16 November 1996

Purgatory.  Yeah, must be.  This is my time in purgatory. 

O wow, what a fucking incredible epiphany.  Suddenly it all makes a bizarre kind of sense.  I can't believe I didn't figure it out before.

You know - it's like how Dante met this dude down there in the inferno who was still alive up there in the real world.  It was just that this guy's soul was so wretched that even though he still walked the earth, his soul was already resident in the seventh circle or wherever. 

As for me - well I'm not in the inferno.  I'm not wild about it, but even though I'm whining, it honestly just isn't that bad.  I do believe this must be purgatory though.  Guess I've accumulated enough kinda bad but not really bad karma that the cosmic balance has shifted a bit, and rendered me in a state of purging it by long and (oooh, dare I say it?) fruitless labor. 

This is week number seven of General Internal Medicine.  We be de' fleas, damn betcha.  Last creatures to leave a dying hulk.


I have fragments of the past weeks, but that's all, really.  Fragmented souls, faces and bodies parading themselves before me.  For three days, eight days, whatever -- I take care of them for a while and send them back whence they came, sometimes a bit better but usually just the same or a bit worse. 


"You're going to let her go home?"


"But she doesn't understand how to take her meds.  Do you truly think she's capable of learning?"


"Then she needs to be sent someplace where they'll make sure she gets her meds correctly."

I think to myself, "O good Christ.  Another would-be savior of humanity."  What I actually say is, "This lady is eighty-six years old, and she still walks to her local grocer every couple of days to buy food.  She probably knows every single goddammed person in her neighborhood.  She grew up there.  Her husband and two of her kids died there."

I get only a blank stare in reply, so I continue, hoping to be able to spell it out.  "Let's say I put her in a personal care home - "

"Yeah, that's exactly what she needs - "

"Shut up.  I'm not done."


"Let's say I put her in a personal care home."  I stop, waiting to see if I'll be interrupted again.  When I'm not, I continue, "I take her away from everyone and everything she's ever known.  I take away her home and her freedom, and no matter what the family says, we both know that folks will stop coming to visit her after a while.  Yeah, she'll get her medicine, and maybe live an extra year.  Her quality of life will be fucking abysmal, but she'll be alive, you know?

"I'm not going to do that.  If she were so demented that she wouldn't notice, then maybe.  But she's not.  I say let her go home and take her medicine incorrectly.  She might die a bit sooner, but she'll be doing the daily gossip rounds with everyone she knows and loves even as she slides down the slope into congestive heart failure that final time . . . so yeah - I'm sending her home."





I didn't truly comprehend what it was doing to me until a few days ago.  I was running my list post-call, trying to figure out what I had to do now versus what I could put off for a few hours while I was trying to do the now stuff.


Mrs. Vertusic?  Eh, stable.  Sick, yes - but stable.  She can cook until this afternoon.  Ms. James?  Ah - getting a new heart valve this afternoon, so it's an easy turf to cardiothoracic surgery.  Off my list, which means that I don't have to see her anymore.  Mr. Plumbson will be getting chemo for his nasty cancer, so he'll go to the oncology service and off my list. 

Off my list is good, you see.

Mr. Chancic left my list by going down to the intensive care unit.  I found out about forty minutes later that he had arrested and they were coding him.  A little while after that I head that he'd gotten a pressure back, and seemed to be doing okay.  A few hours later yet, I discovered that he'd coded again and subsequently died. 

The thing that gets me is that I was rather numb to the whole thing.  Not the numb you get when you hear that a loved one has been rendered ill or suffered a personal tragedy, but rather the "Huh.  How about that?" sort of numb.

I don't like that, not at all.




I'm killing my upper-year resident. 

He's a nice guy, and he's fucking good, but I'm killing him.

About two weeks ago the service had twenty-five patients, my thirteen to Don's twelve.  Aaron has moved on to other pastures, namely the E/D, and we don't have a fourth year medical student this month to help pick up any of the slack. 

It was pretty bad for me and Don.  I had to be on top of thirteen people, about eight of whom had a lot of stuff happening which needed to be addressed fairly acutely.  Don was the same way.  So needless to say, were hurting.

In the "old days" of medicine, you got maybe one major study per patient per day.  Now I can easily schedule three in a day, which is as it should be.  It's what's best for the patient, you know?  But when you're trying to do this with eight folks in addition to four or five fairly stable individuals, things fall through the cracks.  Patient care suffers. 

So it was bad for us two interns, but it was worse for Steve, 'cause he had to be on top of everyone - all twenty-five of them.  I kept missing things, some of them trivial and some very important indeed, and he would just fix them. 

I don't have the faintest clue how he does it - I can only hope that I'll be that good one of these days.  Fortunately it's pretty transparent to the patients, 'cause he smoothes over all of the cracks that I'm leaving. 

In the meantime though, I'm killing the poor guy with my ignorance. 



Purgatory, you know?  Tomorrow's Sunday, and we're taking hits for twenty-four hours.  I'm truly dreading it, which is another thing I'm not used to.  I mean I'm actually kinda nervous and unhappy about going into work.  It's not so bad when I'm in the thick of it, but the foreknowledge of what's to come is a killer.


You know what's craziest of all though?


I love my job.