Робин Кук - The Year of the Intern

Somewhere near and coming nearer, a Volkswagen’s horn was beeping, disturbing the deceptive tranquility of the ER. As the beeping got louder, it began to remind me of the cartoon character called the Road Runner — an absurd association, but somehow appropriate to my mental state. Beep-beep. Maybe it was the Road Runner. Thirty seconds later fantasy was replaced by a VW that pulled up, still beeping, next to the platform. A man jumped out yelling that his wife was having a baby in the back seat. After calling for a nurse to bring a delivery kit, I ran down to the VW and opened the door on the right side. There in the back, sure enough, was a woman lying on her side, obviously in the last stages of labor. The light was very poor, obscuring the birth area; everything would have to be done by feel. As she started into another contraction, I felt the baby’s head right on the perineum. The woman’s panties were in the way, so I cut them off with some bandage scissors, and while she grunted through the contraction, I kept my hand on the baby’s head to prevent it from popping out. After convincing her to roll over on her back, I pushed the front seats forward, and got one of her legs braced on the rear window and the other one draped over the driver’s seat. My hands were moving by reflex now, leaving my mind to do absurd things, such as remember an old joke — what’s harder than getting a pregnant elephant into a Volkswagen? Getting the elephant pregnant in a Volkswagen. With the contraction over, I got the baby’s head out slowly, rotated it, pulling it down to get one shoulder out and then up for the other shoulder, and suddenly I was holding a slippery mass. I almost dropped it trying to back out of the car. Thank God, just then the baby choked and started to cry. Not knowing what to do through all this, the father had been behaving oddly; he interrupted his audible anguish about the upholstery, which was pretty messy by now, to ask whether it was a boy or a girl. In the dark I couldn’t tell. Must not be this guy’s first child, I thought. I wanted to suck the newborn’s mouth out with the bulb syringe, but the baby was too slippery to hold in one hand. Instead, I gave the infant to one of the nurses, with explicit instructions to keep it level with the mother, and, after putting on some clamps, I cut the cord. Then everyone — attendants, nurses, and father — helped lift the mother out of the car. The afterbirth came away without effort in the ER. I was amazed that there were no lacerations. The whole crew disappeared up to the obstetrics area.

That baby redeemed the night. Maybe they would name it after me. More likely they’d call it V.W.

I almost didn’t even mind seeing the dirty drunk who had come in during the excitement of the birth. He had a scalp laceration, which I sewed up without anesthetizing it while he swore at me. Actually, he started to swear and swing at me as soon as I appeared. He was so drunk he was beyond feeling. After the last stitch, I went into the doctor’s room and plopped down on the bed, instantly asleep.

That was 4:45; at 5:10 a nurse knocked and came in to say a patient was waiting to be seen. At first I was disoriented, literally unable to recall where I was and aware only of the hammering of my heart. In the twenty-five minutes between then and now, sleep, the great healer, had incapacitated me, leaving me dizzy and weak, with scintillations in the periphery of my visual field. These passed as I began to move around. Even so, my left eye refused to focus, and when I opened the door the light in the hall was like a thousand flash bulbs. I felt just about as shitty as I could feel and still function.

The patient, where was the patient? The chart in my hand said, “Abdominal pain, twelve hours.” Jesus! That meant I had to record a complete history and probably wait for lab reports. I walked into the room and looked at the patient. About fourteen, soft silky hair of shoulder length, skinny, large nose. Mother sat over in a corner. The check list of questions for possible appendicitis is a long one, and I started in on it. When did the pain start? When did you first feel it? Did it move? Was it like indigestion cramps? Did it come and go or remain steady? Meanwhile, I casually felt the abdomen for sensitivity, through Bermuda shorts, reasonable apparel in Hawaii’s climate — but underneath them was something odd, the distinct outline of a girdle? Crazy. Did you eat today? Tonight? Did you feel like vomiting? The stomach seemed soft. It could not have been very tender, for moving my hand over it evoked no sign of discomfort. Did you move your bowels? Was it normal? I took out my stethoscope. Has your urine been normal? I put the stethoscope in my ears and rested the bell of it on the abdomen, the patient’s words filtering through the earplugs. Have you had trouble with abdominal pain before? Have you ever had an ulcer? For some reason I always left the questions about the menstrual cycle until last. It was just a small propriety. When was your last period? The answer came rather apologetically: “I’m a boy.”

I looked at her — him — for a minute, my dull mind reeling. Long silky hair, loose purple velvet shirt. No, it was a blouse. Girdle! Putting my hand under the girdle, I lifted the whole works up, practically raising him off the table. No doubt about it, that was a penis. The mother just looked away. I was unprepared for such sudden reverses. It all seemed a huge, cruel joke. Here I was struggling to make some sophisticated intra-abdominal diagnosis, and I was wrong even on the sex. Anyway, he didn’t have appendicitis or anything else terribly serious. Probably a simple case of abdominal cramps. I thought to myself, if I told him they were menstrual cramps he’d be pleased.

Being a slow learner, I immediately fell asleep again. Crash! The door came open and a delighted nurse informed me that I had a patient. The same process occurred, the same agonizing gauntlet of getting up and blinking and gradually clearing as I emerged into the light. This one was a dandy, a Sa-moan lady towing along her ailing mother, who couldn’t speak a word of English. With so many languages in use around the islands, we were accustomed to working through translators, but in this case the daughter’s English was not even a serviceable pidgin. Besides, the complaints were so numerous that every organ system seemed to be involved. She had pains here, pains there, headache, weakness, couldn’t sleep, and generally felt crappy. Sounded like me.

Very carefully I asked the daughter if her mother had any burning sensation when she passed her urine, and was rewarded with a blank look. Rephrasing it, I asked if her mother had any pain when she made pee-pee, wee-wee, shishi, umm... my mind had run out of synonyms... when she makes water. I thought this brought a glimmer of understanding, so I put it together again. Does your mother have pain when she makes water? The answer was great, made me want to give up medicine entirely. She said she didn’t know. The lexicon of English does not hold a word to describe my frustration. I said, for Christ’s sake, ask her, then. So she asked her. Yes. That was how it went with every question. Slowly, and every answer was yes. She had burning on urination, frequency of urination, nausea, vomiting, vaginal discharge, diarrhea, constipation, chest pain, cough, headache... Since the mother was quite emphatic about her chest pain, I tried to take an electrocardiogram, but the machine broke. When the birds started singing outside, it was as if they meant to attack me with their song; but of course they were only heralding the light. I was so tired I just didn’t care about the old lady, about anything. In the firm conviction that she would not die within the next few hours, I gave her some Gelusil, which she liked enormously, and set up an appointment in the clinic. It was glorious morning by the time she left.