Intern by Sandeep Jauhar Page B

shepherd. I shall not want. He maketh me to lie down in green pastures.” I asked Mr. Waldheim some questions but he did not respond. Since I was running late, I didn’t press. I was about to leave when his son, who was just coming in, asked me if his father could be moved to a room with a view. “I think some light would do him good,” he said. I told him that I would check with the other doctors.
    When I finally made it back to the conference room, the team had already assembled at the long table, their white coats draped over the backs of the vinyl chairs. “Jauhar’s brother,” someone said as I took a seat. The attending physician, Jonathan Carmen, nodded to acknowledge me. Dr. Carmen was in his late thirties, muscular and square-jawed, with a balding pate and an almost menacing visage. My brother, who knew him well, had described him as smart, savvy, your basic tough kid from Brooklyn who’d made it up the hospital ranks through hustle and hard work. I didn’t know how much of his story was myth and how much fact, but it was appealing nevertheless, and I had been looking forward to meeting him. “I’ve heard a lot about you,” Carmen said, looking me over intensely. “Thank you,” I replied stupidly.
    One of the senior residents turned to me. He was tall, with glasses, short brown hair, and handsome features. “I’m Steve,” he said, extending his hand. “We’ll be taking call together.”
    Carmen quickly went through the logistics of the rotation. There were three intern-resident teams, so call was every third night. Rounds were long, he warned, “so keep your presentations on point. Start with the chief complaint. And don’t just tell me what the patient said. SometimesI’ll hear the chief complaint is, ‘It’s cold in here.’ ” He drew out each syllable in a high-pitched nasal sneer, like Jackie Gleason on
The Honeymooners
, and we all laughed. “That may be the chief complaint, but that’s not the reason the patient is in the hospital.”
    On rounds, we huddled around a metal rack bulging with charts, Carmen and the fellow in the center, then the interns, then the residents, who hovered on the periphery, periodically breaking away to answer pages. Outside each room, arms folded in postures of serious purposefulness, everyone listened intently as Amanda, Nancy, or I read off vital signs, medications, ventilator settings, fluid intake, urine output, nutritional data, and lab results from the flow sheets. Carmen and the cardiology fellow interrupted frequently to fill us in on details or to ask questions or to make clarifying comments. One of our patients was a nephrologist with kidney failure who wept inconsolably when we went to see him. It wasn’t clear what was wrong, except everything. There was a music school teacher who woke up with chest tightness and went to work, only to go to the ER in the evening and be told that he was having a heart attack. A young man with an artificial heart valve had continued to use heroin and now was hospitalized with another valve infection. “When’s the surgery?” he asked defiantly, and Carmen brusquely told him that it was up to the surgeons. When a resident brought up the issue of drug withdrawal, Carmen said, “Just give him what he needs. Let’s not worry about detoxing him here.”
    There was a pecking order to examining the patients. Carmen got first dibs, then the fellow, then the resident on call (today it was Steve), then the intern on call (me), then the remaining residents, and, finally, Amanda and Nancy. Carmen usually placed his stethoscope on a patient’s chest, but rarely did he perform a complete physical exam. He acted more like a facilitator who knew what was there but was trying to direct us to discover it for ourselves.
    I quickly discovered that Carmen loved to teach, and he favored the Socratic method. In true