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A Page On Hospital Leadership

By Eliezer Van Allen, MD

Eliezer (Eli) Van Allen, MD, is a third year resident in internal medicine at the University of California, San Francisco, and he will be starting a fellowship in Hematology/Oncology in July, 2010.  He has found that finding the humor in otherwise stressful situations makes thirty hour shifts in the hospital go by a bit faster.

I feel obligated to report that yes, in fact, I did drop my pager into the toilet last night and yes, the toilet was full at the time of the transgression. But inspiration comes from the strangest of moments, as any brilliant medical resident toughened by years wading through the depths of human experience and excrement would tell you, and for me, this event marked a momentous milestone in my medical training. After all, it was at that precise moment, when the innocent black text pager took a breathtaking plunge into liquid gold, that I gleaned a critical insight into an aspect of human behavior that ties all of us together, no matter our race, profession, or creed. First, however, I feel inclined to probe further into this aforementioned scenario that has led to my awakening.

On a particularly uninspiring night in a bare nook of the hospital, I found myself (as one often does on a Tuesday night) exceptionally bored. My duties as the nighttime “float” resident included supervising the nighttime intern, a lanky Midwestern male with bleached blonde hair and an independent flair (he was responsible for fielding pages from the nurses about all of the previously admitted patients overnight, roughly 50 to 70 patients in all), and admitting any new patients from the emergency room after 3:00 AM. Just to make sure I was functioning at full capacity by that early hour, I was actually required to arrive at work at 8:00 PM the night before, which mostly served to remind me that my life as a resident is perpetually miserable. Practically speaking, this amounted to six hours of time available for wasting, and on previous nights I had done just that. Occasionally, I would be interrupted by the intern, who saved his most pressing matters for me and my sage wisdom.  Such questions included “This one guy up on 6A keeps leaving to smoke crack, is that OK?” and “Is there any reason why the nurses keep paging me at 3:00 AM to tell me that their patients have not had a bowel movement? Who takes a crap at 3:00 AM?” Fortunately, by this time I had six years of medical training under my belt and felt particularly qualified to provide acceptable solutions to these pressing questions.

I spent the first few hours of this particular night applying my superior intellect to Us Weekly, discovering that stars are in fact just like me: wasted and tired in the middle of the night. Yet, as the clock marched towards the fateful 3:00 AM hour that would signal the beginning of my true work day, I developed the strong urge to use the restroom, thus inadvertently answering the intern’s earlier question regarding human bowel habits. As I strolled towards our bathroom (labeled “For Doctors Only”), I saw my intern down the hall but resisted the urge to use my urges as a triumphant answer to his earlier query, instead marching silently towards the restroom to take care of business. After taking care of business, I gently lifted up my scrubs, with my pager clipped to the side, when it began vibrating furiously, yearning to share its important digital message with me. I reached for the pager but it was still in motion, and with a gentle slip it fell out of my hands and vibrated all the way into the toilet.

Crap, indeed.

To pick it up or not? I stared at the device as it slowly sank into an abyss of hospital plumbing.  Would I dare subject my gentle hands, digits and palms that I had already invested six years and almost two hundred thousand dollars towards the refined skill of life-saving, to this netherworld?  Could I in good conscience attempt to flush the toilet, knowing full well that this would likely cause a serious pipe blockage and a rather nasty dilemma for the hospital janitorial staff, not to mention it would also likely lead me to expending significant energy running as far away from said toilet as possible immediately after flushing? 

Years of clinical decision-making were no match for the quandary posed to me that night, and yet it presented a great opportunity to conduct my own thought experiment:  would the average human (or, in my case, the average over-educated academic machine) be willing to subject himself to significant harm (reach into a used toilet to grab a pager) in order to prevent the suffering of others (plumbing Armageddon)? As I churned my way through another 80-hour work-week dedicated towards alleviating the suffering of others, the answer initially appeared obvious. Why else subject oneself to daily rounds of humiliation, harassment, and horror at the hands of our superiors, medical students, nurses, and patients? But did this selfless persona have to be mine at every moment in time?

The fact that I was so immersed in the medical world was clouding my thinking.  Legions of attractive women drawn to young doctors notwithstanding, I thought it best to remove the medical subtext of this scenario. I imagined I was a layman, someone of far less societal significance - say an author - and my tool, the mighty pen, found its way into this toilet under these very circumstances. Would I still lunge to rescue it, risking the very means with which my literary labors made their way onto print just to avoid the prospect of others having to deal with the consequences? The answer seemed less clear, if only for the fact that I recently purchased a package of one hundred pens at a nearby Costco for $3.95. Also, pens are small and would probably go through the pipes without difficulty.

None of this was working. I feared I was not going to come to a conclusion on this matter quickly; yet, every second spent pondering this ethical quandary meant another second in golden purgatory for my pager. And just then, while knee deep in thought, I was interrupted by the soft footsteps of my intern companion and the encroaching beat of inspiration only he could inspire. Any true leader, whether a resident, a president, or any lord of societal groups, has only the power to relegate what he can delegate. How could I conceivably stake my claim to being the sage senior resident in the hospital without trusting my noble staff with a task as simple as pager excavation. The perfect system – the leaders decide, and the subordinates execute the plan. This was not just the foundation of a functional hospital, it was the means with which an entire society could function at its peak. 

Or something like that. 

So on that fateful night, at that early hour, on the orders of his fearless leader, a lanky Midwesterner dipped his hand into a bowl filled with unimaginable waste, and scooped up a pager bathed in filth while his resident looked on with pride.

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