The Intern Blues(36)

I almost thought I was getting excited and interested today. We had rounds with Marilyn Connors, our attending. She was pretty laid back. I’ve heard that all the adolescent attendings are hyper and picayune, so we’ll see.

There’s this intern I’m working with, Margaret Hasson. She was hysterical today, the way you get sometimes when you’re postcall and can barely stay awake. She was presenting a patient she admitted last night and she got really out of line, making off-color jokes and stuff. When you get so tired you’re falling asleep on your feet like that, you think things are hysterically funny when nobody else does. It was great. After rounds, she told me that after she spent July over on 8 West, she decided she totally hated her internship. She doesn’t seem like she’s in a bad mood now, though. She’s not demoralized or grumpy and she doesn’t hate everything.

I’m having my first experience with teaching medical students this month. I was assigned a good student who’s very conscientious, humble, and a hard worker. I try to get her to spend as little time as possible in the hospital. She should be home, reading. That’s what all medical students should be doing. They should spend only enough time on the wards to get an idea of what goes on there. I didn’t do that; I think I spent too much time on the wards. Maybe that’s why I’m so burned out already.

Having a student is interesting. I’m finding I do know a few things. I didn’t think I had picked up anything since I got here, that I was a complete dum-dum. But I’m finding that I can actually talk about subjects intelligently. I don’t know if they’re sitting there thinking, Gee, this guy’s really stupid, he’s saying things that are completely wrong. But the important thing is I actually learned something over the past two months. I don’t remember it happening; it must have been by osmosis.

We’ve got these two residents, Nancy Rodriguez and Terry Tanner, working on Adolescent this month. Nancy and Terry seem real nice, but they’re only second years; they were just interns a couple of months ago. They’re only a few months ahead of me and they’re supervising on a busy ward! It’s scary. I couldn’t do it.

Saturday, September 7, 1985

This is supposed to be an easy ward, but God, there’s just so many goddamned frustrations! Like there was this patient admitted the other day, this cute little fourteen-year-old girl from Barbados with severe mitral stenosis [a tight closure of the mitral valve, the valve between the left atrium and the left ventricle of the heart; stenosis results in the atrium having to work harder to push an adequate amount of blood into the left ventricle and to the rest of the body] as well as pulmonary hypertension [an irreversible increase in the pressure in the blood vessels that carry blood from the heart to the lungs; frequently the cause of death in children with congenital heart disease] and hemoptysis [coughing up of blood]. She’s really sick, but all anyone cared about was fucking politics. Even though she could be dying, the administrators have to decide whether she can stay in the hospital because she’s not a U.S. citizen and not eligible for any kind of insurance. I was told that it would probably be okay if we said that she was here visiting relatives and got sick, rather than that she came here for medical treatment, which was the truth. I was told not to write anything in the chart until administration had cleared it and that I shouldn’t exactly lie, but I should tell the truth in a certain way, you know, make it sound like she’s really more acute than she is. I can’t stand buffing the chart [buff: polish to improve an appearance]; it really bothers me. But fortunately, I had blown the cover the first day when I wrote in my admission note that she had come to the United States specifically for medical care. A lot of other people said the same thing in the chart, so it wasn’t all my fault. Anyway, Loomis, the head of Adolescent Medicine, spoke to some big cheese and got the hospital to foot the bill. It was really nice of him, actually, and it was nice of the hospital, too. This’s going to be a fucking thirty-thousand- or forty-thousand-dollar bill. But all this time, at least a half hour of attending rounds a day was being wasted on this bullshit.

Yesterday was just one of those bad days; I wasted the morning with the attending and the administrators trying to figure out what we were going to do with this kid. Then later on, I was told I was getting a patient with sickle-cell disease who was in painful crisis. Nobody bothered to mention to me that the patient was on the ward until the kid had been there for two and a half hours, lying in his bed down the hall and writhing in pain! I was so pissed I ran over to the head nurse and yelled, “Why didn’t someone tell me this guy’s been here so long? How come I haven’t heard about this?” And she said, “Well, it’s not our fault,” and she looked at me as if it were my fault, that I should have somehow instinctively known the kid was there. I was so furious, it took me two hours to cool down because the main thing was, here’s this poor kid, he’s in agony, and he didn’t have to be! What can I say? It was just one of those days.