The Intern Blues(79)
Take this afternoon, for instance. I was on call last night so I wasn’t supposed to get any admissions today, but there were a lot of electives scheduled and the other intern was at clinic, so they asked me to take a kid who came in at about three. Her only problem was an ASD [atrial septal defect, a “hole” in the structure that separates the right and the left atria], and she was coming in for a cardiac cath. [This is a test in which a catheter is passed through a blood vessel in the thigh and fed up to the heart. In pediatrics, cardiac caths usually are done on children with ASDs and other congenital malformations of the heart to better define the anatomy in preparation for surgical repair.] A pretty straightforward case, right? Sure, until I started taking the damn social history. I made the mistake of asking her if she was sexually active, and she said she was. (At least she didn’t say, “No, I just sort of lie there.” Someone once told me they actually had a patient who said that.) Then I asked if she used any form of contraception and she said she didn’t. So I asked if she wanted to be pregnant and she said no, and I started to go into my “If you don’t want to be pregnant, you have to use contraception” speech, but she interrupted me and said that she knew about that, and in fact, every time she does get pregnant, she just has an abortion. “In fact,” she said, “I had one just last month and, now that you mention it, ever since, I’ve had this smelly, white discharge. Do you think it might be serious?”
That’s when I realized that even this, even this simple, straightforward cardiac cath admission, was going to require a pelvic exam and that even though I was post-call and exhausted, I was going to have to stay late and do it myself. But what could I do? You can’t put something like that off; if she’s got PID, we’d have to cancel the cath and start her on antibiotics. And a pelvic exam isn’t something you can sign out to the person on call: “Oh, yeah, the cardiac cath I admitted needs to have her pre-op bloods checked, and I think she might have PID. So would you do a pelvic exam?” I don’t think that’d go over real well, although I’m sure some of my co-interns have tried to pull stuff like that.
Anyway, I did the pelvic and it turned out she didn’t have PID, just some nonspecific vagitch [internese for vaginitis, an acute inflammation of the vagina], and that wasn’t going to keep her from having her cath. But it did keep me from getting home until after seven. I missed going to my grandmother’s for Tuesday night dinner. And now I’m so tired, all I can think about doing is going to bed.
You know, all these pelvic exams reminded me of something. When you’re in college and medical school, you read all these books like House of God where the interns are spending half their lives in bed with the nurses, the social workers, and all the other females who populate the hospital. By the time I started this damn internship I knew those kind of things didn’t really happen, but I did expect to continue to have at least some semblance of a sex life. But this week, spending so much time in the gynecology room doing pelvics diagnosing PID, I actually realized I have less interest in sex now than I ever remember having! It’s scary. All I care about is getting to sleep. This might be the reason Carole hasn’t been spending too much time with me over the past few weeks. I hope this is reversible.
Well, I’m going to sleep now. I’ve got to get my eight hours every other day or so.
Tuesday, December 10, 1985
I am furious! I can’t believe they’re doing this to me! I tried to be nice to them, to do them a favor when they needed it, and they wind up screwing me, screwing me in return! I just might kill the chief residents, all four of them. I know I’ve said that before, but this time I’m serious! I think I’ll spend the next few hours figuring out exactly how I’m going to do it. Yeah, that might calm me down a little. I just can’t believe they’re really doing this to me!
It all started this afternoon. I was sitting around the nurses’ station on Adolescent, saying how I couldn’t wait for the month to be over because next month I’m scheduled to be on Children’s and I love Children’s. And Arlene, one of the chief residents, said, “Oh, haven’t you heard? We had to pull you from Children’s next month and put you on 6A.” She said that, after all, I had already done July on Children’s and that there were some interns who were never scheduled to work there and it wouldn’t be fair if I wound up doing two months and other people wound up doing none. I very calmly reminded her that I had only done a month on Children’s because the chief residents needed someone to fill in when one of the subinterns didn’t show up and they had promised that if I did them the favor, they wouldn’t pull me from my regularly scheduled month. Arlene said she hadn’t heard anything about that; all she knew was, I would have to spend the month on 6A. I should have pulled her head off right there while I had the chance.