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Hospitals and Cancer Treatment Centers--Stuntz

I’ve spent a fair bit of time around hospitals over the years: two major abdominal surgeries, three lower-back fusions, and more injections and films and tests of various sorts than I can count. The Boston-area hospital I’ve come to know best is Massachusetts General, where my last three surgeries were done.

This past week, I paid my first visit to a cancer treatment center: the Yawkey Center, named for longtime Red Sox owners Tom and Jean Yawkey, whose charitable foundation helped build it. The difference between that center and the hospital that sits next door to it is mind-blowing. Mass General embodies bureaucracy of the coldest sort. Yawkey oozes warmth. The waiting room—where cancer patients sit while waiting to have blood drawn or to see their oncologists—faces one of the best views of Boston I’ve ever seen. You can’t look at that view and avoid smiling. Notice: that smile-inducing vista belongs not to doctors in their offices, but to cancer patients.

It gets better. Sitting in that waiting room, I twice saw a volunteer wheel a cart past my seat, asking whether I wanted something to drink or a snack—no charge. I didn’t, but the offer made me smile more. I felt like a human being, not a number or an item on someone’s checklist. The same was true when I met with my oncologist—actually, it has been true in every conversation I’ve had with anyone at the Center so far. In my experience, most doctors will answer one or two questions, quickly, after which they’re looking for a way to end the conversation and get to the next appointment. (One of the many things I love about my internist, who is nearing retirement, is that he practices medicine the old-fashioned way: he talks with and listens to his patients. Definitely not the norm these days.) My oncologist answers every question my wife and I ask, as though he had nothing else to do that day—which is emphatically not the case. The nurses and assistants do likewise. That kind of behavior lends dignity to the patients who experience it. And for people whose bodies are assaulted by this disease, dignity is in short supply.

Most hospitals are the last places to seek dignity. The physical spaces are, for the most part, ugly and cold (both figuratively and literally: I’m always freezing at Mass General). Some of the doctors and nurses go out of their way to show patients warmth and consideration—and may God bless each and every one of them; the smallest interactions with them are like a drink of cool water in the desert. But for the most part, hospital conversations are tickets being punched, not human beings communicating with one another. The unspoken message goes like this: “There is something I have to do here, and I’m going to do it as quickly as possible. What YOU do or say makes no difference, so you might as well shut up and let me get on with my job.” It isn’t entirely their fault—hospitals are understaffed; the doctors and nurses scurrying around their hallways and operating rooms are overworked. Treating people like people takes time, and the professionals who work in big-city hospitals—they ARE professionals: smart and knowledgeable and relentlessly competent—have far too little of that precious commodity.

Still, however excusable the bottom line may be, it’s deeply wrong. Sick human beings need to know that we’re still human beings. If, as so much medical literature attests, health depends in large measure on attitude, those who work in the health care industry (“industry” is the right word here: hospitals are to the early twenty-first century what factory floors were to the early and mid-twentieth) should think hard about the attitudes they foster. The Yawkey Center may be the exception: the world of cancer treatment is still new to me; I don’t know it well. If it’s the rule, the men and women who dispense that treatment have figured out something very important, something the world of big-city hospitals needs to learn.

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Comments ( 2 )

Your post was very thought-provoking for me. My main experience with hospitals stems from living in Russia for two years. As a volunteer missionary, I spent a lot of time visiting and doing service in hospitals. Without exception, they were horribly depressing places. One Sunday afternoon I learned that two of the children in my congregation had been hit by a car, so I went to the hospital immediately. The conditions were unbelievable. It turns out that Sunday was a day off for the doctors, so the boys were forced to wait until Monday morning to be treated. The staff at the hospital put a few bandages on their heads, but nobody checked for concussions or excessive swelling for more than 24 hours after the accident.  

For the next several days I visited the boys in the hospital every afternoon. One of them vomited in the corner the first night, and the floor was not cleaned for several days. Four days after the accident the hospital staff had still not changed the boys’ pillowcases, which were covered with bloodstains. When the nurses came to give shots to the boys, they did not even address them. To administer the shot, the nurse simply turned the patient over, put the needle in his backside, and hit the needle full force with an open palm. I grimaced each time I witnessed these shots. It almost seemed like a purposeful attempt to make the administration of painkiller medicine as painful as possible.
The meals contained no protein, vegetables, or anything else that would likely give a patient strength—the boys were given only mushy porridge, and not much of that. So my congregation also provided meals for them. One day I gave each of the boys a personal box of juice with lunch—the younger one clasped his without opening it and smiled. He looked at me and said, in Russian, that this was the first box of juice he had ever been given. He did not want to open it because it was so special to him. I am quite sure that I have never been that grateful for any gift I have ever received. I learned a great deal from those boys, who survived the accident (and their hospital experience), though one of them was ever-so-slightly disfigured afterward. They rolled with the punches and were as happy about life after the accident as they were before. But not all of the patients I visited in Russian hospitals came away unscathed—those dark and smelly hospital rooms seemed to rob many of any inclination to smile.As you pointed out in your post, even in the United States the hospitals often leave much to be desired. It really is too bad that increases in medical technology have not translated to higher levels of respect for patient dignity even in some of the best hospitals. But I am very glad to hear what a wonderful experience you are having at Yawkey. The only sad part is that, as you mention, it seems your positive experiences are more the exception than the rule.

Professor Stuntz,

Your experience of hospitals vs cancer centers is the same as mine here in Tucson. My wife recently went through cancer surgery with some horrible experiences with some incompetent staff and nurses who didn't much care at the hospital. The differences with the treatment she has received at our well-endowed cancer center has been mind-blowing. It think Glenn Beck has made the same comments on his radio and TV shows.