Internship 2

The month of May, I spent assigned to the pediatric surgery service at Kaiser Permanente Hospital in San Diego.  The staff pediatric surgeon, Dr JD, a former pediatric surgeon at the Naval Hospital, accepted surgery residents and interns to mentor.  This month gave me the opportunity to get to know Dr CY, the senior resident also assigned to the service.

As an unlicensed physician, as most interns are, I had a very limited role in actual patient care at This hospital for liability reasons.   I primarily observed, not being allowed to write notes and orders in patient charts, cover inpatient call, not even allowed to “scrub in” on surgeries.  The relaxed pace was sometimes boring but a welcome reprieve from the frenetic pace of the rest of the year.   

Preoccupation over my upcoming MRI towards the end of the month blurred my memory of that rotation.   One event does, however, stand out.  I was informed by CY of a little boy that had had a percutaneous endoscopic gastrostomy (PEG) tube for feeding because of a congenital abnormality.  He was having difficulty breathing due to indigestion and bloating.  Later that evening, the father called me with the same complaints.  As instructed, I told him to “burp” the tube and go to the emergency room if his difficulties continue.  I went to bed.  Early the next morning, around three am, the father called me back to inform me his son was dead.  I froze in panic.  “My God, what do I say?  What do I do?” I thought.  I had never been in a situation like this.  Previously I had been a part of a team in these kind of situations.  The more experienced attending physicians handled this stuff and I stayed in the background with the rest of the surgical entourage.  This time I was alone having to talk with an acutely grieving parent. I expressed my condolences for his loss.  I hung up the phone with the unsettling feeling that I handled it all terribly wrong.  Eight months later I would learn that there was nothing I could have said to ease his pain, but to have said nothing would have been deplorable.

The morning of Thursday, May 26 I went to the radiology clinic for my MRI.  The machine looked like all the other CT scanners and MRI scanners I had seen previously.  A nut  and bolt assembly with the bolt being the patient lying in a narrow trough-like table, and the nut being the large square machine that housed the rotating magnets.  But this time, I was the patient lying on the table whose head the unseen magnets would rotate around.  I lay supine on the table.  A cage was placed over my head.  I imagined I looked like a hockey goalie or baseball catcher.  The table slid into the scanner,  automatically positioning my head in the narrow opening.  “!-!-!” went the scanner, then silence.  Suddenly a loud “gnweuew”, followed by “dupt-dupt-dupt-dupt-dupt-dupt-dupt-dupt, blop-blop-blop-blop-blop-blop-blop-blop, doof-doof-doof-doof-doof-doof-doof-doof, rat-tat-tat-tat tat-tat-tat-tat.  The cacophony would have been deafening had it not been for the headphones placed over my ears.  Then silence.  A few seconds later the second cacophonic movement began just like the first.

The following afternoon I called the radiology department to get the results.  I spoke to the neuroradiology resident who was reluctant to discuss the preliminary results.  Radiologists generally don’t discuss results with patients, only doctors.  Dilemma, I was both.  He nervously stressed the results were only preliminary, not yet reviewed by his attending radiologist, not yet finalized.  With a shaky voice, he then delivered his preliminary findings which were word for word of the eventual finalized report, not out of nervousness and insecurity in his interpretation, but out of concern for what his interpretation meant to the person on the other end of the phone line, me.  I listened, hung up the phone, and steadily, with heart pounding, throat closing, and eyes welling, walked to the men’s room.  Once the latch clicked behind me, I collapsed to the floor against the corner, in a heap of wails and sobs.  I wept like I never wept before, and only thrice since.