The work on the ward still is pretty easy. I’ve been getting out between three and four on the days I’m not on call; so has Susannah. The subintern’s been staying until six or seven every night, but of course he’s not really sure what he’s doing yet, so naturally everything takes him longer. He also thinks he has to stay late to get something out of the rotation.
Everything would be perfect if it wasn’t for that idiot Barry Bresnan! He really is dangerous. I hate work rounds in the morning. We do nothing but argue for an hour. He’s got some very strange ideas about medicine, and most of the time they’re wrong. One day last week, Susannah admitted a five-year-old with a hyphema [bleeding into the anterior chamber of the eye; dangerous because it can lead to blindness]. The boy had been hit in the eye with a baseball. Susannah did what the ophthalmology consultant told her to do: She put him in a private room, patched his eye, and kept him sedated so the eye would not get reinjured and bleed again. But on the rounds, Barry said there was no reason to sedate these kids; in fact, it was dangerous for some reason he never explained. He told us to stop medicating the boy and just let him run around and do what he wanted. Susannah told him he was crazy, that if the kid were to rebleed into his eye, it could cost him his vision, and that she was going to continue the medication because that was what ophthalmology wanted done. Barry yelled at her that ophthalmology wasn’t running the ward, he was, and this is what he wanted to do. At that point Susannah figured it was useless to argue with him. She said “All right” and left it at that. She kept the patient sedated though.
Later in the day, when the chiefs made rounds with Barry, they told him the boy had to be kept sedated or else he might rebleed. So Barry came back to Susannah and said he’d changed his mind and she should start sedating the boy again. She told him she’d never changed the order in the first place, and that really pissed him off. But what could he do? He had been wrong and we had been right. He couldn’t very well go to the chiefs and complain that the interns weren’t following his orders, because his orders were wrong! He’s so stubborn and so stupid. And he’s dangerous. He could cause a lot of trouble for our patients. It’s frightening!
Friday, September 13, 1985
I am really angry! That jerk is continuing to find ways to torment me. Every time Susannah or I make a decision, every time we try to do something to help one of our kids, he comes and tells us we’re wrong and we have to change things, and we argue and get into a big fight. And it always turns out that we’re right and he’s wrong! It never fails! I don’t know how he can be a resident and know so little! It’s actually scary!
Today was the worst so far. We started off the morning fighting about a kid with asthma I had admitted last night. Nothing earthshaking or exotic, just a simple, straightforward eight-year-old asthmatic, something we see every day on the wards, and he found a way to screw up the kid’s care!
This was a kid who gets admitted to the hospital four or five times a year. They gave him a minibolus of aminophylline in the ER. [Aminophylline, a drug that dilates the breathing tubes, was, at the time of The Intern Blues, the mainstay of asthma therapy. In severe asthma attacks it was given by vein either in boluses, when a large dose is given once every six hours, or by constant infusion or drip; more recently, newer, inhaled medications have supplanted aminophylline in the treatment of asthma]. I started him on a one-per-kilo drip [a drip containing one milligram of aminophylline per kilogram of body weight per hour, the dose needed to maintain the blood aminophylline level] after checking the old chart and finding that that’s what it took to maintain his level. I drew levels [blood samples to determine the amount of aminophylline in the blood] after the bolus and four hours after starting the drip, and they showed he was in the therapeutic range. By this morning he was much better, but still he was wheezing a little. On work rounds Barry asked me what we had done. I told him and he said, “No, you did it all wrong, that’s not the way to figure out what dose of aminophylline to give an asthmatic.” He then recalculated everything using this strange formula I’d never seen before and told me that we should have started him on a 1.5-per-kilo drip. I told him he was crazy, that if we put the kid on a 1.5 drip he’d get toxic [develop blood levels of aminophylline in the toxic range; signs of aminophylline toxicity include nausea and vomiting and convulsions] in a matter of hours and I certainly wasn’t going to do that to my patient. He told me I was wrong, that he’d always used this formula and he’d never had any trouble with toxicity. That’s when Susannah told him he probably just had been lucky in the past because she was positive that if we changed the dose to 1.5 per kilo, the kid would be vomiting by noon. She also happened to mention to Barry that she thought he was both full of shit and dangerous and that we’d all be better off without him. Although she and I had been thinking all of this since the very first day of the month, neither of us had said it to him before. He yelled back at us that we were the ones who were full of shit and that we could say whatever we wanted about him, but he was sure he had never seen two interns who cared less about their patients. I got really angry at that point and asked how he could say that. He said something to the effect that he had never heard of interns who left the hospital at three o’clock every afternoon.