The Lunch

George Gallardo

Novemeber 17, 2014

This is a story about lunch.

It was a humid July in Wisconsin. Instead of enjoying the wonderful weather, I was on my first acting internship of my 4th year and spent my summer in the dark, windowless ICU. I had been taking care of patients for the first time, writing orders, returning pages, and pretending to be something I was not. It was fun.

I was on a good team. I had known many of the freshly minted interns from medical school and we got along well. Occasionally sit-down rounds would turn into jovial comedy sessions that would last 10-15 minutes. We were doing our best to make it through the month unscathed, and to avoid showing how afraid we all were about our first rotation in the ICU.

There was a small, dark, room in the ICU that belonged to us. We kept our lunches, dirty white coats, bagels, and coffee in that small room. After two weeks, it had developed a comforting stench of stale pizza and alcohol-based hand sanitizer. There was one small window that looked out into the halls of the ICU, but we often kept the blinds closed in a feeble attempt to remove ourselves from our surroundings.  We were happy in that room and were free to be ourselves. Free to joke about patients, complain about the ancillary staff, or pass along other general gossip. That was our safe room, like a bunker in a war zone.

Patients were dying--that’s what they often do in the ICU.  There was one elderly gentleman who had been in the ICU before our team took over. He was not my patient but I was vaguely familiar with his condition: admitted for cardiogenic shock and subsequent renal and hepatic failure. He was intubated as the diuretics were unsuccessful at removing the fluid from his lungs. His body was rejecting life. I didn’t have any useful clinical knowledge but I knew enough that this man was not leaving the ICU alive.

On the third Friday morning of the month, the ICU seemed relaxed; the nurses were chatting, the attendings leisurely drinking coffee and the patients were all fairly stable. I walked by that elderly patient’s room and was surprised to see his family members crowded in the small room uncomfortably examining the ventilators, IV pumps and heart monitors- noticeably disturbed by the orchestra of ventilator alarms. This was the first that I had seen of them. They looked very nice; mostly overweight women in their mid 40s with curly hair who seemed like they would be friendly under different circumstances. I think the family sensed what I had, that his time was coming to an end.

But this is a story about lunch, not death.

We had survived three trying weeks in the ICU and were having fun while doing so. We needed to celebrate. Celebrate the intern’s survival, my growing self-confidence, and the fellow’s success at managing a team. We ordered lunch from the best Thai restaurant in Milwaukee. There was a skip in our step that morning as we waited for the delivery call. Everyone was hustling--furiously scribbling notes and orders to make sure that they would be able to have 30 minutes free at noon. It felt like the last day of elementary school or the first day of spring in Wisconsin. Life was good.  

Lunch came. We were giddy. The smell of curries and roasted duck was enough to earn us leering glares from the nursing staff.  We raided the cafeteria for plates, utensils, napkins, and drinks. Everyone had a task: this was a feast second only to Thanksgiving. We sat around the table, loosened our ties and stripped off our white coats. We were joking, eating, and sharing stories. I had been to this restaurant before, but the food had never tasted like this. It was the taste of success and freedom and realizing that being a doctor wasn’t all seriousness and pain.  

While we enjoyed our feast, I realized the blinds on our small window were open for the first time that month. I briefly stared at the window and wondered what would possess an architect to put a 2x2 window looking from a dark room into a darker hallway. As I pondered this great mystery, I saw one of the women from the dying man’s room walk by.  We made eye contact for an eternal 1/10 of a second. My stomach dropped. I felt sick. She kept walking without missing a step. My mind raced with the possibilities of what she must have been thinking in that split second:

How dare they laugh! How dare they feast on that smelly food! How dare they tell jokes about my dying father! Who the hell are these children!

I felt guilty. I became defensive.

Are we not allowed to eat? Are we not allowed to laugh and feast on wonderful food? Life is for the living! Who are you to judge us?

I stopped eating lunch.

I thought back to when my father was in the hospital for a CABG.  I recall being hypersensitive about my surroundings as we waited anxiously for the surgeon to come out of the OR. The smells of cafeteria food were nauseating. The conversations I overheard were about the most mundane of subjects.  The TV was so loud and commercials had never been so obnoxious. Who gives a damn about fabric softener at a time like this? There are people dying here!

So what is the right answer? What is the right balance? I don’t think there is one. I do know that the responsibility to be aware of how we are being perceived in the hospital rests solely on the physician’s shoulders. There will be no public service announcement to raise awareness for how difficult our jobs are or how tough it is to deal with sadness day in and day out. People want to feel secure; they want to feel like physicians are 100% focused on their care at all times.  It doesn’t matter to them if we are stressed or need to blow off steam when their loved one is critically ill.

The patient died shortly after our lunch party. The family was very grateful for all the efforts of the team and there was no mention about the incident that had made such an impact on me. That experience opened my eyes and reminded me what it felt like to be a patient or the family of a patient.  It’s easy to forget that even though the hospital is a comfortable environment for physicians, it can be scary and uncomfortable for our patients.

This experience helped me to understand why those blinds had been closed for so long, and reinforced for me how emotionally sensitive patients and their families often are during stressful times like hospitalizations. I still love to have fun at work, but I make sure to think about how patients and families will perceive our good times in the hospital.

And I think it’s important to remember that sometimes we deserve a good lunch. And maybe a window with a brighter view.