The Intern Blues(53)

I was ready to strangle the guy! I had already wasted fifteen minutes looking for him and now he was telling me I was going to have to wait longer. And for all I knew, while I was down fucking around with this technician, Henry could have been arresting up on the ward. I was tempted to run the blood gas myself, but I knew that if I touched the machine the guy would have my head on a platter. And yelling at him was completely pointless because I knew that the more you yelled, the more hostile he’d become, and the longer he would take to run the sample. So I just sat on the stool feeling my blood pressure go through the roof.

Finally, the guy picked up the sample, strolled over to the machine, and did it. The gas was pretty lousy. I ran upstairs and showed the resident. Henry was going into respiratory failure in front of our eyes. He was just going down the tubes. And he was scared shitless.

We called the nephrologist and told him we were going to intubate Henry and bring him over to the ICU, and he told us to go ahead. We called the anesthesiology resident, and he did a great job of intubating him. We put him on a respirator and brought him down the hall [University Hospital’s ICU, located down the hall from the Pediatrics ward, admits patients of all ages].

I spent the whole night in there with him. He was all squared away by about three in the morning, but we had to stay and monitor him constantly. At least he was stable on the respirator. He wasn’t getting any sicker and he seemed more comfortable. And I didn’t have to deal with that lab technician again because the unit has its own blood gas machine.

Then, this morning, we spent until about noon rounding. I felt like warmed-over shit. After rounds, I went back to the ICU to write a note in Henry’s chart, detailing what had happened the night before, and as I was sitting there, one of the nurses called a code. There was this obese, middle-aged guy whose heart had completely stopped beating. He was in fucking asystole [without a heartbeat]! And there was no doctor around other than me.

I jumped up onto his chest and started doing compressions. After about ten minutes, the critical-care fellow showed up with a bunch of medical residents trailing behind. But all those guys did was stand around for a while and discuss what to do. They didn’t even offer to help. Finally, they decided to shock him [apply an electrical charge to the chest in hopes that this will start the heart beating again], so I jumped off his chest. They got his heart beating again and they figured he was stable, so everybody disappeared. I sat back down and tried to finish my note, but fifteen minutes later the same nurse yelled out that the guy had arrested again. And again, nobody was around. So I jumped back on his chest and started CPR again. This time the critical-care fellow showed up with the code team really fast, but again, they all stood around talking while I was doing the resuscitation. Finally I said, “Does somebody else want to do this? I’m from Pediatrics, for God’s sake!” I couldn’t believe it.

Finally, one of them took over for me and I went to finish my note. They got the guy’s heart beating again, but what would have happened if I hadn’t been there? The guy would have fucking died because there wasn’t a doctor around to do CPR. And I wasn’t even supposed to be there. What kind of care are these patients getting?





Amy


OCTOBER 1985

Saturday, October 5, 1985

I really needed things to calm down a little after last month ended, but it doesn’t look like that’s going to happen. I finally got away from Barry Bresnan, but I wound up on the Adolescents ward at Mount Scopus, and it’s been terrible. I’m tired, and I’m fed up. I need a vacation. I have one coming up at the end of this month. I hope I’ll be able to make it till then.

It’s been really busy on Adolescents and it’s very depressing. Half the beds are filled with fourteen- and fifteen-year-olds with leukemia, brain tumors, you name it. And the other half is all girls with anorexia nervosa who are completely crazy! It’s impossible to talk to them, it’s impossible to do anything for them. They just want to be left alone, do their aerobics, vomit in any secret hiding place they can find, and lose weight. They don’t want anyone coming near them, especially not a doctor who might actually be able to do something to help them.

My most difficult patient is this eighteen-year-old girl with choriocarcinoma [a malignant tumor derived from the products of a pregnancy]. Two weeks ago, she was completely fine. She knew she was pregnant, and she was looking forward to having the baby. Then suddenly she started having some cramping and bleeding and she came to the ER where the gynecologist saw her. They figured she was having a miscarriage so they did a D and C. The stuff they took out looked strange. They sent it to pathology and found out it was cancer. She got admitted to me on Monday, the first day of the month. We did a quick workup that showed the cancer had spread all over the place, to her lungs, her brain, everywhere.