During his internship, Dr. Robert Klitzman learned to deal with too many patients and too many decisions, all on too little sleep. He tells his story in ”A Year-Long Night: Tales of a Medical Internship” (Viking).
Q-Do doctors and nurses like their patients?
A-Sometimes. I became very fond of a woman who had lost her ability to use language because of a stroke. She was written off by much of the staff, but I felt very close to her. The last time I saw her, she gave me a kiss on cheek, the first time a patient had ever kissed me. But as an intern, sometimes you don`t sleep for a day or two, you don`t eat regularly and you can get very angry toward patients. Medical training must strike a fine balance. It tries to produce people who are comfortable with death but also compassionate.
Q-Why do interns have to work such mind-numbing hours?
A-It teaches doctors to think quickly on their feet in a crisis. It`s also more economical for hospitals, and it gives the patients a sense of continuity of care. But it makes interns feel depressed, anxious and, at times, angry. And, of course, mistakes are made because of fatigue.
Q-How do doctors and nurses deal with the tragedies they see everyday?
A-One of the ways is by distancing themselves from it, sometimes with a special language, sometimes with black humor. Nobody ”dies” in a hospital. They ”code” or they ”box.” Patients are ”dirtballs” or ”something,” as in ”something just came into ER.” Admissions are ”hits.” You`ll hear, ”We got five hits last night.”
Q-What was it like watching your first operations?
A-At my first operation, a nurse said to me, ”If you feel faint, step down from the stool you`re standing on.” I thought: ”Not me. I`m macho. I can get through this. I watched the cut, but then, when a blood vessel was cauterized, a whiff of blue smoke went up my nostrils. The next thing I knew, the nurse was leading me out. She had me lie down, and she gave me orange juice. I recovered and went back, and I never had that problem again.
Q-What did you learn about people, yourself and your profession from your internship?
A-I learned how people can be reduced in their humanity by various situations. One day I pronounced a patient dead and then realized it was 5 o`clock and I hadn`t eaten yet. I found some stacks of half-eaten meals, and there was the untouched tray for the patient who had just died. As I ate it, I felt like a scavenging beast. It was the coldest meal I ever ate. I also learned that there are limits to medicine. I entered the field thinking I would cure most of my patients. I learned that the best you can do for many of them is to hold their hand. That was shocking.
