Before we left, I was obsessed with being on call that last night of October. It became the most important thing in my life. As it turned out, it wasn’t a problem. It was a very bad night; I admitted a new onset diabetic who was in DKA [diabetic ketoacidosis, a buildup of acid in the blood caused by the inability of the body to use glucose as its energy source; insulin, the protein that allows the blood’s glucose to enter the cells of the tissues, is either absent or abnormal in diabetics], and I was up all night managing the boy’s fluids and electrolytes, but Ben King, the senior who was on with me that night, threw me out of the hospital at seven in the morning. Just like that, he told me to leave and have a good time and not to worry about a thing, he’d take care of the patients and sign out to the new interns. So, after all that, I did manage to get home, take a shower, and change my clothes before we had to leave for the airport.
The flights were terrible both there and back. Sarah screamed the whole way. It didn’t bother me that much on the way over; I was completely zonked and I slept most of the trip, so it was Larry’s problem, not mine. But I couldn’t believe it on the way back! I was sure the pilot was going to land and throw us off the plane. But outside of the flights, it was the best vacation of our lives. Larry’s parents were great. They wanted to spend the whole time taking care of the baby; they left Larry and me alone, and they encouraged us to go out on our own and do whatever we wanted. I slept late every morning, and by the middle of the second week, I felt like I had finally caught up on my sleep. We traveled all over the country. I can’t imagine a better vacation. The only problem was that the time just flew by. Before we knew it, it was time to pack up, get on the plane, and come back to work.
I’ve been working in the OPD at Mount Scopus. Things have been quiet. I’ve been getting out between twelve and one on the nights I’ve been on call. Things would be perfect if we weren’t all so jet-lagged. When I’m not on call, I’ve been going to sleep at seven and waking up at three in the morning. And when I am on call, forget it; I have to use toothpicks to keep my eyelids open after nine. But I can see how much calmer I am now compared with before we left. I really needed that vacation, there’s no doubt about it. It’s just too bad I have to wait so long for my next one to come around.
Saturday, November 23, 1985, 2:00 P.M.
I had a very bad night last night. The ER was busy and depressing. I didn’t get home until after three this morning, and I just woke up about a half hour ago. It’s a beautiful day and we’re going to take Sarah out for a walk in a few minutes, but I wanted to record this while it was still fresh in my mind.
At about nine o’clock, I picked up the chart of a three-year-old whose mother said she had had a bloody bowel movement earlier that evening. I didn’t think much of it at first; bloody bowel movements aren’t that unusual. It’s usually due to an anal fissure [a tear in the anal mucosa caused by straining; very common in children around toilet-training age]. I called the patient in and I saw she was a cute, well-dressed, healthy-looking little girl. I took the history from the mother, who seemed appropriately concerned. Then I examined the girl. I noticed right away that her rectum was very red and it looked kind of . . . well, boggy is the best way to describe it. I did a rectal exam and I noticed that the tone of the sphincter seemed a little decreased. I was suspicious, so I called the attending and did the rest of the rectal exam with him in the room. The girl didn’t even cry while I was doing it. There wasn’t a peep out of her, which, to say the least, is not normal for a three-year-old.
I got a sinking feeling in my stomach when I was doing the rectal because I’ve taken care of little kids who’ve been sexually abused and I knew what was going to happen from here. I was going to have to question the mother, she would probably deny everything and accuse me of making it all up, we’d get into a big fight, and she’d eventually start to cry. Then I would have to call the BCW and report the case to them and they’d wind up doing a full investigation, which might end with them taking the child away from her mother. I knew that none of this was fun or interesting and it was going to take up most of the rest of the night.
Anyway, I started asking all the questions I had to ask. Did they live alone, or were there other people living with them? Did she watch the girl all the time, or did she leave her with other people? Was the girl’s father around, and did he have anything to do with her? The mother knew something was up because she answered every question honestly and without too much expression. It turned out that the mother and the girl lived in a two-bedroom apartment with ten other people. Some of the people who lived there were relatives, like the girl’s grandmother; some were friends of their family; and some were just friends of the friends. The woman’s father had been a junkie and had died of AIDS the year before. The family had all been tested for HIV and the girl’s grandmother had been the only other person who tested positive. But some of the other people living in the apartment were junkies, and they hadn’t been tested. And there were two teenage boys who were cousins of the mother and who had been taken into the apartment when they themselves had been abused by their own parents a few months before. It was a very confusing, chaotic story, but I believed it because it wasn’t all that unusual. I’ve heard lots of stories like this one since I started medical school.