Gratitude?
1961, Parkland Hospital, Dallas
A few years before Parkland was thrust into international notice with the assassination of JFK, I was a junior medical student on a Parkland internal medicine ward. The day was winding down, a good time to catch up on chart notes, a tedium not anyone on the physician care team liked—not resident, intern, or senior or junior medical student (me). There were more interesting things to do, but chart notes were a necessity—a bedrock element to document care, enforced by Medical Records’ power to hold salary checks if the backlog of incomplete charts grew too large.
Like other scut work—starting IVs, chasing down missing lab reports or X-rays—the menial chart tasks oozed downhill until it stopped at the lowest point of the care team: the junior medical student, otherwise known at “MSIII” (medical student, third year). Stuck with the chore, we adopted an irreverent mantra, “The patient died but the chart was well.” As a sop, MSIIIs were allowed to write a few low-level orders—enemas, for example, which were required for patients scheduled for abdominal X-rays or gastrointestinal procedures. Here, too, brevity and humor prevailed—”3HE” was standard shorthand for a “high, hot and hell of a lot” enema.
However, for the first time I relished the opportunity to add a note in the chart of a patient I’d been assigned, a borderline retarded young woman with a strange, feverish illness. Frustratingly, her diagnosis was elusive (today better tests would probably confirm our suspicion it was lupus), and she was thoroughly dislikable: disruptive, demanding, and crude. My job was to draw blood, start IVs, collect urine, and stool specimens, and other menial tasks, all the while enduring demands and insults.
Her husband was equally troublesome: unkempt, obstreperous, and more interested in having sex with her in a four-bed ward than in her health. Their hospital stay had ended earlier in the day when they checked out of the hospital AMA (against medical advice) while loudly complaining we hadn’t figured out what was wrong with her, the food was lousy, and they would be better off at home—all of which were arguably true. I watched them storm out, hurling their last insults at me.
I swallowed wounded pride and anger until I came to her chart in the pile. Their leaving was good riddance––how could people be so ungrateful for the free care they got and so oblivious to the ordinary courtesies of life? I was wounded and mad and wrote a flourishing note in her chart about their behavior and ingratitude. After finishing, I grouched to the other MSIII working on the pile with me.
I didn’t realize our resident was on the other side of the partition. A tall fellow with a long neck, sharp features, and acerbic demeanor, he heard me and craned around the edge of the partition with a long silent glare: “Doctor McConnell,” he said, with sarcastic emphasis to remind me I was a junior medical student, not yet an MD, “If you expect gratitude, forget it,” and proceeded to give me a brief, scalding lecture on the ethic of the situation—you give every patient their just due, the best you can deliver—because that’s what every patient deserves, not because you expect a reward like a bone tossed to a dog for a clever trick. I had complained and got a jolting good lesson in return––you owe the same compassion and duty to every patient, even if they are demanding, smelly, ungrateful jerks. It has stood me in good stead for a long time.
English