I’m starting to feel more confident and more willing and able to see patients without supervision. [In the beginning of the year, interns working in the emergency room are supposed to check with the attending on duty before discharging any patient.] It was so busy the other day, I didn’t have time to check everything out. We were about four hours backed up most of the time and I was just running from one thing to another without any time even to think, let alone consult an attending. Occasionally I asked for advice just to check myself, and the attending who was on call in the ER always agreed with what I wanted to do. That felt good; it was a real boost to my ego.
There is one thing about work that’s starting to bother me, though. When I was in medical school, one of the things I liked best about pediatrics was dealing with the parents. Over the past few days, though, I’ve found myself getting really annoyed with some of the parents who bring their kids to the emergency room. For instance, this mother brought her two-year-old in the other night. When I asked her why she was there, she said, “My kid hasn’t gone to the bathroom for two days.” All she had was minor constipation, for God’s sake! And the woman hadn’t even tried anything. Here it is, twelve-thirty in the morning, and there’s an eight-year-old boy in the other room who just got his eye blown out by a firecracker. And there’s a five-year-old sickler with a fever in painful crisis [a child with sickle-cell anemia, a common inherited disorder mainly occurring in blacks and Hispanics, in which the red blood cells collapse when the blood oxygen is low; the collapsed, or sickled red blood cells clog up the smaller blood vessels, leading to obstruction and further lack of oxygen, which results in pain in the hands and feet; in a patient with sickle-cell disease, fever can be a sign of serious, possibly overwhelming infection], it’s time for me to get home, and this woman brings her child in for minor constipation. I wanted to strangle her, just put my hands around her neck and strangle her! And this kind of thing isn’t unusual. It happens all the time, every night, that’s why there’s always a three- or four-hour wait to be seen. I tried to be nice to her, but I can’t help getting really pissed.
Occasionally there’ll be parents who seem really weird. The other day, this woman came in with her two kids who had colds. She was like a street person, she was carrying around all her possessions in shopping bags and she was dirty and her hair was all matted. The kids seemed perfectly okay though. There wasn’t much I could do; just examine them, tell her to give them Tylenol, and send them on their way. But it bothers me; there has to be something wrong there. I’ve tried to figure out a way to get kids like that away from the parents, to protect them, but it seems to be impossible to do unless the parent actually harms the kid. You can’t call the BCW [the Bureau of Child Welfare, the state-run agency that investigates physical and sexual abuse of children] just because a mother looks and acts a little funny. Even when the parent actually does harm the kid, like when they beat the kid with a strap because he or she misbehaves or acts up, it’s sometimes difficult to do anything to prevent it from happening again.
Tuesday, July 9, 1985, 3:00 A.M.
Must internship really be like this? Must it really have hours like this? Today was just one of those long, zooish days. I had clinic this morning, had about three seconds for lunch, went to the emergency room where there was already a big pile of charts in the triage box, and that’s how it stayed until a little while ago. There wasn’t even a minute to get some dinner; I was starving, but there just wasn’t any time to stop. We kept working and working and the triage box of charts of patients waiting to be seen just kept getting bigger and bigger.
I’ve noticed I’m not nervous anymore. I did another spinal tap today, on a little one-year-old with a fever who had had a seizure. It went fine, the kid didn’t have meningitis, it must have just been a febrile seizure [a convulsion that occurs with fever and having no adverse long-term effects]. I admitted a kid with anemia, the second kid I’ve admitted since starting. I used to sweat like a pig when I had to do procedures and stuff; I don’t seem to be sweating much anymore. It happened very suddenly. So far, internship has been a period of exponential learning. I just hope all I’m picking up sticks.
I still can’t believe I’m getting paid for this. But I’ll tell you, I don’t think it’ll be long before I start thinking I’d damned well better be getting paid for this. I think that happens when you start to respect your skills. I’m not there yet; but I’m getting there, I think.