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We delve into the powerful narrative of patient vulnerability and resilience. Our guest, writer Rachel Litchman, shares her deeply personal experience of being hospitalized, highlighting the disconnect between patient needs and systemic responses. We explore the profound moments of empathy that came not from the highest authorities in health care, but from those on the frontlines and in overlooked roles. This conversation uncovers the challenges of authority, compassion, and the shared powerlessness that can spark true human connection in the face of medical crises.

Rachel Litchman is a writer.

She discusses the KevinMD article, “Top-down hierarchies in health care harm patients and health care workers alike.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Rachel Litchman. She’s a writer and a homeless services consultant. Today’s KevinMD article is “Top-Down Hierarchies in Health Care Harm Patients and Health Care Workers Alike.” Rachel, welcome to the show.

Rachel Litchman: Thank you, Kevin.

Kevin Pho: Let’s start by talking about the story that you shared on KevinMD for those who didn’t get a chance to read it.

Rachel Litchman: So, I had a recent hospitalization, and I wrote about some of my experiences during that hospital stay where I interacted with a lot of people in the medical system—nurses, CNAs, doctors—and I found myself, not necessarily surprised, but feeling seen as a lot more human by folks in the health care system who were lower on that hierarchy.

I wrote about some of those experiences and also about some of the really not-so-great experiences I had throughout the hospitalization, where I felt that people higher on the chain of authority really overlooked me. That led to some pretty significant consequences, especially upon discharge when I was essentially discharged into homelessness because I couldn’t get up the stairs to my apartment.

Kevin Pho: Tell us about that hospitalization. Just tell us your story for those who haven’t read your article yet.

Rachel Litchman: Sure. I have several chronic health conditions, and around late July, I noticed things were getting a lot worse. I started experiencing severe hypertension whenever I stood up, and eventually, I collapsed on my floor. I had all these electrolyte disturbances, became very weak, and ended up admitted to the hospital.

I was so weak that I couldn’t walk. After that hospital stay, I was discharged to a physical rehab facility. It was an acute care rehab facility, so those typically last two weeks maximum. While I was there, I struggled to make progress and regain my ability to walk. Unfortunately, because my insurance didn’t want to cover more time, the rehab facility discharged me after only nine days.

The facility knew my apartment had 20 stairs and that I couldn’t climb them, but they discharged me anyway. The initial plan was for me to scoot up the stairs with my arms. However, the day before my discharge, I got hospital-acquired COVID. I became so weak that I couldn’t even use my arms to get up the stairs.

After discharge, I ended up staying in a hotel because I couldn’t access my apartment. Then I stayed at a friend’s place until I recovered from COVID enough to finally make it up the stairs to my apartment. That’s what happened over that month and a half.

Kevin Pho: Tell us about some of the interactions you had with the spectrum of health care workers during your hospital stay.

Rachel Litchman: One of the first interactions that stuck out to me was in the ER. I had been hospitalized in 2020, and I was shocked by how much the health care system had deteriorated since then. Back in 2020, I was seen quickly, but this time, I was placed in a hall bed in the ER for over 24 hours because there were no beds upstairs.

There was this nurse who wasn’t even officially assigned to me, but she really looked out for me. I needed to be catheterized, but the doctors were so overwhelmed that no one was paying attention to how urgent the situation was. This nurse made sure it happened despite the delays and severity of my pain.

That was one of the first interactions where I felt incredibly helpless, but also seen and cared for because of this nurse.

Another significant interaction happened when I was in the hospital and given a medication called Compazine. It caused psychiatric side effects, but I wasn’t warned about them. I became extremely anxious and agitated. I told the nurse that I felt very anxious and asked if there was anything I could take for the anxiety. She told the doctors, but they said, “No, let’s wait for it to wear off.”

For seven hours, I remained agitated while the nurse begged the doctors to prescribe something for my anxiety. Finally, after seven hours, they allowed her to give me medication, and I felt immediate relief. Again, this was a situation where someone lower on the chain of authority—someone closer to my care—advocated for me, while the doctors, more detached from my situation, delayed action.

In the rehab facility, I had several conversations with CNAs and even people cleaning my room. Many of them didn’t want to be in health care—they were just there because they needed a job. Despite this, our conversations were humanizing. We learned about each other, and I felt seen as a person.

On the other hand, my interactions with doctors and case managers were much less personal. They rarely asked about me as a person—what I did for work, why I was there. Instead, it was very transactional: “We need to discharge you because your insurance won’t cover more time.”

Kevin Pho: After reflecting on these experiences, why do you think there’s such a big divide between your experiences with people in lower authority versus those in higher authority?

Rachel Litchman: A lot of it comes down to power dynamics and a shared sense of powerlessness. For me and many nurses and CNAs, there was an understanding of what it’s like to feel powerless within the system. These workers are in the thick of it—they see suffering up close and firsthand.

Doctors, on the other hand, are often not present in the room during medical crises. They’re giving orders from a distance, so there’s a layer of detachment.

There are also socioeconomic differences. My hospitalization wasn’t just about my health—it was also about the fact that I couldn’t get up the stairs of my inaccessible apartment. Many people lower on the chain of authority understand socioeconomic struggles, either from personal experience or from witnessing it frequently.

Doctors, however, might not have the same understanding. Sometimes, there’s a level of blame when social factors are involved. For example, there’s this attitude of, “Why are you in that situation? Just go home.” They might not grasp how social determinants like housing instability contribute to health crises.

Kevin Pho: While you were hospitalized or in the rehab facility, was there any resource, like a patient advocate, you could turn to for help?

Rachel Litchman: Honestly, not really. I’d bring up my housing situation, and they’d respond with suggestions like, “Just get accessible housing.” They’d give me a resource list of organizations, but as someone who works in homeless services, I knew all of these organizations and was already on their waitlists—waitlists that are three to ten years long.

When I told the case manager this, she seemed to think I wasn’t trying hard enough. There was this huge disconnect. People who haven’t experienced housing instability don’t realize that resources are incredibly limited, and many organizations exist simply because the system is broken. Even when you seek help from nonprofits, there often aren’t enough resources to go around.

Kevin Pho: Now, you can’t talk directly to the doctors who cared for you during your hospitalization, but many physicians listen to this podcast. If you could share a message with them, what would you say?

Rachel Litchman: You have more in common with your patients than you might think. It’s really easy for someone to be in a situation like mine—all it takes is one health crisis. You lose your job, your income, your housing. These things aren’t the patient’s fault; they’re symptoms of a system that isn’t working.

The key to empathy is understanding that you’re not so different from the people you’re treating. At the end of the day, it could just as easily be you as it was me.

Kevin Pho: Rachel, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Rachel Litchman: Thank you.