My first admission was “Buck.” Buck was in his 70’s, diabetic, and set in his ways. He was a large man and was not fond of showering, so much so that there was a flourishing micro-ecosystem under his panus (don’t look it up). Normally I am not one to judge, but his odor was to the point that nursing refused to go in after they lifted his panus (don’t look it up) up to clean out his cheese. It was as if opening his folds unearthed an evil that covered the land, not unlike Rita Repulsa. Though I don’t suppose Rita smelled like rotten s**t (but I can’t confirm that; I stopped watching after Power Rangers Neo). However, Buck loved himself and his life and was proud of his lack of basic human hygiene; he even joked that he would use his odor to deter any chores delegated to him from his wife and daughters. As I was amazed at his indirect admission to having had sexual intercourse and subsequently procreated, he showed me the real reason why he was here. He moved aside his blanket to show me his legs; my eyes went from his normal looking plump right leg to the sundried black hotdog that was his left leg. Even though he had his foot wrapped it was obvious that his leg from the knee down had severe gangrene. Buck recalled that he had foot pain two months ago and as time went on it got worse and then it got better. He only came in today at the request of his wife, whom I was still not completely convinced existed. As I undid the wrapping to take a look at his foot, his pinkie toe just popped off. Just like that. Pop. I picked up his toe husk and held it in the air; we both looked at each other in silence. Most men would freak out or cry. Not your boy Buck. He proceeded to reach over to his other middle toe and, with toddler-like curiosity, popped it off. He then started to laugh. And then I started to laugh while screaming on the inside. When you get past the smell, Buck was actually a nice guy. Diabetes runs in his family and his mother had the same issues. I told him that the reason why his foot had stopped hurting was because it was essentially dead. We spoke about amputation as the next viable step, and said that vascular surgery would see him tomorrow morning to speak to him in more detail. As I left, he dropped his joking façade and asked me to update his wife; he blamed himself for his current state and was too ashamed to speak to her. I assured him that there’s no point in blaming anyone at this point and that I would call his family. Turns out, they did exist. Nice people.

When patients come to the hospital, they are scared. An unknown environment, surrounded by unknown people poking and prodding, undergoing alien tests and take unknown medications is nerve racking. Oh, and being told that they will have to pay for this world class experience. So when people are nasty to me, I get it. Hearing bad news and being sick is s**tty. That being said, there is one patient who I will nickname Satan as it serves to both respect her privacy and is an apt description of her. I had the celestial misfortune of taking care of Satan three months ago. Without going into detail (as that is in itself another novel), there was nothing wrong with her medically and she was verbally and physically abusive to the staff for not getting her way; she got a private room because no roommates could stand her. She was on her second hospital appeal. Me, being the optimistic goon face I was, thought that once I was done with my month block I would never see her again. Boy did I f**k up. Turns out she never left. I get a call from the nurses saying that Satan would like to have a word. I was on my third admission at that time and let them know I would be up when I can AKA unless she’s actively dying I’m ghosting that floor. After the third call from the nurse with the tone of her voice hinting she herself would need to put on suicide watch, I came upstairs. Satan was known to make residents and nurses cry. Satan is known to be a trickster and this particular form of him has a set strategy to get whatever she wanted: she would rant about her whole medical history. From the start. All 900 tomes of it. It wore down lesser men to give her what she wanted and that night she was eyeing the good stuff: Dilaudid, or the unhinged cousin of morphine that got sent away to another state because he kept killing small animals and his parents were worried but came back with tattoos and a switch blade and is peer-pressuring you to do whippets and Tide Pods. As she kept going, her voice kept crescendo-ing ever higher to her finale which was wailing cry not unlike a banshee. But ya boy was unshook. Remember, I had dealt with this before. I was Geralt without the good looks or charisma, and I had spent three months brewing a potion for this moment. She asked for the med twice. To the first one I said no; she proceeded continue to wail to appeal to my humanity. Satan truly is treacherous. When she asked me a second time and when denied again, immediately switched to her true form. I mean, she actually snarled. It reminded me of that one scene in LOTR when Smeagol cried and switched to Gollum right after. The Beast then proceeded to throw her dirty trays and dishes at me. I left the Mordor that was her room and told the nurse to call security; little did I know, I would be tested again before the morning sun.

Nurses are the life blood of the hospital. They can make or break your stay, and for interns they can make or break your year. Let me preface with saying that the majority of nurses I have had the pleasure of working with are stellar and that I would trust them with my family members. That being said, just as there are bad physicians there are also bad nurses. Nurses are HEAVILY protected in medicine nowadays. It was largely due in part for the s**tty treatment they had in the past and reform passed to protect them (which I am all for). However, the scales now shifted so much that son put on blinders to protecting nurses in the event of a nursing mistake. With these people, any form of criticism is seen as an attack and not as an attempt to improve or educate. Now remember when I said interns were the lowest of the hierarchy in the hospital? Except for maybe an NA, its not an exaggeration. Even medical students, who look like feeble malnourished gnomes ready to cry at any moment, have a lot of protection against deliberate abuse. At the end of the day, it may be easier bite to bullet for the sake of taking care of your patient. I say all this because sprinkled all throughout my shift were numerous pages from some of the nurses for menial things. There was one particular nurse who would page me for every little thing; now I completely understand if you’re paging me for meds or to check out something worrying you, but if you’re paging me because someone had a bowel movement or if their heart rate is a little slow BECAUSE THEY ARE ASLEEP, then I start getting annoyed. I got even more annoyed when she proceeded to wake that patient up, then paged me to tell me his heart rate is normal but he would like an Ambien because he was woken up. What was the final s**t topping on this garbage pizza was when she paged me to tell me someone had a nightmare and then promptly went back to sleep. When asked why she felt the need to inform me of this, she could not provide a reason. At that moment, I looked outside the window to estimate the likelihood of survival if I were to jump at that height. But seriously, I love nurses.

At this point I had gotten two more admissions back to back. The first was a sweet lady who had Hepatitis C liver cirrhosis. Her cirrhosis got to the point where her belly would fill up with fluid, making it difficult for her to breath. When I walked in, it looked like Octomom but less gross. I promptly started paracentesis on her (long tube with stabby end; stabby end goes in, and fluid comes out of the tube). I drained approx. 11 liters of fluid (shout out to the metric system) from her belly and she was able to breath and sleep for the first time in ages. The next patient was middle-aged man also with breathing problems. I checked his chart for prior admissions and saw that he was admitted to the hospital two weeks ago.. and then two weeks before that.. and then two weeks prior to that. That’s a huge red flag. His underlying diagnosis was congestive heart failure, which is when your heart sucks and can’t pump blood efficiently leading to a back-up in other organs including lungs. This gentleman gets tuned up every two weeks by his cardiologist and comes back because he can’t follow his low salt diet. The culprit this time was a back to back to back visit to a Chinese buffet, followed by attempted sex with his wife when he could not breath. As he went into detail about what positions they had tried prior to coming here, I wondered if there was enough Xanax in the world to alleviate me from this or should I just cut to the chase and choke myself out with my stethoscope. I start his meds and he pissed out 1.5 liters in an hour and felt better. As I was leaving, I heard him ask his nurse if he can get a normal diet because the low salt diet they always give him here doesn’t taste as good. I would see him two weeks later for the same s**t.

The food served in the cafeteria is garbage city. It’s the same food they serve the patients, but they add salt and mark up the price. I’ve seen the same “salad” they served at lunch be rebranded into a “gourmet salad” at dinner and charged four dollars extra. F**k you salad. If I didn’t want you at your best, what makes you think I want you at your worst? At night, the desperation gets real and with all outside places closed, a man is forced to make harsh decisions. I stared at a turkey sandwich and a ham sandwich. There was a reason why these two were left; if these sandwiches were people, those two looked like depression served with a side of lupus. I started to hallucinate about the time I went to the Bronx zoo at the tender age of six (I promise this is relevant). I don’t remember jack s**t else from that trip except an incident in the café where one of the kids asked the teacher where all the sick animals go. Before the teacher had a chance to respond, Charles (who was by all rights a f**king degenerate from the get-go) stepped in to tell him that they come to the café turned into food. This prompted kid #1 to look at his food and begin crying; the teacher spent the whole bus ride back stopping him from making himself throw up. I don’t think I ever remember seeing Charles again after that. The point is, delirium set in and made me question if the bodies of those that died in the hospital ended up as the lunch special. That in itself made me abandon the diseased sandwiches and had me make my way downstairs to the basement vending machines. These machines were ancient Depression- era contraptions, and, when they worked, accepted exact change ONLY. One dollar bill for a 70 cent snack? Go f**k yourself. Oh, you want to spend $1.10 on two 55 cent snacks? What is this, NASA? Have fun starving dumba**. The machine had a potpourri of mediocrity: old gum that hadn’t been changed since ground-breaking of the hospital, candy that looks as if it had been outlawed by the FDA years ago, and for some reason two f**king rows of pretzels. Resigning and reaching into my pocket for change as I mentally prepared my mouth for the coarse pretzel dryness, my eyes caught a hidden jewel. They had f**king lime flavored Flaming Hot Cheetos. And no one had taken any because they stayed hidden under the dirt of the vending machine display window. As I put my money in (exact change and all) and pressed the button, all I could do was helplessly watch as the spring rotated and nothing moved. It was busted. That’s why the Cheetos remained unmolested. That f**king cheetah with his f**king sunglasses just looked at me and smiled, mocking me. I would have said God had plenty of jokes that night, but that would mean there was a God there to begin with. No, we remained godless. There was only the devil.

By the time I had gotten over my Cheetos betrayal and wrapped up another admission, things slowed down and it was time to rest. The sky outside started to lighten and with that marked the coming end to all this bulls**t. As I made my way up, there was an overhead message calling security to the floor which I was covering. I immediately knew who it was and sighed as I made my way up. On transit, I was paged twice by the floor; it had to be Satan and whatever she was doing must have been truly sinister. I found out that she had assaulted a nurse and that nurse, in turn, called the sheriff because our security force is made up of retired gym teachers and adults with shattered knees who still try to play in adult sports leagues. I petition this nurse for sainthood because even after what Satan did to her, she still did not wish to press charges. Even though I was not there for the incident, I had to speak to about three officers and give a statement. My senior admitting resident came up to check up on me. I was happy that someone gave a s**t about my well-being, until I realized he wanted to find me just to give me another admission.

It was over. I had signed out my list, my patients, and finished my work. I ignored breakfast and was waiting for 8 AM so that I could bounce. I checked Amazon to see if there were any rope deals going on, as well as bookmarked a noose tying instructional video on YouTube. At 7:45 AM, everyone got the same page: cardiac arrest. Delirium aside, I could not help but think of the irony of starting this shift with a code and ending with it. I went down with the team and did my compressions like a good little intern. Honestly, I could not remember if they made it or not, if I had breakfast, or my trip home. All I remember was the shower trying to wash off the shame of the night. Two thoughts went through my head: tonight better not go the same way, and if pet dogs also had names for us. As my head hit the pillow, everyone in the neighborhood decided to all at once mow their lawns.

If you made it to the end, thanks. All joking aside, I am truly fortunate to be working in such a rewarding field. Despite all the s**t I have been through, the pros outweigh the cons in the long run and to have people trust their health to me is an honor as well as a humbling privilege. I have tons of interesting stories from the hospital so if you are interested in hearing me ramble again, please let me know. If not, I’ll sink into the darkness and continue to lurk as I eat shredded cheese straight from the bag.