"when the attending physician leaves and
says, 'Phone me if you need anything.'
"That first night on call, I stood in
ICU (Intensive Care Unit) listening to the
cardiac monitors and the respirators,
filled with this enormous sense of responsibility for my patients. For the first time
there was no other doctor standing over
my shoulder. I was the doctor for the
Kate Thompson is a new doctor beginning her internship in Hermann Hospital's
oncology (cancer) ward. Thompson and
99 classmates—including her husband-
received their hoods and diplomas in June
from the University of Texas Medical
School at Houston.
Interns are inducted into patient care
quickly and a rotation on the cancer ward
makes heavy emotional, as well as physical,
demands on them. Death, which doctors
sometimes interpret as failure, is ever
During Thompson's first night on call
she received an urgent message from an
ICU nurse. One of her patients was dying.
"Come here quickly, I think you are going to have to pronounce him soon." Earlier in the evening the family objected to
putting the man on a respirator. No machines, they said, no strangling tubes,
"I told his wife he would probably die
that night without a respirator. She answered that she knew," says Thompson.
"When I got to the ICU the cardiac
monitor was very slow. There would be a
blip and then maybe it would go for 10
seconds before there was another blip."
At the end she saw a straight line and pronounced the patient dead.
"I'd never told a family about a death
before. In medical school there were situations where we could have listened in
but the doctors always closed the door. I
never heard it once. Suddenly, I had to
deal with a family—and get an autopsy
"Your husband has just died," Thomp
son told the patient's wife over the phone,
quietly and simply. Thompson met the
family members when they arrived at the
hospital at 5:00 a.m. "They were crying,
then they would remember something
very nice about the patient and they
would share this and laugh. Then they
would cry, then they would laugh again."
Later, at dawn Thompson walked the
family back out to the parking lot. After
7 a.m. she went to the cafeteria for a
quick breakfast. Fatigue and the emotions surrounding her first patient death
hit, but it was a new day of decisions and
Next, the morning rounds, a time
when each patient's progress is checked
and appropriate treatments and medications are recommended. From 10 a.m. to
noon the interns gather with doctors and
visiting professors for a review of the
cases and an evaluation of the care and
treatment. "I sometimes wonder how my
patients make it at all," Thompson says.
"I feel I've screwed up totally [by] the
textbook, but then I go into their rooms
and they're doing pretty well."
Thompson works with one other intern supervised by a resident doctor and
two cancer specialists. She is assigned approximately 12 patients, each undergoing
experimental chemotherapy treatments.
She's at the hospital seven days a week
and on call every third night. On the cancer ward, being on call usually means 36
nonstop hours for the duration of her
Chemicals that kill to save
Cancer patients undergoing chemotherapy are monitored very carefully.
"These treatments are powerful and wipe
out every living cell, including good blood
Today, one of her patients has only
8,000 platelets. Normal count is 150,000
to 300,000. "This is what we deal with
every day. Patients have the off-the-wall
"The patients are so sick, and there's so much to be done," Thompson says. "Taking
care of about 12 critically ill patients requires a lot of caring, a lot of record-keeping,
a lot of running. You just get cranked up and go on adrenalin," she says.
blood values because of their chemotherapy. With only 8,000 platelets they can begin to bleed from their mouth or under
their skin." This particular patient is not
bleeding, so Thompson and the attending
physician decide to hold off further transfusion for the moment.
Another patient responds well to his
chemotherapy but at 75 years of age emphysema causes other complications. He
may need treatments to dilate his bronchial tubes during the night. Thompson
leaves a note on his chart so this treatment can begin.
A young woman patient in her late
thirties has battled cancer for seven years.
Her hair is thin from chemotherapy treatments and she is back at the hospital for
evaluation and further treatment. She is
apprehensive, but there are not many
minutes for comfort and reassurance.
There are so many patients to see, so
many more treatment decisions to be
Another patient is in a coma in ICU
where he is monitored moment by moment. Thompson checks on him many
times each day and night, using the fire
stairs to run from one hospital floor to
another. Now, she reviews his condition,
orders more blood, updates his chart and
heads back upstairs. "He's not going to
make it, there's just no way. His liver is
all shot, you can tell that from the blood
work. His respiratory status is pretty
good, but his kidneys aren't functioning,
and he's got brain failure." She grimaces,
her chin is set. "I hate it, I just hate it.
He'll never live a normal life again, ever,
but they just persist in keeping him alive.
It hurts me to see it.
"Cancer specialists are the ultimate optimists. They are always hopeful. They
are researchers forever striving for something better. They've got to be optimistic;
they can't get down. The patients are so
sick and there is so much to be done,"
she says."You just get cranked up and go
on adrenalin. I'm always running, running.
Even when there is a pause you think a-
head to what may happen to a patient the
very next moment. Every minute is filled
with decision making situations and now
I'm the one making many of the decisions.
Everyone calls doctor, doctor, all day and
"I had just arrived at the hospital one
morning when my beeper went off," she
says. "I ran to a phone and a nurse said,
'One of our patients is having an arrhythmia. We've got her hooked up to the
cardiac monitor and this is what we see.'
Well, the rhythm was fairly dangerous to
the lady. She could have gone into complete heart block and died. I was running
to get to the floor thinking, 'Oh, my God,
how do I remember what I'm supposed to
do for this. I've learned and I must remember right now.' By the time I got to
the patient's room I knew how to handle
it. I remembered the name of the damn
drug and we brought the lady out of her
rhythm in five or six minutes. I really felt
good about it."
Thompson's afternoons are usually
quieter. "Most patients don't 'crash' in
the afternoon, that happens in the middle
of the night," she says, "so you do paperwork and telephoning to make sure the
tests you ordered are being done. You've
got to be on top of it all."
A young doctor has a lot of necessary
paperwork. There are always case histories and physicals to be written up, charts
that must be updated. "Medical people
have to write thorough case histories.
Others rely on your information. It's got
to be right or the patient suffers." Sometimes that paperwork gets done in the
late afternoons, many other times it is
done at 3 a.m., whenever there is a quiet
"I never see a job completed at one
time," says Thompson. "I'll write a note
on a chart and then get a beep or a nurse
will ask a question or another doctor will
say, 'Let's make rounds.' Consequently,