Intern

by Sayantani DasGupta, MD, MPH

She hoarded index cards and Xeroxed protocols and carefully transcribed antibiotic dosing regimen. She hoarded miniaturized growth charts and lists of developmental milestones and near pornographic images of breast and genital development at various Tanner stages. She hoarded code cards, an instruction sheet on intubation, and a much-creased flowchart on diabetic ketoacidosis ripped out of a textbook. She hoarded her Harriet Lane handbook—the most important pages falling out and held in place by a large purple rubber band.

She hoarded the calculator that hung around her neck on an uncomfortable metal chain along with her ID and electronic pass card. She hoarded tongue depressors, folded up paper measuring tape, gauze pads and gauze rolls. She hoarded IVs, packaged tubing connectors, and an occasional infant’s arm board. She hoarded plastic ear cleaners and long, clear tubes full of black otoscope specula. She hoarded individually wrapped packets of alcohol—which she used for wiping her stethoscope, as well as getting blood off her jacket or shoes.  She hoarded rolls of tape—the plastic kind, not the cloth—and the immensely useful little butterfly adhesive strips.

She hoarded rubber tourniquets—one strung through her buttonholes she was willing to share and a backup stashed in her top pocket she was not. She hoarded the beautiful packets of butterfly needles—her favorite light blue 21 gauge and second favorite indigo 23 gauge and one or two of the obscenely large 19 gauge which she saved for the adolescents.

She hoarded guaiac development cards, six or seven at a time. She hoarded the bottles of chemical developer with their yellow screw-on tops to test the stool for blood once smeared on the card.  These were precious on the floor, impossible to find when you needed them, so she hoarded them, risking the tell tale, astringent leak in the bottom of her pocket.  She hoarded all this because there was nothing worse than standing in a patient’s room with a gloved finger full of excrement and nowhere to put it.

She hoarded all the free drug company stuff. (Screw the ethics) A squeaky duck to hang on her stethoscope, a notepad shaped like a fire truck, a cardboard wheel to help her calculate a teenager’s weeks of gestation based on her last menstrual period. And of course, she hoarded the pens. The pens from Advair and Amoxil, from Zithromax and Zyrtec. She hoarded pens from Ventolin and even ones from Viagra, which were so comfortingly heavy in her hand and, understandably, rare on the pediatric floors.

She hoarded her patients—especially the usually healthy infants admitted to “rule out sepsis.” Those chubby babies were as close to entirely well as one could get in the hospital. She hoarded their piglet toes, their ham-hock thighs. She hoarded their rounded cheeks and buttocks, their jiggly bellies hanging thickly over diapers like ripe melons or pop-n-fresh biscuits. She hoarded their thick fingers, their curving ears, their truffle-like noses. She hoarded the feeling of them, calm and warm against her chest. Sometimes, during a hard night on call, she escaped to the infants’ floor just to hold and rock a baby. When she felt the weight of their bodies against hers, she hoarded the ache somewhere below the pit of her stomach.

She hoarded her body and its senses—taste, primarily, because she found herself so empty. She hoarded memories of meals, rolling the recalled tastes around and around her mouth like marbles—creamy homemade soups, fluffy omelets, shrimp curry made with gigantic prawns. At the hospital, it was all sugary donuts during morning report, tepid pizza during noon conference, an occasional catered lecture with dry turkey on even drier rye bread. The coffee, which she drank in excess, was always dark and dingy in Styrofoam cups that made her teeth ache. She hoarded the desire for a cup of perfectly brewed Darjeeling tea, served in a china cup, like her now dead grandmother would have made it.

She missed the feeling of her own skin, and hoarded travel size tubes of hand cream she bought on a near daily basis from the hospital gift shop. The lotion in the patients’ supply closet had to do when she couldn’t spare the time, but it left her smelling like the supply closet, or worse, like the patients, and its watery consistency did very little to ease her rough, sobbing hands. The process of applying the lotion was a ritual of repetition. Grabbing the tube from her right pocket, she would dab a mound of lotion in the center of her left palm, then rub the moisture into the other with a Lady Macbeth-like hand wringing gesture; interlacing her fingers to distribute the lotion evenly, she finished by circularly massaging her dry cuticles, one by one by one.

Her face, in contrast, was oilier than one of her adolescent patients’, and she hoarded hair bands in her pockets, purse, and car to keep her thick hair away from its inexplicably slick surface. In the procedure room, when she would be assigned the task of holding down a squirming child for an IV, or if she was struggling to find a fat infant’s rubbery veins under of the chief residents’ critical eyes, she would often feel the oil and sweat pouring down from her hairline, trickling under her glasses, making everything hot and cloudy, like the surface of some misty alien planet.

She hoarded astringent, perfume and deodorant, all of which she used in abundance, and to seemingly little effect. She took long, warm showers as soon as she got home, and soon used up those tiny floral soaps she had been hoarding for years. For her birthday, she asked specifically for a basket of them from one of those stores in the mall that specialized in giddy floral aromas and overflowing gift displays. But no matter how much she bathed, or how expensive her soap, her nose seemed filled with the smells of the hospital, the sick, and her own stale and sticky body. The only time she ever remembered being so disgusted by her own stink was during Gross Anatomy, when the cloy of Formalin seemed to glom onto her skin, under her nails, and in her very nostril hairs.

She did not hoard sight and sound but rather hid from them. The too bright fluorescent lights, everything stark and bare, the same at 7am as at 2am. True, there were images of bears and butterflies on the walls, but their cartoonish faces were slightly menacing, like clowns with too red, too wide smiles (even as a little girl, she had never liked clowns). Sounds were worse: the incessant crying, the overhead paging and beeping, the shouting of angry mothers and nurses for all the things she had done wrong that day— the delayed orders for pain medication, the incorrectly taped (and now fallen out) IVs. Worse still was the sound of professional humiliation—‘pimping’ by senior residents or attendings who knew you didn’t know and kept asking you anyway. Sometimes, she walked around with imaginary fingers in her ears so that mouths moved but no sounds came out. She hoarded that albeit artificial tranquility.

She hoarded her comfortable clogs, her absorbent socks, and her Victoria’s Secret cotton underwear. There was no purpose in frilly undergarments that might ride up under scrub pants during a tense trip to the ICU. Yet, there seemed to be undue anxiety on the part of her august institution lest she make a less practical choice of attire. In fact, the resident handbook had a bizarrely complex set of dress codes – such that men were discouraged from wearing their hair long, growing beards, wearing jeans or T-shirts. Women, on the other hand, were chastened to avoid open toe shoes, skirts above the knee and shirts unbuttoned below the “sternomanubrial junction.” Women were to wear their V neck scrubs turned to the back, no rings in excess of a wedding band, and no long nails or “creatively colorful” nail polish. Clearly, the hospital was distressed at the thought of a breast popping out during a code, or a lawsuit by someone poked in the eye with a rhinestoned nail or diamond ring. None of it seemed to apply to her anyway—half the time she didn’t remember she was a woman. Her entire body was usually ensconced in a two sizes too big unisex white coat, with roll-up-able sleeves and too big pockets for all the things she was hoarding.

She hoarded sex, or at least, her memories of sex. The actual experience was few and far between. In fact, most of the time, she resented sex, not just because of the sleep she lost (which she calculated down to the minute on the glowing red digital clock) but its newfound difficulties. Whereas sex had once been mellow and honey-smooth, the combination of sleeplessness and stress had morphed intimacy  into a jabbing and fearsome experience—a spiky medieval mace in her nether-regions  If only she had kept quiet, perhaps her husband would not have lost so much interest after a mere six months of marriage. Crying during intimacy, as it turned out, was not such a turn on for men. Worse still, her traitorous body seemed to have a malicious sense of humor; despite all the pain, she often found herself yearning—aching—to be touched. So she hoarded her dusty recollections of physical pleasure. In fact, the memory of being wanted would creep up on her at the most unexpected of times; when running a blood gas to the lab, calling a surgical consult, being awakened to rewrite a Tylenol order for the twentieth time. It trickled hotly, shamefully, through her brittle veins like some lugubrious IV medication. She hoarded the thought, “Here I am no one, but in another place, another time, I have been loved.”

As a substitute for sex, she hoarded the few things from her former life that made her feel alive, like poetry and dangling earrings (also discouraged by the handbook). When they had first been dating, in medical school, her husband would leave her poems to find in unexpected places. In his almost illegible handwriting, he would copy verse by Shakespeare and Emerson, Neruda and Rumi onto yellow sticky notes and post them on the bathroom mirror, tuck them into the windshield of her car, or stick them in her pharmacology textbook. Now, she rediscovered these notes from the secret places such memories are kept. She folded them like mystical mantras whose meaning has been made secondary to their symbolic power, tucking one into each of her scrubs pockets before a long call night. The words were too beautiful to read all at once, so she hoarded them, slipping a sentence into her cheek, a metaphor behind her ear, and, as if afraid of getting mugged, a really vivid image into her sock.

In the pre-dawn mornings, after she parked her car in the hospital lot, she would sit a moment or two in the steel safety of the machine. In that stillness, she allowed herself to consider—would he wait until the end of internship to leave her? For the rest of the day and night, there would be no more time for such thoughts, but she made it this small gesture in the mornings. Then she reminded herself that at least, she would return, at some point in the near future, to that very spot behind the wheel. That she would be physically intact and that she would return. She hoarded the thought.

She hoarded her youth and her adulthood both at the same time. The former protected her from becoming one of the ancient adult patients she passed in the elevators and hallways, the ones with open, gangrenous foot sores and half missing upper jaws. The latter protected her from being one of the bald chemo kids, their mothers hovering hawkishly over them, or, alternately, one of the hollow shells of children who’d been beaten, burned, and maimed within an inch of their lives by their parents or caretakers.

She hoarded sleep when she could get it, in the darkened backs of lecture halls, on the cheap, scratchy couches in the residents’ lounge, and in the frigid bunk beds of the call room when she could get there. She hoarded dreamless sleep in particular, since her REM had lately been playing movie-show horrors—an unanesthetized surgery in which the patient was her mother, a gruesome dissection of her own maggoty foot, a hallway full of dead patients she had forgotten to check on or medicate.

She hoarded time like a child’s paperclip chain—in the bathroom, in the stairwell between floors, in any crevice where she could pause and not be noticed. Her beepers she did not hoard but fingered intermittently to be reassured of their presence. Were they on? Yes, yes.

She hoarded each breath. In and out. Her chest still moving air into her lungs, her heart still pumping blood in its undulating dance of systole and diastole. She hoarded her legs and their ability to run, her back’s ability to hold her body up, her brain which raced amazingly, frenetically along.

She hoarded herself, and the image of a drawn, worried face glimpsed fleetingly in darkened middle-of-the-night windows. And she longed to hold that girl close, even as she slipped slowly from her grasp.

 

“Intern” appeared in Becoming a Doctor: From Student to Specialist, Doctor-Writers Share Their Experiences (W.W. Norton, 2010), edited by Lee Gutkind. Reprinted by permission of the Creative Nonfiction Foundation. 

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