As a medical student at the Texas College of Osteopathic Medicine in Fort Worth, I have had the opportunity to encounter patients from all walks of life.
Our inpatient rotations are primarily at John Peter Smith Hospital (JPS). It has been fascinating to treat people in the hospital I had only been a visitor in previously.
In my third week of my psychiatric rotation, I was assigned to “consults.” This service includes treatment of patients on the “med-psych” floor of JPS — the ward for patients with acute medical and psychological illness.
I began my morning, as I had many times, visiting patients on the floor. My first two encounters involved patients sharing a room. I entered dark, quiet room, both occupants awake despite the early hour and the darkness. They talked softly about their situation and introduced themselves. My short white coat, loaded down with equipment and reference material, grabbed their attention. Ready or not, my encounter began.
“I suppose this is not news for you, but we will have to discuss everything with your roommate present,” I told Ms. A.
Sitting, I asked, “So what’s going on?”
“Nothing now, I tried to kill myself earlier, but I’m better.” She replied. “I really want to get out of here. I don’t want to lose my new job — I’m worried about losing my home.”
I expressed my concern for her situation as I pursued the point, “Why did you want to kill yourself?”
“I was upset about my financial situation, but it is better now.”
She described her new job that started Monday, and so is no longer worried about finances. She described her network of church friends. She “never was depressed,” and the last time she attempted suicide was over 15 years ago. Something didn’t add up. “What was it this time that made you attempt suicide?” She again deflected by describing her current blessed situation.
I asked the remainder of my questions — appetite, hallucinations, pain — and thanked her. Mrs. B, her roommate, was sitting in bed, staring off to avoid eavesdropping. There were no walls or curtains separating the patients. I had only to turn my chair to face her. Ms. A still lay three feet from me, eating breakfast. Everyone present keenly understood the lack of privacy.
“Why are you here?” I began.
Mrs. B explained the causes of her attempt. Similar methods. Similar background. Slightly different social background. She had chronic depression, changes in her life she didn’t think she could handle, unaddressed medical conditions. I thanked her and left to type up my notes.
A mix of caffeine and curiosity compelled me to recheck Ms. A’s background information. Why would she have attempted suicide if things are going well? I found my answer — a urine drug screen positive for “amphetamines” and “opiates.”
I got up to ask Ms. A about on the drug use. Was this a long-standing habit? Could we provide her support to quit if it is? I walked into the room, again interrupting the two patients talking to each other. I looked at Ms. A, then at Mrs. B. The juxtaposition of the two — the addict and the sick old lady struck me profoundly. Both stared, waiting for me to speak.
“Is there anything else we can help either of you with?” I fumbled.
Both shook their heads “no.” Realizing I could not ask such a sensitive question of my patient in front of a virtual stranger roommate, I nodded and left the room.
Countless medical staff members have consciously or unconsciously changed their behavior because of the double room. And these changes have led to diminished care.
So why have double rooms? I suppose the short answer is that JPS has no choice. In the midst of an increasing (and aging) population, our hospital has had to do more with less. Constant demands for tax cuts cause budgets to shrink or stagnate while costs expand. If JPS spends the resources needed renovating, they must make the cuts elsewhere, leaving hundreds or thousands of patients without care for months. Without specific funds for renovation, privacy considerations will always take a back seat. The human decency of staff make it difficult to bring up sensitive topics, and the pride of patients, especially those with mental illness, makes it nearly impossible for them to show us their psychosocial wounds so we can treat them.
Hundreds of thousands of us rely on JPS for healthcare — from the most basic to the most crucial. To anyone who is fortunate enough not ever to have a family member rely on JPS, know this: the patient I could not help with her drug problem, like many others, will return to the workforce. She will help your parents in their retirement home. She will cook food you eat, clean the facilities you use.
If you do not believe they deserve the same care as you because they cannot afford it, just remember neither you nor they live in isolation. The better we treat our neighbors, the stronger our community, and the healthier we ourselves will be.
Patrick Crowley is a medical student at the University of North Texas Health Science Center in Fort Worth and is a member of the Texas Medical Association's Board of Trustees.