EVERY YEAR, THOUSANDS of undergraduates who have worked extremely hard during college apply to medical school. It is a highly selective process and only the top students are accepted. While admission to medical school is the first step to a successful career as a physician, once students begin their studies, they immediately find themselves at the bottom of the rigid medical hierarchy. As such, they are subject to the whole host of indignities that the medical education system can inflict. It is a tough road, even for those of the strongest character. One of the favorite pastimes of residents in training and attending physicians alike is to harass and intimidate those on the lowest rungs of the ladder, and of course that is medical students.
Surgeons are particularly fond of abusing students, especially in the operating room. It is extremely uncommon for the students to talk back, because there is just not much percentage in it. To illustrate why, there is a story of my classmate from the East Coast with a New York attitude. He was once assisting a general surgeon who was performing a gallbladder removal in the days before laparoscopic surgery rendered a bunch of surgical assistants unnecessary. A studentās role in the operation is minor, since he or she doesnāt have enough experience to do anything important. Generally, it means holding retractors during the operation to give the surgeon better vision of the operative field while he identifies the organs. In this case, my classmate had to hold a large retractor pulling back the liver that covered the gallbladder. This job requires holding and tugging for a long time. It is boring, and your arms get tired. But the medical student must not let go of that retractor while the surgeon is identifying and removing the gallbladder. And in most cases, the student has to remain absolutely quiet. Speak only if spoken to.
That day, the surgeon was taking a long time and the student was getting fatigued and frustrated. His surgical mask covered his face, but beads of sweat collected on his forehead. Suddenly, the frustration boiled over and he broke the unwritten rule. He asked the surgeon, āWell, how are we doing?ā
The surgeon, and everyone else in the room, looked up. They were stunned. A medical student talkingāand not just talking, but talking with impertinence.
The surgeon, taken aback momentarily, regained his composure and continued operating. But he was not about to let the transgression pass unnoticed.
He shot back to the student, āWhat do you mean we?ā
That was a clear signal for the student to shut up immediately. Perhaps it was his New York attitude, but the student ignored the cue and fired back with thinly veiled sarcasm, āI like to think Iām as much a part of the health care team as anyone.ā
The surgeon, now fully engaged, had never encountered such braggadocio from a medical student, and he was prepared to enjoy the back-and-forth.
Now he taunted the student, āPart of the health care team? You? You must be kidding. You are nothing. We could get a monkey to do what you are doing. You are nothing.ā
The battle was on. No longer feeling subservient, the student challenged the surgeon. āOh yeah? Iām nothing? Iāll bet if I let go of this retractor, you would have trouble finishing the operation.ā He made a point not to let go of the retractor, though.
The operating room was silent. The surgeon then decided it was time to pull rank.
āIāll bet if you let go of that retractor, youād have trouble graduating.ā
Point, set, match.
A couple of days later in the surgical locker room, the student told me he just lost his head in the heat of the moment. I asked him if the surgeon retaliated in any way. No, he said, the surgeon actually liked him and didnāt hold it against him. The student survived the battle, graduated, and became a successful physician in Manhattan. But not every surgeon would have been so gracious.
When I became an attending physician, it was not my style to harass or bully the medical students. I tried to help or encourage them whenever possible, figuring they were having enough trouble without grief from me. Once a student of mine, an especially earnest one, wanted to impress me. So I gave him a difficult assignment: to draw blood from a hardened gang member. It was challenging because we needed to draw from an artery to test the oxygen level in the patientās blood, which a routine blood draw from a vein does not provide. It was a test of the studentās skill.
The assignment was to draw blood at the patientās wrist, from the artery where you take your pulse. The artery is close to the bone, so if the needle misses the artery and hits the bone, it can be quite painful. And itās not a good idea to inflict unnecessary pain on a gang member, especially when you are a student. He went to draw the blood from the patientās artery, and it took fifteen long minutes. It must have been agony for the patientāand a different type of agony for the student. When the fifteen minutes were over, he had a sample from the patient, but unfortunately he had missed the artery and the blood sample was from the nearby vein, useless for the information we needed.
The student was disconsolate. Unaccustomed to failure in his academic career, he came to me knowing that he had failed and was worried that he had let me down. Besides that, we still didnāt have the sample we needed. I reassured him, told him how difficult obtaining those samples was, and said we could still get an arterial sample. He told me there was no way the patient would let him try another needle stick.
āThe last five minutes I was trying to draw it, he was staring me down. I donāt think he will let anyone draw his blood now.ā
I said, āDonāt worry, I will draw his blood. Come on, Iāll take you with me.ā
āBut what are you going to tell him?ā
āWatch.ā
We went to the patientās room and, as predicted, he gave us a nasty glare. His right wrist was extremely sore from the unsuccessful blood draw.
āMan, whatāchu guys want?ā He suspected we were there to draw blood again.
āI have to take another sample, Andrew.ā
āHey, he already drew my blood. Whatāchu need more blood for?ā
The student was visibly nervous. He thought I was going to tell the patient he had made a mistake by getting an erroneous sample. It would be devastating to the studentās already shaky confidence.
āAndrew, he got the sample from your right wrist. We saw the results. But we have to draw a sample from your left wrist to compare it with the one from your right. I know that one was painful, but donāt worry, Iāll draw this one. We have to see if the right and left blood are the same or different.ā
Of course, there is no difference between blood drawn from the left arm and the right arm. Same blood. But I gambled that Andrew didnāt realize that. He gave me a suspicious look, considered the problem a minute and said, āOK, Doc. Go ahead.ā
I drew the blood from the artery of his left wrist quickly and painlessly.
āThanks, Andrew.ā
āNo problem, Doc.ā
Andrew nodded approvingly at me, and then at the student. The gang member was actually happy he could be cooperative. He was satisfied, the student was relieved, and I had the necessary sample. The student thanked me for rescuing him. He went on to become one of the countryās top physicians in his field, far eclipsing me and my career. I wonder if he ever tells his students that story.
One of the final indignities of medical school is the interview for residency positions in the studentās senior year. This is not always an unpleasant experience, because some hospitals want to attract the best students and thus treat them well during interviews. But in my case, coming as a student from Chicago and interviewing in the highly competitive atmosphere of New York hospitals, I was forced to run the gauntlet. Manhattan has some of the best hospitals in the United States, and it is a wonderful place to live when youāre young and single, so I had decided to interview there for my residency. New York, New Yorkāeven for a medical studentāif you can make it there . . .
It was right before Christmas. In Chicago, Mayor Daleyāthe first Mayor Daleyāhad just died. Chicago was grieving as I caught the early flight to La Guardia on a cold winter morning, greeted by a frigid wind whipping around the right angles of the downtown Manhattan skyscrapers. The morning of my first interview, I hailed a cab to St. Vincentās in Greenwich Village, a once-legendary hospital.
The legacy of St. Vincentās has faded, but in its day it was quite a grand place, one that recalled a different, more glorious era of medicine. Founded in 1849 with a mission to care for the poor and disenfranchised, it was world renowned for its care. The poet Edna St. Vincent Millay was named after the hospital. How many famous poets have been named after hospitals? Unfortunately, several years ago, after 163 years in business, the hospital closed unceremoniously, a victim of medicineās changing business environment.
But when I interviewed there in the 1970s, St. Vincentās was still a vibrant place. The intensive care unit was among the countryās finest, and the hospital, which turned no one away, took care of the widest variety of patients: bohemians from the Village (the poet Dylan Thomas died there after a legendary bender); alcoholics from the Bowery; high-level professionals from the Financial District; and Chinese immigrants from Chinatown. Nobody knew it then, but St. Vincentās would soon become one of the major AIDS hospitals in the world, an ironic coincidence for a hospital that celebrated its strict Roman Catholic heritage.
The morning of my interview, I was sent to a basement cafeteria and told to wait there. I got a cup of coffee and sat down with a number of students from New York medical schools. It seemed they all were interviewing at the same hospitals and all knew each other. I was the nervous outsider, listening closely to the gossip about the pluses and minuses of the New York hospitals.
I was completely ignored until one of the students unexpectedly turned to me and asked in a thick Long Island accent, āSo, wheah you from?ā
āIām from Chicago,ā I answered in my flat Midwestern tone.
āOh, University of Chicaguh.ā
āNo, actually, Iām from Northwestern.ā
This was my first taste of New York City provincialism. In those days, the common belief was that if you were from Chicago, you had to be from the University of Chicago. There were simply no other universities there. Saul Steinbergās famous New Yorker cover, āView of the World from Ninth Avenue,ā is not without some basis.
The student looked aghast, and proceeded to give me a geography lesson about exactly where my university was located. āNawthwestunās not in Chicaguh, itās in Ohiuh.ā
One of his colleagues, looking to correct him, located Northwestern in the Great Northwest. āNah, Nawthwestunās not in Ohiuh, itās in Warshingtun.ā
Thankfully, a resident with a slightly more refined Manhattan accent rescued me at that moment. āYou can come with me, Iām going to give you a touah.ā A tour of the hospital, which I considered a pleasant gesture. How thoughtful.
It was still early, before 8 AM, and I figured my interview wouldnāt be until at least 9. I relaxed a bit, opened the buttons on my sport jacket, and popped a stick of gum into my mouth, chewing unobtrusively while the resident led on. It was a mistake.
For the next ten minutes, the resident was sullen and rude. He didnāt want to be there and answered no questions, but I found the hospital to be beautiful, immaculate and charming in its dotage. It was certainly cleaner than some of the new, Soviet-style hospitals at which I had interviewed. The hospital was festooned with Christmas decorations. A crucifix hung in every room, and there were reminders everywhere of the proud Catholic tradition of the Sisters of Charity, who had founded the hospital more than a century before. You donāt see that much in hospitals anymore. It is a grand tradition all but gone from American medicine, never to return.
At the same time, I also sensed a real passion for patient care and quite a degree of medical sophistication and professionalism. Passion, sophistication, and professionalism with a tinge of rudenessāitās Manhattan. Even to a non-Catholic like me, the hospital was an extremely impressive place, and I saw why it had the reputation it did. I thought, āI would be proud to work here.ā
No chance of that happening.
About ten minutes into the tour, the dour resident brought me to a room and shoved me in with no warning. It was my interview. Unannounced.
The chief of medicine at St. Vincentās for many years was Dr. William Grace, the elderly scion of the Grace publishing family and one of...