The quietest places in the hospital are still the stairwells. Due to the slow, uncoordinated elevators in the hospital, more people take the stairs than in other hospitals I have wandered through. The stairwells offer more light, space, and breathing room than the cramped elevators. I have had my fair share of silent chuckles while packed in an elevator carrying upwards of twenty people. A large potted plant and I once nuzzled each other while the six other people surrounding me kept me rooted in place.

An intern whom I had not seen in over four months crossed paths on a general medical ward today. His face brightened when he saw me, though a look of concern quickly washed over his face.

“Hi,” he said.

“Hey there,” I greeted. The collar of my white coat felt warm and somewhat sticky against my neck. I really should trade my coat out for a new one, but inertia and laziness prevent me from doing so. “I haven’t seen you in a while—how have you been?”

“Fine, fine,” he said. “You okay? You look… tired.”

“Oh,” I answered, suddenly self-conscious. I looked away, stalling for some time to shift my facial expression.

“I’m not tired,” I continued, “there’s just a lot of sick people in the hospital. You know.” The nimble fingers of my mind tickled through my recent queue: the man with the massive stroke who wouldn’t stop screaming in agony; the woman with metastatic cancer who lost her mind, her identity, and, ultimately, her life, before our eyes; the man who threw himself off of a bridge to escape the voices only he could hear; the woman who delivered a dead baby….

I didn’t want to elaborate. What could I say that he hadn’t already heard before?

“You’re usually smiling, looking cheerful, when I see you,” he continued, watching my face. I was neither smiling nor looking cheerful when he saw me.

In response, I genuinely smiled at him. He himself looked older, more tired. The bags under his eyes were more apparent and he now walked with a calmer air. This is what happens during that intern year.

There was no indication to explain that my smiles serve a purpose. As a consultant, I want to provide high quality service to both medical services and their patients. Part of this involves making the relationship fun, a pleasure. Most people simply expect satisfactory service; courteous and warm interactions are the icing on the cake.

You want a skilled surgeon, right? But the surgeon seems that much more awesome when she’s kind with a good sense of humor, right?

And you might give a bigger tip to the waiter who not only got your order right, but was charming in the service he provided to the table.

Besides, the life of an intern can be frustrating and demoralizing. A little light and laughter might combat the forces of darkness.

“I’m fine, I’m fine,” I said brightly, adding melody to my voice as I spoke. I flashed him an exaggerated smile and continued on my way. A small smile crossed his face before he began to warmly laugh.

“I’ll see you around,” I finished.

“Yeah, you, too,” he replied.

I think there is ongoing construction in the stairwell. Though it appears to be a closed space, I often feel air moving as I tromp up and down the steps. As Spring has awoken and the sun lazily stretches its rays through the tall glass windows, I have squinted into the light and felt the solar warmth on my face. Then that mysterious breeze, a quiet sigh, dances past.

“I could never do what you do,” the surgeon said. Replace “surgeon” with “internist”, “radiologist”, “cardiologist”, “nephrologist”, “obstetrician”, or whatever else you’d like. “I can’t bear to talk to these people. It’s so depressing. They seem to suffer so much. Doesn’t it bother you sometimes?”

And, by “these people”, they mean “people with major psychiatric conditions”.

“Of course it bothers me,” I usually reply, “but that’s why we all work together.” It sounds hokey, doesn’t it? “I can’t imagine being a surgeon and regularly cutting into people. I’d be too scared I’d cut the wrong thing and kill someone.”

But of course it bothers me. We could argue all day which service sees the sickest patients: Medical ICU? “But that’s like veterinary medicine,” some will jest, “you never talk to your patients.” Oncology? Everyone there has cancer. Infectious disease? So many of them have end-stage HIV. Neurology? Their patients often have conditions that lack “cures”.

But of course it bothers me. Services contact psychiatry for a variety of reasons: Sometimes they’re too busy to have life-and-death conversations with their patients… or they’re not comfortable having those discussions. Sometimes their patients are agitated and confused and they don’t know what to do. Sometimes they are worried that patients’ psychiatric conditions are adversely affecting their medical condition and care. Sometimes they really don’t like their patients and believe their patients really don’t like them and hope that we can help smooth things over. Sometimes they just want to make sure they’re providing thorough care.

But of course it bothers me. None of us like to see people suffer and, often, people call psychiatry when people are suffering and they don’t know what to do about it. A little listening can go a long way, but there are also harsh realities that none of us can escape, despite our best efforts.

(Nota bene: This is one reason why physicians can be quick to medicate patients: Anything, anything, to stop the perception of suffering. And anything, anything, to support the idea that you’ve done something to alleviate the suffering. Being can be too painful; doing seems more productive.)

In the stairwell, it is quiet. I thank something, someone, that I am now healthy, that I am able to climb and descend stairs without difficulty, that I can have a brief respite from the scenes of sickness and suffering, that I can go home at the end of the day, that I can momentarily forget the possibility that I myself may fall very ill very soon, that I offer a service that hopefully some people find helpful some of the time, that I don’t have to speak, that I don’t have to mask my facial expressions, that not all people are sick and dying…

… that outside of those windows, the city continues to vibrate and dazzle.