The Impatient Patient: Are you a Vertical or a Horizontal?

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My friends say I am well-informed.

Need to know the name of that new restaurant that just opened up on 14th street?

The latest on the crisis in Iraq?

Which eye doctor to call if your elderly Mom has a retinal problem?

I’m it. Ms. Resourceful.

So perhaps it should not have been a surprise when the doctors in the hospital starting asking me for information –

-instead of the other way around.

In the Fall of 2012 fate decided I should reside for nearly 3 months in a big-city hospital instead of my suburban home.

I was (major understatement here) not an easy patient.

Pain is not my idea of a good time.

The food was awful, the lights too bright, the noise in the halls 24/7.

Making it worse was that mine was a complicated case.

I had multiple doctors in different specialties involved in my care.

Naively I thought they would share their knowledge with each other. And together would make decisions about my treatment.

But instead of talking to each other, so it seemed, the doctors talked to me.

I tried to be helpful – at first.

Dr. Important Cardiologist would drop by around 6:10 a.m. while I was sound asleep.

As I struggled to sit up, he was already asking questions.

“Has Dr. Infectious Disease Specialist been in to see you?”

Trained to be polite, even under unpleasant situations – I would respond:

“Yes, she came by late yesterday.”

“What did she think about your latest lab results?”

(What I wanted to say: why don’t your check my chart? or better yet, ask your colleague yourself.)

What I said: “She thought the numbers had gone down, which was a good sign.”

And Dr. Important Cardiologist would whisk out of my room.

Later that morning, maybe at 8:00 a.m., mid-day in doctor time – in would come Dr. Big-Time Neurologist.

And Dr. Big-Time Neurologist would ask:

“Has Dr. Important Cardiologist been in to see you?”

(What I wanted to say: can’t you people just check my chart?)

What I said: “Yes, he was here earlier this morning.”

“Good, what did he say about your latest MRI?”

Me: “That there was no change.”

“Good” (Dr. Big-Time Neurologist liked that word) – and he would strut out of my room.

On my first hospitalization I thought, O.K. answer their questions.

You are a helpful person, Nancy! Overly-informed, a font of information.

After all, Nancy, what else do you have to do?

In between “this will only be slightly uncomfortable” fun tests, you are just waiting around in bed all day.

But on my 2nd or maybe my 3rd hospitalization within a few months, I began to grow a bit weary of my role as Provider of Knowledge.

Dr. Young Internist came into my room and asked me what tests Dr. Infectious Disease Specialist had ordered the Nuclear Medicine Specialist to perform.

This time, I decided maybe I was not going to be such a patient patient.

And with all the politeness I could muster:

“Uh, Dr. Young Internist. I’m the patient here. Perhaps if you are interested in knowing what tests the Nuclear Medicine Specialist is going to perform, you might check my chart or ask him yourself?”

Dr. Young Internist was taken aback.

He was young, nice and actually seemed interested in my case. I didn’t want to be unhelpful.

But — he was already much too indoctrinated in the Patient as Provider of Knowledge approach which seemed to be this big-city hospital’s governing rule.

So I had to educate him.

And very politely, I said.

“Dr. Young Internist, see this bed, I’m the one in the bed – and see you standing there next to the bed?”

He looked down at his feet.

“That is how you can tell us apart. I am a Horizontal. We are the ones who wear these scratchy polyester gowns that flap open. We get bad food served to us on trays. Needles get stuck in us. We are Patients.”

“And you, Dr. Young Internist, you are a Vertical. You get to wear regular clothes with zippers and buttons. See, how you have a jacket on? Last time I wore a jacket was 2 months ago. You get to walk outside and smell fresh air. You can choose your own food. You do the needle sticking. You are Doctors.”

Dr. Young Internist seemed puzzled at my explanation of the differences between the Horizontals and the Verticals.

So I continued, as helpfully as I could, of course.

“Dr. Young Internist, you are a Vertical because you call the shots. (pun unintended). I am a Horizontal. I lie here and receive the shots. You gather the information. I receive the information. You analyze the information and make decisions. I am told about those decisions. That is why you are a Vertical and I am a Horizontal. So could you please ask your colleagues for information about my care rather than ask me?”

Dr. Young Internist nodded, then quickly backed out of the room.

The next morning, Dr. Infectious Disease Specialist came into the room; 9:30 a.m., nearly evening in doctor time.

She asked me if Dr. Important Cardiologist had been in to see me today.

What did he think of my latest blood tests?

Dr. Infectious Disease Specialist was a very stylishly dressed woman. I was jealous, day after day, seeing her as she came into my room, wearing snappy leather boots, well-cut skirts and interesting jewelry.

I wanted to wear clothes too!

I missed my boots!

I needed a diet coke!

I had become an impatient patient.

So I responded:

“No, Dr. Infectious Disease Specialist, Dr. Important Cardiologist has not been in to see me today. And even if he had, and even if I fully understood what he was telling me, I am not sure I would tell you.”

“Don’t you realize that you are a Vertical and I am a Horizontal? Look down. See? You are wearing leather boots. I am wearing ugly green socks with sticky pads on the bottom so I won’t fall if I can rouse myself enough to go to the bathroom. I am a Horizontal. You are a Vertical. Why don’t you give Dr. Important Cardiologist a buzz and find out what he thinks about my blood work?”

Pretty soon after that conversation with Dr. Infectious Disease Specialist, I noticed that my doctors had stopped asking me for information.

I thought, good, maybe they are talking to each other for a change, instead of to me. Maybe they are even reading my chart before they come in to see me.

Hadn’t I read a recent article about coordinated patient care being the new trend in modern hospital stays?

Proud that I was able to support a positive medical trend, I spent the rest of my hospital stay in (near) silence.

And on the day I was discharged, I got to wear boots and a jacket on the way out of the hospital.

Just like the Verticals!

Probably the sound of loud cheering by all of my doctors as I got into my husband’s car to go home was just my imagination.

19 Comments

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19 responses to “The Impatient Patient: Are you a Vertical or a Horizontal?

  1. Funny! Wow I sure hope they found out what you were in there for and gave you some answers in the end.

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  2. Tricia M Foster

    I spent 27 days in the hospital after being run over by a truck. It is NOT the restful, recuperative experience that people think it is! During the third week, I began asking politely to be discharged, when that didn’t work, I started cussing like a sailor. I understand their concern, my pelvis and lumbar had been fractured, my hip broken (which required a surgical pin), and my legs had swollen to grotesque proportions, but I didn’t care if I had to belly crawl to the bathroom, anything was better than Ms.Absent Nurse, Ms. Grumpy Nurse, and the constant rotation of annoying roommates. Don’t even get me started with that smiley/frowny pain chart!

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  3. Recently I had the unfortunate pleasure of having a very minor surgery. It was discussed in advance and come the day, scalpel in hand, my surgeon looked me in the eye and asked, “So…what’re we doing again?”. I decided he was just being facetious, but upon reflection, what if I’d got it wrong?
    I’m glad you’re in the Land of the Verticals again 🙂

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    • Hope he was just facetious! I had minor surgery at age 9 and surgeon asked me just before, what side is your hernia on again? Maybe that is surgeon humor that they teach in med school? Thanks for reading.

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  4. Dennis Shore

    Being the loved one of someone in the hospital can be a similar experience. When your cousin Barbara was in intensive care I made sure I was present at rounds every morning. Of course the discussions were always outside of the patient’s room where the patient couldn’t participate. There was also the constant stream of Specialists coming and going not knowing or considering what the others were doing . The nephrologist reducing medications to protect the kidneys while the neurologist was trying to figure out how to treat the press syndrome Barbara was experiencing.
    I remember asking the neurologist about one of the Lyrica Barbara had been taking as being a contributing factor and he told me it was a question for the pharmacist.
    It seems like medicine is like auto mechanics. You go in because the engine doesn’t work and end up with a brake job.

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    • Thank you, Dennis. So glad my cousin has you in her corner.

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      • Barbara Sue Silver

        Just a bit of clarification. The nephrologist took me off Lyrica and Clonidine cold turkey when in Hospital to get a fistula put in my arm. The Clonidine is a prophylactic for PRESS syndrome migraine, which I have taken for 30 years. A week after I was discharged, I was back in hospital with PRESS, for another 10 days.

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  5. Bradd Silver

    Well done and great terminology. My 33 years of medical practice would tell me that if patients and doctors could meet in middle, we would be so much better off. So my opinion is we all ought to be diagonals

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  6. So sorry to hear about your lengthy hospital stay – and the concerns you had with it! Hopefully, the lessons were learned – not about you – but about how to interact with a patient! It is my hope that at least impressionable Dr. Young Internist understood the error of his ways!
    Sharing this – it should be a part of med school education!!

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  7. Hi Nancy! What a GREAT way of expressing the frustration of being a patient. Doctors can be extremely insensitive AND frustrating. Good for you for standing up for yourself. And I read somewhere a long time that the people who live the longest and were the healthiest made the worst possible patients. That’s why I too read up and study as much as I can about anything going on with me and then ASK THE DOCTORS as many questions as I can. They are always glad to see me go. I’m hoping you are well into recovery and never have to return. ~Kathy

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  8. suzannestavert

    Loved the diagonal answer. I am currently watching people I love not getting the care they deserve. It is super frustrating and my heart aches for them. I am sorry that you have had such difficulties, but you are obviously resilient and going to beat “this thing” whatever the group of verticals think it is. Stay strong. You Rock!

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    • Suzanne, thanks for reading. I hope that the people you love get well soon. My cardiac valve infection troubles seem to be on hiatus for now. And out of full disclosure, the person who wrote the blog comment about the “Diagonals” is my 1st cousin, a terrific doctor who happens to also have a very good sense of humor. If I meet any Diagonals, I will let both of you know!

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  9. Nancy
    What a great post! I am one of those Diagonal people (a nurse practitioner) and have seen many ask their patients the same questions. I think it is a great reminder we are supposed to be that person supplying the information to the patient not vice versa. Congratulations on speaking up. I often wish more people would

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    • Thank you for reading & writing, Kathy. My cousin, a doctor, contributed the “diagonal” idea. Glad that you, as a nurse practitioner, saw both the humor as well as the point I was trying to make!

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