Having trained at a local county hospital in Houston Texas, I was always taught first the value of limited resources. At the time, it was difficult to understand that I was training in the world’s largest medical center and yet most of the patients that I was caring for would never be afforded the luxury of technological advances that I was exposed to during lectures and noon conferences.
I was able to diagnose many diseases as if they had popped out from Harrison’s Textbook of Medicine straight onto my ward service. Unfortunately, one can diagnose only so much before the paper chart during the years of my training started to resemble Tolstoy’s War and Peace.
Over time, I began to wonder about the point of diagnosing a disease if one was not able to relieve the patient’s suffering by actually treating that disease. There was, of course, one exception to that rule at the County Hospital. The key was looking at more than a patient’s name on the identification stamp on every chart.
The first thing I would notice as an Intern looking at Tolstoy’s recurrent masterpiece was what my upper level resident had taught me. “
Make sure you look to see if they have a second smaller number on the identification stamp because if they do than they have secondary insurance and we can actually help them!
I never took care of those with private insurance because those patients would not be admitted to a County Hospital for obvious reasons. However, I would see some patients with Medicare Parts A and/or B. The local county access card was known as a GOLD card, but if I saw the secondary number, I would label them as having the PLATINUM card.
As timed passed through my residency, I noticed that the number of patients having a GOLD card far exceeded those having the PLATINUM card. What could I do to help the masses that would never be able to receive the therapeutic expertise located down the street at MD Anderson Cancer Center or at The Texas Heart Institute? I was reminded of what an older Attending who still wore bowties had once told me that at the time was not important to me.
Heal with your heart and your mind and you will heal your patients not just their disease.
Easy for someone to say when you don’t have 24 hours on and 24 hours off shift in emergency room or have to admit 20 patients in a 24 hour span.
I continued to look for secondary insurances on the identification stamp on every patient as third year of my residency started. Cynicism was in full bloom and frankly I was not a nice person. Sadly, I fit in with the rest of my colleagues and the only ones sufferings from our combined arrogance were the patients. One day suddenly I saw something new in those identification stamps that had become a daily part of my secondhand ritual. Instead of how many more years until the patient’s 65th birthday (qualification for Medicare), I noticed the actual date of birth. My patient was having his birthday in the hospital! I even noticed his name. His name was John.
Suddenly the quote from the “Bowtie Attending” came flooding back. I ran to the cafeteria and bought a small cupcake. I returned to John’s bedside and offered him the cupcake. He asked me if I was going to sing him a song?! I sang Happy Birthday and saw his eyes fill with tears. He was not alone for the nurse and I also noticed that the twin lakes on both of our faces were also flooded with a sense of joy. It was as if we had somehow found a way to help the GOLD card patient feel as if he/she were a PLATINUM member of society. That day, I labeled John as The Cupcake Man.
Over time, I have added few wrinkles to the ceremony including candles, knowing if patient liked chocolate or vanilla, and singing ridiculously humorous badly translated “Happy Birthday” song from the patient’s native language. I have now become the so called “Bowtie Attending” (rapidly advancing in my age although I don’t wear a bowtie) in this era of sophisticated technology with electronic medical records and multitude of diagnostic and therapeutic applications available even at the County Hospital. I know because I still work at the same Hospital District that I trained at.
When I ask my learners what is the first thing they notice when they look at the medical chart, not a single student or resident has ever replied “the patient’s birth date”, that is until recently. The question was asked by me during bedside rounds and the answer came from the patient.
You should pay attention to him and pay attention to my birth date.
I was astonished not only at what the patient just stated but at what my eyes noticed next. It was John!
Hi doc, it’s been a while. Birthday is still off a few months but who knows may be I’ll be back for my cupcake.
He went on to tell the inpatient team our story from over 15 years ago and not a dry eye was left in the audience.
We often wonder during our training why we do what we do, second guessing our reasons in becoming a doctor. We often struggle as educators trying to convince the Housestaff that their journey is their destination. Hopefully, somewhere along the way we will understand that the power of helping and healing comes in many different forms.
For me, it came in the form of The Cupcake Man.