The Intern Blues (5 page)

Well, it's time to go to sleep, my favorite pastime.

Saturday, July 20, 1985, 3:30
A.M
.

Today was my worst day of internship so far, because of two incidents I had with orthopedics. First, there was a kid with a dislocated elbow. I was doing the IV sedation and the prick ortho resident didn't like the amount of sedative I was giving, he wanted the patient to get more and at one point he actually put his hand on the syringe full of morphine I was holding and started to squeeze. I had to shake his hand off and tell him, “No, you're not supposed to do that.” The rest of the procedure was punctuated by him cursing at me for not wanting to give enough sedation. The jerk!

Later there was another kid who needed sedation, so this same resident and I decided together to give him a DPT
[a cocktail of three sedatives: Demerol, Phenergan, and Thorazine, given through an intramuscular injection]
, but the nurses wouldn't do it. They have this rule that DPT is not allowed to be used. So this started a big stink and things were getting more and more hairy. The pediatric resident who was on got pissed off at the nurses and they got pissed off at us, and the ortho resident's yelling, “Hey come on, guys, hurry up!” Finally we decided to give IM
[intramuscular]
morphine but I wrote the order on the wrong part of the chart and the nurses didn't see it and they didn't give the medication and before you know it, the ortho resident was back, pissed as hell because we were taking so much time, and he started yelling at me for being so incompetent and then I started yelling back at him and I could feel the blood rising in my face. I've never felt that angry at anybody before. It was making me crazy that I had no way to get back at him, so I just kept yelling at the fucking guy, telling him he was a jerkoff and a dickface. It was a very uncool thing to do.

Right after this, I grabbed a chart and went into an examining room but I was still so angry, I couldn't concentrate. So I told the senior I needed two minutes to cool off, and I went down to the vending area to get a Coke. I put my money in the machine, and what came out? A nice, warm Pepsi! No ice! No refrigeration! Oh, God, how I love West Bronx!

I went to a corner, sat down, and tried to cool out for a while. Then I went back to the ER, got some ice, and drank my fucking Pepsi. I apologized to the nurse I yelled at; I even apologized to the ortho resident, even though I think I'd still like to break his arm.

A few of us 'terns got together the other night and went out. We had dinner at an Indian restaurant in Manhattan, then went to get some ice cream and roamed around for a while in the rain. It was pretty good, but we were all so damned tired. Everyone was either postcall or precall. Shit! It's just amazing how often call comes around. It's like you feel you just got off and it's your night again.

Wednesday, July 24, 1985, 12:20
A.M
.

The month's almost over and I'm looking at the end with mixed feelings. On the one hand, this ER stuff is starting to get pretty old. It gets repetitive and frustrating after a while. But on the other hand, I can't say I'm looking forward with any great excitement to being in the NICU next month. I basically like to work decent hours; I don't like staying up all night, which is what you have to do in the NICU. Thank God there're caffeine and other stimulants.

Actually, I've never taken other stimulants. I never liked the idea of speed. Of course, I've never had to go for more than twenty hours without sleep. Being exhausted and having a little twelve-hundred-gram baby crumping
[trying to die; deteriorating]
in front of you, that kind of gets you worried.

Sunday, July 28, 1985

I had a really wonderful weekend. I was on call Friday night and it was really quiet. I got home at twelve-thirty and Karen was here. She had just gotten in. We stayed up and talked until I was too tired to stay awake and then we went to sleep. It was restful, relaxing, and wonderful. Then today we were down in Manhattan and I saw Karen off to her bus to the airport and I started feeling very sad again. I've felt kind of sad and kind of nervous and lonely all day.

I took the train back home. That's the worst part for me: coming home to an empty apartment, knowing no one's going to come home after me, that I'm not waiting for anybody, I'm home and that's it. I called a couple of people; I called my friend Anne from medical school. She's an intern in Boston. We had a nice talk. Then I called my mom, who had just gotten home from England, and we talked for a long time. Then I got ahold of my intern friends Ellen and Ron, and we went out for some dinner. That was nice; I needed the companionship, I needed to be with people I felt close to.

And tomorrow morning I start my new rotation in the neonatal intensive-care unit, and I'm on call the first night. I've heard all sorts of horror stories about being an intern in the NICU.

It's only been a month since I started, and I can already see a big change in myself. I don't think anyone outside of medicine really understands what this whole thing is about. I've had trouble explaining my life this month to people, and I'm sure next month is going to be even more impossible to explain. I'm starting to think that it probably isn't even worth the effort for me to try. Most people in the nonmedical public, they have their own ideas about what doctors should be like, and I don't think they want to have those ideas shattered. They don't want to know about the long hours and the lack of sleep and everything else. They have these myths that we're all like Dr. Kildare or Marcus Welby. I hate to disappoint them by telling them the truth.

Amy

JULY 1985

Tuesday, July 2, 1985

The hardest part of this year is definitely going to be leaving Sarah. There's no question about it. I'm not sure yet what being an intern is going to be like, but I am sure of one thing: There's nothing they can make me do that could possibly be any harder than saying good-bye to the baby was for me yesterday morning.

Some people might think it a little strange to have a child two months before you start an internship. Well, there are a lot of things that went into our decision. First and foremost, Larry and I have wanted a baby ever since we got married. We both love children; that's really the main reason I decided to go into pediatrics in the first place.

Another reason has to do with my family. My mother died when I was in college. I still haven't gotten over it. Ever since, I've wanted to have a baby, a girl, and name her for my mother. That's been very important to me. That's why our baby is named Sarah.

I guess the third reason has to do with my miscarriage. I was pregnant when I was a third-year student. That one wasn't planned; I just got pregnant. Larry and I were both happy about it. I went to my obstetrician's office when I was about ten weeks and he heard the fetal heart. Everything seemed to be going fine, but then two days later, I started to have some pains and Larry had to take me over to the Jonas Bronck emergency room, where the miscarriage was diagnosed. They did a D and C and sent me home. If I hadn't lost that pregnancy, I'd have had the baby in the beginning of my fourth year of med school, which would have been perfect: I would have been able to take some time off then; things aren't too hectic in the fourth year. And I'd have had a one-year-old at this point, and leaving a one-year-old all day with a sitter isn't as bad as leaving a two-month-old. But having had that miscarriage, I started to wonder whether there was something wrong with me. I thought I'd never be able to have a baby. I guess I became obsessed with it.

Well, all of these are reasons for having a baby, but they don't explain why I decided to have one two months before I started internship. I guess the reason I didn't want to wait until after I finished my internship and residency was that you can't tell what might happen; there are people who wait and something happens to them medically and they find out that they can't have a baby. I didn't want to take a chance. I had thought for a while that maybe I'd take this year off and spend my time just being a mother and wait until next year to do my internship. A lot of people advised me against that. I was told it would be hard to get back into medicine after I'd been away from it for a whole year. And Larry encouraged me to go ahead with my internship; he told me he could manage the baby when I was on call. So here I am.

But I didn't think it was going to be this hard to be away from her. From the day Sarah was born until orientation started last week, I spent every minute with her. I took May off as vacation time. In the beginning of May, we put an ad in the paper for a full-time baby-sitter. We chose the woman we finally hired because she seemed really nice and she had great references. Her name is Marie; she's a Jamaican woman who's about forty. She has full-grown children of her own. She started two weeks ago, while I was still around. She's going to come every morning, Monday to Friday, at seven-thirty and stay until Larry or I get home at night. Larry and I will be alone with Sarah on weekends. Marie seems to like the baby a lot, but then again what's not to like? There are a couple of little problems, though: She spends all day carrying Sarah around, she feeds her every two hours because she says she's afraid the baby will cry and get colic. I guess I'll eventually have to talk with her; I'll have to be more assertive. I know Marie'll do a great job and everything'll turn out okay. It's just that . . . I'm worried she might turn Sarah into a wimp!

So far, being an intern isn't any worse than being a medical student. I'm in the OPD
[Outpatient Department]
at Jonas Bronck this month. I was on call last night for the first time and I got out of the ER at about a quarter to three. There was a lot of trauma, plenty of lacerations and head wounds, but since I don't know how to do anything yet, I wound up seeing the more basic medical problems. For some reason, most of the kids I saw were four-month-olds with fevers. There's something going around, I guess. I felt bad for Evan
[the senior resident who had been on call that night]
. He was the only person who knew how to suture, so he wound up spending the entire night sewing lacerations. Since the attending went home at ten o'clock, the other interns and I had to keep interrupting him every five minutes to discuss patients with him. I felt bad doing it, but I wasn't about to send anybody home without clearing it with a senior first!

When I got home, something weird happened. I went to bed and I must have fallen into a deep sleep because Sarah started crying at around four and I thought I was still in the ER getting ready to see another screaming kid. Larry told me he heard me say, “Please God, let me go home.”

Monday, July 8, 1985

I've been on call three times now. Last Friday was the worst so far. Everything had been going pretty well until about eight o'clock, when a thirteen-year-old girl who had been raped came in. I wound up seeing her.

She was a young thirteen; she looked more like eleven or ten. She was really broken up, but I got her to tell me what had happened. She had been alone in her family's apartment when a knock came on the door. She looked through the peephole and saw her fifteen-year-old brother's friend. He told her he had left a book in the apartment, and she let him in. They went into the brother's bedroom and started looking around. Suddenly the girl felt something around her neck. The boy had pulled out an electrical cord and he kept pulling it tighter until she got down on the bed and took off her clothes. He then proceeded to rape her.

He was there a total of about an hour. A little while later the girl's family came home and found her hysterical. They immediately brought her to the ER.

The attending and I went over what had to be done. I did a complete exam and got all the samples that would be needed as evidence when the case went to court. There's something called a rape kit that has to be used, with directions that have to be followed exactly or the whole thing can be thrown out of court. I made sure I did everything right. I was working like a robot all through it, trying not to think about anything except getting the job done. After I finished, I handed the rape kit over to the cop. The social worker came in to talk to the girl and her parents, who were crazy at that point. The father wanted to go out and kill the kid slowly, really make him suffer. The mother just cried. The girl didn't speak much, she was in shock. The cop called a little while later to say the boy had been caught. The parents took the girl home at about midnight. As soon as they left the ER, I just fell apart. I spent the next hour crying. We were still busy, so when I pulled myself back together I had to start seeing patients again. We didn't get out until nearly five in the morning. It was a terrible night. Terrible.

Yesterday was busy, too, but it wasn't nearly as bad as Friday. Yesterday's specialty was trauma. We had all kinds of trauma, kids falling out of windows onto their heads, firecrackers blowing off fingers, and the basic foot laceration from Orchard Beach
[a beach on Long Island Sound]
. Since I still haven't learned how to suture, I spent most of the day seeing kids with head trauma. Most of them were okay; I just examined them, found nothing wrong, and sent them home with a head trauma sheet
[the emergency room provides instruction sheets in English and Spanish covering most of the common pediatric problems]
. At about 3:00
A.M
. we had finally cleared out the triage box and I picked up one of the last charts, a six-year-old who had hit his head on a coffee table. The nurse who had seen him when the mother first registered at about eleven thought he looked all right and put him at the bottom of the pile.
[The nurses triage each patient according to his or her symptoms: Patients who require real emergency care are “up-triaged” and their charts are placed near the top of the pile; patients who are judged to be stable are triaged to the bottom of the pile. On exceptionally busy days, the wait to be seen by a physician may be as long as six hours.]

The mother told me the boy was running around the apartment and had fallen and hit the back of his head on the coffee table. He hadn't blacked out but had become very sleepy. I examined him: He
was
sleepy, but then again, so was I. There were no focal findings.
[A focal neurologic exam, one in which there is weakness, paralysis, or abnormal reflexes on one side of the body, indicates a neurologic deficit. A negative neurologic exam following head trauma is a fairly good indication that the brain hasn't been harmed.]
The senior resident told me it was okay to send the kid home, but when I went to give the mother a head trauma sheet, the kid suddenly couldn't remember anything that had happened over the past few hours. So the senior told me to check the kid out with the neuro fellow
[the pediatric neurology department trains a group of fellows, individuals who have completed two years of residency and have gone on to do another three years in neurology]
. It took him twenty minutes to answer his page, and when he did and I told him the story, he told me he had to check with his attending
[the senior doctor on call for neurology that night]
before deciding what to do.

It took him another forty minutes to get in touch with the attending! There I was in the ER in the middle of the night with nothing to do but wait. I could have been home sleeping! But I couldn't sign this out to the night float. I had to stay.

When he finally called back, he said the kid needed a CT
[CT scan: a computerized X ray of the brain]
and that he had to be admitted. I had to bring him up to the fourth floor and help the technician get him settled on the CT table. Finally, the intern from the ward showed up and I got out of there. I didn't get home until four-thirty. If I hadn't picked up that last chart, I would have gotten about two hours' more sleep.

Thursday was July 4 and I had the day off. It was great: just me and Larry and Sarah. We went swimming in the pool at our apartment complex; Sarah seems to love the water. It was like getting reacquainted.

I had another run-in with Marie on Friday. I'm still having trouble with her. Even though we had a talk, she still carries Sarah around all the time and feeds her every two hours, as soon as she opens her mouth and lets out a peep. We got into a fight last Monday. I came home for lunch after clinic ended at about eleven-thirty. When I came into the apartment, Marie was holding the baby. I tried to take Sarah, but Marie wouldn't let go of her. I just about had to pry them apart. I said a few things I probably shouldn't have said. I don't know what's going to happen with her.

I think having a baby at home is making me into a more efficient intern. I find myself trying to get my work done as quickly as possible and running home. Sarah gives me a lot of motivation to work fast.

Friday, July 12, 1985

I feel bad talking about this, but I think I should anyway. Maybe it'll make me feel better to get it off my chest; I don't know. I feel terrible and it isn't my fault, it just isn't my fault. I did what I was supposed to do, that's all I know, and somehow I got into trouble.

Last week, this adolescent girl came in complaining of rectal bleeding. I recognized her from my subinternship
[a two-month rotation in the fourth year of a medical student in which the student works as an intern, taking night call and admitting and following patients]
. She was on the ward for some psych problem, I don't remember exactly what. I examined her and did a rectal exam; I didn't find anything wrong, and the stuff I smeared from the glove onto the guaiac card was negative
[the guaiac test is for hidden blood in the stool]
. So I thought she was a crock
[a patient who has nothing wrong and is faking symptoms; short for a “crock of shit”; sometimes referred to as a “turkey”]
. I presented her case to Tom Kelly, who was the attending, and I told him . . . I told him . . . I'm sorry, I have to stop for a minute and pull myself together. Crying is not the answer.

Sorry. Anyway, I told Tom I thought the girl was lying. He told me that very well might be the case, but that I should draw some blood for a CBC
[complete blood count: a blood test that measures anemia]
and a sed rate
[erythrocyte sedimentation rate, a test for inflammation or infection, in this case used to rule out inflammatory bowel disease, which is a cause of rectal bleeding]
anyway, to rule out any real problem. I agreed with him and I went back and got the blood. I sent the CBC to the lab and spun a hematocrit
[a direct test for anemia]
myself. It was fine—37 or something like that. I forgot to get the sed rate, though. I just . . . it slipped my mind. The girl . . . she was making me crazy while I was taking the blood and I just forgot about it. I did it, I don't know why they don't believe me. . . . I'm sorry, please forgive my outburst.

A few hours later, Tom got it in his head that I hadn't taken the blood. I don't know why. He didn't come to me directly and ask. He checked with the clerk and she told him she didn't remember sending anything off to the lab. Then he called the lab and they denied ever getting a CBC on the patient. Then he called the girl at home and asked her if anyone had taken blood from her and she denied it. And then he came and confronted me with all this and accused me of having lied about the whole thing. I don't know . . . I did it, that's all I can say. I don't know why the lab didn't get it. The girl's crazy, so I can understand her saying I didn't take it. I don't know. . . .