The Intern Blues(5)

Anyway, there I was, sitting in front of her in the social work office, and the medical resident was standing behind me and there she was, looking at me, not having a clue what was going on. All I could think to say was, “I’m sorry, but I have to tell you, your son is dead.”

She looked at me, her eyes bugged out, and she became completely hysterical. And the woman who was there with her also became completely hysterical. They began screaming in Spanish and wailing and throwing themselves around. I didn’t understand a fucking word they were saying, I didn’t know what was going on, they were making a tremendous ruckus and I just . . . I just didn’t know what to do. It was a terrible moment. I felt completely powerless. I couldn’t think of anything to make her feel better. It was probably the most horrible moment in her life.

As we were walking to that room and I knew I was going to be the one to tell her about her son, I remembered hearing about situations like this, when you have to tell a mother that her child has died, and you don’t even know her; you’re just on call and it’s not your patient and you just kind of get signed out to take care of the dying person. I expected it to happen sooner or later; I’m just kind of surprised it happened so soon in my internship, in virtually the first week.

Wednesday, July 10, 1985

I spent the afternoon in the West Bronx ER, where I had a great case. We had this kid I saw a couple days ago, the one-year-old who came in with a febrile seizure. I tapped him and found he didn’t have meningitis, but today the blood cultures I’d sent came back positive, with gram negative rods [meaning that there was a bacterial infection in the blood with a bacteria called E. coli, a potentially serious infection]. We called the kid back in and he still had fever on the antibiotics I had prescribed, so we admitted him for treatment of sepsis [infection of the blood].

Then later in the day, a little five-month-old came in with a high fever. I did another spinal tap and did the cell count and this time, yes, lots of white cells; this kid did have meningitis and was admitted. That’s routine pediatrics, very routine, I know, but for me it was a very exciting thing. I was able to do everything from start to finish, and that was all stuff I learned here, stuff I didn’t know how to do in med school, and that’s very exciting. I’m now able to do some things that doctors are supposed to do.

I told the mother we’d have to admit the baby and take more blood and she said “No way.” She was frightened to death. I knew there was no way that I, with my vast two-week experience as an intern, was going to be able to convince her to let us do what we needed to do, so I called the attending and he came over and sat and explained the whole thing to her, telling her how important it was that we start an IV and begin antibiotics as soon as possible so that the baby would have the best chance possible of surviving and she listened carefully but it was clear she was so frightened she couldn’t think straight. She finally said, “I don’t know what to do anymore. Call my husband and ask him.” We called the father and he said, “Do whatever you have to,” and he came in. It was very sad: Here’s this beautiful, normal baby with this terrible infection and the real possibility that he’ll wind up retarded, and I was excited because I had been able to do the workup from start to finish. It’s like I’m less interested in the patients and more interested in what I can and cannot do.

I’ve been here a week and a half and I’ve done more spinal taps than I’d done in all of med school. You see a lot in this place, it’s a great program, but I can see how I could get burned out. It’s a real danger in a place like this, with call relentlessly every third night and the ancillary staff somewhat less than helpful. I can see I’m going to have to watch out; down the road when it’s the winter and my vacation is a month or two away, I can see how I could possibly come to hate this, how what seems like fun and is exciting now could turn into a real drag later.

Monday, July 15, 1985

Time seems both to drag and to race onward. It seems like forever since I last saw Karen; it’s only been a week and a half. I really miss her.

Last night I was on call in the West Bronx ER again, and from the word go, it was crazy, packed from the start until about two o’clock. I didn’t have even a second to catch my breath. This is getting to be a very disturbing routine.

I spent Friday and Saturday down in Manhattan with some of my friends from college, Gary and Maura. They live in the city; it was nice to get out of here and see some people outside of medicine. I tried to explain to them about some of the stuff I’ve been doing and seeing. They say they understand, but I get the feeling they only believe about half the things I tell them.