132 Becoming a Patient
Occasionally, individual colleagues could personally be consoling
while institutions as a whole were not. Dan continued:
The administration is not very supportive—not interested in any-
one with a problem. They want all their docs not only to think
they’re God, but to be like God—physically perfect, able to work
28 hours a day, 380 days a year. Anything less than that makes
administrators’ lives very complicated. They want simple, not
complicated, lives. Most colleagues have tended to be sympathetic,
even protective—even more than I’d like: ‘‘Take it easy. Are you
taking your medication? You look tired; did you get a good night’s
sleep?’’ But the hospital as a structure is very uninterested in
anything but its self-preservation. It is a mammoth administra-
tive entity with thousands of employees. It looks at what it con-
siders to be a global picture, and wants no problems out of the
norm. ‘‘If you’re not feeling well, don’t bother us.’’ I’m not sure
hospitals are different from other big institutions, like General
Motors.
Dan and others noted the implicit irony: ‘‘You expect the medical field,
committed to caring for the sick, to be better.’’ Yet hospitals clearly have
conflicting missions of healing the sick and operating efficiently as orga-
nizations. Organizational needs can override those of individual patients,
though such priorities are never explicitly stated. Staff members can thus
separate their human compassion from their professional demands and
expectations of each other.
Peripheralization may be more implicit and indirect, and thus harder to
prove than many forms of discrimination. Often it was unacknowledged,
even by ‘‘enlightened’’ colleagues who saw themselves as merely trying to
‘‘help’’ the ill physician. Sally, the internist with cancer who brought her
laptop to the ICU, said:
People aren’t necessarily aware that they’re doing peripheralization.
They are aware of discrimination in general—they have cate-
gories that one might talk or file a complaint about. But periph-
eralization is a lot more subtle in terms of getting people to
acknowledge that it’s really happening, because it’s really an ac-
cumulative experience, not one item. Colleagues put me in a dif-
ferent category. Partly, they think, ‘‘I don’t want to overburden
her.’’ But part of my ‘‘therapy’’ is working.