when it’s as simple a matter as starting an IV. Then, too, as interns on the same ward wedid have a kind of rivalry going. But Lang had been on the night before, and up for almost all of it with a new diabetic; he was worn out. I guess even his pride couldn’t keephim from wanting to get some sleep, so he finally gave up and let me take over.Everyone has bad days during his internship, times not so much when your minddoesn’t work as when your hands just don’t seem to do what they’re told. Mostly it’s because of tiredness, and on 402 we were always tired. Still, even so you can work thingsout if you’re practiced enough.I’d had my own trouble with spinal taps, real trouble, so I’d gone down to themorgue and practiced on cadavers until I worked it through. The facility I gained withspinal taps spilled over to starting IVs. I was known to be good at it, even with newborns,and I suppose this was one of the reasons Lang was willing to stop.“I’m not leaving you much,” he said, taking off his gloves. In truth there wasn’tmuch left. He’d destroyed every big vein in the child’s arms and legs, even going so far as to ruin the smaller superficial veins on the back of the hands and feet, not to mentionthe cut-down site on one leg which he hadn’t even bothered to suture shut. But at leasthe’d left the patient exhausted, so that when I bent over the table to examine him hehardly moved, much less resisted.After ten minutes of searching for a vessel I was beginning to think I’d have to doa cut-down on the other leg when I found a small vein behind the child’s ear. Lang hadoverlooked it, or thought it was too small to use. I took a tiny scalp needle, and threadedthe tip of it down under the skin and finally into the vein, made sure it was working, thentaped it down. I had the nurse set up the IV bottle and left the room to write up theorders.To have been scrupulously correct about ward responsibilities I should havecalled the resident, McMillan, let him know the difficulty Lang was having and that I’dtaken over the patient. But I’d cared for enough dehydrations to know exactly what to do,and once I got the IV going there was no reason to call. If after nine months of pediatricinternship you don’t know how to write fluid orders you should quit and do somethingelse. So despite the fact that McMillan should have OK’d my taking over, I decided notto bother him, to do what had to be done, and tell him later.
THERE ARE SOME RESIDENTS you would have had to call, if only to keepthem from climbing all over you when they found out what you’d done. McMillan wasn’tlike that; he let you alone to do your work. If he felt you didn’t know something, or if youtold him you were a bit shaky about a procedure or treatment, he’d be right there to showyou how to do it. The next time he would watch you do it yourself, and after that youwere on your own. If you screwed up, though, if you told him something that wasn’t true,or tried something you were unable to do or knew you’d have trouble handling, he’d nailyou to the wall and keep you there the rest of the time you were on the ward with him.If you didn’t step beyond your ability he was fine—more than fine, he wasexceptional. As tough as he could be and as strict as he was, he was liked by everyone— at least we all enjoyed working with him. He was smart, really smart, and he read morethan any other resident on the house staff, even those with more seniority. There wasn’t a