I have pretty much run out of stuff to say about the hospital. Everyone has been asking what I have to say about the hospital. What am I writing? When am I going to write something about the hospital? When I have something to write home about, which is about the hospital these days, I will write something about the hospital. The crucible of the medical residency forges workmanlike prose.
Since it has become a good enough story that everyone has been asking me when they are going to see some work from me about the hospital I get going on sometimes about whatever it was I donât have to say about the hospital. I had made it so clear to them that I had not wanted them to ask about my training. What did I even have to say to them, I wondered, about what I hadnât ever said about the hospital? Not because I hadnât wanted to say anything, by which I meant something about the patrons of the hospital, or the patients of the hospital, I said back to myself, but because they hadnât asked in the best way. And I so desperately wanted them not to ask me so as to ask me to make them ask.
And I got going to Occupy Wall Street to see the goings-on there, outside of the hospital, even though I had spent the morning at an outpatient clinic, a hospital affiliate. There was everything to say about the patients there, and the doctors there, and the patience of the doctors. What would the theys down at the occupation have to say about any of these things they had not seen as a doctor? I always think I have nothing to say about these things because I canât say them in the way they should be said, through the patients. The patients may not have seen all the patients, but they see what they see and when they say it they say 99 percent of what needs to be said.
Maybe theyâd read somebody elseâs book about a hospital somewhere. There are books on the Internet about other doctors who said their training was a wack bulwark against time, and the Internet. One doctor said it was the touching people that did it. An internist from the Seventies says itâs about the times you didnât get to touch anybody, and you touched the nurse. One or the other of them called Americans those motherfuckers, or maybe the two of them, because Americans didnât believe in professions anymore. Or perhaps it was me who did that. Both of them loved their job once, to provide. Both of them loved loving patients. And they loved health care once.
The doctors had once written about how you could get smallpox if you were intrepid in the Tidewater swamps. Tremulous toward civilization, they remembered the British, who ran their mental wards, King George porphyria manifest, with shackles and small rods. All the leeching bled them out into Jacksonian democracy, then the cholera epi back abroad. Something was in there about John Snow and the civil theatres of Wilkes-Booth and the chloroform. Halstedâs heroic surgery, cutting and sharp like a patient not yet onto the opioids, got them etherized upon a cross of gold. Over there, just under the mustard gas, they hid in magic mountain sanatoriums as the post-Tammany brothels pressed the flesh and the patrons trickled out the cardinal stages of syphilis. They dreamed of Wizard of Oz poppyfields drained of their Technicolor, their own color drained as an erythematous maculopapular rash took over their palms and soles.
Then the hospital was a warmine where the doctors lived and toxxed the early chemo patients and detoxed themselves and cured polio and fucked their Irish nurses halfway into American hegemony. On the fronts in the South Pacific they slathered themselves with lousenets and citronella oil until the troops integrated after V-J Day. With the antibiotics on board they could then sit up and douse their armoires with contact paper and DDT. And the antidepressants, from the antimalarials! They came out of it.
Then somebody cocked up the kids in Westchester on the riots and -caine, and we got entitlements. Shaggy psychiatrists, with their Dustin Hoffman hems and their dead-eyed Kinsey mentors, drifted in and out of the ERs and the EDs and EWs until the AIDS patients started going off the grid. The junior doctors were afraid of them until Rock Hudson got them an ambulatory care clinic. Thus went the antiquated home visits and the palliative care and the Harry and Louise. And then the clinics closed.
What is American health care, anyway, if not expansive? These stories are American health care, comparatively effective. These are the references my patientsâ records do not carry over to me when they are charged to me in EMR. They are the references the occupiers carry over to you. They are the ones in the handwritten scrawl they bring in to the mes of the hospitals just to fuck our day over, or give the mes half an hour more transcription to do because some damn scanner canât do our job. The scanning is our job. The constant scamming, thatâs our job, until it isnât and we go to the street.
When I came in to Occupy Wall Street the hospital uptown was continuing the renovations they had spent the last decade trying to fund. They are Wall Street-distended with funds. The others are Wall Street saline flush with the cash, hence the fun. They are paralytic ileus without the funds. Now the money is running out, and what I have to say about the hospital is what I have to say about America, which is to say that I have nothing to say to America except for goodbye to the groggy, sexed-in boondoggle. Do I say things like that? I wonder if I refuse to say much about the hospital because it might end up sounding like that. The hospital, I know as your doctor, is where Americans say their worst good-byes. The occupiersâ goodbyes are best said on the streets, and then they get to Google, where the child is the author of the blog. Children are the best at good-byes.
I think it was after I read all of the people who had said things about the hospital on the Internet, on the 99 percent Tumblr, that I ran out of stuff to say about the hospital. I am the web M.D., a doctor with the face for the in-person. They are counsel to the last acts of witness America has left. Our stasis does not characterize the medics I talked to at Occupy Wall Street. The physicians had been there, they said. They had all been for Medicare-for-All, all two or three of them. I told the EMT, who is applying to medical school this fall, that he may have to be circumspect around the physicians with the funding when he goes to interview. Then I told him to say what he meant to them, to fight back, and to avoid circumspection. He should fight research with research, I said, which is really saying nothing back, because he knew what he would say.
After I left the park and I read the news on the Internet about Jesse Jackson saving the medical tent I thought of the time Jesse Jackson came to my high school to do a blood drive a week after September 11. I was afraid to donate blood then, not because I was afraid something interesting would happen, but because he had asked. He asked the city to save the medics, and the medics tent, and they did what he asked. What do we ask of ourselves as physicians for the 99 percent? What I have to say about the hospital is probably best left said by the medics who have left the hospital to remain outside the hospital. They are younger than I am. They are older than I am. They are there-er than I am. The literature says we shouldnât rule them out.