The Intern Blues

by Robert Marion

  Anyway, I drew the blood, got it into the tube (which I consider quite a save, considering how hard a stick this kid was), and then I started to kind of sort of lie there on the floor feeling very dizzy. Everyone came running; I thought they were going to call a code and start full-scale resuscitation on me. But they didn’t; I guess they realized that I hadn’t arrested, I had just fallen over, so they got me into a wheelchair, and the nurses checked my blood pressure, which was normal, and then they put me in the house staff room, where I collapsed on the couch. I felt dizzy every time I tried to lift my head. This was, needless to say, somewhat anxiety-provoking.

  I stayed in there for a few minutes and then I tried to get up so I could get to attending rounds. I got myself in a sitting position and started to cave in again when Alan Morris showed up. I said to him, “You know, I’m really not feeling too well.” And he looked at me with a very serious face and asked what was wrong. I said, “Well, I’ve been dizzy for the past fifteen minutes.” Then he said (in a formal-sounding voice), “I suggest you continue to rest; if this persists for a few more minutes, I recommend that you be brought down to the emergency room for evaluation.” All in his usual righteous tone of voice.

  Well, he went out and came back a minute later with the wheelchair and said (in the same formal-sounding voice), “You know what? On second thought, it’s been long enough. If you had been out in the street somewhere or in any place other than a hospital, you would have already been brought here by ambulance. I think we’ll take you down to the ER,” which he did. By the time I got down there, I was completely white and really uncomfortable. They slapped me down on one of the stretchers, they stuck an IV in me (at least I didn’t have to do that one myself), they drew blood; I got examined by one of the ER attendings, I got examined by one of the residents in neurology, and God help any of us if we really have a neurological problem and we have to be taken care of by a member of the neurology house staff, because this guy turned out to be pretty hopeless.

  Well, hours and hours passed; many people came and went (actually, it was nice to get all that sympathy). My student, who generally is a moron, stayed with me the whole day and was very sympathetic. And finally, at the end of the day one of the adult neurology attendings came by. I told him what had happened, he did a quick exam, found everything to be normal, and told me I’d hyperventilated and that I should stop consuming anything with caffeine in it.

  Hyperventilation—how about that? He probably was right, too. I was pretty crazed when I was drawing that blood, I was worried about what would happen if I made it to attending rounds late. But can you imagine an intern having to eliminate caffeine from his diet? Caffeine is the only thing that’s been keeping me alive. If I stop drinking coffee, I’ll just lapse into a coma and never wake up.

  Anyway, so I left the ER at about six and Carole, who was coming to see me for the night, picked me up and carted me home. Ever since, I’ve been getting total abuse from my “friends.” That was my emergency room event for the year. It was actually really interesting being on the other side of the bed. As a patient, you realize how sensitive you are to what everyone is saying and how they’re saying it. Really, it was a very interesting experience to have had. And I hope I don’t have it too many more times.

  I was on call Sunday. It was a pretty good day, only two admissions. Then yesterday, I got home after being on call and I found out my phone wasn’t working. It turns out it was some problem with the phone company’s cable, but I didn’t know that; I thought it was something wrong with my phone. I called them and made an appointment for someone to come to my apartment today at four-thirty. So I was in a rush all day, I knew I had to get out of the hospital early. And, of course, when you’re in a rush, everything goes wrong: I went out to my car this morning and found that the damn thing wouldn’t turn over. The battery was dead, I’m sitting out there fuming, it’s freezing cold, and the damn battery’s dead! I called the AAA and wound up getting to work forty-five minutes late. All because I was in a hurry.

  And then attending rounds went on forever! We would have gotten done early because there had been only one admission last night, but then my moronic medical student asked Alan for a lecture on static and cidal levels of antibiotics [cidal: the concentration of antibiotic needed to kill bacteria; static: the concentration needed to prevent the bacteria from reproducing], something I’d heard eight times already. And, of course, I couldn’t get up and leave. No, I had to sit there or face the Wrath of Alan. It took a whole two hours before we were done.

  Then I called the telephone company to tell them I was going to be late, and could they come later, and they told me “Oh, didn’t you hear? The problem was on our side, not yours. Your phone works perfectly now!” So I built up all that serious aggravation for nothing!

  So, to review the past week, I’ve had one episode of hyperventilation, which earned me a trip to the ER; one episode of phone failure, which nearly earned me a nervous breakdown; and one episode of battery failure, which I’ve taken care of by getting a new battery. And who’s to say what lies ahead over the next couple of days; or months; or years, for that matter, in this exciting borough I hope to get out of sometime soon, or at least before I go completely crazy! I’m telling you, one day I’m just going to get this enormous ulcer and bleed right out on the floor! It’s only a matter of time!

  Wednesday, January 22, 1986

  Fine. Now I’ve developed an allergy to something. My nose has been running and my eyes have been itching like hell all night long. I may not survive this month. If I were an insurance company, I certainly wouldn’t allow me to take out a policy!

  I guess you can say yesterday was just another typical day. I admitted this kid who was dehydrated. They thought he had mononucleosis in the ER, but when his CBC came back, it showed pancytopenia [lack of all types of blood cells] and lymphoblasts [immature white blood cells]. A diagnosis of leukemia was entertained (what an ironic expression). And unfortunately, this morning the diagnosis was confirmed. Of course, the family’s really nice.

  Sunday, January 26, 1986

  So tomorrow I start my month in the NICU. I’m ready to jump out the window. It won’t be too bad, though. I have clinic tomorrow afternoon, so hopefully I won’t be around long enough to get really nauseated. [Obviously, an afternoon in clinic exempts the intern from the hospital for the time he or she is scheduled to see outpatients in the clinic.]

  I guess I’m going to miss Children’s. It really is a good place to work. Alan Morris was an excellent attending. Even though he still scares me to death, I really learned a lot from him this month. When I went up to him on Saturday to thank him for the month, he told me I should have more confidence in myself because he thought I was a good intern. I think I’ve figured out what it is about him that makes me nervous: He reminds me of my father, whom I was always terrified of. I was always afraid he was going to yell at me for not eating my vegetables or something.

  The main reason I liked Children’s this month, though, was because of the resident. The resident was wonderful. She’s just totally wonderful in all ways. She’s smart and she’s an excellent teacher. She’s calm and she doesn’t get upset no matter what happens or how many mistakes I make. And she’s great-looking, too, which certainly helps. It’s just too bad I won’t get the chance to work with her again this year. And I swear to God, if she weren’t married . . .

  Bob

  JANUARY 1986

  We’re getting into the seriously depressing part of the year now. New Year’s Day marks the beginning of Intern Suicide season, the time when we really have to start worrying about the house staff’s mental health. There are a number of reasons why January and February are so bad. First, exhaustion is cumulative, and the interns have now built up a six-month supply. They’re chronically overtired and can’t get themselves too enthusiastic about anything. This exhaustion affects all aspects of their lives: They don’t have energy to socialize, so they completely lose contact with famil
y and friends; they eat too much junk food and get little or no exercise, so they wind up gaining a ton of weight. This causes them to feel down about themselves and to lose confidence.

  Second, although everybody around them is celebrating the end of one calendar year and the beginning of the next, the end of the internship year hasn’t even yet appeared on the horizon. There’s just about nothing for these guys to look forward to right now other than another half year of the same shit over and over again. So they develop a feeling of desperation, and that feeling is compounded by the fact that they know there’s nothing they can do to make the time move any faster.

  Finally, the environment seems to be conspiring against them. The weather this time of year is horrible. It’s constantly freezing cold, and the city is frequently getting pelted with snowstorms. It gets dark so early that the house officers can go for weeks without ever actually seeing sunshine; they get to the hospital so early that it’s still dark and they come home again at night, after the sun has set. So the house officers live in a constant world of cold and darkness, and there’s nothing more depressing than that.

  Although January is bad, it’s nothing compared with February. In January, there’s still some semblance of a “spark” left within the bodies of the interns, the last vestige of the excitement that accompanied the holiday season. The department’s Christmas party did the whole staff a lot of good; there were a couple of weeks during which everyone seemed a little happier and a little calmer. But it was really short-lived. And usually by February 1, any spark of excitement has been snuffed out.

  A fair number of pretty strange things happened during January. The strangest involved Andy Ames, one of the interns who’s in Andy Baron’s circle of friends. The story started like this: At the beginning of January, Andy Ames and one of the female senior residents were working together on the Jonas Bronck wards one night and admitted a six-week-old girl with fever. Because a significant percentage of these infants will be shown to have a serious bacterial infection in their blood or spinal fluid, it is policy that all babies under two months of age who come to the emergency rooms with fever routinely get admitted to the hospital. Blood, urine, and spinal fluid cultures are taken, and the infants are started on intravenous antibiotics.

  Anyway, Andy Ames and the senior resident were trying to get a sterile specimen of urine from this little girl by doing a straight catheterization, a procedure in which a plastic tube is inserted into the urethra and passed up into the bladder. The cath went pretty well, and they managed to get an adequate sample of urine for culture and urinalysis. But the mother, who was standing in the treatment room the whole time, went nuts when she realized what Andy was doing. She accused him of sexually molesting her daughter and of “ruining” her for life. The mother yelled and screamed for most of that night, becoming more and more agitated as time passed. Early the next morning, she went to Alan Cozza and the hospital administrators to complain. When the situation was assessed, it was carefully explained to the woman that what Andy had done was completely aboveboard and standard treatment and did not in any way constitute sexual molestation. The mother continued to yell that Andy had “ruined” her daughter and that no man would ever want her after what he had done. The administrators continued throughout that day and the next to try to calm her and explain the anatomy of the procedure to her. When it finally became clear to the woman that she wasn’t going to get any satisfaction from the hospital employees, she decided to take matters into her own hands: She began to threaten Andy Ames with bodily harm.

  From then on, things became exceedingly weird. While the baby was in the hospital, the mother told Andy every time she saw him that she was going to sneak up behind him when he wasn’t expecting it and stick a butcher’s knife into his back. She also told this to everyone else who was hanging around the ward, the house staff, the medical students, the nurses, even some of the other parents. Since the baby was better and no sign of bacterial infection had been found, Alan Cozza decided to discharge the child a day earlier than usual. He hoped that with the baby and her mother out of the hospital, some of the pressure would be removed from Andy, who, needless to say, was feeling quite persecuted by all this. But discharging the baby didn’t help; the woman managed to find other ways to drive Andy crazy.

  After discharge, the baby’s mother began to call the ward asking for Dr. Ames. When Andy got on, she’d repeat the threats. She somehow got the number of the residents’ room and left cryptic messages for him with Lisa, the house staff secretary. She even managed to get Andy’s home telephone number and left messages on his answering machine.

  At about this time, Alan Cozza, concerned about what was happening to his intern, began investigating this woman’s background. Not surprisingly, he found that she had a long psychiatric history and had been diagnosed as having paranoid schizophrenia. Then, about a week after the baby was discharged, a call came for Andy in the residents’ room. The person identified himself as the woman’s psychiatrist. He explained that the woman had told him exactly what had happened and had laid out in explicit detail exactly what she was going to do to get back at “that intern who ruined my daughter.” He told Andy that he was concerned about his well-being because she was angrier and more agitated than he’d ever before seen her.

  This was all Andy needed. If he hadn’t been worried about all this before, the psychiatrist’s call certainly pushed him over the edge. And apparently there was very little at that point that anybody could have done. The woman wouldn’t voluntarily consent to hospitalization in a psychiatric facility because she didn’t think of herself as sick. Her psychiatrist, although truly concerned about Andy, was unwilling to proceed with forcing her into institutionalization against her will. He said he simply hadn’t accumulated enough evidence yet to justify such a move. And so, during January, after work every day, one of the other members of the house staff had to walk Andy out to his car in the parking lot. The interns took turns staying over at his apartment. He had his phone number changed and made sure the new one wasn’t listed. And all of this certainly took its toll on him. He began looking terrible: He was already exhausted from the usual intern routine, and he barely had enough strength to get through a typical day. But now he was no longer able to sleep even on the nights when he wasn’t on call because he was so worried.

  The story finally came to a head in early February. The baby’s mother showed up in the residents’ room at Jonas Bronck one day, demanding to see Andy and wanting to know why he wasn’t on the ward where he belonged. Lisa, the secretary, told her that at the end of January he had rotated onto another service and was no longer at the hospital. The woman demanded to know where he was, and when Lisa, who was well aware of the situation, refused to tell her, the woman pulled a big knife out of her pocketbook. One of the residents who had been sitting in the outer office ran to get the security guard who was stationed on the pediatric floor. The guard ran into the room, surprising the woman. In the confusion, he was able to overpower her and force her to release the knife. No one was hurt, thank God, and the woman was taken to the psych emergency room in handcuffs. She was ultimately admitted to Bronx State Psychiatric Hospital. Andy, who was working on the Infants’ ward at Mount Scopus, was relieved to hear this news, to say the least. He went home that night and had his first good night’s sleep in weeks. And within a week or two, the whole incident was forgotten.

  This melodrama is certainly not an everyday occurrence. But when something like this does happen, you can be sure it’ll occur in January or February.

  Andy

  FEBRUARY 1986

  Sunday, February 23, 1986

  All in all, the two weeks I spent in the Jonas Bronck OPD were pretty good, even though it was so frustrating. My prior ER experience at Jonas Bronck had been horrendous, and I had expected the same. But it was much quieter this time; the asthma room wasn’t constantly packed, it wasn’t constantly filled with screaming, wheezing children who were vomiting all over the floor, ma
king the place smelly and sticky and making the whole emergency room so noisy because of the sound of the oxygen coming out of the wall tanks. Instead, it was much quieter, and on call nights we’d get out of there at twelve or one o’clock, instead of at four or five in the morning. And the chiefs, thankfully, were really nice to me for some reason. They gave me no Friday nights [the night without a night float] and the only even slightly hard thing I had was neurology clinic, which is bad only because there always are so many patients.

  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.”