YOU ARE HERE: LAT HomeCollections

Bitter Pill for Young Doctors

Residency: Treating the people who slip through society's cracks takes an emotional toll on hospital interns.


VENTURA — Slow and sick, the patients shuffle in.

With friends or grandparents or sisters, or no one at all, they slump into the plastic chairs and wait.

It's a group you can find any afternoon outside the emergency room at Ventura County Medical Center.

On this day about 20 patients squirm on the hard seats, waiting for a triage nurse to sort through their cases--ranking them in order of urgency and arrival, and sending them back to the doctors.

The television drones. Babies cry. Men in dirty clothes slide off slippery chairs.

A 32-year-old mother of six is sitting near the counter. She has no car, no husband and a part-time job. Her sister took the afternoon off from work to drive her here from Oxnard. She has Medi-Cal and she needs her gall bladder removed.

There is 10-month-old Saidy. She has a raging fever and glassy eyes. Her mother speaks English but her father doesn't. She has Medi-Cal, but they don't.

There is a 48-year-old homeless schizophrenic woman struggling to get off the methamphetamines that have kept her strung out for the last year. She wants medical clearance to go to a detox center. She wants to straighten out her life, she says.

These are among the patients waiting for the 13 first-year residents at the medical center.

Day in, day out, the steady stream has taken its toll on the young residents--who arrived fresh to save the world last June.

"The pendulum starts out on one side--very idealistic," says Dr. Lanyard Dial, head of the residency program at the county hospital. "It gets moved during the first year--to the more cynical, more frustrated side. During the second and third year it moves back. But it never moves back to where it started."

Nine months into the program, the residents have grown to love the patients who suffer silently, and hate the patients who want nothing but fuel for a drug habit.

They have grown to love the system that helps the poor and the homeless, and hate the system that cannot care for the sick child of hard-working parents without health insurance.

As they enter the final quarter of their first year, they have encountered contradictory emotions that will plague them for the rest of their professional lives.

The patients have made them more jaded and more tired.

But they have also made them feel compassion and connection.

Ultimately, these patients will make them into doctors.

Getting to Know a Cast of Patients

First-year resident Steve Mills strides down the corridor and pokes his head into a sunny room.

It is here--in the intensive care unit and the telemetry section--that the doctors forge many of the strongest bonds with their patients. It is also here that residents pick up patients to fill their own fledgling family practices over the next three years.

Each will have about 150 patients by the time he or she finishes residency, a patient base that will help the doctors develop relationships over time and teach them to get to know the whole patient--the core philosophy of family medicine.

On this floor the young doctors visit each day, and monitor their patients' medications and mental state. They also learn their character and idiosyncrasies.

"When you're treating patients in the ER, it's like a machine," Mills says. "There's an answer for every symptom. You don't take account of anything--if the patient is stoic or emotional, low income or high, it's all the same. But it's nice to walk into the room, see your patient, and say, 'How are you doing?' "

He walks over to a bed and says hello.

A 59-year-old man with a shock of greasy gray hair smiles as Mills enters. He is thin as a rail, lashed to the hospital bed with strips of gauze, wearing a diaper.

"Do you remember why you are here?" Mills asks.

The patient grins, but doesn't respond.

"You were drinking, every day, for a long time," Mills prompts. "You came into the ER. You had a seizure. You got so sick we had to keep you in the ICU for a week. Do you remember?"

A vacant grin.

"You've been here for five weeks. We're looking for a place for you to live."

The man smiles, and mumbles incoherently.

"I can't get up," he finally says.

"Right. We don't want you to get up. You'll fall and hurt yourself," Mills says.

He has drunk so much, for so long, that his brain is addled and his body wasted. He finally collapsed here, on the hospital's doorstep.

Cynicism and Optimism Coexist

The 7,200 patients who pass through Ventura County Medical Center each year are mostly minority and mostly poor.

About three-quarters are unemployed, on Medi-Cal or uninsured. Nearly one-third speak no English. A growing percentage are the county's working poor--scraping by with nothing to spare.

Although there are no precise figures, doctors estimate that 30% to 40% of all the patients who pass through Ventura County Medical Center each year have drug- or alcohol-related illnesses. About 10% are seriously mentally ill.

They are a group with more than their share of human tragedy.

Los Angeles Times Articles