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.I thought.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 |
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