There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It’s the doctors’ twice-daily bedside perambulation, known to everyone as “rounds.”
Whenever a medical student walks into a patient’s room, it’s an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the “good patient,” the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other’s sake, the two of them will hit it off.
But what is it like to go on rounds? It’s a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient’s responses are omitted — because, among other reasons, he’s tired, talking through a sheet pulled over his head and wishing the Student would go away.)
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? …
I realize it’s a quarter to seven in the morning. I need to ask you a number of questions about how you’re feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I’m a medical student, and I have my own questions to ask you. …
Why can’t we all coordinate the questions we ask? That’s a good question. I wish I knew the answer to that. I’ll get back to you on that one. …
I’m glad you’re answering my questions, sir, but please don’t say that I can “practice” on you. My resident tells me I’m a vital part of the team. …
So, about those bowel movements. Made any? Great! That’s good to hear. What about gas? Urinating? How’s your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I’ll speak to someone about the food here. And, what’s that? Too many people asking questions? Your sense of humor is very healthy, sir. …
Now I’m going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I’m sorry! I know it hurts. I know, but I wanted to see for myself. After I’m done examining you, I’ll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. …
Okay, thanks a lot! Any other questions for me? …
Normal food? I think you’ll be eating normal food by tomorrow, but I’m not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How’s the belly?
(Attending performs a thorough examination of the patient’s abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he’s going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I’ll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
(Tries to go back to sleep.)
END OF ACT II
If you missed the first performance, don’t worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Bergerplays the part of the Medical Student. He’s lost many pen caps on morning rounds while much of the city is still sleeping.