The Intern Blues

by Robert Marion

  It all started this afternoon. I was sitting around the nurses’ station on Adolescent, saying how I couldn’t wait for the month to be over because next month I’m scheduled to be on Children’s and I love Children’s. And Arlene, one of the chief residents, said, “Oh, haven’t you heard? We had to pull you from Children’s next month and put you on 6A.” She said that, after all, I had already done July on Children’s and that there were some interns who were never scheduled to work there and it wouldn’t be fair if I wound up doing two months and other people wound up doing none. I very calmly reminded her that I had only done a month on Children’s because the chief residents needed someone to fill in when one of the subinterns didn’t show up and they had promised that if I did them the favor, they wouldn’t pull me from my regularly scheduled month. Arlene said she hadn’t heard anything about that; all she knew was, I would have to spend the month on 6A. I should have pulled her head off right there while I had the chance.

  Not only are they going to do this to me, not only are they going to take me away from the best rotation in the system, but also they’re going to deprive me of working with Amy Sorenson; Amy Sorenson, who, in addition to being one of the smartest and friendliest of all the residents, also happens to be one of the best-looking. I’ve waited all year to work with her; I’ve even dreamed about it. It’s one of the only things that’s been keeping me going. And now they’re making me switch to 6A, where my resident’ll be Attila the Hun. And not only are they taking me from the best ward with the best resident and putting me on the worst ward with the worst resident, but also they weren’t even going to tell me about it until I showed up at the start of January rotation! So what this means is I’m going to wind up doing a total of five weeks on 6A and three weeks of Children’s. I’m getting screwed, and I’ll tell you one thing: Even if I don’t wind up killing the chiefs, you can bet I’ll never be caught dead doing a favor for them again!

  Friday, December 13, 1985

  I’m waiting for Carole to come by. We’re going out for dinner with Bob Marion and his wife, so I’ve got to make this quick. It looks like I won my battle, and I didn’t even have to use force. When I showed up for work on Wednesday ready to go up to the chief residents’ office to reenact some of the more gruesome parts of The Texas Chain Saw Massacre, Arlene came up to me in the hall and said, “Oh, we made a mistake. You don’t really have to work on 6A next month after all.” Apparently the chiefs talked it over and decided they really couldn’t screw me like that. That’s kind of nice, but it threw me off guard. I mean, it’s completely against their nature to be nice to interns. I have to assume they’re setting me up for something. So now my problem is, I’m sure they’re going to try to ambush me, but I’m not sure when. It would have been easier if they had forced me to do the month on 6A and I had just killed them; it would’ve taken all the guess work out of the next few weeks.

  Well, the bell just rang. I guess that’s Carole.

  It’s still Friday night, or maybe it started being Saturday morning already. Yeah, it’s twelve-thirty. I just got home. Carole and I had a big fight. What else is new? I’m such a wonderful conversationalist, so nice to be around. All I ever do is complain about work, and all she ever does is complain about me. Tonight she started in on me about my apartment. We went to this seafood place on City Island and she asked Bob and his wife if they knew of a place where I could move that didn’t have roaches. I don’t want to move! I like my roaches; they give me someone to talk to. So I said, “I don’t want to move!” and that started it off. She said she understood I was working hard but that she was a person, too, and if I wanted her to be part of my life, I was going to have to make some time for her in my busy schedule. I said that life is hard enough right now for me without anybody making demands on my time. Bob’s wife looked kind of uncomfortable through this, but Bob was eating it up. He wants to make this year into a book, so he was salivating with all this intimate social stuff. We fought for a while but then we made up around dessert. So now we’re friends again.

  Carole’s given up on getting married, at least for right now. I don’t know what’s going to become of this, but I do know one thing: If this relationship can make it through this year, it can make it through anything.

  Wednesday, December 18, 1985

  Last night something really funny happened. It almost made it worthwhile being on call. Wow, what a weird thing to say. Nothing could ever make being on call worthwhile. Anyway, here’s what happened: I admitted this fifteen-year-old girl who had been found unconscious in the street. Someone called EMS [Emergency Medical Service] and they rushed her to West Bronx. It was quickly figured out that she had overdosed on a combination of crack and heroin. They worked on her for a while in the ER and got her stabilized, then decided to admit her to Adolescent. So I went down to the ER to pick her up. That’s when she woke up. Lucky me.

  She wasn’t what I’d call the friendliest patient I’d ever seen. What she was was abusive. She cursed out anyone who came within ten feet of her, me, the nurses, my medical student, everybody. I couldn’t examine her, I couldn’t even get close enough to get her vital signs. So I called the senior and she came, and after she got cursed and threatened for a while, she said, “No way! I’m not touching her!” So here it was, nearly two in the morning, and we’ve got this lovely young woman in our treatment room who isn’t exactly happy to be there, and we’re supposed to do something to make her better. So the resident said, “If we can’t examine her, we have to call the person who has ultimate authority. Who’s that?”

  I said it was the attending. She said, “Well, call him and tell him to come in and see if he can talk to her.” And then she left. Very helpful.

  Well, I called the operator and got Hal Loomis’s home number. I felt a little funny calling him that late for something like this, but when I told him the story, he said, “No problem; I’ll be there in a half hour.” He actually seemed happy I had called him at home and woken him up! These attendings are really weird.

  About an hour later, Hal walked out of the elevator and onto the ward. I led him into the treatment room and pointed to the stretcher. She seemed to be asleep, but when we got close to her, she opened her eyes and started yelling at us. “You stay where you are, you fucking son of a bitch. Don’t come any closer or I’ll kick you in the balls, you asshole.” And, without missing a beat, Hal yelled back at her, “You watch what you say, you little bitch! We don’t want to have anything to do with you either, but you’re here and you’re sick and it’s our job. So you better let us do what we have to do or we’re going to tie you down and do it anyway. Now, which way do you want it?”

  Well, it was great logic, and I think it would have worked if she’d been in her right mind, but, of course, she wasn’t. So when Hal and I got close to her again, she started punching and kicking and biting us. But with him there holding her down, I at least could get some sort of a physical exam done. After about a half hour of that, I said I was finished, and we tied her down to a bed in one of the rooms with leather restraints. Then Hal headed back to Westchester, I got a couple of hours of sleep, and this morning she was a real pussycat, believe me. She’s just fine today.

  So I didn’t mind being on call last night. If I could watch an attending make a fool of himself every night I’m on call, I think I wouldn’t even mind being an intern.

  One more week to go on this damn ward. One more week and the year’s half over. I can’t wait!

  Bob

  DECEMBER 1985

  This month marks the halfway point in the interns’ trip through this horrible year. The first half of internship officially ends on December 28, and I’m sure that on that night, as they lie in their beds trying to fall asleep, or sit in nurses’ stations around the Bronx trying to finish yet another admission note, many of our interns will take a minute or two to reflect on what’s happened to them since July 1 and try to work up enough enthusiasm to propel them through next June.

  The p
ediatric department’s annual holiday party was held on Wednesday night, December 18. Most of the interns managed to turn out. That’s surprising when you consider that a third of them were supposed to be on call and another third were postcall and many of these guys probably hadn’t slept in a couple of days. So the fact that so many were there was nice.

  Just watching them, it was clear that something had changed since the last time this group had met at a prearranged site for a party. At the first orientation party, the interns had seemed isolated, nervous, and scared to death. Now, six months later, they were a strong, unified group. Tight bonds had formed among them from the mutual sharing of the good times and bad that have occurred over the past six months. On the dance floor, at the bar, sitting at the tables, there was a lot of backslapping, a lot of laughing, and a lot of inside jokes. These guys have built a strong support network for themselves; they’re there to help each other out. That’s exactly the way it should be at this point in the year.

  Thinking back on it, these people have definitely changed. They’ve gone from being frightened, untrained, technically awkward but very concerned medical students to competent, overworked, and chronically overtired interns. It no longer takes them all night to start an IV or all morning to draw the routine bloods on their patients. They’ve become masters of scut; they’ve learned how to manage their time so that they no longer have to stay until eight or nine o’clock on the nights when they’re not on call, as they did when the year first began. They’ve learned the shortcuts that are necessary to survive.

  They’re also beginning to feel comfortable being around critically ill patients. They no longer feel the impulse to run away as fast as they can when they hear that a three-year-old who’s in the midst of a convulsion or a six-month-old with signs and symptoms of meningitis has appeared in the emergency room. They’ve started to be able to formulate a plan of management by themselves, not relying as much on the residents or attendings to tell them what to do and when to do it. And they’re beginning to develop good instincts; they’re now able to figure out which patient is truly critically ill and in need of immediate attention, and which patient is not so sick and can wait. But these skills are still in an embryonic state. It’ll take a few more months before any of the interns feel confident enough to reject advice given by an attending physician. But one day that will happen. They’ll suddenly realize they can do it all themselves.

  That’s how it was for me. I remember the night everything seemed to come together. It was the middle of March and I was working on the general pediatrics ward: the worst night of my internship. Starting in the afternoon, I had admitted patient after patient, each sicker than the last. By the next morning I had trouble remembering them all; there had been at least eight of them, with three sick enough to quality for admission to our hospital’s ICU.

  It was at about five-thirty in the morning when it suddenly hit me. The sun was coming up and I was finishing with my third ICU admission, a fourteen-year-old girl who was comatose and near death due to acute inflammation of her brain. She had been sick with chicken pox the week before and had now developed post-varicella encephalitis, a very rare, devastating, and often lethal complication. I had admitted her and done the entire workup by myself, including putting in an IV, drawing the bloodwork that I thought needed to be done, and performing a spinal tap. I had decided on a plan of management and had confirmed that plan with all the appropriate consulting services. And as I sat to do my admission history and physical, with the girl’s vital signs finally stable, after this long and terrible night, I realized all of the sudden that I could actually do this stuff. I could be left without someone looking over my shoulder and the job would get done. And once I came to this conclusion, I knew for the first time all year that I would survive my internship.

  But it wasn’t until March that I reached this conclusion. It’s only December now and, although Mark, Andy, and Amy have come a long way, they still have a long way to go.

  Mark came to the Christmas party with Carole. They seemed to have fun, but Carole has to have a tough time at events like this: She has to feel like something of an outsider, not being involved in medicine and knowing few of the people. And Mark has to feel a little uneasy, trying to share the experience with his intern pals while at the same time making sure that Carole is enjoying herself. They spent most of the night off to the side by themselves.

  Andy didn’t show up at the party until after nine. He had gotten out of the hospital late after a busy night on call, and he had stopped at home to take a shower and change his clothes before coming over. He was wearing a bolo string tie, had his hair slicked back, and was wearing a pair of horn-rimmed glasses that he hadn’t worn since sixth grade. The effect of all of this was that he looked as if he were on his way to a costume party.

  Andy immediately joined in with a group of eight other interns who stayed together through the rest of the evening. This group is composed of the interns who had either started the year alone, without “significant others,” or, like Andy, with significant others who lived outside the New York area. These people have supported each other through the first half of the year, and they have formed very tight, close friendships.

  The interns in this group have little to worry about. They may not each be feeling great right now, or be extremely happy about the prospects for the rest of the year, but they know they’ve got each other and they know that no matter what happens, the others will be there to help them through any bad times.

  At the Christmas party, the house officers traditionally put on a skit. This year, the senior residents presented a little play about what life must have been like in the Jonas Bronck ER back in the “Days of the Giants,” the phrase facetiously used to describe the times when the current attendings were doing their training. The myth about the “Days of the Giants” goes something like this: “Back when we were interns, we worked much harder than they do today. We were on call every other night, and we loved it. And when a tough case was admitted, we fought to be able to take care of that patient. We wanted to impress our chief with how good we were.”

  In the skit, senior residents were Alan Cozza, Mike Miller, Alan Morris, and Peter Anderson. They ran around a pretend emergency room trying to prove how macho each was. They got into arguments and ultimately fistfights about who would admit the critically ill patient (played by another senior resident) who was brought in by ambulance.

  But the residents also went on to depict what actually occurred once those Giants got those really tough cases: They didn’t know what the hell to do with them. Because the reality of the situation is that back in the “Days of the Giants,” there wasn’t a tenth of the technological advances that are commonplace today. In fact, pretty much all the Giants could really do was fight over the patients; there was very little that could be done to cure many of the problems presented. The skit ended with a very bitter and melancholy song about the life of the residents.

  The other attendings and I all left the party early; that’s also become traditional. The latter part of the Christmas party belongs to the house staff, a time for them to let loose without having to worry about being judged by their bosses standing off in the corners. The morning after, there were a lot of exhausted but happy interns running around the Bronx. They’ve got six months to go. In many ways, these last six months are much tougher than the first six.

  Andy

  JANUARY 1986

  Sunday, January 19, 1986, 1:00 A.M.

  I started my vacation, as planned, in Portland [Maine] with Karen and her family. We were there for Christmas. I ate like it was going out of style, I vegged out and slept a lot, and I got to know Karen’s family a little better. Three days never went so fast.

  After leaving Portland, we went back to Boston but we only stayed overnight. We had originally planned to go to New Orleans, but we went to California instead. We decided not to go to New Orleans because we saw in the newspaper that it was forty-five degrees and rainy do
wn there and we heard that one of the big college football teams was going to be in town for a bowl game and there were going to be millions of crazed football fans running all over the place. So we spent a week out in Santa Barbara instead. We stayed at Karen’s sister Kathy’s house. Kathy was still out in Portland with Karen’s parents. My brother and his wife, Debbie, and Karen and I shared this little bungalow with a porch in the backyard where you could sit and look out and see the Pacific Ocean in the distance. It was very quiet, very beautiful, and warm. We did a lot of walking that week; we walked on the beach and in the hills and around town. It was really a good kind of meditative thing to be doing. I had a chance to look back and think about what had happened to me over the past six months, what this internship had done to me. We watched a million movies on Kathy’s VCR, just one after the next. I slept a lot, and that was very good, too, just having the chance to catch up on some of the sleep I’ve missed. And I balanced my checkbook, which I hadn’t done in six months. I brought all the stuff out with me because I knew I wouldn’t do it otherwise. And I felt like my life was a little more back in order again.

  At the end of the week, we were all very sad to go home. Karen and I were still enjoying each other’s company a lot. We went back to Boston, where it was frigid and bitter cold. I had a few more days there. I saw a couple of old friends, and then Karen and I packed up all our stuff and got ready to come back to New York. Karen has come out to stay for two whole months. She’s doing a subinternship in psychiatry in Westchester.