I’ve had this whole weekend off and in some ways it felt like my vacation actually started yesterday. I’ll be on call tomorrow and then I leave on Tuesday morning. I’m tempted to wear a big button to work tomorrow that says, “THEY CAN’T HURT ME NOW!” I’ve told several people that no one’s died on me yet this month, and everyone’s said the same thing: “Don’t be so smug. You still have one more night!” But I feel somewhat confident that I’ll make it unscathed off this ward and that I’ll always have fond memories of general pediatrics when it’s provided in a place like Jonas Bronck, surrounded by lots of smart, nice people in a great environment without disasters.
Well, that’s not exactly true; I did have one near disaster, a kid with asthma who I was supposed to admit to the ward but who wound up going to the ICU on an Isuprel drip [Isuprel drip: a continuous IV infusion of isoproterenol, a drug used in cases of asthma when there is danger of respiratory failure]. I was the one who started that Isuprel drip. I didn’t know how to do that before. Hey! I now know how to do an Isuprel drip! Now I pretty much know everything.
We’re going to New Orleans this vacation, I just found out yesterday. I got home post-call, turned on my answering machine, and there was a message from my brother saying he and his wife and Karen all decided it would be great fun to go to New Orleans and they asked if I wanted to do it and I said sure. I’d go anywhere. Just to get the hell out of the damn Bronx!
I know this sounds weird, but a lot of people I talk to say I’m the most enthusiastic person about the program. Isn’t that ironic? Here I am, I’ve been depressed for months, and now I’ve even decided to leave at the end of the year, and I’m the most enthusiastic of the interns! But it’s true, I have been in a good mood for the past month, and I’ve started to wonder why. I think it had a lot to do with two things: first, being on 8 East, which was really great; and second, knowing I’ve finally got this vacation coming up. I survived, I’ve made it through six long months! I’ve reached the halfway point.
I feel like I’ve gotten a lot out of this first half of the year. I think I’ve learned a lot. I don’t know how I’ll compare with those second years at Children’s when I start out there next year. Will they be way ahead of me? Will they know a lot more, having been in that highly academic environment for their internships? Will my vast ability to do scut really pay off at all? Will it matter? I don’t know.
Will my learned ability to manipulate the ancillary personnel to get patient care done quickly and efficiently make any difference in a place where the ancillary services are actually good? I mean, I’ve gotten good at working through this system, I’ve finally learned how to get things done fast. I’ve just watched how the third years do it and I’ve figured out you either stretch the truth or you simply lie outright. You have to make everything seem like an incredible emergency or people will ignore you. You tell the elevator operator that you need an elevator right away or else the patient’s going to die. And they’ll do it! That elevator will be there in a second. It’s too bad, but it’s just the way it is here, it’s just a game you have to play if you want to get things done or you want to take proper care of your patients. You have to lie; they just don’t give a shit any way else.
I’m learning to be efficient and how to be smart. Friday night on call was pretty quiet, I didn’t have a bad night, I only got two admissions; one was a FIB, the other a UTI [urinary tract infection]. I even got a couple of hours of sleep. So on Saturday morning when I was postcall, instead of going right home, I sat down and wrote four of my off-service notes on my chronic patients. I put them in my clipboard, I’ll bring them back tomorrow, date them, then I’ll stick them in the chart, and I’ll be done with them. The fact of the matter is, I’ve got to get out of there Tuesday morning and catch a plane, and I want to be able to bolt at early as I can.
The UTI I admitted was kind of interesting. It was a one-month-old who came up as a FIB. Of course, no one in the ER had done a sed rate [erythrocyte sedimentation rate—the rate at which red blood cells settle when left to stand in a capillary tube; an elevated sed rate is a sign of inflammation and therefore an indication of infection] or a UA [urinalysis]; thanks a lot. It’s always the second and the third years who send them in unworked up. So I basically did the whole admission by myself. Pat kind of danced in for a minute, copied down the history I took, poked and prodded the kid, then went back to sleep, and I finished the rest of the workup. I actually got one of the night-shift nurses to hold the kid while I drew the blood and did the suprapubic [bladder tap], and there they were on the unspun urine, sheets of polys [polys: polymorphonuclear leukocytes, white blood cells that flock to the site of a bacterial infection] and gram-negative rods [the microscopic appearance of E. coli]. So I decided what to do: I wrote the orders to start the antibiotics, went in, woke up Pat, and said, “Pat, this kid’s got a UTI and I’m starting her on ampicillin and Cephotaxime [two types of antibiotics], a hundred per kilo of both. How’s that sound?” He mumbled something like, “Huh? Fine,” and went back to sleep. In the morning he said he was very impressed with the gram stain. I had done the right things. So how do you like that? I can now manage unbelievably simple problems all by myself!