The rest of the ward is filled with assorted disasters. There are three babies with spina bifida who have shunt infections [infection of the ventriculoperitoneal shunt, the device that drains fluid from the brain into the abdominal cavity] and are getting IV antibiotics, there are two babies with infantile spasms [a severe form of seizures] who are being treated with ACTH [the medication used in this type of seizure disorder], there’s a nine-month-old with AIDS who was in the ICU last week with PCP but who’s getting better. There are even a few normal children who have bronchiolitis.
Working on this ward really takes a lot out of you. It’s emotionally very taxing. So having today to spend with Sarah was especially good. It raised both our spirits.
I’m on call tomorrow night. I’m going to stop now and actually cook dinner.
Sunday, June 8, 1986
I’ve been in a good mood this weekend. The schedule for the next year finally came out on Friday. They actually came through with what they promised: I’m scheduled to have my CERC rotation [a month spent learning developmental pediatrics at the Children’s Evaluation and Rehabilitation Center on the east campus; CERC is a calm, nonstressful experience] in October, my vacation in November, a month of elective without night call in December, and my neuro selective [a rotation learning child neurology; like CERC, neuro is pretty laid-back] in January. They gave me what I wanted. Finally, after everything that’s happened this year, I wound up getting something without getting screwed!
It’s hard for me to believe that I have only three more weeks of internship left. At this point in time, I’m fairly sure I’m going to be able to make it the rest of the way. I hadn’t been able to say that before this week. I’d been dreading working on Infants’ for months; I’d heard only bad things about it. But actually, although I can’t say I’m really enjoying the patients I’m following, I am having a good experience here. We have a very good attending, Alan Morris. He’s an excellent teacher and I’ve been learning a lot from him on attending rounds. And we have a strong team: Ellen O’Hara and Ron Furman are the other interns, and they’re a lot of fun to work with. And our senior resident is my very favorite person in this whole program, Ben King. Ben’s a little burned out at this point; this is his last month of residency, and I don’t think he really wants to be in the hospital. Yesterday, on work rounds, he got into a wheelchair and made Ron push him around the ward. He’s funny and he makes working easy because he’s got excellent judgment. So, probably for the first time all year, I’m actually part of a team I like being on.
I was on call with Ben yesterday. It was a very quiet day. I had only two admissions, an eight-month-old sickler with dactylitis [inflammation of the hands and feet, usually the first painful manifestation that occurs in children with sickle-cell disease] who didn’t require any work, and a nine-month-old with bronchiolitis who was admitted from the West Bronx emergency room but who Ben immediately sent home. It was really funny: I went down to the ER to get the baby at about three in the afternoon and he really didn’t look that sick. But I didn’t question it, I just brought him up to the ward. Then Ben came by to see him and he said, “Why did they admit this kid?” I told him I didn’t know. He listened to the baby’s chest and said, “This kid doesn’t have bronchiolitis. He’s healthier than I am! Send him home before something bad happens to him!” Just like that. His mother got him dressed and they left. I don’t know any other resident who would have done that. But if you ask me, it was the right thing to do.
So all in all, I haven’t been too overly stressed on Infants. Calls haven’t been bad, and I’ve been getting out at a reasonable hour: not three or four in the afternoon, but usually no later than five. It’s staying light out until seven o’clock now, so when I get home I can take Sarah out onto the lawn in front of the apartment building and just sit out there with her. It’s nice. It’s too bad the rest of the year hasn’t been like this.
Sunday, June 15, 1986
Kara Smith died Friday night. She had developed a fever on Thursday; Ron was on, he examined her, and he thought she had pneumonia. He didn’t do anything about it, just wrote a note documenting it in the chart. Then on Friday during the day her breathing became very labored. She must have been hypoxic. I felt very uncomfortable. I kept coming into the room to check on her. I knew she was DNR, but just sitting around doing nothing really bothered me. I wanted at least to get a blood gas and maybe start some oxygen, but the rules are no treatment.