On the last day of the month, Alex took us all to lunch, which no attending has done for me before. He was a role model for me. I felt maybe I could actually do this kind of thing for a living. Even though it was depressing and even though taking care of critically ill children is so far removed from what I originally thought I’d wind up doing, I felt having someone who really cared made a big difference. When you think about it, all you really need in the ICU is a good technician who knows how to run all the machines and monitors. You don’t need an Alex George to run a unit. But I think his heart makes a big difference; Alex is what makes that place seem human and not just a mechanical torture chamber. I’m sure his being there has helped a lot of families. I know it really helped the house staff; his fatherliness, his caring attitude, it really made a difference.
And finally, there were the nurses. I really got to like those nurses. They’re superb; they’re fun to work with, they’ve got a great sense of humor. I learned to depend on them totally and to trust them. They do a lot of things that need to be done without you ever knowing about them. They ask you to write the orders for them after they’ve finished. They know so much, they’re each like a doctor. Many times we’ll be sitting there, scratching our heads, trying to figure things out, and they’re flipping the dials, running the lines, drawing up meds, making decisions they are confident with. And they just say, “This is what you want, isn’t it?” as they push it in the line. So they are real lifesavers, and I’m going to miss them.
Amy
FEBRUARY 1986
Sunday, February 2, 1986
All year, anytime anybody’s asked me to do something, I’ve done it without an argument. It seems it works only one way, though, because whenever I’ve asked someone to do me a favor, nobody’s willing to help out. It’s disgusting.
This is what happened: I started my two weeks in OPD last Monday. I had only two weeks to go before my vacation, so I figured it would be a cinch. But when I got home from work last Monday afternoon, Marie told me she thought Sarah was coming down with something. She hadn’t eaten well during the day, which isn’t like her, she’d been kind of sleepy, and she had a runny nose. Sure enough, I put her to bed at about nine and she woke up at a little after eleven, screaming at the top of her lungs. Larry and I ran into her room and found that she was burning up. I took her temperature: It was a 103.4°. It took about twenty minutes to get her to stop crying, and when she finally calmed down, I checked her over. I couldn’t find anything specifically wrong, her ears looked fine and everything, but she still had rhinitis [runny nose] and she was coughing a lot, and I noticed the whites of her eyes were red. I figured it was just the virus that was going around. I gave her some Tylenol and rocked her back to sleep, and she finally dropped off at about midnight.
She woke up again at 2:00 A.M. She was screaming, and her temperature was back up. I gave her more Tylenol and tried to calm her down, but this time she just wouldn’t stop crying. I was sure she had meningitis and I told Larry to get dressed because we had to take her to the emergency room, but just as he finished getting his clothes on, she quieted down and fell back to sleep. I guess the Tylenol had kicked in. Anyway, she slept the rest of the night, but I didn’t; I stayed awake in her room, watching her constantly. I was sure something terrible was going to happen.
On Tuesday morning, she woke up in a much better mood and her fever was gone. I figured whatever was wrong had reached its peak and now she was getting better. When Marie came, I told her about what had happened and made sure she knew how much Tylenol to give if the fever came back. I had clinic that morning and was going to be in the ER that afternoon and night, so I left Marie a schedule of where I’d be if she needed to contact me, and I left for work.
I should have called in sick, but I went to clinic anyway. Marie called at about ten-thirty to tell me that Sarah’s fever was back and that she had this rash all over her. I told her I’d be home in a few minutes and I rushed through the rest of my clinic patients. I was done by about eleven and I ran home to find Sarah’s fever back up to 103. She was miserable; she was coughing and sneezing and covered with snot, and she had a whopping conjunctivitis. And she had a raised red rash on her face and chest. I wasn’t sure what it was, so I called Alan Cozza. He told me to bring her right over.
Well, to make a long story a little shorter, Alan took one look at her and said, “My God, she’s got the measles!” I had never seen anyone with measles before; kids just don’t get it, because we immunize them. Alan brought some of the other interns who were on the floor in to see Sarah just so they’d know what measles looked like. I have no idea where she got it; she’s a baby, she doesn’t go outside, she doesn’t hang around with other kids except sometimes when Marie takes her down to the lobby, but that’s rare. But anyway, she had it. Alan told me to take her home and give her Tylenol and fluids and just make her as comfortable as possible and that it would pass in a few days.
By that point it was nearly one o’clock. I was supposed to be in the ER starting at one, and since I was on call that night, I’d be staying in the ER until maybe three or four in the morning. So I decided to stop in and talk to the chief residents; I figured, hearing that Sarah was so sick, they’d naturally say, “Well, why don’t you just stay home with your daughter tonight?” Yeah, right!
What they said was that two people who were supposed to be on call that night had already called in sick and they had to pull one person from the emergency room to cover and although they sympathized with me, they just couldn’t let me off. If I didn’t show up, there’d only be two house officers to staff the entire emergency room, and they just couldn’t allow that to happen. They told me I should try to switch with someone who was scheduled to be on the next day, if I could find someone who would be willing to switch, but there was just no way they could give me the night off.
How nice of them! After all the abuse I’ve taken through these seven months! After everything I’ve done for them! Whenever they’ve asked me to do anything, I’ve always done it without a whimper! I filled in for other people, I covered wards I’d never been on before because somebody was out, and I never complained. I’ve repeatedly put my job ahead of my family, and this is the thanks I get! The one time my daughter is sick, the one night I need to take off, of course no one would do a thing for me. I asked everybody if they’d switch, if they’d cover for me this one night, and they all had some excuse. I should have just gone home. I should have taken Marie and Sarah home and stayed there and when they called me to find out where I was and why I wasn’t in the emergency room, I would have said . . . I don’t know exactly what I could have said. But, of course, I didn’t do that. What I did was, I brought Sarah and Marie home and went back to the hospital.
The rest of that day was ridiculous. We were short-staffed in the emergency room; the place was like a zoo. Everybody in the Bronx was sick with the flu and had fever and vomiting and coughing. There was a six- to seven-hour wait to be seen through most of the afternoon and night. I rushed around that emergency room until four in the morning, and during all that time I didn’t see a single patient who was as sick as Sarah. I really resented being there, and I must have told that to the nurses and the rest of the staff at least a thousand times.
Marie kept calling me all through the afternoon. She didn’t exactly feel comfortable taking care of a baby with a fever that ranged between 103 and 104, and I can’t say I blame her. I’m sure she was afraid Sarah was going to have a seizure or something. That idea crossed my mind a few times. So she called every half hour or so, saying, “Her fever’s still up. What should I do?” or “Her eyes are getting very glassy. Are you sure you can’t come home now?” Even she had a hard time understanding why I couldn’t just come home to take care of my baby. And there wasn’t anything I could say to her to make her understand because I wasn’t sure I understood it myself.
I finally got out of the emergency room at about four. Larry was wide awake; he hadn’t gotten any sleep,
having been up with Sarah all night. Her fever was still up, and she was very irritable. She’d sleep for maybe a half hour and then wake up howling. It’s so strange seeing her like this; she usually has such a good personality. And she was absolutely covered with the measles.
I was all set to call in sick on Wednesday, but Larry had already made arrangements to take the day off, and he told me I should go in. I went, and in the morning Alan called to ask me how Sarah was doing. I gave him a piece of my mind! I told him about how the chiefs had made me work the night before, and he seemed amazed by it. He said he’d go have a talk with them, but a lot of good that’s done me! I’m really so angry. I’ll tell you, this episode has really taught me a lesson. Let them ask me to do anything, let anybody ask me to cover or to switch; my answer is going to be “NO!” I don’t care what it is or who it is, I’m not doing anything for anybody ever again! I’ve had it with these people! I’ve got to look out for my own interests, because no one else is!
Sarah’s better now. The rash is starting to fade. Her temperature came down to normal on Friday, and she’s not irritable anymore. By tomorrow she should be back to her old self. But I’m not going to forget this. You can bet they’re going to regret making me work Tuesday night!
Saturday, February 8, 1986
I’ve just finished packing. My vacation starts after I finish my call in the ER tomorrow night, and we have a ten-twenty flight to Fort Lauderdale on Monday morning. I really need this vacation. I’m physically and emotionally exhausted. We’re spending two weeks in a condominium near Fort Lauderdale; two weeks of lying in the sun and sleeping late. I can’t wait!
Things have pretty much returned to normal. Sarah is back to her old self. The measles have disappeared, and the only things left from the whole episode are my anger and resentment.
Mark
FEBRUARY 1986
Monday, January 27, 1986
Today was my first day in the nursery. What fun I had! I love staying until ten-thirty, running around like a chicken with my head cut off, having no idea in the world what the hell I’m doing. It was a million laughs! I can’t wait to go back there tomorrow!
Well, let’s see: How can I describe what the day was like? I came in at about eight o’clock, and Ed Norris, the director of the neonatal ICU at Jonas Bronck, tried to give us an orientation lecture. He certainly made things very clear; it was like listening to a lecture in Swahili! I couldn’t understand a good 50 percent of the things he was talking about. He kept referring to the inhabitants of the unit as “your patients.” You know, “your patients this” and “your patients that.” And then we walked around and he showed us these so-called patients. My God, those things weren’t patients! They’d have to quadruple their weight to be classified as patients. Right now, they’re mostly tiny portions of buzzard food with lots of ridiculous wires and tubes coming out of them. This is going to be a long month!
They gave me eight of these things to take care of. For most of them, the kid’s chart weighs more than the kid does, which is a very bad prognostic sign. And, of course, I didn’t have a clue about what the hell was going on with any of them, so I spent the whole day sitting in the nurses’ station trying to read these ridiculous charts, which were filled with words I had never seen or heard before and numbers I couldn’t even attempt to figure out. I was trying like hell to make sense of all of this before one of these things wound up dying. At least I didn’t have to go to clinic this afternoon; it was canceled. Thank God, because there’s no way I would have made it anyhow.
I really can’t believe this! It’s ten-thirty, I’m just getting home from work, and this is my good night! It’s just amazing! I have eight patients, they’re all stable, and none of them is really that complicated, but even uncomplicated preemies have this long, annoying history, most of which I don’t give a damn about. I mean, truly, I just don’t care! There was a point there, about five o’clock tonight, where I swear I was this close to just taking all the charts, throwing them out the window, and saying, “Forget it! I’m sorry I ever applied to medical school! I never really wanted to be a doctor anyway!” I just couldn’t take it anymore: just all these little runts who shouldn’t be alive in the first place! Damn! Really annoying! But hey, I stuck it out, because I have such great self-control, and here I am, celebrating by eating my favorite food, Sno-Caps. This is the first thing I’ve placed in my mouth since breakfast. That was over fifteen hours ago! Working in this damned ICU is like being on a self-imposed fast! I feel like Gandhi, for God’s sake!
I better try to eat neatly. This looks like it’s going to be one of those months where I’m not going to get to wash the dishes or do the laundry! Maybe I’d better just start using paper plates right now. It’s too bad they haven’t invented paper clothes. That’d be perfect: disposable clothes for the house officer. Maybe if they could be made edible, that would solve both problems at once. I’m not making any sense anymore. I’ve got to get some sleep!
This place really sucks. What am I going to do?
Wednesday, January 29, 1986
Well, I’m home again. It seems like only yesterday I was last here, but actually it was the day before yesterday. I’m exhausted. I was on last night and I didn’t get any sleep. No one ever gets any sleep in the nursery, so saying you didn’t get any sleep on a night you were on call is redundant. I spent the whole night running around from bed to bed, doing stuff I didn’t understand on babies I didn’t think were human, for reasons that are totally beyond me. What a rewarding experience.
Here are a few more of my thoughts about the neonatal intensive-torture chamber. What a fun place it is. Starting to work in the NITC [neonatal intensive-torture chamber], or the NICU, as the neonatologists like to refer to it, is like being thrown into prison in a foreign country where you have no idea what the fuck’s going on. I really don’t know anything! I’ve never even taken care of well babies before. I can barely tell the difference between the respirators and the babies. Before Monday, I’d never seen a kid with jaundice. [Neonatal jaundice is caused by immaturity of the liver, the organ that removes bilirubin from the bloodstream; it’s a common problem in infants and is treated with phototherapy, placing the infant under banks of fluorescent lights.] I don’t know when to turn on the lights, when to turn off the lights. I don’t even know what a normal bilirubin is for a baby!
And I don’t know what you’re supposed to feed these things. I don’t know how much they’re supposed to eat, how much they’re supposed to pee, nothing! If it weren’t for the nurses, who, thank God, seem to know what the hell’s going on, I’d probably have managed to kill off every last kid by now!
And even if I did know all that simple, obvious stuff, there’s all this other information I don’t even have a clue about. There isn’t one word that they use in there that even sounds like anything I’ve ever heard outside the unit. It’s like they make up terms just to make our lives more miserable, if it’s possible to be more miserable than I already am! Every one of those kids has biochemical rickets. What the hell is biochemical rickets? I have no idea! And besides that, who cares?
As you can tell, all these little annoyances aside, I’m really having a lot of fun. I’m really enjoying taking care of these bags of protoplasm. My favorite patient is this kid Moreno. He’s a three-month-old with congenital hydrocephalus. [Hydrocephalus is a condition in which an excessive amount of cerebrospinal fluid, the substance that normally bathes and protects the brain and spinal cord, accumulates in the skull. Usually it is due to obstruction of flow of the fluid from the brain, where it is produced, to the spinal cord, where it is absorbed. When hydrocephalus occurs at birth, it is usually caused by an abnormality in the formation of the brain.] This kid is all head! He weighs twenty-five hundred grams, and about twenty-three hundred of those are housed above his neck. And of those twenty-three hundred grams, 99 percent of that is fluid. His cerebral cortex looks like a ribbon around a water balloon. And that’s after he had a shunt put in that
seems to be working. [A shunt is a piece of plastic tubing, one end of which is placed in the brain, the other end of which is placed in either the abdominal cavity, the chest, or the heart, that drains the cerebrospinal fluid out of the brain in patients with hydrocephalus.] His head circumference today was forty-nine centimeters. [Normal head circumference for a newborn is thirty-five centimeters. At three months, the head circumference should be about forty centimeters.] This kid’s got a great prognosis!
So anyway, Moreno’s mother called me today. I wasn’t in a very good mood, having been up all night and not having understood anything anybody has said to me in nearly three days, so I wasn’t really in much of a mood to put up with her. She calls every few days to ask what the kid’s head circumference is. She’s fixated on his head circumference. I told her it was forty-nine centimeters this morning and she got all panicky, saying it was only forty-eight centimeters on Sunday and now it was a centimeter larger, and wasn’t I worried about it, and what was I going to do about it? I calmly explained to her that no, I wasn’t worried about it because it had been forty-nine centimeters when I got there on Monday and it was still forty-nine centimeters now and he wasn’t irritable or vomiting and he didn’t have any of the other signs of increased intracranial pressure, and since the neurosurgeons and the neurologists had been by to see him and neither of them had been upset by his head circumference, I wasn’t going to do anything about it. I think I also told her that I was happy that his head circumference was forty-nine centimeters, I was pleased as Punch, and if she wanted to find someone who wasn’t happy, I suggested she call the neurosurgeons or Ed Norris to see what they think. I think I said that, but I’m not sure because, like I say, I was kind of tired and I haven’t been making much sense over the past few days. But I’m pretty sure of one thing: I don’t think Mrs. Moreno is going to be calling me much during the rest of the month!
The Intern Blues Page 29
