And I think about the Infants’ ward I have to go to tomorrow on call and all the sick children I have to take care of there, two of whom are trying to die on me all the time. I don’t feel up to taking care of these fragile little things. I’m tired of being abused by the system, of having my sleep taken away every third night, of the stress I’m put under and the illness I’m exposed to, and the pain I have to see and cannot heal. I’m tired of dealing with parents whose pain I can never completely understand because there’s never enough time. The only time I have to try to understand what’s happening to them is the time I take away from my own sleep. It’s a constant battle. The doctors who do the best with their own lives, who get the most sleep and get out the earliest, are the ones who don’t talk to the families, who don’t play with the children, who don’t thoughtfully consider things. But I’m not that way; I’m not efficient. I spend time with the families, I talk with them, and so I get sleep-deprived.
Tuesday, April 15, 1986, 9:00 P.M.
There’s something I haven’t talked about yet, something that’s really hard about training that most people outside of medicine don’t have to deal with, and that’s the sense of loss of social skills that happens after you’ve been working all night. You then have to interact with people in a complex fashion. You have to go on rounds and talk to other members of the staff. I very often find that I have no idea how I’m coming off to anybody else. If people laugh, I can’t tell if it’s because I said something funny or if I’ve done something really dumb and embarrassing and that’s the only reaction they can have. Am I offending anybody? Do I curse too much? Should I just fart and get it over with? A lot of times I just can’t tell, I can’t judge what people are saying to me: Are they being serious, are they making a joke?
It’s not so bad with other residents. They understand, they can say, “Hey, he’s been up all night, he’s just post-call.” But what about the parents of my patients? What the fuck do they think is going on? I might be acting really weird. Do they understand it’s because I haven’t slept in two days? They must think I’m just batty or something. And that’s not good, because here they are, trusting me with their most precious thing in life, and I’m acting really flaky. It’s an ill-defined concern of mine, but it really bothers me.
Today my student had to give a presentation of a patient. It didn’t go too well; it was very rough, to say the least. I like Ron, he’s a good guy. He reminds me of how I was as a student. Real nervous, disorganized, can’t think on his feet, that’s just how I was when I started out as a third-year. Shit, I still get like that sometimes. Anyway, after rounds, Mike Miller, who’s our attending, came up to me and said, “Andy, I think you guys have to work on your student’s presentation. It really isn’t very good.” And I told him I would, it was on the top of my list of priorities. So a little while later I sat down with Ron and we went over how to write up and H and P [history and physical exam] and how to present it on rounds. I can imagine what he was feeling: defensive, embarrassed, humiliated. It’s one of those awful rites of passage. I don’t know, I didn’t get much sleep last night, I was really tired, and I wonder what he was thinking. I don’t know if I was coming off as a hard-ass, if I was being condescending. I didn’t mean to be; I kept saying to him over and over that you’re not expected to know this, nobody ever teaches you this. I spent about twenty minutes talking to him about this, telling him the same stuff over and over again. He probably thought, You asshole, stop repeating yourself! I hope he learned something from it, and I’ll tell you, the next time I’m on call, next Friday, he’ll just have to take the admission and just go over it with me first. When I’m done with him, he’ll sound like a master.
It’s a beautiful, sunny spring day today. I came home and I really wanted to sit out on the porch with some friend and drink some beers, but I didn’t feel like calling anybody; I guess I really wanted just to be by myself. I’m too fucking tired to talk anymore.
Saturday, April 19, 1986, 11:30 P.M.
Last night one of my patients coded and died. It really hurts to go through the story again, but I suppose I’ll try.
It was a little five-month-old with bad heart disease, doesn’t matter what type, who had been admitted several times before for congestive heart failure. This time she was coming in to get a cardiac cath done so they could plan her surgery. When I first saw her, she was in some failure: She was puffing away and a little cyanotic [blue], but her mother said she always looked that way. And so I got her plugged in and talked to her attending and he also told me not to worry because this really was her baseline, so it wasn’t necessary to start oxygen. The cath was scheduled for the next morning. In the evening, she spiked a temp; there was no obvious source, and it was only a low-grade fever. I figured maybe it was the start of a URI [upper respiratory infection; cold]. The resident who was covering looked at the kid and said she had an otitis [otitis media, an ear infection]. She didn’t have an otitis, no more than I did. But the resident insisted, so we gave her some amoxicillin and some Tylenol and she defervesced. But she had spiked and it was the day before her cath.