Of they may occur as a slow response to nurses for ridiculous cross-cover calls. A pervasive sense of cynicism develops as another means of coping. By now the emphasis has shifted from helping others to energy conservation and managing time efficiently. This is evident in the language used. The classic example is the veteran male who is emergently transferred to the VA hospital once a military service record is established.
Survival becomes a peculiar game, one that frequently neglects the patients' best interests.
The game may necessitate coercing other departments into providing the consultation or needed tests. On weekends or after hours at the VA, it means relying on hope and prayer that the patients will not get sick, because it requires even more than the normal hassle to get basic laboratory or Y-rays done. The hours are frequently spent dealing with the patients' social issues, rather than the medical illnesses. Alcoholics initially present with massive gastrointestinal bleeds, are transfused, treated, and released only to return bleeding again after yet another drinking binge. By this time the syndrome has taken it's toll.