Authors: Robert Marion
I don't know what Eric told Barry, but he came out about a half hour later and didn't say a word to us. We finished work rounds without him and made all the medical decisions ourselves.
At about three o'clock I was signing out to Susannah in the nurses' station. I didn't have much going on; it's been kind of quiet. I only have six patients, and two of them are chronic AIDS patients.
[The back rooms on 8 West are reserved for children with AIDS and AIDS-related illnesses. On any given day there are four to six patients residing there. Most are not sick; they have come to live in the hospital because there's no other place for them]
. While I was signing out, Barry came up to me and said, “What are you doing?” I told him I was signing out and he said, “Look, you can't sign out at three o'clock.” He said there had to be some work I still had to do. He said that I had a responsibility to teach the students and obviously they weren't getting taught anything if we were all going home at three o'clock.
I didn't answer him; I just continued signing out. After a while he said, “Didn't you hear me? Why don't you answer me?” I told him I didn't answer him because I didn't have anything to say to him. He looked really hurt and walked away. A couple of minutes later, Jon Golden came into the nurses' station and asked if he could talk to me in private. I had finished signing out and was getting ready to leave. He took me into the chief resident's office and said, “I know things aren't going well on the ward, but don't you think you could try to be nice to him?” And I said, “Why? He's not being nice to me!” I told him about what Barry had just said to me and he kind of sighed and just asked if, in the future, I would just play along with Barry, at least make him think I was being friendly. I said I'd try. And then I got up to leave and on my way out, I ran into Barry again. I said good-bye to him and this time he ignored me! Unbelievable!
There are two more weeks to go on this ward. If it hadn't been for this jerk, this would've been a very nice month. As it is, I can't wait until it's over!
Monday, September 23, 1985
Thank God the month is almost through. I haven't recorded anything in over a week. It's been too depressing. I hate going to work every morning and spending the whole day fighting.
It wasn't as bad in the beginning of the month because we weren't all that busy. But last week the place started to fill up and there are a lot of complicated patients around who need a doctor who knows how to make decisions. Susannah and I don't know enough, and since we've stopped talking to our resident, there's nobody to turn to except the chief residents, who aren't all that thrilled about being bothered with our trivial stuff every five minutes. But these cases are complicated and we can't manage them alone!
I now have nine patients. They include three asthmatics, one of whom was really sick and almost needed to be intubated
[had a breathing tube placed through the larynx and into the trachea to facilitate artificial ventilation]
; a four-year-old girl with nephrotic syndrome
[a condition in which the kidney fails to retain protein; the protein spills out in the urine and the patient becomes protein-deficient, which leads to severe swelling of the entire body];
an eight-year-old girl who's GORKed out after being in a fire and inhaling a lot of smoke
[brain damage occurs in patients with smoke inhalation usually because of carbon monoxide poisoning]
and whose only sign of brain activity is her daily convulsions; two FIBs on antibiotics, one of whom probably has meningitis; and Winston and Salem, my AIDS twins (it's still hard to believe anyone would name a pair of twins “Winston” and “Salem,” but there they are, on my ward). And even they're not doing so well. Susannah's got ten patients and the subintern's got six and we have to cope with an idiotic resident.
What happened today with Winston and Salem is a perfect example of what's going on. Salem developed some pimples on his chest this morning. I was pretty sure it was chicken pox and I had Susannah look at them and she confirmed it. And Winston's had a cold for the past day or two, now he's probably coming down with it also. Susannah and I got very worried. We both know that varicella
[the virus that causes chicken pox]
could kill them
[varicella, usually the cause of mild illness, can cause an overwhelming infection in persons who are immunodeficient]
, but we didn't know what to do. Neither of us wanted to ask Barry; we knew he wasn't going to have anything helpful to say. So I went to Jon Golden right away and he said it probably won't be a problem because both of them are getting gamma globulin treatments
[a treatment modality that has had some success in children with AIDS]
and that the gamma globulin had antibodies to varicella so they probably wouldn't get an overwhelming case. Going over Barry's head worked out okay this time, but what's going to happen on those nights when there's nobody else around except him?
At least I have Sarah and Larry to come home to, and that makes me feel much better. Even after a day like today, ten minutes after I saw my baby, I was back to my old self. You know, when I started this internship I was concerned because I didn't know if I'd be able to be a good mother and a good intern. Now I don't understand how you can be a good intern without also being a good mother. I'll tell you, though, if I had to choose at this point whether I wanted to be a mother or a doctor, it wouldn't be a hard decision to make.
Sunday, September 29, 1985
I don't have much time. We're waiting for some friends to come for dinner. What can I say? I made it through the month, but it took a lot out of me. I'll never speak to Barry Bresnan again, that's for sure, but I survived it. It's now three months down, nine months to go. Eight if you count vacations. I'll survive it, I'm sure of it. I've managed to make things at work relatively easy for myself, but trying to be a mother and a doctor is taking a lot out of me. So far I think I'm doing a reasonable job at both; I just hope I can keep it up.
Sunday, September 1, 1985
Ah, one day on call in the emergency room and suddenly I remembered exactly what it was that made me become a doctor in the first place. Yes, I'm sure the reason I became a doctor was so hundreds of mothers and fathers who don't speak a word of English could curse at me in their native tongues while expecting me to cure their little darlings completely within minutes. What a rewarding experience yesterday was!
Actually, it wasn't all that bad. It wasn't too busy. I spent most of the afternoon taking care of a six-week-old who came in with fever and a cough. Everyone, even a lowly intern, knows that a six-week-old with fever is an automatic admission. But apparently that's not something that's taught to the interns at BEPI
[internese for Bronx Episcopal Medical Center, a voluntary hospital in the South Bronx]
because this kid had been seen there a day before, had been started on amox
[amoxicillin, an antibiotic]
, and sent home. Sent home, for God's sake! The mother brought him to Jonas Bronck only because his fever hadn't gone away and she happened to be visiting a friend in Jonas Bronck's neighborhood, so she decided to stop in and spend a few hours watching TV in our waiting room for a change. So not only did I have to do a whole sepsis workup
[spinal tap, blood, and urine for cultures]
on the kid, I also had to explain to the mother that the baby would have to be admitted. This must have sounded a little strange to her. After all, the kid was better than he had been the day before, and if he was so sick, why didn't the doctor at BEPI say that he needed to be admitted?
What can you say in a situation like that? “Oh, the doctor at BEPI didn't admit him because he was a malpractice major at Our Lady of the Offshore University of Medicine and Hair Design”? It's hard to tell a woman that the last doctor to whom she trusted her kid was a moron who might have killed him! So I told her that some doctors are more conservative than others about these things and that keeping the child was mainly a safeguard. That's the first time I ever used the word “conservative” as a euphemism for “competent.”
Anyway, the story doesn't end there. That was really just the beginning. I finally convinced her that the kid needed everything, including a workup and admission. I went ahead and drew the blood and did the spinal tap. I also did my first bladder tap, which is a pretty nasty procedure
[to do a bladder tap, a needle attached to a syringe is passed through the abdominal wall and plunged downward until urine appears in the syringe]
. So I finished all that and I told the mother to go back out to the waiting room and hang out until someone from the ward came down to pick her up. Up until that point, everything was fine.
I called the intern upstairs and it took her about a half hour finally to get down to the ER. It was Amy Horowitz. I sent her out to the waiting room to find the kid but she came back a few minutes later and said, “They're gone. Do I still get credit for the admission?”
[Admissions are distributed evenly to the two interns taking call on the inpatient wards at Jonas Bronck; they alternate, admitting every other one.]
I went out to look and I couldn't find them either. It looked like they had vanished into thin air. Bob Marion was the attending and he told me to try to call the woman at home using the number listed on the ER sheet. So I called and I got some woman who claimed not to be able to speak any English. I asked for the kid's mother by name and this woman on the phone said something about “no speeka de English.” So I got one of the nurses to translate and she told me that the woman was saying that she had never heard of anybody by the name that was listed on the sheet. I figured I dialed the wrong number, so I hung up and tried again. I got the same woman on the line and we went through the same routine again. I was sure I was talking to the mother of the patient; I was positive she had decided that she didn't want the kid admitted, that she had never believed me in the first place, and that she had gone home and would deny that she had ever been to Jonas Bronck. It made me crazy! I told Bob about this and he got angry, too. He called the number himself and told the woman in Spanish that the baby could be very sick and if she was lying about it and the kid did die, it wouldn't be his responsibility, it would be on the mother's head and not his. Amazing! I had never heard anybody using the concept of Jewish guilt translated into Spanish. It didn't work, so it may have lost something in the translation, because the woman told him he was crazy, that she had never heard of the people he was talking about, and if any of us tried to call her back again, she'd call the cops and have us all arrested.
Bob hung up, and his face was bright red. He yelled that I'd better call the police and have them go out to the address listed on the ER sheet and bring the baby back, dead or alive. That is, if the address listed was correct. So then I started trying to contact New York's finest. Jesus, what a day!
I called the precinct house in the neighborhood they lived in and spoke to the desk sergeant. He took all the information but didn't know what to do with it so he tried to connect me with his supervisor but somehow the phones got disconnected. So I called back and got somebody else, who reconnected me with the desk sergeant who again tried to connect me with the supervisor. While I was on hold, the senior resident came up to me and said, “The charts are starting to back up. When are you going to be done with this nonsense?” I started to answer but then someone picked up and I never finished my sentence. I had to give whoever was on the phone the information all over again, and he said, “Well, you understand we can't just go out there and arrest them. We can't drag them in against their will. If the woman doesn't want to come, we can't force her.” I told him just to do his best; he said he'd try and asked for their address. When I gave it to him, he said, “That's in the projects, isn't it?” I didn't know, so he looked it up and said it was. Since it was the projects, it was out of the city cops' jurisdiction. He told me I'd have to call the Housing Police.
So I'm sitting in the emergency room, the patients are starting to pile up in the waiting room like the planes over Kennedy International Airport on a Sunday afternoon, and I'm getting a civics lesson in the structure of the New York City Police Department bureaucracy. I was pretty pissed off about all this. I called the number of the Housing Police and went through the same business again but finally a sergeant told me he'd send out a squad car to see what they could do.
I figured that phase of this mess was over and I went to pick up a new chart from the triage box but before I could even make my way to the microphone to call the next patient in from the waiting room, one of the nurses came running up to me and told me to follow her. She led me into the adult ER and there, in the holding area, lying on a stretcher, was the woman with the baby in her lap, both dead asleep. She had lost her way out to the waiting room, had come across this nice, cozy, empty stretcher, and had decided to use it to catch up on some sleep. I couldn't believe it! I went back to the ER, called Amy, and told her to come down and pick up her patient.
Then I remembered that a crack unit of the Housing Police was preparing to swoop down and make a raid on the woman's apartment. I figured it was my civic responsibility to try to prevent them from going on this wild-goose chase, but when I called, I found out I was too late; a squad car had already arrived at the projects and they couldn't be called back. About ten minutes later, two huge Housing Policemen marched into the ER leading this panicked little eight-year-old kid. “He said his mother wasn't home,” one of the cops said. “He said she was still here with the baby.” Bob and I explained the story to them very nicely. They weren't even upset. They didn't threaten to slug us in the mouth or anything. They even volunteered to take the boy back home. So the story had a happy ending. What a strange job this is!
I waste a lot of my time in the ER talking on the phone. If it's not the police, it's the labs. The lab techs don't give a shit about anything. There's this rule that before they give out any information to a house officer, they have to torture him verbally for a while. And if it's not the labs, it's a consultant from one of the subspecialty services who wants to avoid coming in to see a patient at all costs. And if it's not a consultant, it's the Bureau of Child Welfare. BCW's the worst! I never really knew what the term “terminal hold” meant until I made my first BCW referral. If putting people on hold were an Olympic sport, the BCW would be the gold medal winner. They can keep you waiting for twenty or thirty minutes without breaking a sweat. If all of us house officers could just see patients and not deal with the rest of the bullshit, there'd be no waiting to be seen in the emergency room.
Thursday, September 5, 1985
A week in the Outpatient Department has done me a lot of good. I'm more relaxed now, less on edge than I was on Infants'. Take Hanson, for instance. When I think about him I actually find myself laughing at some of the things that happened two and three weeks ago, how angry I got when he crumped. I guess with the passage of time, there'll come a point where I actually have fond memories of him. I can imagine: “Ahh, that Hanson, what a wonderful child, what I learned from him, how I wish I could take care of him again!” This is all kind of frightening. I think it's these kind of warped remembrances of internship by people in charge of training programs that keep us working every third night!
Sunday, September 8, 1985
I had this whole weekend off, and Carole and I sat down and actually tried to plan out my vacation. Carole can get only the second week of it off, so I'll have to figure out something to do the first week. We argued about it for a while; I wanted to go to some quaint New England village and just sack out, but Carole didn't like the idea of wasting a whole day in the car getting there and another whole day coming back. She wanted to go to some hotel in the Poconos. So we compromised: We're going to a hotel in the Poconos. Ahh, what the hell, it doesn't matter that much to me. Anywhere we go is fine. As long as there's a place to sleep and it's far away from here.
Working in the ER is fine. I'm seeing a lot of patients, nothing major or earth-shattering, just routine walk-in clinic pediatrics. I think I'm holding my own. I'm learning to do a lot of things I never knew how to do before. I'm even learning a little Spanish. I now can have three-year-olds refuse to open their mouths, stick out their tongues, and say “Ahhh” in two languages. Who says internship is not an educational experience?
Hanson keeps repeating on me like a bad hot dog you get from one of those umbrella carts. I got a call from Jennifer Urzo, the intern who picked him up when he came back to Infants' after being discharged from the ICU. She said he was doing fine, hadn't crumped in over a week, and wasn't he the most adorable thing I'd ever seen? I restrained myself. She said they're starting to think about discharging him and wanted to know if I had any idea how to get in touch with his mother. I told her I'd never set eyes on the woman, that she never once showed up during August, but if she was able to contact her, she should give me a call because there were a few things I'd like to say to her!
I have nothing much else to say. I can't wait till Thursday. Imagine, I'll be able to stay in bed past seven o'clock two days in a row!