On the first day of internship, the only people more nervous than the new interns at a research hospital are the patients who know that they are being cared for by green recruits. My first night on call I was awakened by a page from an anxious nurse who said, "Come quick. Mr. Jones's heart rate is in the 200s and I can't find his pulse." I sped off toward the unit, simultaneously flipping through the little book that tells me what to do in emergencies, my heart rate rivaling that of Mr. Jones, and tripped. I made the final leg of my journey on my stomach as if "sliding into home plate". I glanced at the EKG then gave my first order as a physician. "Let's get ready to shock him." Much to my relief, my resident calmly walked in and shepherded me through the resuscitation.
That was the beginning of a love-hate relationship with my pager. On busy days it would go off 40 to 50 times, calling me to emergencies or asking for sleeping pills or enemas. Eating, sleeping and other functions became subject to its dictates. My life ran on my pager and caffeine, plus the adrenaline rush brought on by the fear making a mistake.
Within a few months, the interns' idealism began to give into a kind of cynicism reflected in the slang of the hospital subculture. Very sick patients not likely to leave the hospital soon became "rocks." One might ask an intern on the geriatrics service," How big is your rock garden?" Getting a new patient from the E.R. was called "taking a hit." "Torture" analogies dominated. "I really got flogged with pages last night..." Or, "I was hit hard."
The emotional, physical and existential stress of telling a young mother she was full of cancer and making literally fatal errors took its toll on us. The changes in personality produced by this stress were described as "becoming toxic." We learned to overlook our colleagues' depression and irritability as "toxicity." Each of us faced the same questions, "Why am I doing this? What is the meaning of my patient's suffering? What is the value of my work?"
