The Intern Blues

by Robert Marion

  Mark

  NOVEMBER 1985

  Friday, November 1, 1985

  Yesterday was Halloween. I was on last night in the Jonas Bronck ER, and I learned an important lesson: If you want people to trust you, it’s probably not a good idea to dress up like Bozo the Clown. I know that because I did dress up like Bozo the Clown yesterday and none of the parents of my patients wanted to have anything to do with me. I guess I can’t really blame them; it’s one thing to come to the ER and wait four hours to be seen by a competent, or at least a semicompetent, doctor. It’s another thing to wait four hours and finally get called in to find out your kid’s going to be treated by Bozo the Clown.

  But, hey, it was Halloween, and we’re supposed to be taking care of kids, aren’t we? We all decided the day before to come in dressed in costumes. Peter Carson, who’s about six feet three and weighs at least 250 pounds, came dressed as a ballerina, the chief residents were dressed as killer bees, Terry Tanner (a junior resident) was dressed as a witch, and I was Bozo the Clown. The kids seemed to like it even though their parents weren’t ecstatic about it. And everything would have been fine if I hadn’t had to tell a mother that her kid was dead.

  It was about eight o’clock, right in the middle of the busiest time of the evening, of course. All bad things seem to happen when we’re really busy. We got a call from the EMS [Emergency Medical Service] saying they were bringing in a traumatic arrest [a patient who, as a result of some accident, was not breathing and whose heart was not beating]. So Bozo the Clown; the six-foot, three-inch prima ballerina; the witch; and one of the killer bees stood around the trauma area waiting for the disaster to show up. It took maybe two minutes and they brought in this eight-year-old. He had run out into the street and had gotten flattened by a van. The van then stopped and the kid got pinned under the back wheels. They started CPR out on the street, but you could tell it wasn’t doing him much good. He was pulseless and breathless, and when they hooked him up to a monitor, he was flatline [he had no electrical activity in his heart].

  We knew it was probably going to be pretty hopeless, but we started doing everything anyway. The chief intubated him, Peter started pumping his chest, and Terry and I tried to get lines [IVs] into him. I somehow got one in his right arm, which was a miracle in itself, and we started pushing bicarb [sodium bicarbonate, to reverse the buildup of acid in the blood] and epi [epinephrine, in an attempt to get the heart to start beating again], but nothing happened. Then the surgeons came by and offered to crack the kid’s chest for us [perform an emergency thoracotomy, an operation in which the chest is opened so that the heart can be directly massaged]. Hey, when five surgeons walk up to you with scalpels in their hands and say they’d like to crack a patient’s chest, it’s hard to say no. So the kid got his chest cracked and they found that he had a bronchopleural fistula. [The impact of the van had caused the left main stem bronchus, the main windpipe to the left lung, to tear in half. Oxygen that was being forced into the boy’s windpipe was ending up in the pleural space outside the lung, causing an ever-worsening tension pneumothorax.] It was about then that we realized that this code was pretty much over.

  I walked out of the trauma area, and the boy’s mother was standing there less than ten feet away. She was literally being held up by one of the nurses. She said, “Doctor, how is he? Is he going to be okay?” I didn’t see any way out; I was too upset to come up with a lie. So that’s when I, wearing my Bozo wig; my Bozo makeup; my Bozo shoes; and my Bozo suit, which was now covered with blood, told the woman that her son had died.

  She went crazy. She started crying and she fell down on the floor. I felt like a total idiot standing there dressed like that, and there was nothing I could do to change anything. One of the hospital administrators, the guy we call the administrator-in-charge-of-patients-dying because he always seems to show up when this kind of thing happens, came, and he, the nurse, and I lifted the mother up off the floor. The administrator led the woman out of the ER. I don’t know where they went, but before seeing the next patient, I changed my clothes and took off the stupid makeup. I don’t think I’ll wear that costume again. The bloodstains kind of take all the fun out of it. And next year, if I’m on call on Halloween again, I don’t think I’m going to dress up.

  Tuesday, November 5, 1985, 10:00 P.M.

  I’m feeling much better today. Sure, a weekend off, that’s just what I needed. It gave Carole and me two whole days to fight about whether we should get married. It was a whole lot of fun. At least she didn’t make me wear my Bozo costume while we argued.

  I really don’t know what to do about this. I don’t want to get married during my internship. Can you imagine that? Falling asleep standing up right in the middle of the ceremony. And then the wedding night! Yes, the wedding night must be a memorable event for the intern’s spouse. Eight continuous hours of snoring. Seriously, being married is hard enough when you lead a relatively normal life. I don’t think it’d be possible for us to survive if we got married while I was doing this. But Carole thinks we should do it. She says if we got married, she’d be able to take better care of me for the rest of the year. I think I’ll eventually wind up marrying Carole. We get along very well and we basically want the same things out of life. I just can’t do it yet. I think I’ll be able to think a little more clearly after this is over, but that’s not for seven months yet. Well, what can I do? I’ll just try to hold her off as long as possible.

  And then, after that fabulous weekend, I got to be on call again last night in the Jonas Bronck emergency room. And what a night it was! We were five hours behind the whole time. We had two security guards stationed at the doors to protect us. Every five minutes, another angry customer would appear and want to know why his or her precious little child who had been sneezing for three days hadn’t been seen yet. And what interesting patients I had to take care of! I got this four-day-old who, through some sort of screwup in our world-renowned Social Service Department, wound up getting discharged from the nursery with his psychotic mother who also happened to be a crackhead. Usually when a baby’s born to a crackhead mother, Social Services picks up their hot line and gets a BCW hold slapped on the kid so that the baby can be kept in the hospital while the BCW figures out what to do with him. We usually have to keep them longer than three days anyway because the kids usually have withdrawal symptoms and need to be treated. But somehow Social Services missed the boat and sent him home early.

  When the nursery’s social worker realized the kid had been discharged, she called the cops and had them find the kid and bring him back. The cops did a great job: They went out and scooped up the baby, the mother, and, lucky for us, the father and brought them all in. Of course, they didn’t mention to them what was going on. So not only did we have two psychotic crackheads roaming around the ER, we also had two psychotic crackheads who were paranoid and had no idea what was going on, which is a wonderful combination.

  Well, it didn’t take long for them to figure it all out. Once they woke up to the fact that we were planning to admit the kid and slap a BCW hold on him and that their chance of ever getting him back again was about the same as my chance of being elected president of the United States, they let their best qualities come to the surface. The father picked up the baby like he was a football and started to move toward the exit. The city cops, who were still hanging around, knew the mistake had been the hospital’s and not the parents’. They also knew that the parents hadn’t done anything wrong, at least not at that exact moment, and so they didn’t try to stop them. The cops left, and that’s when the hospital security guards stepped in. They caught the guy, brought him back, put them all in a room, and watched them for the rest of the night, but they weren’t exactly happy to do it. They acted as if they had better things to do than baby-sit for a couple of ranting junkies.

  I tried my hand at talking the parents down. I told them that putting the baby in the hospital was the best thing for him, that if he was hooked we could give him medic
ation to make him better and slowly wean him off. It sounded great to me, but of course the parents, who were pretty crazed, didn’t buy it. Then the social worker showed up and she talked to them for about a half hour. Obviously she made just as great an impact on them as I did, because when they came out, the mother was still holding on to the baby. We didn’t know what to do next, so we had a priest come down and talk to them, we had some friend of the family’s who had shown up talk to them, but nothing seemed to do any good. Finally, after about five hours of this nonsense, the mother said she had to get home right away because she needed something to steady her nerves. She handed the baby over to the social worker and she and the father kind of ran for the door. So we got the baby back. Her fix was more important than the baby in the long run.

  We got out this morning at four-thirty. I didn’t get home until after five, and I fell right to sleep. I didn’t even get out of my clothes. I had two and a half hours of sleep. But it was quality sleep, so that makes a big difference. Yeah, right! And when I woke up, I was still wearing my smelly, dirty clothes. What a wonderful experience this internship is!

  At least I got to go to my grandmother’s for dinner tonight. My grandmother’s good, she’s doing fine. I’m sure she thinks I’ve lost my mind or something because I can’t keep up even boring conversations with her and I keep falling asleep every five minutes. But she doesn’t say anything. She just keeps the food coming.

  I’m going to sleep now. Maybe when I wake up, I’ll realize this has all been a dream.

  Monday, November 11, 1985

  I’m suddenly not feeling very well. I think I’m coming down with something. I’ve had this stomach ache and a sore throat since this morning. I have the chills, too, so I probably have a fever. I can’t understand why I’m getting sick. After all, all I do is hang around an emergency room, working twenty-hour shifts, seeing sick children who sneeze on me, cough on me, pee on me, shit on me, and vomit on me. What possible means would I have of getting sick?

  My mother came to visit on Saturday. She walked into my apartment, took one look, and said something like, “Oh, dear, I hadn’t heard anything about a nuclear attack in this part of the Bronx.” (I get my sense of humor from my mother’s side of the family.) I have to admit, I have kind of neglected the housework over the past few months. So my mother rolled up her sleeves, got to work, and spent the next six hours cleaning up my apartment. I had all sorts of great things planned; I was going to take her to lunch at the Jonas Bronck coffee shop. I figured she’d love those mock-turkey sandwiches. Oh, what the hell! We did go out for dinner at a nice Italian restaurant. It was nice to see her. And now I can be sick in a nice, clean apartment.

  I took some Tylenol, but it hasn’t done any good. I think I’m really sick.

  Wednesday, November 13, 1985, 9:00 P.M.

  I’m dying. I didn’t expect it to be one of the patients who would finally get me, and I never thought they’d use germ warfare. But there it was, the most virulent GI [gastrointestinal] bug ever to exist, and now I’m sure it’s only a matter of time.

  I fell asleep Monday night at about seven. I wasn’t feeling well Tuesday, but I made it to work and somehow I made it through the day. I took my temperature in the ER at about one in the afternoon. It was over a hundred. But hey, I’m an intern, and interns can do anything, including working a full fourteen-hour day when they’re sick. I came home yesterday and fell asleep right away. I slept until 11 P.M., and when I woke up, I had the worst cramps in the history of the human race. I ran to the bathroom and stayed there for the next four hours. I got back into bed sometime after three and I fell asleep for a while. Then I woke up with worse cramps than before and tried to get up to run to the bathroom. My brain was strongly in favor of the idea but my body just wouldn’t budge. I managed to crawl out of bed and make it to the bathroom just in time and I fell asleep in there until my alarm went off at seven-thirty. I still could barely move. At that point, something told me that I probably wasn’t going to be able to make it to work.

  I called Jon Golden [one of the chief residents] and told him what was going on. I told him I was on call and that I probably wouldn’t be able to make it in. Calling in sick on the day you’re on call is the biggest sin an intern can commit. But what could I do? I couldn’t even walk! Jon told me not to worry, just to try to get well and make it back tomorrow.

  I got into bed and fell asleep, but Elizabeth woke me up at about ten. She’s on the Jonas Bronck wards this month. She’d heard I was sick and wanted to know if I was making it up just to cash in on some sympathy. I guess when she heard my voice, she realized I was serious. She asked if there was anything I needed; I asked for cyanide. She said she’d see what she could do. She asked if I thought I was dehydrated and I said I was easily about 10 percent dry. [The main complication of gastroenteritis is dehydration. Five percent dehydration is enough to require hospitalization; 10 percent is serious, and 15 percent may lead to shock.] She said I should come in and let her start an IV. I told her I hated pain, and knowing her technical skills, I would never allow her anywhere near me with a needle in her hand. She thanked me for the vote of confidence and said I must be feeling better to be making jokes. I said, “Who’s making jokes?”

  I am actually feeling better tonight, but I still fall down every time I try to get out of bed, and I don’t think that’s normal. I feel guilty about not going to work. I know the other people on call tonight are probably working their butts off and cursing me every chance they get. But what can I do?

  This is such a screwed-up job. In what other profession would you actually feel guilty calling in sick when you really are sick? Lawyers get sick and take a week off, schoolteachers take days off like it’s coming to them, which it is. It’s only us interns and residents who feel guilty about it.

  Sunday, November 17, 1985

  I’m feeling 100 percent better. Well, maybe not 100 percent, maybe only 80 percent, but I’m feeling well enough today to go into the city with Carole to see a movie. I don’t know what we’re going to see yet, and it doesn’t really matter. The only thing I care about is that the theater has seats comfortable enough for me to fall asleep in. Of course, after last night, a chair with spikes coming out of it would be comfortable enough for me to fall asleep in.

  I won’t say last night was bad but at about two o’clock there were still about ten charts in the box, and Peter Carson and I were seeing patients in the asthma room. Peter’s kid was a really cute three-year-old girl. She was sitting there alone because her mother was out registering her and she was scared. But very shyly, she asked Peter if he was a doctor. “Yup,” Peter said.

  “And you don’t ever go to sleep?” the girl asked.

  “Nope,” Peter answered.

  “Never?” the kid asked, amazed.

  “Never,” Peter answered. And he meant it. Then we both ran out of the asthma room and cracked up. It seemed really true last night. I’ve got to get out of this ER!

  Thursday, November 21, 1985

  Did I say something the other day about having to get out of the ER? Well, the chief residents must have overheard me, because on Tuesday afternoon they called me into their office and told me that I wouldn’t have to work in the ER Tuesday night. That would have been wonderful, except for the fact that they also told me that I had been selected, out of the entire intern group, to have the distinction of being the first person ever to take call in the new neonatal intensive-care unit that had opened that morning on 7 South. What a thrill that was! It sure is something I’ll never forget as long as I live! And you know what? After one night on 7 South, I’m ready to spend the rest of the year in the ER.

  What happened was, Val Saunders was supposed to be on that night, but she called in sick. Everybody said she wasn’t really sick, she just didn’t want to be on call the first night in the new unit, which was really very sweet of her if it was in fact true. Somebody had to work there, and since I was supposed to be on in the ER and there were four oth
er people down there that night, the chiefs figured I was “it.”

  So there I was, sitting in the nurses’ station on 7 South, waiting for some disaster to happen. I’d never even been in a NICU before, and here I was, taking care of twenty-eight tiny babies. Just looking at them scared me to death! And nobody knew how anything worked! They hadn’t even figured out how to turn the heat on yet! They couldn’t find the outlets to plug in the damn ventilators! And sometime during the move, somebody had misplaced the coffee pot, so we couldn’t even make coffee! And I was supposed to cover all those babies! It’s the kind of situation that’d make for an outstanding horror movie!

  Somehow, the babies and I all made it through. I didn’t get any sleep. I spent the whole night running from room to room trying to figure out what was going on, but nobody died, nobody even crumped, and when the morning came, I was still standing on my feet. I think I did pretty well. Maybe I’ll go into neonatology.

  By the way, after I finished yesterday morning, I went into the chiefs’ office and they thanked me for filling in. I very graciously told them that if they ever pulled anything like that on me again, I’d reach down their throats, yank their spleens out through their mouths, and refeed it to them. I was very polite about it. I think they got the point.

  Bob

  NOVEMBER 1985

  When I was a house officer, we occasionally saw children who were beaten or molested by their parents or other adults, but these cases seemed to be few and far between. I vividly remember one of the first abuse cases in which I was involved. In clinic one day during a month of OPD at Jonas Bronck, I found that I had been assigned a new patient, a little eleven-year-old girl named Brenda. As soon as I called her into the examining room, her mother began to tell me that Brenda never seemed to have any energy; she was always tired, was complaining of too many bellyaches, and seemed to be gaining a great deal of weight. When I started to examine the girl, it took less than a minute to diagnose the problem: Brenda was about six months pregnant.