Another publication from way back when, detailing the insanity of intern year.
At 0622, I walked into the resident room. I pulled on my scrubs and clipped my stethoscope, cellphone and trauma shears to my waist. A patient had joked I looked like a gunslinger from an old western. I felt more like Don Quixote, with my makeshift strapped on armor, trying to do good against all odds.
I walked into my shift at 0645, into the busy urban Emergency Department I called home. The night intern signed out to me. The sign out included the usual scattering of the very sick, and the very intoxicated, everyone else had gone home before dawn broke.
I walked up to see a new patient that EMS had just rolled in, an elderly Vietnam vet who’d fallen and couldn’t get up. He was terrified he’d broken his back. I reassured him and his wife as best I could without lying to him. Leaving, I got a call from the nurse of one of my patients. “The woman in 19 wanted to leave, is at triage.”
Stale alcohol wafted through the air. As I tried to make sure she was sober, she grew irate. When I asked her to walk, she huffed and took two steps to me with her middle finger raised, stopping right before she slammed into me. I went to print her discharge to a commentary telling me where I could put it.
I’ve been a resident in Emergency Medicine for two months now, but I’ve already begun to find those encounters blasé. As I bade her good health and walked back, the veteran called me over. He and his wife seemed terrified so I reassured them and explained what to expect as the day went on.
I walked over to go see my new patient and I got a call “Bed 14 wants to talk to you”. As I approached, I saw the half-naked, well built, angry looking fellow I’d been signed out and had a sinking feeling. He cursed at me with a fluency I’ve grown to expect, with his sweet, old mother sitting next to him holding his dirty shoes and clothes on her lap. “Let me go!” he spat, as I kept my distance, a muscular technician at my side. As I tried to examine him, his anger grew. He ripped off his C-collar in one mighty swipe and his blood pressure cuff in another. As he was rising from bed, security officers materialized, as if beamed down from Star Trek. Under their gentle, watchful gaze, I finished examining him and finding him sober, discharged him.
As my day progressed, I saw a handful more patients, dispositioning them with the eagerness and ineptitude of an August intern.
The veteran ended up having a compression fracture, and as I helped put him in his back brace, he thanked me effusively. As I said goodbye, he looked me in the eye and said, “I don’t know how you do it. I heard that woman curse at you, and I saw how badly that kid wanted to rip your head off. How do you do it? All this pain and suffering day in and day out would destroy me…” I smiled, shrugged my shoulders and said “It comes with the job.”
As I walked away I was forced to confront my flippant answer. I’m an intern, two months into residency and already I’ve lost a handful of patients. I see terrible violence every day and as I dip into and out of people’s lives I feel a faint echo of their misery. To survive as I tilt my lance at windmills, I wear a coat of emotional armor that allows me to take the hits and keep working. My armor is adaptive: titanium when I see angry, intoxicated patients and cotton when I see scared sick people.
Then I sign out, walk out of the Emergency Department’s bright neon lights and try to leave it all behind me. As I get home, to a loving significant other and puppy, I take a deep breath as I walk in the front door, take off the armor, piling it carefully by the door. After all, I work again tomorrow.