Sorry. Anyway, I told Tom I thought the girl was lying. He told me that very well might be the case, but that I should draw some blood for a CBC [complete blood count: a blood test that measures anemia] and a sed rate [erythrocyte sedimentation rate, a test for inflammation or infection, in this case used to rule out inflammatory bowel disease, which is a cause of rectal bleeding] anyway, to rule out any real problem. I agreed with him and I went back and got the blood. I sent the CBC to the lab and spun a hematocrit [a direct test for anemia] myself. It was fine—37 or something like that. I forgot to get the sed rate, though. I just . . . it slipped my mind. The girl . . . she was making me crazy while I was taking the blood and I just forgot about it. I did it, I don’t know why they don’t believe me. . . . I’m sorry, please forgive my outburst.
A few hours later, Tom got it in his head that I hadn’t taken the blood. I don’t know why. He didn’t come to me directly and ask. He checked with the clerk and she told him she didn’t remember sending anything off to the lab. Then he called the lab and they denied ever getting a CBC on the patient. Then he called the girl at home and asked her if anyone had taken blood from her and she denied it. And then he came and confronted me with all this and accused me of having lied about the whole thing. I don’t know . . . I did it, that’s all I can say. I don’t know why the lab didn’t get it. The girl’s crazy, so I can understand her saying I didn’t take it. I don’t know. . . .
The worst part of this is that now everyone knows. I didn’t do anything wrong, I swear it, but all the ER attendings are talking about it. Some of the residents know. Nobody’s going to trust me, I know it. I’ve been crying for the past three days. I’m on tomorrow and I can’t let this affect me. I have to go on and just ignore this. But how can I do that?
Wednesday, July 17, 1985
Things are a little better today. On Monday, Jon Golden [one of the pediatric chief residents; the chief residents are responsible for the house officers; they directly manage the patients, make up the on-call schedules, and look after house staff morale] came to talk to me. He told me he had heard about what had happened in the emergency room and he assured me he didn’t believe it and that I shouldn’t let it bother me or interfere with my work. It was nice to talk to him, it made me feel much better, but it’s sad to think it had reached the higher-ups that fast. Even though we’ve got so many interns and residents, this is a small department in terms of gossip. You have to be really careful what you tell people.
Then yesterday, Tom Kelly talked to me in the ER. We cleared the air. He apologized for the story getting around. I understand it in a way; the ER attendings at Jonas Bronck are all close friends and they have to talk to each other about something! Anyway, it looks like this storm has passed. Now if I could only straighten things out with my baby-sitter.
I’m still having trouble with Marie. I don’t know what to do about her; she’s very good but she’s got her own ideas about things and there isn’t anything I can do to change her. It comes down to two options: Either I try to live with the way things are, or I let her go and try to find someone else. I don’t think it would be very easy to find a replacement for her right now. I barely have enough time to eat; I don’t think I can afford to go through another round of interviewing. So, I guess I’ll have to keep her. It could be worse.
I wonder what the other interns are doing with their free time. I mean, I spend all my time away from the hospital with Sarah. I never talk to anybody outside of work.
Friday, July 26, 1985
Yesterday was a terrible day. I was on call. I seem to be on call every night! But yesterday was worse than usual because it was Sarah’s birthday. She was three months old and I wasn’t there to see her. In the last couple of weeks, she changed into a real person. She doesn’t just lay in her crib anymore: She can lift up her head and look around and she smiles when she sees me. She’s got a beautiful smile. It’s great coming home to see her. I just wish I could spend more time with her!
We were really busy all day and I couldn’t seem to do anything right. In the afternoon, I had this four-year-old who came in with a high fever and chest pain. She was coughing and congested and I was sure she had pneumonia. I listened, and sure enough, I heard rales [a crackling sound in the lung fields, usually associated with pneumonia] in the area of the right lower lobe. I sent her for an X ray but it turned out normal, no evidence of pneumonia. I went to the attending, Harvey Abelson, for help. He examined her and said he didn’t hear any rales but he found that she had right CVA tenderness [tenderness over the costovertebral angle, the area of the back that overlies the kidneys] and told me to check the urine. Sure enough, the urine was loaded with bugs [bacteria] and white cells. I gram-stained it [a test to identify the type of bacteria causing the infection] and found E. coli [the most common bacterial cause of urinary tract infections]. She had pyelonephritis [an infection of the kidney], not pneumonia. She needed to be admitted, and I had almost sent her home! I’m just about finished with my first month of internship, and I think I know less now than I did when I started.