The Intern Blues

by Robert Marion

  Then later in the day, a little five-month-old came in with a high fever. I did another spinal tap and did the cell count and this time, yes, lots of white cells; this kid did have meningitis and was admitted. That’s routine pediatrics, very routine, I know, but for me it was a very exciting thing. I was able to do everything from start to finish, and that was all stuff I learned here, stuff I didn’t know how to do in med school, and that’s very exciting. I’m now able to do some things that doctors are supposed to do.

  I told the mother we’d have to admit the baby and take more blood and she said “No way.” She was frightened to death. I knew there was no way that I, with my vast two-week experience as an intern, was going to be able to convince her to let us do what we needed to do, so I called the attending and he came over and sat and explained the whole thing to her, telling her how important it was that we start an IV and begin antibiotics as soon as possible so that the baby would have the best chance possible of surviving and she listened carefully but it was clear she was so frightened she couldn’t think straight. She finally said, “I don’t know what to do anymore. Call my husband and ask him.” We called the father and he said, “Do whatever you have to,” and he came in. It was very sad: Here’s this beautiful, normal baby with this terrible infection and the real possibility that he’ll wind up retarded, and I was excited because I had been able to do the workup from start to finish. It’s like I’m less interested in the patients and more interested in what I can and cannot do.

  I’ve been here a week and a half and I’ve done more spinal taps than I’d done in all of med school. You see a lot in this place, it’s a great program, but I can see how I could get burned out. It’s a real danger in a place like this, with call relentlessly every third night and the ancillary staff somewhat less than helpful. I can see I’m going to have to watch out; down the road when it’s the winter and my vacation is a month or two away, I can see how I could possibly come to hate this, how what seems like fun and is exciting now could turn into a real drag later.

  Monday, July 15, 1985

  Time seems both to drag and to race onward. It seems like forever since I last saw Karen; it’s only been a week and a half. I really miss her.

  Last night I was on call in the West Bronx ER again, and from the word go, it was crazy, packed from the start until about two o’clock. I didn’t have even a second to catch my breath. This is getting to be a very disturbing routine.

  I spent Friday and Saturday down in Manhattan with some of my friends from college, Gary and Maura. They live in the city; it was nice to get out of here and see some people outside of medicine. I tried to explain to them about some of the stuff I’ve been doing and seeing. They say they understand, but I get the feeling they only believe about half the things I tell them.

  Today I acted as the supervising physician for IV sedation in a kid who was getting a radioulnar fracture [a fracture of the two bones of the forearm] reduced by the orthopods [internese for orthopedic surgeon]. Although the attending popped his head in a few times to make sure everything was all right, I basically just did it on my own. Even though nothing really happened, it’s still kind of a nerve-racking experience.

  Thursday, July 18, 1985, 2:00 A.M.

  Just finished another call in the West Bronx ER. The past few days have been mixed. Today was pretty good, but the two days before pretty much sucked. I had a couple of aggravating days in clinic [all pediatric house officers are assigned to a “well-child clinic” in one of the hospitals; interns and residents have office hours once or twice a week in clinic during which they usually see six or seven of their own patients], where I just felt overwhelmed and disorganized; it was driving me crazy. The problems were pretty boring, but I’m picking up lots of new patients, slowly but surely drumming up my clinic. I have the feeling it’s going to be a booming clinic pretty soon. It seems like every walk-in [a patient who comes to the emergency room] needs a regular doctor. They ask me if I’d be their doctor, I say sure and give them the clinic’s number. I have a feeling this is going to be a mixed blessing in the long run, but anyway . . .

  I was really tired most of today. I just don’t seem to have any pep. It’s this every-third-night-on-call business, the inevitability of it, it’s just dreadful. Even though this is the easiest rotation I’ll have and I get to go home every night (even though it might be at three or four in the morning), these hours just get very tiring. Is it possible that I’m really starting to get tired this early into the year? I’m worrying about everything; I’ve even started to have trouble sleeping on the nights I’m not on call. I didn’t sleep well last night—I woke up three times before my alarm went off.

  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 mo
re 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 atte
nding 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.]