Well, we were yelling loud enough at that point to get the chief residents out of the ICU, where they were rounding. Susannah said something about the fact that she and I were able to get out early because we had learned to be very organized and that maybe Barry’s problem was that when he’d been an intern he hadn’t learned anything and that was why he’d turned into such a bad resident.
That was when the chiefs separated us. Jon Golden pulled Susannah and me down the hall, and Eric Weinstein took Barry into the residents’ room. Jon asked us what had happened, and I related the incident from start to finish. Jon said that Barry, as usual, was definitely wrong and that we were definitely right. He told us they were having a lot of problems with Barry, that he really did have some problem with his knowledge base and that, on top of it, he had no confidence in himself. “Of course he has no confidence in himself!” I told Jon. “He doesn’t know anything! There’s no reason for him to have any confidence!” Jon told us that may be true, but they were stuck with him, and we would have to try to make the best of the situation. He also told us we should try to be nice to him because it might help him with this confidence problem. That’s not exactly what I wanted to hear and it wasn’t what Susannah wanted to hear, either. She said there was something really wrong with all of this, that this guy was dangerous and he shouldn’t be in a position where he had the chance to harm the patients. I said I thought he should be thrown out of the program. Jon kind of groaned and said that he really wasn’t that bad and that we just should give him a chance. We just walked away at that point. There was nothing else we could say. We weren’t getting through.
I don’t know what Eric told Barry, but he came out about a half hour later and didn’t say a word to us. We finished work rounds without him and made all the medical decisions ourselves.
At about three o’clock I was signing out to Susannah in the nurses’ station. I didn’t have much going on; it’s been kind of quiet. I only have six patients, and two of them are chronic AIDS patients. [The back rooms on 8 West are reserved for children with AIDS and AIDS-related illnesses. On any given day there are four to six patients residing there. Most are not sick; they have come to live in the hospital because there’s no other place for them]. While I was signing out, Barry came up to me and said, “What are you doing?” I told him I was signing out and he said, “Look, you can’t sign out at three o’clock.” He said there had to be some work I still had to do. He said that I had a responsibility to teach the students and obviously they weren’t getting taught anything if we were all going home at three o’clock.
I didn’t answer him; I just continued signing out. After a while he said, “Didn’t you hear me? Why don’t you answer me?” I told him I didn’t answer him because I didn’t have anything to say to him. He looked really hurt and walked away. A couple of minutes later, Jon Golden came into the nurses’ station and asked if he could talk to me in private. I had finished signing out and was getting ready to leave. He took me into the chief resident’s office and said, “I know things aren’t going well on the ward, but don’t you think you could try to be nice to him?” And I said, “Why? He’s not being nice to me!” I told him about what Barry had just said to me and he kind of sighed and just asked if, in the future, I would just play along with Barry, at least make him think I was being friendly. I said I’d try. And then I got up to leave and on my way out, I ran into Barry again. I said good-bye to him and this time he ignored me! Unbelievable!
There are two more weeks to go on this ward. If it hadn’t been for this jerk, this would’ve been a very nice month. As it is, I can’t wait until it’s over!
Monday, September 23, 1985
Thank God the month is almost through. I haven’t recorded anything in over a week. It’s been too depressing. I hate going to work every morning and spending the whole day fighting.
It wasn’t as bad in the beginning of the month because we weren’t all that busy. But last week the place started to fill up and there are a lot of complicated patients around who need a doctor who knows how to make decisions. Susannah and I don’t know enough, and since we’ve stopped talking to our resident, there’s nobody to turn to except the chief residents, who aren’t all that thrilled about being bothered with our trivial stuff every five minutes. But these cases are complicated and we can’t manage them alone!
I now have nine patients. They include three asthmatics, one of whom was really sick and almost needed to be intubated [had a breathing tube placed through the larynx and into the trachea to facilitate artificial ventilation]; a four-year-old girl with nephrotic syndrome [a condition in which the kidney fails to retain protein; the protein spills out in the urine and the patient becomes protein-deficient, which leads to severe swelling of the entire body]; an eight-year-old girl who’s GORKed out after being in a fire and inhaling a lot of smoke [brain damage occurs in patients with smoke inhalation usually because of carbon monoxide poisoning] and whose only sign of brain activity is her daily convulsions; two FIBs on antibiotics, one of whom probably has meningitis; and Winston and Salem, my AIDS twins (it’s still hard to believe anyone would name a pair of twins “Winston” and “Salem,” but there they are, on my ward). And even they’re not doing so well. Susannah’s got ten patients and the subintern’s got six and we have to cope with an idiotic resident.