Watchful Waiting

They say it's autumn now but it feels like summer. I'm new here and people tell me to be grateful it's a “dry heat,” but my sweat stains show no appreciation. Was this supposed to be business casual? My slacks and pressed linen shirt now cling to my lower back where my bag rests. I hadn't anticipated the air conditioning to be nonfunctional on the commuter train this morning, but as long as I keep my arms down, no one needs to know.

On a Thursday morning, I meet some fellow classmates at the lobby piano and wait for our facilitator. Our assignment is vague: some kind of meditative watching. We chat about recent mental breakdowns, technical issues with Canvas and Anki, and weekend plans (studying). We're hypothetically ready to “observe” and “be present” while distracted by the realities of our hectic lives. All of us agree: we've lost the ability to quiet our thoughts, to focus on only one thing at a time. Whether you blame the state of the world or school, medical students are highly functional distractomaniacs and constant multitaskers. A moment of internal peace seems laughable.

Our facilitator arrives and has us sit in the busy entryway to urgent care, our eyes closed, the goal to notice what we aren't noticing. She explains that we take so many things in as background noise and we forget the people and things they're inherently attached to. Remembering to notice the little details will make us more empathetic physicians they tell us, but I am skeptical.

The following sentiment circulates amongst us, “When will I ever have time to care like this? I'm only carving time for this right now because it's for a grade. As if we'll be rewarded for sitting and doing nothing.”

Nevertheless, I try not to fidget. Having my eyes closed in such a busy area is unnerving. I keep expecting someone to touch me. I hear the click of bicycle spokes, a fussy baby who wants to sleep (how relatable), shoes padding about, directions explained, and the constant cacophony of coughing. But patients also give thanks and spout apologies and affirmations as voices drip warm tones, comforting one another in a familiar human fashion. It smells like vanilla and coffee as Starbucks roasts and blends. It's comforting chaos.

Now they have us walk. The cafeteria offers the smells of the restaurant station with its weekly rotating menu options. The walls are smooth and warm-toned woods, cold to the touch, the skylights above casting a deep blue hue on everything. The effect is both calming and soporific. It feels like a mind game: if you're frustrated with construction and parking outside, come in and have the tailored space engage your parasympathetics. Don't take your frustrations out on your clinician, just relax—try a carotid massage.

You are both invited and disengaged. It's a mirage: the departmental signs and shouting of last names like roll call make dissociation impossible. Down to the trademarked red-based color scheme, you know you're in this university hospital in this particular state, with sounds of medical equipment never out of earshot. Yet the waiting rooms and hallways have been curated to create dissonance, alluding to comfort and welcome despite being accessible by invitation and necessity only. The environment encourages seeking care and feeling nurtured, but with the constant reminder that this is not a place to let your guard down. It is an illusion of comfort in a place that often means pain. Even the chairs, situated just out of earshot from the desks to maintain patient privacy, are only comfortable for a short period. They falsely appear plush, but the armrests are oddly small or misshapen and the cushion is not supportive; these are quiet things the hospital does to say, “Do you really need to be here? Go home.”

Is there a need for change? In many ways, health care in America is about getting as many people in and out, as quickly as possible: maximization, efficiency, and the illusion of customer service with the (hopeful) priority of baseline safety and health. We provide a clear path for the flow of traffic, bifurcating the labs and pharmacy from the coffee shop and the welcome desks. It is bland and somehow distracting all at once, business here, pretending there. The aura is clinical in its anonymity and dirty in its speckled appearance. It is sterile and uncomfortable without explicitly validating anxieties, the perfect sort of balance to say, “Come in quickly, if you must, but leave as soon as you can.” I wish it didn't have to be this way. Maybe it doesn't.

But this was one institution, a research hospital and the level 1 trauma center for this region. For sake of comparison, I headed next to the privately owned pediatric hospital, which is apples to oranges: a children's hospital is filled with outrageous colors and lights and distractors of every kind. Every hallway is an animal kingdom: radiology is under the sea, ENT is in the African sahara, and immunology is a tropical jungle. There are a dozen TVs in every room with a different cartoon playing on each one. The air smells like toffee and melted grape popsicles and every person in scrubs has a funny badge reel and Play-Doh in their pockets. In contrast to the university hospital, there's no quiet here, not even an illusion of calm. The most successful inhabitants of this biome thrive in chaos and know all of the characters from Bluey, Frozen, and PAW Patrol.

Yet the themes persist. The adult hospital invites us in, but creates discomfort so you'll leave quickly: there are more patients to be seen. The children's hospital provides distraction and entertainment for their patients of concern, but falls back on exhaustion as its major “move along” factor. Parents will find no rest or respite, and children will ultimately associate this place with pain or fear despite the sounds and baubles. A tired parent with a sick child will ultimately want to go home, to the comfort of bed and favorite blankets without the constant desat alarms and plethora of wires dangling from every surface.

Should hospitals be made more comfortable? Should they be more communal spaces? Is there a future where health care centers are integrated into normal social areas and encouraged to be a standard part of everyday life? Would this change the level of trust between clinician and patient? I don't have the answers. I'm not sure what the future looks like for innovation in the physical presence of clinical spaces. There is certainly a call for revolution in many different aspects of our system, from the structure to the payment schemes to what a facility looks like, but I look forward to the next stage in the ambiance and emotional evocation of where I work and provide care. Sometime, if you ever get the chance, take a moment to notice what it really feels like to be a patient walking into your care center.

Back to the March 2025 issue of ACP IMpact