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Sam Harris
Dr. Walls
ENC 1102H
22 April 2014
I Got Myself Here, but Get Me Out of Here!: An Ethnography of a Hospital Floor
One of the two doctors on shift on the fourth floor of the Halifax Hospital in Port
Orange, Florida, was a petite, blonde, Caucasian woman in her late twenties/early
thirties. She walked through the long, narrow, well lit, hallways of the fourth floor with an
eager to learn pre-med student in a lab coat behind her, carrying an iPad, taking notes
on everything he saw as fast as he could. They had already seen eight patients together
that today, but there was still two more left to check up on before the young man had to
depart back to his gated community apartment in Orlando, Fl.
Prior to entering the ninth patients room the doctor read over the patient’s
records and notes, she has all the information of the patients she is seeing today folded
up in to three pieces of paper stapled together in her pocket. This paper was printed for
her at the beginning of the day, same as every other day. The paper that she
referenced informed her that Patient 9 is a woman with Chronic Obstructive Pulmonary
Disease (COPD), a common reason for hospitalization, directly related to long term
usage of cigarettes.
When the Doctor and Observer entered the room, the observer noticed that the
patient had her phone lying next to her head on the bed, the phone was producing
classical music. She had her eyes closed, looking serene and peaceful as she lay on
her back. As they approached closer, the patient paused her music and greeted them.
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The very first thing the patient asked was how much longer she would need to be
hooked in to the IV’s in her arm. The doctor informed her that it would be at least one
more day, and she responded with a frown and a sigh, expressing her discomfort and
disappointment.. The patient absorbed this and agreed as the conversation segued in to
how grateful the patient was for the view of the window, which overlooked a man made
lake, many green trees covered in moss, and some parking lot. Following a short
conversation about the view, the doctor and observer left the patient, and she resumed
her classical music.
The doctor repeated the process of checking her “cheat sheet” before entering
the tenth patient’s room. It informed her that the patient was a woman with congestive
heart failure. The patient was told of her condition being a combination of “congestive
heart failure and pneumonia” to which she smiled, laughed, and responded, “Oh great,
a double whammy.” Immediately following this diagnostic she asked when she would be
able to leave, the doctor informed her that she would possibly be able to leave
tomorrow. The patient expressed happiness on her face, and coincidentally also
mentioned how she was grateful for the view out the window (Patient 9 and 10 had
rooms directly next to each other so they had the same view). She explained that her
and her husband were here for the winter and that he was visiting her earlier but the
hospital is no place to be when it is so nice outside and she told him to come back after
dinner.
This personal story of these two patients accurately depicts the overlying claim,
and a couple of the sub claims that I intend to make about the discourse of a hospital
based on my observational research of the Fourth floor of Halifax Hospital. I spent over
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five hours there taking note of social interactions involving technology, texts, and
people. The purpose was to identify patterns of actions that categorize a hospital floor
discourse in of itself. After research I found that I wanted my research question to
specifically only focus on the patients as my subject, and exclude the observed actions
of the hospital staff. I use Gee’s interpretation of discourse in What is Literacy? to define
a discourse as an “identity kit”; actions or language that identify you as fitting in to a
particular group (1). “This “identity kit” is the exact ability to interpret a new situation and
act accordingly.” (Harris 1). In order to identify this common “identity kit” among patients
I focused specifically on what patients said to the Doctors and Nurses, how they
conducted themselves through actions, and how they utilized texts and technologies.
My thesis is that patients are almost without exception eager to leave the hospital.
The proportion of patients that asked when they would be able to leave during
the doctor’s check up on them is the first observation that supports this thesis. Within
the conversations between the doctor and the patient when she was checking up on
him or her, almost every single patient asked (or it came up somehow) when he or she
would be able to leave. An affirmative answer to any of these questions was met without
exception with a smile. The negative answer to these questions was met with sighs and
frowns. One patient actually sent her husband home because she told him that, “It is too
nice of a day outside to spend in the hospital.” Logically it makes sense, these people
have lives outside of the hospital, one patient desired to leave because he wanted to
take care of his mom, and another because she didn’t want to have to leave her kids
with her husband any longer. After an extensive research study done on self discharge
against medical advice it was speculated that one aspect of the unspoken code
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between doctors and patients is that, “the hospitalization is aimed at the betterment of
the patient’s health, which I more important than the business that the patient might
need to attend to outside the hospital.” (Ibrahim, Kent Kwoh, and Krishnan 2207). Both
patient and doctor understand this unspoken code. Although getting healthy is the more
important objective, observation would support that it does not prevent patients from
wanting to leave.
A major factor that seemed to contribute to patients wanting to leave the hospital
is that patients seemed to be very uncomfortable with their situation. Other than asking
when they could leave, other questions expressing discomfort were asked such as two
patients asked when they would be able to eat solid food, and a third patient asked
when she would be able to get her IV’s out. There was a patient who was repeatedly
yelling from pain, expressing her discomfort. One great example of a patient being
uncomfortable is she was quoted saying, “don’t come to the hospital if you are trying to
sleep.” Just the sheer number of patients who requested pain medication is an accurate
representation of their discomfort. The problem of discomfort in the hospital is clearly
understood by both patient and doctor, because there is a pain scale on the wall that
the doctor
updates
upon
checking up
on the
patients
Figure 1: Pain Scale
(see figure
1). Another
aspect of the unspoken code between doctors and patients in a hospital mentioned by
Ibrahim, Kent Kwoh, and Krishnan is, “The patient will stay in the hospital as long as
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necessary, but no longer” (2207). This understanding is due to the level of discomfort
that is common among almost all patients in the hospital.
Another behavior that categorizes the “identity kit” of someone in the hospital is
an attempt to escape from the present moment by distracting themselves with text and
technology. Within my observations I saw patients spending time doing everything from
reading cosmopolitan magazine, to playing trance like iPhone games, to listening to
classical music from their phone, to staring at Spanish moss out of their window. It was
a strange
coincidence that
two patients in
rooms next to
each other
both noted that
they were
using the
beautiful view
out of their
window as a
visual escape
(see figure 2).
The books that
the patients
Figure 2: View from Window
had in their
possession ranged from James Patterson, to The New Rules of Marketing and PR. I
did not observe a pattern in the type of texts that the patients were using to distract
themselves, because everyone had different interests when it came to literature. I don’t
think there was an observable pattern present within the type of text, although the fact
that over half of the patients had some sort of technology or text that they were actively
using is an observable pattern within itself. One patient in reference to his iPhone game
said that it was what was, “getting him through”. Even with patients that did not have
their own technology or text present, almost every single one had the television on, and
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one patient in particular was very invested in her unknown soap opera that was on her
television. To further this observation I think that the presence of technology and texts
as a distraction represents the fact that the patients do not want to face the reality that
they are very sick, and some of them facing death. This use of text and technology as a
distraction further supports the thesis that patients desperately want to leave the
hospital. By distracting themselves with books, games, shows, movies, music, etc. they
can occupy their brains from thinking of the one thing that they desperately want; which
is freedom.
Another pattern of observations that I made is that patients and relatives of
patients have more patience with the doctors than the nurses. For me, this translates in
to a claim that the patients respect the doctors more than the nurses. Is it because they
have a superior education? Is it because the letters at the end of their name are
intimidating? No, it is because the doctors have control over when the patients can and
cannot leave. A third aspect of the unspoken code between doctors and patients is,
“Only the physician has the knowledge and skills to decide when to discharge the
patient” (Ibrahim, Kent Kwoh, and Krishnan 2207). The presupposition, assumptions
made based on the context of a situation or text, leads the patients to openly respect
the doctors more than the nurses (Porter 35). The observation that supports the
patients’ understanding of presupposition is that I did not have one example of
witnessing a patient asking a nurse when they could leave. They only asked the doctor
this. I observed many examples of patients showing respect for the doctor, and also a
couple examples of patients not respecting the other staff. First of all, almost every
single patient thanked the doctor upon her leaving; that is a sign of respect. One of the
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nurses specifically came in to request that the doctor go talk to a patient’s son, because
he had been butting heads with her all morning, she followed it by saying of course he
was nice to you, “you are the doctor”. On multiple occasions, the doctor was requested
specifically to discuss medication with the patients, not because the nurses were
incapable of explaining it, but because the patients wanted the explanation additionally
from the doctor. My conclusion is that this respect for the doctor is based off of the
unspoken code referenced earlier. The patients visibly show more patience for the
doctor because only the doctor as control over when they can leave, and all of the
patients want to leave.
There are countless observations that support the claim that the main thing on
patients’ mind is they want to leave the hospital. Within the community of the fourth floor
of Halifax Hospital, in order to fit in to the discourse as a patient, these many observed
patterns that most patients engage in all lead to this claim. The number one example
supporting the claim is the simple observation that almost every patient asks the doctor
when they will be able to leave. The patients express a level of discomfort, through
asking for changes in their treatment plan, further supporting their desire to leave. The
patients show a level of lack of presence in their situation by distracting themselves with
technology and texts. The patients show more respect for the doctors than the nurses,
because the doctors have immediate control over how long their stay will be, and the
nurses don’t. The contribution this paper has on the research community of hospitals is
to further explain the reasons why patients have a strong urge to leave. Through
observation it supports and applies the unspoken code between doctors and patients
that was established by Ibrahim, Kent Kwoh, and Krishnan (2207). It can be particularly
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useful when studying in the future why patients discharge themselves against medical
advice. Many studies have been done statistically, by crunching numbers, to decipher
what factors contribute to patients self discharging (such as ethnicity, income,
insurance, etc.). What differentiates this study is it delves in to the psychology of the
patient, not just the numbers and facts. This study contributes to the field of research of
hospital patients because it adds a personal explanation to the meaning of what is
behind the statistics about patients leaving hospitals established by other studies.
Work Cited
Gee, James Paul. “What is Literacy?” Becoming Political: Readings and Writings on the
Politics of Literacy Education (2001): 1-9. Print.
Harris, Sam. “Navigating New Situations Using Literacy” (2014): 1-8. Print.
Ibrahim, Said A., C. Kent Kwoh, and Eswar Krishnan. "Factors Associated With Patients
Who Leave Acute-Care Hospitals Against Medical Advice." American Journal Of Public
Health 97.12 (2007): 2204-2208. Business Source Premier. Web. 22 Apr. 2014.
Porter, James E. “Intertextuality and the Discourse Community.” Rhetoric Review 5.1
(1986): 34-47. Print.