The Intern Blues (38 page)

Mark

MAY 1986

Thursday, May 1, 1986

My mother told me I should always try to find something nice to say about a situation. I started my rotation at University Hospital last Monday, and ever since, I've been trying to figure out something nice to say about the place. I finally came up with something: The food is good. No, that's not even exactly true. It's not actually good, it's just plentiful. Plentiful and easily available and free; they give us meal tickets so we can eat three meals a day. And that's it. Outside of the food, I haven't found anything I've liked at University Hospital.

I've been on call one night and so far I've had one patient die. It was a patient I'd met before: the kid I saw in the West Bronx ER a few weeks ago who got bitten by the horse. Her name was Melissa Harrison, and she had this horrible disease, metachromatic leukodystrophy. She'd been going downhill for a while. She came in on Monday in status epilepticus
[the state in which constant seizures are occurring]
. Dr. Ruskin, her neurologist, came in and spent about an hour and a half talking to the parents. At the end of the meeting Ruskin came out and told me they'd decided that this was going to be it. We weren't going to do anything heroic, just fill the kid with enough morphine to keep her comfortable and then wait for the end to come. The end happened to come when I was on call Tuesday night.

This wasn't exactly the most comfortable situation I'd ever been in. I mean, I didn't know this kid from a hole in the wall. And here I was, being called on to stand by her bed and let her die without doing anything to prevent it from happening. Ruskin might have felt comfortable being in that situation, but she wasn't standing there at the kid's bedside. I was, and I felt pretty bad about the whole thing.

This kid's mother was a saint, though. I guess she saw I was pretty uncomfortable, and she spent a lot of time trying to calm me down. She told me about what Melissa had been like before she started going down the tubes. Isn't that wonderful? The mother of this dying girl had to spend the last minutes of her daughter's life calming down the intern who had gone completely out of his mind. Well, listen, it isn't completely my fault that I'm berserk; I'll be the first to admit that I might not have started out this internship with a full complement of marbles, but most of the berserkness I've been demonstrating recently is the result of the deep frying my brain's been receiving over the past few months.

Anyway, Melissa's mother was really great. She's a real Mother Teresa type. I can only imagine what kind of hell her life's been over the past few years.

So that was a great way to start out the month. I'm on again tomorrow, and since I seem to have become the Intern of Death, I wonder which one of my panel of patients will be tomorrow's selection in the Meet Your Maker sweepstakes. Will it be Nelly, the three-year-old with AIDS who has PCP
[pneumocystis carinii pneumonia, a common cause of death in patients with AIDS]
? Will it be Jesus, the one-year-old with yet another bizarre metabolic disease, the name of which I can barely pronounce? Will it be one of the parade of renal transplant patients who are constantly marching onto the ward to get treated with medication that might stop them from rejecting their transplanted kidney? Or will it be a completely different patient, one I haven't even met yet, one who's waiting in the wings to make my life completely miserable over the next forty-eight hours? Only time will tell. And I don't think I want to know.

I'm going to sleep now. Maybe I'll sleep through tomorrow and the entire next two months, and when I wake up, I won't be an intern anymore. I can always hope!

Sunday, May 4, 1986

Great news! I was on Friday night and no one died. Nobody; no patients, no nurses, not even me! At least if somebody did die, I wasn't told about it.

Actually, Friday night was nice, if any night spent in any hospital can be called “nice.” I didn't get a single admission. I even got five hours of sleep in University Hospital's very lovely intern on-call room. The on-call room is in reality a closet with furniture; it's about six feet by six feet and it's got a door, a telephone, and a cot. When they were building this hospital, they obviously decided to spare no expense when it came to the comfort of the interns. I shouldn't complain, though. I heard that as of four years ago, the interns didn't even have this closet to sleep in. They had to sleep in empty patient beds. That's always very dangerous, especially here at University Hospital, where there's an actual blood-drawing technician. There's always the chance the tech will find you lying in bed some morning, mistake you for a patient, and suck out all your blood.

I discovered another good thing about University Hospital. There's this porch attached to the cafeteria that you can actually go out on and get some sun. Actual sun in the Bronx! Anyway, I found this porch at lunchtime on Friday and I spent an hour out there on Friday afternoon. It was really beautiful. The weather's been great all weekend, too. The temperature's been in the seventies. Yesterday Carole and I went to this inn about an hour north of here. It was great, really relaxing, and we weren't caught in a rainstorm, a monsoon, a tornado, or any other natural disaster. Amazing! Maybe my luck is actually changing. Nah, it probably was just a fluke.

I don't really have too much to say tonight. I just wanted to show that it's still possible for me to be in a good mood. See—there's hope for me yet.

Tuesday, May 6, 1986, 9:00
P.M
.

I was on last night. What a good time I had! What a wonderful learning experience it was! I had such a good night last Friday, I thought I was actually going to like the rest of my month. I thought it was going to be really quiet and restful. Then I was on last night and now I feel as if somebody dumped a fifty-pound bag of excrement on my head.

And I feel better now than I did a couple of hours ago! At six o'clock I was a genuine basket case! I was ready to manually extract the spleens of each of the chief residents without the use of anesthesia. But then I went over to my grandmother's. She fed me a nice dinner and calmed me down. Thank God for Grandma! Thanks to her, the chief residents will live another day.

When I talk about it, I don't think it'll sound like last night was all that bad. I mean, I had six admissions, which is kind of bad, but all of them were electives and none of them was sick, so it should have been pretty easy, right? It would have been easy had they all come in at a reasonable hour. It would have been easy had at least of few of them come in at a reasonable hour. Did any of them come in at a reasonable hour? Of course not! Why would anyone expect a kid who's scheduled to have surgery the next day, who needs to be seen by residents from at least three services
[pediatrics, surgery, and anesthesiology]
, and who needs to have blood work and all kinds of other tests done, to come into the hospital before nine o'clock at night? What a silly idea that is!

Well, anyway, they started to arrive at about seven-thirty and they continued to show up until nearly midnight. I couldn't believe it: A six-year-old who was scheduled to have a T and A
[removal of tonsils and adenoids]
this morning didn't show up until midnight. A normal six-year-old shouldn't even be awake at midnight, to say nothing of a six-year-old who's scheduled to have an operation a few hours later! I was pissed, the anesthesiology resident who came to see the kid was pissed, the surgery resident was pissed, everyone was pissed except the kid and his mother, who couldn't understand what we were all so upset about. To them a six-year-old coming in for an elective procedure at midnight was completely natural.

So it took me until after two-thirty to finish all my scut work on six lousy electives! And of course just when I was finished and I should have been able to get to sleep, Nelly, my AIDS kid with pneumocystis carinii pneumonia, decided to try to die on us. Boy, how happy I was to see that! It's me and Diane Rogers
[the cross-covering senior resident]
in a hospital that doesn't have a pediatric ICU, trying to keep alive a kid who's trying her best to get to heaven. It was amazing: She was perfectly fine one minute, and the next minute she was dropping her pulse to sixty and her blood pressure to sixty-five over forty-five. It really looked like the end was near. We stood around scratching our heads for a couple of minutes, trying to figure out what the hell was going on and what we should be doing about it. Her blood gas was still okay, so we knew it wasn't a ventilatory problem. Diane finally figured maybe we should try some Dopamine
[a drug that increases blood pressure, among other things]
to see what that did. I didn't understand the reasoning (of course, there isn't much reasoning I do understand), but the Dopamine seemed to do the trick. Nelly was good as new after that.

So there we were, with a kid with AIDS and PCP, who was going into shock, getting a Dopamine drip while on the regular ward. I had to stay with her for the rest of the night. I didn't get any sleep, and then I had to start rounds so I could have my usual morning fight with the blood-drawing tech who was refusing to draw blood on everyone. This has become a regular part of my day, I've kind of become addicted to it. Fighting with the blood-drawing tech is like drinking coffee.

So much fighting goes on at this hospital, it's unbelievable. Working at University Hospital is definitely like being drafted into the army during wartime. It's us against them, with the “them” being everybody who's not a house officer: the attendings, the nurses, the lab techs, and especially the patients and their mothers. Work rounds in the morning are more like a pre-battle strategy session. We plan out the tactics we're going to use that day. But there are a lot of situations you can't plan for; things like sneak attacks. They tend to keep you on your toes.

Friday, May 9, 1986

I really don't know what to make of this place. This hospital definitely has some schizoid tendencies; sometimes it seems like the nicest place in the world. There are some afternoons when it's so peaceful and quiet, you can relax, sit out on the sun porch, even take a nap. And then there are some days where the patients all get sick at once, there are millions of admissions, and all you do is fight with everybody you can find. Take yesterday afternoon. At about three o'clock, the whole team got stat-paged to the adult ICU. We had one patient in there, an eight-year-old who had been hit by a car a couple of days before and had been unconscious ever since, so we all were sure she had arrested. We went running into the ICU and found she was fine, but the neurosurgery attending and one of his residents were standing by her bedside. As soon as we pulled up, the attending started yelling about how poorly we were managing the patient and how embarrassed he was that a patient who had been referred to him was getting such lousy care. She wasn't getting lousy care, she was getting great care. We all knew that. It's just that this guy has this quota: He has to yell at at least one house officer a day.

It was really hard to keep a straight face while this guy was yelling at us because he was sucking on a lollypop the whole time. It's hard to take this neurosurgeon seriously in the first place, but when he's got a lollypop in his mouth, it's damn near impossible!

And that wasn't even the end of it. Today, when we were on work rounds, we ran into the neurosurgery team. In spite of how poorly we had managed the kid, she had awakened out of her coma last night and seemed just fine today. Now her prognosis is excellent, and the neurosurgery chief resident told us we had done a great job with the patient. The attending immediately yelled at him, saying, “How can you tell them they did a great job less than twenty-four hours after I yelled at them for doing a lousy job?” The chief resident apologized and told him that since he hadn't been on rounds yesterday afternoon, he didn't know the attending had yelled at us. Then the attending got real pissed and said, “Next time I yell at somebody, I want the whole team there. I don't want to have to yell at people twice for the same thing!”

So last night I had a really quiet night. No admissions, just some coverage, and almost everyone remained stable. This was mainly due to the fact that Nelly, the AIDS kid, got transferred over to the ICU at Jonas Bronck. When Al Warburg, the daytime senior resident, found out that we had a patient on the ward on a Dopamine drip, he picked up the hot line to the chief residents' office and told them they had to transfer Nelly. So after I had been up all night with the kid, she got whisked away to Jonas Bronck. Don't get me wrong, I'm not complaining.

I guess the sickest kid on the ward right now is José, a one-year-old with this weird metabolic disease called argininosuccinicademia. The name of this thing is longer than the kid is! Anyway, having José on the ward is like taking care of an unremitting Hanson. He's constantly crumping and then stabilizing and then crumping again. He's lived in the hospital for the past couple of months, and all the nurses have come to love him. That's always a bad prognostic sign.

This disease has something to do with the urea cycle, and the kid is being treated with all these weird chemicals that make him smell really strange. I spent a few minutes standing at his doorway yesterday, sniffing his bouquet, trying to figure out what in hell it was he smelled like. It took a while, but it finally came to me: He smells just like the bottom of a birdcage. The kid smells like parakeet droppings! It's the strangest thing, but that's exactly what it is. Since I figured that out, I've become fixated on thinking of him as a parakeet. I'm waiting for him to start singing. And I'm sure it won't be long before he sprouts wings and just sort of flies away.