The only hospital in which the intern’s day deviates significantly from what I’ve outlined above is University Hospital. University is a hospital with a split personality. On the one hand, it seems like a laid-back, friendly community hospital nestled in a neighborhood of two-family houses; all the patients have private attendings (in sharp contrast to the two municipal hospitals, where the opposite is true), the nurses and the rest of the staff are like the boy and girl next door, and the pace is slow and relaxed. This makes University Hospital seem like a place you might actually like to visit during your summer vacation. However, the hospital is a major teaching affiliate of the Schweitzer Medical School and therefore is in reality a high-powered academic center. It’s the place where many of the full-time clinical faculty of Schweitzer admit their “interesting cases” for special studies. As such, the hospital contains patients with rare and often deadly diseases who need vigorous, round-the-clock management. Trying to fit these two personalities into the same building is not the easiest job in the world. And who suffers because of this? The interns and residents, as usual.
There are very few teaching conferences and much more free time at University than at the other hospitals. During the day, the interns work as glorified secretaries. Each patient’s attending really makes all the important decisions affecting the patient’s care, but attendings are not permitted to write in the nurses’ order book. The nurses are instructed to pick up and carry out only those orders written by an authentic intern. So any time an attending wants to change a medication or order a test, he or she must get hold of an intern and ask that an order be written. The interns rarely have the opportunity to argue with an attending’s request. They simply have to write down exactly what’s been dictated.
Although there are very few emergency admissions, interns on call frequently spend a good part of their night fighting with the lab technicians. University’s community hospital personality carries over to its laboratory. At night there are very few technicians covering the hematology lab, the chemistry lab, the bacteriology lab, and the blood bank. Because of the shortage of personnel, the technicians are never exceedingly happy about running any tests in the middle of the night, and if an exotic test needs to be done, they can turn downright ugly! Since a fair number of the patients on the ward can be very sick, it sometimes becomes critically important to get tests done after midnight. And this often results in massive arguments.
The patients at University Hospital are exceptional, to say the least. One reason people who train in pediatrics are attracted to the field is because children are basically healthy; their recovery usually is rapid, and it’s a rewarding experience for the doctor. But at University Hospital, you have a ward full of children with uncorrectable chronic diseases. The pediatric renal service is housed at University Hospital, and all the kidney transplants are performed there. At any one time the ward will have five or so kids whose kidneys don’t work and who are either waiting for, in the midst of recovering from, or actively rejecting a renal transplant. Except for the patients who have recently gotten a new kidney, few of these children are acutely sick. That’s a mixed blessing: The chronically sick patients don’t require a great deal of concentrated hard work, but they usually don’t get remarkably better. And that can be discouraging.
Interns find different ways of coping with the aggravating parts of working at University Hospital. Some get into fights with the patients and staff; some spend their time hanging out in the cafeteria; and some try to get out of there as early as possible. The interns spend only one month out of their year there, so the rotation doesn’t usually cause any serious or long-lasting damage.
Andy
SEPTEMBER 1985
Friday, August 30, 1985
I’m out of the NICU; I made it, although I had some question about whether I would that last night when I had to supervise at the death of a full-term kid who had aspirated meconium [meconium is the first bowel movement; fetuses who are stressed intrauterinely frequently pass meconium before birth; they then breath it into their lungs during their first inspiration and develop a severe meconium pneumonia as a result] and who wound up on maximum doses of tolazoline, dopamine, and the highest respirator settings possible. He finally died at four in the morning. The rest of the month is all a delirious blur. I think I actually learned something, but I just don’t know whether it was worth the price I had to pay.
And now I’m on the Adolescent floor at Mount Scopus. I’ve been told it’s easy street, but I don’t totally agree. Life is certainly better, though. The veins of these kids look like pipelines. No more four hours wasted trying to start an IV. So far I haven’t been beaten or abused, and if I can get a good night’s sleep tonight, I’ll be rejuvenated for call tomorrow. You know, I’ve been so burned out lately, I just hope that maybe in the next few days I’ll get excited and interested again.