There aren’t a lot of patients on the ward right now, and most of the ones who are there are just post-op cleft lips and palates [Mount Scopus has a large craniofacial center]. We do have a couple of fairly sick patients, and one of them is mine. She’s a really sad case: She’s a ten-year-old with neurofibromatosis. [This is an inherited disorder in which, for reasons that are not yet clear, the affected individual may develop dark pigmented spots and a variety of tumors of the skin, optic nerve, the brain, and other internal organs. Most people with neurofibromatosis live a normal life; some are severely deformed.] She was perfectly well until last week, when she started having trouble urinating. Her mother brought her to the ER last Tuesday and they did a KUB [X ray of the abdomen; called KUB for kidneys, ureters, and bladder] and found she had a big mass in her pelvis. Then they did a chest X ray and found another tumor in her lung. She was admitted to Children’s, and on Thursday she had a CT scan that showed she also had a brain tumor. They’re taking her to the OR tomorrow to biopsy the pelvic and the lung tumors, but the oncologists don’t think she’s going to do very well. It’s too bad, too; she seems like she could have been a nice, normal girl.
Wednesday, December 4, 1985
It’s getting cold. It’s really turning into winter, and I don’t know if I’m ready for that to happen yet. I guess I’m kind of depressed and the weather isn’t helping things any.
Things on the ward are getting worse. This morning a little girl with sickle-cell disease died while we were on work rounds. She had been admitted a few hours before with what looked like pneumonia. Harrison had brought her up from the emergency room, started her on antibiotics, put her on oxygen, and went on with the rest of his work. At about eight-fifteen, while we were on work rounds, the girl’s mother came up to us and said her daughter was breathing funny. We ran into the room and watched as she arrested. We called a code, and people started flying into the room from all over the place. We worked on her for over an hour, but we never got her pulse back. Her mother was hysterical. It was completely unexpected. After it was over, Harrison locked himself into the on-call room and wouldn’t come out. It was terrible. And we still have no idea what happened or why it happened.
On Monday I admitted six new patients, which is busy for Children’s. Most of them were pre-ops for Tuesday, but they still needed to be worked up and have bloods drawn and all the rest of the endless scut that goes with an admission. I tried to get my student to help, but she simply refused. I don’t know what it is with these medical students; when I was doing my clerkships, I’d sooner jump out a window than tell my intern I wasn’t going to do the things he or she asked.
Angela, that girl with neurofibromatosis, is not doing well at all. She went to the OR on Monday to have her tumors biopsied. They turned out to be different types of malignancies, which is very unusual. It’s also terrible in terms of her prognosis. She spent Monday night in the ICU and then came down to the ward again on Tuesday. The oncologists are talking about what they’re going to do with her, it looks like she’s going to need both chemo and radiation, but they have to decide which order to do them in and when to start. Nobody’s said anything to Angela yet. I think she knows, though. She’s pretty smart and she seems very sad.
I went to talk to Mike Miller today about next year. I went up to his office, and when he saw me standing there, he said, “Amy, what’s wrong?” I guess my face told him I was upset. I went into his office and we closed the door and I started telling him everything that had been happening, and about five minutes into it I started crying and I just couldn’t stop. He held my hand and tried to calm me down, but I just couldn’t stop crying. I cried for fifteen, twenty minutes. I knew he was starting to get bored with me so I tried hard to control myself and finally I stopped. I told him I wasn’t sure whether I wanted to come back next year. He told me he understood and that whatever I wanted to do would be okay but that I had to sit down and give it some serious thought, taking everything into account before making up my mind. He said he’d hold off submitting my name for reappointment for another few days but I should try to get back to him by sometime next week. Then I left and went back to the ward.
That’s the first time that ever happened to me. I’m not a crier. The last time I remember crying is when my mother died. This isn’t nearly as bad as that was, so I’m kind of surprised. I don’t know, maybe it’s because I’m so tired, or because working in the Bronx is so depressing, or maybe it’s because I miss Sarah so much and I know I’m missing so much of her infancy. All I know is, if the rest of internship is going to be like this, I’m never going to make it.