Today I acted as the supervising physician for IV sedation in a kid who was getting a radioulnar fracture [a fracture of the two bones of the forearm] reduced by the orthopods [internese for orthopedic surgeon]. Although the attending popped his head in a few times to make sure everything was all right, I basically just did it on my own. Even though nothing really happened, it’s still kind of a nerve-racking experience.
Thursday, July 18, 1985, 2:00 A.M.
Just finished another call in the West Bronx ER. The past few days have been mixed. Today was pretty good, but the two days before pretty much sucked. I had a couple of aggravating days in clinic [all pediatric house officers are assigned to a “well-child clinic” in one of the hospitals; interns and residents have office hours once or twice a week in clinic during which they usually see six or seven of their own patients], where I just felt overwhelmed and disorganized; it was driving me crazy. The problems were pretty boring, but I’m picking up lots of new patients, slowly but surely drumming up my clinic. I have the feeling it’s going to be a booming clinic pretty soon. It seems like every walk-in [a patient who comes to the emergency room] needs a regular doctor. They ask me if I’d be their doctor, I say sure and give them the clinic’s number. I have a feeling this is going to be a mixed blessing in the long run, but anyway . . .
I was really tired most of today. I just don’t seem to have any pep. It’s this every-third-night-on-call business, the inevitability of it, it’s just dreadful. Even though this is the easiest rotation I’ll have and I get to go home every night (even though it might be at three or four in the morning), these hours just get very tiring. Is it possible that I’m really starting to get tired this early into the year? I’m worrying about everything; I’ve even started to have trouble sleeping on the nights I’m not on call. I didn’t sleep well last night—I woke up three times before my alarm went off.
Well, it’s time to go to sleep, my favorite pastime.
Saturday, July 20, 1985, 3:30 A.M.
Today was my worst day of internship so far, because of two incidents I had with orthopedics. First, there was a kid with a dislocated elbow. I was doing the IV sedation and the prick ortho resident didn’t like the amount of sedative I was giving, he wanted the patient to get more and at one point he actually put his hand on the syringe full of morphine I was holding and started to squeeze. I had to shake his hand off and tell him, “No, you’re not supposed to do that.” The rest of the procedure was punctuated by him cursing at me for not wanting to give enough sedation. The jerk!
Later there was another kid who needed sedation, so this same resident and I decided together to give him a DPT [a cocktail of three sedatives: Demerol, Phenergan, and Thorazine, given through an intramuscular injection], but the nurses wouldn’t do it. They have this rule that DPT is not allowed to be used. So this started a big stink and things were getting more and more hairy. The pediatric resident who was on got pissed off at the nurses and they got pissed off at us, and the ortho resident’s yelling, “Hey come on, guys, hurry up!” Finally we decided to give IM [intramuscular] morphine but I wrote the order on the wrong part of the chart and the nurses didn’t see it and they didn’t give the medication and before you know it, the ortho resident was back, pissed as hell because we were taking so much time, and he started yelling at me for being so incompetent and then I started yelling back at him and I could feel the blood rising in my face. I’ve never felt that angry at anybody before. It was making me crazy that I had no way to get back at him, so I just kept yelling at the fucking guy, telling him he was a jerkoff and a dickface. It was a very uncool thing to do.
Right after this, I grabbed a chart and went into an examining room but I was still so angry, I couldn’t concentrate. So I told the senior I needed two minutes to cool off, and I went down to the vending area to get a Coke. I put my money in the machine, and what came out? A nice, warm Pepsi! No ice! No refrigeration! Oh, God, how I love West Bronx!
I went to a corner, sat down, and tried to cool out for a while. Then I went back to the ER, got some ice, and drank my fucking Pepsi. I apologized to the nurse I yelled at; I even apologized to the ortho resident, even though I think I’d still like to break his arm.
A few of us ’terns got together the other night and went out. We had dinner at an Indian restaurant in Manhattan, then went to get some ice cream and roamed around for a while in the rain. It was pretty good, but we were all so damned tired. Everyone was either postcall or precall. Shit! It’s just amazing how often call comes around. It’s like you feel you just got off and it’s your night again.