The residents’ shared call rooms, the correction of mistakes, the change of command, and all eleven forms of public transportation to the hospital were discussed. Manhattan Hasbro had three paging systems, in addition to direct calls to personal Vox. Nearly every bed also served as a monitor. All charting was electronic and could be accessed through the many stations and, with certain privacy installations, through portable palm-pross terminals. She ran through the various colors of codes and how to handle every one. The security systems seemed overbearing and Orwellian in their duplication and complexity, especially on the Obstetrics Unit.
Just when Susan wondered if her brain could absorb any more information, the woman finished.
A moment later, another man took the stage. He sported a face full of honest wrinkles and a head of thin white hair. He wore a pair of glasses balanced on a leathery nose. Either his age had caught up to his eye surgery or he had chosen not to risk it. Despite appearing ancient, he walked with a solid and deliberate tread and did not look debilitated in any way as he stepped to the podium.
“My name is Dr. Kevin Bainbridge, University of Pennsylvania, class of 1985. I’m sure you’re all happy to know I’m your last speaker this morning.”
Scattered murmurs and bits of applause followed.
Bainbridge cleared his throat, then spoke some of the most dreaded words in the English language: “When I was a boy . . .”
Susan dodged Kendall’s gaze. If he so much as smiled, she would burst into laughter.
“. . . just beginning my residency, things were much different, much harder.”
Susan settled more comfortably into her seat, prepared for another long-winded speech, this one more self-serving.
“Our call schedule was one in two. That means, we were on call every other night, and there was no such thing as an ‘after-call’ day off.”
Kendall leaned toward Calvin and stage-whispered in a gravelly, old-man parody, “And we liked it.”
Calvin choked a laugh into a snort, biting her lips.
Oblivious, Bainbridge continued. “And we worried we were missing half the good cases by going home every other night. Some rotations, we had shifts that went twelve hours on, twelve hours off or twenty-four hours on, twenty-four hours off every day for a month. And we still worried we were missing half the good cases.
“We once calculated our pay at ninety-seven cents an hour, working approximately one hundred to one hundred twenty hours per week. Then came a few high-profile cases of sleepy residents making foolish mistakes, and the system that had worked beautifully for a hundred years became obsolete overnight.” Bainbridge sighed deeply, shaking his head. “There followed all the so-called humane residency laws that treat you all like grade school babies. Limited call, after-call days off, minimum wages.” His head shaking grew more vigorous, as though the very idea of wanting mere sixty-hour weeks and expecting half a living wage made a person soft as bread dough.
“I want you all to realize how lucky you are compared to your teachers. We don’t want to hear any complaining about hours or wages; you have it easy. We expect you to spend a significant amount of your home-time learning, reading, and studying journals. You will come to work up-to-date on diagnoses and treatments, prepared for difficult patients and conundrums, and ready for any emergency. From this moment forth, lives depend on your capability as medical professionals, on your ability to retrieve knowledge, on your every small decision.
“You had best not think of your off-time as downtime. The law demands you take this time for rest and to refresh your brain, to make sure you’re not a danger to your patients, not for fun and games. It exists solely to make sure you come to work ready to perform your duties to the best of your abilities. If you attend a party, it had best be someone’s birthday or retirement. If you find an alcoholic drink in your hand, think about how it will affect your performance, and your sleep, before downing it. Your years of residency are not the time to give birth, get unnecessarily ill, or entertain your hobbies. The next several years belong to Manhattan Hasbro and to your future patients, not to you. Whatever you do, think how it will improve your acumen and the lot of your patients. If it won’t, don’t do it.”
Susan dared a glance at Kendall. He looked straight ahead, but his profile revealed a grin she could not currently handle. She turned her attention to her Vox, where Bainbridge was saying his thank-you and stepping down from the podium.
Susan typed a quick message to her father: “Hey D. Lss thn 1 hr & alrdy broke 1 crdnal rule. Only othr thng lrnt is dn’t wnt wrk w/ ol doc Bainbridge. Hpfully, he’s pathologist or smthng. Luv S.”
Brentwood Locke, the first man who had spoken, retook the podium. “And now, if you will all step out into the hallway, we will divide you by residency program. You will find someone holding a sign with your specialty, and that person will take you to your residency quarters and lockers.”
The residents rose, turning toward the exit. In the conversational din, Kendall resumed his scratchy, mocking voice. “Patient records consisted of piles of parchment, which we scratched out of inkwells using turkey quills. We performed surgery by gaslight, using nothing but nitrous oxide. And, when we did these things, we worried about missing half the good cases.”
Chapter 2
The psychiatry residents’ office consisted of fifty cubbies, two-thirds of which contained medical bric-a-brac; a circular table that held three palm-pross computers; eight chairs; and lockers lining every wall. Taped to several of the lockers, Susan saw comics, silly drawings with cryptic jokes, photos, and small dangling toys. The new residents were called away in groups of five until only Susan, Kendall, and three others remained with the young man who had escorted them all to the office.
Susan studied their guide. He had a perfectly round head topped with a frizzy ball of dark blond hair. She doubted even the greasiest hair care products could tame it. His ears and lips stuck out prominently, making his nose look relatively small, and his cheeks were pudgy and flushed. Though not fat, his figure had a softness to it; his arms and legs were a bit short for his torso, and his hands were enormous. When he spoke, tiny bubbles pooled at the corners of his mouth.
“Hello, R-1s.” He used the shorthand term for first-year residents.
“My name is Clayton Slaubaugh. I’m the R-2 assigned to oversee you on the PIPU, the Pediatric Inpatient Psychiatry Unit.”
“Pediatric inpatient psychiatry?” said a woman in an incredulous tone. One of the two female interns Susan had not yet formally met, she had pixie-cut black hair, dark eyes, and a swarthy complexion. “I thought that had gone the way of ostomy bags and oxygen tents.”
Clayton glanced at the Vox on his left wrist. “Are you Susan? Nevaeh? Or Sable?”
The woman bobbed her head, her face a long oval. “Sable Johnson, R-1. It’s just we learned in medical school —”
Clayton interrupted, anticipating the question. “Pediatric inpatient psychiatry has become rare, but it’s not defunct. We even have ‘lifers,’ kids who’ve been there so long, they might as well call it home.” He looked around the table. “It’s the most heartbreaking unit in all of psychiatry, which makes it the perfect place to start. That was my first rotation as an R-1, too.” He hitched his chair toward the table. It caught on the rug, teetered, and fell backward, dumping Clayton to the floor.
Horrified, Susan leapt to her feet to assist. Kendall turned his head, as if to wipe something from his face, but Susan suspected he politely hid a smile. The other three R-1s simply stared in surprise.
Clayton scrambled awkwardly to his feet, tangling himself up with the chair’s legs in the process.
Worried about getting caught in his thrashing, Susan stepped back.
It took inordinately long for Clayton to right the chair and place his bottom cautiously back into it. “Sorry about that,” he said with a matter-of-factness that suggested he did such things all the time. “I’d like to get to know whom I’ll be working with over the next month.
Could you introduce yourselves, one by one, and tell me something special about you?” He looked toward Sable to begin.
She obliged. “As I said, my name’s Sable Johnson. I graduated from the University of Hawaii, and I’m interested in psychiatry because my mother is schizophrenic.”
Susan retook her own chair, between Kendall and Clayton.
Clayton nodded next at the male R-1 beside Sable. He had short, spiky brown hair, hazel eyes, and a slender figure. “I’m Monk Peterson. I graduated from Johns Hopkins at the age of twenty-three.” Clayton made no comment, simply moving his gaze to the next woman.
She wore a dress polo, like the others, in plain khaki that matched her pants. A braided rope belt circled her tiny waist; and, unlike the others, she did not wear a Vox. “Nevaeh Gordon. Medical College of New York. I’m a vegan.”
Really, Susan thought, some people take “you are what you eat” a little too seriously.
At a gesture from Clayton, Kendall piped up next. “I’m Kendall Stevens, graduate of New York University.” He added, deliberately sounding like a personals ad, “I like dogs, long walks on the beach, and peace on earth.”
The group chuckled. Then it was Susan’s turn.
“Susan Calvin. Thomas Jefferson Medical.” She racked her brain for some tidbit worthy of remaining permanently lodged in her colleagues’ thoughts of her. “I also happen to like dogs, though I don’t own one. I live with the perfect man,” she said, then added conspiratorially, “my father.”
Smiles wreathed every face.
“Thanks, everybody,” Clayton said, rising. “Now we have to get your thumbprints established on the door lock and assign lockers and cubbies. Then, we’re on to the on-call rooms to allow another group in here.” He glanced at his Vox. “After that, it’s a tour of the hospital, particularly the psychiatry areas, restrooms, cafeterias. And, finally, to the Pediatric Inpatient Psychiatry Unit, where Stony Lipschitz, our supervising R-3, is holding down the fort single-handedly until our arrival.” He took a step toward the door, nearly tripping over the askew leg of his chair.
The tour of a cheery hospital with impressively up-to-date facilities ended with a descent into the basement that betrayed everything the new psychiatry residents had previously seen. Janitorial staff rolled massive equipment through bleak, gray hallways broken by unmarked doors, beyond which Susan Calvin could hear the whir and hum of machinery. At length, they turned down a quieter corridor, no less dreary, that ended in a thick metal door with an old-fashioned key lock below the handle.
Clayton Slaubaugh, R-2, stopped the interns in front of it, removing a key from his pocket. “It’s an ugly part of the hospital, but necessary. The unit itself is far more upbeat, but the inpatient children need quiet isolation from the rest of the hospital. They’re locked in for their own protection, and to prevent elopement, and the location keeps adults from wandering in where they don’t belong.” With that warning, he unlocked the door onto an empty hallway broken only by two doors and ending at another metal door with another key lock. “You will not be issued keys. Only the attending, the R-3, and certain members of the nursing staff carry them. To come and go, you will have to use the buzzers.” He indicated a recessed intercom-type system.
Feeling extremely uncomfortable, Susan went silent as she looked around at the empty walls and listened to the echo of the door closing behind them. Even Kendall seemed to have nothing funny to say. As they passed the first doorway, Susan peeked inside to see an adult couple playing a board game with a girl who appeared to be about ten years old. The room across from it was empty. Clayton used the same key to unlock the second door, opening the way into the world of inpatient pediatric psychiatry.
The unit itself looked far brighter than the hallways leading to it, the walls painted a mellow blue with paper drawings and watercolors taped to them. A wall broke the area directly ahead into a large staff area on the right and a hallway on the left. Immediately to Susan’s right, a door opened onto an enormous restroom; then a smaller area contained a medication room, where an orderly was placing items onto a snack cart. Directly to the left, Susan saw two doorways opening onto simply furnished bedrooms that mostly consisted of a metal bed and shelving, all fastened securely to the walls and floors. Compared to the sleek, monitored beds in the rest of the hospital, these looked like ancient devices of torture.
After making certain the door closed and latched behind him, Clayton led the residents into the staffing area. A large nurse, a head taller than Susan, met them at the opening, nodded at Clayton, then stepped aside to allow them entrance. As the six resident physicians funneled through the opening, Susan noticed the nurse casually pushing a chair out of Clayton’s way with her foot. Apparently, the clumsiness he had displayed in the psychiatry residents’ office was not a fluke.
The staff area contained multiple tables, desks, chairs, and cabinets. Most of the level surfaces held computer consoles, some being accessed by staff members. Other than the cinder block partition that divided the staff area from the main hallway, the walls consisted of what appeared to be glass. Through it, Susan could see several more bedrooms swinging around the back of the unit, a closed white door marked SELF-AWARENESS ROOM, another restroom, and a large open area that currently held several children varying in age from elementary school to adolescence. Most sat on chairs and couches, watching an enormous television screen enclosed in a clear, unbreakable box. A few played games or sat talking in small groups. None returned her gaze. Apparently, what she had first mistaken for glass was actually a series of one-way mirrors.
A young man no older than thirty rose from his seat in front of one of the consoles. Tousled jet-black hair fell rakishly across his forehead, emphasizing eyes so strikingly blue, Susan assumed they were tinted. His nose jutted, perfectly straight, over a mouth that clearly smiled a lot. He had classic high cheekbones and a solid, undimpled chin. Though he was slender, his chest and arms revealed him as an athlete. Susan caught herself staring and swiftly looked away, only to notice every other R-1 studying him as intently.
“Stony Lipschitz,” Clayton introduced, passing the key he had used to open the unit doors on to the R-3. “Our peerless leader.”
“Hello,” Stony said. Accepting the key, he dumped it into the pocket of his dress polo, along with a pack of laminated patient cards. “I’m the R-3 supervising PIPU this month.” He spoke with just a hint of a lisp, which likely worsened with agitation. Susan winced at the irony of a lisper with so many s’s in his name. “Actually, I’ve been getting to know our patients the last three days. R-3s switch rotations a bit early so we’re ready for the new R-1s and the patients don’t completely lose continuity of care. Three days before you’re finished, I’ll train my replacement and move on to adult outpatients. But, for the rest of this month, you’re stuck with me.”
Clayton ran through a brief introduction, probably as much to refresh his own memory as to inform Stony. He pointed to each R-1 as he spoke his or her name. “Kendall Stevens, Monk Peterson, Sable Johnson, Susan Calvin, Nevaeh Gordon.”
Stony paid close attention to Clayton’s words and gestures, then nodded. “I think I have it, but I may ask once or twice more, if that’s all right.”
All of the R-1s bobbed their heads and mumbled their okays.
“The interesting thing about doctors is that no two treat patients exactly the same way.” Stony retook his seat, leaned back against the desk, and gestured for the others to sit as well.
A wild scramble for the chairs sent Clayton dropping to the floor again. Stony smiled, as if at a private joke. “Clay, do you mind handling the patient work for a bit while I finish orienting the -1s?”
Clayton’s round face turned pink, and he rose, brushing dirt from his pleated slacks. “Of course. No problem.” He headed off toward the nurses.
Stony watched him pass beyond hearing range, then pulled his seat closer to the R-1s. “Ol’ Clamhead’s not a bad guy, though he doesn’t have much grace, physically or s
ocially.”
Though Stony could surely tell the R-1s needed a moment to process the nickname, he did not miss a beat. “Every doctor finds his or her own niche. Some are sticklers for procedure and use the most cautious approach to every patient in every circumstance. Some are more liberal and experimental in their approaches. Others fall various places in between.” He glanced around at each of them in turn, as if reading their futures. “You will wind up working with examples of each type of physician, and most of them will be excellent doctors in their own way. Despite protocols and studies, no two doctors approach a patient exactly the same way, and that’s not a bad thing.”
Stony leaned backward, against the desk again. “All of you will develop a style, and it might change over time. Some of the R-3s, and most of the attendings, believe their way is the only right way. I’m not one of them. I’m more of a hands-off leader. You can’t learn responsibility, or to think for yourselves, if I’m always telling you what to do. These are your patients. If you want to try something different, go ahead. If it’s outlandish, stupid, or dangerous, I guarantee the nurses will run to me before implementing it.”
Susan saw her peers’ heads bobbing in agreement and found herself doing the same thing. With long-term patients, especially children, nurses often became every bit as attached and protective as the parents.
“You’ve probably heard the pediatric inpatient unit is the hardest psych unit, and it is. But it’s also a great place to try new approaches. It takes a serious situation to land a child here, and conventional medicine has already failed them. You’re unlikely to make things worse, and who knows? You might have a brilliant breakthrough that doctors with more rigid ideas have missed.”
Stony looked around the group. “If you’re uncomfortable with the sink-or-swim approach, Clamhead and I are here to help you with any problems or questions. Any. You’re here to treat the patients. We’re here to keep you, and the hospital, out of trouble. So, if you feel you need some backup, or just some advice from someone more experienced, come to Clammy or me.”
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