The nurses are great on Infants’; I really like them. But the place is a zoo; the private patients drive me up a fucking wall. They make me wonder what I’m doing going back to a privately run system. This lady today told me she didn’t want me to draw her baby’s blood. Jesus Christ! These parents are so uptight and nervous, they always want to come in and see the procedures being done. They can’t accept the fact that they shouldn’t be in the room. What do they think we’re going to do, break their kid’s arms? I have to think of nice ways to say, “No, you should wait out here, we’ll be back when we’re done, it’s best for the child, and it’s best for you, too. So don’t come in!” Usually I don’t get nervous when I’m doing procedures, but this lady today was making me crazy! And I couldn’t get the blood. It was the first time that’s happened to me in months!
I got these new medical students today. Brand-spanking-new students, never been on a ward before, I have this big, hulking guy named Ronald; he seems very nice. God knows; maybe he’ll turn out to be a tyrant surgeon a few years down the road. He looks like one. He looks like he’s going to be an orthopod. Anyway, I did my best to teach him stuff today, to get him over the jitters of being on the floor with real patients for the first time.
I’ve been hanging around the hospital too much. I stay too late. I was there until seven tonight. It’s ridiculous! Finally Keyes said, “Get the hell out of here, you’re just making work for yourself.” He was right! What you’re supposed to do is write your notes and get the hell out of there and let the person on call hassle with your patients. I think I’ll do that tomorrow. I say I’ll try, but I never can; I’m never able to get out before five.
I’m already in bed. It’s eight-thirty and I’m already in bed, can you believe that? I’m going to sleep, I don’t care. I’m always sleep-deprived; sleep’s like going out of style for me. This job is so damn stupid! It’s just stupid!
I spoke to Karen tonight for the first time in about a week, because of my stupid on-call schedule.
There I go; I fell asleep again. God! So, I spoke to Karen tonight. She’s doing all right. We didn’t talk for a long time. I miss her. I can’t stay awake any longer.
Monday, April 7, 1986
For some reason, I’ve had all these revelations over the past week. At least they seemed like revelations at the time. Coming back to them now, they really seem like just a bunch of mundane thoughts. I seem to have them on the scut run between the chemistry elevator and the hematology elevator. I have no idea why, but over and over I get these things popping into my mind while I’m in the back corridor by the back entrance to the kitchen.
One of the things I realized was that, at this point in the year, I feel like I’m getting stupider, not smarter. I know it’s not true, but I think maybe it has to do with the fact that the barn door has swung open to the world of knowledge. I guess I’m just realizing what you really need to know to be a decent resident. It’s unbelievable; I just feel so stupid. And it doesn’t matter whether I read or not; I don’t remember anything an hour after I’m finished with it. But I’ve got to keep persevering. It’s funny; I thought I was smart a couple of months ago. I’m not!
I also had this thought about nurses and how night nurses seem to be universally weak in all places except maybe the ICU, where they’re still good. I don’t know why this is. At night, there seems to be a certain stereotype: the middle-aged, fat, black nurse who’s kind of disgusted and noncommunicative. And while she may not be all those things, the stereotype of being noncommunicative and disgusted seems to hold true. I don’t know why, but from hospital to hospital, it seems to be the case. And it’s kind of distressing because at night there’s nobody else there, and sometimes you need to talk to somebody about a patient, and these nurses, they just don’t want to talk about anything! Everything seems to be an effort when you ask them to do something.
Monday, April 14, 1986, 2:00 A.M.
It’s 2:00 A.M. and I’ve woken up for some reason from my precall sleep. I really should be asleep. I have insomnia. I keep thinking terrible black thoughts because last night I wrote up the protocol for the M and M Conference [Morbidity and Mortality Conference, a teaching conference run much like chief of service rounds in which a patient who has died is presented; the clinicians discuss the disease process, and the pathologists bring the autopsy report and describe what really happened] on Emilio, my patient with AIDS who died when I was in the ICU in February. Yesterday I got Emilio’s chart from the record room and I wrote up a summary of what happened to him over the weeks I took care of him. It really hurt to do it, to go through that chart again and to see that he was deathly ill the minute he arrived and never improved and that he finally, finally, by the grace of God, died. I remembered how he suffered and how his mother would come and sit by the bedside for hours. About a week before he died, she told me how at times when the Pavulon [a paralyzing medication] was wearing off, before he got his next dose, she would see tears forming in the corners of his eyes. She knew he was suffering terribly. But of course he couldn’t cry out because he had a tube between his vocal cords and because he was more paralyzed than not. And we constantly would do horrible things to him in our effort to save him from certain death. So I wake tonight with these terrible black thoughts that I’m going to get AIDS, die the same death that poor Emilio died, having my lungs pumped with ventilator air every second, and my limbs poked with needles by young physicians in training, and my neck or groin poked by the fellow trying to put in a line, or my lungs needled and cut, while I hear the doctors saying crass and horrible things about my death and illness, making fun of my debilitated state, while I’m lying naked on a table and shitting on a blue chuck [a pad made out of the same material as disposable diapers, which is placed under incontinent patients], the way poor Emilio did, with no dignity. Just pain. How he must have hurt.