The lobby of the main entrance to Yale New Haven Hospital’s Saint Raphael Campus was cold and quiet. I was there, waiting for Dr. Lisa Sanders, at 7 a.m. on a Wednesday morning—early for the average person, but normal, if not late, for the average doctor. Aside from the security woman leaning absent-mindedly on a stray podium in the far-left corner, I was alone. The occasional pack of medical residents rushed by with crisp white coats and Starbucks coffees, but they were gone before I could even register their faces. Bursts of energy followed by stillness.
At exactly 7:30 a.m., I looked down the hallway to find a woman whom I assumed to be Sanders walking briskly towards me. If not for our direct eye contact, she would’ve been just another white coat rushing off and away. But as the sound of her clicking heels came closer, I was sure that the journalist-turned-doctor-turned-Netflix celebrity was approaching.
Sanders has the focus of a doctor and the attitude of a television star. She features in Diagnosis, a Netflix docuseries, which aired this summer. And that’s just her latest media success; the new show is based on both Sanders’ book by the same name and her column for The New York Times. The column, which crowdsources diagnoses for perplexing medical cases, also inspired House, the popular Fox series about a doctor who brilliantly (if overdramatically) solves medical mysteries. Her gripping narratives and investigative expertise—evidence of her background as an English major at William & Mary College and Emmy Award-winning journalist at CBS News—have garnered a cult-like following. The numerous media projects Sanders has undertaken have been immensely popular, and yet, as I follow her into a dated family care room, I’m reminded that she is, first and foremost, a doctor. As a writer and an aspiring doctor myself, I’m eager to see how her perspective as a storyteller informs her medical practice.
Beneath Sanders’ white coat, she wears a bright red dress, accented by a scarf and matching red, pointed heels. She has double ear piercings—pairs of pearls and gold seashells—and rimless glasses that are as gentle and keen as the face they sit on. Two pens, a thin stack of notecards, and a phone rest neatly in her front coat pocket, and her pixie cut gives off what I can only describe as cool-mom vibes.
We walk over to join her team outside the room and I’m introduced to the two residents, two interns, and lone medical student in Sanders’ service for the week. A few residents stop to give her hurried, only semi-coherent updates, and I learn afterward that they haven’t slept in twenty-eight hours. Sanders begins every day at 5 a.m.
In the room, case after case is reviewed to prep before rounds—a ritual in teaching hospitals like Yale New Haven that gives residents and medical students an opportunity to present a patient’s case to senior physicians. Stacks of paper are balanced on books balanced on legs, phones sit precariously on knees, laptops and iPads teeter on the arms of chairs, and small notebooks are held up with whatever limb is not occupied. The mood is lighthearted and calm, reminding me of the countless scenes from House where Dr. House, the protagonist, casually pours himself coffee while discussing the near-death of a patient.
A man was brought to Yale New Haven last night after overdosing on opioids. He’d likely be dead if his friend hadn’t immediately administered Narcan and brought him to the hospital. An overwhelmingly complex narrative unfolds before me as the medical students talk. Heroin. Cocaine. Marijuana. Cigarettes. Released just last Friday from prison. A fifteen-month-long sentence for a ninety-milligram possession charge. Light banter and the occasional laugh punctuates the story. Someone pulls out a granola bar and takes a few bites. History of Hepatitis C. Diabetes. I learn that during the first week after release from jail, drug overdose mortality rates are significantly higher. “Policy failure or policy success?” a resident jokes, in response to this fact.
Sanders sits quietly on a worn couch at the end of the room, legs crossed in a gesture that suggests both ease and acute awareness. “He’s lucky to be here,” she says. Her words cut the room. For a second, the sleep-deprivation-induced relaxation dissipates as Sanders reminds everyone that last night, someone almost died.
As the team begins to formulate a plan of action, a resident asks how best to ask a patient for permission to administer HIV and Hepatitis C tests. Sanders never hurries to answer questions, always letting a mildly unsettling bit of silence hover in the room before giving her own thoughts. But this time she jumps in. “Remember—you don’t have to get consent. You just inform and they can decline.” Put simply, her answer was a don’t-explicitly-give-them-the-option-of-saying-no ploy. And with that, everyone in the room knew that they would simply be “informing” today, telling the patient that they would be receiving a test, and waiting obligatorily for an answer that the patient likely didn’t know was an option.
She warns her team about the consequences of bringing patients to the Hep C clinic. The Hep C treatment program “takes real adherence,” she says. And from the patient’s perspective, “it’s hard with anonymous white guys telling [them] what to do,” she adds. The team eventually agrees on calling Addiction Services, a pilot program at Yale New Haven that launched in 2017 and seeks to treat patients’ addictions while they’re in the hospital rather than refer them to a treatment center after discharge, the common practice elsewhere.
They talk through a few more cases. One patient has had a potential stroke but is refusing to undergo a critical MRI because she is scared—not of what the test may show, but of the machine itself. Another patient refuses to leave despite being stable and cleared for discharge. A man who needs a right heart catheterization discovers his insurance has refused to pay for his hospitalization. I feel behind and incapable of catching up, stuck processing for the first time things that the people around me have evidently encountered hundreds if not thousands of times before. I wonder if and when hospital workers became desensitized.
Before entering each patient’s room, the team huddles, like a high school soccer team before kickoff. Someone quickly runs over the game plan, and Sanders offers a few final words before letting her players loose.
She later explains to me that she thinks of her job as a supervisor to the residents the same way she thought of herself as a mother to her teenage daughters. For both, she says, “My goal was to allow them to have a wide variety of experiences, as long as they didn’t get hurt.” As the daughter of a mother who had the very same parenting approach, I knew exactly what Sanders meant. The long pauses and quiet observation made sense. “They don’t have to do things my way,” she says. “As long as they aren’t going to do anything that hurts anybody.”
“But it’s very hard for me to shut up,” she adds.
For the patient who refuses to leave despite being stable and cleared for discharge, Sanders tells her team to focus on making the patient’s husband comfortable “because if he’s comfortable, she’s comfortable.” Sanders’ advice makes perfect sense, and yet, patient care can become so technical that some medical professionals forget that a patient is a human being, influenced by their surroundings and relationships. This woman likely trusts her husband infinitely more than she will ever trust a group of young, fresh-eyed budding doctors. Why try to win her over when he is right there?
As I follow Sanders into a dated family care room, I’m reminded that she is, first and foremost, a doctor.
Faced with the woman who refused to submit to an MRI, Sanders’s approach was strategic: emphasize how seriously we take the patient’s concerns, tap into your 7-year-old self manipulating your mom, and remember that it’s all about what the patient wants. Sanders ended by saying, “We sell the right thing to do while still telling the truth.”
Dr. Sanders credits her unorthodox literary background for her extraordinary ability to connect with patients. Studying the humanities as an undergraduate conditioned her to be “used to uncertainty”—something she says that many doctors struggle with. In medical school, Sanders points out, students learn the science in black and white. They have to pass multiple-choice tests with right and wrong answers. But, as Sanders says, “It’s not that way in medicine.”
“Coming up with the right answer is meaningless unless you can make it make sense to a patient,” Sanders adds, reminding me of my former English professor who always advised me to “remember [my] audience” when I wrote. Sanders has mastered this storytelling technique both on and off the paper.
In the patient rooms, Sanders camouflages herself. She leans on the hospital room trash can near the foot of the patients’ bed and stands quietly behind her team as they take turns giving patients updates and answering questions from loved ones. With her small stack of notecards in hand, Sanders jots down the occasional observation, shuffling cards as she goes. I later learn that she keeps these cards to remember ways her team could improve.
When Sanders did talk to patients, I was struck by how blunt she was. It’s one thing to be straightforward with jaded, stubborn fourth-year residents, and another to be blunt with the person in the hospital bed. Looking straight into the eyes of the patient who had overdosed on opioids the night before, Sanders said: “You’ve used heroin for years, so you know: The goal of addiction medicine, and ours, is to give you the tools you need to get it under control. You’ve been in the business for a while now,” she said. “You know it’s not under control.”
Her words cut the room. For a second, the sleep-deprivation-induced relaxation dissipates as Sanders reminds everyone that last night, someone almost died.
Perhaps the most intimate interaction I witnessed between Sanders and a patient was with the man whose insurance refused to pay for his hospitalization. Hospital costs average $3,949 per day and each hospital stay costs an average of $15,734, according to debt.org. Both the patient and Sanders knew he couldn’t afford a stay. Sanders walked into his room, arms crossed and ready for what she would later tell me was a disturbingly typical situation. “Your insurance company is saying ‘Why are you in the hospital?’ I am going to wrestle them to the mat, but you have to be ready if I lose.” The patient was frustrated with a system that neither he—nor most Americans—could understand. If he could have jumped up from the worn, tattered arm chair beside his hospital bed, he would have. But he couldn’t. So he said aloud, to no one in particular, “I’m gonna fight. I don’t want to be here. I don’t want to be sick. I have a life to live.”
To anyone who has watched their fair share of medical dramas, that line may sound familiar. I grew up watching, reading, and hearing stories about this exact situation. Yet as it unfolded in real time right in front of me, I was taken aback. Sanders was unwavering. She sat down on the edge of his empty bed, looked him in the eye, and firmly said: “I tell you this because I want you to know. I’m not the one who’s gonna end up with the bill. You are.” The patient fell silent after this, glancing away as Sanders sat with him, her legs crossed, hands rested over her knees, the sharp tip of her bright red stiletto heel barely touching the toe of his hospital-issued-sock-covered foot. This was the uncertainty that Sanders, unlike many doctors, feels at ease handling. She shines in moments like these. I was reminded that, in addition to being a doctor, Sanders is a mystery hunter, writer, and solver.
After I told Sanders I hoped to be a doctor, she warned me of what lay ahead. “You don’t get through medical school unless you perform the way the system wants you to perform. So doctors, by the time they get through medical school, are specialists at identifying what is expected of them. When you get paid more, that’s a way of telling you what you’re supposed to do.” She managed to avoid this path. But could I?
For now, Sanders is focused on wrapping up what she calls her “Netflix elective.” When she’s done with that, she hopes to negotiate a sort of semi-residency with Yale New Haven Hospital’s dermatology department to increase her exposure to a field in which she has little experience. “I want to know more so I have more to teach…You don’t go into medicine unless you’re committed to lifelong learning.”
As I gathered my things, Sanders repeated something she’d heard the Dean of Yale’s medical school say on opening day this year. “Fifty percent of what you learn in medical school is going to be wrong. Unfortunately, I can’t tell you which 50 percent.”
On television and in her writing, Sanders guides her readers and viewers through a search for the right answers to rare medical mysteries. But in person, she seems more comfortable with not knowing all the solutions. She’s determined to make people realize that uncertainty is inevitable, and that we must learn to be content with that fact.
—Katherine Yao is a sophomore in Jonathan Edwards College.
