The Intern Blues (24 page)

Amy

DECEMBER 1985

Sunday, December 1, 1985

This internship is really rotten. There's nothing about it that I like. The only thing that gives me any kind of enjoyment right now is Sarah, and I can't even really enjoy being with her because in the back of my mind I always know that I'm going to have to be back at the hospital soon. And when I'm in the hospital, I spend my time with all these nice children who have terrible things wrong with them, and I know I'm going to have to watch them get sicker and sicker for thirty-six hours at a stretch. I don't know, I have pictures of about a half dozen of these children burned into my mind. I haven't been able to forget the little girl I saw in the ER last week who was sexually abused; I've been thinking about her constantly. There's her, that leukemic who died on Adolescent, and a couple of others.

I've been thinking this weekend that if I knew then what I know now, I never would have done this internship. Everything's so hopeless; I'm so hopeless. It isn't even half over yet, I just got back from vacation, and I'm already so tired of all of it! I don't know what I'm going to do. I don't know what I can do.

Mike Miller called me into his office last week. He told me some of the people in the department were kind of upset with my attitude. Screw them! He said there were some people who thought I wasn't taking the job seriously enough. Terrific, just terrific! I asked Mike how many of these people had to take night call every third night with a baby at home. How many of them had to neglect their responsibilities as a parent in order to work in the hospital? I told him I was doing the best I could and if he or anybody else didn't like it, he should just fire me! He said it wasn't him, that he understood what was going on, but that this had come up at some meeting they had had and he had been the one who was supposed to have a talk with me about it.

He also asked if I wanted to come back as a junior resident next year. He said he needed to know within a few days. I told him I'd have to think about it. After what he'd said to me I was pretty damned angry and I seriously thought of going in and telling him to go fuck himself, that I wouldn't be coming back next year or ever again. But after I cooled off a little, I finally told him on Friday that I would be back. I don't know. I could have taken a year or two off; Larry was encouraging me to do whatever I thought was best, and for a while, taking some time off made a lot of sense. But then, after I'd been working in the emergency room for a while, I figured this wasn't too bad and I thought I could stick it out. I still have the feeling that if I were to decide to take some time off, I'd have a lot of trouble getting myself motivated enough to get back into it. But this whole weekend, I've been thinking, maybe I made a mistake. Maybe staying isn't such a good idea. The problem is, I don't know what I can do about it now.

I'm doing Children's at Mount Scopus this month. It was good to get out of the Jonas Bronck ER. The actual work there isn't so bad; it's just that there are so many bad things that happen to the kids who come in, like that sexually abused girl. Seeing kids like that every day gets to be too much pretty quickly.

Coming to Mount Scopus isn't great either. It seems like everybody has an attitude, all the nurses and the clerks. They all seem to resent having us around, like we're getting in the way of their work or something. This week, Harrison
[Harrison Boyd, the other intern on the Northwest 5 Children's team]
wrote a q4h order for Demerol
[an order for the pain killer Demerol to be given every four hours, around the clock]
for this five-year-old with sickle-cell disease who was in with a painful crisis. One of the nurses came up to him while we were on work rounds and said, “We don't give pain meds q4h on this floor.” Just like that; she simply refused to do it. Harrison told her that the child was in a lot of pain and he thought she required medication around the clock. The nurse told him it didn't matter, the rules are that they can only give pain meds on a prn basis
[prn: as needed]
. So now this little girl has to feel pain and beg for her medication before someone will give it to her. The nurses say they're afraid a q4h order will make the patient addicted. They say they're afraid they'll wind up turning the child into a drug addict. Turn a five-year-old into a drug addict? That's a lot of nonsense. But that's the way things are done at Mount Scopus, and there's nothing you can do to change it.

There aren't a lot of patients on the ward right now, and most of the ones who are there are just post-op cleft lips and palates
[Mount Scopus has a large craniofacial center]
. We do have a couple of fairly sick patients, and one of them is mine. She's a really sad case: She's a ten-year-old with neurofibromatosis.
[This is an inherited disorder in which, for reasons that are not yet clear, the affected individual may develop dark pigmented spots and a variety of tumors of the skin, optic nerve, the brain, and other internal organs. Most people with neurofibromatosis live a normal life; some are severely deformed.]
She was perfectly well until last week, when she started having trouble urinating. Her mother brought her to the ER last Tuesday and they did a KUB
[X ray of the abdomen; called KUB for kidneys, ureters, and bladder]
and found she had a big mass in her pelvis. Then they did a chest X ray and found another tumor in her lung. She was admitted to Children's, and on Thursday she had a CT scan that showed she also had a brain tumor. They're taking her to the OR tomorrow to biopsy the pelvic and the lung tumors, but the oncologists don't think she's going to do very well. It's too bad, too; she seems like she could have been a nice, normal girl.

Wednesday, December 4, 1985

It's getting cold. It's really turning into winter, and I don't know if I'm ready for that to happen yet. I guess I'm kind of depressed and the weather isn't helping things any.

Things on the ward are getting worse. This morning a little girl with sickle-cell disease died while we were on work rounds. She had been admitted a few hours before with what looked like pneumonia. Harrison had brought her up from the emergency room, started her on antibiotics, put her on oxygen, and went on with the rest of his work. At about eight-fifteen, while we were on work rounds, the girl's mother came up to us and said her daughter was breathing funny. We ran into the room and watched as she arrested. We called a code, and people started flying into the room from all over the place. We worked on her for over an hour, but we never got her pulse back. Her mother was hysterical. It was completely unexpected. After it was over, Harrison locked himself into the on-call room and wouldn't come out. It was terrible. And we still have no idea what happened or why it happened.

On Monday I admitted six new patients, which is busy for Children's. Most of them were pre-ops for Tuesday, but they still needed to be worked up and have bloods drawn and all the rest of the endless scut that goes with an admission. I tried to get my student to help, but she simply refused. I don't know what it is with these medical students; when I was doing my clerkships, I'd sooner jump out a window than tell my intern I wasn't going to do the things he or she asked.

Angela, that girl with neurofibromatosis, is not doing well at all. She went to the OR on Monday to have her tumors biopsied. They turned out to be different types of malignancies, which is very unusual. It's also terrible in terms of her prognosis. She spent Monday night in the ICU and then came down to the ward again on Tuesday. The oncologists are talking about what they're going to do with her, it looks like she's going to need both chemo and radiation, but they have to decide which order to do them in and when to start. Nobody's said anything to Angela yet. I think she knows, though. She's pretty smart and she seems very sad.

I went to talk to Mike Miller today about next year. I went up to his office, and when he saw me standing there, he said, “Amy, what's wrong?” I guess my face told him I was upset. I went into his office and we closed the door and I started telling him everything that had been happening, and about five minutes into it I started crying and I just couldn't stop. He held my hand and tried to calm me down, but I just couldn't stop crying. I cried for fifteen, twenty minutes. I knew he was starting to get bored with me so I tried hard to control myself and finally I stopped. I told him I wasn't sure whether I wanted to come back next year. He told me he understood and that whatever I wanted to do would be okay but that I had to sit down and give it some serious thought, taking everything into account before making up my mind. He said he'd hold off submitting my name for reappointment for another few days but I should try to get back to him by sometime next week. Then I left and went back to the ward.

That's the first time that ever happened to me. I'm not a crier. The last time I remember crying is when my mother died. This isn't nearly as bad as that was, so I'm kind of surprised. I don't know, maybe it's because I'm so tired, or because working in the Bronx is so depressing, or maybe it's because I miss Sarah so much and I know I'm missing so much of her infancy. All I know is, if the rest of internship is going to be like this, I'm never going to make it.

Sunday, December 15, 1985

I haven't recorded anything in a while. I've been going through a very difficult time. I think I'm finally out of my depression, though. I don't know why that happened. Nothing's changed; I'm not spending any more time with my family, the work on the ward is just about the same, but for some reason I'm feeling a little better.

Maybe one thing that made me feel a little better is that I finally made a decision about next year. I went to see Mike Miller again last week and told him I had decided to stay. He seemed relieved to hear it and then he said some nice things to me. He told me he had been very upset after our conversation the day I broke down in his office and that he was glad I had decided to stay because he thought I'd make a good resident. I don't know whether he meant it or not, especially after what he told me about that meeting the faculty had last month, but it still was a nice thing for him to say. It made me feel good to hear it.

Sarah stood up by herself for the first time yesterday. I was on call, of course, so I didn't get to see it, but Larry called me at work to tell me. He said he and Sarah had been sitting on the floor of the living room and at one point she just climbed up the edge of the couch and stood there. She isn't even nine months old yet! She's done everything early; she sat at five months, so I'm not surprised she stood by herself so young. She's like a miracle; it's absolutely amazing just to be around her and watch as she grows and develops. I've been so worried, but she seems to be a normal, well-adjusted little girl. Maybe she's better off with me at work; maybe Marie is doing a better job with her than I would have.

Things at work are about the same. Angela is getting worse; we started her on chemotherapy about a week ago, but it isn't doing any good. She had a seizure last week. We brought her out of it with IV Valium and Dilantin
[an anticonvulsant medication]
, but the seizure wasn't a good sign. She had a repeat CT scan a few hours after the seizure and it showed the tumor was larger than it had been before the biopsy. Right after the seizure, her mother, who's been at her bedside ever since Angela got here, told me for the first time that she thought Angela was going to die. Angela's going to start radiation therapy next week. Maybe that'll help; everyone doubts it, though. I hope they're wrong.

Sunday, December 22, 1985

Tomorrow's my last night on Children's. After that I go into the nursery at Jonas Bronck. I'm not looking forward to that. Nursery's the one rotation I'm really frightened of. My month on Children's wasn't all that bad. It would have been great had I not gotten so depressed in the middle of it. Children's is a good place; most of the patients are pretty healthy and almost everyone gets well without much work from us. Angela isn't getting better, though, and we're all getting depressed about that. I guess we've all come to accept the fact that she's going to die sometime soon. I just hope she holds out till Wednesday. I'd really rather not have her die on my time.

Mark

DECEMBER 1985

Tuesday, December 3, 1985

Well, I finally figured out how they decide what ward a kid'll go to when he gets admitted to Mount Scopus. If he still sleeps in a crib, they put him on Infants'; if he's out of the crib but hasn't committed any violent crime yet, they put him on Children's; and once he's committed his first violent crime, he automatically goes to Adolescent. Yes, what a wonderful experience it is to take care of ten- and eleven-year-olds wanted by the police in three states for armed robbery.

Okay, so maybe I'm exaggerating, but only a little. What a weird place this Adolescent ward is! As I see it, we've got three groups of patients. The first are those kids with truly medical problems; these are mainly kids with different types of cancers; they really make things pretty sad. The second are the girls with eating disorders like anorexia nervosa and bulimia; what a thrill it is to take care of eighteen-year-old girls who weigh seventy pounds and think they're too fat, and who spend the entire day exercising and trying to find places to hide their vomit. And the third group are the drug addicts who come in for detox and for antibiotics for their skin abscesses. Yes, this is all a very rewarding experience.

And, of course, everybody's got VD. I've had to do pelvic exams on everything that's come through the front door! At least on every female; I haven't had to do one on a male yet, but hey, the month's still young, and anything can happen. It doesn't even matter what they come in with, they always wind up having PID
[pelvic inflammatory disease, the common name for infection of one or more pelvic organs, usually caused by gonococcus, the bacteria that causes gonorrhea; PID is diagnosed by pelvic exam and confirmed by culture results]
.

Take this afternoon, for instance. I was on call last night so I wasn't supposed to get any admissions today, but there were a lot of electives scheduled and the other intern was at clinic, so they asked me to take a kid who came in at about three. Her only problem was an ASD
[atrial septal defect, a “hole” in the structure that separates the right and the left atria]
, and she was coming in for a cardiac cath.
[This is a test in which a catheter is passed through a blood vessel in the thigh and fed up to the heart. In pediatrics, cardiac caths usually are done on children with ASDs and other congenital malformations of the heart to better define the anatomy in preparation for surgical repair.]
A pretty straightforward case, right? Sure, until I started taking the damn social history. I made the mistake of asking her if she was sexually active, and she said she was. (At least she didn't say, “No, I just sort of lie there.” Someone once told me they actually had a patient who said that.) Then I asked if she used any form of contraception and she said she didn't. So I asked if she wanted to be pregnant and she said no, and I started to go into my “If you don't want to be pregnant, you have to use contraception” speech, but she interrupted me and said that she knew about that, and in fact, every time she does get pregnant, she just has an abortion. “In fact,” she said, “I had one just last month and, now that you mention it, ever since, I've had this smelly, white discharge. Do you think it might be serious?”

That's when I realized that even this, even this simple, straightforward cardiac cath admission, was going to require a pelvic exam and that even though I was post-call and exhausted, I was going to have to stay late and do it myself. But what could I do? You can't put something like that off; if she's got PID, we'd have to cancel the cath and start her on antibiotics. And a pelvic exam isn't something you can sign out to the person on call: “Oh, yeah, the cardiac cath I admitted needs to have her pre-op bloods checked, and I think she might have PID. So would you do a pelvic exam?” I don't think that'd go over real well, although I'm sure some of my co-interns have tried to pull stuff like that.

Anyway, I did the pelvic and it turned out she didn't have PID, just some nonspecific vagitch
[internese for vaginitis, an acute inflammation of the vagina]
, and that wasn't going to keep her from having her cath. But it did keep me from getting home until after seven. I missed going to my grandmother's for Tuesday night dinner. And now I'm so tired, all I can think about doing is going to bed.

You know, all these pelvic exams reminded me of something. When you're in college and medical school, you read all these books like
House of God
where the interns are spending half their lives in bed with the nurses, the social workers, and all the other females who populate the hospital. By the time I started this damn internship I knew those kind of things didn't really happen, but I did expect to continue to have at least some semblance of a sex life. But this week, spending so much time in the gynecology room doing pelvics diagnosing PID, I actually realized I have less interest in sex now than I ever remember having! It's scary. All I care about is getting to sleep. This might be the reason Carole hasn't been spending too much time with me over the past few weeks. I hope this is reversible.

Well, I'm going to sleep now. I've got to get my eight hours every other day or so.

Tuesday, December 10, 1985

I am furious! I can't believe they're doing this to me! I tried to be nice to them, to do them a favor when they needed it, and they wind up screwing me,
screwing me
in return! I just might kill the chief residents, all four of them. I know I've said that before, but this time I'm serious! I think I'll spend the next few hours figuring out exactly how I'm going to do it. Yeah, that might calm me down a little. I just can't believe they're really doing this to me!

It all started this afternoon. I was sitting around the nurses' station on Adolescent, saying how I couldn't wait for the month to be over because next month I'm scheduled to be on Children's and I love Children's. And Arlene, one of the chief residents, said, “Oh, haven't you heard? We had to pull you from Children's next month and put you on 6A.” She said that, after all, I had already done July on Children's and that there were some interns who were never scheduled to work there and it wouldn't be fair if I wound up doing two months and other people wound up doing none. I very calmly reminded her that I had only done a month on Children's because the chief residents needed someone to fill in when one of the subinterns didn't show up and they had promised that if I did them the favor, they wouldn't pull me from my regularly scheduled month. Arlene said she hadn't heard anything about that; all she knew was, I would have to spend the month on 6A. I should have pulled her head off right there while I had the chance.

Not only are they going to do this to me, not only are they going to take me away from the best rotation in the system, but also they're going to deprive me of working with Amy Sorenson; Amy Sorenson, who, in addition to being one of the smartest and friendliest of all the residents, also happens to be one of the best-looking. I've waited all year to work with her; I've even dreamed about it. It's one of the only things that's been keeping me going. And now they're making me switch to 6A, where my resident'll be Attila the Hun. And not only are they taking me from the best ward with the best resident and putting me on the worst ward with the worst resident, but also
they weren't even going to tell me about it until I showed up at the start of January rotation
! So what this means is I'm going to wind up doing a total of five weeks on 6A and three weeks of Children's. I'm getting screwed, and I'll tell you one thing: Even if I don't wind up killing the chiefs, you can bet I'll never be caught dead doing a favor for them again!

Friday, December 13, 1985

I'm waiting for Carole to come by. We're going out for dinner with Bob Marion and his wife, so I've got to make this quick. It looks like I won my battle, and I didn't even have to use force. When I showed up for work on Wednesday ready to go up to the chief residents' office to reenact some of the more gruesome parts of
The Texas Chain Saw Massacre
, Arlene came up to me in the hall and said, “Oh, we made a mistake. You don't really have to work on 6A next month after all.” Apparently the chiefs talked it over and decided they really couldn't screw me like that. That's kind of nice, but it threw me off guard. I mean, it's completely against their nature to be nice to interns. I have to assume they're setting me up for something. So now my problem is, I'm sure they're going to try to ambush me, but I'm not sure when. It would have been easier if they had forced me to do the month on 6A and I had just killed them; it would've taken all the guess work out of the next few weeks.

Well, the bell just rang. I guess that's Carole.

 

 

It's still Friday night,
or maybe it started being Saturday morning already. Yeah, it's twelve-thirty. I just got home. Carole and I had a big fight. What else is new? I'm such a wonderful conversationalist, so nice to be around. All I ever do is complain about work, and all she ever does is complain about me. Tonight she started in on me about my apartment. We went to this seafood place on City Island and she asked Bob and his wife if they knew of a place where I could move that didn't have roaches. I don't want to move! I like my roaches; they give me someone to talk to. So I said, “I don't want to move!” and that started it off. She said she understood I was working hard but that she was a person, too, and if I wanted her to be part of my life, I was going to have to make some time for her in my busy schedule. I said that life is hard enough right now for me without anybody making demands on my time. Bob's wife looked kind of uncomfortable through this, but Bob was eating it up. He wants to make this year into a book, so he was salivating with all this intimate social stuff. We fought for a while but then we made up around dessert. So now we're friends again.

Carole's given up on getting married, at least for right now. I don't know what's going to become of this, but I do know one thing: If this relationship can make it through this year, it can make it through anything.

Wednesday, December 18, 1985

Last night something really funny happened. It almost made it worthwhile being on call. Wow, what a weird thing to say. Nothing could ever make being on call worthwhile. Anyway, here's what happened: I admitted this fifteen-year-old girl who had been found unconscious in the street. Someone called EMS
[Emergency Medical Service]
and they rushed her to West Bronx. It was quickly figured out that she had overdosed on a combination of crack and heroin. They worked on her for a while in the ER and got her stabilized, then decided to admit her to Adolescent. So I went down to the ER to pick her up. That's when she woke up. Lucky me.

She wasn't what I'd call the friendliest patient I'd ever seen. What she was was abusive. She cursed out anyone who came within ten feet of her, me, the nurses, my medical student, everybody. I couldn't examine her, I couldn't even get close enough to get her vital signs. So I called the senior and she came, and after she got cursed and threatened for a while, she said, “No way! I'm not touching her!” So here it was, nearly two in the morning, and we've got this lovely young woman in our treatment room who isn't exactly happy to be there, and we're supposed to do something to make her better. So the resident said, “If we can't examine her, we have to call the person who has ultimate authority. Who's that?”

I said it was the attending. She said, “Well, call him and tell him to come in and see if he can talk to her.” And then she left. Very helpful.

Well, I called the operator and got Hal Loomis's home number. I felt a little funny calling him that late for something like this, but when I told him the story, he said, “No problem; I'll be there in a half hour.” He actually seemed happy I had called him at home and woken him up! These attendings are really weird.

About an hour later, Hal walked out of the elevator and onto the ward. I led him into the treatment room and pointed to the stretcher. She seemed to be asleep, but when we got close to her, she opened her eyes and started yelling at us. “You stay where you are, you fucking son of a bitch. Don't come any closer or I'll kick you in the balls, you asshole.” And, without missing a beat, Hal yelled back at her, “You watch what you say, you little bitch! We don't want to have anything to do with you either, but you're here and you're sick and it's our job. So you better let us do what we have to do or we're going to tie you down and do it anyway. Now, which way do you want it?”

Well, it was great logic, and I think it would have worked if she'd been in her right mind, but, of course, she wasn't. So when Hal and I got close to her again, she started punching and kicking and biting us. But with him there holding her down, I at least could get some sort of a physical exam done. After about a half hour of that, I said I was finished, and we tied her down to a bed in one of the rooms with leather restraints. Then Hal headed back to Westchester, I got a couple of hours of sleep, and this morning she was a real pussycat, believe me. She's just fine today.

So I didn't mind being on call last night. If I could watch an attending make a fool of himself every night I'm on call, I think I wouldn't even mind being an intern.

One more week to go on this damn ward. One more week and the year's half over. I can't wait!