The Intern Blues(31)

My new diarrhea patient has a strange story. He came in with his grandmother, who said he got all his care at another hospital but she doesn’t remember the name of either the hospital or the doctor. She said she came to Mount Scopus this time because that other place had the kid for all those months and they couldn’t do anything to make him better, so she was coming to give us a chance to cure him. To tell the truth, he didn’t look that bad to me, but to hear his grandmother tell it, he’s at death’s door. I’m going to have to figure out what’s going on with him, but I sure as hell wasn’t going to do it today.

So finally I sat down to write my notes and got out of the hospital at about four-thirty. My progress notes have gotten worse and worse. It’s gotten to the point now where I can’t even read my own handwriting. An attending came up to me yesterday and asked me what I had written on his patient’s chart and I simply could not read the thing. I’m pretty sure I’m going to get yelled at about my handwriting sooner or later. But what can I do? If I decided to take my time and write neatly, I’d never make it back to my apartment. It’s kind of a shortcut I’ve got to take to keep my sanity at this point. Maybe this is how the doctors’ handwriting myth began.

Monday, August 19, 1985

Things are looking up. Really! Last night wasn’t bad, I only got one hit [hit=admission], and for the first time this month I actually got into the bed in the on-call room and fell asleep for a while. And Hanson is better. His fever went away without any change in his antibiotics, so either it was the virus that was going around or maybe one of his IVs actually was infected. We started feeding him formula again last weekend [he had been NPO for a few days following his most recent episode of diarrhea], and he’s tolerating it pretty well. He hasn’t had any diarrhea and he actually gained a few ounces. He’s a pretty cute kid, actually. I’m getting to the point where I actually like him. If he behaves himself and doesn’t crump or do anything stupid like that, he may become one of my favorite patients. We’re even starting to think about sending him home. The only problem is, his mother, who’s an IVDA, has never come to see him. I’ve never met her or even spoken to her on the phone. So it looks like he’s going to turn into a social hold. I’ve got to start talking to the social worker about placing him somewhere. Oh, well, he’ll probably wind up staying on Infants’ until I’m a senior resident.

And that patient with the meningomyelocoele I admitted last week turned out to be a great kid. It’s a funny thing about him, he turned out to be kind of cute. He’d sit in his little stroller and make this weird clicking sound with his cheek to get your attention, and when you’d look over at him, he’d smile at you. I liked that kid a lot and I really miss him since he went home. He was the only kid I’ve taken care of this month who’s old enough to actually be sociable.

So far, the weirdest story of the month has to do with Fenton, that GE reflux kid I admitted on Monday. I sat down and talked to his grandmother on Wednesday. She’s the kid’s caretaker; his mother’s about fourteen and is treated more like an older sister. Anyway, the grandmother told me this real bizarre story. She said he vomited everything they fed him when he was a little baby and she brought him to some hospital in Westchester, which we all finally figured out had to be Westchester County Medical Center [a teaching hospital affiliated with New York Medical College, in Valhalla, New York]. They worked him up, diagnosed the reflux, and did a fundoplication and a feeding gastrostomy [placing of a tube directly through the abdominal wall and into the stomach, to facilitate feeding while the esophagus is healing]. But he never seemed to get any better after the operation. The grandmother took him home but he kept vomiting whenever they fed him anything by mouth and got diarrhea when they gave him anything through the g-tube [gastrostomy tube]. She kept bringing him back to the hospital and they finally started him on continuous gastrostomy drip feedings [sort of like an IV, delivering small amounts of fluid throughout the day and night, into the stomach]. She told me that that was the only thing that seemed to work.

Well, none of this made any sense to any of us, including Dr. Gordon [the pediatric gastroenterologist]. There’s no way this kid could have so many problems and look so healthy. And the grandmother is a pretty suspicious character; she knows all the medical terms and the names of all the procedures. So yesterday we called the gastroenterologist at Westchester County Medical Center and he told us what really was going on. He said that the grandmother kept bringing him to the ER there with a history of diarrhea and vomiting but the kid never looked dehydrated. They admitted him a few times and he did have loose stools but for a long time they couldn’t figure out what was happening. Finally, during an admission about a month ago, one of the nurses found a bottle of laxative in the grandmother’s possession. They couldn’t prove it, but they’re convinced she was giving the kid the laxative in his bottle to make him have diarrhea. Amazing!