Young Doctors Try To Survive First Days on Job

By TONY ROGERS, Associated Press Writer

DATELINE: BOSTON

It's 10:29 p.m., and Jonathan Taylor, M.D., is rushing through the New England Medical Center, caring for patients.

It's his third day on the job, and he has a problem.

"I'm lost," he says, squinting up at a florescent light in the hallway.

Armed with a white coat, stethoscope, beeper and medical degree from the University of Pennsylvania, the 27-year-old calls on all his training and makes a snap decision.

"I'll go this way," he mutters, and sprints off.

Taylor is one of about 15,000 medical school graduates embarking this week in U.S. hospitals on the tiring and sometimes confusing three-year residencies. It's likely to be the most demanding time of their professional lives.

As first-year interns, they must survive 100-hour weeks and soak up knowledge to make the transition from student to foot soldier on the front lines of medical care.

What they find is that school doesn't always prepare them when a hospital corridor leads to a dead end. Nor is studying human illness quite the same as caring for real people in need.

As one resident put it, "If medical school was boot camp, then this is the war."

Taylor is a "night floater," watching over the patients of other interns while they snatch a few hours' sleep. This night, he rushes from ward to ward, juggling the records of 60 patients.

It's a tough shift to start the year on. There are many patients, and less supervision than on longer shifts, where older doctors work closely with interns. Taylor was in Spain when the hospital made out the year's schedule, so he got stuck.

"No one wanted to do this starting out, and I didn't either," he says. "But I took the last vacation I'll get for the next three years."

Under the flickering light of a TV set, Taylor draws blood from a 70-year-old woman with a blood clot in her lung. He wraps a rubber tourniquet around her arm just above the elbow. She grips the bed rail, bracing for the needle, then cringes when it pricks her skin.

Later, Taylor checks a 26-year-old cancer patient awaiting a bone-marrow transplant. Her immune system is shot. A sign on her door warns against germs from things like uncooked food and ice. Her temperature is shooting up, and Taylor consults a superior about what to do.

"She could die from the fevers," Taylor says afterwards. "So he told me to check her white blood count. And we might start her on another antibiotic."

The bad joke among doctors is that, with hospitals full of interns in July, medicine can be dangerous to your health. Critics charge that dazed interns working 36-hour shifts can make potentially lethal mistakes.

Two years ago, New York became the first state to limit intern hours, after the death of a patient at New York Hospital that a grand jury attributed to inadequate care and errors by unsupervised interns.

Since then, some other hospitals have cut interns' hours. The night floater shift that Taylor works is an attempt to relieve the burden.

But older physicians still argue that interns have much to learn, and that supervised marathon shifts are the only way to understand the vicissitudes of human illness.

"They don't know their rear ends from their elbows right now," says Dr. Richard Kopelman, a supervising physician at New England Medical. "But that will change."

It's changing quickly for Bob Patz, a surgical intern in the emergency room at Boston City Hospital, where the city's poor come for treatment and the place that partially inspired television's "St. Elsewhere."

"My first day I sewed up the scalp of a guy who'd been stabbed in the head," says Patz, 26. That same day he saw his first bullet wound when he helped patch up a man who had been shot three times in the leg and buttocks.

Twelve hours into her 36-hour shift at New England Medical, Andree Phillips, a 26-year-old intern in the cardiology ward, scurries into the cafeteria to wolf down a pita bread sandwich, a few chocolate chip cookies, a Diet Pepsi and an apple.

Between mouthfuls she consults an older physician about a patient. Twice during the meal her beeper goes off and she races to a phone. Twenty minutes after the meal begins, it ends with another beep.

"I think it's hard on your system to work this many hours," Phillips says.

Harder still are the lessons interns learn about the limits of their profession. Phillips, a Montreal native in her fifth day on the job, has already brushed against those limits. One of her patients is dying.

"I can't do anything for her," Phillips says. "It's frustrating when you know what you're supposed to do and it doesn't work."