Doctor shows have always been a popular genre. Hell, Gray’s Anatomy has been on as long as my almost-college-grad has been alive. And people get a sense from these dramas what it’s like to work in a hospital. Sort of.

I’ve heard it said by colleagues that Scrubs is the most realistic medical show, probably because, despite its being a sitcom, it doesn’t flinch from the emotional toll medicine takes on healthcare professionals. Plenty of other shows have been more or less realistic in other ways, but this one, for some reason, hits.

The show ER came out when we were in med school and most of us would take a break from our studies on Thursday evening to watch, enjoying the drama, guessing diagnoses, arguing about what was more or less realistic. Entertaining, sometimes-realistic, but still, just a show.

Some medical shows focus on the soap opera, others on blood and gore, but I think most medical folks who watch The Pitt feel seen. It’s been decades since I did an ER shift, and almost as long since I regularly worked in a hospital and I feel like I know all of those people, all of those scenes. I feel their mistakes, their successes, their sadness, their manic delight in learning.

For me, medical school and residency was, at least in retrospect, fun. OK, not “fun”, that’s inaccurate. It was the most intense, rewarding educational experience of my life. But it’s “not entirely a benign procedure”.

There have been many, many books about medical training, some good, some bad, some both. In the latter category is Samuel Shem’s “House of God”. It is a book of its time (the early 70s)—gross, sexist, inhumane, funny-not-funny. But one thing it did capture was a mood, a deep set of emotions, fears, and a dehumanization of doctors, nurses, and patients that, despite all our progress, is still around us.

So last night my wife and I were watching the Pitt and one of the “frequent fliers” was being treated for his cirrhosis. The docs were draining fluid from his belly, a procedure I did dozens of times. He was a cheerful, kind alcoholic, well-known to everyone in the ED. And of course, things went bad. And I was suddenly a thirty year-old ICU resident in stained scrubs standing next to a middle-aged woman with liver failure, bleeding slowly and unstoppably. Just that fast.

I just went back to my old journals and reminded myself of the episode, as if I needed to. Look, I’m not complaining about being “traumatized” by my training. It was what it was—amazing, horrific, fun, terrifying, sad, exhilarating. Most of all exhausting. But one thing writing does is help process these things, and in medicine, you have to learn from everything you do, good and bad.

Maybe at some point I’ll post the story, I don’t know. Is it really my story to tell? Sure, I’m not violating the privacy of someone who has been dead for decades, but dead or alive, I’m not really sure it’s my place to share her last moments.

One thing I will share though. One night, as a teaching attending, my team admitted someone with gout. My med student did a great job getting a history, documenting her physical exam, and presenting it to the team. It was a nice case for a student—fairly simple but with some nice biochemistry and pathophysiology to read up on.

The next morning, my student got in bright and early to prepare for rounds but when she went to pre-round on our gout lady, she couldn’t find her.

“Did you guys discharge her?” she asked. A reasonable question as gout doesn’t normally buy you a hospital stay.

“I’m sorry but she died last night.”

The student, who’d just began the rotation, looked up at me in disbelief and quietly said, “but she just had gout.”

“No. She was admitted for gout. She was also 84 and had diabetes and heart disease. I’m very sorry.”

I hope that, in a time of unprecedented attacks on public health, people benefit from seeing what we actually do. There is a science and humanity to medicine, inseparable from each other, but like any tools, dependent on who wields them. We need to learn from everything we do, especially the human interactions. And we need to listen.

Because why should anyone believe us if we don’t believe them?

-pal