"There was a feeling of loneliness, of being shut off from everybody," Joyce Endo said.
"Things you take for granted, like eating or going to the bathroom, become so much more difficult," John Kim said. "You have to get permission to brush your teeth."
"The frustration gets to you very quickly," Ellen McEwen said. "When is the doctor going to come? How long am I going to be here? I knew I was going to be rescued tomorrow, but what if they forgot?"
Anyone who has ever been a hospital patient can identify, sympathize. You lie there, and they come and poke you and prod you and jab you and stick you. They wake you six times a night, then tell you you ought to get rest. Worst of all, they never tell you why.
Breathes there a patient with soul so dead who never wished that if only for a day, just to see what it's like, his doctors could change places with him?
Last week they did.
Endo, Kim, McEwen are all doctors. They and three other first-year residents at Memorial Medical Center of Long Beach checked in last Tuesday evening as patients, suffering from a variety of ailments. Names and symptoms were fictional. I.v.s were hooked up in some cases; intranasal oxygen; a variety of affronts to the flesh and the psyche.
Discharged the next morning, the doctor-patients--young, eager but considerably chastened--assembled to swap stories. Unanimously, all agreed that what they'd lost in sleep and dignity they'd gained in insight.
"What I've learned," Dr. Linda Lis said between yawns, "is to give the patient more control, let him make more decisions, share a lot more information with him. Convey to him the notion of a partnership with the doctor, both aiming toward the same goal: making him well."
'Terrifying and Frustrating'
The Memorial program was inaugurated last year by Dr. Stephen Brunton, affable, articulate Australian-born director of Memorial's family-practice residence program and a former patient himself. Brunton revealed that when he was a resident he was hospitalized with a serious eye condition. "I was put in a situation where I was no longer in control," he said. "It was terrifying and frustrating--and it was probably the most important learning experience of my career."
Brunton's purpose in establishing the Long Beach program--to his knowledge the only one of its kind--was to "teach new physicians the value of compassion and empathy."
Last year, six first-year residents checked into Memorial incognito, all with "symptoms of AIDS."
"Results were pretty much the same as this year," Brunton said, "but all of them ended up in the same room." To broaden and strengthen the program, "to get away from a kind of pajama party," this year's volunteers chose their own symptoms and set out alone into what can often seem the vast and intimidating impersonality of a major hospital.
Endo had a "seizure disorder." She was pleased with the efficiency of the admitting process--"no more than 10 minutes"--but "once I got up there into the hospital room, the only thing that kept me going was knowing that it was a pretend thing, that I could go home the next day. Imagine being there three or four days!"
Dr. Katie Beckstrand suffered "anxiety depression" and was sent to the Psychiatric Unit. "Immediately, I was upset that I couldn't go down the hall without permission--which I didn't get until the next day."
To Kim, "suffering" chest pains, with every indication of cocaine abuse, "the first problem was waiting--waiting for this test, then that one." Once he was suspected of drug abuse, he said, "the staff's attitude changed. They were cooler--almost imperceptibly, but you could feel it. The whole experience was very depersonalizing. As a health-care provider, I'm really going to try to involve the patients more, give them some control. I didn't have much."
'Convenient' for Doctors
Brunton smiled, wryly. "Hospitals," he said, "are not built around patients as much as they should be, though they're very convenient for doctors. But as doctors, we need to understand how important for health it is to make the patient's experience a positive one. It's one of our most important roles."
Lis, "suffering" from abdominal pain, possibly acute appendicitis, agreed. "I'd never been in a hospital before," she said. "I just sat in admissions, supposedly suffering, and I got a really strong feeling for someone in pain having to wait."
McEwen's "symptoms" were of alcoholism. "Reading from books is one thing," she said, "but I shared a room with a wonderful woman, heard her pour out her story, straight from the heart, and it was a real eye-opener. The sense of hopelessness, the destruction of relationships, the yearning to go straight. Here we were, the two of us, cast adrift. . . ."
"We need to spend more time not just talking but listening," Brunton said. "You can be sick with fear of what your diagnosis might be, and sometimes a doctor gives it in such an impersonal way."
Dr. Bradley Smith checked in with "fever, lethargy, all the symptoms of AIDS." "My fear," he said, "was that people would treat me differently, avoid me." Instead, "They were very friendly, very caring. They talked openly about the disease, asked about my family, my 'partners.' I have nothing but good to say about Memorial. All residents should get the opportunity we did."
Beckstrand concurred, but with reservations: "It wasn't restful at all. Strange environment, strange noises during the night--the opposite of relaxing. I didn't sleep at all."
The Memorial doctor-as-patient program has already stirred interest as far afield as the American Assn. of Family Physicians in Kansas City.
"I don't think anyone else has ever done it," said Dr. Daniel Ostergaard, association vice president for educational and scientific affairs, "but I think they should be. My hat's off to Dr. Brunton. I think we need to get him out here to present the program on a national level."
Brunton, for his part, approached the experiment from a strictly personal level:
"I had an eye operation. Every day the doctors would come in and check on inflammation. If there was any, I was going to lose the eye.
"They'd come in, look at the eye and converse with me. Now, I was already an intern and I knew the lingo, but I was in such naked fear that I'd have to ask a nurse, or even a fellow patient, 'What happened?' I began to think of the doctor-patient relationship, and the misunderstanding on both sides."
Isn't it true, Brunton was asked, that doctors are too harried, possibly even disinclined to fully explain to the patient what is happening?
"The doctor's visit is the highlight of the day," he said, "so even when you're rushed, you can give at least the impression of taking more time. It may take a second or two longer, but you can sit by the bed a moment, even take the patient's hand--touch is important. You can ask, 'What questions do you have of me?' In effect, you can give the patient permission to ask."
"We make an unconscious assumption that people do know," McEwen confessed. "After so many years of medical school, it's hard to remember that there was a time we didn't know all these things."
A concluding anecdote from the irrepressible but compassionate Dr. Brunton:
"We had a recent patient who refused to wear patients' pajamas, or even to sit in his bed. He wore his suit and sat in a chair. He wasn't going to allow the hospital to depersonalize him. Nobody on the staff was going to treat him as a patient.
"We've got to remember that our patients are real people with real lives. Not 'patients' at all, but rather people who are temporarily ill.