The Intern

"Hello Mrs. Leblanc, I'm Dr.Marriott. I understand you're not feeling too well."
She moved to the right side of the frail woman's bed. The tear stained face that greeted her tore at Anne's heart.
"No doctor, I don't. I'm old and I'm tired. I don't want any more needles." Large tears spilled over the thin blue lids of eyes swollen from hours of crying - lonely tears of feeling helpless.
"I understand. Your arm is sore. Do you think if we turned off this light you might be able to rest? We'll leave that IV out for the night and see how you are in the morning."
The shrill beep of her pager signalled to Anne that the ER patient had arrived. Anne glanced at the number from the ER.
"Mrs. Leblanc that noise means I have to go. I'm the new intern on this floor so I will be seeing you again. Try to sleep." Anne smiled and gave the woman's hand a gentle squeeze.
Anne wrote the order to give the 6 o'clock antibiotic dose orally. Handing the chart to Gert, she said "You know where I am. Be back to do the other paper work as soon as I can." With that she headed for the stairwell, her mind occupied with remembering all she had been taught about diabetics in renal failure.
Running along the glassed breezeway that connected the two wings she took the shortcut to the ER. Down another flight of stairs, she emerged opposite the ER registration desk and waiting room. At this hour the waiting room was empty, the rush of the night just ended. Passing the security guard and the ambulance crew, Tim Horton's coffee in their hands, Anne smiled and said "You guys just bring in the patient from Dartmouth?"
"Last exam room on your left. Desk clerk is pissed at you for not answering your page. That's a 'no, no' doc." The ambulance attendant grinned.
"I was on my way for God's sake," she muttered to herself. She had long since lost her usual sense of humour, although she recognized that such comments from the crew were made to interns they liked. Strange dynamic. Anne admired the crews for the life saving care they gave in the field. She knew how the guys felt about transfers, no adrenalin rush. Her adrenalin, however, surged as a sound doubled her heart rate; her new patient was gasping with wheezy, laboured breaths. Entering the exam room she saw her new patient.
The ER nurse whose name tag said "Branson, RN" didn't take her eyes from the clipboard she had propped on her hip.
“About time you got here. This is Mr Foster, a fifty-four year old man arrived from Dartmouth General fifteen minutes ago in respiratory distress. Has 100% O2 going, sats are 92%, IV of normal saline at TKVO, he is tachycardic and tachypneic but his pressure is good - 130/86. EKG looks okay. I drew the routine blood work and had the RT do blood gases that aren’t back yet. Chest sounds pretty wet so I called X-ray for a portable chest film." Still no eye contact.
"Thanks Ms. Branson. Mr. Foster, I'm Dr. Marriott. Are you able to speak ?"
The man was sitting, leaning forward, his elbows bent and hands clasped in his
lap, his chest heaving with each inspiration. As he looked up at her, she could see the
terror in his eyes. "Yes", wheeze, "I can," wheeze.
"Good. You're doing fine. I'm going to listen to your chest," Anne adjusted her stethoscope, listening to the crepitations at his lung bases. “I am going to give you some medicine in your IV and in that mask. Your breathing will get easier."
Turning to the nurse, confidently Anne asked "Please get a 5cc syringe of 1:10 morphine and also 2.5cc of salbutamol in 3cc of saline for a nebulizer. I also want to put on 1/2" of nitro paste. And he needs a catheter. Did they send any notes with him?"
Without a word Ms.Branson handed her the clipboard and slipped from the room. The X-ray tech came in, asking if she still wanted the films and if so, he needed a requisition filled out.
"Yes, thanks." Anne stepped outside the door, reading the transfer notes as she walked. The lab results indicated that Mr. Foster 's kidneys were virtually non-functional and his potassium level was dangerously high but so far his cardiac function had not been affected. Mr. Foster would need haemodialysis within the next couple of hours. Anne felt a rush of satisfaction. Confidence in her ability as a physician was a challenge with which she struggled daily. However, in this situation she realized her knowledge and ability to accurately assess this patient’s situation was on target. She knew what needed to occur to save this man’s life.
"Dr. Marriott," Ms.Branson handed Anne the syringe containing the morphine,” if you give this I'll get his mask going and put on the nitro. The lab tech is at the desk with the lab results."
Approaching Mr. Foster Anne smiled again as she injected 2cc of morphine into the port of the IV line.“ Not long now and you'll be feeling better. Then we will be moving you upstairs to a special unit. I'll explain what is going on when talking is easier for you. I'll give your family a call as well."
Mr Foster visibly relaxed as the drugs took effect. Within minutes his breathing was less laboured. Anne excused herself and leaving the room, adrenalin still
coursing through her body, she breathed easier as well.
She headed to the desk. The first call was to Dr.Hill. He agreed with the assessment that she gave and said he would come in to see the patient as well, and to arrange for the dialysis. Dr Hill’s reputation as an exemplary teacher and brilliant physician preceded him. Anne looked forward to the next four weeks under his tutelage.
As she dialled Mr. Foster 's home she was thankful for her past years of experience in speaking with the families of the ill in her previous jobs. And personally she had experienced illness in her own family, more than once being on the receiving end of such early morning calls. Her father had suffered a massive stroke many years before, partially recovered, and then ten years later another clot had left him unrecognizable to Anne. He died in this same hospital, in the month of May in1984, eight years ago.
Having answered as many of Mrs. Foster 's questions that she was able, Anne glanced at the clock over the desk. The time was now five thirty. She made her notes on the chart. Leaning back in the chair, running her hands through her hair, she felt a flood of exhaustion wash over her. Knowing full well she had a minimum one hour's work yet to do getting Mr. Foster settled, and a further hour on the fifth floor ward, she mentally calculated that she just might get a few minutes to shower before Admission Rounds began at eight; if her pager stayed quiet. On cue the pager beeped to life. The ambulance crew was going on a “Timmie’s” run and wanted to know if she needed a donut.
Twelve hours later Anne leaned on the wall of the bus stop around the corner from the hospital. Checking her watch for the fifth time in as many minutes, she breathed a sigh. She could see the Dartmouth bus waiting at the lights on the corner of Spring Garden Road. Hers was the next stop. She lifted her heavy leather bag, swinging it onto her shoulder and stepped into the line forming at the curb. Buses were crowded at rush hour. She feared she would be standing for most of the thirty-minute ride home to her apartment in Dartmouth’s south end. Showing her pass, she joined the crush moving toward the back of the bus. Reaching above her head to grab the bar, she steadied herself as the bus jerked forward.
August could be warm in Nova Scotia and today the thermometer had soared to eighty degrees despite the cool salty breeze blowing in from the Atlantic. Barrington Street was alive with activity on this Friday afternoon; the Busker Festival in the downtown had begun. Tourists moved in waves up and down the hill to the waterfront. Sounds of summer in the city filled the air. For the next ten days performers would entertain onlookers scattered along the wharves of the harbour and the quaint side streets of the old Halifax core. After sundown the bars would be filled with sunburned vacationers and locals, the parties lasting to near dawn.
The crowded bus crawled along its route. Anne’s mind was on heading to the family cottage, slipping into a comfortable bed and a restful sleep. Movement in the aisle disturbed her thought. A man stood up and excusing himself pushed by her. Easing herself down into the seat Anne relaxed into the warm vinyl and gazed to the right. The bus was about to begin its climb onto the MacDonald Bridge. Childhood memories flooded her. The mile long span connecting the two cities stretched over Halifax Harbour. In years past she had walked the sidewalk of the two-lane bridge, pausing in the middle to watch the ferry, or the sails of the daysailers, or count the Navy ships at the jetties a hundred feet below. She had been so young and the days were full of everything that was possible. This evening tears of exhaustion obscured her view.