Intern (16 page)

I arrived on the floor at six forty-five to find Rohit, a second-year resident, sitting at the nursing station. He was a short Indian man with a bright, open face and a broad, insincere smile. He looked like someone I might have avoided at my parents' kirtans (prayer meetings) when I was growing up.

“You're late,” he said, checking his digital watch. “We have to pick up night-float admissions at seven o'clock.”

“Yes, I know,” I said, hovering in the corridor.

“All right, hurry up and see your patients,” he snapped, turning back to the computer. “You've got fifteen minutes.”

I went down the hall to the first room, which was filled with the stale effluvium of sleep. Michael Harrison was a typical patient on 10-North, an emaciated black man of about seventy who was on dialysis for end-stage kidney and heart failure. His neck was sinewy, his arms pencil-thin. His temples were bony, yet full at the forehead, imparting an intellectual look. Short wispy hairs were growing out of his chin. His skin looked like it was frosted with ice, probably a sign of kidney failure. It was obvious that he had once been handsome.

I said good morning. He opened his eyes slowly, nodded, and then closed them again. It was early; he wanted to sleep.

I asked him how he was feeling. “Okay,” he mumbled. I pulled
down the blanket that was covering his body. A catheter filled with dark, reddish brown urine the color of beer passed through the end of his shriveled penis. I pressed gently on his edematous legs, leaving tiny craters with my fingertips. “You're going to get more dialysis today,” I said. He opened his eyes. “Not today, I ain't goin',” he said, shaking his head. “They took me upstairs yesterday and they left me on the machine two hours longer. They said three hours and then they did five. They said I be back in three hours but I ain't come back.”

“Well, maybe they needed to take out more fluid,” I said.

“No, that ain't what it was,” he replied, shaking his head. “They was just foolin' around. In that dialysis room, all they do is drink beer.”

“I find that hard to believe.” Mr. Harrison was always making such claims.

“Yeah they do. I think so, at least. Probably smoke pot, too. I told one of the aides there, ‘I'm goin' to speak to your manager.' He didn't care. He just laughed.”

He coughed, and then cleared his throat loudly. His head moved searchingly from side to side. I picked up a box of tissues and offered him one, but he had already raised the bedsheet to his lips and wiped his tongue of the phlegm. It was thick and green and coagulated, with a pinkish tinge, and it stuck to the sheet like a thick gob of glue. I swiped a handful of tissues and wiped the sputum off the bedspread, trying to avoid looking at it.

“Nobody cares,” he continued philosophically. “Nobody wants to bother with you when you're like this. They go on past you, they don't care. They say, ‘I'll be back,' but no one come back. I need pills, but they don't care. Yesterday they gave me nothing to eat.”

“Why? Did you have a test?”

“No.”

“So why didn't they bring you a tray?”

“I don't know,” he replied, exasperated. “They overlooked it.”

I glanced at my watch. It was ten minutes to seven. “I'll come by to see you later,” I said.

“Can you turn me over?”

“I can't do it right now,” I replied automatically. “I'll tell the nurse to come in.”

“You can't just turn me over? The nurse said she couldn't do it; she didn't have the time.” I looked over my list. Rohit was surely going to give me a hard time if I didn't at least get my patients' vital signs before rounds.

“All right,” I said, putting down my sheet. “I'll turn you over.” I lowered the bed rail. His body lay crumpled on the bedsheets. I reached around him, wedging my hand under his moist armpit, and scooted him up in the bed so that his head reached the pillow. Then, with my other arm, I reached under him and spun him onto his side.

“That's better,” he said. “If you ain't been through this, you don't know what it's like. The nurses tell me I ain't allowed to sleep on my stomach. It's the regulations, somepin' about it's against the law. But I can sleep on my stomach if I want to. It's my body.”

I nodded impatiently.

“All peoples are human,” he continued, like a man who had seen his share in the world. “It don't matter if you white or black or a foreigner like you. It don't matter. We all human. Everybody deserve to be treated right. Not like this. You ask them, ‘Can you turn me over?' and they say, ‘Go to sleep; just go to sleep.' I say, ‘I can't go to sleep. My butt be hurtin', how am I supposed to sleep?' ”

I shifted on my feet. I had to get out of the room.

“What day is it?” he asked.

“September 8,” I replied.

His eyes glimmered. “It's my birthday.”

“Oh,” I said, pleasantly surprised. “How old are you?”

“Six . . . nine.”

“Sixty-nine?”

“No, six . . . plus . . . nine.” He smiled devilishly. “I'm fifteen years old.”

Outside, I jotted down a few notes. The encounter had taken almost fifteen minutes. At the rate I was going, I'd have to start coming
in at five o'clock to preround. I immediately dismissed the thought. Why ever go home?

At the nursing station, Alphonse and Rohit were waiting for me. “Did you know that it's Mr. Harrison's birthday?” I said. “Nice,” Rohit replied, turning away. “Tell the nurses to give him something.”

We walked down the long hallway to the stairs. Up ahead were the resident call rooms. Through a window, off in the distance, I could see a smokestack, a few skyscrapers, and the Triborough Bridge. Every morning I would spend a few moments staring out at the bridge, watching real life go on. It reminded me of the Bay Bridge in San Francisco, and looking at it reminded me of my old life. The view was both sad and something that I relished.

We headed downstairs to the conference room to pick up our admissions. Rohit took the scuffed gray steps two at a time as Alphonse and I followed. We exited the stairwell on the fifth floor and took a shortcut through the oncology unit. The atmosphere here was quieter, more sedate. The ward smelled of disinfectant, unlike 10-North, which always had a musty odor. We marched through double doors, entering a carpeted back hallway where a fax machine had printed out the admission list by ward and resident team. We picked up a sheet.

In the conference room, the night-float residents were presenting cases as the ward teams, arranged in small groups, took notes. “This is a lady that's a soft admit because she's a VIP,” said a resident. “This guy's a two-pack-per-day smoker for thirty-five years and we're putting him up in a two-thousand-dollars-a-night hotel room,” said another. In one group, a team giggled as a resident explained how he was trying to arrange a CAT scan for a morbidly obese patient by transferring him to the Bronx Zoo, where they had a scanner for elephants and other large animals. Cynthia, a classmate, came over to say hello. “Rumor has it you don't preround,” she whispered. I was stunned; who had been talking? “I preround,” I protested. “Just not on every patient.”

After picking up our admissions, we hurried back to the floor. Precariously resting our coffee cups on the wooden banister outside each
room, we made rounds. Since Alphonse had managed to preround on all his patients, he had a lot more to say than me.

One of his patients was Peter DiGeorge, whose room had the rank odor of morning breath. “He has that HIV look,” Rohit said out of earshot. When I asked him what that meant, he just looked at me and shrugged, as if it required no further explanation. At the bedside was a wooden table with drawers, and on the far side of the room were light pink curtains framing windows overlooking the central atrium. Di-George had been admitted to the hospital because of tiny blood clots that were seeding his skin. He had a broad nose, a high, arched forehead, and a beard that looked like a patch of ragweed. In deportment and appearance, he resembled a boxer dog. Two gold teeth jutted out of his mouth like fangs. His goatee, complemented by his arch eyebrows, gave him a sinister look. He was wearing large aviator glasses that partially obscured crusted lesions around his eyes. When he opened his mouth, I could see it was coated with large white plaques of
Candida fungus
, an opportunistic infection often seen in AIDS patients. Rohit exposed his legs, which looked like the surface of a blueberry muffin. The bluish spots culminated in a large round one above the right ankle, which was about a centimeter wide, with red and black crust, exuding pus. With his bare hands, Rohit pushed on the sides of it, and DiGeorge winced. Rohit had taken a Polaroid of the lesion yesterday to present at morning report with Dr. Wood. When DiGeorge had asked for a copy, Rohit had promised to make him one, but we never did. “We're going to continue your antibiotics,” Rohit told him. “Nothing new today.”

Our next patient was a tiny man who had lost both his legs in a car accident several years earlier. Despite his devastating disability, he was fairly spry. Above his bed, which had a special mattress to prevent bedsores, was a pulley contraption, which he immediately grabbed with his unusually muscular arms to help himself up. As he leaned forward, holding on to the metal handlebars, Rohit pointed out a pressure ulcer on his upper buttocks, which looked infected. On his abdomen was a stapled wound from a recent gallbladder operation. Again with his
bare hands, Rohit pressed on it, trying to see if it was tender, which it wasn't. The patient pointed to a tiny bulge under the skin of his abdomen. “What is this?” he asked.

Rohit rubbed over it with his fingers. “Maybe a gallstone.”

“But they took my gallbladder out.”

Rohit shrugged. “Call Surgery and have them take a look at it,” he told Alphonse. Then he tapped on the man's stumps and walked out, Alphonse and I following in step.

In the hallway, I looked over at Alphonse and made a face. The thought of all the resistant microbes in the room—perhaps even on my skin—was making me queasy, and I was disgusted by the fact that Rohit hadn't washed his hands. “Wash your hands, dude,” I said before we moved on. Rohit gave me a withering look. “Oh, I guess I forgot,” he said.

My team had several Russian-speaking patients. They always insisted on talking through interpreters, but there was never anyone around who spoke Russian. On rounds, we managed to get by with a few miscellaneous words, like
balit
, rubbing our chests or abdomens or pointing to our temples to inquire about pain. We often promised to come back to talk to these patients, but we rarely did. By the time an interpreter showed up, you were done with your notes and had already written orders and made a plan for the day, without any verbal input from the patient.

We went to see my night-float admission. Agnes Lahey was an obese woman of about seventy with a large broad face and a mouth that was missing several teeth. She was wearing dark, horn-rimmed glasses, a steel bracelet, and several rings, even though jewelry was supposed to be put away by the nurses for safekeeping. She had the overweight, sweaty look of a trailer-park queen.

Rohit had described her as a “social admit,” a “frequent flyer,” and, in fact, this was her eleventh hospital visit, including visits to the ER, in the past six months. Social admissions were a significant percentage on 10-North. The hospital, we were told, nearly always lost money on these patients. “Utilization reviewers”—hospital spies, basically—would
continually check with us to make sure we were getting these patients out in a timely manner.

Lahey met all the demographic criteria for the type of patient who is often a social admit. She was elderly, a widow, with a long list of chronic medical problems, including diabetes, hypertension, arthritis, perhaps even a touch of dementia. She was a retired hospital cook whose husband had died in a “personal fight” about ten years ago. Now she was living with her daughter and granddaughter in a small apartment on Seventy-seventh Street. A social worker had written that in the summertime, Lahey frequently came to the hospital complaining of heatstroke. The hospital had even bought her an air conditioner to prevent repeated visits to the ER.

When I asked her why she was in the hospital, she said that she slipped while walking with a cane in her house and fell into her cat's litter box. “I went to three hospitals before I came here,” she said. I asked which ones. “One was St. Charles . . . or St. George . . . or some such saint. Another was—” She stopped.

“St. Luke's?” I said.

“No, it was a funny name.”

“Presbyterian, Bellevue . . .?”

“No, those are natural names. I think it started with an
S
.”

“Southside?” I said.

“Yes, Southside,” she replied hesitantly. “Yeah, I think that was the name.”

I took my stethoscope out of my coat pocket. “Everyone here keeps saying I want to be here,” she said. “But I don't want to be here. I hurt my hip falling down and now I can't walk. I hear what people say. They say, ‘I wish she wouldn't come around so much.' It makes me feel really rotten, real bad. I'm here because I need to be here. I don't get a thrill from it.”

I lifted the edge of her diaper to inspect her hip. A rancid, fishy smell wafted into my nostrils. “Years ago, the hospital was very good,” she said as I took a step back. “You could call a nurse and ask for this, that, and the other, and you got it. Don't get me wrong, I like it here.
People are more friendly in the hospital than on the outside. I'm just saying that the old hospital was much better. People had more time for you. The food was pretty good, too.

“Look here.” She pointed to her IV, which had a half-filled syringe attached to it. “The nurse came in to give me an injection and she just left it here. She said she'd come back but she didn't. She was flushing the IV and then she went off, said she had something else to do. I just noticed it. It's hard to get something, sometimes. They're always doing something, the nurses.”