This feeling I have, that I have to start making up my own mind and not relying on other people, it’s really something that can’t be taught beforehand. I’m just realizing it myself, and I’ve been doing this for six months now.
I got on the elevator in the DTC building [the clinic building at Mount Scopus] the other day and the elevator stopped at one of the adult floors. This middle-aged man came on with these two middle-aged women, and he said something like, “All they see when they look at you is dollar signs.” Then he said, “Look at their mistakes. They fill the graveyard. They don’t give a damn. All they care about is money. I don’t trust doctors one damn bit anymore.” This guy was standing three inches from me! And I was really biting my tongue. I felt like saying, “Look, there are some bad apples out there who suck, who are only in it for money, and who don’t give a shit about people. But most of us really do care about our patients.”
I don’t know, I find myself feeling defensive about organized medicine and at the same time being more disillusioned about it than ever. I do look at the mistakes that are made and the horrible outcomes that result, and yes, our mistakes do end up in the graveyard, but they dot them, they don’t fill them.
Well, I’ve gotten a little off the subject. Anyway, I don’t think there’s any way that people can be taught about what it’s like to be in the uncomfortable position of having to start to use their own mind but having very little to base decisions on. There’s just no way anybody could have prepared us for this transition from the little puppy dogs who do everything the attending tells us to independent doctors who wind up being very uncomfortable with some of the decisions we have to make. I’m constantly feeling as if I’ve got a green belt in karate, that I know enough to kick someone but I might break my own foot doing it.
Amy
JANUARY 1986
Friday, December 27, 1985
It snowed yesterday for the first time this winter. Sarah’s amazed. We took her out in her stroller a little while ago and she kept looking down at the ground and looking up at Larry and me as if to say, “Where did all the grass go?” It’s funny to watch.
I’ve been in the nursery at Jonas Bronck for a few days now. So far it’s been a mixed experience. I’m assigned to the well-baby nursery, which is nice. I spend most of my time examining newborns and talking to their mothers. That’s what I really liked about pediatrics in the first place, and it’s nice to have the chance to do it without all the other nonsense that usually takes up our days. So that part of it is good. What I don’t like, though, is that my night call is in the neonatal ICU. It’s frightening in there! And it’s harder for me than for the other interns because, since I’m only in the NICU at night, I don’t know the sick ones very well. All I know about them is what the interns sign out to me, and it’s impossible to get a really complete sign-out on a patient who has a hundred different problems. So that’s frightening to me, but what can I do? It could be worse; I could have to spend all my time in the ICU.
Another bad part about working in the well-baby nursery is that we’re always on call to the delivery room. If there’s a premature baby being born or a baby who’s in distress, the resident and I get called to come to the delivery. It’s not really that bad, though, because during the day there’s usually a fellow [neonatal fellow, a physician who has completed a pediatric residency and is getting specialty training in neonatology] or an attending around, and one of them usually comes in with us. If they weren’t there, it would be terrifying!
I have to admit, I’ve been lucky with my schedule over the past couple of months. I’ve worked with very good residents and I haven’t been on the hard wards or had a lot of bad patients. I guess I should say that I finished on Children’s last week and Angela [the young girl with neurofibromatosis] was still alive. I heard she got worse the day after I left, though. She had another very long seizure and they had trouble stopping it, so they transferred her up to the ICU. They had to anesthetize her to get the seizure to stop [general anesthesia is used as a last-ditch effort to stop intractable seizures only after every other treatment modality has failed]. The intern who picked up my patients told me they don’t expect her to survive much longer, only another few days at most. It’s really sad; one month ago, she was a completely normal child. Now she’s almost dead. That’s not supposed to happen to children.
I was on call Wednesday, Christmas Day. It wasn’t so bad, since we don’t celebrate Christmas, but it was like working an extra weekend day. The hospital was completely dead, even deader than most Sundays. But babies don’t know anything about holidays; they crump whenever they feel like it. I did get a couple of hours of sleep that night and I guess I should be thankful for that, but I can see that night call during this month is going to be terrible.