The Intern Blues(20)

6. I’m not depressed, something about which I worried when I came out here.

What’s Wrong with My Life

1. I’m not with Karen, and I miss her a lot.

2. Even though I’ve made a few friends, I don’t have any really good friends here. I miss having good friends around whom I can call and talk to about the things that are troubling me.

3. I’m not wild about this neighborhood. As time goes by I find more and more that I do like, but basically it’s a kind of boring neighborhood that tends to roll up its sidewalks at about eight o’clock.

4. I miss my family—my parents, my brother, his girlfriend, they’re all back in Boston. I used to see all of them very often; they were a source of great support, of great enjoyment.

5. I miss Boston. I really like it. It’s much more hassle-free than New York, a more sane and easy place to live, and far less crazy and bizarre.

6. Sometimes I wonder if I’m in a program that has just too goddamned much scut and is too goddamned big. Sometimes I wonder if the great downfall of this program is the fact that we rotate through too many fucking hospitals and we have to spend so much time and energy on just learning the mechanics of survival on all the different wards that there’s almost no time and energy left for stuff like relaxing, socializing, reading, sleeping, and just thinking constructively and thoughtfully about the patients.

So, those are my lists. Now that I think about it, they are basically arranged in order of importance.

Tuesday, August 6, 1985

Things are going all right, I guess. I got rid of a couple of patients. I have only three right now, and they’re pretty stable. And I got a decent night’s sleep last night. I really needed it; I basically collapsed at nine-thirty after I got home totally wiped out from another all-nighter without any sleep. So right now, things are looking up.

But Sunday night was one of the worst possible nights I could imagine. I was on with Larry, the senior resident, and we were both working our butts off. I spent most of the afternoon and evening doing shitloads of scut. At about one in the morning, I finished most of my work and went up to the well-baby nursery [the well-baby nursery, maternity ward, and labor and delivery suites are on the seventh floor of WBH] to try to finish all the physsies [physical exams; all well newborns must be examined within twelve hours of birth]. There were a lot of new babies, and I was plowing through them all. At about 3:00 A.M. I realized that the chart of the baby I had just examined was still over in labor and delivery, so I went over there to get it. Just as I got through the door, a nurse came running out of one of the labor rooms, yelling, “Get peds! Get peds stat!” She saw me and asked if I was from peds. I told her I was and she said, “There’s a little preemie just delivered right in this room.”

Great! This was just what I needed at three o’clock in the morning. I thought, Oh, my fucking God, what am I going to do? I had never been alone with a new preemie. So I turned to the unit secretary, yelled at her to call Larry stat, and then I ran into the labor room.

Lying at the foot of the labor bed was this little fetus. The midwife said, “I measured him. He’s twelve inches long.” [A baby’s gestational age in weeks is roughly equal to two times its length in inches. Therefore, this baby was probably at about twenty-four weeks of gestation.] The baby was tiny but he was moving and I didn’t know what the hell to do.

Last week I had gone to the delivery room with the neonatal fellow to see a micropreemie who had just been born. We knew about that baby in advance and we knew that it wasn’t going to be viable, but the fellow had taken me to teach me about what’s viable and what’s not. That baby had no breast buds, his skin was gelatinous, his eyelids were sealed shut, and he was only ten inches long [all signs of extreme prematurity]. And the fellow said, “This baby is clearly not even twenty-four weeks; he’s not viable. There’s nothing to do for this baby.” So we didn’t do anything, and he died. And that had been my one experience with extreme prematurity.

Well, I checked all those things out in this kid. I measured him, and sure enough, he was twelve inches long. I looked at the eyes and they were sealed and there were no breast buds and the skin was gelatinous and I thought that this kid couldn’t possibly be viable. Then I listened to his chest; he had a strong heartbeat, so I rethought the situation and figured maybe I was wrong. I didn’t know what to think.

I decided to take the baby over to the warming table in the DR [delivery room; all delivery rooms are outfitted with resuscitation equipment for preemies] to see what I could do. Everything I knew was telling me that this baby could not possibly survive, but I just hadn’t had enough experience and I was all alone. I ran into the delivery room with the baby and I laid him down on the warming table. I realized I didn’t have any idea what to do next. I figured I’d try some oxygen: I grabbed the oxygen mask, turned the oxygen on and started to try to bag the baby, but the face mask was too big; it went over his whole head. I wasn’t having any success.