The Intern Blues(107)

Karen left a couple of weeks ago after nearly two months of that subinternship she was doing. It was sad taking her to the airport. Fucking LaGuardia Airport; I really hate that place! I’ve felt very blue since she left. I’ve been missing her a lot and it’s been a real drag being apart like this. She’s doing obstetrics/gynecology now; she has to be on call every third night, and our schedules are completely out of whack. We’ve been able to talk only a couple of times in two weeks. It’s weird. But we’ll be together soon. It won’t be too long before this insanity is over.

Last Tuesday was my birthday. I was post-call and I felt terrible, and I didn’t want to celebrate at all. I went to visit my friend Gary and his roommates out in Brooklyn. I had a good time. The next day I went out with my friend Ellen. We went into Manhattan and had a wonderful time. Anyway, the weekend was pretty good.

I’ve been kind of reflecting on what’s happened over the past few months. I’ve been thinking about what’s changed. One thing is, I really don’t feel much like a medical student anymore. Occasionally I get into situations where I remember what being a student felt like, when I have no idea what I’m supposed to do. That’s what being a medical student is all about, always with an undefined role. When that happens now, I remember how frustrating it was. I am more comfortable with making decisions now, but I don’t think I’m ready to dictate those decisions to other people the way residents do. That’s still frightening to me.

I’m staring to realize what I need to do to become a better doctor. I’ve got to become faster and more selective, be able to narrow things down quickly and home in on the diagnosis, because those are the things I’ll need to be good at when I’m a resident.

So anyway, I guess I’m starting to become a master of internship, which is supposed to happen around now. I’ve become damn good at being a scut puppy, a data gatherer. I have a couple of tough months ahead: Infants’ (pain and torture but with some good people); and a month in the Jonas Bronck OPD, which will be great but tough; and then my last month here, 6A. What a good-bye kiss!

Thursday, March 13, 1986, 1:30 A.M.

I got back from the West Bronx ER a little while ago. It was a typical West Bronx night. As soon as I walked in, Andy Ames signed out a child-abuse case to me. It took the usual form of no one understanding where the second-degree burn on the child’s right leg came from. The social worker who called in the case had naturally gone home, and Andy was also gone, so that left me in charge. When the father came in angry and hostile, he couldn’t find anyone but me to threaten. Everything was getting out of hand, and then the police showed up to start their investigation and that led to more havoc. Christ! Anyway, the BCW finally decided that since there was no obvious perpetrator—that is, no one had come forward and said, “Yes, I did it, I was the one who burned the baby,” they let the kid go back home with the parents. I said, “Fine! Let him go home. What the hell do I care?” That’s typical of the BCW! And what usually winds up happening is the kid’ll show up next week or next month or next year dead. But what can you do? You can’t fight the parents and the BCW. That’s a little too much to take on.

The rest of the night was the usual. We had a bronchiolitic [a child with inflammation of the bronchioles, the small airways leading from the larger bronchi to the lungs; children with bronchiolitis are usually under one year of age, and have respiratory symptoms that are very similar to those of asthmatics] who probably has pneumonia [since bronchiolitis is caused by a viral infection, it’s not unusual that pneumonia, or inflammation of the lung itself, is often an accompaniment] who bought himself a bed on 6A. I also saw this girl, a skinny seventeen-year-old who had hematuria [blood in her urine] and stabbing pain in her right lower quadrant. When I told her I had to do a pelvic exam, she refused. She said she’d allow it only if someone from Gynecology did it. I paged Gynecology three times and they didn’t answer. The next thing I knew, the patient’s uncle was calling from a phone booth on Jerome Avenue. He said the girl had got fed up with the whole thing and just walked out of the ER and he followed her down to Jerome. So he was calling very apologetically to say that she wouldn’t come back. Right under our noses, she just walked. She was actively bleeding from somewhere; whether it was her vagina or her uterus, God only knows. But she up and left. Unbelievable! So I got on the phone with her and said, “Look, you know you’re leaving against medical advice. I advise you to come back to the emergency room right away.” She said, “No way! No fucking way!” So I said, “Promise me one thing: If you start to bleed profusely, you’ll go see another doctor.” She said, “Well, maybe.” That was it. She just walked!