Editor’s Note: This blog post complements a collection of articles in our March issue that explores physicians’ and trainees’ understanding of how social structures and structural competency influence health. Check back throughout the month for additional perspectives on this topic.
By: Ken Martin
Mr. Martin is a onetime crisis intervention counselor turned entrepreneur with a passion for family, culture, and community. He is also a writer and photographer for Street Sense; his work can be found here.
May 11, 2014. Mother’s Day.
The doctors said I had a heart attack. I had surgery that Monday to repair a ruptured main artery and to have a stent inserted. I rested in the hospital on Tuesday. On Wednesday, following consults with an administrator who announced, “Mr. Martin, you didn’t have a heart attack, you had a cardiac episode,” and a hospital caseworker who concluded that the nation’s capital had no recuperation facilities for me, I was released.
Living on the street, with no place to rest, I sat in front of a nearby Starbucks and experienced great discomfort that I first attributed to anxiety. Thursday morning, I returned to the ER in pain, disillusioned and afraid. The hospital staff again said, “Heart attack!”
After a barrage of tests, they asked me to sign a document releasing them so they could find the problem. I signed. I went back to the operating table Friday morning. They performed surgery but still no findings. Instead, I got another “Mr. Martin, it was only a cardiac episode, not an attack. You’re discharged!”
“Whatever,” I replied. “So either you lied or you’re incompetent. How can I continue to trust you?”
My fears originated within—fear of my body’s response to my mind and vice versa. Did a surge in my adrenaline trigger the “episode?” Would another experience in vulnerability lead me back to the place I neither trusted nor respected? Should I survive, what would I say to my children about the world my generation was leaving to them?
Perhaps perception is my problem. As a proud relic of bygone days—when bedside manner mattered and patients were treated as members of society rather than relegated to statistics—I still expect to be viewed that way.
While the hospital staff did not extend my stay for recuperative purposes because they needed the bed space, it would have been a considerate gesture to forewarn me prior to performing the procedures that I would need “postsurgical bed rest.” And when the Gold Team learned I had no such option, their mentors might have demonstrated some humanity by insisting the public health authorities took steps to avoid adding stress to my heart-diseased postoperative state. What could they have done? I don’t know, but I do know that if I were in their position I would have used my status to make some local officials and nonprofits feel mighty uncomfortable.
I also would not have misrepresented the case to any patient twice, particularly to such a degree that his trust (in their integrity) became nonexistent! It is a disgrace that “First, do no harm,” is now optional. And morbidly laughable.
If they were heart attacks, they were. If they were cardiac episodes, they were. Recovering patients—especially those without access to bed rest and protection from both the elements and the usual two- and four-legged predators—endure enough stress without the very professionals to whom their care is entrusted playing self-interest-based semantic games.
Most of what should have been done differently in my case originates as empathy. I developed it long before college. I grew up in the era when doctors made house calls. And some were paid with bartered services. A time when life was measured by quality, community, and longevity rather than by quantity, commodity, and bottom lines. If a physician’s mission is still to save lives, how is it accomplished by risking them?