Sandeep Jauhar - Intern: A Doctors Initiation

intern

A DOCTORS INITIATION

SANDEEP JAUHAR

FARRAR, STRAUS AND GIROUX NEW YORK

FARRAR, STRAUS AND GIROUX
18 West 18th Street, New York 10011

Copyright 2008 by Sandeep Jauhar
All rights reserved
Distributed in Canada by Douglas & McIntyre Ltd.
Printed in the United States of America
First edition, 2008

Portions of this book originally appeared in different form in The New York Times, The New England Journal of Medicine, and The Lancet.

Library of Congress Cataloging-in-Publication Data

Jauhar, Sandeep, 1968

Intern : a doctors initiation / Sandeep Jauhar. 1st ed.

p. cm.

Includes bibliographical references.

ISBN 13: 978-0-374-14659-7 (hardcover : alk. paper)

ISBN-10: 0-374-14659-4 (hardcover : alk. paper)

1. Jauhar, Sandeep, 1968 2. Medical studentsUnited StatesBiography. 3. Interns (Medicine)United StatesBiography. 4. Residents (Medicine) United StatesBiography. I. Title.

[DNLM: 1. Jauhar, Sandeep, 1968 2. PhysiciansPersonal Narratives. 3. Internship and ResidencyPersonal Narratives. WZ 100 J4095 2008]

R154.J39 A3 2008
610.92dc22
[B]

2007009161

Designed by Gretchen Achilles

www.fsgbooks.com

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This is a work of nonfiction. The author has changed the names and identifying characteristics of most people. Dialogue is recounted from the authors memory.

FOR SONIA, RAJIV, AND DAD
BUT MOST OF ALL, FOR MOHANALWAYS, ALWAYS

T he cardiac monitors are whistling like blowpipes and the ventilators are playing the kazoo. I pull open a sliding glass door and close it behind me. In the dark, I can barely make out the patients face. It is delicate, wrinkled, almost peaceful. The ventilator that has sustained her for nine days sits unplugged in a corner, next to a small aluminum sink and a pullout toilet. Clear plastic bags of medicated fluids are hanging on a metal pole next to her bed. On the wall is a cheap print of a coastal village with yachts floating on azure blue water. I gaze at it for a moment. Right now, at four oclock in the morning, it seems impossibly far away.

The data from the monitor swirl in my head like a maelstrom. Im not sure what it all means, but I do know that right now the patients blood pressure is normal and her heartbeat is a regular picket fence. I sigh, relieved. Nothing more for me to do tonight.

Then she opens her eyes. Welcome, Doctor. Will you have a drink? She points in the dark toward the fully stocked bar. You know where everything is. And fix me one as well.

I ask her where she is. My apartment, she replies, bewildered. She seems to know nothing about being sick or in the hospital.

I stare at her quietly. Its too much trouble for these people, she says.

Which people? I ask.

The people... People... Its too much trouble.

I assume she means the nursing staff. Are they coming into your room? I ask.

I dont know, she replies. Coming here, coming there... coming anyplace.

The monster has come back. Only hours earlier it took up residence in Mr. Schilling down the hall. I found him sitting at the side of his bed, his sheets soaked with blood. Get me out of here! he roared. Youre keeping me here against my will. The head of his penis was lacerated. A nurse explained that he had pulled out his catheter.

You cant keep me here! I dont belong in jail. Earlier he had spoken to me quite normally of his grandchildren and his country club. Now he was a raving lunatic.

I am a doctor! I shouted, grabbing the lapels of my white coat. This is a hospital, not a jail!

It is a jail, he cried, and you are the warden!

I ordered him sedated, and though I was confident that he would soon be his normal self again, I stopped outside his room to ponder what Dr. Carmen had told us residents that morning. Get this patient out of the unit as soon as possible, he warned. People like him dont do well here.

No one could ever say what exactly caused the monster to appear, but something about the environment of the intensive care unit makes some people lose their minds. Perhaps it is sensory deprivationbeing kept in a windowless room, away from family and familiar things. Or perhaps it is the sensory overloadbeing tethered to noisy machines running all day and night. Perhaps it is sleep deprivation or pain. I had read about brainwashing experiments on American POWs: in environments of intense isolation and immobility, they often experienced psychotic reactions. But that was the jungles of Southeast Asia. This is a respected hospital on the Upper East Side of Manhattan.

I wish I could be a better host, but Ive been under the weather, my patient explains, and I nod cautiously. For a moment I wonder whether perhaps I am the one who is hallucinating. Maybe she is sitting in her living room. Maybe I am about to pour her a drink.

Youve been sick, but youre getting better now, I tell her, hoping to jog her memory.

She looks through me. Even in the gray light, her eyes appear bloodshot. Yes, Doctor, she says. Now please fix me that drink.

I squeeze the bag of saline hanging next to the bed. Thank you, she says sweetly, and then goes off to sleep.

I head back to the conference room. Through a window the moonlight is shimmering off the East River. A barge floats by, loaded with crates. The steady current provides comfort, especially now, the nether time, when it is too late to go to sleep and too early to be awake.

The door to the conference room closes behind me like a trapdoor. I dim the lights; in the middle of the night, bright lights are almost unbearable. I gaze at the grid on the whiteboard. Twenty beds, eighteen patients, a nearly full unit. Scribbled in each square is a list of scut work. Still so many tasks to finish. Still so much to do before morning rounds.

I can hear the alarms behind the door. Some are low-pitched, like the sounds a head submerged underwater would make: glug, glug, glug. Others are high-frequency chimes. Sometimes they ring out of sync, like dueling banjos. Out of the din I hear the Berkeley Campanile announcing the turning of the hour. It is a sound from a different time, a different place. I am surprised that I still remember it.

I start running around the conference table, hopping up and down, shadowboxing. My fists are furiously pumping up and down as I fling away the tension that has accumulated over the past few weeks here. I am running, runningnow sprinting. My legs seem to possess a spirit of their own. I am back on the Fire Trail, racing around the reservoir, punishing my calves on the steep, crevasse-ridden hills. Now I am slipping on the polished tile floor, punching stiffly at the air while Sympathy for the Devil plays in my head. I am running, running, trying to escape: the patients, the monster, this hospital, this life. Perhaps Mr. Schilling was right. Perhaps this is a prison. Perhaps we are all being kept here against our wills.

I dont know how much more of this I can take.

The education of a doctor which goes on after he has his degree is, after all, the most important part of his education.

JOHN SHAW BILLINGS, THE BOSTON MEDICAL AND SURGICAL JOURNAL , 1894

E very profession has an apprenticeship, and the apprenticeship in medicine is called residency. The first year of residency is known as internship, when new medical school graduates rotate through different hospital settingsoutpatient clinic, intensive care unit, cancer wardto learn how to treat patients and see how medicine really works. This introduction to the profession is a legendarily brutal year, for many doctors the most trying of their professional lives. Working eighty or more hours per week and staying up every fourth night or so on call, most spend it in a state of perpetual exhaustion, as near ascetics with regard to family, friends, food, sex, and other pleasures. The intensity of the training has inspired a kind of awe among medical students, perhaps not unlike that of minor league baseball players waiting for their chance to go to the majors. Medical school is the farm team; internship is the show.