What they’re doing is this: Usually the interns are divided, two working with a senior resident, the other two working with a junior resident. Because we were short, the chiefs decided that the other two interns would work with the junior resident and I would work alone with the senior resident. The senior this month is Ben King, who is one of the best people in the program. He was the person who let me leave the morning after my last night on Adolescents’ so I could catch the flight to Israel. So I’m very happy to be working with him. The junior resident is Dina Cohen, who’s one of the worst people we have.
Because there’s only one intern on our team and two on the other, we started off the month with only one third of all the patients. And not only that, but on that first morning, Ben was smart enough to realize that most of the patients who were assigned to us didn’t belong in the hospital in the first place. I started Thursday morning with seven patients. When we made rounds, Ben decided that three of them could be sent home right away, so I was down to four. I got only one admission Thursday night, and one of the other patients went home yesterday, so tomorrow I’ll start with only four patients. That’s not bad for 6A; that’s not bad for anywhere. And none of them is what you’d call sick. Two are preemie growers. [Six-A serves as an “overflow valve” for the neonatal intensive-care unit; when the unit gets crowded, preemies who have outgrown the problems of prematurity and only need to gain weight are transferred out to the ward. These babies frequently continue to have more problems than normal, healthy babies of the same age, however. Caring for a preemie who graduated from the unit is not just a baby-sitting service.] One is a kid with AIDS who’s here just because he’s got no place to go. And one is a six-month-old with meningitis who’s doing pretty well; he’s just in the hospital to finish his two-week course of antibiotics. So, so far I don’t have much to do. I’m not complaining about it. I know it won’t stay like this for long.
Thursday, March 6, 1986
I was on last night with Dina Cohen. Jesus, what an airhead that woman is! She’s completely incapable of making a single decision. She’s totally incompetent. Yesterday afternoon, Margaret was signing out and she told me she had this adolescent girl who had come in the night before with abdominal pain and a positive urine pregnancy test. An emergency sonogram had been done that showed something around the right ovary. Ben was sitting next to me, and when he heard Margaret say all this, he got very upset because he knew the girl had to have an ectopic pregnancy [a pregnancy in which the gestational sac implants someplace other than in the wall of the uterus; it is dangerous because it can cause a massive hemorrhage]. Ben asked if Gynecology had come to see her, and Margaret said, “No, they haven’t even been called yet.” Ben just about blew his top! He ran over to Dina and asked her about it and she said, “Well, the ultrasound attending said it wasn’t a conclusive study. He thought it could either be an abscess or a cyst or an ectopic—” Ben interrupted her and yelled, “It is an ectopic! You have to call Gynecology right now!” And Dina said, “Well, I’d rather be sure first. I think we should do a beta HCG [a blood test for pregnancy; more accurate than the usual urine pregnancy test], but you can’t get it done until tomorrow morning. Can you imagine? You can’t get a beta HCG done in this hospital after twelve o’clock—” Ben stopped her right there and said, “Dina, think a minute! You’ve got an adolescent with abdominal pain, a positive urine pregnancy test, and a finding consistent with an ectopic on ultrasound. You don’t need a beta HCG. What you need is a gynecologist. They have to take her to the OR right now or she may bleed out before tomorrow morning!” Then Dina said, “Well, I thought we should do more tests—” And Ben said again, “You have to call Gynecology right now. Don’t you understand?”
He finally convinced her to make the call. They came and saw her at about five o’clock and took her to the OR almost immediately. Of course, she had an ectopic. If Dina had waited and hemmed and hawed a while longer, that girl might have bled out right there on the ward!
Needless to say, I didn’t feel very comfortable being alone with Dina for the rest of the night. The girl with the ectopic did okay. She stayed in the recovery room for a few hours and then came down to the floor at about midnight. And luckily, it was a quiet night; I only got one admission, and that was an asthmatic who didn’t require any kind of expertise in his management. So I didn’t ask Dina for any help all night long. I didn’t even see her after midnight; she went off to sleep in her on-call room.