Intern (15 page)

Under an aluminum canopy outside a Korean deli, she asked me where things with us were heading. Were we going to stay together after she moved to Washington? Were we eventually going to get married? I told her I didn't know. We had only been together a couple of months. I couldn't look much beyond my next rotation, let alone months or years into the future. Plus, I remained ambivalent about the relationship, if not about Sonia. Though I didn't tell her this, marrying a doctor seemed limiting to me in some fundamental way I couldn't quite put my finger on. What would we talk about? I pictured a future sitting at the dinner table discussing arterial blood gases or Medicare reimbursement. Internship was already beginning to confirm my worst fears that medicine was a cookbook craft, bereft of beauty. Wouldn't I get more out of marrying a linguistics professor, or even a lawyer?

At the same time, I knew how lucky I was to have met Sonia, and so soon after coming to New York, too. She was warm and funny, sexy and stylish, upbeat and forgiving. Her mind was somehow able to sample all the possible outcomes of a situation and settle on the most positive one. She had a great sense of humor. When Bruce, my goldfish, was sick, Sonia put him into a plastic yogurt container filled with water and stress-coat liquid, dubbed it the “FICU,” and said he was having a “code orange.” We shared many of the same interests: literature, dining out, walks in Central Park. Growing up, we both had felt a sense of alienation from our Indian peers, and yet as adults we both wanted to reconnect with our heritage. She was even Punjabi; our mothers had grown up in the same district of northern India, and her family was fairly traditional like mine (which is why, like mine, they were pressuring her to marry and settle down). Of course, we had our differences—if she was Venus, I was more like Saturn—but the relationship seemed to have all the makings of one that could lead to marriage. Yet the doctor issue was holding me back.

My father sensed my ambivalence about the relationship. When my parents came to visit in the late summer, they met Sonia at my apartment. A couple of days later, my father and I went to the Hi-Life to talk about my budding romance over a couple of beers. Sonia had made quite an impression on him. After meeting her, he had described her, only half facetiously, as Sophia Loren with Einstein's brain.

“Your problem is that you want someone from heaven, but you live on earth,” my father said, sipping a Budweiser.

“That's not true,” I said.

“Then what's the problem?”

“No problem, just stuff I need to think over.”

“What kind of stuff?”

“Just stuff.”

“Like what?”

“Well, for one thing, she's a medical student,” I blurted out. “I don't think I want to marry a doctor.”

I expected a scornful response, but my father nodded thoughtfully and said, “I can understand that. How will you find time for each other?”

Of course, my concerns ran much deeper than that, but I decided to let it go. I was glad that for once my father could see my point of view.

When I talked with colleagues, most of them thought that marrying another doctor was a good idea. A friend of my brother's, a gastroenterology fellow, told me: “Marry a doctor. When you get paged away during your anniversary dinner, only another doctor will understand.” Dr. Carmen, who was married to an internist, said there were advantages to marrying another doctor. “Julie and I speak the same language,” he said one morning when I stopped by his office. “We belong to the same clique. I don't have to go home and say, ‘I started a dopamine drip on a patient today. Oh, and by the way, dopamine is a drug we use to . . .' ” Amanda, my co-intern in the CCU, who was married to a lawyer, said that being in the same demanding field could be good for our marriage. “You'll always have your work to talk about”—but that was precisely what worried me. Her advice presupposed an equivalent level of commitment to our profession, which I knew wasn't there—at least not yet.

For Sonia, medicine was a cornerstone of her life. She loved reading all about lipid physiology and diabetes. What I was content to memorize, she wanted to dig into more deeply. I was afraid she and her family would eventually see through my façade.

When I spoke with Dr. Carmen, I told him about a recent study I'd read in a medical journal. A group of researchers surveyed over a thousand doctors, comparing the quarter in dual-doctor marriages with the rest in “mixed marriages.” Overall, they found that dual-doctor marriages were relatively happy and stable. Compared with other physicians, doctors in dual-doctor marriages reported greater satisfaction in discussing and sharing work interests with their spouses, more involvement in child rearing by both partners, and a higher family income.

The survey also found that dual-doctor marriages were traditional in unexpected ways, particularly in the area of family. Compared with other female doctors, for example, women in dual-doctor marriages spent more time rearing children, more often arranged their work schedules to fulfill family responsibilities, worked fewer hours, and earned less money. That was surprising. I was so used to seeing assertive, independent women in the hospital that it was hard to believe they reverted to traditional roles at home. “Medicine is not a radical profession,” Dr. Carmen said. “The women are by and large traditional, and so are the men. They come from good families that stress education and family values. Probably the most radical thing women in this field do is go out and have a career.”

Sonia felt like many of the doctors I spoke with. “I would never feel comfortable with a lawyer or a Wall Streeter,” she said on that languid summer evening. “For me it's about finding yet another place of common ground. I love that we are in the same field. We can help each other. We can even go into practice together!” Inside, I groaned. I never wanted her to see me practicing medicine. In the hospital I felt constricted, anxious, racked with doubts. I didn't want her to see that side of me.

“So are we going to get married?” Sonia asked me again, as we waited to cross the street.

“Let's see how things go,” I replied.

“So I guess in the coming months you'll be deciding whether to rule me in or out,” she said with a mischievous glint. It was a reference to my time in the CCU, where we were always ruling out myocardial infarction. It was the kind of comment Sonia was always making: pithy, honest, funny, without a hint of animus. I burst out laughing.

Medicine, as a general technique of health even more than as a service to the sick or an art of cures, assumes an increasingly important place in the administrative system and the machinery of power.

—MICHEL FOUCAULT
,
POWER/KNOWLEDGE: SELECTED INTERVIEWS &
OTHER WRITINGS, 1972—1977

 

T
he clock-radio alarm sounded at 5:45. It was still dark outside. Even though Sonia had been in Washington for several weeks now, I still kept to what was now my side of the bed, as if transgressing into her space would mar a sweet memory. I lay in bed for a while, swathed in the covers, drifting in and out of sleep. The month in the CCU had left me with a touch of insomnia, and I had tossed and turned most of the night. So this must be what Rajiv had meant, I thought. In medical school, when I confessed to him that I worried about whether I'd be able to wake up in the morning during internship, he replied rhetorically: “Do you wake up for finals? Then you'll wake up for internship. It's like having a final every single day of your life.”

A Neil Young song came on the radio, and for a few minutes I was transported back to parties in the Berkeley Hills, where beer and joints were passed around liberally from one friendship-braceleted hand to the next. Those days held so much promise: living among the giant redwoods, the rooftops peeking out over the dense clouds, everything
green and fresh. Now I was living in a concrete jungle, and the thought of going to the hospital across the street and standing on my feet for twelve hours and rounding on patients I hardly knew, and drawing blood and inserting IVs and doing all the other things that were expected of me, filled me with dread. It felt like I was in a boat being pulled along by a powerful current, not knowing where I was heading, only that I was being propelled toward some discovery I might not want to make, but that I needed to confront.

I forced myself out of bed, put on my shorts and sneakers, and went downstairs for a jog. A morning run to relieve stress had become an indispensable part of my day; I knew I'd be useless in the hospital without it. Outside, the air was hazy, as the rising sun diffracted through the early morning fog. The sidewalk in front of the building was the usual minefield of dog turds. People were buying coffee from the cart at the corner. A few green-scrubbed figures were already scurrying toward the hospital. Must be surgical residents, I thought, always the first to get to the wards.

I sprinted down the bike lanes of the promenade. The East River reflected the sunlight like a mirror. Roosevelt Island glittered like a shiny brooch as cargo boats floated by. I was crossing over a peeling overpass when I ran into Alphonse, a fellow intern, who was heading into the hospital in slacks, a button-down Oxford shirt, and tie. I had first met Alphonse during the outpatient month in July. Tall and muscular, intense and soft-spoken, he had a strong Caribbean accent and an elusive, tranquil island air about him. His hair was thick and curly, and his short mustache looked like it had been painted on. “Just coming back from your run?” he said, grinning impishly. I nodded, trying to hide my embarrassment. Most mornings Alphonse arrived on the 10-North ward, our current assignment, nearly an hour before I did.

By the time I went in, it was almost six-thirty. In medical school, I had strolled proudly into the hospital in my short white coat. Now, I marched in at an anxious clip, head down, as though to duck the long day that stretched before me. I thought of how my father used to walk me to the school bus stop in New Delhi when I was a boy. We usually
left home at dawn. My fingers would ache as his warm, sweaty palm tightly squeezed them as we crossed the busy road, trying to avoid the slow traffic and bullock carts and roaming white Sindhi cows. At the bus stop, or sometimes in the park on the way there, he'd force-feed me an overripe banana. On this morning, nostalgia for that time, for my father, came flooding back. It was on mornings like these, when I yearned for the day to have ended already, that I missed having someone there to hold my hand, to force-feed me breakfast, to pull me forward, to watch my back.

I hurried past the dour security guard, past the library and the café, which were closed, and into a marble lobby. This was the Greenberg Pavilion of New York Hospital. For all the drama I always imagined going on in here, right now it was placid, almost like a museum, displaying gilt-framed portraits of hospital benefactors instead of masterpieces. In a corner was a small piano, and hanging nearby was a notice addressed to hospital employees:

Welcome all customers in a friendly manner. Make eye contact and smile. Create positive first impressions. Treat everyone with respect. If possible, exceed your patient's expectations.

Next to the notice was a typed testimonial from a patient:

“You take the time to listen, answer questions, and make patients feel, no matter what, that they are your number one priority.”

I shook my head, as if to block a thought, and rode the elevator to the tenth floor. Ward 10-North was one of only three general medical wards in a hospital sectioned mostly into subspecialty units. Here, the patients, often underinsured, some homeless or with criminal backgrounds, were treated for bread-and-butter disorders: AIDS, pneumonia, congestive heart failure, and the like. 10-North was the place in the
hospital where you were most likely to find security guards carrying revolvers or orderlies conducting 1:1 surveillance watches (while sitting in the hallway outside the wayward patient's room reading
People
magazine). It was ward medicine in all its unfiltered mess.

The physical plant, however, like the rest of the pavilion, was gleaming and new. At the end of a long, brightly lit corridor were tall windows looking out onto the sloping steel girders of the Triborough Bridge. The staff workstation had a fax machine, a copier, a chart rack, several desktop computers, a shelf with about thirty different requisition forms, and a whiteboard with the names of the forty-odd patients, color-coded by intern/resident team. It was here that doctors, nurses, and social workers took refuge, writing orders, checking labs, pressing on their eyeballs while on hold on the phone. Sometimes a patient or family member would lean over to ask a question, but even that was frowned upon.

The routine on 10-North was call every fourth night, with a cap of six admissions per night per intern (the overflow went to more senior residents), except on Saturdays, when you were expected to admit patients all night long. At 10:00 p.m., chief residents came around for “cookie rounds” to discuss the day's admissions over a box of Entenmann's. (They always brought an assortment of goodies but never the thing you desired most after sixteen hours on your feet: fluid.) Overnight, you were responsible for your own patients (those you'd admitted in previous days), plus the patients you admitted that night, plus all the other patients who had been signed out to you for the evening. “Cross-coverage” was definitely the hardest part of being on call. You had to make critical decisions about patients you barely knew. Sign-outs were often inadequate (sometimes just names and lists of medical problems) as interns and residents rushed to get out of the hospital after their own long shifts. The nurses could call you for anything, and they often did: fever spikes requiring blood cultures, respiratory distress requiring an arterial blood gas, insomnia requiring sedatives. It helped to have a short “differential,” a list of diagnostic possibilities, for the cardinal symptoms—chest pain, abdominal pain,
shortness of breath—committed to memory. The next day, post-call, you could go home after your notes were done and you had taken care of any unfinished business from the night before—including signing out all your patients to other doctors. It was supposed to be done by midmorning, but it almost never was. Around noon, other residents would start offering their help. “What're you still doing here?” they'd say, as if they had just noticed you. “What can I do to get you out?” The key was to finish your work quickly, or you could easily stay past three o'clock. The longer you stayed, the less efficient you became, the more time it took to write notes or call consultants, and once you hit the wall, any chance of getting out in a timely fashion was pretty much shot.