The Intern Blues (21 page)
Authors: Robert Marion
Tuesday, November 5, 1985
I've pretty much decided that I'd like to go back to Boston for next year, but things still are up in the air. It looks like Karen might get accepted into Columbia's psych program, and that's going to be pretty hard to turn down.
This past week has been really, really hard, with this decision hanging over our heads, and we've both been incredibly stressed out. I'm in OPD
[the Outpatient Department]
now on the Jonas Bronck side, although I spend two days a week here at Mount Scopus for clinic. I've been on call it seems like an inordinate number of times already in the past week; I've already done two every-other-nights and I'm on call again tonight. I'm finding the Jonas Bronck ER a real drag to work in. The nurses are extremely hostile and critical and cold. They're very good nurses, very efficient, and they obviously know what they're doing. They're much better than the nurses in the West Bronx ER, but they all seem to have a chip on their shoulder. I've been told that there's some kind of war going on among them but, hey, you know, that's no excuse. That just makes it a drag for everybody else to work there.
The place is unbelievably busy. I end up getting out at four-thirty in the morning on nights when I'm on call. It's just fucked. You come home, you sleep for three hours, and you're supposed to be back at the hospital for the eight-o'clock teaching conference the next morning. Forget it! It's really unfortunate. I really was looking forward to the Jonas Bronck ER, and I do enjoy the work I do there. The pathology that walks through the door, the patient population, the mix, it's unbelievable; it's fantastic. I'd love it except dealing with all these angry nurses is a real drag!
So far I've been thrown into that fucking asthma room a lot more than I think I should've been. Some of the other interns are going to have to help pitch in with that.
[In the Jonas Bronck ER, all patients with asthma attacks are placed in the asthma room. When things get busy, one house officer, usually an intern, winds up doing nothing but working in the room. That person may see nothing but asthmatics for four or five hours at a stretch.]
It gets really boring in there, seeing the same thing over and over again without a rest. I've already complained about it but I don't think anybody really cares. That's all; I've got to go back to clinic now.
Thursday, November 7, 1985
I'm in the P
2
C
2
[Pediatric Primary Care Center, the pediatric clinic at Jonas Bronck]
conference room waiting for the conference to start. I have to talk quietly or they'll think I'm talking to myself. Nobody else is here yet.
Last night I was so tired, I slept eleven and a half hours straight. I could have slept another five easily. Can't work every-others, they just wear the shit out of you. And on both of those every-others, I worked in the ER till about 5:00
A.M
. Then yesterday I had to work in the ER all day, from nine to five. Jesus Christ, this place is a goddamn zoo!
Karen's been here for the past few days. We're still trying to decide whether to go back to Boston or stay in New York. It's tough, there are a lot of things to consider, but so far it looks like we're both leaning toward going home. They've been really good about it here. Miller knows what's going on, and he's giving me the time I need to decide. He says he wants me to stay. It's nice of him to say it, but does he really mean it?
I've got to stop now; someone just came in.
Friday, November 8, 1985
I'm here in the thirteenth-floor conference room of West Bronx, where the pediatric OPD conference is supposed to be. I got here at eight, and I just found out it doesn't start until eight-thirty, so I'm about twenty minutes early now.
Today's an important day because after long and tedious deliberation, Karen and I have definitely decided to go back to Boston for the remainder of my residency. Karen's been getting internship offers from everybody. Every single place she's applied to is offering her a position. It's hard to turn opportunities like that down, but we've decided to go back. Karen feels she'll be happy at Boston University, the program where she'll wind up going, even though it's not in the same league as Cornell and Columbia.
The important thing that we've decided is that we want to be around family and friends. This year has been so hard for me because of the separation. I don't think internship can ever be easy, but I know I would have been better off had I stayed in Boston instead of coming to the Bronx. Plus, we both think Boston is a nicer and easier city to live in than New York, which is very exciting but also crazy and congested and stressful. So this morning I'm going to call up Scott Thomas, the director at Boston Children's, and tell him I'd like that spot if he's still got it. If he hasn't got it, I'm going to wring his little neck. Then I'll have to call Mike Miller and let him know that I've made my decision. Hopefully I'll get the contract and the whole thing will be signed, sealed, and delivered within the next week or so.
A couple of days ago, I thought for the first time that I'd ultimately like to subspecialize. It's not because I have some burning interest in any one field; I don't really. A lot of things interest me, but there's not any one field I'm that attached to or interested in. I want to subspecialize because I'm tired of being so inexpert at so many things. I don't think I could spend the rest of my life knowing a little about a lot of things, like many of the OPD attendings do. I need to feel like there's one area in which I have a great depth of knowledge. Someone just walked in; I'm going to have to stop now.
Sunday, November 10, 1985
Karen's still here. I'm finding myself getting all depressed again, and I'm not really sure why. I just can't put my finger on it. There's just nothing that's obviously wrong: I'm in OPD, and that's pretty easy, I'm not lonely. Something's just wrong.
I guess one of the reasons I'm depressed is that I made this massive decision about going back to Boston, and now there's a kind of letdown. It's official now: I called Dr. Thomas the other day and accepted the job. And Karen officially turned down Cornell and accepted the place at Boston University. On Monday, Thomas is going to call Mike Miller and discuss it with him, then he's going to call me back and let me know it's all sealed, and that's it! That's it; we're going back.
Last Friday was a horrendous day. I started working at my clinic at Mount Scopus at nine o'clock, and I began the day with a child-abuse case. A patient who requested me because they had seen me in the emergency room once, came in. I saw signs of abuse and reported them. That was a very unpleasant situation; they were very angry, and I can understand why. And then at noon, I went to the Jonas Bronck ER, and I was there until seven the next morning. I was so tired, I fell asleep taking a history! While I was talking to the mother, I just zonked out! Soon as I woke up, I picked it up with the next question I had in my mind, but I knew I had been asleep. The mother was sitting there staring at me with a strange look in her eyes that hadn't been there a second before (because it probably had been several seconds). Then I fell asleep listening to some asthmatic's chest several times. I kept wondering, Why is it taking me so long to get a respiratory rate? Because I kept falling asleep every time I put the 'scope on the kid's chest, that's why! So that was an abysmal night.
I guess all the shit I've been seeing at Jonas Bronck's depressing me a little, too. All the child abuse and the codes and all that, that stuff gets me down. And it's been really cloudy and nasty and rainy, and that doesn't help. And living in the Bronx is just a bore.
And there's something else: I've started to become obsessed that I've got AIDS. I've started waking up in the morning feeling anxious, thinking I'm going to die. That's one of the main criteria for major depression. I've been trying to go and get the test
[blood test for antibodies to HIV]
but I haven't done it yet, initially because if I think rationally about it, there's no reason I should have it, and then because I realize I don't want to find out if I'm positive.
I'm getting a little bit of the feeling I used to have in medical school, that I'm trapped in a prison, and the rest of the world out there is beautiful and happening and I'm not in it. I saw
The New York Times
today; I read the headline saying that the Democrats had taken over the Senate, controlling fifty-five of the seats. I didn't even know there was an election. I didn't know until after it was over. So I feel very much isolated from the mainstream of humanity. And at times I feel like I'm not taking this seriously enough. I mean, each mother brings her kid in and the kid means all the world to her, but to me, it's just another set of wheezing lungs. I try to do my best with each one, I try to think of each one individually and I do, I know I do, but, I don't know, in some ways it all becomes a blurred mass of humanity flowing through the doors of the emergency room.
There are these two kids, I see them all the time, the mother calls me every week, she comes into clinic every week. She's a really good mom, maybe a little neurotic. She has a Down's baby; the other kid's normal. And she's really great. Seems like there are so few other patients and families I'm happy to see, though. That can't be right; you can't just like one family out of the hundreds who come through.
The streetlights are still on. It's the middle of the day but it's so dark that the lights are still on. I'm supposed to go shopping to get my brother and his wife a wedding present. I don't know what the fuck to get them.
Wednesday, November 13, 1985
It's cold outside, it's turning into winter. You can see your breath in the air. I'm still in the OPD. And I'm feeling better.
My depression has gone, for the most part. At least the acute exacerbation. I'm still left with the chronic, smoldering depression I've had since August. It turns out I was also getting sick. Got this goddamn viral syndrome from some kid and now I've got this residual cough.
Monday, November 25, 1985
I haven't talked into this for a while. Karen left yesterday, and when she's here, I usually talk less. I'd rather spend time with her than this machine.
Today's the end of the fifth month. I finished outpatient this afternoon. Tomorrow I start on 8 East at Jonas Bronck. And while part of me is relieved to get the hell out of that ER, which has just been a madhouse, I'm kind of dreading tomorrow because I'm on call and I have my clinic, so it's going to be a dreadful night. I'll be up all night. I'm already sure of that.
But I'm also looking forward to being back to the somewhat protected environment of a floor where I know what my work is. The work's cut out for you, and even if what most of the other interns have said about Jonas Bronck wards is true, that there are too few nurses up there and the nurses who are there don't want to work, in a lot of ways it's better than being out in the unprotected emergency room.
I've been paying more attention to some of the other interns lately. Some of them are a lot worse off than I am. Take Peter Carson, for instance. I've been working with him in the ER. My God, is he an angry man! He makes the rest of us seem like laughing hyenas. I'll give you an example. Saturday we were both on call. It was a horrendous day in the emergency room. The third year resident was Larry Brooks, and he said it was the worst day he'd ever seen in that ER. It wasn't because we had so many terrible things happening. We did have a few kids in the back
[the back: the trauma area of the Jonas Bronck emergency room],
but there weren't any real tragedies that took up a lot of time. It was because of the volume; it just never let up, and there were only three of us working until four in the afternoon when the evening float resident showed up four hours late (ooops). I literally had only ten minutes to eat during the entire nineteen hours I was there. It was exhausting. By 4:00
A.M
. I was just going cross-eyed. I couldn't concentrate for shit.
Anyway, at 4:00
A.M
. we were ready to get out of there, but the triage box wouldn't empty. Finally it got down to two charts. The night float was there, he was all alive and peppy, and we were getting ready to leave, but Larry came in and told us there were a couple more to see and I heard the night float say, “Just give them to the interns and go home yourself.” Well, when Peter heard that, he went completely berserk. He started screaming, “That fucker! Let the interns do it? Let me at him! I'll rip his testicles off, one by one!” He was screaming so loud that everybody in the emergency room could hear him. A nurse came knocking on the door in a second saying, “You know, not everybody out here wants to hear about testicles being torn off!” But Peter was beyond help; he was so incensed, he just kept screaming. We were saying, “Peter, Peter, shut up or we're going to have to call security on you,” and then he kind of calmed down, but only a little. He was wild. And then what ended up happening was that Larry told us to go home and he wound up seeing the last patient himself.
Peter and I split a cab back to our apartment building, and all the way there he was just cursing, saying how much he hates being an intern and how much he hates the ER. He was just absolutely infuriated. But he's back there every day, somehow or other. I guess I'm not the worst off, but I think I'm getting a reputation as being one of the depressed interns.