A Walk in Their Shoes
Date: June 7, 2010
A resident's desire to better know his patients leads physicians to the docks and shipyards of Baltimore.
Sheldon Gottlieb has treated patients who load and unload ships, drive heavy equipment at the docks, and monitor the flow of cargo through one of the nation’s busiest ports. Over the years, he has often wondered about the world framed by the tall, elegant cranes he can see from the hilltop campus.
But it wasn’t until the Bayview cardiologist visited Seagirt and Dundalk Marine terminals last month that he actually observed the work conditions of longshoremen and women, and also gained a sense of their challenging schedule.
“I didn’t realize how intense the atmosphere was,” he says. “Even in the bus, I could really feel the energy and how relentless the pace of the work is.”
Gottlieb was one of roughly 30 Hopkins physicians on a rare guided tour of the two Port of Baltimore terminals only three miles from their offices. Organized by Adam Possner, one of the chief residents of Johns Hopkins Bayview Medical Center’s internal medicine residency program, the two-hour journey brought the providers into a striking industrial landscape. They took photos of brightly colored containers, some stacked high enough to create temporary city blocks, and of high-tech and heavy-equipment vehicles, while a guide described the complex operation of the terminals.
For academics who are increasingly used to iPhone-size tasks, the outing was a powerful reminder of the satisfactions and stresses of physical labor. You might also consider it a preliminary step in the medical history-taking of an entire community.
“It’s a way of putting on the patient’s shoes, if not exactly walking in them,” Possner says. “Mostly patients come to us and everything revolves around us and our exam rooms. This way you can see where someone works, which helps you empathize and connect more deeply with them.”
Because of the port’s Homeland Security concerns, the outing took many months to arrange. Except for a brief stop for photo-taking, the group remained on the bus under the watch of communications and risk-management personnel from Ports America, the company that operates the two terminals.
“Longshoremen are the guys you [doctors] probably see the most of,” says guide Darren Thompson, a yard manager at Dundalk Marine Terminal. “They are at the highest risk of getting injured. One of the most physical jobs here is lashing and unlashing cargo. That’s where strains, pulled backs and slipped disks can happen.”
However that doesn’t mean that the work of equipment operators is less demanding. “Being a crane operator is a high-skill, high-stress job. A lot of guys have been doing it for 40 years, and if they take three days vacation a year, that’s a lot.”
Long hours also take a nutritional toll. “It’s hard to get a healthy salad somewhere when you get off your shift at 2 in the morning,” Thompson told the physicians.
Eager to learn more about the lives of his patients, Adam Possner began investigating industrial areas of Dundalk as a first-year resident. With the support of David Hellmann, vice dean and chair of medicine at Bayview, Possner organized the first Hopkins group tour at the steel mill at Sparrows Point two years ago.
Hellmann says such outings embody medical pioneer William Osler’s belief that “It is much more important to know what sort of patient has a disease than what sort of a disease a patient has.”
“Certainly one of the best ways to get to know the patient as a person is to visit where he or she works,” he points out.
Alicia Arbaje, a physician in geriatric medicine, says her experience at the terminal will help her understand the work history of elderly patients as well as the challenges faced by family caregivers employed there.
“Many of our patients depend on family help in taking medicines and getting to their appointments,” she says. “A caregiver’s work schedule may make me choose medicines that have less frequent doses during the day—or assess whether a patient needs other community services I can help obtain.”
Gottlieb used his new knowledge recently when treating a 350-pound worker admitted to Bayview for “sky-high” blood pressure and heart failure. The 27-year-old man told him that he worked part-time driving cars on and off ships.
“Oh, you mean the Ro-Ro ships?” Gottlieb asked, using port slang for the vessels that carry wheeled cargo.
“He gave me this big smile, like a kid who’d been recognized for doing something special,” the doctor recalls. Before long, they were discussing various aspects of his work and reasons behind the large amount of weight the patient had gained in only one year. The young man said that because of his low seniority in the union, he never knew when he’d be called in to work and that the lack of control over his schedule was stressful. He also told the doctor about other difficulties, such as snoring and fitful sleeping.
“We were able to have a very real, fluid conversation about things he wouldn’t ordinarily have mentioned to me,” Gottlieb says. “In this case, he knew that I understood what he was all about.”
For information about upcoming tours, contact
Jennifer Cheng at email@example.com.