The Intern Blues(38)

We got a really fascinating patient last night. She’s this poor little thirteen-year-old Hispanic girl, very cute and extremely suicidal. She was brought in by ambulance because she told someone she had taken a full bottle of asthma medication. She didn’t have any symptoms and her theophylline level was zero, so she really hadn’t taken anything. But she told the people in the emergency room that voices in her head were telling her to kill herself, so they admitted her. Poor kid, she comes from the original scrambled family. She’s under the care of her grandparents, each of whom has attempted suicide multiple times. She’s with the grandparents because her mother is a drug abuser who severely beat the girl when she was younger. She lives in a complete fantasy world; she told me about it in vivid detail. But other than listen to her talk, there wasn’t anything I could do for her. What she really needs is a psychiatrist. It’s sad, it’s really sad.

Karen’s been here almost a week now. She’s doing an elective in Manhattan. I’ve spent maybe six or seven hours with her, total. Next weekend she’s dying to go to Philadelphia and she wants me to come along for this party a friend of hers is throwing. But that would mean I’d have to do every other night on call and I’d have to trade with Margaret, who would have to work an extra weekend day. I don’t want to ask her to do that; it’s not fair to her and it’s also not fair to me. It would mean having to sleep on somebody’s floor or something, and I’d come back and have to do the every-other. I’d be completely fatigued and I wouldn’t even get to see Karen for five whole days. And that’s just to try to go to a little party in Philadelphia. In other jobs, you’d expect to have every weekend off, and it wouldn’t be such a big deal to go somewhere and have some fun. As an intern, you can forget it.

This past week Karen has had a very difficult time adjusting to my life. She’s been really upset at my absence, at the fact that the first night she was here I fell asleep four times over dinner. She had just had this interview at a program for a psych residency and it hadn’t gone well. The place seemed extremely disorganized, the people were disinterested, and they didn’t know a thing about her. She was upset and she wanted to talk about it and all I could do was fall asleep; I’m worthless to her! So she was very frustrated. And since that night she’s been getting angrier and angrier about the fact that two out of three nights I’m either away or asleep. Fortunately we have this weekend to be together. It’s only Saturday afternoon now. I’m going to go to sleep for a while and then we’ll have tonight and tomorrow together.

Friday, September 13, 1985

We are going down to Philadelphia tonight. I wound up having to go. I’m just waiting for Karen to come home. I don’t know how I’m going to get through this, but I found myself in a position where I couldn’t say no.

All the patients I’m taking care of now are psychopaths. Every adolescent in the Bronx is trying to commit suicide. They’re either trying to do it by an overdose, by shooting themselves, or by starving themselves to death. The floor is chock full of anorexics and bulimics. There are two types: the “walkers” and the “liers.” The “walkers” spend the entire day pacing up and down the halls. Whenever you need to find them, you just walk the corridors and there they are. They walk because they’re trying to expend as many calories as possible, and this is about the only exercise they can get while they’re in the hospital. They can’t do their “jazzercise” four or five hours a day, so they just walk. The “liers” are worst off, though. They all look like concentration camp survivors; they’re nothing but skin and bone. They’re so debilitated, they can’t do anything but lie in bed.

And there’s nothing I can do to help them. I go and I try to talk to them, I try to reason with them about eating. They say they’ll eat more but I know they’re just doing it to get rid of me. They’ll tell me anything they think I want to hear. Then they’ll just go and do whatever they want.

I referred one of the psychopaths to my clinic today. A patient of mine, one of my suicide-attempt kids. He’s nuts, but he’s really a good kid. I think he just needs someone to look after him. I can’t do a very good job of that as an intern, but I can at least be a little bit more of a support system. While I was making the appointment for him, I was thinking, Do I really want to do this? Do I really need this much of a problem coming to my clinic every week for the rest of the year? I hope I don’t regret it.