Relationships: The Front Line of Health Care0

Chaos is the score upon which reality is written.”

– Henry Miller, American novelist and painter

This article first appeared on the PBS affiliated Website This Emotional Life.

As the Chief Executive Officer of a community hospital in the Los Angeles area, I am a big fan of the television drama “House.”  While it may on occasion stretch the boundaries of medical plausibility, it does an excellent job depicting the often tenuous relationship between doctors, nurses, administrators and patients in a hospital setting.  For seven seasons – nearly as long as I have held my current position – I have been a faithful viewer, but tonight I find myself in unfamiliar territory for a number of reasons.  First, there are zombies in this episode, which strikes me as odd for a show based in reality.  Second, there is an infant in my house, screaming as newborns tend to do.  Finally, there are two plates of fish at the table, and I am eating alone.

Working in a hospital, I have come to accept the fact that very few things surprise me anymore, as the unexpected and strange have long since replaced the usual and customary.  At any given day on the job I might observe the miracle of birth or the tragedy of life cut short, and on occasion even the phenomenon of life brought back from the brink. But regardless of whether art imitates life, work supplants home, or zombies magically appear in a medical TV drama, one thing remains constant – it quickly becomes clear to those involved in any emergency that the likelihood of survival rests on the stability of the relationships that are formed in the environment at hand.

As the onscreen events transition from the macabre to the surreal and the baby heads to his first bath ever, I sit eating my salmon while a small Pekingese dog stands on his hind legs, desperately begging for food.  I think of my young son, dependent on my wife to keep him clean.  I think of the dog, dependent on me to keep him fed. I think of patients dependent on House to keep them alive and House dependent on Dr. Lisa Cuddy et al. to keep him employed. And through it all I remember something else important – I really hate fish.

In every aspect of life, people are only as strong as the relationships they forge, be it to one another or their environment. Hospitals are a great place to see this phenomenon at work, as the continuous presence of the unknown that lurks around each corner has a way of setting into motion a series of events almost unimaginable by most people’s daily standards.  When a patient walks, runs, or is wheeled in through those emergency department doors, he or she forms an immediate and often profound bond with every hospital employee encountered. Depending on the reason for the patient’s visit, the impact of these relationships may last a lifetime, or save a life.

In such a high-pressure, highly skilled environment, hospitals depend on the various links between their members to achieve results.  In order to function at their peak, hospitals must rely on a tightly woven set of relationships between doctors, nurses, technicians and administrators, each of whom at times must take the lead.  Though seldom seen by patients, such an ebb and flow is instrumental to allowing a medical facility to address the many issues involved in emergency care.  While doctors, of course, often take the point position when it comes to diagnosis and treatment, such responsibilities for carrying out round-the-clock care fall to the nursing staff for much of a patient’s stay.  Technicians play an equally important role through their ability to assist physicians by providing them with accurate, up to the minute reports on a given patient’s health.

Although patient care is of utmost importance in any medical facility, hospitals are also in business.  Providing quality medical attention costs money, and without a system of checks and balances hospitals would soon have to close their doors, depriving their community of health care in times of need.  This is where the administrators come in, as they must see to it that patients get the treatment they require without an overabundance of unnecessary tests or procedures that might drain the hospital’s coffers.  A critical part to efficient health care in today’s society is effective communication between all parties involved.

The ways in which a group of individuals with varying skills and responsibilities can maneuver through chaos define the modern hospital. Time and time again, success comes down to the relationships that these professionals, both clinical and non-clinical, have forged, sometimes over a period of years, and sometimes in the blink of an eye or an all important heartbeat. Every case is different, and a challenge in its own right, which is what makes health care so gratifying in the long run.

Like anything in life, relationships can change, revealing previously untapped perspectives. Although I have overseen such processes for nearly nine years, just a few weeks ago I found myself on the other side of the health care equation. Early one morning my wife and I passed through the emergency department doors at St. John’s Health Center in Santa Monica, preparing to give birth to our first child. That hospital has over 1,260 employees overseeing 14,000 plus inpatients and 150,000 emergency department or other outpatient visits each year.  But even with such dramatic turnover, I found myself forging a relationship with each and every person with whom I interacted, from the car to the third floor labor and delivery wing.  Make no mistake, in this hospital I knew I was not in charge.  Like a good patient I did exactly as I was told, and before I knew it I was wearing surgical scrubs in an operating room behind a makeshift curtain next to my wife as we welcomed our son into this world.  For the next few days, a new set of bonds was to develop between mother and son, father and son, and new parent to new parent. These roles were formed against the backdrop of new relationships with each and every individual who blessed us with their kindness, compassion, smiles and advice.

When it comes down to it, relationships are the only real defense health care has in response to its inherent chaos. At the moment the unexpected becomes manageable, when potential crisis turns to calm, that is when I recognize my gratitude for each and every bond that affects me, be it at work or at home.  Of course, it is much easier to make this statement from a child’s room that is now quiet than in the midst of an emergency department when addressing an incoming trauma. Chances are that I haven’t heard the last of an infant crying between now and morning, though I take comfort in the fact that the new and wonderful relationships developing within my house will eventually lead to something long lasting, powerful, and full of reward for all those involved. There may not be much sleep in my future, but at least tomorrow there won’t be any salmon, either.

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