Intern by Sandeep Jauhar Page B

be graded after so many years?” someonesaid as we munched on popcorn. There were murmurs of agreement. We had all become so reward-dependent.
    We laughed about our mishaps over the month. Cynthia said she still hadn’t figured out how to work the computer system. Just last week she had ordered blood tests for a patient that somehow never got transmitted to the lab, so for forty-five minutes the lab kept sending the patient back to her office, asking her to reorder the tests. Ali emitted a loud, uninhibited cackle not unlike the laugh of a hyena.
    Rachel said the clinic experience had convinced her to subspecialize. She recounted how one morning she had seen a patient whose voice was hoarse. She had no idea what was wrong with him, but her preceptor, on a routine flyby, immediately diagnosed goiter, an enlargement of the thyroid gland. “You have to know too much to do primary care,” she said. “I just want to focus on something I can be good at.”
    â€œIt’s strange,” Ali said. “Sometimes it feels like I’m wearing someone else’s clothes and I can’t wait to get home to put mine back on.” We all nodded. We all felt the same way.
    â€œDoes anyone here think we’re really helping patients?” Cynthia asked skeptically. “I mean, I can’t convince myself that what we’re doing is making that much of a difference.”
    â€œI don’t know,” I answered, surprised to find myself defending the profession. “Look at lawyers. What do they contribute?”
    Afterward, around eight o’clock in the evening, I walked alone to Central Park. Someone had once told me that when he was a kid visiting New York, he thought the avenues were like tunnels. When I crossed Park Avenue, I saw what he meant. In the distance the apartment houses, rising majestically, seemed to reach out to each other, as if collapsing under the weight of their own grandeur.
    I sat down by a tree near the park entrance. A stooped man wearing a blue overcoat and a bowler was feeding nuts to squirrels, beckoning them with, “Come, come, come, little boy.” A tiny mouse was chasing its own tail in the grass, going round and round, tirelessly, ceaselessly; a crowd had gathered to watch it. I looked up at the magnificentbuildings on Fifth Avenue with their balustraded terraces and molded façades, each a small world in itself, reaching up to the sky.
    In the grass I perused a handbook on critical care cardiology Rajiv had loaned me. In internship your next hurdle is always the biggest, and yet this evening, that really seemed to be the case. The cardiac care unit at New York Hospital was the epitome of pressurized, high-intensity medicine. For all intents and purposes, my residency was going to begin on Monday: overnight call, emergencies, all the craziness and hullabaloo of inpatient medicine. Residents in the CCU wore cotton scrubs like a badge of honor. The very term told me that I was finally going to get my hands dirty.
    I thought back to my one and only experience in the CCU, in my first clinical clerkship in internal medicine at the beginning of my third year in medical school. I was working with a star resident of the internal medicine program at St. Louis. David was confident, competent, quick. He thrived under pressure.
    One afternoon, my team was called to the CCU. A patient, James Abbott, had just been admitted with excruciating chest pain that had started a few hours earlier. He was in his early fifties, extensively tattooed, just the sort of tough I wouldn’t want to meet alone in a parking lot at night—but right then he was whimpering. He kept stroking his sternum up and down, as if trying to rub the pain away. It was obvious that he was having a heart attack. He had all the classic risk factors: hypertension, high cholesterol, a history of cigarette smoking. His electrocardiogram and blood tests showed characteristic signs of low blood flow to