The medical intern and the real world
Showing newbies the street can be illuminating
By Michael Morse
Dr. Francis Sullivan is a prominent ER doc in Rhode Island Hospital, as well as the guy who greets and indoctrinates the new interns at the Brown University Alpert Medical School’s emergency medicine program. Dr. Sullivan sets up ambulance ride-alongs for the new interns every July. It’s a great program; we get to know the new interns, and they get to see the real Providence.
Being a fossil, I have seen a few classes of interns come and go. I like to watch their progression from recent med school graduate to second year intern, then third, then attending physician. Some stick around Rhode Island’s ERs and make their lives here, while others move on and make their lives somewhere else.
But a lot of excellent emergency physicians get their start on our ALS units, and it makes me proud to know that they started where so much begins, on an ALS call. I’d also like to think they get an invaluable perspective on emergency medical care. I know one recent intern did.
Real world experience
We picked our intern up around 1:30 p.m. at the repair garage, deep in the heart of the West End, because Rescue 2, her assigned unit for the day, broke down. Things get a little nutty in the afternoons; it’s tough to schedule anything around the 911 calls.
I was a little beat up by then. The day started at five the night before, and all sorts of fun had already passed my way. There was a two-year-old with a change of mental status; a man on a pay phone having a seizure while telling the dispatchers where he was; an emotionally unstable man threatening people with a knife; a building fire on Benefit Street — and that wasn’t even half of it. Let’s just say I was not firing on all cylinders when the good doctor appeared.
Anyway, there’s no crying in EMS, so I put my best foot forward, letting her sit in front, supposedly so she could see the city, her being from South Carolina and all. In reality it was more of a snooze opportunity (those captain chairs can swallow you whole when you let them).
Two fairly standard transports went by without much fanfare; the third might stay in her mind for a while.
“Rescue 6, respond to 126 [redacted] Avenue for a female requesting medical aid.”
We arrived at the address and asked if the folks living there called us. Blank stares, slammed doors and confused looks everywhere. Nobody had called, it seemed.
A furious woman came charging up the street, all 300 pounds of her body wiggling, even her face. She screamed that they “needed us down there!” So down there we went.
We had barely opened the doors to the rescue and hadn’t set foot on the ground when a woman opened a second floor window and screamed, “She’s going to Saint Farthest, Rhode Island Hospital is full of idiots!” Mind you, our intern had chosen the Emergency Medicine intern program at Rhode Island Hospital as her first choice, and it is one of the best, if not the best, program anywhere.
Smoke and sorrow
We left the safety of the truck, navigated through a pile of rubbish, walked up some grimy stairs and into a tobacco den. I thought the place was on fire. The matron of the home accosted us, puffing smoke like mad. Her man stood guard; he was also puffing away while glaring at us.
Two children, one in diapers, the other in a filthy shirt and underwear, crawled on the floor, or more aptly the impetigo forest, and breathed it all in. I could actually see the grime being transferred from the worn linoleum onto their tender skin.
The doctor took it well, and managed to keep her expression neutral. Not bad for somebody unfamiliar with the sights and sounds of the ghetto.
“Them idiots at Rhode Island Hospital don’t know nothing!” the first lady shrieked. “They had her in the hospital five days, did a bunch of useless tests and nothing! She still has head pains!”
I looked at the papers she thrust into my hands. CAT scan, MRI, blood work, EEG and some others that I have no idea what they were. Tens of thousands of dollars worth of tests.
“Where is she?” I asked.
“In there,” thumbed the man. “She got in a bad accident a week ago, had headaches ever since. It’s the accident, I tell ya, the accident!” His voice was earnest, begging to be heard.
Putting things in perspective
Our patient was a 30-year-old woman who suffered from cerebral palsy; she was lying on her side in bed, unable to move. She refused to move, stating that it was absolutely, 100 percent impossible.
“I’m going to St. Farthest! They’re idiots at Rhode Island.”
I smiled at our intern, who was still handling things remarkably well. She asked some questions, never taking the insults personally, just trying to find out what went wrong.
After some more yelling, threats, accusations, and finally reconciliation and peace, we got some help from Engine 14 and carried her out of the house. The doctor talked with the kids. I gave them as much attention as I could, but we left them there. The next generation of firefighters and EMTs, and maybe even an intern or two, will be returning here for generations.
Later, just before we dropped our intern off, we had a quiet moment.
“That was just so sad,” she said, and I could see in her eyes that she meant it. “I’m glad I got to see that; it puts things in perspective.”
I’m pretty sure that’s what the program is all about.