No.. unlike my dear wife, I haven't manage to get a paper in NEJM... yet.
There is an excellent humanity piece in the "Perspective" section in this edition... given it's free online, I'll reference it, then copy and paste it here..
Invisible Colleagues
Benjamin J. Oldfield, M.D.
At least twice monthly, I see Ms. F. in the hospital where I'm training. Tall, with olive skin, freckles, and short curly hair, she walks with perfect posture in immaculate sneakers. She's in her late 20s and has moderate persistent asthma. Her two children, who occasionally visit her at work after school, both have asthma and eczema. Born and raised in East Baltimore, Ms. F. wears Ravens earrings on pregame Fridays and scorns the paucity of purple in my wardrobe.
The rest of her medical history is unknown to me, since Ms. F. is not a patient of mine. I have never seen her medical chart. Rather, we share a place of work: she as a janitor, and I, a resident. I last saw her out of the corner of my eye while discussing a case in the medical ICU, as she carted linens to and from the hospital laundry facility.
We met during my intern year when I was lost in the bowels of the hospital with an elderly patient, looking for the MRI suite. As I simultaneously steered the patient's gurney and called my senior resident for directions, I nearly ran over Ms. F. She dodged, smiled knowingly at my distress, and escorted us to the scanner. She remembers that event, and her toothy grin has brightened each interaction since.
Ms. F. has had a few more years of hospital experience than I have, and her knowledge spans gaps that haven't been covered in my medical training. Her stories add another perspective to the one told by these gilded hallways lined with portraits of Nobel laureates and policymakers. From her, I hear about neighbors displaced by commercial expansion in East Baltimore, or the evolution of wage discussions between her union and the hospital administration.
Shortly after I met Ms. F., she spent 2 months in a nearby homeless shelter because of financial insecurity brought on by her father's death. She continued to work during that time, earning about $12 per hour, similar to the income of many janitors at Maryland teaching hospitals.
1 Today, she and her family have their own place, and she connects the dots between public assistance programs to satisfy their basic needs. Food-assistance programs help sate her son's craving for green grapes. And Medicaid pays for his bronchodilators — the hospital's family health plan is unaffordable on her wages.
Ms. F.'s story runs contrary to the purported mission of my academic medical center — and probably most others. We claim on banners, websites, and pamphlets that, in addition to pursuing excellence in research and medical education, we seek to improve the health of our communities. But rarely, it seems to me, are those communities defined — or consulted. The people who live near and work in these institutions appear to have no place in these missions: they are not celebrated as our colleagues, nor can they afford to be our patients.
During a recent shift in our emergency department, I was reminded of how Ms. F. suffers from this exclusion. Her son presented with difficulty breathing after having run out of his asthma medications. When I entered the room, Ms. F. was sitting with her wheezing son in her lap while he received his third back-to-back nebulizer treatment. She tapped his well of albuterol with her purple-painted fingernails, lest he miss out on the last drops of medication — as if those drops might make the difference between a disposition to home and a disposition to the inpatient pediatric floor.
She smiled when she saw me and asked for an update on how her son was doing. At the provider workstation, I found the admitting team already receiving sign-out on his case. “Our third asthma admission in 2 hours,” lamented my coresident. Ms. F. met me at the door to her son's room as I walked back. When I told her he was to be admitted, she said, tearing up, that she didn't think she could continue to make ends meet, what with the missed days of work. As we spoke, we looked in at her son, tachypneic but giggling at the tablet computer our staff had given him to use.
As a resident in internal medicine and pediatrics, I'm being trained to foster healthy families — exactly what our health care institutions purport to promote. Yet here was a friend, colleague, and patient who was left out of that story. I recalled my harried search for the MRI scanner that night in the hospital basement when Ms. F. and I first met; our roles were now reversed. Now she was the one lost and in trouble in the bowels of a larger machine. I wished I could show her the way to where she wanted to go, as she had done for me.
Ms. F.'s story echoes through neighborhoods surrounding many U.S. academic medical centers. And it helped me realize that, as physicians who serve our local communities, we should advocate for policies that promote health, productivity, and dignity in the people who work alongside us. Ms. F. and her family deserve a place in our missions.
The initial and identifying characteristics of the employee have been changed to protect her privacy.
