The Intern Blues(60)

Anyway, later on Wednesday night (actually it was about five o’clock on Thursday morning) I admitted a fourteen-year-old with Down’s syndrome who was having an asthma attack. Now, asthma’s pretty straightforward. At this point, I can manage asthma in my sleep. In fact, that’s when I usually do the best job. But this kid was just a touch more complicated because, in addition to his Down’s syndrome and his asthma, he also had chronic renal failure. The problem with that is that aminophylline [a medication used in the treatment of asthma] is removed from the bloodstream by the kidneys. I could give the stuff to him and it’d probably help his asthma but he wouldn’t ever be able to get rid of it. He’d probably wind up with toxic side effects; he’d stop wheezing and start seizing, and that wasn’t going to be very helpful. We thought about it for a while and decided to turf him [turf: internese for “transfer to another service”; also referred to as “a dump”] immediately to University Hospital, where the renal dialysis unit is located. So I had to ride over to University Hospital in the ambulance with him and drop him off at the ward.

Well, I got over to University, brought the kid up, and introduced him to Andy Baron, who was the intern on call over there. He wasn’t exactly happy to see me. What the hell happened to him? I mean, I haven’t seen him in a couple of months. He used to be a kind of easygoing, friendly guy. He yelled at me when we got there. He accused me of dumping this kid on him, which of course I was. But, hey, that’s not my fault. We weren’t doing it to make Andy’s life more miserable, we were doing it because it seemed to be the best thing for the patient.

It’s kind of scary, running into people you haven’t seen for a while. It’s like going to see a horror movie and realizing that you and your friends are the main characters. You look at Andy and you see what kind of a monster he got turned into and you start to wonder if maybe the same thing hasn’t happened to you, but you haven’t noticed it because you live with yourself every day and it’s hard to notice any changes. I don’t know, it’s pretty scary.

Anyway, Saturday was pretty quiet. I got only two admissions the whole day, so I had a chance to spend the day sitting in the residents’ room watching TV and eating mock-turkey sandwiches. It was good; I needed a chance to relax a little and figure out who all my patients actually were. And today was pretty quiet, too. So right now I’ve got most of this straightened out.

I spent yesterday in the city with Carole. We went to a matinee. We saw Cats. I fell asleep four times and Carole had to wake me up because my snoring was disturbing all the people around us. I don’t think I missed much; from what I saw during the short period when I was conscious, it looked pretty lame. I can’t figure out how they get people to wear those silly costumes eight times a week. I guess if they can get me to do the ridiculous stuff I do, they can get anybody to do anything!

Thursday, October 10, 1985

As if my life weren’t bad enough, Hanson’s back. I couldn’t believe it! I got called down to the ER to pick up an admission last night and all I knew was it was supposed to be a six-month-old with diarrhea and dehydration. I got down there and there he was. There was no doubt about it. No other six-month-old I’ve ever seen has that characteristic putrid look about him. His mother had brought him to the ER, and of course she didn’t recognize me. During the entire month he had made my life miserable on Infants’, she had never once come to see him. All I knew about her was that she was a drug addict. When I realized she was his mother, I almost said, “Oh, I’m sorry, I didn’t recognize you without the needle in your arm,” but I showed excellent restraint and tact and kept quiet. I’m getting really good at this patient-relations stuff. Anyway, poor little Hanson had been home maybe two weeks and had developed diarrhea again. I asked his mother why she didn’t bring him back to Mount Scopus since, after all, all his records are there, and she said, “I don’t like those doctors at Mount Scopus. They don’t know nothing. They’re all a pain in the ass.” I guess she came to Jonas Bronck because she wanted a second opinion. Very smart!

Anyway, I figured I should try to get some history on his last days at Mount Scopus, so today I got in touch with Jennifer Urzo, the intern who discharged him from Infants’. I said, “I just admitted Hanson,” and I could hear her groan. It’s amazing how one tiny baby can cause such a uniform reaction from everybody who’s come in contact with him. Jennifer told me this weird story about how she spent the entire month of September working really hard to get him straightened out. Not only did she work on getting him relatively healthy, she also arranged for a bunch of outpatient follow-up appointments, home visits by the VNS [Visiting Nurse Service], social work involvement, the works. It sounded as if she genuinely liked the kid (there’s no accounting for taste). When everything was arranged, Jennifer somehow got in touch with the mother and actually convinced her to come in and learn how to take care of the baby, which must have been a major miracle. The mother came a few times. Jennifer said she never felt really comfortable around her but that the nurses felt the mother knew what she was doing. So Jennifer told her she could take the baby home. She started going over all the appointments she had made and the mother said something about the fact that she was going to take the baby home and she’d keep most of the appointments but she sure as hell wasn’t going to come back to see Jennifer because she didn’t like her, she didn’t think she was doing a good job with the baby. She said she didn’t think she was a very good doctor. This obviously really hurt Jennifer. She even got tearful on the phone just talking to me about it.