The Intern Blues (43 page)

“Do you miss medicine?”

“No, not at all. When I started medical school, I really did want to be a pediatrician. But somewhere along the way, I just stopped wanting it so much. Residency kind of beat the desire out of me. And then when my baby died . . . well, that kind of put the icing on the cake. After living through that experience, I just didn't care about medicine anymore. It was just a job, something to do to earn money, and since we didn't need money, there was no need for me to do it.”

Knowing the answer in advance, I asked whether she thought her internship was worth it. “Internship was the second-worst experience of my life,” she responded. “I don't have to tell you what the first-worst experience was, because you were around for that, too. But other than watching your baby die, I can think of nothing I'd want to do less than spending a year as an intern. It was degrading, depressing, and frightening. It brought out the worst in me, in my classmates, in those in charge of the program, in everyone. It was unhealthy, and it was just unfair—unfair to us, unfair to the patients, unfair to society. Back when I was doing it, I couldn't see why I had to do it, and looking back on it now, I still can't understand why I had to do it. So Bob, you can put me down for a ‘no' vote. I don't think it was worth it!”

 

 

And so,
as in so many different events that occurred in this book, we're left with a difference of opinion. Amy Horowitz, who following completion of her training chose not to practice medicine, believes that internship could never be worth the torture she was forced to endure. Andy Baron and Mark Greenberg, however, agree that internship was worth it, because it proved to be a means to an end, the end being a career in medicine. They never would want to go through it again, though.

Something Andy told me during our recent conversation is still reverberating in my head. “Internship is like a bad dream,” he said. “When you're having it, it seems like the most terrifying thing in the world. In the morning, it still seems pretty bad, but in the light of day, the details are blurry and don't make a lot of sense. Then, after a few days have passed, you almost can't remember it anymore. You know you had a dream, you know it was scary, but all the details are gone.”

I think that's how most physicians remember their internships.

Glossary

abruptio placentae
Separation of the placenta from its attachment on the wall of the uterus. Dangerous because it deprives the fetus of oxygen.

acidosis
Buildup of acid in the blood.

acute abdomen
Term used to describe condition in which an abdominal catastrophe is occurring. Causes of acute abdomen include ruptured appendix, and inflammation of the pancreas and gallbladder.

agonal rhythm
A pattern of electric activity generated by the heart just prior to death.

A-line
Abbreviation for arterial line, a tube placed in an artery used for sampling blood.

ALL
Abbreviation for acute lymphocytic leukemia, a common form of childhood cancer.

AMA
Abbreviation for “against medical advice,” the situation in which a patient signs out of the hospital before his doctor considers it safe to do so.

ambubag
A device used to force air into the lungs; consists of a mask that covers the mouth and nose and a rubber bag that, when squeezed, generates a gust of air under pressure. Used in respiratory arrests.

aminophylline
Drug used for treating asthma.

aneurysm of the ascending aorta
A ballooning out of the aorta, the main artery bringing blood to the baby.

antecubital vein
A vein at the elbow that usually is most accessible for blood drawing.

APGAR scores
A scoring system, designed for use in the newborn, that monitors fetal and neonatal well-being. Maximum score is 10.

ARC
Abbreviation for AIDS-related complex.

ARDS
Abbreviation for adult respiratory distress syndrome, a condition in which respiratory failure occurs.

argininosuccinicaduria
A rare inborn error of metabolism that leads to mental retardation and often to premature death.

aspiration
The act of breathing in; aspiration pneumonia results from the breathing in of foreign substances, such as meconium in the newborn.

atelectasis
Collapse of the lung.

ATG
Abbreviation for antithymocyte globulin, a drug used in patients who are rejecting transplanted organs.

bagging
The act of forcing air into the lungs of a patient having difficulty breathing.

BCW
Bureau of Child Welfare, the New York State agency charged with investigating and acting upon cases of suspected child abuse.

Benadryl
An antihistamine used in treatment of allergic reactions.

beta HCG
A blood test to diagnose pregnancy; more accurate than a urine pregnancy test.

bicarbonate
A drug used in patients with acidosis (
see above
).

bladder tap
Procedure in which a needle is passed through the lower abdominal wall and into the bladder so that an uncontaminated sample of urine can be obtained.

blood gas
A test done on a sample of arterial blood that tells the amount of oxygen and carbon dioxide within the body.

bradycardia
Abnormal slowing of the heart rate.

bronchiolitis
Inflammation of the bronchioles, the small air passages leading to the lungs. This is a condition that resembles asthma and occurs in children under a year of age.

bronchopleural fistula
A leak in the main air tube that causes air to leak into the pleural cavity, causing a tension pneumothorax.

BUN
Abbreviation for blood urea nitrogen, a substance that builds up in renal failure and in dehydration.

CAC
Abbreviation for “clear all corridors”; a general request, announced over the loudspeaker, for help at a cardiac arrest.

cadaveric transplant
A transplant performed using an organ obtained from a person who has died.

cardiac cath
A procedure in which a catheter is placed in an artery or vein and threaded up to the heart, at which point a dye is inserted. Used to define the nature of heart disease.

CBC
Complete blood count. A blood test to examine the content of hemoglobin, red blood cells, and white blood cells within a sample of blood.

central line
A tube placed in one of the major blood vessels, usually in the neck or the groin.

cervical adenitis
Swelling of the lymph nodes of the neck.

chemo
Short for chemotherapy.

chief of service rounds
A weekly conference in which an interesting case is presented and discussed by an expert in the field.

choriocarcinoma
A cancer that develops from a molar pregnancy.

CIR
Committee on Interns and Residents, the house staff union.

CP
Cerebral palsy, an abnormality usually caused by lack of oxygen around the time of delivery.

CPR
Cardiopulmonary resuscitation; technique used at cardiac arrests to keep the patient alive.

cracking the chest
The surgical opening of the chest wall to gain access to the heart and lungs.

creatinine
A substance in the blood that's elevated in cases of kidney failure.

crump
To deteriorate rapidly.

CSF
Cerebrospinal fluid, the liquid that bathes and protects the brain.

CT scan
An X-ray procedure; most CT scans examine the head, looking for specific defects of the brain.

cutdown
A surgical procedure in which a vein is isolated and a tube is placed into it for access. Used when no superficial veins can be found.

CVA tenderness
Tenderness at the costrovertebral angle, the area of the back under which the kidneys are situated. CVA tenderness is present with many types of renal disease.

cyanosis
Blue discoloration of the skin usually due to lack of oxygen in the blood.

dactylitis
Swelling of the hands and feet; usually the first presentation of sickle-cell disease in an infant.

DKA
Diabetic ketoacidosis; a severe metabolic abnormality that occurs in diabetics who have a marked buildup of sugar in their blood. If not cared for correctly, it may lead to death or brain damage.

DNR
Do not resuscitate.

double footling breech
Condition in which baby is heading out of the birth canal feet first; dangerous because there's a chance the fetal head can get caught, leading to the baby being unable to be born.

DPT
Two meanings: (1) immunization given to young children that protects against diphtheria, pertussis (whooping cough), and tetanus; (2) a mixture of Demerol, Phenergan, and Thorazine used to sedate children who are having some painful procedure.

dual response
Procedure used in cases of child abuse in which the child is considered to be in danger. The police and the BCW (
see above
) are informed, and an immediate investigation is carried out.

dysplastic kidneys
Condition in which the kidneys did not form normally and therefore cannot function well. Often leads to chronic renal failure.

E. coli
A type of bacterium.

ectopic pregnancy
A pregnancy occurring in a location other than the womb.

EEG
Electroencephalogram; a test in which the electric activity of the brain is examined.

EMS
Emergency Medical Service; the agency that staffs the ambulances.

endotracheal tube
A tube passed through the larynx and into the main breathing tube that allows the individual to be placed on a respirator.

epinephrine
A drug used in patients whose hearts have stopped beating.

ER
Emergency room.

extramural delivery
Delivery of a baby that occurs outside of a hospital.

fascinoma
An interesting case.

febrile seizure
A convulsion caused by a marked elevation in fever.

FFP
Fresh frozen plasma; a part of the blood that sometimes is used as a transfusion.

FIB
Fever in baby; all babies under two months of age with fevers should be admitted to the hospital and treated with antibiotics.

Foley catheter
A tube that has an inflatable balloon at the end; Foleys usually are passed into the bladder to help monitor urine production.

fundoplication
A surgical procedure used to correct gastroesophageal reflux (GER—
see below
).

gastrostomy
A surgical procedure in which a hole is made in the abdominal wall and the stomach so that feeding through a tube can be accomplished without the patient's having to suck and swallow.

GC
Gonococcus, the bacterium that causes gonorrhea.

GER
Gastroesophageal reflux, the regurgitation of stomach contents back into the esophagus.

gonococcus
The bacterium that causes gonorrhea; also known as GC (
see above
).

gram-negative rods
The appearance, under the microscope, of certain bacteria when stained with dye using a special technique.
E. coli (see above)
is the most common form of gram-negative rod.

G-tube
A tube placed through the opening of a gastrostomy and through which blenderized food is squirted.

guaiac
A test looking for blood, usually in a sample of stool.

Haldol
A drug used in patients with psychosis.

H and P
History and physical; the admission note that must be completed on all patients staying in the hospital overnight.

headbox
A Plexiglas box that fits over the head of an infant and through which oxygen in high concentrations can be administered.

hemifacial cellulitis
Infection of the skin on one side of the face.

hemoptysis
The coughing up of blood.

HIV
Human immunodeficiency virus; the agent that causes AIDS.

hydrocephalus
Dilatation of the ventricles of the brain, which can lead to increased intracranial pressure.

hyperbaric chamber
The center on City Island in New York City where the barometric pressure can be increased. Patients who have inhaled smoke and have a high level of carbon monoxide in their blood are sent there for treatment.

hypoxia
A deficiency of oxygen in the blood. May lead to brain damage.

infantile spasms
A particularly severe and damaging type of seizure disorder.

interosseous infusion
Procedure in which fluids or drugs are injected into the bone; used in dire emergencies when an IV cannot be started.

intracardiac infusion
Procedure in which drugs are injected directly into the heart; used as a last-ditch effort to save a patient's life when IV access cannot be established.

intracranial bleed
A hemorrhage into the brain; usually causes brain damage or death.

intubation
Procedure in which an endotracheal tube (
see above
) is inserted through the vocal cords and into the main breathing tube.

Isuprel drip
Constant infusion of isoproterenol, a drug used in severe asthma.

IVDA
Abbreviation for intravenous drug abuser.

kerlix
Rolls of bandages, often used to restrain little children.

KUB
Abbreviation for kidneys, ureter, bladder; a type of X ray in which the abdomen is examined.

Lasix
A diuretic drug used in hypertension and heart disease.

lidocaine
A local anesthetic.

LMD
Abbreviation for local M.D. The patient's private doctor.

LMP
Last menstrual period. Important because it's used to determine how premature a baby is.

LP
Lumbar puncture; a procedure in which a needle is inserted through the back and into the spinal canal so that a sample of CSF (
see above
) can be obtained for study. Also known as spinal tap.

main-stem bronchus
One of the two main tubes connecting the trachea and the lungs.

M and M conference
Morbidity and mortality conference, a teaching exercise at which a patient who has died is discussed.