Yesterday was busy, too, but it wasn’t nearly as bad as Friday. Yesterday’s specialty was trauma. We had all kinds of trauma, kids falling out of windows onto their heads, firecrackers blowing off fingers, and the basic foot laceration from Orchard Beach [a beach on Long Island Sound]. Since I still haven’t learned how to suture, I spent most of the day seeing kids with head trauma. Most of them were okay; I just examined them, found nothing wrong, and sent them home with a head trauma sheet [the emergency room provides instruction sheets in English and Spanish covering most of the common pediatric problems]. At about 3:00 A.M. we had finally cleared out the triage box and I picked up one of the last charts, a six-year-old who had hit his head on a coffee table. The nurse who had seen him when the mother first registered at about eleven thought he looked all right and put him at the bottom of the pile. [The nurses triage each patient according to his or her symptoms: Patients who require real emergency care are “up-triaged” and their charts are placed near the top of the pile; patients who are judged to be stable are triaged to the bottom of the pile. On exceptionally busy days, the wait to be seen by a physician may be as long as six hours.]
The mother told me the boy was running around the apartment and had fallen and hit the back of his head on the coffee table. He hadn’t blacked out but had become very sleepy. I examined him: He was sleepy, but then again, so was I. There were no focal findings. [A focal neurologic exam, one in which there is weakness, paralysis, or abnormal reflexes on one side of the body, indicates a neurologic deficit. A negative neurologic exam following head trauma is a fairly good indication that the brain hasn’t been harmed.] The senior resident told me it was okay to send the kid home, but when I went to give the mother a head trauma sheet, the kid suddenly couldn’t remember anything that had happened over the past few hours. So the senior told me to check the kid out with the neuro fellow [the pediatric neurology department trains a group of fellows, individuals who have completed two years of residency and have gone on to do another three years in neurology]. It took him twenty minutes to answer his page, and when he did and I told him the story, he told me he had to check with his attending [the senior doctor on call for neurology that night] before deciding what to do.
It took him another forty minutes to get in touch with the attending! There I was in the ER in the middle of the night with nothing to do but wait. I could have been home sleeping! But I couldn’t sign this out to the night float. I had to stay.
When he finally called back, he said the kid needed a CT [CT scan: a computerized X ray of the brain] and that he had to be admitted. I had to bring him up to the fourth floor and help the technician get him settled on the CT table. Finally, the intern from the ward showed up and I got out of there. I didn’t get home until four-thirty. If I hadn’t picked up that last chart, I would have gotten about two hours’ more sleep.
Thursday was July 4 and I had the day off. It was great: just me and Larry and Sarah. We went swimming in the pool at our apartment complex; Sarah seems to love the water. It was like getting reacquainted.
I had another run-in with Marie on Friday. I’m still having trouble with her. Even though we had a talk, she still carries Sarah around all the time and feeds her every two hours, as soon as she opens her mouth and lets out a peep. We got into a fight last Monday. I came home for lunch after clinic ended at about eleven-thirty. When I came into the apartment, Marie was holding the baby. I tried to take Sarah, but Marie wouldn’t let go of her. I just about had to pry them apart. I said a few things I probably shouldn’t have said. I don’t know what’s going to happen with her.
I think having a baby at home is making me into a more efficient intern. I find myself trying to get my work done as quickly as possible and running home. Sarah gives me a lot of motivation to work fast.
Friday, July 12, 1985
I feel bad talking about this, but I think I should anyway. Maybe it’ll make me feel better to get it off my chest; I don’t know. I feel terrible and it isn’t my fault, it just isn’t my fault. I did what I was supposed to do, that’s all I know, and somehow I got into trouble.
Last week, this adolescent girl came in complaining of rectal bleeding. I recognized her from my subinternship [a two-month rotation in the fourth year of a medical student in which the student works as an intern, taking night call and admitting and following patients]. She was on the ward for some psych problem, I don’t remember exactly what. I examined her and did a rectal exam; I didn’t find anything wrong, and the stuff I smeared from the glove onto the guaiac card was negative [the guaiac test is for hidden blood in the stool]. So I thought she was a crock [a patient who has nothing wrong and is faking symptoms; short for a “crock of shit”; sometimes referred to as a “turkey”]. I presented her case to Tom Kelly, who was the attending, and I told him . . . I told him . . . I’m sorry, I have to stop for a minute and pull myself together. Crying is not the answer.