic status, a rehab neurologist directing surgical management and diagnostic imaging. Seriously guys. You don't see us going over and telling you how to transplant a heart, stay away from my brains and spinal cords.

I met the humblest of patients the other night on call. She was homeless, disheveled, and unkempt with her dust worn clothes and uncanny amount of facial hair. She had a piece of surgical metal that had been eroding through her scalp for months, but for which she paid no mind as vanity was long discarded on her road. But her friends had freaked out enough to persuade her to come to the ER, so she did. She was cooperative, unassuming, and grateful despite the wait and knowing nothing would be realistically done over the weekend. She was the kind of patient you wished your so called VIPs would be like. But then I discovered she had lice and the wistful appeal of the homeless dissipated. We still took good care of her.