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A few days ago was the start of internship for a few thousand lucky young physicians. I happened to see a group of the fresh-faced men and women walking down the hall. They were all dressed in white with broad smiles and wide eyes. They looked exactly like...
Sheep to the slaughter.
I vividly remember the first day of internship. "Finally," I thought, "some RESPECT!" No more "this is our medical student, he's going to observe." No sir, I was a DOCTOR...an MD... a PHYSICIAN. I was going to change the world.
I arrived to take call at San Francisco General. I was dressed head to toe in freshly starched white linen (as the residents did at Duke). My trembling hands betrayed an otherwise convincing facade of confidence. Rounds were to start on Ward 5C. My fellow intern on the team was Jeff, a very friendly guy from Dartmouth. We exchanged pleasantries and met our resident who led us down the hall to meet our new patients.
"Mo, you can take Mr. Smith here. He's a 30 year-old homeless IV drug user who was admitted to the medicine service after he did some heroin and fell asleep in the same position for about 24 hours. He ended up getting rhabdomyolysis and developed renal failure. While he was being dialyzed, he was, unbeknownst to us, shooting heroin into his dialysis catheter. He ended up with a line infection and then developed endocarditis. He is now on day 3 of a 28 day course of nafcillin. He has a personality disorder and was given a dishonorable discharge from the military so he's not elligible for transfer to the VA. He's affectionately known as "the Creach".
Jeff was given a female patient which much the same history as Creach. It was my turn to take the next hit.
"Mr. Jones is a 56-year old homeless diabetic alcoholic. He never takes his insulin. He's been admitted to the ICU 20 times this year with diabetic ketoacidosis. He has chronic pancreatitis and is dependent on opiates. He has been kicked out of every shelter in the city for drinking. He's been arrested a bunch of times but the jail can't take care of his diabetes. Last time he was arrested, he purposely took an overdose of insulin, had a hypoglycemic seizure and shit in the police car. So, they brought him here. That was three days ago. He was never in the military because of his diabetes so we can't transfer him to the VA. He's exhausted his social service options. Good luck."
I felt like Charlie Brown in that Halloween special where everyone gets candy and he gets a bunch of rocks.
Jeff took the next patient. I don't recall the details, but he was bad enough to have acquired the label "red-hot eye poker" from the previous interns.
My turn.
"Mr. Doe just got to San Francisco from Albany, New York. He travelled ten days on a Greyhound bus. He came to the ER shortly after arrival because of cough and shortness of breath. Workup revealed bilateral hemopneumothoraces. The sputum stain showed sheets of acid-fast bacilli, most likely Mycobacterium tuberculosis. We figure he's exposed a couple of hundred people along the way. We are trying to track them down. He needs at least two weeks of inpatient therapy. Oh...he's homeless and he's not a veteran. No shelter in the city is going to accept him."
Just then, the resident's beeper sounded "8059...8059". It was the ER, better known as the "male ward". An admission was awaiting us. I followed my resident down to receive our gift from the senior resident.
We arrived to find a surreal scene. The male ward was a room about forty feet long and twenty feet wide. Nine gurneys lined the room, separated by pea-soup green curtains. Every bed was taken. The place smelled horrible. I had avoided porta-potties that smelled a whole lot better than this place. At the end of the room was a 3 by 6 foot desk behind which sat the male ward resident. He was eating an Egg McMuffin. He looked up and pointed to the third bed. "White skin, black stool," was all he said.
My resident took this to mean acute upper GI bleed. He strolled over and began to take a history. "Hi, I'm the medical resident and I need to ask you a few questions. First, are you a veteran of the armed forces of the United States? No. Well, have you been seen at any clinics which admit patients to the Family Practice service? No. Do you have any insurance? No. Well sir, I'm afraid we'll have to put a few tubes in you now."
I pulled my resident aside to ask whether more history was in order. That's when I discovered his genius.
"What are you gonna ask him? 'Do you drink? Do you take aspirin? Has this happened to you before? Do you have liver problems?' No matter what his answer, you're gonna order the same tests and call the GI fellow to scope him. So, let's get two IV's and an NG Tube in him and get upstairs before the cafeteria stops serving breakfast. Now, go stick your finger up his ass so we can get outta here."
We got upstairs at 9:28, two minutes before the doors were closed. However, my resident's joy at making it to breakfast was short-lived.
"God dammit...no fucking Frosted Flakes. Have you ever tried to eat this Kellogg's All Bran shit? It should be renamed Kellogg's Super Colon Blow. I can't eat this. I'll be on the crapper all day. I still haven't recovered from the last bowl. I'm gonna get some bacon. It's not gonna be a good day."
The next 36 hours blurred into one really bad experience. I learned never to wear white at SFGH again. I left the hospital at 8PM the next day to discover that my car had been broken into and my stereo had been stolen.
Only 363 more days of internship were left.
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