Month: January 2009

Intern’s Journal–Surprises

Jennifer Reckrey

Editor’s note: Jennifer Reckrey is a family medicine resident in New York City. Each week while she was an intern, Dr. Reckrey recorded some of her experiences as a brand-new doctor. Today’s stories are from weeks number nine and twenty-five.

Week Nine

I dreaded my rotation in the Intensive Care Unit. Though all the tools to keep a body alive are right there, their continuous bells and beeps jangle my nerves. I’m always afraid that in this place I will be called on to act decisively and invasively. And my mind will go blank. I will hesitate, and that hesitation will make an already awful situation worse. But even more than that, I dreaded this rotation because I think of the ICU as a dead end–a place you don’t leave alive, or if you do, it’s as a shadow of your former self.

So when I met my first ICU patient–a sixty-year-old woman with metastatic lung cancer, intubated for respiratory failure after a routine chest-tube placement–I imagined the worst. 

She was fully conscious and mentally sharp. For the first two days I cared for her, she was very stable. But she wasn’t improving–any time we turned down …

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Chemo? No, Thanks

Elaine Whitman

“If I were you,” said the radiologist, as I sat on the gurney discreetly wiping goo from my right breast, “I’d make an appointment with a breast surgeon as soon as possible.” His somber tone of voice, the white blotch radiating ugly spider tendrils on his ultrasound screen…neither of these made me nervous. If anything, I felt mild interest: “How very odd. He must think I have breast cancer. Or something.”

Ten days later, after a lumpectomy and sentinel lymph node biopsy, my husband and I sat in the breast surgeon’s office. “I’m so sorry,” he said. “You have Stage IIb breast cancer. There’s a 1.1 cm tumor in your right breast, and the cancer has spread to three of your lymph nodes.” 

I looked first at his solemn face, then around the room. Who was he talking to? I believe the psychological term is “dissociation”: a defense mechanism against painful emotions. Oddly, I didn’t feel particularly frightened–just very, very tired. Neal drove me home and I took a five-hour nap. 

When I woke up, I realized it was true. I had breast cancer. 

Three days later, barely recovered from the lumpectomy, I had a second surgery to …

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Apologies

Alex Okun

You were right.
That IV was no good.
Looking at his arm all swollen like that,
I thought, “That says it all.”

I’m sorry we kept bothering you.
“Please don’t wake him for vitals,”
You told us.

Sometimes we don’t see the signs.

I was hoping she would stay home longer,
That you would have had more time together.
She liked starting school every September.
She loved that backpack.

I’m sorry it always took so long
To get into the room.
I’m sorry I took so long to call you back.
I liked our long talks.

If I say “we,”
Then maybe I’m not to blame.
We don’t know why some children
Develop this complication.

We don’t know why
The brain is so fragile,
Yet so enduring.
That’s not very nice.

We don’t know why
It happened.
I know you had some ideas.
So did they.

Remember the time
We didn’t start the dopamine?
She pulled through that fine,
Amused at our discussions.

Or the time
We got the antibiotics started so fast,
And his blood culture grew out
Only a few hours later?

Those storms down South were nothing
Like what hits you every day.
The levees …

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First Night Call

Abby Caplin

During my first night on call as an intern, I felt scared. Not just scared–terrified. I was serving on the medical center’s pediatric oncology floor, and medical school hadn’t prepared me for children with cancer. What did I know about cutting-edge chemotherapy regimens? What if a child suddenly developed an overwhelming infection or a seizure triggered by a tumor? Someone would expect me to know what to do.

“It’s okay,” said Brad, the second-year resident. “The nurses do everything. You just treat the kids’ hypertension.”

“How?” I asked.

“Hydralazine,” he answered, glancing at his watch. He looked tired and ready to split. “Ten to twenty milligrams IV every four hours.” When I looked up from my hasty scribbling, he was gone. I was alone.

For reassurance, I touched the small but reliable pediatric handbook in my white coat pocket. My other pocket was stuffed with index cards, each labeled with a patient’s name, diagnosis and quantities of information written in my tiny print.

I looked down the hall towards the spill of light at the nursing station, the darkening corridors lined with rooms of sick children all trying to sleep–or at least not vomit from the chemotherapy.

I …

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Snowscape

Jeffrey R. Steinbauer

The snowstorm had started on Friday, before I’d gone on call for my group. At first I’d thought the weekend would remain quiet, that the small town where I practiced might just slumber under a fresh blanket of snow. But by early Saturday morning, things had gotten busy at the hospital. Several emergency-room visits, phone calls and admissions from the nursing home changed the stillness I’d felt amid the snowfall. In no time, there was the familiar stress of trying to bring order to a day that was rapidly becoming chaotic. 

Sometime that afternoon, I looked up from a chart to see the town sheriff standing at the nursing station. Although we were acquainted through weekly Rotary Club meetings, he now was barely recognizable–bundled in heavy winter clothing, his head covered by a parka hood. Flakes of snow lingered on his jacket and caked his boots. Beneath the hooded parka, his eyes were severe and his face ruddy; together they broadcast an unspoken weather report. He was not smiling.

“Doc, we need you to come with us,” he said.

This was an unusual request, coming at an inconvenient time. There was much to be done–phone calls to …

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