So today, while the grandmother was off the ward, we started the kid on regular feeds and he took it like a normal child. When the grandmother showed up, she got really angry and tried to sign him out of the hospital AMA [against medical advice], but we stopped her and slapped a BCW hold on the kid [the Bureau of Child Welfare can order a child retained in the hospital if the child’s well-being is endangered]. The grandmother went crazy but the social worker talked her down; the social worker handled the whole situation pretty damned well.
Well, there’s only about another week of this insanity left. I can’t wait. I’ve had about enough of this Infants’ nonsense!
Friday, August 23, 1985
I meant to record this yesterday, but I fell asleep as soon as I got home and I couldn’t do it. Wednesday was another classic night on Infants’. I’m beginning to lose my sense of humor about all this, which is a pretty serious problem. It’s definitely time to get off this ward. I’m going to OPD [Outpatient Department—the ER and Clinics] for two weeks and then I’ve got vacation.
Well, Hanson crumped again yesterday morning. He started stooling out again and got acidotic, and while we were trying to start an IV his heart rate dropped and we had to call a CAC [resuscitation for cardiac arrest]. We got him back but the chiefs decided he was sick enough to be transferred to the ICU, so we shipped him up to the sixth floor. Just like that! I don’t know, he’s fine as long as he doesn’t do anything to bother you. But the kid crumps at least once a week! He’s got to learn a lesson if he expects anyone ever to like him.
And Fenton is fine, absolutely fine. His grandmother has become a basket case, though; she simply can’t cope with the fact that he has no medical problem. It’s really weird. The grandmother told one of the nurses that she herself has had over twenty operations; she even had a CAT scan last week while the baby was in the hospital because she’s afraid she’s got a brain tumor. The nurse pointed out to us that she wears one of those plastic hospital bracelets as jewelry! The social worker has been trying to get her into some sort of therapy but the woman is resistant. I’m not sure, but I think it’s going to come down to either the woman gets some form of help or the baby is going to be placed in a foster home.
I’m on tomorrow for the last time on Infants’. I can’t wait to get it over with. Carole and I are going to go out for dinner Sunday night to celebrate. I’m really afraid I won’t find anything funny anymore. I really think I’ve lost my sense of humor on Infants’.
Bob
AUGUST 1985
Although I was a medical student at Schweitzer and did my residency at Jonas Bronck and the Schweitzer University Hospital, I was an intern at a medical center in Boston. I left the Bronx because it was suggested that I should see how medicine was handled at places other than those associated with the Albert Schweitzer School of Medicine. So I spent a year in Boston; I’m still recovering from it.
I did my first month of internship in the neonatal intensive-care unit of a maternity hospital that was affiliated with the program’s main teaching hospital. I arrived at work on the first day, a Saturday, and took sign-out from the old intern who had been on call the night before. After he left for home that morning, I was pretty much left on my own with thirty-five of the sickest premature babies you could possibly imagine. That first day of internship was definitely in the top ten of the most frightening days of my life.
When I started in that NICU, I knew absolutely nothing; the intern who signed out to me communicated in what seemed to be a foreign language. He spoke a hodgepodge of medical terms, slang, and numbers all mixed together. I just wasn’t ready for: “That’s a forty-five-hundred-gram IDM who aspirated mec and got PFC. We tubed him and put him on the vent with settings of twenty-five over five, 100 percent, and forty, and his last gas was seven point thirty, forty-four, and forty-five. He blew two pneumos so we put in tubes. He’s on DIOW at eighty per kilo per day.” I had absolutely no idea what any of this meant; I just wrote as much of it as I could on my clipboard, nodded my head to make him think I understood what he was saying, and hoped to God that the nurses knew what the hell was going on.
I eventually figured it all out. It didn’t take long before I could translate even the most complex of these monologues into English. (By the way, the intern was talking about a nearly ten-pound newborn whose mother was a diabetic. The baby had passed a bowel movement while still in the womb and had breathed in the contents of the bowel movement, causing severe respiratory and cardiac problems. He was being breathed for by machine, had too much acid and not enough oxygen in his blood, had had two episodes of collapsed lung, and was being given intravenous sugar water. That baby, one of my first patients, survived and did fairly well in spite of me.) And eventually I even became comfortable with the preemies. But that Saturday was terrifying for both me and my patients.