The Intern Blues(52)

My eyes are burning. Someone told me at work that they’re really red. What do you expect? Christ, I lie down, trying to get an hour of sleep, and the nurses wake me up. Fucking transplant kid had a headache. I had a headache, too, for God’s sake, and I didn’t see why the hell they had to wake me up about the transplant kid. But no, they said he had a headache and they took his pressure and it had decided to hop up from 120 to 180.

So I called the renal fellow and told him the kid’s pressure was up and he told me to give him a dose of captopril [an antihypertensive medication]. I gave it, the pressure immediately came down, and I went back to bed. About a half hour later, just as I was getting into some deep sleep, a nurse knocks on the door and tells me this other renal kid had a headache. It’s an epidemic, for Christ’s sake.

I went to see this second patient, and she said that not only did she have a headache but she also had fucking blurry vision. And her blood pressure was 200. So I gave her some captopril, too, and her pressure came down, but she was still complaining of the headache and the blurry vision. I thought about it for a while and I figured, screw it; if her pressure’s down, there’s nothing wrong. There wasn’t anything else I could do.

I went in to talk to her and tried to calm her down. She said she’d try going to sleep. I went back to the on-call room but now I couldn’t fall asleep. I was too worried about her. So I got back up and went to her room and sure enough, she was sound asleep.

I kept getting woken up all night long for little things. It was a quiet night and I still couldn’t get any sleep.

Another week to go at University Hospital. It’ll be a great feeling to be a third of the way through the year, knowing I’ve completed four tedious months of internship.

Friday, October 25, 1985

I just woke up. I was on call the night before last and I’m on again tonight. I’m doing an every-other, which is okay, I guess, because I get the weekend off. Thank God.

Karen called last night, I think. I think she called and said she’d been offered a place in Boston at the program she wanted to go to. But I’m not sure. I was so tired! I’ve managed to hold them off here. Mike Miller asked me whether I’m planning to be a resident here next year. He offered me the job. I told him I wasn’t sure yet, that I had to do some thinking. We’ve got to make a decision about this pretty soon.

Tomorrow is my last day at University Hospital. So what have I learned this month? I don’t know. Maybe I’ve learned how to handle many patients all at once. I don’t think I learned too much about kidneys, even though that’s about all we see.

I better get up before I fall back to sleep.

Saturday, October 26, 1985

My last night at University turned out to be pretty shitty. Everybody on the ward was sick. They all had fever spikes and high blood pressure and headaches, and everything necessary to ruin my day.

And then in the evening, Henry got sick. I guess I haven’t mentioned Henry yet. He’s an eighteen-year-old with Down’s syndrome who’s had end-stage renal failure for a long time. He’s pretty high-functioning: He’s no genius or anything, but he’s a really sweet kid with a good personality, and everybody loves him.

Henry has a cadaveric transplant [transplanted kidney obtained from a cadaver] and hasn’t been doing very well. He came in at the beginning of the month with rejection crisis. We gave him steroids and he got better and went home. Then earlier this week he got admitted because he was rejecting the kidney again; he’s been hypertensive and peeing tea-colored urine for days. We’ve been giving him these massive doses of antirejection medication but he seems to be getting sicker and sicker.

He got really sick last night. He’d been feverish in the afternoon, but we weren’t told about it. The nurse who took his temperature called the renal fellow directly and didn’t bother informing us. At about six o’clock last night, the fellow called to find out what the results of the sepsis workup were. “What sepsis workup?” I asked. That’s how I found out that Henry had spiked a fever.

I went in to see him at that point. He was feverish to about 102 and was tachypneic [breathing rapidly]. He didn’t look very comfortable. I ordered some Tylenol for him and told the nurses to sponge him down. As the night wore on, he became more and more tachypneic and his fever just wouldn’t stay down.

At about ten o’clock, he was looking really uncomfortable. I ordered a chest X ray and drew a blood gas. I brought the blood gas down to the lab myself but I couldn’t find the technician for about ten minutes. He was hiding in a back room somewhere. I finally found him and he ran the test grudgingly. The gas just showed a little hypoxia [the oxygen was a little low], so I went back upstairs, put Henry in 35 percent oxygen, and then went down to radiology to look at the chest X ray. It didn’t look too bad, but when I got back to Henry’s room, he was looking more uncomfortable. We turned up his oxygen to 50 percent and, after about another half hour, I did another blood gas. I ran it down to the lab, and again I couldn’t fucking find the technician anywhere. I looked all over the damned place; the guy was nowhere to be seen. I spent at least fifteen minutes looking for him. And when I finally found him and told him that I had a really sick patient and needed the gas stat, he said, “I have something else to do stat. I’ll get around to yours when I have a chance.”