Author's Foreword: The Intern started life on Wattpad, and I will be forever grateful to the many Wattpadders who loved the story and encouraged me to keep going with it. I am thrilled to tell you all that the story of Maggie and Bobby and all the other quirky characters at 'Our Lady of the Golden Arches' in Spanish Harlem was picked up for publication by TouchPoint Press (April 2020) and is available now for pre-order on Amazon.
The story has changed some for sure, but the basic story line which many of you helped me form is still there. I think it is interesting to note that my agent changed quite a bit about the story, but the editor who bought it changed much of it back to the original story line.
For those of you who want to see how the story came out, here is the link to the Amazon page for The Intern: https://amzn.to/2Qx1eUw
For those of you who would like a free copy in exchange for posting a review; Please message me or e-mail at peter@peterhogenkamp.com
Thanks again to you all.
I have left the original first few chapters up in case anyone is interested in seeing how the story evolved.
The Intern
When she was later asked about it-at the Disciplinary Review Board meeting that would convene at the end of the year-the intern answered that she wasn't sure what had brought her to Room 12, other than a 'vague uneasiness' about the welfare of her patient.
'Uneasy?' the attending physician would inquire. 'About a dying patient? What did you expect to go wrong?'
'He was twelve,' would be her response, 'Twelve year old boys shouldn't die.'
But she was not privy to this future conversation as she descended the back stairway to the pediatrics floor and pushed open the creaky metal door that let out onto the dimly lit ward. Room 12 was at the end of the hall and to the right, at the far side of an alcove which few patients ever entered-and none left. She padded down the hall as quietly as she could in her plastic clogs, hoping not to wake the pyelo in Room 2 or the appy in 4. Passing Room 6 she was pleased to hear nothing other than the soft hiss of oxygen, indicating that the wheezer she had admitted yesterday was responding to the treatments she had ordered.
The main ward stopped abruptly at this point-as if the builders had suddenly realized they had neither the space nor the funding to continue-and the alcove began, jutting out from the hallway like the afterthought it was. She paused at the corner, reaching into the recess where the nurses stowed the food cart, and tucked away a couple packages of graham crackers into the pocket of her long white coat. She had never cared for graham crackers, but Bobby loved them and there were few things-none actually-she wouldn't do to see a smile on his pale, drawn face.
The door to Room 12 was ajar, and she squeezed through, ignoring the signs that Disease Control had plastered all over the door. The room was dark save for the reading light she had fixed to the headboard of Bobby's bed so he could read the latest edition of the X-men for the 100th time. To her lack of surprise Bobby was curled up in a ball underneath the light, clutching the beaten magazine in the only hand that cancer hadn't stolen from him.
"You shouldn't be in here," Bobby said without looking up. "Didn't you see the signs?"
"How did you know it was me?" she asked.
"Nobody else ever comes in."
She didn't doubt it: there was no family listed on his chart and the chief resident and attending physician seemed happy to let her run the case on her own. Several clever replies-No one else deserves you or Try being less sarcastic-flitted through her head but she just nodded and sat down in the hard plastic chair next to the bed.
"Why don't you try reading something else?"
He rolled up the comic book and swatted the pocket of her lab coat, stuffed with medical manuals and small notebooks overflowing with her neat script. "I could say the same about you."
"I have my boards tomorrow morning," she replied, rubbing the knot in her neck where the collar of the coat dug into her trapezius.
"Why aren't you studying then?"
"I wanted a break."
"Where's Toothy?" he asked, referring to her boyfriend who had rotated through Pediatrics last month.
He was studying, of course, and detested any kind of interruption or distraction, especially on the night before such an important exam.
"No clue," she said.
"He's not good enough for you," Bobby said bluntly. It was one of the things she loved about him, his bluntness. As he had told her many times before, 'When you don't have long to live, there isn't time not to get right to the point.'
"I think you're jealous," she said, deflecting.
"I'm jealous of people who buy green tomatoes," he replied. "Stop changing the subject."
"You don't even know him," she replied, flinching at the realization that she had said the same thing to her mother.
"Ha!" he croaked, barely able to muster the volume necessary to sound triumphant. "Whose place do you think you took?"
"Ah, yes," she said. "You two didn't get on well?"
"Pppppffffhhhhhhh," he answered.
"You better pipe down or I'll go back to the library."
"See if I care," he said, but dropped the comic book and reached out for her arm with his shriveled hand. Bobby weighed only 50 pounds soaking wet and stood only four-and-a-half feet high-when he had the strength to stand-living proof that mustard gas and rat poison should never be given to growing boys.
The intern closed her eyes and tried to conjure up the sheet of formulas she had been studying, but all she could see was a page of full of insensible smudges superimposed on Bobby's face. Her beeper vibrated on her waist, and she pried open her lids to check the number. It was the Emergency Department: again. She fished the crackers out of her pocket and tossed them onto the bedside table as she extracted herself from the chair.
"You just got here," Bobby complained.
"That was my other boyfriend."
"Who's that?"
"Dr. Foster," she said, heading to the door. "And he doesn't like to be kept waiting."
"You're leaving me to see that prick," he complained, but she was already out the door and standing at the basin, washing her hands of the microorganisms his body was too weak to defeat. She ran her hands through the microwave drier and walked past the elevator on her way to the ED using the staircase at the back of the ward.
'Rule #1 of being an intern,' Yoda had told her on the first day of her residency, a thousand years ago, 'Never take the elevator.'
'Why not?' one of the other interns had asked the short, slight woman who would be serving as their chief resident for the entire year.
'There is no why or why not, Intern,' had been the response. 'There is only do.'
The intern reached her destination without seeing anyone and found Dr. Foster at the nurse's station, holding court with a small group of people-nurses, orderlies, and residents, all of them female. She shuffled to the back of the line, but her height betrayed her.
"Thirteen," he said, barely glancing in her direction.
Room thirteen was a depression in the old back wall of the hospital against which the orderlies parked a gurney when space was tight. Someone-most likely one of the faceless administrators lurking in the bowels of the main building-had rolled a pair of mobile curtains there to give the illusion of privacy. She fought her way back through the chaos of darting bodies, flashing lights and the banshee wail of a dozen alarm bells and slipped between the two dividers. A small stool was positioned in front of the stretcher, and she sat down and opened up her computer on her lap.
There was a girl lying prone on the stretcher, fifteen or sixteen years old, dozing peacefully despite the noise. The intern called up her chart and noted that her vitals hadn't been taken in almost two hours-about par for Room 13-and she set her laptop aside and reached for the cart.
When she was sure her patient was stable, she scrolled to the history taken by the triage nurse. The word 'overdose', in small font, was all it said. She clicked on the downward arrow and found the ambulance report, in the hope of finding out what the patient had taken, but all she saw were the times of dispatch and arrival-more fodder for the suits to analyze inside the cube farm.
She was tempted to click on the toxicology report and satisfy her curiosity right then and there, but she sat the computer aside and fished her stethoscope out from inside her mother's old lab coat.
'Rule # 2, interns,' Yoda said, 'Take any opportunity to learn, no matter how busy or tired you are, because most of your time will be spent doing my scutwork.'
There was nothing remarkable about the patient's exam, other than her tachycardia (few patients didn't have a racing heart in the ED, a place Yoda referred to as 'the asshole of the hospital') and dozens of horizontal cuts on her arms in various states of healing, none very fresh.
The divider rolled back for a second and the nurse came in, pushing her aside as he reached for the vitals cart.
"I already took them."
The nurse, a veteran of the nightshift with a furry mustache that looked like a fuzzy bear had been glued to his alabaster white face, nodded and walked out without saying a word. She wanted to say 'your welcome,' but it had never been her nature to be sarcastic and she wasn't about to let the 100 hour work week, the never-ending list of menial tasks, and the nagging feeling that she wasn't smart enough to be a doctor change her personality. Sarcasm worked for some people-Bobby came straight to mind-but not her.
She scooped up her laptop and found the urine tox screen. As was often the case in these teenage overdoses, the patient's urine looked a lot like a medicine cabinet: there was Tylenol, of course, Advil, aspirin, Benadryl and a smattering of Xanax for good measure-all washed down with a half-pint of cheap vodka. The mixture was a tough go for anyone's stomach and-fortunately-she had vomited up most of it, and the ED had done the rest. By the time they had stuffed a tube down her nose-the biggest one they had to accommodate pill fragments-vacuumed her out and then stuffed her full of charcoal to absorb the rest, there was only enough sedative in her system to obtund her and buy her a night on the peds floor. In the morning she would have one hell of a headache-which the intern would allow her to keep for the day-but would be otherwise ok.
For a moment the intern wondered why the patient had done it, but the moment faded and her mind filled with more practical concerns such as the dosing of the drug used to reverse the Xanax and the type of IV fluids she should be ordering. She was sure that her previous self-the one who had applied to med school with such enthusiasm-wouldn't approve of her indifference, but there was room enough only for so many thoughts in her head. And the why wouldn't make any difference if the patient didn't survive the night.
She typed the History and Physical and then wrote the orders, deciding on ½ Normal saline as the fluid for the patient's intravenous, and went back to the Nurse's Station to find Dr. Foster. He was the kind of Attending that could be heard before seen, but she didn't discern the smooth, self-assured voice or the cackle of feminine laughter that invariably followed anything he said. Her friend Rhonda had taken over as the charge nurse, and the intern moved over to her desk in the center of the station, positioned there to get the panoramic view of the chaos.
"Have you seen Foster?"
"Dr. Delicious?"
"Yes," the intern replied, "him."
"I think he's in the cafeteria."
She was going to ask Rhonda about something else, but a drunk approached from the other side, bellowing to wake the dead, and she slipped away as Rhonda silenced him with a look and a lifted finger.
The cafeteria was usually quiet around this time and tonight was no exception. She walked past the plastic-wrapped sandwiches and the basket filled with sad-looking fruit and located Foster in the back of the cafeteria, sipping a cup of coffee and reading a battered copy of People. He looked up as she approached and nodded for her to sit down. She would have much preferred to stand, but Yoda had been clear about the issue: 'You don't have to be a suck-up, but don't be a pain in the ass either. No one likes a pain in the ass.'
Foster set the magazine down and regarded her with his eyes the color of the spruce trees that were planted in between the hospital and the McDonald's next door.
"How's the Overdose doing?" he asked.
The intern reached for the notes in her pocket but decided against using them, fearful of being accused of 'bad form,' and launched into her presentation of the case, using the same formula interns had been using for all of eternity. With no audience around-he was a different person with an audience around-Foster listened carefully and didn't interrupt or interject any of the clever one-liners for which he was famous.
"Plan?" he asked when she completed her assessment.
She rattled off the buzzwords that she had learned in the last eight months: observation; hydration; monitoring; I/O's and nothingbymouth. Foster nodded as if the words actually meant something and asked: "Fluids?"
"Half-normal saline at 250cc/hour.'
He rubbed his pronounced chin-the one with the central dimple that mesmerized most of the nursing staff. "No potassium?"
"It was normal when the ED checked it."
"Yes, you mentioned that, but that was 3 hours ago. Check it again-you said that the patient had been vomiting. Vomiting wastes potassium and it usually takes a while for the potassium debt to show up in the blood work."
She nodded, vaguely remembering that she had heard Yoda say that before.
"Did you place a Foley?"
"The ED did, yes, but I was going to take it out."
"Leave it in, it's the only good way to measure urine output."
She jotted this down on her notebook and looked up expectantly. "Anything else?"
"I don't think so," he said. "You covered most of it."
She guessed it was meant as a compliment but she was too wary of Foster to be happy about it. 'Foster's a dog with fleas,' Bobby had warned her. 'He's just trying to get down your pants.'
When she looked up he was halfway to the back exit of the cafeteria. "Rounds at five," he said before disappearing.
She opened up her laptop and ordered the repeat blood work and added the K to the bag, annoyed with herself she had missed something. Foster had left the copy of People on the table, and she flipped through it by way of distraction, wondering as she leafed through the worn pages what she might have done with her life besides doctoring-not that her parents would have allowed any other choice. She flipped to a book review and thought about her ambitions to be a writer, which her father had squelched when she was about Bobby's age. 'No money in it,' he had said. 'Maybe as a sideline.'
The intern tossed the magazine back on the rack and headed back to the peds floor. The night shift was on the way in and she was glad to see Babe shuffling back to the break room where she would take report from the charge nurse on evening's. Babe hung up her enormous pea coat on the hook by the door and wedged herself in to the table. The intern followed her in, and took the seat beside her. It wasn't mandatory to attend the nursing sign-out, but the intern had made a practice of it-and what else was there to do anyway? Trying to sleep at this hour was an exercise in frustration, and she couldn't even stomach the idea of studying for the Boards; she was either going to pass, or she wasn't. At this moment in time, she had no preference.
"Damn, am I glad to see you," Babe said, clapping her on the back with her thick hand. "That damn fool Melendez nearly killed half the damn ward. That boy's got less sense than hair, and he's got damn little of that."
Melendez was one of the other interns rotating through peds this month, and it had taken him only a few days to catch ire from Babe. One of the other nurses gave her an encouraging look, and Babe launched into an embellished tale of his incompetence and arrogance, highlighted by his failure to administer racemic epinephrine to the crouper in respiratory distress.
"You got to give them croupers the epi," she said, "Everybody knows that."
When she was done, the charge nurse on evening shift, an agency nurse named Sarah who none of them cared for much, started her report in her dry, nasally tone. The intern took out her notebook and started scratching down a ToDo list, but her mind was elsewhere and the words-intravenous, transdermal, parenteral-just sort of floated through her.
She was just about to nod off when the shrill wail of the code beeper whipped her eyes open.
Shit.
She ran out into the nurse's station and followed a pair of nurses pushing the crash cart, heading towards the alcove where Bobby's room was.
Please. No. Not Bobby.
They rounded the corner and plunged straight into Room 12, liberating the flyers Infection Control had posted there. The intern followed them in and saw him, pale and lifeless on the bed with his fingers still clutching his comic book. She ran to his side and opened his mouth to check his airway, but there was no obstruction. She auscultated his lungs, hoping to be rewarded with the hiss of his breath sounds, but all was quiet. A quick check of his carotid revealed no pulse.
Damn. Damn.
She grabbed the defibrillator and placed the pads on Bobby's tiny chest as Babe shuffled in, huffing and puffing like an old freight train. One of the nurses switched the machine to the diagnostic mode and a rapid wave appeared on the screen.
"It's ventricular fibrillation," the intern said. "Twenty-five joules."
"What are you doing, girl?" Babe asked. "What are you doing?"
The intern tried to ignore her, but Babe wouldn't be ignored: "This is a mistake, and you know it."
"Clear," she yelled, and checked the bed to make sure no one was touching the patient.
Her thumbs found the triggers and she depressed them, arcing twenty-five joules of energy through Bobby's body, which caused it to leap off the bed.
"Diagnostic," she barked, only vaguely familiar with her own voice.
One of the nurses switched it back, and the dancing line reappeared, even more chaotic than before. "Charge," she yelled.
She felt Babe brush up against her. "I'm going to ask you one more time, Intern. What are you doing?"
"He's a full code, Babe."
"Only because his state-appointed guardian doesn't have a lick of sense."
"He's a full code," she repeated. "We have to run a code."
"So run it slow..... and let this poor boy go."
The intern hesitated for a minute until she heard it, Yoda's hoarse voice whispering in her ear: 'The nurses are smart and experienced, intern, but they are not in charge. You are in charge. Always remember that. When things go bad-and they will go bad-the nurse isn't going to have to answer to the attending. You are.'
Babe looked at her expectantly, and the intern leaned her shoulder into her and pushed hard with her legs, driving the charge nurse away from the bed.
She yelled 'clear' and shocked him again, filling the air with the smell of ozone and scorched flesh. This time the chaos went away, yielding to a nice clean rhythm.
"He's got a pulse," one of the nurses yelled.
"Blood pressure?" the intern asked.
"80 over palp."
She took one last look at the neat, organized complexes on the LED screen-she had never seen anything so beautiful in her life-and risked a glance at his face. His cheeks were stained pink and his eyes were open and locked on hers.
Somewhere behind her she heard the sound of Babe stomping back to report, muttering loudly under her breath: "Don't you ever cross me again, Innnternnnn."
(Author's Note: Hope you enjoyed chapter 1 of The Intern. If you did, PLEASE vote for the story before you move ahead to chapter 2. And don't forget to follow me and let your friends know about Maggie. Comment as well, or make a suggestion, I respond to any and all. Thanks again for your support.)