Wishwdeep Dhillon

I recently arrived back in the U.S. from a sub-internship rotation in anesthesiology at a university hospital in Austria. Before heading abroad, I’d expected to enjoy the Viennoiserie in the hospital bakery and learn airway management and regional blocks. What I did not expect was a sustained meditation on what a healthcare system’s values look like when translated into daily practice.

A friend of mine, a nurse, sent an email one morning pointing out a safety issue. Nothing dramatic. Just something she noticed that didn’t seem right, the kind of thing medicine tells us constantly that we should speak up about. See something. Say something. Shortly after she sent it, her phone rang. Leadership. Not to discuss the safety issue itself, but to advise her to be careful about putting concerns like that in writing.

She came in for Botox. That was the chief complaint — if you can call it that — written on the intake form in neat, careful handwriting. Botox. Forehead lines. Maybe filler. She was in her 50s, a retired schoolteacher, and she had driven more than 30 minutes to reach my office. She sat in the chair with the particular uprightness of someone who had practiced appearing composed, and when I asked her what she was hoping to achieve, she looked at her hands for a moment before answering.