So I decided I’d better do a complete examination. I got her undressed, and lo and behold, she had big contusions across her back and across her upper right thigh. I just thought, Oh, fuck! You get a feeling down in the pit of your stomach when you finally figure out what you’re dealing with, and I got it at that moment.
Then I examined her vagina, and it looked kind of red and smelled bad, and I thought, Oh fuck! again. To make a long story short, I reported the kid to the BCW and the cops as a suspected physical and sexual abuse case. And I had to fill out only about a thousand forms among the chart, documenting the living shit out of it, the BCW 2221 form, and the rape evidence kit [documents and materials that will be needed when the case goes to court].
The whole thing was horrible. The parents were crazed; at one point they tried to take the kid out. They started to dress her and said they were going to take her to Washington Hospital [a municipal hospital in the South Bronx]. Give me a break! I called security at that point. Once I called security, that was it, they knew the jig was up. They knew they had been caught. Oh, man! It was horrible. I hate it. After I called security, I was shaking and nervous for a while because it’s such a bad thing to have to deal with. I don’t want to help take kids away from their parents! Kids don’t want to be taken away from their parents; they love them even if they are horrible! So even though the parents have done something terribly wrong, I’m the one who feels like he’s committing the crime.
Anyway, it takes so long to do everything, God knows what the kid’s disposition will be. I don’t know what to say. I hate it, I hate child abuse so much, I wish it never existed.
Wednesday, May 21, 1986, 9:30 P.M.
It’s been a typical wild month in the Jonas Bronck ER. I’m getting out of this month exactly what I wanted: I’m learning how to manage trauma, and I’m learning how to see multiple patients in a short period of time. I’m a lot better at it than I was; I’m still not able to be as accurate as I’d like to be, but I can see some improvement every day. I can be fast when things aren’t too complicated; I still haven’t gotten good at seeing a complicated patient and a couple of uncomplicated patients at the same time. But I have another week in the ER and maybe I can get a handle on that.
I can’t remember anymore what I’ve talked about and what I haven’t talked about. I don’t know, there are so many stories, so many stories of frightened mothers and frightened children, sick children, and I don’t know why, I just don’t want to talk about any of it anymore. I’ve had some bad nights, I’ve had some good nights. I’m sorry . . . I’m sorry this is deteriorating. But the year’s almost over, it’s just another five weeks or so and I’ll be moving back to Boston. I really need to start making arrangements. I haven’t done that yet. I’ll have to take a day off from work to get that squared away.
Everybody seems to be calling in sick all the time now. Except me. There’s one intern in particular who’s always calling in sick, or coming late to clinic. I’m thinking that maybe I’ll fucking call in sick one morning and get everything arranged for the move. But I think maybe this is another fantasy of mine. I haven’t missed a day of work yet this year and I probably won’t start changing and calling in sick with so little time left. It pisses me off a lot when other people call in sick. It’s totally irresponsible and everybody always winds up having to work a little harder to make up for the person who calls in sick, and that’s not fair.
My clinic’s going fine, and I have a couple of specialty clinics including renal, which I think I like a lot. I think I could actually do renal. I’m not sure yet, I’ll have to try it again when I’m in Boston, but there are a lot of good things about it: It’s interesting, it isn’t a lot of hard work, and the people seem nice. I don’t know, it’s something I might be able to be content with for the rest of my life.
People have been saying a lot of nice things about me over the past few weeks. They tell me how much they’re going to miss me and that I’ve added a lot to the program. A couple of the attendings have said that I’d make a good chief resident. That’s all very nice and very flattering; part of me likes that fantasy of staying here and being asked to be chief, even though I know it’s just a fantasy, and part of me now is very slowly, very slowly recognizing that I’m actually going to be leaving soon. I haven’t started thinking of myself as being a resident in Boston next year; I don’t have an emotional attachment to that program yet. I can see myself as a junior resident here much better than I can see myself as a junior resident there. I really wonder if I’ll be ready for the demands of that place.