The Intern Blues(82)

That’s how it was for me. I remember the night everything seemed to come together. It was the middle of March and I was working on the general pediatrics ward: the worst night of my internship. Starting in the afternoon, I had admitted patient after patient, each sicker than the last. By the next morning I had trouble remembering them all; there had been at least eight of them, with three sick enough to quality for admission to our hospital’s ICU.

It was at about five-thirty in the morning when it suddenly hit me. The sun was coming up and I was finishing with my third ICU admission, a fourteen-year-old girl who was comatose and near death due to acute inflammation of her brain. She had been sick with chicken pox the week before and had now developed post-varicella encephalitis, a very rare, devastating, and often lethal complication. I had admitted her and done the entire workup by myself, including putting in an IV, drawing the bloodwork that I thought needed to be done, and performing a spinal tap. I had decided on a plan of management and had confirmed that plan with all the appropriate consulting services. And as I sat to do my admission history and physical, with the girl’s vital signs finally stable, after this long and terrible night, I realized all of the sudden that I could actually do this stuff. I could be left without someone looking over my shoulder and the job would get done. And once I came to this conclusion, I knew for the first time all year that I would survive my internship.

But it wasn’t until March that I reached this conclusion. It’s only December now and, although Mark, Andy, and Amy have come a long way, they still have a long way to go.

Mark came to the Christmas party with Carole. They seemed to have fun, but Carole has to have a tough time at events like this: She has to feel like something of an outsider, not being involved in medicine and knowing few of the people. And Mark has to feel a little uneasy, trying to share the experience with his intern pals while at the same time making sure that Carole is enjoying herself. They spent most of the night off to the side by themselves.

Andy didn’t show up at the party until after nine. He had gotten out of the hospital late after a busy night on call, and he had stopped at home to take a shower and change his clothes before coming over. He was wearing a bolo string tie, had his hair slicked back, and was wearing a pair of horn-rimmed glasses that he hadn’t worn since sixth grade. The effect of all of this was that he looked as if he were on his way to a costume party.

Andy immediately joined in with a group of eight other interns who stayed together through the rest of the evening. This group is composed of the interns who had either started the year alone, without “significant others,” or, like Andy, with significant others who lived outside the New York area. These people have supported each other through the first half of the year, and they have formed very tight, close friendships.

The interns in this group have little to worry about. They may not each be feeling great right now, or be extremely happy about the prospects for the rest of the year, but they know they’ve got each other and they know that no matter what happens, the others will be there to help them through any bad times.

At the Christmas party, the house officers traditionally put on a skit. This year, the senior residents presented a little play about what life must have been like in the Jonas Bronck ER back in the “Days of the Giants,” the phrase facetiously used to describe the times when the current attendings were doing their training. The myth about the “Days of the Giants” goes something like this: “Back when we were interns, we worked much harder than they do today. We were on call every other night, and we loved it. And when a tough case was admitted, we fought to be able to take care of that patient. We wanted to impress our chief with how good we were.”

In the skit, senior residents were Alan Cozza, Mike Miller, Alan Morris, and Peter Anderson. They ran around a pretend emergency room trying to prove how macho each was. They got into arguments and ultimately fistfights about who would admit the critically ill patient (played by another senior resident) who was brought in by ambulance.

But the residents also went on to depict what actually occurred once those Giants got those really tough cases: They didn’t know what the hell to do with them. Because the reality of the situation is that back in the “Days of the Giants,” there wasn’t a tenth of the technological advances that are commonplace today. In fact, pretty much all the Giants could really do was fight over the patients; there was very little that could be done to cure many of the problems presented. The skit ended with a very bitter and melancholy song about the life of the residents.