Politics in the workplace

Part of the standard doctrine we are taught, in parallel with doing no harm, is that the service of providing care to another is and must remain entirely apolitical. I have always thought this to be wrong.

There is nothing apolitical or politically neutral in providing care to the ill, the injured, the scared, or the underserved;

in establishing a free clinic for the uninsured;

in watching a patient die but having to sanitize your hands and immediately visit another patient without letting them see the cracks in your shield;

in reviewing radiographs to weigh your suspicion of elderly abuse;

in demanding the prison guard leave the room to provide the county inmate even a modicum of privacy;

in risking your license by subverting elected officials who wish to outlaw or restrict maternal health services;

in referring a drug-dependent patient to a methadone clinic or two;

in rapidly transfusing blood into a pregnant woman hit by an intoxicated driver who, by the way, happens to be recovering rapidly in the adjacent trauma bay;

in recognizing that transferring a patient to a higher level of care is not a sign of failure;

in grieving with a family;

in locking eyes with the patient and apologizing for making a mistake in the operating room;

in presenting gravely disappointing research on why certain races, for example, receive better care in certain hospitals;

in stepping up to and challenging your role models who question those research findings;

in questioning yourself and your own biases when thinking about a patient;

in sneaking in a dying patient’s pet for the night;

in fighting with greedy insurance agencies;

in watching a patient become weaker, slowly, and weaker;

in sending a particularly strict unit secretary on a wild goose chase so that a loving wife can stay beyond visiting hours in the ICU with the only person in the world she trusts;

in navigating the odd urge to reset the encounter and apologize to a patient you reprimanded for making threatening or derogatory remarks toward your staff;

in dressing a homeless man’s leg wound and hiding extra supplies in his bag;

in never feeling confident but showing up to work every day;

in figuring out how to see eight clinic patients in one hour without them staging a revolt in the waiting room;

in figuring out how to see eight clinic patients in one hour without quitting medicine once and for all;

in recognizing that a mentee’s absence may just mean they’re too intimidated to reach out;

in getting on a knee and speaking at eye-level with a patient;

in procuring a liver from a man who, just hours ago, was making sandcastles with his daughter before his devastating fall;

in calling to doublecheck all of the region’s pharmacies for an out-of-stock medicine;

in guiding a trainee through a chest tube placement and resisting every urge to take over;

in cursing hospital executives as a matter of principle, but secretly recognizing that theirs is also a tough fight;

in trimming a comatose patient’s beard or braiding their hair before family arrives;

in checking in on a colleague after hearing about another physician suicide;

in pleading with the dialysis unit to stay open for just one more hour, just one more, please;

in sharing a prayer with a patient and their family, even if your faith has shaken;

in summing up the courage to tell her that the cancer has returned;

in learning that people are not meant to live forever, that death is natural;

in empowering one another, as humans, in this life and the next.

This is radical work. We play politics every day, shrewdly, in between yawns, sharing in the worst days of people’s lives and coming back for more, hiding or outright ignoring the stress we shoulder and the ever-looming guilt we carry, our own personal minefields. However we do it, we play politics every single day.