The Power of the White Coat

Now that I’ve finally established a (sort of) regular work schedule, which involves going to the Unidad de Infectología in the Hospital de Clínicas in the morning and then going to the Dermatología office in the Hospital Militar in the afternoon, I find myself dead tired. I’m not even working a full 8 hour day, but I realized that this is my body’s way of telling me that it’s working overtime trying to understand so much Spanish, much less medical terminology. At the moment I feel like my Spanish (accent, vocabulary, grammar, you name it) has actually gotten worse, and I find myself pretty confused about what’s going on more or less half of the time. But I’m hoping I’m in one of those moments where things get really jumbled and confusing before they make a giant leap forward.

I had been warned that some of the doctor’s can treat the patients, who are mostly aymaran and from El Alto like complete crap, but luckily Dr. Revollo and the two Claudia’s don’t fall into this trend. However, upon bringing some of the patients to other doctors for consultations, I really started to get a sense of how much of a problem discrimination and disinformation can be. During the mornings the hospital is filled with patients and the families of patients wandering down the open-air corridors or sitting in waiting rooms, and it seems like no one really knows what is going on. The doctors fail to tell the patients why they are being taken to x building, why they need a consult, what the diagnosis of the consult is, or how their medicine will help them get better. How can they blame these people for failing to take the full course of their medications when they are constantly left in a state of confusion?

Yesterday a new patient with pulmonary tuberculosis was admitted to the ward – he was so sick that he couldn’t swallow a pill, much less speak. They had this frail, pathetic man walk from the Infectología unit to his throat consult, supported by two family members on each side, so weak that he had to stop halfway to sit down and catch his breath. Once he was in the exam, the doctor sprayed an anesthetic in his throat that hurt him so much that he started to gag, drool, and cry. The doctor examined him, as the man visibly cringed, tears welling in his eyes, and then without saying a word more than “tilt your head back and open up” the doctor started talking to Claudia #2 about the diagnosis (laryngitis as a complication of TB) and the treatment. The man was left sitting there, silent and dejected, his head practically hanging between his knees. I reached out, touched his arm, and said “está bien” (it’s okay) - with that tiny gesture, for the first time he seemed to relax and smile just a little bit. Come on doctors, is that so hard?

Most of what I’m doing now involves paperwork—reading charts, watching other people read and write in charts, bringing the charts to different areas of the hospital. It’s hard to believe how incredibly decentralized this hospital is. You have to personally walk each individual “consulto external” sheet and it’s accompanying patient to the distinct units, and then you have to wait in person while the patient is seen, so that you can then bring the patient back with the appropriate paperwork. I honestly have no idea how they keep track of everything here – when we went to the test results office, it was filled with piles and piles of papers spilling out of cabinets onto the floors and shelves, in no apparent system of organization. While I didn’t come here to experience the joys of medical paperwork, I have no doubt that once I’m more familiar with the basics of the system, and once I develop more of a relationship with the patients (since most of them are there for at least a week) that things will get a lot more interesting. Hell, I guess they already are.

Everyone in this hospital, especially the little children, look at me as if I’m some sort of alien.
Just because I am Caucasian and I wear a white coat (which as I mentioned earlier, I bought on the street, which means anyone can buy one), patients and families refer to me “doctora” and ask me for medical advice. I am completely (in every sense of that word) unqualified to give any recommendation, and yet people try to ask me about their medical conditions and take every word that I say as truth. A tuberculosis patient in our ward was asking Claudia #2 about a toothache – she wanted to know if the pain from her wisdom teeth could spread to her throat and make her sick again. Claudia kept telling her no, I don’t think so, really, but it was only until I said that I didn’t think so either that she really started to believe us. She looked at me with the penetrating stare, and without questioning what I said, she started to nod. That sort of power really makes me scared.

Every time I walk in there I have to overcome the urge to escape, not only because I can see the sickness, but also because of the smell, a gut-wrenching combination of sickness, dirty bed linens, and stale food. Today another TB patient came in, and I actually got the chance to see them reading his X-Ray (which showed dense clouds of white in his lungs) and also diagnosing him with renal insufficiency. He was clearly quite sick, talking with a rasping voice and coughing every now and then. What really disturbed me, however, was as he was describing that he had been coughing blood, one of his relatives opened up the drawer of his bedside table and held up a plastic cup filled with bloody sputum. And while I was thinking “Oh my god, someone please throw that away,” the 15 year old boy with cerebral palsy and bedsore was screaming and crying as the nurses tried to change his sheets and re-dress his wounds.