The 3 Tiers

All institutions have tiers. Somebody or a bunch of somebodies at the top, and then various steps down from there until the very bottom, the dishwasher, the old woman scrubbing floors on her knees, the clerk that just started in the union, the messengers, the mailroom, the guy who cleans the door handles (HMS Pinafore) and so on.

In the business world, the tier you inhabit may actually correlate to what floor you occupy, i.e. not very many corporate presidents have offices in the basement.

I could have just skipped that entire opening, since this is about two tiers in the health business, but I like the idea of the wide panoramic shot, zooming in to the subject in extreme close up.

Obviously, I tell this from the p.o.v. of two years of being a patient, which in terms of tiers is close to the bottom.


The doctor, usually a specialist is at the top of the food chain in terms of what is done to or for you. In the typical hospital, after the initial diagnosis, you see them the least.

They order tests for you. Stop by while making rounds with other “white coats.” Maybe one a week. Depending on your condition and how many patients they have.

The white coats come in different lengths. Usually the attending physician has the longest coat. The ducklings that follow them around,residents et. al. have shorter jackets.

And if you should be introduced to an old graybeard in an ordinary suit who asks you to wrinkle your brow, or wiggle your tongue around then you are in the presence of a top healer, with an excellent track record, that doesn’t need a uniform of any kid. He is that revered in his line of work.

In my case that was the stroke dept. and I was diagnosed with my first stroke by this old man who asked me to furrow my brow. Who asked me to wriggle my tongue back and forth. And in front of white jackets declared I had had a stroke.

Of course he missed a bunch of other ailments I had that contributed to my condition but nobody is perfect.

I was rushed to the neuro ward, and spent a few weeks being poked and prodded the way they do at hospitals, with various roommates coming and going, food that I wouldn’t feed to a sick person, and completely deprived of sleep.

It seemed as if thousands of white coats would come by (it was a teaching hospital) and ask me the same questions every day: did I know where I was, what was the date, could I count backwards from a hundred, and the one test I initially failed, draw an analog clock.

They shone bright lights ins my eyes to see if the retinas closed fast enough. Or the pupils. They pressed down on my elbows when they were in the “chicken” position to test what strength I had.

They constantly rubbed both legs and asked if they felt the same or different.

And they were on a search for reflexes. But couldn’t find any tho they hit me for hours with hammers.

They did things with tuning forks, electric needles, and even did a spinal tap which really does hurt like hell if yiu hit a nerve.

The spinal tap was the most painful. Yes, a white coat student did it and I was sitting on a chair in my room, backwards, so they had access to the spine, and it is a delicate maneuver I guess because once she veered to far to the left and I saw stars, possibly ferris wheels as well, and screamed, and once she went to someplace that was attached to my testicles and I yelled BINGO! You hit the JACKPOT. And she said, sorry.

That of course is another subject about doctors everywhere: please don’t say this might cause some slight discomfort when you know it is going to cause excruciating pain.

(to be continued)

And so I was interrupted by PT as I was going through the three tiers. One of my knees ended up buckling towards the end of my session (happened once before) and I ended up sitting on the foot pedals of the wheelchair.

I was picked up by three women and seated in wheelchair again. So that was the delay. I’ll go on with the tiers in the next post.

Published by Dave

My name is David Beckerman. I am a fine art photographer working in New York City. Or I was before I had two strokes. I now write from a Nursing Home.

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