While conferences like Clarion have helped bring many new writers into the field,
even for many successful authors writing remains only a part-time vocation, usually
not even the primary source of income. One case in point is the writer of the
following article, Sharon Farber, who is a Neurologist when she is not writing
fiction. Sharon's newest article in her "Medical Life" series looks back at her
medical school days, and her Clinical Year there.
The unofficial motto of my medical school class was "Life is tough and People are weird." This was stated by our long-haired class philosopher, and considered quite profound. Others opted for "We're like mushrooms, kept in the dark and fed shit." Sometimes I'd talk to doctors who trained in the dark ages before penicillin, and who looked upon medical school and internship as the high points of their lives. I figured they must be demented.
My clinical year didn't start too badly, with neurology and psychiatry and "country club" -- ophthomology and otolaryngology. The last two were rotations so quick you never learned your residents' names. My main memory of ENT is of a surgeon who liked an audience, so we'd have to stand there in the operating room. Since he was operating inside the nose, which even in Jimmy Durante or W. C. Fields must be considered a rather small area, I never saw anything more educational than the back of the surgeon's neck.
One day he was doing something or other to the nose of an awake woman who felt nervous. He began the surgery by taking an entire shot glass of gleaming white pharmaceutical grade cocaine and stuffing it up her nostrils until she was about as hyper as you can get without leaving earth orbit.
"Talk to me," she demanded. "Tell me a joke."
He, being a surgeon, had no jokes to his possession. My classmates had even fewer. So by default I found myself doing an hour of standup comedy punctuated by the commands "suck" and "bovey" and "clamp." It was surreal. (A bovey is a device that electronically coagulates tissue. You can tell when a surgeon is using a bovey. The place smells like barbecue.)
It was also the only time I required anything remotely resembling thought in an operating room.
# # # #
Next I went to general surgery. Unfortunately this was at an affiliated hospital where the rotation was under the direction of a tyrannical chinless man who seemed to hate women. When he didn't have any female students he would celebrate the end of the rotation by taking the boys out for pizza and beer, and would tell them "Women shouldn't be doctors." He didn't bother covering up his opinion.
The medical school dealt with this blatant sexism in a typically idiotic way -- they made sure they never sent more than one woman at a time for him to teach. That way you were not only alternately abused and ignored, you were also alone. However, since he also made life miserable for anyone who seemed effeminate, I had an equally miserable classmate with whom to commiserate. (He also invariably chose the handsomest student as teacher's pet. This was generally agreed to be one weird assignment.)
The first day he took us to learn how to scrub and gown. The acquisition of surgical cleanliness is a ritual as intricate and exacting as the Japanese tea ceremony.
The first step was to get into scrubs. At this hospital, it seemed that the nurses (there were no women doctors' locker rooms then, even though a third of my class was female) had not even the usual geeky women's scrubs, but worse -- they were made with a pattern of flowers. Great. Try to look professional and dignified and powerful covered with lilacs. (Later I got a friend to sneak real scrubs to me.)
I exited, humiliated by this idiotic garb, and looked around. The others had not emerged yet from the male locker room. "Amazing," I thought. "Aren't women supposed to be the slow dressers?"
So I waited. And waited. For forty-five minutes, while the professor and the boys exchanged crucial information, or male-bonded, or whatever. Several times I thought about going in and asking if they needed mommy to tie their shoes, or if they were being naughty -- but at that moment I still foolishly harbored the notion of getting good grades. But I had a sinking feeling that the next six weeks were going to suck. And I was right.
It wasn't just this guy. Our chief resident -- we called him "Frank Psychosis" (a psychiatric term meaning, well, frank psychosis) -- was losing it. We'd start rounding around six a.m., then work the evening. But some days he'd make us stay and round again at night. Rumor was he couldn't go home.
One day we were restraining a completed demented old woman who needed an amputation. The anesthesiologist was trying to get a spinal needle into the squirming babbling patient.
"Hold still, ma'am," I said. "It's just acupuncture."
Frank stopped what he was doing and spun on me. "What did you say?"
So I repeated it.
"You have a surgeon's sense of humor!" he cried happily.
"Wonderful. Can I have it removed?"
Yes, under the force of constant harassment by the head of the rotation I had gradually lost all sense of tact. I was scrubbed with a colorectal surgeon one day when he looked up from a bowel anastomosis, caught my eye and said, "You know, I don't think women should be doctors." This was getting monotonous.
I just looked him back and said, "Yeah, I really wanted to just marry a doctor, but I was too smart and too ugly so I had to be one instead."
Somehow though I got out of surgery alive, and went on to internal medicine. This was just as bad, even though I had intended to be an internist. I got a resident who was so nasty and vicious that every single one of his students wound up complaining to the chief resident. Not that the chief did anything about it. Like maybe tell the attendings that the guy was a liar. Whenever anything went vaguely wrong, this resident would claim it was my fault!
The attending wasn't much to speak of either. He seemed to resent teaching for keeping him out of his laboratory. One day I had a patient with congestive heart failure and a rare form of cancer called 'mycosis fungoides' which, as the name implies, makes the victim resemble extras from that classic movie Attack of the Mushroom People.
I had spend most of the night preparing to answer any question about heart failure or cutaneous leukemia. I presented the case, and sat back waiting to show my stuff.
"Well," the attending said. "What's going to kill her, the rare disease or the common one?"
"The common one," I replied, and he moved on to another topic, namely his research.
I was certain things would get better when the residents changed, right before Christmas break. The new one was a tiny, quiet woman. We third year students were required to follow our supervisors at heel like obedient puppydogs, and I trailed her down to the emergency room. She wanted to talk to the guy who would be starting soon as our new intern.
It was a Friday night, and he was charting on a teenage girl who had been in the front row of a concert. The lead singer had singled her out for a kiss, at which point she had fainted.
"Darn," said the intern. "I should be able to call this something instead of just syncope."
"How about Disco Fever?" I suggested.
He grinned and started writing -- "Friday Night Fever," but it was close.
This was a hopeful sign. A sense of humor. This would be a good team. Then I left for Christmas vacation.
I got back two weeks later, bright and early and ready to work. "Hi," I said.
My resident ignored me completely. She looked up at the intern. "Hello," she said wistfully.
"You're looking very nice today," he squeaked in reply.
Yes, they had fallen in love (and eventually married). But if there's one thing young lovers don't need, it's a medical student tagging along. They ditched me constantly -- and rather than feel bad about the fact that they were not educating me, translated it into hostility. They avoided me like the plague, and then would yell that I wasn't available to do their scut.
A few days before my Professor's Rounds -- my case presentation to the Chief of Service -- the resident remembered I existed. Perhaps it was the fact that when the student totally screws up Professor Rounds it looks bad for the resident, who is suppose to help with the write-up and the research and even do a practice run. "Better let me see your work-up," she said.
I gave it to her. When I asked for it back, she looked blank. She'd lost my Professor's Rounds! When I got a bit upset -- less than twenty-four hours to reconstitute a magnum opus -- she said, "Well, you should have made a copy. It probably wasn't any good anyway."
At the end of the rotation the resident and intern took me for lunch, the most consecutive minutes I'd seen of them since I'd returned. "We discussed your grade with the chief and it was between a pass and a high pass," she said, "so we went with the lower grade."
All in a bland voice like I should be thanking her. I refrained from tossing my iced tea in her face.
Surprisingly, my next resident and attending weren't complete assholes. They even expressed wonder at my low grade for the prior six weeks. I got honors, honors on the exam, all of which evened out to a high pass for the course.
That above average grade meant that I could get a letter of recommendation from the Chairman of Internal Medicine himself, so a year later I sat in his office while the noted endocrinologist looked at my records. "You got a pass first rotation," He stared at me angrily. He had an Italian Renaissance face, resembling a Botticelli painting of a Medici. A scowling Medici.
I had long since learned not to try to complain about residents. And I had somehow deluded myself into thinking that, when one goes from a C to an A, with an A on the exam as well, then people would either say "Gee, what went wrong the first part?" Or "Nice work, you improved." Yeah sure. Not in medical school. My letter of recommendation sucked.
But that was later. I'd done well. Once my resident sent me in to see a confused patient with instructions to find out what had gone wrong. The man had asterixis, an inability to hold the outstretched hands still (known also as 'liver flap', or flippantly as 'waving goodbye to the liver'). I emerged from his room, caught my resident's eye way down the hall, held up my hands and flapped them. He grinned and was proud -- unlike my prior residents, who had either claimed personal responsibility for my few intelligent acts, or decided that I'd stolen the information.
Another time I found a treatable cancer in a patient in for something totally unrelated, and the patient and my resident both bragged about my accomplishment. So I'd been appreciated, encouraged. I was finally stoked. I'd gone from beaten down to gung ho, the proper med student attitude.
# # # #
I couldn't wait. Pediatrics was next. I'd decided to go into neurology, and I hoped to make an impression on peds neuro. I did. It was such an unpopular rotation, dealing as it did with brain damaged kids, that they were just pleased to have someone who wanted to be there, rather than the usual last picks.
I went at it gung ho. When I had a patient with Sturge-Weber (a rare disease with seizures, brain damage, and a strawberry birthmark on the forehead) without skin manifestations, I checked the literature back to the 1890s. On my call nights I'd work up not one, but two patients. I became pals with the chief resident and the adult neuro rotator -- not by sucking up, but by my enthusiasm and sheer love for the subject.
The rotation wasn't all beer and skittles. I got the crud -- I always got sick on pediatrics, everyone did -- and was leaning against the wall trying to stay alive while they discussed a new admission.
"What virus does he have?" the pediatric resident asked the subintern, an unhappy fourth year medical student required to take this rotation and loathing every minute of it.
"Wait," the chief said. "Let's ask Sharon. After all, she's got it too."
I thought that was unnecessary cruelty. I didn't know the name of the damn bug. I just hoped that if it was fatal, it would kill me immediately.
# # # #
My next rotation was pediatric infectious disease. There were three students, the other two being a woman who admitted to smoking (all the other smokers lied), and a huge guy who'd been one of the first people I'd met on arriving at med school. He'd been in the dorm lobby, reading a newspaper.
"I'm going to be a plastic surgeon and help little deformed children," he'd told me.
It would have been a lot more convincing if he hadn't been reading the Wall Street Journal at the time.
He was a consummate ass-kisser, spending most of his time trying to impress the attending by borrowing articles. Neither of my colleagues wanted to work very hard. We were supposed to spend one evening a week in the emergency room. They decided to arrange our schedules so our assigned ER times coincided with ward call, which would take precedence. When my protests were of no avail, I let them handle the schedule, then switched with my friend Carol so I could do the ER work after all.
One afternoon my resident ran up to me in a state of frenzy. "You have to help. We're getting bombed."
They had too many patients and the big guy, who was supposed to be the student on call that day, was not to be found -- "as usual" my resident said. The other student had disappeared also.
"But I'm due in the ER at six."
"Look," said my resident. "We've got this five-year-old with a septic hip. It's a great case, you can do a great presentation. Work her up, take care of things, and when you have to be in the ER, just stop whatever point you're at, tell the intern, and we'll take it from there."
That sounded fair. At six I wheeled the kid to the OR for the hip to be aspirated, found the intern and signed out, did my shift in the ER, got home at midnight and read til the wee hours about pediatric joint infections.
The next morning we went over the cases with the attending. I presented the case, ending with a well-organized differential diagnosis.
Out of the corner of my eye I could see the intern and resident give me thumbs up. I was smoking. I was their helpful little star. Things couldn't have been better.
I finished and looked at the attending. I was tuned. I was ready for any and all questions.
She stared at me, an expression of fury and hatred coming over her face. "Last night at seven o'clock," she said, "my husband was not home for dinner. My husband was in an operating room with a syringe full of pus...and he had no one to hand it to!"
No questions. No "why weren't you there?"
No helpful residents or interns saying "Look, this was extra work she did just to help us out because your teacher's pet is a total sleaze. We dropped the ball, not her."
Nothing but silence. And the distant sounds of the clock ticking and my grade plunging.
Our grades also featured written evaluations. When I went to read mine in the pediatrics office, I ran into the Big Guy looking like the cat who swallowed the canary. I'd expected as much.
I also expected only the worst from Infectious Disease. But I'd had hopes for Peds Neuro.
The grade wasn't great. And the commentary: "Did a lackluster presentation on febrile seizures."
I read it over three times. Then I started laughing hysterically. I couldn't stop. When I noticed the department secretary looking like she was about to call security, I gave her back the grade -- never to see light of day again -- and left.
In the end, it hadn't really mattered that I'd worked my ass off, that I'd done well. It didn't seem to matter what I did. I just couldn't win.
They'd given me the subintern's grade.
I met the subintern again a few years later, now a pediatrics resident. I never asked if she'd got my evaluation. I wanted to think that someone had benefited from the experience.
All illustrations by Joe Mayhew