“How was Christmas break?” he asked.
“Too good,” I said. “I almost didn’t come back.”
He was quiet for a second, then asked, “How serious are you when you talk like this? Like for reals, are you thinking about quitting?”
I thought this was going to lead to another intervention like when my friend Marcus gets all serious and tells me he’s here for me if I need any help. As if dropping out of med school is like being addicted to crack or having a friend die in a car crash. Or like when Emily says, “Really, though, it can’t be as bad as it seems like it’s going to be” which is a less convincing argument than anything else I can think of.
“Pretty serious,” I told Dustin. “I started looking up different grad schools and stuff over the break. And I asked my mom if she’d be pissed about me moving back home for a while. She probably just thinks I’m depressed, but I can always come home she said. Come home and play Pictionary and stuff.”
Dustin looked around nervously, like he was scared someone was listening over our shoulders. “I’m thinking about bailing too.”
I could tell he was getting excited about what he was going to say. He held his hands in front of his chest and kind of bent over them and started to stutter and talk wicked fast. “No j-j-joke, man. I’m not getting anything out of this. I’m just so unmotivated by all the shit about T cell receptors and beta globulin that it’s starting to make me sick. And, you know, it’s... it’s... it’s like, I just don’t give a shit, man. I just don’t. I don’t know if I ever did, and I don’t think I ever will.”
“That’s why I never show up to class. I just sit in my room and write bad poetry and then go hang out with friends every night.”
“Why did we even come, man? I mean, I mean, th-this was my goal for so long I can’t even remember wanting to do anything else. It was like getting into a good medical school was my goal forever, b-b-but I don’t think I ever considered whether I really wanted to be a doctor.”
“I guess I was just thinking, ‘What, medical school’s super hard to get into? Ok, watch me do it then. . . bitch.’”
My last comment to Dustin was a bit of an oversimplification. I didn’t really apply to medical school on some form of a dare. I can’t, however, claim that it was much more informed than that. It was kind of like thinking about old age; you just assume that things will be okay once you’re there and you stop worrying about it. I had put myself on the path of medicine because that’s what smart kids did who liked science. And every time I told people I was going to be a doctor they seemed to assume good things about me, which I liked. I had a part time job in the operating room during college, but that was just to boost my med school resume and consisted primarily of wheeling beds around and cleaning blood off the floor. So, if anything, that job only taught me that I didn’t want to be a janitor.
I always felt fine about my decision, but that might be just because of the company I kept. A lot of my friends were in their late twenties, working sporadically at different jobs, throwing parties that got more depressing every year, deflecting any prying questions about their plans with a casual reference to an unspecified grad school in an unspecified field somewhere in the unspecified future. Compared to those kids I was set. I was the one with his shit all figured out.
-- -- --
Dustin and I got on the subway to go uptown to a hospital where we were going to interview a psychiatric patient. After we sat down I continued our earlier conversation. “So how about the obvious question: what else would you do?”
“Don’t know,” said Dustin. “Ski more. Start a business. Anything I guess. Sit on a beach in Brazil with a beautiful girl and a soccer ball.”
“A girl you tricked into thinking you were still enrolled at Columbia Med?”
“I’ve just got to figure something else out so I can bail before I dig myself in too far. Seriously, think about it. We’re going to be working 80 hours a week in residency. Have you ever really thought about how much work that is? Think about it this way: if you work six days a week for 12 hours a day, that’s still not 80 hours. Have you ever worked that much on anything? I can’t even play video games that long. And they pay you nothing. And those big hospitals are like sweat shops, man. They throw you around ‘til your fingers bleed and you can’t think anymore. You put that much time into anything else for five years and you could be a millionaire if you’re decently intelligent.”
I sat back in my chair and looked around. Since I was in a complaining mood I noticed everything wrong with the subway. The ads made me think they were trying to pressure me into paying attention to something else I didn’t care about—laser hair removal or a community college degree in criminal justice. The fluid on the floor which could be either melted snow from someone’s shoes or piss from a man that slept on the train the night before was definitely piss, no question, while I was in that mood.
“I just can’t think of anything else I want to do besides read and write and hang out,” I said. “Maybe rock climb a bunch. But none of those are ever going to make me any money or help convince anyone to date me. My poetry would be way too terrible to compensate for my poverty. If I could write like Neruda I’d be set. But I can’t, so I haven’t dropped out yet.”
“W-w-well this medical stuff won’t make you any money either. Not until you’re 36 anyways. And by then you’ll be busy paying off debt and buying a house and all that. You’ll be married and boring and... and... and you’ll have to work all day in a hospital to make enough money to convince yourself it was worth it and then your wife will hate you because you’re never home and then she’ll leave you and then you’re screwed. And alone. And boring as shit, man.”
I know happiness isn’t all about money or prestige or possessions. There are plenty of aphorisms (an aphorism is by definition a cliché) to remind me of that. But happiness also doesn’t come from sitting in my parents’ basement kicking myself for not having tried harder. It doesn’t come with an unfulfilling career in a dead-end job. It doesn’t come when everyone says, “What happened, do you think?” when they talk about what I do or don’t do. It doesn’t come from looking at the longer and more difficult paths I could have taken and thinking, Well I’m sure glad I didn’t go to grad school and stayed home and got nationally ranked in Fifa 2011 on X-box Live instead. Those sucker doctors don’t know what they missed out on.-- -- --
Every Tuesday night since school started I’ve volunteered at a health clinic for the homeless and uninsured in Harlem. It’s the only real medical experience I’ve had so far. Everything else in our first year is just anatomy and immunology and epidemiology and those T cell receptors that Dustin hates.
At the clinic I see people from all over the world: some sick, some just fine, some depressed, some wonderful, some happy, some plain crazyshit out of their minds. I get a feel for what it will actually be like to be a doctor and turns out it’s not the worst thing ever. I take a history, do a physical exam, and then report to the attending physician who tells me everything I did wrong and does it over again for me.
It’s in this clinic that my medical education is actually interesting. There’s the man who comes almost every week wearing the same leather cowboy hat, denim vest, boots with spurs, a v-neck that dips down to his stomach, a handlebar moustache and a portable phone on a chain around his neck. He’s a walking idiosyncrasy. He’s homeless but plays Bach concertos from memory on a keyboard on Broadway. If you run into him at his street post he’ll look you right in the eye, have a conversation, ask you for a buck or two, and keep the music flowing effortlessly. He comes in every week for something new. A backache or an ear infection, high blood pressure or depression. He’s probably just bored on the street and wants somebody to sit down and chat with him. We humor him; we check his blood pressure, listen to his heart and his stories, then send him on his way, grateful at least that he’s got someone to check in with.
Then there’s the hugely overweight man whom I’ve been following and treating for high blood pressure and diabetes, the tag team disease combo that afflicts nearly every patient we see. He used to work as a security guard; now he sleeps on the A train every night. It was with this man that I had my first adrenaline rush as a med student, but it wasn’t because of anything that happened to him. I was doing some routine blood tests on him when my hand slipped and I stuck myself through the thumb with the needle I had just pulled out of him. I stared blankly at my thumb for a few moments as a dark red sphere of blood emerged from the puncture. Then I looked up at the patient. He was a homeless 30-something-year-old male minority in New York City. It would be hard to find many people with a higher risk of having HIV. My mind went into emergency mode. I thought maybe if I squeezed out as much blood as I could and washed it well I’d be okay. After I came out of the bathroom I asked the attending physician what I had to do. He gave me thirty dollars and told me to take the patient to the emergency room and have him tested for HIV and Hepatitis and that we’d worry about paying for it later.
In the cab on the way over, the patient said, “Shit man, I bet you’re sweatin’ bullets. I bet you’re like, ‘Oh shit, not a homeless dude.’ I bet you’re like ‘Damn, couldn’t I have mixed blood with anybody else?’”. He saw me looking out the window nervously. “Nah man, don’t worry about nothin’. I swear I’m clean. I ain’t had a chick for like 3 years, man.” After two hours waiting around in the ER the doctor came out and pronounced us both clean. I bought my new friend a sandwich to thank him for his time. I gave him the rest of the cab money and told him to just take the train and pocket the leftover.
So the clinic has at least shown me that medicine can be interesting and unpredictable and maybe even rewarding. I crave the affirmation that I feel there: that there is more to this experience than just the immunology and microbiology. There are people and feelings and jokes and stories.
I hold on to the clinic like a prayer.
-- -- --
A few months ago, before our conversation in the classroom, I was sitting out on the back deck of the student lounge with Dustin when the what the hell are we really doing narrative started. The lounge is in a building right on the edge of a steep bank, giving us an unimpeded view of the Hudson River, George Washington Bridge, and New Jersey coastline. We were leaning back in our chairs and, as seems to happen in those situations, we were talking about big ideas to fit with the expansive scenery.
“Four years is going to be a long time,” said Dustin. “And then four more? At least four more. But I guess this is what we signed up for, right?”
“Yeah,” I said. “But we’re still pretty young.”
“Speak for yourself, man. I’m not looking forward to never having free time again until I’m too old to enjoy it. Maybe I should have traveled around for a year. Why didn’t we just do that?”
I didn’t respond.
“Austin? Are you all right?”
Although, of course, on some level I had always known it, in that moment above the river I really thought about the idea that I only have one go at all of this. If I choose to be a doctor for my career, I can never come back and try something else out. It sank in like mortality hits after a cancer diagnosis; like responsibility after a child is born. I stared at the bridge and started to get a headache..
“Holy shit,” I said, finally looking over at Dustin. “This is it. And I mean, like, for real. We’re choosing right now that this, and only this, is going to be our thing. Once we’re 70 and we’re done, we can’t not have been doctors. We can’t change our minds and be in our 30s and try a career in business or teaching or writing. We’re signing up for hundreds of thousands of hours right now. We’re signing on the dotted line of our whole lives. I mean... Shit, this is what we are going to do. Do you get that? This is the only thing we are ever going to have done.”
I laid back hard in the chair, stared up at the bridge, at all the cars slowly making their way to and from the city. “Hoooolyyyyy shit.
-- -- --
The great Catch-22 in medicine is that you’ll have no idea what it’s really like until it’s too late to change careers. Nobody tells you that going in, though. Undergraduate premedical education is just science: chemistry, biology, physics, and some other mixtures of those three basic ingredients. You never have to step foot in a hospital before starting medical school. Two kids in my class were piano performance majors. Another one was a competition knife thrower. Nobody I know here worked for any significant period of time in an actual medical job.
Once school starts, it’s just more and more science until the third year when you finally do clinical rotations, but by then you’re $70,000 in debt, and you still don’t get to actually treat any patients. It’s not until your residency, when you have a six-figure debt and four years invested that you get to try your hand at actual doctoring. If you then decide that it’s not right for you, you’d better hope your parents will let you move back into the basement for a while until you find out what else you can do with your intimate knowledge of the immunological system.
Some of the kids in my class seem to be classic overachievers. For them, there is no question of whether or not they want to be here. They couldn’t ever do anything else. They were raised to go to an Ivy League Medical School. It apparently was never not the plan. For them it was just the next inevitable stage in their only-child, student body president, obsessive compulsive ladder to success and prestige. They don’t care whether or not they’ll enjoy it, because why the hell would you ever actually enjoy something?
Others I know are in the same boat as me. They’re here because this is a good thing. Because nobody is going to tell us we’re screwing up if we’re at Columbia Medical School. Everybody looks impressed when we tell them what we do and where we are. Others people’s fathers raise their eyebrows and say, “Well you must be quite the genius then” and we laugh and say something funny and dismissive. Our uncles always ask us how Columbia is instead of just asking how’s med school, and our uncles emphasize the name in a way that makes us know he brags about us to his friends. Everyone assumes we’re “in it for the right reasons,” that we want to “really help people” and “make the world a better place.” I never deny any of that, though I can’t fully claim it either, especially since any good graces I would win from trying to serve others are more than lost by how much I try to milk the “noble” image when I’m trying to pick up on girls.
But sometimes I wonder what the big rush is, why we’re all racing to start working for the rest of our lives. I stare at the bridge and imagine a life with no more spontaneous road trips, no more sleeping in until noon, no more wandering the streets on warm nights and not caring where I end up or when I come home.
-- -- --
Two days after my talk with Dustin, I went to the homeless clinic again. I saw a new patient—an immigrant man experiencing panic attacks on top of a generalized anxiety disorder. I spent two hours with him. What began as a comprehensive interview of his past medical history turned into a therapy session. He told me about his work, his life, his family. He talked to me about the stresses he faces every day when his boss comes in and tells him to mop another entire floor right before he’s supposed to go home. He liked his job, he said, and he was thankful to have a way to make some money, but there just wasn’t enough time to always do another floor. That is when he says he started having the panic attacks. He would feel stressed by his boss and then begin to sweat. He said, “I get, like, waves of heat from down in my belly up through my neck to my face and I have to sprint outside. I cannot breathe. It is like hands are on my face. It is like, how do you say it, a choking?”
I did a physical exam and then consulted with the resident on duty. We gave him some benzodiazepines for his anxiety, scheduled lab tests at another free clinic, and then I talked to him about ways to manage his stress to prevent further attacks. He went back to the waiting area and spoke with his wife while I wrote up the notes in his file.
A few minutes later, he came looking for me as he was leaving. He took my hand in both of his and shook it firmly. “Thank you, Doctor,” he said in his staccato English. “You are very very good.”
“Oh, no, no,” I said. “I’m just a student still. I’ve got a long way to go before I’m a doctor.”
“Absolutely not,” he said. “You are very important. You do very important work. You are very a respected person. You are my doctor.”
I couldn’t help smiling as I thanked him and said I’d see him in a couple weeks. As I walked back to see another patient, I was completely felled by his praise. I was a very good doctor. Forget that I didn’t know how to diagnose him, that I had just followed a written set of instructions for the physical exam, that I never had a clue what sort of treatment we should give him, and that the resident had to re-interview him to fill in all the gaping holes I left in his reported history. Forget all that. He said I was his doctor, and that touched my ego just enough to keep me motivated for another week. As for the others in my class, they all have their own booster shots I’m sure. Maybe they watch doctors on TV or daydream about the nurses they’ll meet once they get in the hospital. Maybe they get excited by anatomy lab or they just love telling their friends over Facebook all the smart-sounding things they’re doing. But whether it’s false praise for me or TV dramas for them, we all need something to keep us moving, to keep us from becoming still and stagnant and scared. And then years later, hopefully, when we sit out by the bridge again, telling stories of lives we’ve tried to save, of noble goals at least halfway met, of uncles who still brag about us, maybe we’ll decide it wasn’t so bad, that we’re glad we didn’t wuss out, that we’re really okay doctors now, that our husbands and wives didn’t leave us after all, and that, unlike Dustin’s dire prediction, we’re not boring as shit at all.