Jon and Arlene were sitting at their desks and I walked in and said, “Hi. Guess what? I’m three months pregnant. I’m due next November and I need to arrange maternity leave.” Just like that. You should have seen the looks on their faces. I thought Arlene was going to fall out of her chair. Of course, whether I’m pregnant or not doesn’t really make any difference to them; they’re not going to be here after June 1, so it isn’t their problem, it’s the new chiefs’ problem. But they certainly were stunned just the same. It took them about five minutes to recover enough to congratulate me. In some ways it was worth suffering through these weeks of nausea and exhaustion just to see the looks on their faces!
Anyway, what’s been done in the past is that a three-month period of maternity leave has been created by taking the one month of vacation and the one month of elective without night call we’re entitled to [residents have a one-month period called free elective; during this month, because they have no night call, they can travel to other cities to do electives] and adding another month of elective with night call. I told the chiefs that that’s what I wanted to arrange, but they immediately started giving me a hard time. They said that as far as they knew, all I could get was my one month of vacation. They were unwilling to give me the other two months; they told me three months off would cause enormous problems in the schedule, and they just couldn’t afford to do that. I’ve found out since then that three other women are pregnant and expecting at about the same time I am, and if they give us all two or three months off, it just might destroy the schedule.
Well, I don’t care if my having a baby does destroy their precious schedule. I’m finished worrying about everybody else. What it comes down to is they’re trying to discriminate against me and I’m not going just to sit back and stand for it this time! I’m tired of being pushed around and doing things just because the chief residents or the attendings or someone else tells me that that’s the way it’s got to be! So I made a call to the CIR [Committee of Interns and Residents, the house officers’ union] office in Manhattan. I got the vice president on the phone and asked him exactly what the policy was for maternity leave. He told me that I’m entitled to six weeks of leave above and beyond any vacation or elective time I might have coming. That means that what I’m really entitled to is six weeks of maternity leave, four weeks of vacation, four weeks of elective without night call, and another four weeks of elective with night call. That’s a total of four and a half months, and you can be sure I’m going to take all of it! If they hadn’t tried to screw me over in the first place, I would have settled for three or maybe even two months. Now I’m going to take four and a half months, and if they don’t want to give it to me, I’m just going to file a grievance with the union!
I went back to tell the chiefs about this on Thursday and they said they’d have to talk with the higher-ups before they could give me an official response. I got a call on Friday from Mike Miller’s secretary, setting up a meeting for tomorrow. It looks like I finally got some action! After all this time, I finally figured out how to get things done around here. It’s too bad everything has to be done through threats, though.
Wednesday, May 14, 1986
On Monday I met with Mike Miller about my maternity leave. He was very nice about the whole thing. First, he hugged me and told me how happy he was to hear the news. He seemed really sincere about it. Then he told me how upset he had been when he found out what the chiefs had tried to do to me. He said that in our program, we’ve always been very liberal about maternity leave. He went into a whole lecture about how we as pediatricians were supposed to be advocates not only for children but for their parents as well and how it would be hypocritical for us not to allow the residents proper time to be with their newborns. He was being nice to me, so I didn’t start up with him about breast feeding and how it was hypocritical that none of us could ever breast-feed our children because we weren’t provided with the proper facilities to ensure its success. Anyway, he told me he would guarantee that I got at least two months of leave after the baby was born and that I’d have easy rotations both the month before I was due and the month I came back after the baby was born.
Mike’s always been nice to me, and I think he really meant what he said. I don’t think he was saying those things just to try to prevent me from filing a grievance with the union. So I’m going to take his word for it. I’m going to trust him and I’m not going to speak to anyone from the union, at least not until next year’s schedule comes out at the beginning of June. But you can be sure, if two months of leave are not written into that schedule for November and December, I am going to be on the phone to the CIR so fast it’ll make your head spin!
I was a little distracted when I went in to talk to Mike because I’ve been really worried about my father. I called him on Sunday night and right near the end of this very nice conversation, he happened to mention to me that he had passed some bright red blood with a stool earlier in the day. Just like that, very matter-of-factly he said it. I immediately got upset and I asked him what he was going to do about it. He said, “Nothing.”
I almost went crazy! He always does this to me. I yelled at him that he had to go to see a doctor the next day, and if he wasn’t going to make an appointment, I would call his doctor and make the appointment and then come out to New Jersey and drive him to the doctor’s office to make sure he got there. I think he got the message because he said he’d try to make the appointment but told me that his doctor was a very busy man and he might not be able to get to see him for weeks.
Anyway, right after I came out of Mike’s office, I called my father at work. He said he had been able to make an appointment for this morning. He called a little while ago to tell me that the doctor had seen him, had done a full examination including a sigmoidoscopy [an examination of the sigmoid portion of the large intestine], and that the bleeding had been due to hemorrhoids. Everything else was fine. So I felt a lot better. My father told me I had made him worry for nothing. I told him that we didn’t know it was nothing until we checked it out. It might have been something, and if he had ignored it, it might have cost him his life.
The doctor did tell my father that he did have to have the hemorrhoids removed as soon as possible because there was a possibility that there could be massive bleeding. He said he could arrange for the surgery to be done next Monday, and amazingly my father agreed; he’s not admitting it, but he must either be in a lot of pain or really be scared about this. Whatever it is that’s causing it, I’m glad he’s acting so reasonably about it. But now I have to try to get next Monday off so I can go out to New Jersey to be with him. It shouldn’t be too much trouble. Then again, you wouldn’t expect it to be too much trouble to get a day off to stay with your baby who has the measles and a fever of 103, would you?
I’ve been feeling better over the past few days. My nauseousness is completely gone, and I’m not so tired anymore. I think I’ve made it through the worst part of this pregnancy. When I was pregnant with Sarah, once I made it through the initial yucky part, I felt wonderful until about three weeks before I delivered; then I felt like a blimp and couldn’t move at all. So it should be smooth sailing for me over the next few months. There’s only one more month of this internship left. I haven’t enjoyed most of this year; maybe I’ll be able to salvage this last part of it.
Tuesday, May 20, 1986
They did it to me again! I can’t believe it! Yesterday was the day my father had his surgery. I had been trying since last Wednesday to get the day off. I thought it would be easy. I should have known better.
There were lots of problems from the beginning this time. First of all, I have clinic Monday afternoon, so I went to the director of the clinic and asked if I could switch my patients to another day just this once. I’d never asked her for a single favor in the past and I’d done lots of things for her like covering for other doctors who were sick. She hemmed and hawed for a couple of minutes and then when I explained that I needed to go to be
with my father who was having an operation, she said she’d see what she could do. She called me on Thursday to say that she’d tried everything but there was no way she could cancel or reschedule the patients.
Fine. I understood what that meant. What that meant was that I wasn’t going to be able to approach this whole thing as a grown-up. I was going to have to call in sick and lie about it. And because of that, I didn’t even go to talk to the chiefs about switching my night call. I’d just call in sick and leave them hanging in the wind.
Well, yesterday came, and that’s exactly what I did. I called everyone I had to, the chiefs, the clinic, and the emergency room, and I told them I had gastroenteritis and I couldn’t make it in. Then I got dressed and got ready to leave for New Jersey. But just as I was about to leave the apartment, the phone rang. It was Mike Miller. He asked me if anything was wrong. I thought for a minute: Should I tell him the truth, or should I continue the story I made up? I decided to tell him the truth. It was obviously the wrong decision, because after I got finished telling him about my father, he said that they were strapped today, that a lot of people had called in sick, and if I didn’t come to be on call at least that night, there would be only one person in the emergency room from five until midnight. So he made me a deal: He told me he’d let me take that day and the next day off if I came in to be on call that night. He said they were depending on me. He was so nice and so straight about it, I didn’t see that I had much of a choice. So I went out to New Jersey and sat outside while my father had the surgery and stayed in the recovery room. I had to leave to come back to the Bronx just as he was going back to his room. It was so stupid; I didn’t get to spend any time with him at all.
At least I knew he had done well during the operation. But all during the night, while I was seeing patients in the emergency room, I kept thinking how stupid this was. I mean, my father’s not a young man; an operation like that can cause complications. And he had nobody else in the world to stay with him except me. So what was I doing while he was waking up from the anesthesia? I was seeing kids with runny noses and ear infections. I didn’t need to be there; Evan Broadman, who was the senior resident, could have seen everyone by himself.
Well, I spent all day today at my father’s bedside. He’s in a lot of pain. The surgery’s very uncomfortable. He didn’t say anything about my not being there last night, but I knew he would have liked me to have been there. And I would have liked to have been there, too.
Monday, May 26, 1986
I was trying to think last night if I’d learned anything this year. I was taking care of a six-year-old girl who had been hit by a car. She had about a five-minute loss of consciousness but seemed to be fine by the time she reached us. I handled the entire case myself. I started an IV and sent off a CBC and a set of lytes [examination of blood electrolytes]. I got skull films, which were negative; I did a UA and found some blood in her urine, so I arranged for an IVP, which also was negative [any patient who has had significant trauma and is found to have blood in the urine must have an intravenous pyelogram, an X-ray evaluation of the kidneys, to make sure that no damage has been done to the kidneys]. I cleaned out her forehead laceration and sutured it myself. Then I called the intern up on the floor and admitted the patient for observation. I think that was pretty amazing! Considering I couldn’t start an IV or put in a suture when I started last July, I think you’d have to say I’ve come a long way. It’s funny, though; you never see it that way while you’re doing it. While you’re working, you’re only aware of the things you don’t know, not the things you do know.
Mark
MAY 1986
Thursday, May 1, 1986
My mother told me I should always try to find something nice to say about a situation. I started my rotation at University Hospital last Monday, and ever since, I’ve been trying to figure out something nice to say about the place. I finally came up with something: The food is good. No, that’s not even exactly true. It’s not actually good, it’s just plentiful. Plentiful and easily available and free; they give us meal tickets so we can eat three meals a day. And that’s it. Outside of the food, I haven’t found anything I’ve liked at University Hospital.
I’ve been on call one night and so far I’ve had one patient die. It was a patient I’d met before: the kid I saw in the West Bronx ER a few weeks ago who got bitten by the horse. Her name was Melissa Harrison, and she had this horrible disease, metachromatic leukodystrophy. She’d been going downhill for a while. She came in on Monday in status epilepticus [the state in which constant seizures are occurring]. Dr. Ruskin, her neurologist, came in and spent about an hour and a half talking to the parents. At the end of the meeting Ruskin came out and told me they’d decided that this was going to be it. We weren’t going to do anything heroic, just fill the kid with enough morphine to keep her comfortable and then wait for the end to come. The end happened to come when I was on call Tuesday night.
This wasn’t exactly the most comfortable situation I’d ever been in. I mean, I didn’t know this kid from a hole in the wall. And here I was, being called on to stand by her bed and let her die without doing anything to prevent it from happening. Ruskin might have felt comfortable being in that situation, but she wasn’t standing there at the kid’s bedside. I was, and I felt pretty bad about the whole thing.
This kid’s mother was a saint, though. I guess she saw I was pretty uncomfortable, and she spent a lot of time trying to calm me down. She told me about what Melissa had been like before she started going down the tubes. Isn’t that wonderful? The mother of this dying girl had to spend the last minutes of her daughter’s life calming down the intern who had gone completely out of his mind. Well, listen, it isn’t completely my fault that I’m berserk; I’ll be the first to admit that I might not have started out this internship with a full complement of marbles, but most of the berserkness I’ve been demonstrating recently is the result of the deep frying my brain’s been receiving over the past few months.
Anyway, Melissa’s mother was really great. She’s a real Mother Teresa type. I can only imagine what kind of hell her life’s been over the past few years.
So that was a great way to start out the month. I’m on again tomorrow, and since I seem to have become the Intern of Death, I wonder which one of my panel of patients will be tomorrow’s selection in the Meet Your Maker sweepstakes. Will it be Nelly, the three-year-old with AIDS who has PCP [pneumocystis carinii pneumonia, a common cause of death in patients with AIDS]? Will it be Jesus, the one-year-old with yet another bizarre metabolic disease, the name of which I can barely pronounce? Will it be one of the parade of renal transplant patients who are constantly marching onto the ward to get treated with medication that might stop them from rejecting their transplanted kidney? Or will it be a completely different patient, one I haven’t even met yet, one who’s waiting in the wings to make my life completely miserable over the next forty-eight hours? Only time will tell. And I don’t think I want to know.
I’m going to sleep now. Maybe I’ll sleep through tomorrow and the entire next two months, and when I wake up, I won’t be an intern anymore. I can always hope!
Sunday, May 4, 1986
Great news! I was on Friday night and no one died. Nobody; no patients, no nurses, not even me! At least if somebody did die, I wasn’t told about it.
Actually, Friday night was nice, if any night spent in any hospital can be called “nice.” I didn’t get a single admission. I even got five hours of sleep in University Hospital’s very lovely intern on-call room. The on-call room is in reality a closet with furniture; it’s about six feet by six feet and it’s got a door, a telephone, and a cot. When they were building this hospital, they obviously decided to spare no expense when it came to the comfort of the interns. I shouldn’t complain, though. I heard that as of four years ago, the interns didn’t even have this closet to sleep in. They had to sleep in empty patient beds. That’s always very dangerous, especially here at University Hospital, where ther
e’s an actual blood-drawing technician. There’s always the chance the tech will find you lying in bed some morning, mistake you for a patient, and suck out all your blood.
I discovered another good thing about University Hospital. There’s this porch attached to the cafeteria that you can actually go out on and get some sun. Actual sun in the Bronx! Anyway, I found this porch at lunchtime on Friday and I spent an hour out there on Friday afternoon. It was really beautiful. The weather’s been great all weekend, too. The temperature’s been in the seventies. Yesterday Carole and I went to this inn about an hour north of here. It was great, really relaxing, and we weren’t caught in a rainstorm, a monsoon, a tornado, or any other natural disaster. Amazing! Maybe my luck is actually changing. Nah, it probably was just a fluke.
I don’t really have too much to say tonight. I just wanted to show that it’s still possible for me to be in a good mood. See—there’s hope for me yet.
Tuesday, May 6, 1986, 9:00 P.M.
I was on last night. What a good time I had! What a wonderful learning experience it was! I had such a good night last Friday, I thought I was actually going to like the rest of my month. I thought it was going to be really quiet and restful. Then I was on last night and now I feel as if somebody dumped a fifty-pound bag of excrement on my head.
And I feel better now than I did a couple of hours ago! At six o’clock I was a genuine basket case! I was ready to manually extract the spleens of each of the chief residents without the use of anesthesia. But then I went over to my grandmother’s. She fed me a nice dinner and calmed me down. Thank God for Grandma! Thanks to her, the chief residents will live another day.
The Intern Blues Page 37
