In early spring of 1989, Amy told me that she and Larry had decided to move to Israel. “There’s not a lot for us here,” she explained. “I don’t have a job and Larry’s not happy with his. The only family I’ve got is my father, and he’s thinking of retiring and moving away. And there are all these memories of what’s happened.”
I hadn’t spoken with her since that day. But now, here she was, picking up the phone after the third ring and saying “Shalom.”
She said she was happy to hear from me. “We live just outside of Jerusalem,” she told me, sounding exactly as she had more than ten years before. “Larry, me, and our four kids.”
“Four kids!” I repeated. “When you left New York, you only had two.”
“That’s right,” she answered. “Our last two are sabras. Aviva was born in 1990, and Seth, our baby, was born in 1992.
“And Sarah and Eric must be teenagers.”
“Right, again. Can you believe it? Sarah’s going to be sixteen in a couple of months. And Eric’s fourteen. It’s been great watching them grow up.”
“Have you been working?” I asked.
“Well, I’ve been a mother, which is a full-time job. But no, since coming to Israel, I haven’t worked as a pediatrician. That’s not the way I planned it; when we first arrived, I thought I would. I investigated how to go about getting licensed. But it was a lot of trouble. At the time, there was a glut of doctors here, and they were making it as difficult as possible for physicians who had trained outside the country to get jobs. To me it was no big deal: I had the kids to take care of, Larry had a good job, we didn’t have to worry about money. Since then, the time’s just passed, I’ve taken care of my children, and here we are in 2001.”
“Do you miss medicine?”
“No, not at all. When I started medical school, I really did want to be a pediatrician. But somewhere along the way, I just stopped wanting it so much. Residency kind of beat the desire out of me. And then when my baby died . . . well, that kind of put the icing on the cake. After living through that experience, I just didn’t care about medicine anymore. It was just a job, something to do to earn money, and since we didn’t need money, there was no need for me to do it.”
Knowing the answer in advance, I asked whether she thought her internship was worth it. “Internship was the second-worst experience of my life,” she responded. “I don’t have to tell you what the first-worst experience was, because you were around for that, too. But other than watching your baby die, I can think of nothing I’d want to do less than spending a year as an intern. It was degrading, depressing, and frightening. It brought out the worst in me, in my classmates, in those in charge of the program, in everyone. It was unhealthy, and it was just unfair—unfair to us, unfair to the patients, unfair to society. Back when I was doing it, I couldn’t see why I had to do it, and looking back on it now, I still can’t understand why I had to do it. So Bob, you can put me down for a ‘no’ vote. I don’t think it was worth it!”
And so, as in so many different events that occurred in this book, we’re left with a difference of opinion. Amy Horowitz, who following completion of her training chose not to practice medicine, believes that internship could never be worth the torture she was forced to endure. Andy Baron and Mark Greenberg, however, agree that internship was worth it, because it proved to be a means to an end, the end being a career in medicine. They never would want to go through it again, though.
Something Andy told me during our recent conversation is still reverberating in my head. “Internship is like a bad dream,” he said. “When you’re having it, it seems like the most terrifying thing in the world. In the morning, it still seems pretty bad, but in the light of day, the details are blurry and don’t make a lot of sense. Then, after a few days have passed, you almost can’t remember it anymore. You know you had a dream, you know it was scary, but all the details are gone.”
I think that’s how most physicians remember their internships.
Glossary
abruptio placentae Separation of the placenta from its attachment on the wall of the uterus. Dangerous because it deprives the fetus of oxygen.
acidosis Buildup of acid in the blood.
acute abdomen Term used to describe condition in which an abdominal catastrophe is occurring. Causes of acute abdomen include ruptured appendix, and inflammation of the pancreas and gallbladder.
agonal rhythm A pattern of electric activity generated by the heart just prior to death.
A-line Abbreviation for arterial line, a tube placed in an artery used for sampling blood.
ALL Abbreviation for acute lymphocytic leukemia, a common form of childhood cancer.
AMA Abbreviation for “against medical advice,” the situation in which a patient signs out of the hospital before his doctor considers it safe to do so.
ambubag A device used to force air into the lungs; consists of a mask that covers the mouth and nose and a rubber bag that, when squeezed, generates a gust of air under pressure. Used in respiratory arrests.
aminophylline Drug used for treating asthma.
aneurysm of the ascending aorta A ballooning out of the aorta, the main artery bringing blood to the baby.
antecubital vein A vein at the elbow that usually is most accessible for blood drawing.
APGAR scores A scoring system, designed for use in the newborn, that monitors fetal and neonatal well-being. Maximum score is 10.
ARC Abbreviation for AIDS-related complex.
ARDS Abbreviation for adult respiratory distress syndrome, a condition in which respiratory failure occurs.
argininosuccinicaduria A rare inborn error of metabolism that leads to mental retardation and often to premature death.
aspiration The act of breathing in; aspiration pneumonia results from the breathing in of foreign substances, such as meconium in the newborn.
atelectasis Collapse of the lung.
ATG Abbreviation for antithymocyte globulin, a drug used in patients who are rejecting transplanted organs.
bagging The act of forcing air into the lungs of a patient having difficulty breathing.
BCW Bureau of Child Welfare, the New York State agency charged with investigating and acting upon cases of suspected child abuse.
Benadryl An antihistamine used in treatment of allergic reactions.
beta HCG A blood test to diagnose pregnancy; more accurate than a urine pregnancy test.
bicarbonate A drug used in patients with acidosis (see above).
bladder tap Procedure in which a needle is passed through the lower abdominal wall and into the bladder so that an uncontaminated sample of urine can be obtained.
blood gas A test done on a sample of arterial blood that tells the amount of oxygen and carbon dioxide within the body.
bradycardia Abnormal slowing of the heart rate.
bronchiolitis Inflammation of the bronchioles, the small air passages leading to the lungs. This is a condition that resembles asthma and occurs in children under a year of age.
bronchopleural fistula A leak in the main air tube that causes air to leak into the pleural cavity, causing a tension pneumothorax.
BUN Abbreviation for blood urea nitrogen, a substance that builds up in renal failure and in dehydration.
CAC Abbreviation for “clear all corridors”; a general request, announced over the loudspeaker, for help at a cardiac arrest.
cadaveric transplant A transplant performed using an organ obtained from a person who has died.
cardiac cath A procedure in which a catheter is placed in an artery or vein and threaded up to the heart, at which point a dye is inserted. Used to define the nature of heart disease.
CBC Complete blood count. A blood test to examine the content of hemoglobin, red blood cells, and white blood cells within a sample of blood.
central line A tube placed in one of the major blood vessels, usually in the neck or the groin.
cervical adenitis Swelling of the lymph nodes of the neck.
chief of service rounds A weekly conference in which an interesting case is presented and discussed by an expert in the field.
choriocarcinoma A cancer that develops from a molar pregnancy.
CIR Committee on Interns and Residents, the house staff union.
CP Cerebral palsy, an abnormality usually caused by lack of oxygen around the time of delivery.
CPR Cardiopulmonary resuscitation; technique used at cardiac arrests to keep the patient alive.
cracking the chest The surgical opening of the chest wall to gain access to the heart and lungs.
creatinine A substance in the blood that’s elevated in cases of kidney failure.
crump To deteriorate rapidly.
CSF Cerebrospinal fluid, the liquid that bathes and protects the brain.
CT scan An X-ray procedure; most CT scans examine the head, looking for specific defects of the brain.
cutdown A surgical procedure in which a vein is isolated and a tube is placed into it for access. Used when no superficial veins can be found.
CVA tenderness Tenderness at the costrovertebral angle, the area of the back under which the kidneys are situated. CVA tenderness is present with many types of renal disease.
cyanosis Blue discoloration of the skin usually due to lack of oxygen in the blood.
dactylitis Swelling of the hands and feet; usually the first presentation of sickle-cell disease in an infant.
DKA Diabetic ketoacidosis; a severe metabolic abnormality that occurs in diabetics who have a marked buildup of sugar in their blood. If not cared for correctly, it may lead to death or brain damage.
DNR Do not resuscitate.
double footling breech Condition in which baby is heading out of the birth canal feet first; dangerous because there’s a chance the fetal head can get caught, leading to the baby being unable to be born.
DPT Two meanings: (1) immunization given to young children that protects against diphtheria, pertussis (whooping cough), and tetanus; (2) a mixture of Demerol, Phenergan, and Thorazine used to sedate children who are having some painful procedure.
dual response Procedure used in cases of child abuse in which the child is considered to be in danger. The police and the BCW (see above) are informed, and an immediate investigation is carried out.
dysplastic kidneys Condition in which the kidneys did not form normally and therefore cannot function well. Often leads to chronic renal failure.
E. coli A type of bacterium.
ectopic pregnancy A pregnancy occurring in a location other than the womb.
EEG Electroencephalogram; a test in which the electric activity of the brain is examined.
EMS Emergency Medical Service; the agency that staffs the ambulances.
endotracheal tube A tube passed through the larynx and into the main breathing tube that allows the individual to be placed on a respirator.
epinephrine A drug used in patients whose hearts have stopped beating.
ER Emergency room.
extramural delivery Delivery of a baby that occurs outside of a hospital.
fascinoma An interesting case.
febrile seizure A convulsion caused by a marked elevation in fever.
FFP Fresh frozen plasma; a part of the blood that sometimes is used as a transfusion.
FIB Fever in baby; all babies under two months of age with fevers should be admitted to the hospital and treated with antibiotics.
Foley catheter A tube that has an inflatable balloon at the end; Foleys usually are passed into the bladder to help monitor urine production.
fundoplication A surgical procedure used to correct gastroesophageal reflux (GER—see below).
gastrostomy A surgical procedure in which a hole is made in the abdominal wall and the stomach so that feeding through a tube can be accomplished without the patient’s having to suck and swallow.
GC Gonococcus, the bacterium that causes gonorrhea.
GER Gastroesophageal reflux, the regurgitation of stomach contents back into the esophagus.
gonococcus The bacterium that causes gonorrhea; also known as GC (see above).
gram-negative rods The appearance, under the microscope, of certain bacteria when stained with dye using a special technique. E. coli (see above) is the most common form of gram-negative rod.
G-tube A tube placed through the opening of a gastrostomy and through which blenderized food is squirted.
guaiac A test looking for blood, usually in a sample of stool.
Haldol A drug used in patients with psychosis.
H and P History and physical; the admission note that must be completed on all patients staying in the hospital overnight.
headbox A Plexiglas box that fits over the head of an infant and through which oxygen in high concentrations can be administered.
hemifacial cellulitis Infection of the skin on one side of the face.
hemoptysis The coughing up of blood.
HIV Human immunodeficiency virus; the agent that causes AIDS.
hydrocephalus Dilatation of the ventricles of the brain, which can lead to increased intracranial pressure.
hyperbaric chamber The center on City Island in New York City where the barometric pressure can be increased. Patients who have inhaled smoke and have a high level of carbon monoxide in their blood are sent there for treatment.
hypoxia A deficiency of oxygen in the blood. May lead to brain damage.
infantile spasms A particularly severe and damaging type of seizure disorder.
interosseous infusion Procedure in which fluids or drugs are injected into the bone; used in dire emergencies when an IV cannot be started.
intracardiac infusion Procedure in which drugs are injected directly into the heart; used as a last-ditch effort to save a patient’s life when IV access cannot be established.
intracranial bleed A hemorrhage into the brain; usually causes brain damage or death.
intubation Procedure in which an endotracheal tube (see above) is inserted through the vocal cords and into the main breathing tube.
Isuprel drip Constant infusion of isoproterenol, a drug used in severe asthma.
IVDA Abbreviation for intravenous drug abuser.
kerlix Rolls of bandages, often used to restrain little children.
KUB Abbreviation for kidneys, ureter, bladder; a type of X ray in which the abdomen is examined.
Lasix A diuretic drug used in hypertension and heart disease.
lidocaine A local anesthetic.
LMD Abbreviation for local M.D. The patient’s private doctor.
LMP Last menstrual period. Important because it’s used to determine how premature a baby is.
LP Lumbar puncture; a procedure in which a needle is inserted through the back and into the spinal canal so that a sample of CSF (see above) can be obtained for study. Also known as spinal tap.
main-stem bronchus One of the two main tubes connecting the trachea and the lungs.
M and M conference Morbidity and mortality conference, a teaching exercise at which a patient who has died is discussed.
meconium The baby’s first bowel movement; when meconium is passed while the baby is still in the womb, it often is a sign of fetal distress and can lead to respiratory problems if it is aspirated.
mediastinum The central part of the chest that houses the heart.
membranes The structures that contain the fetus, the placenta, and the amniotic fluid. Rupturing of the membranes, followed by a gush of amniotic fluid, often causes the onset of labor.
meningomyelocoele A defect in the spine, present at birth, that often is associated with hydrocephalus, neurologic deficits of the legs, and urologic abnormalities. Also called spina bifida.
methotrexate A chemotherapeutic agent used in the treatment of some cancers.
“mets to the brain” Metastatic cancer affecting the brain.
mitral stenosis Tightness of the valve that separates the heart’s left atrium and left ventri
cle.
monilia A type of fungus that frequently causes diaper rash in infants; also affects patients with immune deficiencies such as AIDS.
NEC Abbreviation for necrotizing enterocolitis, a severe disorder affecting the intestines of some premature babies.
nephrotic syndrome A condition affecting the kidneys that results in the inability to retain protein.
neuroblastoma A relatively common form of cancer that affects children.
neurofibromatosis A genetically inherited disorder that can cause abnormalities of the skin, the central nervous system, and other organs. Also known as the Elephant Man Disease.
NICU Abbreviation for neonatal intensive-care unit.
night float A resident who is scheduled to work the overnight shift in the emergency room.
NPO Abbreviation meaning “nothing by mouth.” Ordered for patients with intestinal abnormalities and patients who are pre-op.
occipital hematoma Hemorrhage into the back part of the skull or the underlying brain.
OPD Outpatient Department, composed of the ER and clinics.
orthopods Internese for orthopedic surgeons.
osteogenic sarcoma A type of cancer affecting bones.
otitis media Infection of the middle ear. Very common cause of fever in infants and young children.
oxacillin A type of antibiotic.
painful crisis A complication/result of sickle-cell disease; sickling of red blood cells leads to lack of oxygen reaching the tissues and results in development of severe pain.
pancytopenia Deficiency of all types of blood cells, both red and white.
patent foramen ovale An opening between the two atria of the heart. If untreated, it might eventually lead to pulmonary hypertension (see below).
Pavulon A drug that paralyzes the recipient; used in patients on respirators who are agitated and said to be “fighting the machine.”
PDA Abbreviation for patent ductus arteriosus, a congenital defect of the cardiovascular system that is common in premature infants.
perineum The genital region.
periorbital cellulitis An infection of the skin surrounding the eye. Dangerous because it can lead to infection of the eye (orbital cellulitis), which can lead to infection of the brain.
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