Author: mlassar

Empathy (noun): the action of understanding, being aware of, and vicariously experiencing the feelings, thoughts, and experience of another (Merriam Webster). Empathize (verb), empathically (adverb), empathic (adjective). Four different versions of the same word all trying to tap into a surprisingly complex human emotion. We are taught to empathize from a very young age, from children’s books detailing what people are feeling to at-length discussions in elementary school. Although people are designed to be around others, I believe that empathy can be taught. It is an ever-flowing feeling that can be absorbed, ignored, and expanded. After working in this hospital for the past ten weeks, I have seen every variation and level of empathy, from the nurse that will go above and beyond his duties to ensure a patient gets home safely to the social worker that curses out patients after they leave the office. I have seen residents roll their eyes when the same patient walks in twice in one day and cab drivers that are willing to take patients fifty blocks home for no pay.

I always thought empathy was a given in the healthcare profession, something that innately went along with the job description. It turns out, it is far more complex than that. The first time we actively discussed empathy in this job was when we were given the scary statistic that the moment you enter your third year of medical school, your empathy starts to decline. This both made sense but also changed the way I watched medical professionals interact with patients. I still saw the diagnosis, the procedures, and the tests, but I was watching how they employed their empathy. Were they going through the motions or actually taking the time to understand the patient? And of course, like any difficult questions, the answer was mixed. On days when there were thirty patients and only two doctors, the team had to move like a machine; there physically was not enough time to sit and hear the complete story of the patient. And there were times when physicians would see and internalize the pain a patient was feeling, trying their hardest to alleviate this suffering through both care and treatment. But the hardest part about all of these interactions is that I began to feel myself experience the same see-sawing of emotions.

I went into the summer as a naïve, hopeful, and optimistic volunteer. I could not see the faults of patients, only how the healthcare system was harming the well-being of those it served. I could not see the never-ending demands of this job or the ways in which healthcare providers worked to maintain some level of sanity. I could see pain, suffering, and a lack of caring, all of which I vowed to alleviate in some capacity. And for some patients, I hope I did just this. Being the wide-eyed volunteer allowed me to sit with patients for hours on end, trying to absorb some of their pain. It gave me the ability to listen to their stories and give them the attention they so rarely received. But it also started to change how I view healthcare.

Although I have only been working at this hospital for two months, I already feel myself burning out. Empathizing is tiring. It forces you to feel things, good and bad, but it also drains you out. I came in with endless enthusiasm, empathy, and patience, but then began to realize that this was not a sustainable lifestyle. If I went into every interaction, exam, and procedure with the same level of empathy as before, I would burn out to no end. But where is the line? Where is the balance between understanding patients and taking care of yourself? How can healthcare providers protect their empathy while maintaining efficiency? Is our healthcare system even set up to answer these questions? These are the things that I have been thinking about from the moment I first saw a physician get angry with a patient, or when no one would explain what was happening to the trauma victim.

Working in a public hospital is by no means an easy feat; rather, it pushes you to the edge of your sanity and caring. Understanding that this is all a balancing an act–an immense game of juggling emotions, feelings, and treatment–has been my biggest takeaway from this entire summer. Knowing that I too will inevitably feel some level of burnout in my time in the healthcare profession is scary yet empowering, because I am ready for what is to come. I am ready to push myself to feel and control when I can no longer do so. I am ready to throw myself into situations with the same level of zest I have done this summer. And most importantly, I am ready to take what I have learned and carry it with me for the rest of my life.

Did you know that Medicare has parts A to L, each with a different purpose? Did you know that despite being a public hospital, Bellevue still sends a bill to each of its patients? Did you know that 30 million people in this country do not have health insurance? Do you know what the differences are between an HMO, PPO, PSO, and EPO? There is no denying that the US healthcare system is one the of least accessible systems in our country, yet it is still objectively one of the most important. It has been a hot topic in political debates and the news, but I would argue that very few people fully understand these discussions. I am one of the few lucky people to understand the different numbers and acronyms on my health insurance card, but I am by no means an expert. Even my beginner level of proficiency took a college-level class to impart this knowledge, one that is rarely accessible to most of the population.

In all honesty, the woman living in a shelter who was bounced from hospital to hospital needs to know this information more than I do. The man who decided to leave AMA (against medical advice) because he did not want to pay for his care needs to know this more than I do. The elderly gentleman who needs an assisted living home but does not have insurance needs to know this more than I do. I am not discounting the importance of my education, as I think that everyone who wants to go into the healthcare industry needs to know how our healthcare system works.

What about the millions of people who use our healthcare system daily? They have more than just a right to know; they have a right to be educated. I think that health care professionals need to capitalize on their role as educators rather than just providers–teaching patients both when to take their medicine, but also what a co-pay means and how much they are going to get billed for their visit. In reality, however, most physicians know little more than the patients when it comes to our healthcare system. It is seemingly impossible to wade through the layers and layers of bureaucracy, the mountains of paperwork, and the thousands of exceptions to truly understand this system.

How are we supposed to give our healthcare system the facelift it so desperately needs when there is no clear answer? We are stuck in this ever-draining and difficult system of insurance, administration, and government battles all speckled with inefficiencies. Doctors can still treat the patient with high quality medical care and comfort, but the healthcare system and hospital are not set up in a way to benefit the patient.

Watching how the hospital system functions has been one of the hardest things to comprehend this summer, as it does not seem to have the patient’s best interests in mind. I am not discounting the amazing work all of the healthcare providers perform, as the individuals clearly want the best for their patients. In fact, I have met some of the most passionate and empathetic people in this job, and they are the reason I can keep returning to work. But how can I just sit in this hospital and deliver clothes to the man I know I will see shirtless the next day? And when a patient walks in with an infection contracted from their homeless shelter, why is discharging them to same shelter all that the physicians can do?

When I reflect on my experience (which I do a lot), it is not the mysterious sickness or intense trauma that stands out to me; it is the never-ending cycle of abuse from the patients to the hospital and back again. In all honesty, many of these patients know how to work the system. They know what to say to the doctor, they know the rules to qualify for a detox bed, and they know how to ask for the social worker. If this is all the hospital can do for them, they might as well make it part of their routine.

Having been there for over a month now means that I am officially part of their routine, both good and bad.  Providing someone with their first hot meal in three days is one of the better moments, even if I know I will see them next week. Treating a patient with benzos (medicine for alcoholism/withdrawal) only to see them intoxicated the next day is one of the worse moments. Our healthcare system is so focused on the short-term it is impossible to see through the presenting symptoms and try to fix the problem at hand.  Who is going to spend the time to implement more stable housing initiatives through the hospital when it is so much easier to continue as is?

Again, I do not blame any individual for the way this hospital or this healthcare system is run; it has been built upon years and years of complicated policies and bureaucratic nonsense. But watching how it trickles down all the way to the patients is beyond painful. I am at a point in this internship where I am unsure if I could ever work in a hospital. I am at a point where I feel myself becoming numb to these issues, and that scares me more than anything. At this point, all I can do is continue asking questions, criticizing our systems, and craving answers. You have given me the ammunition to push myself into this system with a critical eye and an open heart, and for that, Bellevue, I thank you.

As I walk the seven blocks to the hospital each morning, I pass the same faces time and time again: the Vietnam veteran sitting under an awning of subway station asking for money and prayers, the man sleeping on a box across from the hospital, and the double amputee bumming cigarettes while holding all of his belongings in a single black duffle bag. Consistency is a foreign topic when it comes to emergency medicine, and these faces have become the only thing I can expect to see on my way to work. Although this is hard to admit, my interactions with these people involve nothing more than averted eye contact and a quick side-step, followed by my own anger for this instinctive reaction. I have been conditioned by society to ignore and even fear these people. But the moment they step into the hospital, everything changes.

Bellevue Hospital is the oldest public hospital in the United States, steeped in history and medicine. It was the first hospital to treat tuberculosis, open a psych ward, and in recent news, take care of an Ebola patient. With over 100,000 ER visits and 460,000 outpatient visits each year, this hospital sees all sides of New York–the good, the bad, and the ugly. But arguably one of the most impressive things about this hospital are the patients: 80% of the patients in Bellevue are from medically underserved communities, and 25% of the patients are either currently experiencing homelessness or have experienced homelessness in the past twelve months. This hospital treats everyone who walks in their door with the same quality of care from the woman sleeping in a shelter to a visiting diplomat.

Homelessness is truly an invisible epidemic, one that Bellevue works so hard to treat with every IV placed or meal provided. Patients have come to rely on this hospital for primary care, a roof to get out of the rain, or just a familiar face. Bellevue has garnered the reputation around the city as the hospital with all of the crazy people, but what people forget are the hordes of healthcare professionals, social workers, and administrators who are dedicated to providing a level of care no other hospital does. Despite this mission, the emergency department is not immune to societal stigmas and assumptions about the “frequent flyer” experiencing homelessness who comes to the ED (Emergency Department) three times a week for a hot meal. Regardless, these are the patients who I will never forget.

As a volunteer and patient advocate in the Emergency Department, I won’t bore you with the details of the grunt work I perform, but my main role is to speak with patients, listen to their stories, and ensure that they receive the care they deserve. What this means is that I blindly approach patients with a smile and hope that they are not in too much pain to speak with me. I have been used as a punching bag (figuratively), a shoulder to cry on, and a confidant. In fact, as I am writing this blog post, a patient whom I have seen in the ED three times over the past two weeks just walked by the window of the café I am in! But it is these interactions that have changed how I view homelessness.

Remember the Vietnam veteran outside the subway? Well, the moment that he steps into the hospital, he is no longer just a face, he is a story. He is the man I spent three hours with trying to navigate our healthcare system, find the only pharmacy in all of NYC that can fill his prescriptions, and help him obtain a metro card. He is the man who tells me about his travels when he was my age and his first love. He is the man who tells me he would rather be sleeping in a park right now than in this hospital any longer. He is the man who I know I will see again both in and out of the hospital. But in the moment, he is the man to whom I can provide a smile, a conversation, and small moment of clarity in this crazy, complex system.

The intersection between homelessness and emergency medicine is a never-ending cycle that bounces people between the street, the hospital, the shelter and back again. It is well understood that one’s health is dictated by more than just access to healthcare. Ideally, providing someone with stable housing will improve overall quality of life, decrease health costs, and break this cycle. Although this is well understood within the healthcare industry, it is much harder to carry out than providing basic healthcare. Bellevue is working alongside different hospitals and organizations to address this epidemic through housing-first initiatives, which work to find stable housing for patients alongside treating their major health concerns. Working within Bellevue has shown me the impacts of homelessness far beyond the street. I am slowly beginning to understand the system, and hopefully my small contribution to this organization will be just enough to bring joy to one person’s day.