One Monday morning, a number of years ago, the administrators at the family health center where I used to work instituted a new and time-consuming procedure for registering patients. They did this in an attempt to satisfy the rules and requirements imposed by the many different insurance plans our center accepted.
There was just one problem: the administrators forgot to tell anyone what they'd done--not even the center's medical director, who happened to be on vacation at the time.
As the clerical staff stumbled over a brand-new, complex set of protocols that day, a line of patients, mostly poor, snaked around the lobby, out the front door onto the sidewalk. Tempers grew short. A fight nearly broke out. We providers sat in the back twiddling our thumbs, waiting for patients to trickle into the exam rooms.
Finally, after an hour-and-a-half, enough patients had been registered so that the line could finally fit inside the lobby. The exam rooms were all filled, and the doctors and nurses were desperately trying to make up for lost time.
At that moment, the health center fire alarm went off--signaling one of our periodic fire drills.
Needless to say, it couldn't have happened at a worse time.
We got our patients dressed, coaxed them out of the exam rooms and exited the building with them, fuming. Outside, we were cheerfully greeted by employees from our mother hospital down the street. They were there to make sure that every last person in the health center, no matter how elderly or incapacitated, had been evacuated.
Then, as if we hadn't suffered enough, these same employees handed out--and then collected--quiz sheets that asked the staff how we might handle a real fire.
It was surreal.
I remember one question: "How should you dispose of an empty fire extinguisher?" As I thought of how I might use such an implement to knock some sense into the individuals who'd cooked up our new registration procedures and were now tormenting us with a fire drill and a pointless quiz, this use for the empty fire extinguisher would not have been a correct answer, but it did reflect my frustration at a health system whose financial priorities were topsy-turvy, whose leadership seemed to be tone deaf, and whose publications extolled the glories of research-based medical science without noticing the sorry state of real-world medicine as it was often practiced.
Around that time I began to wonder what it would be like to have a publication that told the real story of medicine, the one that my colleagues and I experienced every day. A publication that could listen and respond when someone such as the hospital's director of nursing said, as she'd said to me in a stairwell, “For the first time in my long career, I’m ashamed to be in this business.”
A few years after this memorable fire drill, Pulse--voices from the heart of medicine was launched in early 2008 by the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, with the support of colleagues and friends around the country.
Pulse arose out of a belief that our stories and poems can make a difference. They can heal our hurts; they can teach our students to be more compassionate; and they can reveal the truths that need to be told if our healthcare system is ever to right itself. They can bring us together--patients, nurses, doctors, everyone--to share our experiences and achieve a goal we all believe in: better health care for all.
In the time since Pulse's founding, much has changed. As a nation we have acknowledged the need for universal health care.
And much remains the same. We are still struggling to make good on that realization.
Where I work now, there isn't a line of patients snaking out the door, but we're still trying to take care of too many needs in too little time. And we're often hampered by protocols and technologies that were supposed to help us. Protocols and technologies that instead make it harder to look a patient in the eye and form the human bond that is the first step toward healing.
Meanwhile, Pulse is read by health professionals and patients looking for inspiration and nourishment, by medical educators who use it to teach their students, and by policymakers who want reminders of what life is like on medicine's front lines.
Pulse is a quiet and powerful voice whose medium and message have drawn the attention of many, including some influential allies who share our common quest.
Welcome to Pulse. I hope that our stories, poems, images and haiku resonate with you, and I invite you to contribute your own healthcare experiences to this ongoing conversation.
Paul Gross MD