The Intern Blues(136)

Over the past week or so I’ve started listening to some of the tapes I made back at the beginning of the year, and I noticed something: It seems like I remember the bad things much more vividly than I remember the good. I’ve forgotten a lot of the good things, the successes, the patients who have walked out of the hospital and have said, “Thank you” and have shaken my hand. Those people have been crowded out of my memory by all the ones who died or who did poorly, the ones who wound up breaking my heart.

Internship is supposed to be an important educational experience, but I’m still not sure what I’ve learned. One thing I’ve accomplished this year is I’ve managed to develop my own personal style as a doctor. I’ve turned out to be more compulsive than I thought I would be. I’ve gotten very efficient; I’m more able to decide what’s important and what’s not than I was a year ago, when I don’t think I really knew how to prioritize at all. And probably a year from now, I’ll look back and realize how little I know about what’s important right now. I also think I somehow managed to retain my sense of humanity and my sanity among the inhumane environment of the hospital and the insanity of everything we do and the craziness of the Bronx. Thinking about it like this, I guess I really did pick up a lot this year.

But I definitely don’t feel ready to be a second-year resident yet. I don’t feel ready for that next step, that sudden acquisition of great responsibility where I’m the one who has to make the decisions and oversee the interns. I’ve gotten pretty good at doing what I’ve been called on to do as an intern. I have my own opinion now about how things should be done, but I don’t argue much if I disagree with the residents or the attendings. They’ve got their jobs to do and I’ve got mine.

The other day we got new medical students. Brand-new, green, third-years, who’ve never been on a ward before. Our resident took great pains to explain carefully everything that was happening to these guys, like what a FIB is and what tests were done in a CBC. I was bored to tears.

We were all on our best behavior during rounds, but as rounds were ending, the other interns all tried to impress the students with how jaded and how cynical they had become. I stood there for a while as this discussion began and I just thought, Listen to all this bullshit! After a few minutes I couldn’t take it anymore; I didn’t want to be a part of this scene. So I just walked off. This kind of thing, trying to impress these poor third-year students, gets old really fast.

But I had fun with my stud [student] the rest of the day. I caught him in the library reading at about noon and I said, “Give me a break! What are you going to do, put on a nice clean shirt and tie every morning and spend the entire day sitting in the library reading textbooks? You’re not going to get anything out of sitting in the library.” So I forced him to get up and follow me around. I showed him some of the ropes. This afternoon I asked him to write a progress note on one of the patients he picked up and he wrote one of the worst notes I’ve seen in my entire life. It’s so funny. He had absolutely no idea what was expected of him or what was supposed to be written in the chart. It kills me because he seems to be so bright and eager to work, but he just doesn’t understand how to do anything yet. So tomorrow I’m going to have to really start to teach him things from scratch. But it’s so hard to try to get my mind back to where a beginning third-year student is. I just can’t put myself in his place.

Friday, June 27, 1986, 8:00 P.M.

My friend Ellen always used to talk about the need to process what was happening to all of us. She told me recently that it wasn’t until the last few months of internship that she’s been able at least to start to fit some of the pieces together and begin to understand what had happened inside her. I guess I’ve been able to do that only a tiny bit so far. I’m still standing too close to things to have any real insight. There’s a lot of my internship I haven’t talked about on these tapes. There have been things that were just too painful to go into; they would have been too damaging to bring up at the time, and now I’ve forgotten a lot of the details. But they’ve had their effect on me.

I’d like to think that overall this has been a good year, but I can’t. It has been good in the professional sense. I was transformed from a medical student into a doctor. I’ve learned a great deal about patient management and how to think on my feet while half asleep. I think internship did all that extremely well. Thank you, Schweitzer Peds Department. All of you helped me make that transition.