The Intern Blues(143)

We spent about an hour talking together in that group. As the time passed and as the list of anxieties I was recording on the piece of paper in front of me grew longer, I could feel at least some of the nervousness, some of the tension, gradually die away. By the time Mike Miller finally came to call us all to lunch, I had the sense that these three had made some progress; they were ready to begin the year.

I saved the anxiety list from that morning’s group and brought it home with me. I compared it with the list that Andy, Mark, and Amy had generated exactly one year before. The lists were almost identical. Not in the same order, not in the same words, but the concerns, the issues, the worries all are universal. Although Andy, Mark, and Amy have moved on, we attendings are dealing with the same problems, counseling away the same anxieties, coping with the same fears in a new group of interns.

Nineteen months have passed now since the day in June 1985 when I asked Mark, Andy, and Amy if they would like to participate in this project by keeping a diary of their internship year. Today those three interns are more than halfway through their junior residency and more than 50 percent finished with their mandatory three-year period of training. And even those three interns with whom I sat at orientation in June 1986 have only four months left until they say farewell to internship. Like the interns who came before them and like the interns who will follow them, they’re at present trapped in the depths of the February depression. But I’ve told them to take heart. The light for them is beginning to appear at the end of the tunnel.

A lot has happened to the public’s conception of internship over the past year. Various cases of suspected medical malpractice caused in at least some small part by the fact that unsupervised, overtired, and overwhelmed interns had allegedly made errors in judgment at critical junctures in the management of patients have received a great deal of publicity. The effect of this media attention has been that the lay public’s eyes finally have been forced open to the fact that young doctors are often required to work over a hundred hours a week in a system that’s antiquated, unnatural, and unhealthy for both the patients and the physicians themselves.

The state of New York has looked into the issue of internship training. The New York State legislature has proposed placing limits on the number of hours a house officer is allowed to work. There are two mechanisms for doing this that are currently being studied. The first of these limits the total number of hours a house officer can work in a single week to eighty; the second limits the number of hours that a physician can work in a single day to twenty-four.

Limiting the number of hours that can be worked in a single day to twenty-four would mean that interns would never again have to work thirty-six-hour shifts; overnight call would be illegal. However, because the wards and emergency rooms have to be staffed twenty-four hours a day, additional house officers would have to be hired. Although the state of New York has announced that funds for these new physicians would be forthcoming, there is a real question whether adequate numbers of medical school graduates could be found to fill these new slots. If sufficient personnel could not be recruited, the new regulations would ensure that interns would wind up working six or possibly even seven days a week. In discussing this possibility with our house officers, almost all state that they would much rather work thirty-six hours at a stretch knowing that they’ll have a day off rather than work shorter hours without a day away from the hospital.

But limiting the number of hours an intern can work to eighty a week seems like a viable option. This would essentially outlaw the every-third-night call schedule, replacing it with a more human every-fourth-night scheme.

These reforms are long overdue. But the changes will take time to establish and to institute. So for the time being, at least, internship and residency proceed as they always have.





Early on the morning of June 29, 1986, I drove to the Bronx and stood out in a drizzle as two enormous guys loaded all of Andy Baron’s possessions into an Avis rental truck. Andy, Karen, and I stood out there during the hour it took to get everything loaded, getting soaked by the rain. We didn’t say much to each other. I knew there were a lot of things going on inside Andy’s head, but apparently he didn’t want to let either Karen or me in on them. So we just stood there, getting wetter, and silently watched Andy’s furniture disappear into the truck.

The two guys were finished by about ten. Andy paid them, and then he and Karen got ready to climb into the truck. Before he got behind the wheel, I put out my hand. Still in silence, Andy came toward me and gave me a bear hug. After a few seconds he released his grip, turned, and climbed into the cab of the truck. A minute later I watched as the truck disappeared down Gun Hill Road, heading east toward the entrance to I-95 and his junior residency at Children’s Hospital in Boston.