The VIP

I was a first-year medical student observer at the cancer center shadowing overnight during my winter break. It was 4:00a.m. and I was on my third cup of coffee and my second of tea. Although I had opted for the placebo effect of decaf, the drinks were useful for keeping me warm. I hadn’t realized how chilly the hospital got in the wee hours of the morning. An hour and a half before, our team, which included four hospitalists and a physician assistant, had received an email that came directly from the hospital president. A VIP patient was being flown in from out of the country and would arrive within the hour. His documents were being faxed over and he was to be admitted in preparation for the medical oncology team.

I had seen a few admissions that night and had even observed during rounds with high profile patients, but I had never experienced something like this. From what we gathered, the patient had been diagnosed the day before and was flying in today for treatment. With the sort of fevered energy only achievable at four o’clock in the morning, I watched the hospitalists review the records that had been uploaded so far into the electronic medical record. The labs were not in English, but were easy to decipher. A two-page report gave a basic history. Additional notes said the patient was arriving with his personal medical team who had flown in with him. At the bottom of the note, someone had written, “VIP.”

The patient was in the Emergency Department, where he was being triaged. It was a process that involved getting a clear picture of him as a patient, determining the steps for his immediate care and arranging for him to be admitted to the hospital. As we walked down the hallway, our shoes squeaking in the silence, and my thoughts soon became occupied with the enterprise it took to fly out of your country the day after your diagnosis in the hopes of receiving the best possible care. I considered that should I ever be in such a situation, and could muster the means, I would likely do the same. I had been reading a series of medical essays on mortality lately and could not help feeling that in spite of the evidence questioning it, the pursuit of extraordinary measures to extend life in the face of incurable disease was an innate one that resisted penetration by figures and statistics.

For one thing, what constituted an extraordinary step for one individual was simply a matter of course for another. I had witnessed end of life discussions where the patient had stated their desire for an additional, and likely unhelpful, round of chemotherapy because they wanted their child to know they had done everything possible. I prayed to never be in the position to have to face this incredibly difficult decision, but I knew I too would want to try everything. I wondered how I would learn to convey the idea to my future patients of accepting mortality and choosing instead to focus on quality of life.  This idea which, at the time, I intrinsically, emotionally rebelled against.

But our international patient was not at this point; he was newly diagnosed and prepared for a plan of action to fight his cancer. He was checked in now and would go through the admissions process as expediently as possible – in a busy Urgent Care Center – before being sent up to the top floor of the hospital where high profile patients often opted to stay. The floor provided an additional level of privacy that could prevent against undue attention to one familiar to the public eye. It served the additional purpose of removing the sometimes overwhelming markers of hospitalization: the pale, humourless walls that matched the paler curtains hiding a view that could grow burdensome; the antiseptic smell of a freshly cleaned floor that hung about long after its job was done; the reminder, by sound or sight that just behind a thin sheet lay another person fighting a similar or worse battle.

This thought had often been an uncomfortable but persistent shadow in the back of my mind: Shouldn’t this level of privacy and comfort be available to all patients? Cancer already renders its victims so vulnerable. And then there are the additional effects of cancer that are not directly related to disease. In Pathology, we called these paraneoplastic syndromes; observed clinical effects not attributable to tumor invasion or metastatic disease. However, there doesn’t seem to be a term for the non-clinical burdens that weigh upon the cancer patient, upon his family, upon his friends. The burden of insurance bills, of coordinating transport to the hospital, of accepting a loss of privacy and autonomy, and of adjusting to new and often uncomfortable alterations in lifestyle. There is an intrinsic stress to coping with cancer and, to some degree, it seems the hospital tries to alleviate it.  More so for patients with means. The uncomfortable truth seems to be that while there is no denial of care to any patients, there remains a disparity in access to certain comforts. And those comforts have a price tag attached. And yet, I can’t deny the need to secure extra privacy for public figures, such as politicians and celebrities. It’s a dilemma I can find no resolution to, but one I hope to understand better as I move further into the world of medicine.

“Are you ready?” The doctor asked after taking one last look at the patient’s electrocardiogram results.

“Yes!” I was eager, nervous too, at being part of what was unchartered territory to me. I could also admit to being grateful for the distraction from my thoughts.

“Okay, let’s head down,” she said with a smile.