By Alexandra Robbins

Welcome to the land of health care’s 1 percent. During the four years I spent interviewing and following nurses for my book, I was continually astonished by the red carpet some hospitals rolled out for certain classes of patients. A Virginia nurse explained that this is why Washington might not understand health care. He said, “Politicians have such a warped sense of how the health care system works because they never have to be part of the actual system.”

Politicians and other VIPs, it turns out, can get special access to critical care. Hospitals across the Washington area—and, indeed, across the country—have exclusive rooms and sometimes even separate floors for treating the rich and famous.

That surprise was hardly the only secret that transformed the way I understand the world of medicine while writing my book. If you want to know what’s really happening in a medical building, don’t ask a doctor. Instead, turn to the best-informed, hardest-working and savviest professionals in health care: Nurses.

Many nurses call their profession—3.5 million strong in the United States and more than 20 million worldwide—a “secret club.” In the years I spent going behind the scenes in hospitals, I learned why. Their experiences are so novel, their jobs so intimate and occasionally horrifying, their combination of compassion and desensitization so peculiar, that nobody else could possibly understand what it is like to work in their once-white shoes.

“Doctors breeze in and out. They do not share the most intimate moments with the patients, but they are the ‘important’ ones who get the media accolades,” a New Jersey nurse practitioner told me. “It is the nurse who holds the hand of a patient without a family, who talks to them while they take their last breaths. It is the nurse who cleans the patient’s body, wipes away the blood and fluids, and who says goodbye to the patient for the last time.”

And it’s the nurse who knows best what really goes on in the florescent-lit, often-dizzying world of IVs, open-heart surgeries and oxygen monitors. Here are some of the health care secrets they told me.

Listen up—some of them might just save your life.

Don’t get sick in July. Every year in teaching hospitals at the start of July, medical students become interns, interns become residents and each successive class of residents moves up a level. These new doctors are immediately thrust into direct patient care. “On day one, new interns may have the same responsibilities that the now-second-year residents had at the end of June (i.e., after they had a full year of experience).”

This upheaval causes what health care workers call “The July Effect” in the United States and “August Killing Season” in the United Kingdom (where the shift happens in August). The changeover harms patient care, increasing medical errors, medication mistakes and the length of hospital stays. In July, U.S. death rates in these hospitals surge between 8 and 34 percent—a total of between 1,500 and 2,750 deaths. University researchers found that fatal medication errors “spike by 10 percent in July and in no other month.” In Britain, August mortality rates rise by 6 to 8 percent as new doctors are tasked with surgeries and procedures that Britons say are “beyond their capabilities.” Patients in English hospitals have a higher early death rate when they are admitted on the first Wednesday in August than patients admitted on the previous Wednesday.

The residents who know enough to know what they do not know—and therefore listen to and seek out nurses for advice—are not the problem here. But too many residents, enamored of their M.D., won’t ask for help. “Nurses are correcting every error and preventing major mistakes every day,” said a Maryland solid organ transplant nurse.

If you must be hospitalized in July for particularly complex procedures, you might consider avoiding teaching hospitals.

Sometimes we are told to treat certain patients better. Many hospitals treat VIPs better than the average patient, saving deluxe private rooms for the celebrities, politicians and officials who know about them. While some luxury rooms are available to any patient who can pay for them, others are kept secret.

A Washington, D.C., hospital has a VIP unit devoted to patients such as visiting foreign dignitaries, senators and professional football players. “It doesn’t have typical hospital furnishings—the rooms are much bigger, with fancy bedspreads, decorative pillows and lavish curtains,” said a Maryland nurse who used to work at the hospital. “The patients are served excellent food—much better than the food on the regular floors—and they are given anything they request; the nurses cater to their every whim. It’s a restricted floor, with no access from the regular elevators. Most people don’t even know this floor exists.”

Across the country, nurses described VIP accommodations that look more like spacious luxury hotel suites than hospital rooms, with kitchenettes, beautifully glass-tiled bathrooms and other amenities. In one Washington State hospital, when a VIP comes in, the staff combines two rooms to make a large one. They are instructed to bring in a large-screen TV and the “VIP furniture.” After the VIP is discharged, a nurse there said, the furniture is removed and stored until the next VIP admission. “They do this for rich and influential people and we nurses are disgusted by it. Nurses are taught to treat each patient as an important person and to give our best care to each one of those patients,” she said.

VIP care becomes problematic when those patients unnecessarily take up resources that more critical patients need. “Sometimes they will get a one-on-one nurse or we are all told to give them extra special treatment,” said a New Jersey nurse. “I have seen critical patients who should be next to the nursing station moved so that a relation of a board member, a big donor, or celebrity could have the better room even if their condition didn’t warrant that level of observation. At another local hospital they had an entire VIP section set aside; those rooms were not to be used for the riffraff.”

Every hospital at which the Virginia nurse has worked had “a couple of rooms, if not a floor, dedicated to VIPs, which is often hidden. At one hospital, there was a room specifically maintained only for the use of a very famous person with a very crappy heart. They’ll get the best food, the nicest rooms, the most accommodating physicians and the nurses who are easiest to push over. The hospital left the VIP section completely empty unless a VIP was present. No intermingling.”

Some doctors and nurses are placing bets about you. Several nurses around the country confessed that hospital staffers have wagered on patients. “Guess the Blood Alcohol” is a common game, where actual money changes hands. Other staff members try to guess the injuries of a patient arriving via ambulance. And surgeons have been observed playing “games of chance” during operations, placing bets on outcomes of risky procedures.