The Intern Blues(94)

Even dealing with the ER staff was easier in January. I really felt like I was getting along well with the nurses for a change. When I had worked in the ER last there was this one nurse named Eve whom I didn’t like at all. One day during my first month there I just said to her, “I’ve had it with you! I’m not going to ask you for any help anymore. All you ever do is give me a hard time! As far as I’m concerned, you’re not even here! I’m not talking to you anymore!” And she said, “Fine.” So we left on horrendous terms. She was in a really bad mood because she was going to be quitting at the end of November and at that point she hated being in the Jonas Bronck ER. And then one day I was seeing a patient in my clinic at Mount Scopus and I walked out of the examining room and there she was, there was Eve, whom everybody else loved and I hated. We were standing there, staring at each other eye to eye, and she kind of looked afraid. It was a strange thing; I had never seen Eve like that, she’d always been so nasty and aggressive. She had an almost scared look on her face. And I kind of just laughed and walked past her and said, “Oh, you’re here!” And she said, “Yeah, I’m working here now, I’m one of the nurses here.” And we both laughed, and she said, “Don’t worry, I’m not going to be such a bitch because I don’t know what I’m doing yet.”

Things still weren’t exactly great. But then, the next time I saw her, we talked for a little while and then we went out to lunch and now we’ve become friends. She’s really a good nurse, she’s fast and efficient, and she’s funny. Now I even like her.

I should mention one patient I had in neurology clinic. He was a seventeen-year-old autistic, severely mentally retarded, violent guy who had been sent over from Bronx Developmental Center [a residential facility for moderately and severely developmentally disabled children and adults] for evaluation because he was becoming increasingly depressed and had been losing weight. He was on all kinds of phenothiazines [a class of tranquilizers], but nothing was helping. I brought him into the examining room with the health care worker who had come with him. While I was looking through his old chart, he suddenly started to become extremely agitated. He got up and began stomping his feet on the ground and then he started slamming his head into the green tile wall over and over again. I looked over and realized there was blood on the wall, and there was blood coming out of his mouth. He had actually knocked a couple of teeth loose!

Then he started going completely wild; he attacked the health care worker and turned around and slugged me in the ribs a couple of times. Then he went and smashed his face against the wall again. The health care worker, a large, matronly black woman, grabbed him and tried to hold him still. All this time, he was screaming and making unintelligible grunting noises. Pretty soon he began flailing around, and the health care worker, who was getting kind of panicked, looked over and said, “He doesn’t like to be in tight spaces. We need to get him out of here!”

I thought I had been very calm up until that moment. I opened the door, walked out, and everybody was looking toward the door because there had been a lot of ruckus in my room. I said, “I have a problem here.” We got the kid out of the room and into the hallway, where apparently he didn’t feel so enclosed, and we called security and I sat down with the neurology attending to whom this guy had been referred and said, “Why did you put me in that room with him? You knew exactly what was going to happen.” And she made some comment like, “Well, you have to learn to take care of these kinds of patients,” and I thought, No, I don’t. As a resident, I don’t have to take care of severely disturbed, autistic, retarded, violent patients who’ve been referred to a specific doctor for evaluation. In fact, the neurologist didn’t want anything to do with him either. She finally said, “You know, we just can’t evaluate him.” So we sent him back with a letter saying sorry, there’s nothing we can do. It was too bad, but we had nothing to offer.

I’ve thought about that patient a few times since this happened. I’m wondering how I would have reacted to the whole thing if this had happened back in July instead of in January. I think in July I would have tried a little harder, maybe looked farther through the chart or pushed the attending a little more. I don’t know, the kid was crazy, he was dangerous, but when I was in OPD last July, I did some things for patients I don’t think I’d do now: I stayed late to finish the workups on patients, things like that. I don’t know if that’s bad; it’s just that it’s a real change in me.