I don’t really have too much to say tonight. I just wanted to show that it’s still possible for me to be in a good mood. See—there’s hope for me yet.
Tuesday, May 6, 1986, 9:00 P.M.
I was on last night. What a good time I had! What a wonderful learning experience it was! I had such a good night last Friday, I thought I was actually going to like the rest of my month. I thought it was going to be really quiet and restful. Then I was on last night and now I feel as if somebody dumped a fifty-pound bag of excrement on my head.
And I feel better now than I did a couple of hours ago! At six o’clock I was a genuine basket case! I was ready to manually extract the spleens of each of the chief residents without the use of anesthesia. But then I went over to my grandmother’s. She fed me a nice dinner and calmed me down. Thank God for Grandma! Thanks to her, the chief residents will live another day.
When I talk about it, I don’t think it’ll sound like last night was all that bad. I mean, I had six admissions, which is kind of bad, but all of them were electives and none of them was sick, so it should have been pretty easy, right? It would have been easy had they all come in at a reasonable hour. It would have been easy had at least of few of them come in at a reasonable hour. Did any of them come in at a reasonable hour? Of course not! Why would anyone expect a kid who’s scheduled to have surgery the next day, who needs to be seen by residents from at least three services [pediatrics, surgery, and anesthesiology], and who needs to have blood work and all kinds of other tests done, to come into the hospital before nine o’clock at night? What a silly idea that is!
Well, anyway, they started to arrive at about seven-thirty and they continued to show up until nearly midnight. I couldn’t believe it: A six-year-old who was scheduled to have a T and A [removal of tonsils and adenoids] this morning didn’t show up until midnight. A normal six-year-old shouldn’t even be awake at midnight, to say nothing of a six-year-old who’s scheduled to have an operation a few hours later! I was pissed, the anesthesiology resident who came to see the kid was pissed, the surgery resident was pissed, everyone was pissed except the kid and his mother, who couldn’t understand what we were all so upset about. To them a six-year-old coming in for an elective procedure at midnight was completely natural.
So it took me until after two-thirty to finish all my scut work on six lousy electives! And of course just when I was finished and I should have been able to get to sleep, Nelly, my AIDS kid with pneumocystis carinii pneumonia, decided to try to die on us. Boy, how happy I was to see that! It’s me and Diane Rogers [the cross-covering senior resident] in a hospital that doesn’t have a pediatric ICU, trying to keep alive a kid who’s trying her best to get to heaven. It was amazing: She was perfectly fine one minute, and the next minute she was dropping her pulse to sixty and her blood pressure to sixty-five over forty-five. It really looked like the end was near. We stood around scratching our heads for a couple of minutes, trying to figure out what the hell was going on and what we should be doing about it. Her blood gas was still okay, so we knew it wasn’t a ventilatory problem. Diane finally figured maybe we should try some Dopamine [a drug that increases blood pressure, among other things] to see what that did. I didn’t understand the reasoning (of course, there isn’t much reasoning I do understand), but the Dopamine seemed to do the trick. Nelly was good as new after that.
So there we were, with a kid with AIDS and PCP, who was going into shock, getting a Dopamine drip while on the regular ward. I had to stay with her for the rest of the night. I didn’t get any sleep, and then I had to start rounds so I could have my usual morning fight with the blood-drawing tech who was refusing to draw blood on everyone. This has become a regular part of my day, I’ve kind of become addicted to it. Fighting with the blood-drawing tech is like drinking coffee.
So much fighting goes on at this hospital, it’s unbelievable. Working at University Hospital is definitely like being drafted into the army during wartime. It’s us against them, with the “them” being everybody who’s not a house officer: the attendings, the nurses, the lab techs, and especially the patients and their mothers. Work rounds in the morning are more like a pre-battle strategy session. We plan out the tactics we’re going to use that day. But there are a lot of situations you can’t plan for; things like sneak attacks. They tend to keep you on your toes.
Friday, May 9, 1986
I really don’t know what to make of this place. This hospital definitely has some schizoid tendencies; sometimes it seems like the nicest place in the world. There are some afternoons when it’s so peaceful and quiet, you can relax, sit out on the sun porch, even take a nap. And then there are some days where the patients all get sick at once, there are millions of admissions, and all you do is fight with everybody you can find. Take yesterday afternoon. At about three o’clock, the whole team got stat-paged to the adult ICU. We had one patient in there, an eight-year-old who had been hit by a car a couple of days before and had been unconscious ever since, so we all were sure she had arrested. We went running into the ICU and found she was fine, but the neurosurgery attending and one of his residents were standing by her bedside. As soon as we pulled up, the attending started yelling about how poorly we were managing the patient and how embarrassed he was that a patient who had been referred to him was getting such lousy care. She wasn’t getting lousy care, she was getting great care. We all knew that. It’s just that this guy has this quota: He has to yell at at least one house officer a day.