Transcript

149:

Bedside Diplomacy
Transcript

Originally aired 01.14.2000

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Full audio: http://tal.fm/149

Prologue.

Ira Glass

Robert had a friend whose mother was a feared and powerful judge in New York City. And at some point, she got sick and had to go into the hospital.

Robert Lipsyte

Surrounded by doctors kind of shuttling in at a teaching hospital, this old lady kind of looks up from her pillow and she says, do you know the sweetest words in the English language? Not being English majors, all these doctors kind of shook their heads. And she said the sweetest words are "don't be afraid, I'm a doctor." And after that, there was nothing that she couldn't get in that hospital.

Ira Glass

How smart.

Robert Lipsyte

Yeah, how smart.

Ira Glass

In the hospital, we give up our normal schedule and sleep patterns. We give up our normal food and clothing. We're in a place that has its own rules and its own language and its own customs. We're not exactly helpless, but often we're not far from it. And in the midst of all this, there is this delicate human interaction which we have to negotiate. And it's one on which our lives, our actual lives, can depend.

We have to deal with doctors and nurses, and all sorts of other staff. We have to get what we need from them, in a situation where they have all the power and knowledge, and they may not be as concerned with our care as we are ourselves. Robert Lipsyte wrote all about this in his book, In the Country of Illness. When he got chemotherapy, he says, it meant dealing with a lot of different people in the hospital.

Robert Lipsyte

People who check you in, people who weighed you, took your blood pressure, gave you a finger stick because there would have to be a little blood test. And there would be these little interactions with all the people, which always seemed really important. They could hurt you, more or less, depending on the mood. Certainly, they could keep you waiting long or less. And it was almost kind of a ritualistic dance to see how you would really deal with them.

Some liked to be joked with, some didn't. Anatole Broyard wrote wonderfully about the need to seduce your doctor, to make medical personnel interested in you.

Ira Glass

In the hospital, we're reduced to the tactics that people have always used throughout human history when they have no power. We yell and scream, hoping that they'll give us what we want, just to shut us up if nothing else. Or we act like supplicants, beggars before the medici, all sweetness and goodwill. Well, today on our program, diplomacy does not just happen at Camp David and in Geneva and at the UN. Some of the most delicate and charged diplomatic negotiations happen every day over matters of life and death at your local neighborhood hospital, as patients try to get what they want, and staff tries to do what they think is best.

Act One of our program today, Is That Your Final Answer?, the story of a family in a hospital and why dressing well might get you better medical care.

Act Two, The Other Nursing Staff, in which reporter Nancy Updike answers this question, do Rosie O'Donnell and Jerry Springer have healing powers?

Act Three, Fire and Ice Cream, a 14-year-old boy tries to figure out what it means when his nurse asks him out for dessert.

Act Four, Looking for Love in all the Wrong Places, the story of what happens when a patient violates one of the most basic rules of what to do in a hospital over and over again, and survives, for a while anyway. Stay with us.

Act One. Is That Your Final Answer?

Ira Glass

Act One, Is That Your Final Answer? When Terry Shine's father was in hospital, bleeding in his brain, Terry and his four brothers rushed into action. Of course, as anybody who's ever been in this kind of situation knows, action mostly just means sitting around the hospital room trying to figure out what might possibly help things, which is made all the more difficult by the fact that figuring out what might help first requires learning the language and customs of the average American hospital, which Terry Shine's family diligently tried to do.

Terry Shine

Nothing's changed. He just lies there. Everything's changed. No one goes to work. No one goes to the store. No one makes any plans other than to be at our father's bedside. We've become hospital rats. By day two, we know where the best soda machine is. It has Fresca. By day three, we're no longer using the pay phone, but making free calls from deep inside nursing station B2. By day four, we know who the good nurses are.

They're so much smarter here in ICU. In the bed, here comes that bitch. By day five, Bill somehow knows what kind of car every doctor drives. The neurosurgeon has an STS Cadillac Seville. The cardiologist, the classic Corvette, The internist, the GMC Yukon. But I think it's his wife's, Bill says. He's got an eye for that kind of thing.

By day six, we know the orderly's hobbies. Gerard flies those radio-controlled airplanes, the big ones. But we know no more about my father's condition. After the surgery, it was all about the swelling going down. The brain has been through two surgeries within a week, the doctor said. Once the swelling goes down, we'll see where we're at. Well, the swelling must have gone down by now, but we don't see a thing.

Bill has been personalizing the room, bringing in photos and hanging up an article from a Valley Stream, New York newspaper that recently chronicled my father's feats during World War II. There's a photo of 24-year-old Daniel Lawrence Shine in a cool, fur-colored bomber jacket. Bill has marked details in the story with a yellow highlighter.

I want the photos by his headboard so the army of medical workers taking blood every hour and constantly needling him for tests can see he's not just a gown and limbs. He's a person who stood next to a Christmas tree two weeks ago in a Pebble Beach golf sweater with grandchildren wrapped around his legs. But my brothers think the pictures should be on the far wall, in his line of sight, so they will be immediately visible when he becomes coherent. They win.

We've had a breakdown in communication with hospital personnel this past week. And I believe I've nailed down the reason. It's fashion. That's what it's come to now. Something tells me that the nurses will start giving us respect. The doctors will start returning our calls. The lady in the gift shop will stop following us to see what we're doing behind that rack of Beanie Babies. All this will happen if we step up our appearance.

We're a motley crew, and the shorts and Pete's Wicked Ale T-shirts, and Danny always wearing that stupid Fanny pack with his sweat pants are not helping. We've been dressing like emergency room people. The family of citizens who have cut their hands at barbecues or get in freak car accidents on the way home from the beach and have to show up in flip-flops and half-shirts, these poor people are caught with their pants down, but we have no excuse. We have days and days to plan our wardrobe.

We have to start dressing like intensive care people, I tell my wife. I'm certain that the doctors and the nurses will be much more attentive of my father's needs if we only put a little more effort into our appearance. I can hear a nurse now. I know, I just checked on Mr. Shine, but I'm going to check on him again. Those boys of his are so well-groomed

So today, I am meticulously laying out my best clothes, running my thumb and forefinger along the sharp creases in my trousers, spray starching my withered collars. Maybe we should get a second opinion, Bill said yesterday, questioning the diagnosis so far. We haven't got a first opinion yet, I told him. Nobody's talking to us anymore. Peter has a million questions about the blood thinner, Coumadin. He's adamant that the doctor should never have prescribed it for my father's heart condition to begin with. From what he's heard, it could have been the cause of the excessive bleeding.

I looked it up on the computer, and you can't eat salad when you're on it, he says. What kind of medication doesn't allow you to eat salad? Dad loved salad, I say. I want some answers, he says. One doctor up here told me he would never prescribe it for his heart patients. He says something as simple as stopping short in your car can cause bleeding in the brain when you're on that stuff. Someone has to give us some answers.

But we keep getting passed up and down the chain of command. No one explained the fact that one doctor becomes the primary on the case and coordinates all procedures until after we call half a dozen of the doctors listed on his charts. Not that any of them called us back to tell us that. We had to hear it from a college kid in the snack bar who was recuperating from a street hockey accident. The primary, he said, that's the guy you've got to get to.

Once he put us on the right trail, the nurse told us that we had to talk to our father's cardiologist. But it's his brain that-- He's the primary, she said. But the cardiologist has yet to return our phone calls. Not that we're sitting by the phone anyway. When I get to his room, the nurse tells me the doctor was just in. Which one? I ask. Oh, I haven't seen him before, she says. This is how it works. No matter when you're in the room, the doctor has just been there.

We decide the one thing that would probably make us feel better on a day like this would be if we stop respecting doctors. We won't call them doctor anymore. We'll leave off the title and only call them by their last names, I say. They hate that. As the day drags on, we reach a point where not calling doctors doctor doesn't seem extreme enough. We should start calling them by their first name. That'll get 'em, Bill says. But how are we going to find out their first names? Well, Bill says, we'll just call them all Jim.

The physician who's been the primary case, the one who's supposed to coordinate all the others and keep the family up to date, finally phones us to tell me he's putting another doctor in charge of my father because, well, I'm not as knowledgeable about the neurological stuff, he says. He schedules a meeting for this evening. You'll meet Dr. Bozeki in the conference room near the ICU, he says. She'll take care of everything from here on out. I wonder what her first name is.

The conference room turns out to be the nurses' break room, and they're just getting ready to have a platter of neatly rolled cold cuts and cake for a staffer's birthday. All this for us? Danny says. Dr. Bozeki, who looks like an actress playing a doctor, very ER, can't be more than 27, but she still has the power to get her party moved down the hall with a mere "please move it." She asks us to stand around the garbage can by the phone because my brother Pete in New York is being patched in on the speaker phone.

"Hello," Pete says. The doctor starts talking quickly. I don't know your father. I saw some pictures in there. War hero, whatever. But anyway, you have to start thinking about his quality of life from this point on. "Did your father ever talk about death with any of you? Did the subject come up in conversation," she says. Each of the questions is landing with a thud, like mangoes from a tree.

We are not yet aware that this subject will come up in every conversation we have from this point on, but right now it seems to soon. We were in shock. "You still there, Peter," the doctor asks. Peter's still there. All our days till now have been spend waiting for the swelling to go down so we'll have him back. We know he's still in there. We've seen glimpses of the real him in a squeeze of a hand, a hint of expression, a fleeting moment of eye contact.

The nurses aren't seeing those things, Dr. Bozeki says. A couple of nurses boisterously fling open the door and then go speechless as they gaze upon us all standing around the garbage can talking about death. The party moved, I say. Anyway, the doctor continues, it's time for you to decide this. If your father's heart stops, do we restart it? The consensus of all us doctors is not to. Our consensus is to.

The doctor also has one of my father's nurses, a good one, on hand for support. And she asks her to step forward. You shouldn't restart it, the nurse says. She steps backward. We don't know what to say. Up until now, the biggest decision most of us have made in our lives is whether to buy or lease. Our minds are reeling. How much recovery time is a person allowed? I ask. It depends, she answers. Would not restarting his heart include withholding sustenance and water? Bill says.

Has your father talked to you about this? Bozeki asks pointedly. Bill says yeah but doesn't give her any more detail. He wants to know more about how much progress they actually think my father could make. Would he be able to watch TV? Yes. There's more to life than watching TV, the doctor says. We all look at one another. It is times like this when I know my brothers and I are truly related. God, I wish I had a sister.

So you're saying he'll be able to watch TV, Danny says. The doctor sees she's getting nowhere, tells us to sleep on it and quickly exits, probably in a hurry to get to the party. Peter, are you still there? the nurse asks. Peter's still there. OK, we're going to hang up on you now, the nurse says. OK, Peter says.

His legs are kicking and his arms are flailing, and this is no seizure. After the doomsday talk from Bozeki, while the rest of us were whining, Bill has spent hours with Dad, barking directly into his ear, telling him he had to put on a show or the doctors were going to give up on him. And something must have clicked, because today he's dancing. We brought in some of his CDs. Louis and Ella are on the boombox, and his toe is tapping.

[MUSIC - "A FINE ROMANCE" BY ELLA FITZGERALD AND LOUIS ARMSTRONG]

We are impressed, but the nurses aren't. They look at us like, yeah, that's OK if you want someone who's just going to tap his toe for the rest of his life. They want to see more than instinctive movement and the following of commands. They want to see communication. Dad, can you respond to a question by holding up one finger for yes and two for no? Bill says. Nothing. But we keep working, trying different things. I tickle his feet, but Danny scolds me. You don't tickle a man's feet when he's in this condition. New family rule. We're to do everything in our power to bring him back around, but we draw the line at tickling.

Our brother, Pete, bursts into the room. There's no door to swing open or even a curtain to throw aside, but he always oozes adrenalin and his stocky Beretta build pushes you aside. He's come directly from the airport and he's desperately charged up. Dad, it's me, Pete. Nod if you can hear me. He nods. We jump in the air. How could we not think of the nod? How come you didn't think of the nod? I punch Danny. Why do we have to fly a guy in from New York to come up with the nod? Shouldn't the doctors have thought of the nod? Danny says.

Believe me, we're not high-five people, but we're high-fiving. For me, it's a first. You're not good at it, Danny says. I've got a copy of the living will in my pocket, but there's no need for it now. If they want to know if he wants his heart restarted, they can ask him. We've got his attention. If anyone can pull through this, you can, Dad, Bill says. We run into the hallway and drag a nurse in. Ask him a question, Peter demands. She asks, he nods yes. He shakes no.

So what are you going to tell the doctors if they ask you if he's able to communicate? Peter corners her. What are you going to say? She nods yes. Yes, victory. We have communication. We have confirmation. We have progress. We're progress in motion. We've got all four corners of his bed covered. We don't know how long this window of coherency is going to last, so we're frantically asking yes and no questions and manipulating his arms and legs.

He's shuffling his legs around like he's restless and he wants to get up and walk. I take my hands and apply pressure to the soles of his feet, and he starts pumping his legs. His knees are up and he's wildly peddling against my hands. Yeah, this is OK, if you want someone who's just going to ride a bike around for the rest of his life, I howl. I ask him for the thumbs up, he delivers. Applause breaks out.

The nurse catches the erect thumb out of the corner of her eye and gives us a sort of pitiful grin. Yeah, that's OK, if you want someone who's just going to give you the thumbs up for the rest of his life. She's the rain pouring through our open window, but we're not going to let her bring it all down. Our blue eyes are clear. I love you, Dad, Pete says. I can't believe we didn't think of the nod, Danny says.

We're coming from opposite ends of the hospital parking lot. We've got newspapers tucked under our arms. We both have big plans today. I'm going to turn that corner of the hospital room and Dad's going to be feeling good enough to sit up, and I'm going to read him current events. The prime is down and John Glenn's going up. Bill has bigger plans. I brought his reading glasses, he says, so he can read the paper himself.

We're only a couple of days away from the thumbs up, but he's a million miles away. There'll be no reaching him today. For the first time, I not only feel sorry for my father, but I feel sorry for us. We are standing on opposite sides of the bed, our papers in hand, and we do look pitiful. It's just what the nurses had been saying. My father lying there motionless, us incessantly, relentlessly trying to get a rise, a trick out of him like he's a show pony. Maybe all he needs is some peace.

I wonder if our one great day with Louis and Ella wasn't quite the glorious lift toward the plateau we'd been hoping for, but more of a gift, a chance for us to openly profess our love and for him to give us the nod of acceptance. You know, when he was responding with hand signals and whatnot, I had asked Bozeki if we could hold up the living will and ask him for a yes or no. She said, absolutely not.

I scoffed at her at the time, but I realize now how any man at this point, lying there clamped down like a trapped animal with burning medicine chasing the pain through his veins, any man in that condition is going to want desperately to fight to the end. Just as they say the soul is the last thing to leave the body, mental confidence must be the first thing to flee in a situation such as this, not only for him, but for all of us, I'm afraid.

We're like a crazed animal. At this point, the only thing his body has left to offer is instinct and insanity. And it's become so hard to trust our judgment, because I wonder if we are not on the same course.

The pulmonary doctor, a young guy who looks sort of like a QVC fitness guru, charges in and gives us a little pep talk, tells us to keep it up. Don't worry about what the nurses think. He responds to you guys. You've got to keep working it, he says. He's fiddling with the end of his stethoscope, as if any second he's going to put it to his lips, blow it like a whistle, and my father's going to shoot out of the starting blocks.

Before you know it, he'll be ready for aggressive rehab, he says. Just keep it up, up, up. You're making a difference. As soon as he leaves the room, Bill says, Mitsubishi 3000GT, black. I mentioned to one of the nurses that we really like that doctor. And she explains to me in her own convoluted way that the personable doctors are the bad doctors. And the ones with no personality are the ones you'd actually want operating on you. Well, in that case, I think we've got some of the best in the business.

Ira Glass

Terry Shine. This is an excerpt from his book, Fathers Aren't Supposed to Die.

[MUSIC - "TOMMY GETS HIS TONSILS OUT" BY THE REPLACEMENTS]

Act Two. The Other Nursing Staff.

Ira Glass

Act Two, The Other Nursing Staff. It seemed to us that no radio program about caregivers in a hospital could be complete without a few words about the caregiver that is the most omnipresent, in every room, 24/7, in the waiting rooms, at the nurses station a lot of times. I'm talking, of course, about television. To investigate its power in a medical facility, reporter Nancy Updike went to the most television-friendly hospital imaginable, the one that actual television stars go to when they get sick, Cedar Sinai in Los Angeles.

After staying at Cedar Sinai and seeing the quality of what was on the tube there, Milton Berle and Johnny Carson both donated old shows of theirs to broadcast in-house. Here's Nancy's report.

Nancy Updike

This is how a lot of people feel about watching television in the hospital.

Jay Mason

I should be a much better person and I should've tried to improve my mind while I'm here, but I just don't have the patience for it. So I slip into the degradation of this crap television.

Leshaun Smith

I would like to think that I'm the kind of person that could just turn it off and that it wouldn't affect me.

Nancy Updike

Do you know this is what alcoholics say?

Leshaun Smith

[LAUGHTER]

Nancy Updike

Oh, I could quit any time.

Leshaun Smith

But when I think about it, if I couldn't watch TV, I'm not, you know-- I don't know, I think that maybe I would go a little nuts.

Nancy Updike

These are two of the patients I talked to at Cedar Sinai. The guy is Jay Mason, a 74-year-old with a nasty scar running from just under his adam's apple all the way down his chest. He's had a lot of heart surgery. The woman is LeShaun Smith, who's been lying in the same uncomfortable position for almost a month. She's 31 and having her first baby, and she has to stay in bed with her whole body angled head downwards so that her water doesn't break too soon. She'll stay in that position until the baby's born. She has three months to go.

And to begin our discussion, let's start here, in this very hospital. So OK, even if you've never actually been a patient in a hospital, you kind of already know what it's like, right?

Jay Mason

There is no such thing as privacy.

Leshaun Smith

You know, people going in and out of your room, looking at you and peeking at you, wondering what's wrong with you.

Jay Mason

Taking your temperature, taking blood.

Leshaun Smith

They wake me up early to do vital signs and stuff, and I try to go back to sleep. I mean, we're talking, like, 5:30.

Jay Mason

The day goes very, very, very laboriously.

Leshaun Smith

You know, having people to have to do everything for you, and not being able to do things for yourself.

Jay Mason

You know, you live for the day you get outta here.

Nancy Updike

So let's summarize. You're sick, you're lonely, but also completely without privacy. You're exhausted, helpless, and you are so, so, so bored. The culture of the hospital is divided into one group of people that is rushing around from the moment they walk in the door in the morning until the second they leave at night, and another group that is just languishing, numb. And you and I are probably going to be in that second group, right?

So we comfort ourselves. And we're not too choosy about how.

Leshaun Smith

7:00 in the morning, watch the news. Then I watch Sally Jesse.

Tv Announcer

One night stands become booty-calls, next Ricky.

Jay Mason

I just watch crap here. And like anything, a cooking show, a--

Leshaun Smith

Steve Harvey, Moesha, The Parkers, Malcolm & Eddie. I love seeing black people on televisions. Channel 2, Young and the Restless. And then Channel 7, All My Children. Then Channel 4, Days of Our Lives.

Tv Personality

So you're just as bad as Sasha here. you slept with your best friend's man.

Nancy Updike

It's almost as provocative in America to say that television has therapeutic value as it is to say that smoking pot does. We associate both with wayward teenagers, wasting their lives and rotting their brains, engaging in insidious activities like hanging out and chilling. But TV is so important to the patients at Cedar Sinai that the woman who runs the video department there has been paged at home, on weekends and at night, by irate patients complaining about missing a ballgame or a movie because of some technical problem or programming change.

One patient I talked to had even been so desperate to amuse herself that she hunkered down one day and became the world's leading expert on--

Woman

Weekend at Bernie's. I think I must have saw it, like, four times on Saturday, because I couldn't find anything else on there that I wanted to watch.

Nancy Updike

Talk about making lemonade from lemons. What is this except the mind tenderly saying to the body, listen, don't you worry about me for a while, I'll take care of myself, you just focus on getting better? This is the life-changing lesson hospitals have to offer-- TV is good for you.

Man

This is unbelievable. Can you imagine people before used to lay in hospital beds for days and weeks on end, and just stared at this wall, and sometimes turned their head sideways and looked at that wall? That's horrendous. But my god, you've got to-- you know, you can turn loose a little bit of fantasy. And if it's junk, what the hell's the difference? It's junk, so who cares? At least it's killing time.

Nancy Updike

I guess I'm sort of arguing that, in that sense, it's not junk.

Man

Well, I think that you're right. In that sense, it is not junk. It fills my lonely hours and kind of gets me through the day. And that's a good thing.

Nancy Updike

Outside the hospital, people call TV crap, because it's an anesthetic. Watching hours and hours of TV makes us feel spoiled, self-indulgent, numb. But so what? I mean, think about it. Novocaine and morphine make you feel numb, too, and no one's calling them crap.

Ira Glass

Nancy Updike in Los Angeles. Coming up, an argument that Medicare payments should cover trips to pick up Ben and Jerry's, and somebody who actually liked staying in the hospital, liked it so much that it got her in trouble. That's all in a minute, from Public Radio International, when our program continues.

Act Three. Fire And Ice Cream.

Ira Glass

It's This American Life. I'm Ira Glass. Each week on our program, of course, we choose a theme, bring you a variety of different kinds of stories on that theme. Today's program, Hospital Diplomacy, stories of the delicate and sometimes less-than-delicate interaction of patients and hospital staff in a setting where lives are at stake. We have arrived at Act Three of our show. Act Three, Fire and Ice Cream.

This is a story about how patients and medical staff actually can get along just fine, but how when that happens, it can still leave everybody involved scratching their heads with unanswered questions. About a decade ago, when Brent Runyon was 14, he was burned badly enough that he ended up in Children's National Medical Center's burn unit in Washington, DC. Burns covered 85% of his body. He put together this story about it with the help of radio producer, Jay Allison.

Brent Runyon

During the first weeks in the burn unit, pain blurred from my ones like airhorns at a high school football game. I hated my body, my nerves, my brain. I wanted them all to just shut up. There were only a few times I wasn't in pain. Once before burn therapy, Tina, my nurse, pushed morphine straight into my bloodstream instead of dripping it through the IV. I asked her to push it. I begged her to let me feel it all at once, to blow out my mind like an overexposed photograph, and she did.

For 30 seconds, I couldn't feel my body. My vision was whitewashed, and I understood why someone would want to be an addict. When I could talk again, I mumbled, why don't they sell this stuff on the streets? They could make a fortune. Tina unwrapped my bandages, exposing my legs to the air. I looked down. They didn't look like legs at all. They were skinny and useless, so many shades of purple they didn't even look real.

I saw the massive wound, as big as a mailbox on my left thigh, where the fire had burned all the way through to the muscle. Tina saw me looking, leaned over and whispered what she always said, it's OK. It's going to get better. The redness means that it's healing.

I closed my eyes and braced myself for what was coming next. She would begin by cleaning each open wound on my feet, working up to my thighs, and then she would turn me on my stomach to clean the holes on my back. The pain roared from my legs as she cleaned the first wound. Tina explained that my body was healing, and that healing was one of the most painful things a body could do. She said that pain meant I was getting better.

It didn't feel like I was getting better. My skin was tissue paper, and she was tearing at it with steel wool. She told me that if it hurt too much, that I should scream as loud as I could. And at first, I didn't want to. I thought it would be rude or disruptive, and that I could just close my mind to the pain if I tried. But she said that I should scream, and that would let some of the pain out.

And so she cleaned every wound three times, I screamed, and it became a kind of Waltz, with Tina counting her swipes aloud, and me screaming, 1, 2, 3, scream. 1, 2, 3, scream. After she covered me in gauze and Ace bandages, my body was shivering. I was exhausted, crying a little bit, trying not to think about how I'd have to do it all over again in eight hours.

Tina stood at the head of my bed, her thick black curls spiraled toward my face. Brent, she said, do you like ice cream? It seemed like a silly question, since I was still getting fed through a tube in my nose. When you get that nose tube out, when you can walk again, I'm going to take you to the best ice cream shop in DC. It had been weeks since I'd eaten anything, and I hadn't even thought about ice cream. I couldn't believe it. Tina and I would go out for ice cream when I could walk. We would go on a date.

It was eight weeks later, and it was going to be my first time outside the burn unit. Most of the pain had gone and been replaced by the itch. Anyone who's ever had a burn can tell you that the itch comes after the pain, and that it's sometimes worse because it's constant. It made me feel like the skin on my body didn't belong to me, as if it had been stripped away in my sleep and replaced with raw wool.

I prepared for hours for my date with Tina. My mom and another nurse named Barbara picked out the loosest, least-irritating clothing, and they helped me into a pair of baggy athletic pants and a Hard Rock Cafe London T-shirt that my mom said looked really cool. They discussed whether I should wear the pressure bandage that masked part of my face. And then Barbara slipped the chin strap over my head and Velcroed it behind my neck. She put a purple Los Angeles Lakers cap on me to cover part of the bandage. They both said that I looked handsome. I didn't look in a mirror.

Finally, Tina came to pick me up for our date. She had taken off her scrubs and put on a loose white sweater. Her functional shoes were replaced with green All Stars, and she was wearing shorts. I'd never seen her in shorts before. She looked so relaxed, not like a nurse at all. She smiled at me from the doorway. As a burn nurse in a children's hospital, Tina rarely had patients that she could talk to. Most of the kids she took care of were two-year-olds, kids that could walk well enough to pull boiling water down from the stove, but couldn't understand that it wasn't her fault that they were in pain.

Those kids hated her for hurting them. They panicked every time she came near them. But I knew that the pain wasn't her fault. I talked to her, and we made each other laugh. Could a 26-year-old burn nurse be interested in her 14-year-old patient? I was in love with Tina, and I was sure that she was at least a little bit in love with me, too. Why else would she take me out on a date? And she had called it a date. Why else would she wear shorts, or green shoes, a clear sign to a 14-year-old boy that says, go, go, go?

We waited for the elevator next to a hospital directory sign, and I decided to make my first joke. I cleared my throat and said, spina bifida, that sounds like some sort of Greek food. Tina made a face and said, you wouldn't say that if you knew what it was. The elevator doors opened. Walking out of the hospital with Tina made me feel like I was on a real date, although I had never been on a date before. Something about being on my own feet, walking into the fresh air, the afternoon sunlight, a woman next to me, a woman who had, I reminded myself, already seen me naked.

But by the time we got the car, I was exhausted. Sweating from the few remaining pores in my forehead and armpits, the itch which had been mercifully quiet during the first few minutes of our date started buzzing in my legs. Tina must have noticed that I was uncomfortable, because she put the back of her hand-- no rubber glove, her actual hand-- against my forehead, and wiped the beading sweat away. What did that mean? I wondered to myself.

Tina parked about a block away from the ice cream place she'd been telling me about, got out of the car and rushed around to my side to open the door. That's sweet, I thought. I wish I had done that for her. She helped me on to my feet, and we began walking towards the ice cream place. You OK? she asked. Sure, I said. You?

I was trying to ignore the itch that had spread up my legs and into my back. I was walking. That was the important thing. And I was on a date. Inside, the cool air dried the sweat on my forehead, and I began to feel more confident. I let out a sigh of relief just to let her know that the worst was over, and that we would start to have fun any second. We stood in line behind a few senior citizens that were deciding between pistachio and butter pecan.

I smiled at her and rolled my eyes a little as if to say, can you believe these old people? They're so slow. And she smiled back. This is working, I thought. This is really working. It was then that I saw the ice cream guy checking Tina out from behind the counter. He was college-aged, handsome. I knew what he was thinking.

We stepped up to the counter and I prepared myself for the flirting. And then he looked at me, and a smile dropped into an expression of mock pain as he said, ouch, what happened to you? As soon as he said it, I felt the blood pool in my legs and the itch throb all over my body. I backed up a little, stepped away from the counter. I looked down at my feet. I put my hands in my pockets. I didn't want to talk to him anymore. I didn't want to say anything.

Tina finally broke the spell and asked me what kind of ice cream I wanted. It was all I could do to mumble, chocolate. My head still cast downward, studying the tile patterns, I asked her if we could eat it in the car on the way back to the hospital. And she said that we could. On the way home, I reached up and touched the long purple scar on my cheek. I pinched the edge and blanched it white between my fingers. The scar was numb on my cheek, lifeless and hard, like a wad of gum under a school desk.

Thanks to ice cream guy, I realized that redness didn't mean I was healing anymore. It meant that I was disfigured. I understood that I wasn't going to get much better. Despite all the reassuring things Tina had said to me in the burn unit, this was it.

Ice cream boy saw me for what I was, scarred. All I wanted then was to go back to the hospital. I wanted to climb into my mechanical bed and watch Regis and Kathie Lee for the rest of my life. I wanted to eat chocky pudding and flirt with the nurses. I wanted to be able to scream.

When we got back to the hospital, Tina walked me to the elevator, and we rode up to the third floor. We hadn't said anything on the ride back. She never asked me how I liked the ice cream, which is good because I wouldn't have known what to say. Right before the doors opened, she put her hand on my forehead. I looked at her, and she said, good night, beautiful. And I walked back to the burn unit, the safest place in the world.

Tina

My name is Tina Bobo, and I am a nurse. And I worked at Children's National Medical Center in Washington, DC for about eight years as a burn nurse there.

Ira Glass

How old were most of the kids who were there?

Tina

Well, primarily the kids that we saw there were toddlers, because children have thinner skin than adults do, so an injury, a cup of coffee from a microwave would severely burn a young child, whereas for you it might make just some redness and maybe a blister.

Ira Glass

Actually, as you say this, I'm picturing little kids' skin, where you can see all the capillaries on the surface. You can just see the blood moving through it in a way, where--

Tina

This is much thinner.

Ira Glass

Now, you were in the unit for eight years?

Tina

Mmm-hmm.

Ira Glass

How often would you take a patient to go and get ice cream?

Tina

Once in eight years.

Ira Glass

Really? I should say here that you are the nurse in Brent's story, and we tracked you down. You live here in Chicago now. And I'm surprised to hear that he was the only one. Somehow, when I heard his story, I thought, oh, well, this is a nurse who, like, at some point, in her arsenal of tricks to help a kid keep a good attitude and get better, she'll just do the ice cream thing at some point.

Tina

No. I wanted to do something for him. I wanted to do something outside the hospital with him.

Ira Glass

Why? Why him?

Tina

Because he and I had developed a very strong bond over those few months. We spent-- you know, I worked day, during the day, so I was there during most of the waking hours. The one thing, too, that was so special about Brent was that he was an adolescent. I identified. I was still very young. I was in my early 20s to mid-20s, which was very young, and you can't help but feel-- I don't want to say sympathy, but it is sympathy. I felt sorry for him. I really did. And so I wanted to do something to make his life better.

Ira Glass

It must have been strange when you took him into the outside world and then there are the two of you, and you're not in your nurse's uniform, and he's not the patient. And there you are--

Tina

Feeling like I was supposed to protect him, and feeling very uncomfortable with that, because you can't-- I couldn't prevent what people were going to say or how they were going to look at him. And I couldn't control how he was going to feel.

Ira Glass

On these trips, do you remember noticing other people reacting to Brent and him noticing them reacting?

Tina

Oh, certainly. I remember in the ice cream shop in particular, even the people who worked in the ice cream shop staring at him. And I remember being just really nervous that someone might say something that would really hurt his feelings, or stare for a prolonged period of time, or have some strange expression or something from seeing him.

Ira Glass

The thought must have flashed through your mind at some point when you were out with him that maybe he thought of this as a date.

Tina

You think? Well, not really. He was only 14. It never-- not really, no. I didn't think of it that way at all. It was just a really special friendship and bond that I had with him. But I didn't think of it that way. I don't know. Did he think of it that way?

Ira Glass

I think, yes. I think the thought went--

Tina

Really?

Ira Glass

--through his mind that, well, maybe. Yeah, kinda.

Tina

Really? I'm just so flattered. He-- Wow. Well, I hope that was in some way beneficial to him to think that an older women with, you know-- and maybe that helped somewhat with his self-image. And I hope that's not a disappointment to him if he hears that it wasn't that way. But it doesn't mean that I didn't care about him any less. It just was very different.

Ira Glass

You know, when you think about becoming a nurse, I would imagine the picture in your head is, you're going to be caring for people and helping them through this really hard time. And part of that picture must be that certain people you'll get close to and you'll really help them and be this person for them. How often do you get to feel that connection? I mean, would you actually accomplish it every day?

Tina

No, you don't. In reality, you don't. You don't make those kind of bonds on a-- I can think back, of all the children I took care of-- and there was probably thousands of children-- and I remember distinctly probably 20 of those thousand in that eight years. And again, that was a special place, because it was all children, and it was a place where we had such great resources and wonderful people. It seems like, because back then, resources for health care weren't like it is now, so it was kind of like an ideal world then. And every time I think back, oh, I wish I had that kind of job again. But that doesn't exist anymore. Wonderful place.

Ira Glass

You're saying, literally, like, places like that don't exist?

Tina

I just can't find it if it's out there.

Ira Glass

This is just 10 years ago or something.

Tina

I know, but--

Ira Glass

It's changed that much?

Tina

--things are so dramatically different, just in terms even of staffing. Today, because there's such restraint issues with money, it seems as if staff are kind of in opposition with administration. And hospital, it just doesn't seem cohesive. Back then, it was just, the whole hospital, it just felt this cohesiveness. And I've been back, it's very different. In fact, the burn unit doesn't exist there anymore. Things are so different now than they used to be.

Ira Glass

I remember thinking that something had changed in America when I saw this movie, that was not a very good movie, called As Good As It Gets last year. It was Jack Nicholson and-- what's her name? Helen Hunt.

Tina

Helen Hunt, right.

Ira Glass

And I realized, god, something has happened in America if you can have a movie and the heroic thing that the guy does is get the kid off the HMO and get him to a private doctor, like that's the heroic act.

Tina

Right. It was incredible, right?

Ira Glass

Uh-huh.

Tina

Kind of like Santa Claus, almost.

Ira Glass

Well, no, like, people clapped. You know what I mean? I was like, what has happened in this country that, like, just getting somebody out of regular health care can be, like-- Did you see this movie? Do you know what I'm talking about?

Tina

Oh, sure. I've seen it, like, two or three times.

Ira Glass

And did it strike you too? The fact that, like, what's going on here?

Tina

Well, for me, it wasn't so amazing because I know, well, that is a big deal. My husband was just like, who cares? OK, fine. The kid got to go see a good doctor. I was going to say one more thing.

Ira Glass

Say it.

Tina

[SIGHS] I remember, when I would do Brent's wound care, I felt like, because it was difficult to make an emotional detachment, oftentimes I felt like I didn't do a very good job doing that, because it was hard to push myself to do something that I knew was going to hurt him so badly. I'm not sure that was necessary to his benefit. I'm not saying it caused him any harm, but it was difficult to do.

Ira Glass

It's so interesting talking to you, that even now when you think about it, you worry that you went too far and got too close.

Tina

Mmm-hmm. I often wonder if that was beneficial to me at that time, too. It didn't make my life easy. When I talked to Brent, he asked me--

Ira Glass

When you talked to him just recently?

Tina

When I talked to him just recently, he was telling me that what he had written, the story that he had written, and he basically said, one of his big questions, he would lie in his bed and wonder what the heck I was doing when I left his bedside. Like, why isn't she in here? I'm going through all this pain. I am totally alone. Someone should be with me. Why isn't she in here? What is she doing?

And it was important for me to get away, too. Like, after I had been through that with him, I needed to kind of cleanse myself, too, of-- you know, get myself together. That was one very difficult thing for me to go through, too. Do you know what I mean?

Ira Glass

Yeah.

Tina

It affects you. It's not like you can just shut it off when you come home. You're supposed to be able to, and most of the time you can. But in a situation like that, it's impossible.

Ira Glass

But in a way, if you think about the kind of nurse you'd want to have, you'd want the nurse who would be affected by it outside of the hospital.

Tina

Mmm-hmm. You would, if it were you, if it were me.

Ira Glass

But you're saying, from a nurse's perspective, that it's too much to ask a person to do, it's too much to ask a nurse to do. It's just like, as the health care provider, you have to be able to have your own life or you'd go nuts.

Tina

You do. You have to be able to separate.

Ira Glass

Tina Bobo. Brent Runyon's story was produced by Jay Allison as part of his Life Stories series, with help from Christina Egloff and funding from the Corporation for Public Broadcasting.

[MUSIC - "SAY YES" BY ELLIOTT SMITH]

Act Four. Looking For Love In All The Wrong Places.

Ira Glass

Act Four, Looking For Love in all the Wrong Places. So what if you don't obey the rules and customs of the hospital? Wendy Dorr has this story of one woman who did, over and over, disobey those rules, and what happened to her.

Wendy Dorr

The first time Wendy Scott went into a hospital, she was 15. She had her appendix out. And she was surprised how much she enjoyed it. This was back in her hometown of Wemyss Bay, Scotland.

Wendy Scott

I enjoyed it when the nurses would come and fluff up my pillows and ask me how I was, and how was the night, show a little bit that they cared, which is something I never really had at home.

Wendy Dorr

A year later, feeling depressed and alone, working at a holiday camp on the east coast of Scotland, she got the idea to walk herself into an emergency room and tell them that she was feeling sick when she wasn't.

Wendy Scott

I knew I wasn't sick, but I wanted somebody to care about me. They kept me in a few days. They did a few blood tests, a few X-rays, said you're fine, you can go home. For a long time, that was all it ever was, which suited me. I mean, they took me into hospital, they cared about me, they gave me the attention I wanted. If you like, they recharged my batteries, and I was able to go back out and face the world and try and be normal again for a while.

Wendy Dorr

In the same way that prison can be the best place to learn how to become a better criminal, in hospitals Wendy learned how to become a better invalid. Over time, she came up with her own set of rules. Number one, always pause after the doctor asks you a question. It makes it look like you're thinking about the answer. Number two, never change your story. Number three, when all else fails, tell the doctor you have a stomach ache. They can't prove you don't, and stomach pain can mean 100 different things. Number four, listen closely to what the doctor says. He'll tell you everything you need to know.

Wendy Scott

Doctors taught me most of what I know. I mean, I would go into the emergence room saying I've got a stomach ache, and they would examine me, and then they'd say, have you got Crohn's disease? No, what's Crohn's disease? And then they'd tell you all but Crohn's disease and how it affects people and things. And of course, you're lying there taking all this in, ready for the next time you might want to use it.

Wendy Dorr

Wendy claims to have been a patient 850 times at over 650 different hospitals all over Europe and Great Britain. It's hard to confirm these stats, as nearly all her hospital visits were registered under different names, names she'd randomly chosen out of the phone book. What she had was a psychological disorder called Munchausen syndrome.

People with this syndrome go to extreme measures pretending to be sick just to get attention. And it's shocking how successful some of them can be. There are cases of people having amputations of one or more limbs, performed by doctors who believed they were ill.

Wendy Scott

I mean, I've had 42 abdominal operations on my stomach. And I never wanted them, but if I've gone to a hospital and the doctor comes and says he doesn't know what's causing this stomach ache and maybe he better have a look and see, if I say no, he's going to wonder why I don't want to find out what's causing this pain that I'm supposed to have. And so you go ahead and you have the operation.

Wendy Dorr

Sometimes, during the operation, the staff would realize that she was faking it. And then she'd be stuck in the hospital, recovering from her surgery with everyone knowing she lied. Twice, she was even sent to prison, charged with illegally obtaining drugs, food, and lodging. The hospital, like any other ecosystem, has a set of rules, and there are certain rules you simply can't break and survive in the system.

For 12 years, Wendy lied to doctors and nurses and shuttled from hospital to hospital. It was all she did with her life between the ages of 16 and 28, she says. She never held a job or had any close relationships. It was just too risky. As a result, her name and photo were permanently included in hospital blacklists all over the UK and Europe. Hospital blacklists are illegal here in the US, but not in countries with nationalized health plans.

Finally, when she actually got her wish and needed hospitalization, she couldn't get medical care. About 18 months ago, she started to feel a pain in her groin while she was driving.

Wendy Scott

I saw a surgeon and, well, he poked me around. And he said he couldn't feel a lump in my groin. And as for the pain I had in my stomach, well, that was payment for my past and I just had to put up with it. Payment for my past. And I just sat there in tears.

Wendy Dorr

She finally got medical attention through a doctor she'd met on the internet a couple of years ago. Doctor Marc Feldman is an expert on Munchausen syndrome. And Wendy contacted him through his website after she started a Munchausen support group in London. Two and a half years and 100 emails later, they were friends. Wendy phoned him this past summer for advice about this pain she'd been having, so Doctor Feldman invited her to his hospital.

Doctor Marc Feldman

When the doctors went into her abdomen, they spent about two hours just cutting through the scar tissue that had resulted from all of those abdominal procedures she had had in the past. But once they had done that, they found what they described as a tumor the size of a small soccer ball.

Wendy Dorr

People lie in all sorts of institutional settings, in schools, at their jobs, on loan applications at banks, but most of us don't lie in hospitals. And it's not because we're worried about wasting hospital resources or humiliating doctors. We don't lie in hospitals because it's just too frightening. We worry there'll be mortal consequences.

And in Wendy Scott's case, there were, because she violated the rules of medicine and she couldn't get care for 18 months. And in that time, the cancer spread to the point where there was nothing that could be done to save her. Though doctors told her she had two years to live, she died this fall, just a month after our interview.

Wendy Scott

I'm not proud of what I did, in that I spent many thousands of pounds, wasted hospital time and money, but I couldn't help it. It was something I had to do. I just didn't know any other way to get somebody to care. And although it wasn't exactly the kind of caring I wanted, it was better than no caring at all. So you accept it.

Wendy Dorr

And in the end, Wendy got over her attachment to hospitals. When her illness got more advanced and she could've spent her remaining days on a ward, she instead chose to leave the hospital and spend the rest of her days at home.

Ira Glass

That story from Wendy Dorr.

Credits.

Ira Glass

Well, our program was produced today by Julie Snyder and myself, with Alex Blumberg, Susan Burton, Blue Chevigny, and Starlee Kine. Contributing editors Paul Tough, Jack Hitt, Margy Rochlin, and Alix Spiegel, Nancy Updike, and consigliere Sarah Vowell. Production help from Todd Bachmann. Elizabeth Meister runs our website.

[ACKNOWLEDGEMENTS]

To buy a cassette of this or any of our programs, call us here at WBEZ in Chicago, 312-832-3380, or visit our website, where you can order tapes or you can listen to our programs for free, www.thisamericanlife.org. This American Life is distributed by Public Radio International.

[FUNDING CREDITS]

WBEZ management oversight by Torey Malatia, who will tell you that when he and I went out just last week for that drink, he'll say it was not a date.

Tina

I didn't think of it that way at all. It was just a really special friendship and bond that I had with him.

Ira Glass

I'm Ira Glass, back next week with more stories of This American Life.

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