Here’s my column in the April EM News.  The power of place in medicine.  Can you replay in your mind the many hallways you’ve walked down, the many patient rooms you’ve entered?  The stories the contained?

https://journals.lww.com/em-news/Fulltext/2014/04000/Second_Opinion__If_These_Walls_Could_Talk.6.aspx

A Southerner at heart, I find myself in love with places.  We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite tree-stand sits.  Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hare is always associated with her beloved Tara just as Faulkner is ever infused into Mississippi.

Personally, I will always and forever remember the way daffodils broke through the snow at my paternal grandmother’s house, beneath the enormous maples that lined the property.  We called them jonquils, not daffodils, but that place is deeply ingrained in my memory.  And Summer, for my wife and me, is now inextricably linked with the South Carolina beaches where we vacation with the children.

But in my life, place also has to do with hospitals.  They have character, you know.  And while that character is made up of physicians and nurses, patients and administrators and support staff, it also has to do with the rooms and walls, the hallways and even the location of those places where we work, day in and day out, night after night.

I suppose I first realized this love of hospitals, as places worth wandering, when I was in medical school. The old medical school at West Virginia University, was a place of tiles and institutional paint, with less light than newer places.  Situated on a hill-top (like everything else there), the vistas were lovely when one had time to look.  It has since become a perfectly wonderful office building, but it was the place where I did my first clinical rotations in school and it is embedded in my psyche.  It calls up wonder, and excitement and anxiety to think of the blue and grey colors, and recall the feel of steam-heat on snowy days.  Mid-way through my third year, we moved into Ruby Memorial Hospital, bright and cheery, with larger windows and spacious work-areas, it was wonderful.  But my tastes had already been shaped somewhat.

When I first came to South Carolina to work, Oconee Memorial Hospital was barely visible behind a beautiful pine forest.  In fact, it was so heavily forested that the grounds supported a thriving population of deer and turkey, which could often be seen at night when I drove to work.  Occasionally, a bear made it’s home there, only to be removed by the DNR.  (Considering some of the more difficult clientele, I’d have taken the bear in trade in a heartbeat.)

In those first years, before rennovation, it was clear to me that I was a late-comer to an old facility that had seen much.  The hall-ways and patient rooms had the sort of tiles that spoke of earlier times.  And along the hallways, there were photos of the venerable doctors who had built the place over the decades.  Professional and grey-headed, their lined eyes had seen much in those old hallways; life and death, hope and despair. It was in older labor and delivery rooms that my first two children were born; how many children had entered the world there I couldn’t imagine.  And it was in the old ER that I was first baptized by fire after residency, a young physician adding my story to a place that was so much older than me.  I loved walking those halls, to codes, to medical records, to the cafeteria and just because I could; they felt haunted, but not in a frightening way.  (Southerners often see the world as haunted by spirits, by the way.)  Finally, it was there, and in the newer version, that I realized after our fourth and final child, that those would probably be the last very happy visits we would make to any hospital.  Time proved me right on many levels.

I’ve wandered the halls of others. For instance, in St. Vincent’s Hospital, Winchester, IN, there were inspirational words and art-work.  I loved the quiet of that tiny place, night or day, and the way that crucifixes appeared everywhere. For me, it is a great comfort to see that reminder of my sustaining faith interwoven with my profession.

While working at the Memorial Hospital and Medical Center, in Jasper, IN, I loved other things.  The way the cafeteria had a corner with a fireplace, which I did not have time to use, but which spoke of home and comfort.  And there was the way that I worked my first cardiac arrest, an unsuccessful effort, after which there was (on the code-cart) a prayer to be read at the death of the patient.  The room then seemed warmer to me, less hopeless.  A place should have some hope, even in darkness.  It’s the essence of a hospital, it seems.

Weather can also affect a hospital. I’ve worked as the snow falls, and particularly in the smaller facilities, I’ve enjoyed the chance to walk the halls at night as the snow blows past lights outside; landing on statues of saints or merely on cars.  At the Memorial Hospital in Craig, CO, the sky is vast and from the safety of the hospital, and yet another fireplace in a long hallway, I can see the storms move across the mountains, ripe with snow.  That weather makes more poingant the photos of settlers and pioneers that can be found on the walls here and there. A reminder that even a small hospital is a huge advance over the days of old, when brave men and women suffered with little to no care.

I lately came full-circle.  I worked in North Greenville Hospital, two counties over from my home. Essentially a free-standing hospital, it is old.  The rooms small, and oddly arranged.  However, it’s wonderfully snug and functional; and delight of delights, two of the patient rooms are former surgery suites, with the ancient tile walls and floors of my medical school days.  The place has character, and is frequented by characters.  But it’s essential to that little community, and I find it a delight.

I suppose I am what I am. I am ever in love with the idea of place.  I anchor myself to geography and to the layout of the places where I work.  I try my best to remember, from place to place, town to town, where everything is.  I don’t play computer games much, nor do puzzles. But this endless fascination with locale exercises my mind well enough.

And ultimately, it adds my presence, my memory, my ghost if you will, to the many rooms and hallways where I have worked and wandered.  That’s a great gift to a romantic like me.

I hope that you, whereever you are, can find love for the places and buildings your work takes you. Because every place, like every patient, is an endless encyclopedia of stories waiting to be uncovered, or made-up.  Waiting for you to insert yourself.

Alfred Lord Tennyson, in Ulysses, says, ‘I am a part of all that I have met…’  And no place is it more true than in our hospitals.

 

 

 

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