I waste a lot of my time in the ER talking on the phone. If it’s not the police, it’s the labs. The lab techs don’t give a shit about anything. There’s this rule that before they give out any information to a house officer, they have to torture him verbally for a while. And if it’s not the labs, it’s a consultant from one of the subspecialty services who wants to avoid coming in to see a patient at all costs. And if it’s not a consultant, it’s the Bureau of Child Welfare. BCW’s the worst! I never really knew what the term “terminal hold” meant until I made my first BCW referral. If putting people on hold were an Olympic sport, the BCW would be the gold medal winner. They can keep you waiting for twenty or thirty minutes without breaking a sweat. If all of us house officers could just see patients and not deal with the rest of the bullshit, there’d be no waiting to be seen in the emergency room.
Thursday, September 5, 1985
A week in the Outpatient Department has done me a lot of good. I’m more relaxed now, less on edge than I was on Infants’. Take Hanson, for instance. When I think about him I actually find myself laughing at some of the things that happened two and three weeks ago, how angry I got when he crumped. I guess with the passage of time, there’ll come a point where I actually have fond memories of him. I can imagine: “Ahh, that Hanson, what a wonderful child, what I learned from him, how I wish I could take care of him again!” This is all kind of frightening. I think it’s these kind of warped remembrances of internship by people in charge of training programs that keep us working every third night!
Sunday, September 8, 1985
I had this whole weekend off, and Carole and I sat down and actually tried to plan out my vacation. Carole can get only the second week of it off, so I’ll have to figure out something to do the first week. We argued about it for a while; I wanted to go to some quaint New England village and just sack out, but Carole didn’t like the idea of wasting a whole day in the car getting there and another whole day coming back. She wanted to go to some hotel in the Poconos. So we compromised: We’re going to a hotel in the Poconos. Ahh, what the hell, it doesn’t matter that much to me. Anywhere we go is fine. As long as there’s a place to sleep and it’s far away from here.
Working in the ER is fine. I’m seeing a lot of patients, nothing major or earth-shattering, just routine walk-in clinic pediatrics. I think I’m holding my own. I’m learning to do a lot of things I never knew how to do before. I’m even learning a little Spanish. I now can have three-year-olds refuse to open their mouths, stick out their tongues, and say “Ahhh” in two languages. Who says internship is not an educational experience?
Hanson keeps repeating on me like a bad hot dog you get from one of those umbrella carts. I got a call from Jennifer Urzo, the intern who picked him up when he came back to Infants’ after being discharged from the ICU. She said he was doing fine, hadn’t crumped in over a week, and wasn’t he the most adorable thing I’d ever seen? I restrained myself. She said they’re starting to think about discharging him and wanted to know if I had any idea how to get in touch with his mother. I told her I’d never set eyes on the woman, that she never once showed up during August, but if she was able to contact her, she should give me a call because there were a few things I’d like to say to her!
I have nothing much else to say. I can’t wait till Thursday. Imagine, I’ll be able to stay in bed past seven o’clock two days in a row!
Bob
SEPTEMBER 1985
People who live outside of New York City carry a vivid image of what the Bronx is like. That image is based on a picture that appeared in newspapers around the country, a photograph of then-President Jimmy Carter standing amid the burned-out rubble of Charlotte Street. But the poverty and the dilapidation of the South Bronx is really only one view of the borough. At the opposite end of the spectrum, at the northernmost part of the Bronx, there’s Riverdale, one of the wealthiest sections of New York City. And in between the North and the South there are numerous middle-class neighborhoods, each with its own special character and ethnic flavor. The people from all these communities share one thing in common: They receive their medical care at the hospitals in which our interns and residents work.
But the poor children of the South Bronx are by far the Pediatrics Department’s biggest customers. They’re the ones who crowd the waiting areas of our emergency rooms and fill past capacity the beds of our hospitals. Many of the problems from which these children suffer are directly related to the extreme poverty in which they live: They get anemia and growth failure because of inadequate diet, lead poisoning because they eat the paint chips that fall from the ancient walls and ceilings of their apartments, and asthma from inhaling the polluted air that hangs over the South Bronx like a deadly cloud. Other medical problems are indirectly related to the poverty: As young children they’re physically and sexually abused and abandoned by their angry and frustrated parents and other adult caregivers; as adolescents, unable to find jobs or stimulation, seeing little to look forward to, they turn to drugs and sex, having babies when they themselves are still children and getting infected with venereal diseases and the human immunodeficiency virus in the bargain. And all these problems fall into the laps of our house officers, who have to work doubly hard to figure out how to relate to these abused children, sixteen-year-old mothers, and adolescent crackheads while very often functioning simultaneously as doctors, psychologists, and social workers.