I used to get upset about doing pelvics, but I really don’t care about them that much anymore. They really aren’t so bad as long as you’ve got a kid who isn’t going to be hysterical. That’s about one out of every five kids. I’m not wild about doing the other hysterical four, but one of those will be only semihysterical, and only one of the other three will be completely off the wall. But you really can’t blame them; most of them are twelve years old and they’ve never had a pelvic before, and then they find out they’re pregnant. Uhh, God forbid! Anyway, it happens all the time. And sexual abuse, you know—what can I say?
We had this attending on today who was driving me up a wall! She was so indecisive, I wish I’d never asked her anything! I think she made more trouble for me than anything else. But I kind of liked her, she was really very nice, and she actually gave me a little off-the-cuff talk on pharyngitis that was very good. But every other time I asked her for help, she just wound up making everything very confusing.
I’m getting to the point where I don’t want to bother with the attending, I just want to ask other residents for advice. The attendings usually wind up mucking you up, unless they’re really good, and that isn’t too often. I’m realizing that it’s best just to listen to their advice as a suggestion and then do whatever you want to do. Shit, it’s my name that goes on the bottom of the ER sheet, not theirs! [Although the attending is supposed to be supervising the care of all patients in the ER, the house officer is the one who signs the chart at the completion of the patient’s care.] I’m the one who’s really responsible!
I really can’t complain about anything tonight. First, I got home at a great hour. I mean, I left that emergency room at twelve-thirty. That’s almost unbelievable! And I have the next two days off because Monday is Martin Luther King’s birthday and all the clinics are closed. Hallelujah! What will I do with myself with all this spare time? Sleep, probably.
Sunday, January 19, 1986, 11:30 A.M.
I was just lying in bed here thinking about how no one tells you, really, how to be an intern. They tell you what to do, when to do it, how much to do it with, and how you’re not doing it fast enough, but no one tells you really how to be an intern. For instance, where do you draw the line between your own decisions and those of your superiors? Over the past few months I’ve come to feel comfortable with making decisions; I can deal with a lot of issues on my own now. But when the attending tells you to do something and you don’t think it’s exactly the right thing to do, what are you supposed to do? After all, it’s your name that’s on the paper, not the attending’s. A lot of times it seems like the attendings don’t really fully understand the case, and they make snap decisions with only a half or a three-quarter understanding, and you’re the one who’s supposed to carry out their orders. So what it all comes down to is, you have to decide for yourself. You’re not a medical student anymore, you’re really a doctor, even though you barely know how to function as one. That’s what no one can tell you. It’s something I can barely tell you myself.
The other night I examined a little three-year-old girl who came in with a vaginal discharge. The history wasn’t suspicious at all, and there were only a couple of very, very subtle things on the physical exam aside from the vaginal discharge, but the first thing you’re supposed to think of in a case like that is sexual abuse. And that’s exactly what went through my mind.
But I found myself getting talked out of reporting the case to the BCW because it wasn’t all that clear-cut. The attending argued that the discharge could have been caused by something other than sexual abuse. I had to agree. And I felt really pressured by the attending and the social worker, people who have had years and years more experience than I, just to let it pass, to sign it out as nonspecific vaginitis rather than sexual abuse. We talked about it for a long time, and they told me to think about what reporting it would do to the family; the child would be removed and placed in a foster home. The parents would be labeled as criminals, whether anything really happened or not. It might be years before these people’s lives would return to normal. And with all that pressure, I decided to go along with them.
Now I’m regretting it. I’ve been thinking about this kid ever since. The attending told me to be sure to follow the girl carefully. But let’s say this was a case of abuse: What if they don’t come back for their follow-up appointment? What can I do then? And, of course, I called the bacteriology lab at Jonas Bronck today and was told that they have no record of receiving the GC [GC: gonococcus, the bacteria that cause gonorrhea] cultures. Great! I’ll keep looking for them; I’m sure they’ll turn up sooner or later. I hope to God the messenger didn’t throw them down the elevator shaft or something like that. But if they don’t show up and we never find the cultures, what can I do? And what’ll happen if this girl comes back dead next week because whoever molested her decides to whack her over the head with a hammer? It’ll be my fault, because I listened to the attending and the social worker rather than doing what I thought was the right thing.