On the evening of October 14, our phone rang almost as soon as I got home from work. It was Andy; he said he needed to see me right away; it was important, and he couldn’t talk about it over the phone. He asked if I could come down to the Bronx immediately.
I was worried. I knew Andy had been depressed, and I also knew that anything was possible. So without losing a minute, I got into my car and headed back to the Bronx.
Andy lives on the twentieth floor of the Mount Scopus apartment tower. He has a studio apartment with a terrific view. From the balcony, looking east, you can see parts of the Bronx, City Island, Long Island Sound, and, in the distance, the lights of Long Island and Westchester County. After showing me around, Andy sat me down and said, “I guess you’re wondering what’s going on.” After I told him that was an understatement, he continued: “You have to promise not to tell what I’m going to say to anybody else, not even your wife. It’s very secret and I could be extremely damaged if word leaked out.”
After we negotiated a little and I finally promised, he told me: “I’ve been offered a job at another program.”
I must admit it was kind of a letdown. I was expecting something juicier, something like he was having an affair with one of the other interns or possibly even with one of his ex-patients on Adolescents. He went on with the story; he told me that before this year had started he had talked with the director of Pediatrics at Boston Children’s, the program he had originally ranked first on his match list last year, and had asked him about the possibility of coming back to Boston as a junior resident next year. The director had told him that no jobs were available at that time, but if one were to open up, Andy would be No. 1 on the list. Then yesterday the guy had called, had told him one of the interns was planning to leave and that Andy could have the position if he still wanted it.
Andy told me he was feeling very conflicted. There were a lot of things to think about. First, in spite of everything that’s happened, he thinks our program is good and he’s made some close friends; he feels bad about the prospect of leaving. Next, Karen is applying to some of the more impressive New York psychiatric residency programs and has a better than even chance of getting in.
“So stay,” I said.
“It’s not that easy,” he replied. “My family’s all in Boston. And I know I’ll get a good education at the other program. And Karen and I are planning on settling in Boston. We want to have a family; staying in New York will just delay that.”
I told him it sounded like a tough decision but that it wasn’t a bad situation to be in; I mean, he’s going to win either way. I told him I’d definitely be sorry if he decided to leave.
We talked for about an hour and a half. Of course, nothing was resolved. I’m not sure what’s going to happen to Andy, but if I had to bet, I’d bet on his going back to Boston. There’s simply more to draw him there at this point than there is to keep him here.
Every October, all the attendings who have contact with the house staff meet to discuss the internship group. This meeting serves two purposes: First, it identifies those people who are or may soon be having trouble so that some form of intervention can be planned; second, the meeting allows us to come up with some idea of who will be returning the following year and, more importantly, who will be leaving.
It’s rare that all the interns come back as residents. Two members of each year’s incoming group are accepted with the understanding from the very beginning that they’ll be leaving for residencies in psychiatry, radiology, or other specialties in which a year of pediatric or internal medicine training is mandatory. A few more, people like Andy Baron, decide to change programs for personal reasons. So during this meeting, Mike Miller tried to get a head count of prospective junior residents.
The meeting this year was interesting. Mark Greenberg and Andy Baron were both viewed as very good. Andy, in fact, is considered by most people to be outstanding, an excellent candidate for one of the program’s four chief resident positions. Since he had sworn me to secrecy, I didn’t mention a word about his job offer in Boston.
The intern about whom there was the most discussion was Amy. She’s apparently made more than a couple of enemies among the attendings. In addition to her problem in the emergency room back in July, she tends to do a lot of little things that get people upset, such as leaving the hospital early; complaining frequently and loudly; and criticizing other house officers, such as Barry Bresnan. I spoke up for her; I said I thought a lot of her complaints were justified and that she shouldn’t be condemned for voicing them.