Children’s isn’t so bad, though. First of all, Elizabeth is there this month [Elizabeth Hunter, one of the other interns, went to medical school with Mark], and it’s nice to be together with her. And the other intern, Peter Carson, seems like a nice guy. And everybody tells me that Children’s is much easier than 6A. I can see that that may be true: I was on last night and actually got three hours of sleep. Three hours of sleep! It was the first time I’ve even seen an on-call room since I got here. There are fewer admissions, and the patients aren’t as sick. The chiefs have promised me that they’ll still give me the month of Children’s I’m scheduled for later in the year, so maybe this will work out well. I doubt it, though; in internship, nothing is supposed to work out well.
I spoke with Carole a little while ago and told her I missed her. I think she was surprised to hear me say that. I’m not what you’d call the most demonstrative person around, but I really do miss her. I miss everybody! All I’ve done since starting this internship is work or go home and fall asleep. I don’t know if it’s possible to survive a year like this.
I’m going to sleep now. Maybe I’ll dream that it’s next June and all this is finished.
Thursday, July 11, 1985
Yesterday was my third night on call on Children’s. When I was on last Thursday and Sunday, I didn’t have any trouble. I didn’t get a single admission, and I slept three or four hours each night. I was thinking maybe I’d try to arrange to go to Children’s for my vacation this year. So I wasn’t at all prepared for what happened last night.
I got five admissions. There was one every hour or two. I’d just have time to finish working up one when the next one would show up. They weren’t really very sick: an eight-year-old who came in to have a repair done on his cleft lip that had originally been repaired when he had been a baby; a kid who had developed an infection in his leg after he had been bitten by a dog and needed IV antibiotics; another kid who had periorbital cellulitis [an infection of the tissue surrounding the eye; dangerous because it can lead to infection of the eye itself and, occasionally, of the brain] and who needed IV antibiotics; and an asthmatic. The sickest kid was also the most interesting; it was a four-year-old with a week’s worth of facial swelling.
He had kind of an interesting story: His mother noticed the swelling around July 1 and brought him to their local doctor. The LMD [local M.D.] sounds like he graduated from a medical correspondence school. He brilliantly decided the kid was allergic to trees and started him on Benadryl [an antihistamine used to reverse effects of allergic reactions]. The mother was back at the guy’s office in two days: Not only didn’t the Benadryl work, it also seemed to make the swelling worse. Now not only was the kid’s face swollen, but also his hands and feet were puffy. The LMD told the mother that sometimes it takes a while for the allergy to get better, especially since there are so many trees around, and that she should give the medicine more time to work.
Well, she gave the medicine as long as it took for the kid’s belly and scrotum to get swollen and then she brought him to our ER, where one of the residents made the diagnosis in less than a minute. The kid, of course, had nephrotic syndrome. [This is a disorder in which the urine contains large amounts of protein and, as a result, the body becomes protein depleted, leading to swelling of the body. The face, especially the area around the eyes, is typically the first area affected in children. The disorder usually is self-limited; it is treated with steroids and usually resolves in weeks.] For God’s sake, even I could’ve made the diagnosis! So we admitted him, I called a renal consult, and we started him on ’roids [internese for steroids].
One of Elizabeth’s patients almost got kidnapped two days ago. This three-year-old had been brought to the hospital by her aunt last week. The kid had a couple of episodes of blacking out while the aunt was baby-sitting for him. A whole workup was done and everything was negative except the tox screen [toxicology screen, a blood and urine test looking for toxic substances in the system], which was positive for alcohol. So social service started an investigation. The mother and her boyfriend showed up on Tuesday at noon, and after visiting with the kid for a while, asked to speak to the doctor. Elizabeth showed up and they asked her how the baby was doing. Elizabeth said that he was fine, and before she could say another word, the mother said, “If he’s fine, I want to take him home.”
So Elizabeth told her he couldn’t leave yet, that tests were still pending and that, for the sake of the child’s health, he’d have to stay at least one more night. Then the mother started yelling that if her baby was fine, the only thing that could happen to him in the hospital is that he could get sick, which was actually a good point, and she picked the kid up and started moving toward the elevator.