The Intern Blues(28)

Ricky’s much better. He had a pretty rough time last week but by Friday he was about back to normal. His kidney seems to be functioning well, and his BUN and creatinine came down to all-time lows today. He’s been out of bed and walking around the ward, playing with some of the other patients. His mother’s also calmed down a lot. Dr. White is pretty sure that no harm was done to the kidney but he says we’ll still have to see what the future holds. He plans to send Ricky home either tomorrow or the next day.

Sunday, August 25, 1985

Today is Sarah’s four-month birthday and we had a little party. My father came and so did Larry’s parents. It was the first time we’d all been together since Sarah was born. My father was doing pretty well; he looked good and he seemed happy. Everyone was worried about me. They thought I looked pale and tired. I should look pale and tired; I’m working hard and I haven’t exactly had a lot of time to go sunbathing, but I told them I think I’m doing okay. I think I am. I think I’m doing better than most of the other interns I’ve seen around.

Sarah rolled over for the first time last week. She did it first for Marie. Marie said she put her down in the crib on her belly and when she came back a few minutes later, she was lying on her back. So she put her back on her belly again and watched her, and sure enough, she flipped right over again.

I’ve been getting along very well with Marie. She really does love Sarah. I think she’s been holding back on the feedings a little and not carrying her around as much. At least that’s what she’s been telling me. So things are going well on that front.

The renal team discharged Ricky on Friday. The nurses had a little going-away party for him. It was really nice. He was definitely my favorite patient of the month.

I finish this rotation on Tuesday. I’m on tomorrow night, the last night of the month, and then I start on 8 West [one of the general pediatric wards at Jonas Bronck]. Going to 8 West’ll be like coming home. I did my subinternship and my third-year rotation there. I’m looking forward to it. But I know I’ll never beat the hours I’ve been able to keep at University Hospital.





Mark


AUGUST 1985

Sunday, August 4, 1985

I started on Infants’ [a ward at Mount Scopus Hospital] last Monday and so far this place makes Children’s look like an amusement park! I was on yesterday; I worked my ass off all day long, running from one thing another; and at no time did I have any idea what the hell I was supposed to be doing. Usually, when you’re on call on the weekend, you start with work rounds where you and the resident decide what needs to be done on each patient. It doesn’t work quite that way on Infants’. First of all, when I got to work at eight o’clock, the resident who gave us sign-out was a cross-coverer [a resident who works in another part of the hospital during the day and covers the particular ward at night only], and she didn’t have much of an idea of what was going on with the patients. We didn’t get any kind of intelligible sign-out, so we started off with one strike against us. And then when we finally got everything sorted out and came up with a plan of what we wanted to do for each kid, the private attendings starting calling to tell us what actually was going to be done. And then there were all these admissions coming in. I just wanted to say, “Okay, I’m going to go outside now and come back, and then we’ll start the whole damned day over again.”

I picked up some real terrific patients when I came over to Infants’. I’ve got this incredible specimen named Hanson, who’s four months old and has never been out of the hospital. When we went into his room on Monday morning, he was lying there in his crib, weighing all of about two pounds, with these wasted, shriveled arms and legs that were stiff as boards. He wasn’t able to suck on a pacifier, and it seemed like he was having these little seizures. He looked like warmed-over death, and the senior actually said he was looking good that day compared to how he looked last week. My God, he must have looked like rotting hamburger the week before! It turned out he had crumped before we changed services and when they worked him up [in this case, the workup consisted of blood cultures, a spinal tap, and urine cultures] they found he had a disseminated fungal infection. A fungal infection! Now, there’s a common cause of a crump. But I guess it wasn’t so strange in this kid: He’s had chronic diarrhea for the past two months and he hasn’t gained an ounce in all that time. Since his mother’s an IVDA [intravenous drug abuser], we’re sure he’ll be a candidate for admission to the AIDS clinic.

Anyway, he’s being treated with amphotericin [a drug for systemic fungal infection], which is so toxic that even if the infection doesn’t kill him, there’s a good chance the treatment will. It’s got to be given by IV. He has a central line [an indwelling catheter passed through the skin into one of the major veins in the chest], but we’re giving him his TPN [total parenteral nutrition, a treatment in which a large number of calories are provided by vein] through that, so we have to give him the amphotericin through peripheral lines [normal IVs]. His IVs usually last only about twenty minutes, and most of the veins in his arms and legs are already blown, so I can see this kid is going to take up a lot of my precious time this month.