Internship was also good in providing the battlelike atmosphere that brought me close to a bunch of strangers, my fellow interns, and very close to a few people to whom I’ll forever have a bond, no matter how infrequently we communicate, no matter how physically far apart we drift. In all other respects, though, my internship was a draining, dehumanizing, destructive experience. It’s almost like we started out in July smelling of cologne and perfume, and dressed in freshly laundered formal evening clothes, well-mannered and even-tempered with warmth in our hearts and great expectations, but by the end of the year we had become tattered, unshaven, smelly, cynical, snarling survivors of a long and somewhat meaningless struggle with ourselves and the rest of the world.
Amy
JUNE 1986
Thursday, June 5, 1986
So far, this has been the best day of my internship. Today’s the day of the Pediatric Department picnic; the attendings all cover the wards so we can all go out to some park somewhere and have a good time. That’s not exactly what I decided to do. When our attending showed up and told us we could leave, I came right home, picked up Sarah, and took her to the Bronx Zoo. Just the two of us; it was the first time all year I got to be alone with her during a workday. I’m so glad I decided to spend the day with her instead of going to the picnic. I’m really missing the best parts of her childhood.
The Infants’ ward is pretty much what I expected. In some ways it’s like being in the NICU except there aren’t any really tiny preemies around. There are a lot of babies who graduated from the NICU. The ones with any real chance of a normal life go home; the disasters come to Infants’.
Of three babies on the ward who are DNR’s, I’m taking care of two of them. One is Kara Smith, an eight-month-old who got meningitis about four months ago. She spent most of February in the ICU upstairs; she had everything wrong with her, there were problems with every single organ system, and all the doctors who had anything to do with her were sure she was going to die. But she didn’t die, and eventually they transferred her down to Infants’, to the DNR room, where she’s been living ever since.
It’s really sad; she’s completely vegetative; she can’t do anything. She has no head control, she can’t smile, she can’t suck. The nurses feed her through a G-tube [gastrostomy tube: a tube inserted through the abdominal wall and into the stomach; G-tubes facilitate feeding of children who are neurologically impaired enough not to be able to suck or swallow]. Five times a day they squirt blenderized baby food into her, and an hour or so later they change her diaper. She also has a trach so she can be suctioned [babies with no gag reflex will not swallow the normal secretions that build up in the back of their throats; as a result, if these are not removed mechanically, the children will choke]. And pretty much, that’s the extent of her care. Since she’s a total DNR, we don’t draw bloods on her for anything, we don’t culture her if she gets a fever, and we’re not supposed to start her on any antibiotics. Eventually she’ll probably develop pneumonia and die. But it’s already been four months and she hasn’t gotten pneumonia yet.
One of the nurses who’s really attached to her told me that Kara’s mother used to come every day when she was first moved down here. Eventually she only came every other day, then a couple of times a week. Now she comes maybe once a week. I haven’t met her yet; usually she shows up late at night, so I suspect some night when I’m on call I’ll run into her.
My other DNR baby is Lenny Oquendo. He’s six months old. He’s never been out of the hospital, and it looks like he never will be. He was one of the NICU disasters; he weighed a little less than six hundred grams [one pound, five ounces] at birth and spent three months on a ventilator. He has a grade IV IVH, severe hydrocephalus, and about a dozen other problems. He also has a G-tube and a trach. Lenny’s mother hasn’t come to see him in months. She seems to have completely lost interest in him.
There’s a third DNR baby in the same room, but he’s Ellen O’Hara’s patient, and I don’t know much about him. But that room is so depressing! The nurses and the rest of the staff buy these kids clothes and toys and things to try to liven up the atmosphere. But it doesn’t help, it only makes everything that much sadder; the clothes and toys only make you realize how different these kids are from normal children. Just going in there and seeing those three hopeless and helpless babies lying in their cribs, it makes you want to cry! But at least they aren’t much trouble. The only thing we have to do for them is rewrite their orders once a week and remember to sign them out to the intern on call.