It begins with the printing of the list. This Saturday, there are 22 names, a manageable number. The names are listed alphabetically by default. I should print them by room number, as that is how the nurses usually reference them, but invariably I forget and cannot be bothered to go through the process again.

“The man in 113 Bed 2 needs a new insulin order.”

“113-2…” I mutter, flipping through my pages, scanning quickly, frustrated at myself for not taking the time to reprint them.

I always associate the patients with their names. For me, it unites the person with the medicine. Putting a face to a name, I suppose. Room numbers are not static anyway. “Bed moves,” refers to the great shuffle that occurs to accommodate both the isolation of the contagious and the maximization of space. As a result, I feel like I spend a great deal of my time shuffling through the list, sorting out who is where before I head down the hall, double checking the given name before I don my PPE, so that I can address them correctly.

By the end of the seven-day stint, my clipboard is stacked with papers. Columns for name, room number and diagnosis cover the dog-eared pages. Front and back they are annotated in various colours of ink. Hand drawn little boxes adorn the pages, for tasks that need to be completed. It is an imperfect system yet hopefully, by the end of the week, every box contains a check mark.

I keep the lists from the previous few days at the bottom of the pile. What if I wrote down a detail or a piece of precious advice imparted by a hard-to-reach specialist? I worry about missing something or it not being recorded in the computer chart. The ink-stained papers are my insurance policy. Once handover to the incoming doctor is complete, however, there is a wonderful feeling of release as I dump the whole lot of them into the shred bin.

The list is constantly in flux. Every day, new patients are admitted. They come through the emergency department or are transferred from other hospitals. Everyday some leave. Hopefully, for their sake, they go home. The system’s goal is for everyone to go home and never stay longer than is medically necessary. Just one wrench in the gears can have major downstream effects. One more patient admitted to the emergency department means one less room to see urgent cases and worsening waiting room crowding.

As I start my rounds, I linger at the bedside of a young woman, young by inpatient standards. She tells me about her devasting cancer diagnosis. She wants me to call her original surgeon who works at the downtown hospital. She trusts him implicitly as he saved her life two years ago. She had been told that surgery was too risky yet without it, her prognosis far worse.

“I told him, because he didn’t want to do the surgery either, that if he took a chance on me, I promised not to squander even one minute of the time I was given. And I haven’t.”

I want to know more, want to know how she has spent her found time, this gift she was given. Maybe I can learn how to live my life better. But I must move on, the buzzing in my pocket is incessant.

My job as hospitalist is to assess newly admitted patients and form a plan for their care. There is a need to consistently revisit the diagnosis and adjust the plan accordingly, as first impressions can be wrong and cognitive anchoring is dangerous. I talk to nurses, pharmacists and specialists, read old notes and review test results. I spend time at the patients’ bedside and provide family updates, while order tests and medications, and write progress notes and discharge summaries. Throughout the day, there is a constant bombardment of distractions, that derail my train of thought. Electronic chats pop-up, and my phone rings with urgent issues that need my immediate attention.

Constantly being pulled in different directions wears me down. By the end of the week, I feel like my brain is quite literally mush and it is hard to form an original thought. I feel as though I have been wiped clean like rooms post patient discharge. However, if you were to ask me what Mr. Pearson’s potassium level was today or when Bed 116’s MRI is booked for, I would be able to answer without skipping a beat. After days on the hospital ward, I am deeply entrenched in the lives of these patients.

I attend a meeting with an elderly male patient and the social worker, while his son joins on the phone. His family refuses to have him come back to live with them. Throughout the week I have heard from staff about his personality and behaviour towards the staff. Perusing the chart, I gather second-hand information about his family’s position. His son and daughter in law took him in when he had nowhere else to go but their relationship has been strained for decades. The nurse manager is frustrated. The measure of her success is the movement of bodies through this building. He cannot be a wrench in her gears. I hear judgement in her voice—how can a family close their doors to their father? Who would do such a thing?

But I am curious. Instead of running from room to room, putting out fires and dictating notes that will likely go unread, I would rather spend the day understanding this man’s story. Who is he now and who was he in the past? What happened in this family to bring them to this time and place where I now insert myself in their lives? We may think we have all the answers, but we rarely ask the right questions.

My local colleagues have all given up inpatient work, each for their own reasons. I plug on, abandoning my family practice for a week, spending ten-hour days at the hospital and turning my brain to mush.

“Why do you still do it?” they ask.

There is never just one reason. I like the challenge of the medicine and the familiarity of our hospital. For the most part, I keep coming back for the chance to dip into someone’s story. To gain understanding of their context. Maybe I will find a nugget that will make a difference—a more accurate diagnosis or a better plan—or maybe I’ll make a meaningful connection.

It is late Friday afternoon, and I want to get home. There is one more patient to see whom I’ve left to the end. I lean against the radiant heater in room 107 and my body starts to relax. He talks about his prior experiences in hospitals and their effect on him. I tune into this patient, this person, as we explore his fears about his upcoming bypass surgery. I wish him good luck, realizing that it is moments like these that are truly why I keep coming back.

As I leave the room, I glance at my clipboard and find his name. Not surprisingly, there is no little box to check off, but I am deeply satisfied just the same.