The Intern Blues

by Robert Marion

  I really needed things to calm down a little after last month ended, but it doesn’t look like that’s going to happen. I finally got away from Barry Bresnan, but I wound up on the Adolescents ward at Mount Scopus, and it’s been terrible. I’m tired, and I’m fed up. I need a vacation. I have one coming up at the end of this month. I hope I’ll be able to make it till then.

  It’s been really busy on Adolescents and it’s very depressing. Half the beds are filled with fourteen- and fifteen-year-olds with leukemia, brain tumors, you name it. And the other half is all girls with anorexia nervosa who are completely crazy! It’s impossible to talk to them, it’s impossible to do anything for them. They just want to be left alone, do their aerobics, vomit in any secret hiding place they can find, and lose weight. They don’t want anyone coming near them, especially not a doctor who might actually be able to do something to help them.

  My most difficult patient is this eighteen-year-old girl with choriocarcinoma [a malignant tumor derived from the products of a pregnancy]. Two weeks ago, she was completely fine. She knew she was pregnant, and she was looking forward to having the baby. Then suddenly she started having some cramping and bleeding and she came to the ER where the gynecologist saw her. They figured she was having a miscarriage so they did a D and C. The stuff they took out looked strange. They sent it to pathology and found out it was cancer. She got admitted to me on Monday, the first day of the month. We did a quick workup that showed the cancer had spread all over the place, to her lungs, her brain, everywhere.

  On Wednesday or maybe it was Thursday, she got sick; she had a headache and was vomiting. The oncologists figured it must have been due to mets in her brain [metastases to the brain cause increased pressure within the skull, leading to symptoms such as headache, vomiting, irritability, etc.]. We started chemo [chemotherapy] on Thursday afternoon, but that didn’t help. In fact, she felt a hundred times worse; she spent all yesterday vomiting. It’s pathetic.

  I hate going into her room. On the one hand, I know her prognosis isn’t bad, even with the mets; but on the other hand, I know what this girl’s going to have to go through over the next few months: She’s going to have a lot of chemo, her hair’s going to fall out, she’s going to be vomiting constantly, she’ll have to spend a lot of time in the hospital. Also, if we can’t eliminate the cancer with chemo, the next step is to do a hysterectomy. It’s really sad. And so sudden; I mean, one day, she was looking forward to having a baby, the next day she finds out that not only is she having a miscarriage, but also she’s got cancer that’s spread all over her body, and if it can’t be controlled with medication, she may have to have a hysterectomy and never be able to have any children. She’s very depressed; you can’t blame her. I haven’t told her about Sarah. I don’t know if it would be good for her to know I’ve got a baby. It might depress her more.

  She’s the worst, but they’re all like that. I’ve got an eighteen-year-old who’s got a brain tumor. He was fine until about six months ago, when he started waking up having to vomit every morning, with really bad headaches. He came to the emergency room; they did a CT scan, and it showed this huge mass. He’s spent a lot of time in the hospital, getting the works, surgery, chemotherapy, radiation, but he’s just gotten sicker and sicker. At this point he knows he’s going to die and he doesn’t want anything done anymore. He screams at any doctor who comes near him. He only trusts one person and that’s one of the nurses.

  The only good thing about working on this ward is that there’re a lot of doctor types around, so nobody gets too many patients. We’ve got three interns and two subinterns on our team and the whole ward holds only thirty-five patients, so the most anyone can get is seven if things are equally distributed. But seven of these patients are worth fourteen University Hospital patients!

  There is one other good thing about this ward: Susannah’s working here this month, too. If she hadn’t been around last month, I’m positive I would have gone crazy. As it was, I don’t know how I survived it. So it’s good to have her here. But I can see that neither of us is going to be able to keep the same hours we had last month. The days of getting out at three o’clock in the afternoon are definitely over.

  Things at home are quiet. Sarah has a little cold, but I don’t think it’s too bad. I’m not worried about it. I’ve been feeling kind of sick myself, so I think we’ve probably got the same virus. I spent most of today sleeping. I’m on tomorrow, so I won’t get to spend any time with her again. It’s really impossible being a mother like this.

  Thursday, October 10, 1985, 9:00 P.M.

  What a week! This has definitely been the worst week of my internship. Every bad thing you could think of has happened to me. And it’s not over yet. I’ve got all day tomorrow and I’m on Saturday.

  First, Sarah got sick. She woke up last Saturday night at about 3:00 A.M., screaming her brains out. She had a fever of 103 and she just wouldn’t stop crying. I was sure she had meningitis; that’s what kept going through my head, “She’s got meningitis, she needs a spinal tap, and she’ll have to be hospitalized for two weeks and then she’s going to end up retarded and I’m going to have to go to work tomorrow and every day from now on and try not to think about it.” I somehow got her and myself dressed and we brought her over to the Jonas Bronck emergency room. She kept crying all the way over; she was inconsolable. Rhonda Bennett was the night float. She saw Sarah right away. I was sure she was going to examine her and turn to me and say she needed to draw blood and do an LP [lumbar puncture], but no, she found that all it was was a bad otitis [otitis media: infection of the middle ear, a common medical problem during the first few years of life]. She just gave us some Amoxicillin [an antibiotic used to treat otitis media] and Tylenol and said she’d be fine in a couple of days.

  What a relief! We went back home but I didn’t sleep a wink for the rest of that night. Sarah stayed up screaming until about five in the morning, when I guess the Tylenol started to work. She finally fell asleep, but I had to get up and go to the hospital and be on call like usual, as if nothing had happened. I was tired and nauseous and I couldn’t concentrate on anything all day except Sarah. I called Larry about forty times. Sarah had a fever most of the day but it was gone by the night and Larry said she looked better.

  I admitted this girl with conjunctivitis [inflammation of the conjunctiva, the outer part of the eye; also called “pink eye”] who turned out to have GC [gonococcus, the bacteria that cause gonorrhea; gonococcal conjunctivitis can be very serious, potentially causing blindness, therefore the infection must be treated very vigorously]. I washed my hands about a hundred times after I examined her but I was sure I got some of the stuff into my eyes. I was positive I was going to turn out to have GC conjunctivitis.

  I got maybe an hour of sleep Sunday night and then I had to stay to start fresh on Monday. By that morning I was sick as a dog. I was vomiting and I was sure I had a fever. Larry was going to take the day off from work and stay home with Sarah, but he got called into his office on some emergency, so he had to leave her with Marie, who I’m not sure I trust with medication. I tried to get my work done so I could get home, but I was running at about 10 percent of my usual speed. Susannah told me just to go home, that she’d take care of my patients, but she wasn’t feeling so well herself. Of course, nobody else volunteered to help, neither of the subinterns, who have a total of three patients between them; or the other intern, who I must say had to go to clinic that afternoon; or the resident. I plugged on and on and I didn’t get home until about seven. By that point I felt like I was going to die. I didn’t even care about Sarah anymore. I just got into bed and fell asleep.

  When I woke up on Tuesday my eyes were glued shut. I had conjunctivitis. I was sure I had GC. I wanted to go to the hospital and scratch that girl’s eyes out, but when I tried to get up I realized I wasn’t going anywhere. I literally couldn’t get out of bed. My arms felt like they weighed a ton each. I called Arlene, the chief who was on that day, and told her I had
the flu and wasn’t able to come in. She gave me a really hard time. “Are you sure you can’t make it?” she asked me. “Are you really too sick to come to work?” I couldn’t believe it!

  Larry had to go to work again that day. Before he left, I had him go out and get me some medicine and I wound up staying home and fighting with Marie all day. We mostly fought over little things, but I’ll tell you, it’s a good thing I’m away at work all day because if I had to spend a lot of time with that woman, I’m sure it’d be the beginning of World War III. Of course, if I wasn’t away at work all day, there’d be no reason for her to be coming into my house.

  I couldn’t face spending another day alone with her, so I went to work yesterday. I was also on call, and there’s no way you can call in sick on a day you’re on call. When I got to the ward, I found out nothing had been done on any of my patients the whole day before. They had left everything for me! It wasn’t like everyone was busy or anything like that, they just didn’t think to help me out. So I had a stack of labs to check, notes to write, consults to call, tests to schedule, tons of scut. I got yelled at by the oncologists for not doing something on one of their patients. How could I have done it? I was sick in bed all day!

  And I found out that my patient with choriocarcinoma had developed a painful infection in her mouth. She got these sores last week and they were getting worse so I sent off a culture and it turned out to be monilia [a common type of fungus]. It was so painful, she hadn’t been able to eat or drink for thirty-six hours! She couldn’t chew or bite, and nobody had even thought to give her anything to make her feel better. When I went into her room, she was literally crying in pain. I talked to the oncologists, and they hadn’t even been told about it. We decided to give her some morphine to see if that relieved the pain. I shot it into her IV and held her hand. Within three minutes, she was feeling better. What’s going to happen to her when I leave at the end of the month?

  Anyway, I didn’t have a bad night, but I only got about three hours of sleep, and this morning I was feeling lousy again. I don’t give a damn anymore about anything! When everybody showed up for work this morning, I just told them I was going home. I came home, went to sleep, and slept until a little while ago. Larry’s home and Sarah’s pretty much back to normal. I feel better myself today. It’s not good being a sick intern. You never get a chance to recover. I can see that this flu is going to drag on until the end of the month because I’m just not going to get a chance to rest it out until then. I’m tired and sick, and I’m upset that I’m not able to be a mother to my baby. I really need this vacation. But even that’s been a headache.

  We’re planning to go to Israel at the end of the month. I don’t know if I’ve mentioned that Larry’s whole family lives in Israel. His sister is getting married and we’re going to the wedding. But Larry’s mother gave me a list of things she wants me to bring for her; nothing expensive or anything, just things that are hard to get there. In order to get the stuff, I’d have to spend a whole day shopping. I don’t have time for that. I can’t just take a day off from work to go shopping! So I told Larry that unless he goes out and gets the things himself, we’re just not going to be able to bring it with us. I’m sorry, but I don’t think it was right of her to ask me to get it. It goes back to the fact that she doesn’t understand what this internship business is all about. Nobody understands it. Nobody could possibly know what it’s like to go through this unless you’ve gone through it yourself.

  The other problem about going on vacation is my schedule. We’ve got tickets to leave from Kennedy International Airport on Monday, October 28, at 11:00 A.M. My vacation officially starts that morning, but of course I’m on call the night before. If I work that night, as I’m supposed to, there’s no way I’ll be able to make it out of the hospital before nine o’clock in the morning. And considering that I’ll be signing out to interns who have never been on the ward before and don’t know any of the patients, it’ll probably be much later than that. There’s no way I’m going to make it to the airport on time. So I’m trying to make a change. The only person I could possibly switch with is one of the subinterns. She says she’ll think about it, but she’s not committing herself yet. If she can’t do it, I just might not show up that day.

  Sunday, October 20, 1985

  I got into a big fight with Marie on Wednesday. I was postcall and tired but I knew we needed some things, so I called before leaving the hospital and told her I was going to be stopping at the supermarket and was there anything special we needed? She said there wasn’t, so I just got the things I knew we needed. Then when I got home, I found out we were out of Pampers. I went crazy! “Didn’t you realize we were out of diapers?” I asked. She said she forgot, and I let her have it! The bottom line was that the baby had to spend the night without a diaper change because I was too tired to go out again.

  Then Larry yelled at me for yelling at Marie, and I let him have it, too. I told him I wasn’t a superwoman, I couldn’t do everything. I can’t be expected to work and take care of the baby and do the shopping and the cooking. I told him he was going to have to pitch in more and do some of the things that needed to be done around the house. Then after I let him have it, I felt even worse because I hate fighting with him. He’s one of those people who just doesn’t fight back; he never seems to get mad. He’s so calm, it drives me crazy! So we’ve been fighting a cold war since then.

  And things are terrible at work. I hate my patients, except Lisa [the young woman with choriocarcinoma]; I hate the house staff I’m working with, except for Susannah, who’s had the flu herself; but most of all, I hate the medical students. They’re terrible. I’ve never seen anything like it. I’ve got this third-year student who’s been assigned to me the past two weeks. He actually deserves to fail. He’s an M.D.-Ph.D. [a special track in which college graduates are accepted for a course of study that will ultimately grant then both an M.D. and a Ph.D. degree; Schweitzer accepts a handful of these students each year], and he’s got this attitude problem. He thinks he doesn’t have to do anything, all he has to do is show up. I ask him to go and check labs and do other scut and he actually refuses. He says it’s not in his job description.

  And the subinterns are big pains also. I asked one to switch with me so I don’t have to be on the last night of the month. At first she said she’d think about it. Then a few days later she said she’d do it. Then this week she told me she’d decided she couldn’t switch for some reason. She didn’t tell me why, but it doesn’t matter. It was the one time this whole year I really needed somebody to help me out, and nobody would do it. So now I don’t know what I’m going to do. Maybe I’ll just walk out of the hospital early the next morning. I mean, I’m not going to miss my flight.

  My patient with the brain tumor died last week. He had been in a coma for about a week. After talking it over with his parents, we all agreed to make him a DNR. I don’t think he was in much pain; his heart just stopped one night and they declared him dead. I never got a chance to talk to him. He was always so angry when he was conscious.

  At least Lisa’s doing much better. I’m glad about that. She’s the only patient I care about right now. Her mouth sores are better and she’s able to eat again. She finished her first course of chemo and she’s not nauseous anymore. She’s actually improving; she’s about the only patient all month who has gotten better.

  I told Lisa about Sarah on Friday. She asked me if I was married and I told her about Larry and the baby. She said she was happy for me and that she was really sorry that she wasn’t still pregnant because she really wanted a baby of her own. She said she thought I must be a good mother because I’m a doctor and I know what to do when children got sick. I don’t know about that, but it was a nice thing for her to say. She said she’d like to meet Sarah sometime, so maybe tomorrow, when I’m on call, I’ll have Larry bring her over to the hospital.

  Well, a week from tonight I’ll be on call for the last time on Adolescents. And a week from tomorrow,
we’ll be on our way to Israel. I can’t wait.

  Saturday, October 26, 1985

  I can talk for only a minute. I’m very busy tonight, but I wanted to get this down on tape before I left on vacation. This is a terrible story.

  Tuesday I admitted this seventeen-year-old named Wayne who’d had leukemia in the past but had been in remission for years. He came to the hospital because of shortness of breath, and as soon as he hit the floor, it was pretty clear that his leukemia had recurred. His shortness of breath was due to his enormous spleen. His white count [while blood cell count in the peripheral circulation] was over a hundred thousand [normal is between five thousand and ten thousand], and he was anemic and thrombocytopenic [thrombocytopenia: low platelet count; platelets are factors that aid in clotting of blood]. The hematologists jumped on him right away. They gave him all sorts of poisons to bring his white count down. He was sick, but he was in pretty good spirits, considering what was happening.

  Then yesterday morning, we were on work rounds and Wayne’s mother came to tell me he was acting funny. I didn’t think much of it, but I went to check him anyway. He was acting really strangely. He was shifting around in bed making gurgling sounds; he didn’t respond to questions; it was like he was in a coma, but his eyes were open and he was moving around. I got him to respond to pain, but he didn’t respond to anything else. I called for help, and everybody came running. The resident noticed that his right pupil was fixed and dilated [a sign of an acute and serious change in neurologic function]. Then he arrested.

  We all worked on him for about an hour. We were never able to get anything back. Everybody was in there: Alex George [the director of the intensive-care unit], the chief residents, everybody.

  That was my first death. All I kept thinking about through the whole thing was Sarah. A patient’s death always bothers you, but when you’ve got a baby, it means a lot more. I went home after work and just hugged her and hugged her. She’ll never understand it. I don’t think I’ll ever forget it.