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Sparrow's Point

We Are a Different Group Now

By Melissa Sparrow

Melissa SparrowResidency is a time of both feeling and witnessing pain in a world where there is little time for recovery, nor is there salve, though our profession demands that we give it to others, all the time. Still we return each day, as do all of the people who keep this hospital intact, from the uniform cleaners to the department heads, from the nurse who turns the feeding tubes to the residency program coordinator who keeps candy on her desk, from the guard who greets me each morning with a friendly hello, to the attending who tells me softly after a long night, " Go home before you fall asleep in the chair."

What gives us strength?

There can be moments of sudden recognition: One day, a few weeks ago, the pediatric interns were called to attend a trauma conference. It was an all-day affair organized for us by the pediatric emergency medicine attendings. The day included multiple lectures, a piquant Chinese food lunch, and a denouement of emergency technique simulation stations. For us interns, this parade of frightening possibilities was still largely theoretical, since as first-years, we hadn’t yet been called to the adult emergency department trauma bay, where the dangerously injured "alpha" and "bravo" children were carried in.

Early in the morning before the conference began, we interns pre-rounded on the children in our care and wrote the requisite daily notes. Then we all met in a conference room. On this rare day away from our patients, the senior residents had kindly and involuntarily taken over our work on the floors, in the Neonatal Intensive Care Unit, and in the emergency room. For their sake and ours, they’d agreed to spend a few hours stepping back into that seemingly distant and easily deniable role of intern.

Still, as I sat through the neatly organized trauma lectures, my learning was punctuated with pages requiring me to find a phone and answer questions about my patients. Since I was in the midst of a GI rotation, those discussions were about food, vomit, and stool. A 130-pound four-year-old was sucking on two popsicles at once, and when the nurse had tried to take them away, he’d wrestled her to the floor. The radiologist conducting an ultrasound on a child with cholestasis needed a 10 French feeding tube, stat. Another feeding tube wasn’t flushing and clot buster didn’t break through. Parenteral nutrition needed reordering again. One child had vomited, another was having liquid stool, so and so hadn’t pooped yet. Some issues, so to speak, I addressed by phone. The rest, I secretly relished passing off. "Could you let the senior know please? I’m at a trauma conference today."

We were sitting in the fourth-floor conference room when Dana, the second-year resident covering oncology, poked her head in the door and whispered in a low voice to an intern sitting catty-corner to me, "I just wanted to let you know Steven died." I didn’t know Steven, but the very manner in which the resident delivered this message made me understand that Steven had died of cancer, after some long and terrible battle, and all at once this became to me an event so profoundly sad that I suddenly found myself sitting helpless and struck dumb.

Had Steven been a patient discussed at a morbidity and mortality conference, I might have had my coping mechanisms in gear. I might have been able to call up some of the dizzying array of techniques I’ve mastered to stay whole. But Dana’s words slipped in unaugered, like an invisible flame.

I looked around at my fellow interns. It was the first time we’d gathered together in one place since that first day of internship orientation, eight months ago. We were a different group, paler and thinner, our muscles softened, except for the gastrocnemius, a crucial muscle for sprinting up and down backstairs when the elevators are too slow or broken, or when the code pager has gone off and the elevator’s not an option, or when we can barely stay awake and need to pump extra blood to our brains. Among our group of interns, one person’s mother had died of stroke. Another intern’s sister was killed in a car accident. Catherine was back only a few weeks later, caring for her patients, listening, attempting to focus through her grief. Another intern’s close family friend had burned in a college fire. She had to leave the room when the trauma conference turned to burn assessment charts, inhalational injury, and fluid resuscitation. After a few moments to gather herself, she returned.

Though we were weary and sad and a bit scruffy that day, I could also see something inside each of us that was new and different from before, a strength of character, an ability to withstand. I could see how we were linked and how this link gave us strength and then, I got paged.