The Intern Blues(49)

Sunday, October 6, 1985

I just got home. I’m postcall, I got no sleep, it was a busy night. I admitted four patients, which isn’t bad, but there was an AIDS patient who was exsanguinating [hemorrhaging; losing all his blood] on the floor, a renal transplant kid who was in the midst of an acute rejection crisis, and some other patients who were basically causing trouble. My admissions were hideously staggered throughout the day and night, and I didn’t know what the fuck was happening.

I actually got a really interesting case last night: a little kid with argininosuccinicacidemia [an extremely rare inborn error of metabolism caused by a deficiency of an essential enzyme that results in liver disease, neurologic dysfunction, frequent infections, and, often, death in early childhood]. The kid is really sick, but he looks just like the Michelin Man. He’s got layers of fat around his belly and arms and legs, and it looks like tires. It’s hard to feel sympathy for him because I laugh every time I look at him.

Harvey Abelson, the director of pediatric home care, the service that manages all the chronically sick patients, is the Michelin Man’s doctor. He’s really nice and he’s smart and he’s a good teacher from what I can tell. Very intense, totally intense guy.

The transplant kid sounds like the beginning of a sad story. He got this new kidney in August. His mother donated it to him. There were some problems around the time of the transplant, but he pulled through. Now he comes in with rejection crisis. His blood pressure’s about 180/140 [normal for this patient would have been about 100/60]. They’re talking about having to take out the good kidney to bring down the blood pressure. The mother’s beside herself.

Monday, October 7, 1985, 11:00 P.M.

I think I want to be Harvey Abelson when I grow up. He’s hyper but he’s a pretty impressive guy. He’s right on top of everything all the time. You should see him working out what needs to be done with the Michelin Man. He knows everything! Yes, Harvey Abelson, that’s who I want to be.

My brother got married today. He didn’t want anybody else to be there, so he invited only a couple of people. My parents weren’t invited, I wasn’t invited, we were “uninvited.” I wished I could have been there, but I respect their wishes. My parents, however, are major-league pissed off. My brother and his wife, they were going to do it in December but then at the last minute they decided to do it today. I heard about it, of course, from Karen. I don’t know . . . there has to be a better way.

I had to stay late tonight to get my work done. My transplant patient seems to be better; his renal function’s coming back and his mother’s calmed down a little, too. But there was a lot of scut work to do so I had to stay until nearly eight. Now I’m going to bed. A solitary life, that’s what I’m leading.

Let me check if there’re any roaches in my bed. I’ve had roaches in my bed recently, roaches crawling in my bed. I woke up the other day and there was a dead roach underneath me. I must have rolled over and squished it.

I don’t know how I’m going to make it until Christmas, when I have my vacation. I just don’t know how I’m going to make it. It’s just too long.

Some kid asked me what I was doing, who I was today. He asked me if I was a doctor and what kind of doctor I was. I told him I was a hospital doctor. Just a hospital doctor. Someday I’ll look back on all this and cry. Has it always been this hard?

Tuesday, October 8, 1985

I’ve got to do something about this. I’ve been wallowing in this low- to moderate-grade depression for about the past month now, and that’s all I’m doing is wallowing. I can’t stand this feeling anymore. I’ve got to do something about changing my attitude. It’s the only way, because if you can’t go over and you can’t bow out, you gotta go through it. And that’s what I’ve got to do.

Thursday, October 10, 1985

I spent a long time teaching my medical student today, telling him about fluids and electrolytes. Very exciting! I feel like I don’t know anything. I guess that’s not exactly true, though. I do know how to teach about fluids and electrolytes. But that’s about it.

And I got myself reorganized again. Started using my daily flow sheets again on all my patients, something I hadn’t done for the past week because I was too depressed. I didn’t give a shit, and I never really knew what was going on, and that made me more depressed and so I gave less of a shit. Getting organized should help. Getting organized will make things better.

I’m feeling kind of horny these days. Doesn’t help having Karen two hundred and fifty miles away. Kind of get to eyeing the nurses, you know? But I don’t think I’m going to follow up on any of that. Nope! Think I’ll just stay true blue and all that stuff. It’s just a couple more weeks; I think I can make it.