More than Twenty Years in the Making: The Genesis of The Intern

It was 2015 by the time I sat down to write the book that would eventually become my first published novel (The Intern, TouchPoint Press, April 13, 2020) a solid twenty years after meeting the twelve-year-old boy who inspired me to write his story. Maya Angelou said that “people will forget what you said, people will forget what you did, but people will never forget how you made them feel,” and she was dead on, because I can’t remember many of the things he said and did, but I can remember, with complete and absolute clarity, the way he made me feel, the punched-in-the-gut feeling that has stayed with me all these years.

It was the spring of my internship, April, 1994, and the skies in Syracuse, New York were leaden and grey, doing nothing to improve my mood which had become dour with the long hours, lack of sleep and the never-ending scutwork. I was on Pediatric call for the weekend, meaning that the never-ending scutwork had now been multiplied by four, and I’d just gotten over a stomach virus that had ransacked my intestines like a horde of angry Vikings. One of the attendings—a private physician who only called the interns on a case when it mostly involved busywork—had asked me to admit a twelve-year-old boy dying of cancer. As I trudged down to the Emergency Department to get the task done, my attitude was at an all-time low.

It was a straightforward enough case, a patient with refractory Acute Lymphoblastic Leukemia being admitted to the hospital so that his family didn’t have to watch him die at home. No, there wouldn’t be much to do, IV fluids and comfort medications, but that also meant there wouldn’t be much to learn, and learning is the intern’s compensation for doing all the paperwork, all the scutwork, and anything else the attending physicians don’t want to do. In this case, there wouldn’t be any learning at all (or so I thought at the time) meaning there would be no payoff for doing all the monotonous tasks. Grrrrrr.

I arrived in the Emergency Department, a place the interns called “the asshole of the hospital,” and located the patient’s room, which was not really a room but more of a recess in the hall walled off by a pair of curtains on wheels. I narrowly avoided an orderly carrying a freshly used bedpan, squeezed between the curtains and introduced myself to the patient’s parents, who were kneeling on the dilapidated tiles, holding their son’s hands. They nodded hello and went back to watching their son, who was lying on the stretcher on his back, his torso covered by a thin sheet. The chemotherapy, which had been unsuccessful in killing the cancer cells in his body, had been successful in wiping out the hair follicles on his head, leaving his scalp bare and his skin the color of a dirty athletic sock. He looked up at me with big eyes and smiled as best he could given the amount of pain he was in. At a loss for anything else to say, I asked him how he was.

“I’m good, thanks,” he said, despite the fact that he would die in less than twenty-four hours.

“Do you have any pain?”

“No, I’m okay.”

His body language and facial expression said otherwise, so I asked again, rephrasing the question as I’d learned to do in some forgotten class at some remote point in my previous training, which felt a long time off and far away from kneeling next to this dying boy in a hallway in the bowels of an old hospital with the staccato chorus of alarm bells and bellowing drunks in the background and the smell of burnt coffee and stale urine floating in the air.

“On a scale from one to ten, with one being just a mild discomfort and ten being the worst pain you’ve ever had, how would you rate your pain?”

“One or two, maybe. I’m not sure. I'm fine really.”

He stopped talking to rest his breathing, and I flipped open the chart I’d brought with me from the Nurses’ station. His labs were a mess. The leukemia had completely overwhelmed his bone marrow, which had stopped producing red blood cells, white blood cells, and the platelets his body used to control bleeding. He'd been getting transfusions of all three blood products for several months, but he’d recently decided enough was enough, and had refused any further transfusions.  His parents, however, were still not ready to let him die; in a hand-written note at the front of the chart, his mother begged me to convince him to resume the transfusions. My hands started to shake so badly that the chart rattled; I set it down on the bed before I dropped the damn thing.

“I can order some blood for you? It will make you feel better.”

He shook his head. “No, thank you, let someone else have it.”

My pager buzzed but I ignored it. All I could think about was this courageous twelve-year-old boy who was looking death square in the eye and not flinching, who was lying about his pain so that his parents didn’t have to bear the additional burden of his suffering, as if his dying wasn’t enough.

“Are you sure?”

He nodded, wiping away the blood that trickled out of the corner of his eyes.

A large crater opened up inside of my stomach, spewing hot lava inside my abdomen. I tried to speak, to say something to make the situation better, but no words issued from the dry barrens of my mouth. He reached over with his right arm (his left had been amputated because his chemotherapy had withered it away) and grabbed my hand, staring into my face, which must be wearing all the angst I was feeling. “It’s going to be okay, doctor.”

What was he talking about? Of course, it wasn’t going to be okay. He was twelve and he was bleeding out of his eyeballs. There was nothing okay about any of this. It was terribly, horribly wrong and there didn’t seem to be anything I could do about it. And how was it that he was trying to comfort me? Shouldn’t it be the other way around? I tried to pull my hand away to write orders (as if that was going to accomplish something) but he hung on to it with a strength that belied his cancer-pillaged body, so I let the orders alone for a while and held his hand, which was cool and clammy from his poor circulation. And so there we were, the four of us, the patient lying on the stretcher with his parents on one side, and me on the other, all of us holding on to each other for dear life. 

There are times in life when logic and reason take a back seat. (In what calculus, I ask you, does a twelve-year-old boy suffer and die as his parents and his doctor look helplessly on?) This was one of those times, one of those moments in which only emotion exists. Sadness and grief swirled like a mist in front of me and anger germinated from some dark abyss. And, strangely, hope blossomed, weakly at first but gaining vigor and sharp color even as the color in his cheeks faded and ultimately went out. Yes, cancer did ravage his body (he weighed less than fifty pounds when he died) but it never blemished his spirit, which remained resilient and courageous and strong to his last breath. That’s cause for hope.

It’s a hope I still feel, twenty-five years later. I like to regard it as his legacy, for which I am forever thankful. I think of him from time to time, when life's twists and turns bring me to a low point, and I remember the twelve-year-old boy who tried to ease my burden as he lay dying. The juxtaposition of the problems he faced with those that I am facing always gives me perspective; the mopey look on my face is replaced by a smile, and I press on. It's happening again right now, as COVID-19 rips through our country, closing and cancelling almost everything--including at least one of my scheduled book signings--in its wake; I think about his courage and his resilience and some of it leaks into my veins. My shoulders don't sag, my chin lifts, my smile broadens. 

Which brings me back to The Intern, coming out April 13, 2020. I can only hope the tale I told about him, written more than twenty years after I met him, does him justice. I think it does, but I will let you be the judge. Keep in mind that his character has been influenced by dozens of other people--patients I have treated, people I have known, characters I have met in books and several editors who have worked on the book--but that original boy is still there. 

May he rest in peace.

If you enjoyed what I had to say, consider clicking on one of the following links to buy on one of my books and/or browse my website. Thanks for that; I truly appreciate the support:

The Intern (TouchPoint Press, 4/2020)

The Vatican Conspiracy (Bookouture/HachetteUK, 10/2020)

Peter's Author Website

Cheers, peter

:)

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Peter Hogenkamp is a practicing physician, public speaker and author living in Rutland, Vermont. Peter's writing credits include The Intern, TouchPoint Press, 4/2020; The Vatican Conspiracy, the first book in the Marco Venetti thriller series, October 2020, Bookouture/HachetteUK; Doubt, Marco Venetti #2, April 2021; and THE LAZARUS MANUSCRIPT, a stand-alone medical thriller; Peter can be found on his Author Website as well as his personal blog, PeterHogenkampWrites, where he writes about most anything. Peter is the founder and editor of The Book Stops Here, the literary blog for readers and writers written by authors, editors, agents, publishers and poets. Peter is the creator, producer and host of Your Health Matters, a health information program, which airs on cable television, streams on YouTube and sounds off on podcast. Peter tweets--against the wishes of his wife and four children--at @phogenkampvt and @theprosecons. Peter can be reached at peter@peterhogenkamp.com or on his Facebook Page.