I think I probably get flustered too easily. I shouldn’t allow myself to get angry about these things. Okay, so the patient’s lying there, writhing in pain. Complaining to the head nurse didn’t do him any good, and it sure as hell didn’t do me any good. I could have just very quietly, very calmly filled out an incident report that I wasn’t informed of the patient’s presence. I could have sent that down to administration and then, whoever’s ass had to be cooked, let his or her ass be cooked! I shouldn’t allow myself to get aggravated about stuff like that; there’s more than enough other stuff to get aggravated about. That’s easy to say, but I still get all fumy and angry whenever something like this happens because, really, deep down inside, I want to do a good job, and I don’t want people to be suffering. It really pisses me off.
I also got into a fight with a lab technician last night. I admitted a teenager with leukemia at about 6:00 P.M. He came in because he had fever and the hematologists were sure he was septic [had a bacterial infection in his blood; especially dangerous in patients with malignancies because their white blood cells, an important line of defense against invading organisms, are usually markedly deficient]. He got sent up to the floor very fast; they had seen him in clinic but they hadn’t even done any of the lab work. They were really worried about him, so they sent him up directly from clinic.
As soon as he got to the floor, I drew all the admission blood work out of his central line and sent it off to the lab stat. Of course, I included a CBC [complete blood count] with diff [differential cell count: percentage of various types of white blood cells within the sample], and I wrote the diagnosis on the lab slip so they couldn’t blow off doing the diff [the differential count requires some tedious microscope work; therefore it is done only in cases where there’s an abnormal number of white cells or in cases of malignancy]. When I called the lab about an hour later to get the results, they told me nothing was ready yet. I called back a half hour after that and they gave me the CBC, but the tech said they hadn’t done the diff. I said, “What do you mean, you haven’t done the diff? I checked off ‘diff’ on the lab slip and wrote the patient’s diagnosis.” He said, “We don’t do diffs at night.” And I said, “What do you mean, you don’t do diffs at night? I need a diff on this patient; he’s got leukemia, for God’s sake, and he might be septic. I have to have a diff! This kid could die.” And the guy said, “Lots of people die every day,” and then he hung up. He fucking hung up on me!
I was ready to go down there and kill. But the senior I was on with said it wouldn’t do anybody any good and that all I had to do was take another sample over to West Bronx’s lab and they’d run it for me. I did that, and sure enough, the kid was neutropenic [had a deficiency of the particular type of white blood cells most important in fighting off infections] and septic. He’s pretty sick. He may die. But the people in the lab don’t care about stuff like that. They only know what the rules are.
The aggravations of being an intern are just endless. I would say nine out of ten interns say these same two words over and over again: “Internship sucks.” I’ve heard that particular phrase so many times in the past week or two.
I mean, think about it: To the nurses and most of the rest of the staff, we’re nothing but another piece of shit. To the nurses, anything that goes wrong is the intern’s fault. Somehow they’re always innocent and the intern always is wrong. And nobody around here seems to give a shit! There are really only three good nurses on this ward. The rest are worthless, lazy, uncaring shitheads who spend most of their time sitting around on their fat asses in the back room, watching TV and eating junk food. They don’t want to do anything. They certainly don’t want to take care of patients. They’re so fucking, incredibly lazy! Anytime you ask them to do anything, even take a patient’s temperature, they either take it as a racial slur or as a personal insult. Oh, my God, it’s a federal case to get a temp done! I’m used to being in a hospital where the nurses were superefficient; they’d fall all over each other to get an order filled. I’m not used to this attitude.
And there’s another problem: There’s a major cultural difference. Here I am, this white, upper-middle-class Jewish kid, and most of the nurses are black, working-class women. We’re from completely different worlds. God knows what they’re thinking when they look at me and the rest of us, but I definitely get the feeling that they think we’re a kind of annoyance they have to put up with. There’s so few of them who really want to make the effort to work together. Oh, well, what can you do?