The Intern Blues (3 page)

And so what follows is the edited, collected diaries that resulted from the suggestion I made on the lawn of Peter Anderson's house. As witnessed on that evening in the emergency room in May, Andy, Mark, and Amy came a long way during that short year: They were transformed from medical students into competent doctors. And each survived their year of internship with their lives largely intact.

But what happened between that day in June 1985 in Westchester and the day one year later when it was all over is an amazing story, a story that, for people who have not lived through an internship, might seem more fictional than real. But all that follows is true.

Andy

JULY 1985

Sunday, June 30, 1985
*

I suppose I should have started this diary forty-eight hours ago, before I'd actually started my internship, but I only got this tape recorder today. So now I've actually had a day and part of a night of call. I think I'll start by talking about what I think about being an intern.

The fact that this was going to be starting didn't really hit me until I began packing up my stuff last week. The last couple of months have been the best time of my life. I finished all my medical school requirements back in March, and after that, Karen and I took off for Asia. We traveled around for two months, having a great time and then got back to Boston near the end of May. I loved that time we spent traveling. It gave me time to think about the future. But then a couple of weeks ago, I started getting ready to move, and that's when I really began to think about being an intern. I've had some pretty weird feelings about all this, and I guess I should try to put them into words.

Leaving Boston has been very traumatic for me. Except for the time I spent at college, I've lived around Boston since I was ten years old. It's a great city; I really got to know the place like the back of my hand. I met Karen a couple years ago; she's a fourth-year medical student now, and we lived together this past year. To leave all that, the city, my friends, my girlfriend, our apartment, my family, it's been a really a difficult, dramatic thing. It's going to be a big adjustment. The only thing that's making it a little easier is that Karen came out with me; she'll be around for another week or so, just until I've had a chance to get myself settled. But after that, she'll be gone, too. I don't know what I'm going to do after that.

I've felt kind of lost since getting to the Bronx. I moved in last Sunday night, and Monday and Tuesday, the first days of orientation, were really stressful. I came home on Tuesday after the lectures on management of emergencies and cardiac arrests and I just fell into Karen's arms and cried for a while. I've never done that before; it kind of scared me. I felt so wound up about these new responsibilities that were looming larger and more threatening every second. I felt terrible. I just thought, “What am I doing here? I can't do this, I'm not good enough to know how to rush in there and save people's lives when they're dying all over the place, when they are bleeding and not breathing.”

Something about those lectures scared the shit out of me. It wasn't that I hadn't heard the stuff a million times before; it was the way the lectures were saying it. “Well,
you'll
want to do this and
you'll
have to know this, because
you'll
be the intern.” They weren't talking
at
us, like they did in medical school, they were talking
to
us. That was scary. I really didn't sleep well those first couple of nights, mostly because there was so much to think about.

I guess one of the things I'm worried about is how much this internship means. When I started medical school, I had great expectations about how much I'd know and how skilled I'd be when I graduated. I thought I was going to be a doctor with a capital “D.” Now that I've finished medical school and I've been through all the disillusionment about the capabilities of twentieth-century technological medicine, I feel like I don't even deserve to be called doctor with a small “d.” Medical school turned out to be a very negative experience, a real grind for the first two years, sitting in lecture halls day after day, week after week, being bored to death by people who don't seem to care about anything except what's happened in their research lab over the past ten years, and a mixture of wasted time, humiliation, and feeling intimidated the last two years. As a third- and fourth-year medical student, you get to realize how unimportant you are, how things go on whether you're there or not; you're only there to get yelled at by the attendings for doing stupid things, or to get abused by the house staff, who treat you like a slave. You don't really learn how to be a doctor in medical school. So I'm coming into this internship hoping and praying it's everything medical school wasn't. I'm hoping again that when I finish this part of my training, I'll be that doctor with a capital “D,” but this time there's more pressure on me: This has got to be it. When I leave here, I've got to be a doctor.

And I'm entering with expectations that this'll be an exciting and interesting time in my life, with memories I'll always cherish. I know it's not going to be easy, and it's not going to be a lot of fun. I'm going to feel lousy a lot. But I hope when I'm all done, I'll be able to look back at these years and be able to say that the time was better spent as an intern than in almost any other way I could have spent it. I've invested four years in this already; if I invest another three years and wind up realizing I hate being a doctor, well, that's seven years of my life completely wasted. I'm twenty-seven, I'm still a young guy, but seven years of wasted time, that's pretty sad.

And finally, after all these emotions and worries, it started. I was on call on Saturday in the Mount Scopus emergency room. Once the day began, it really wasn't so bad. There was just a resident and me. My first case was a little eight-month-old with a really bad case of cervical adenitis
[swelling of the lymph nodes in the neck due to infection]
, and I thought, wow, here I am, a real doctor, with real pathology. I wound up having to admit the kid for IV antibiotics.

I did pretty good during the day, I was really enjoying it. I wasn't scared, I wasn't freaked out and I don't think I made any really horrible mistakes. I went at my own pace, which was about half the speed of the second-year residents but I felt good about it. I did an LP
[a lumbar puncture, commonly called a spinal tap, a test in which a needle is inserted through the back and into the spinal canal, so that a sample of spinal fluid can be obtained for analysis]
on an 18-month on whom we had a suspicion of meningitis, and it went perfectly. I got the spinal fluid and I started an IV without any problem at all. I did a CSF cell count
[counting the number of white and red blood cells in the spinal fluid specimen in order to diagnose meningitis]
, and I learned a bunch of good bench lab stuff that I never knew how to do before. Hell, it was a good day and we even got a chance to eat dinner. I got out of there at 12:30
A.M
., which isn't bad. I have to say my first night on call was a positive experience, which gave me a good feeling about coming to this program in the first place.

Sunday, July 7, 1985

Karen went back to Boston today. Even though she'll be back in three weeks to visit for a weekend, I know things are not going to be the same as they were for at least this whole year. I took her to the airport, she went through the gate, and I stood there waving and she waved back until all I could see was her arm. Then that disappeared and she was finally gone.

I got back from the airport and putzed around the apartment for a while, feeling aimless. I dropped off Ellen O'Hara's
[one of the other interns]
car keys—she had loaned me her car for the weekend—and Ellen and I talked for a while. She was a little spacey; she'd been on in the NICU
[neonatal intensive-care unit]
last night and didn't get any sleep. Then I went out shopping.

I was in the vegetable store and I had this really funny feeling, like I couldn't think clearly for a minute. I couldn't figure out what was wrong at first, but then I realized that I was shopping for myself. I started feeling really bad because I'd be the only person in the apartment eating this stuff. When I got back from the store, I called Karen right away. She was home already. I told her how much I missed her and how lonely I felt. She told me she felt the same way. We talked for a while and when we got off the phone, I felt real down, real down, and I didn't know what to do. I just walked around the apartment, feeling very empty. I felt like I wanted to cry, so I sat down at my desk but the tears wouldn't come. I had to talk to someone; the only person I knew was Ellen, so I called her and told her I'd like to come and talk for a while and she said sure. I went up to her apartment, she opened the door and asked what was wrong, and I told her I was feeling real low. We sat down on her couch and I started crying. I kind of fell onto her shoulder and cried for ten, fifteen minutes, really crying, soaking her blouse. She held me and I held on to her. I felt a lot better after that. We talked about getting together for dinner, and so I went back down to the store to get more food.

That was amazing! That kind of thing, crying on a total stranger's shoulder, is not something I've ever done before. I was feeling bad, really bad, and she was the only person I even knew here. All I can say is, I'm glad there are people like Ellen in this program.

But all is not lost. When I went out for food the second time, I found a store that sold Häagen-Dazs ice cream! Häagen-Dazs in the Bronx! Amazing!
[Häagen-Dazs ice cream has always been manufactured in the South Bronx.]
There's hope for this place after all!

Work is good. I've finished my first week as an intern, and it's shown me that I actually like being a doctor. I enjoy the people I'm working with, I like the kids . . . I'm rediscovering some of the things that made me go into pediatrics in the first place. This week, working in the ER
[emergency room]
and the clinics, I saw more kids than I had seen during the entire six-week rotation I spent in pediatrics in medical school. I love the kids, but I can see that the adolescents can drive you nuts!

There are a lot of things I don't understand about adolescents. Do you examine them with their parents in the room? Do you throw the parents out, and if so, when do you throw them out? And there are all these hidden agendas going on between the parents and the kids. The other day, I saw a fifteen-year-old girl with a vaginal discharge. Her mother insisted on staying in the room the whole time. I felt pretty uncomfortable asking the girl whether she was sexually active or not with her mother standing right there next to her, but the woman just wouldn't leave. So I wound up doing a pelvic exam and getting all the cultures and stuff without even knowing what I was looking for. I guess when I get some of these issues sorted out, I'll feel better about them, but as of now, give me those toddlers and little kids anytime!

I'm starting to feel more confident and more willing and able to see patients without supervision.
[In the beginning of the year, interns working in the emergency room are supposed to check with the attending on duty before discharging any patient.]
It was so busy the other day, I didn't have time to check everything out. We were about four hours backed up most of the time and I was just running from one thing to another without any time even to think, let alone consult an attending. Occasionally I asked for advice just to check myself, and the attending who was on call in the ER always agreed with what I wanted to do. That felt good; it was a real boost to my ego.

There is one thing about work that's starting to bother me, though. When I was in medical school, one of the things I liked best about pediatrics was dealing with the parents. Over the past few days, though, I've found myself getting really annoyed with some of the parents who bring their kids to the emergency room. For instance, this mother brought her two-year-old in the other night. When I asked her why she was there, she said, “My kid hasn't gone to the bathroom for two days.” All she had was minor constipation, for God's sake! And the woman hadn't even tried anything. Here it is, twelve-thirty in the morning, and there's an eight-year-old boy in the other room who just got his eye blown out by a firecracker. And there's a five-year-old sickler with a fever in painful crisis
[a child with sickle-cell anemia, a common inherited disorder mainly occurring in blacks and Hispanics, in which the red blood cells collapse when the blood oxygen is low; the collapsed, or sickled red blood cells clog up the smaller blood vessels, leading to obstruction and further lack of oxygen, which results in pain in the hands and feet; in a patient with sickle-cell disease, fever can be a sign of serious, possibly overwhelming infection]
, it's time for me to get home, and this woman brings her child in for minor constipation. I wanted to strangle her, just put my hands around her neck and strangle her! And this kind of thing isn't unusual. It happens all the time, every night, that's why there's always a three- or four-hour wait to be seen. I tried to be nice to her, but I can't help getting really pissed.

Occasionally there'll be parents who seem really weird. The other day, this woman came in with her two kids who had colds. She was like a street person, she was carrying around all her possessions in shopping bags and she was dirty and her hair was all matted. The kids seemed perfectly okay though. There wasn't much I could do; just examine them, tell her to give them Tylenol, and send them on their way. But it bothers me; there has to be something wrong there. I've tried to figure out a way to get kids like that away from the parents, to protect them, but it seems to be impossible to do unless the parent actually harms the kid. You can't call the BCW
[the Bureau of Child Welfare, the state-run agency that investigates physical and sexual abuse of children]
just because a mother looks and acts a little funny. Even when the parent actually does harm the kid, like when they beat the kid with a strap because he or she misbehaves or acts up, it's sometimes difficult to do anything to prevent it from happening again.