The Soul of a Doctor

by Gordon Harper

  Rewiring

  Mohummad Minhaj Siddiqui

  IF EVER THERE’S BEEN a period where people feel that they are undergoing a major transition in their life, third year of med school must qualify. In the Transition to Third Year course, a chief resident told us that if we were to stop our education right then, at best we would be highly educated individuals, but that at the end of third year, we’d be much more physicians than not. By the end of this year, our views on the world would be changed, the very experience of riding the T would be forever transformed; we’d see people and walk up to them and say, “You don’t know me, but you should get that bump on your neck looked at.”

  Now five weeks into third year, I realize how accurate those statements actually were.

  I was walking down the street today and I saw a man who looked to be homeless, sitting with his belongings in plastic bags, staring at the ground, mumbling to himself. He was smoking and looked emaciated, with sunken temples. I saw him and I swear I instantly took the model of a few other patients I have seen and had a picture in my mind of what was going on with him. On the spot I found I was making up a patient history about him: Here is a forty-eight-year-old man with a fifty pack-year history of smoking now presenting with emphysema and multi-infarct dementia secondary to severe vascular disease. Or perhaps he was a fifty-two-year-old man with an eighty-nine pack-year history presenting with weight loss due to primary lung cancer.

  Farther down the street I saw an old lady slowly crossing the street with a cane, clearly strained by the effort and breathing heavily. She was a bit overweight. I was instantly drawn to her feet, which were completely swollen and bulging out of her shoes. I thought, eighty-five-year-old female with h/o CHF presents with SOB and 3+ pitting edema bilaterally along with crackles in her lungs. I was wondering if she was volume overloaded and couldn’t benefit from a little furosemide.

  It’s not that I’ve learned all that much in the past month; rather, I think there has been an intrinsic rewiring of my thought processes. I’ve started relating everything we’ve learned in our first two years to the world around me. Truly I’ve undergone a transition from a highly educated individual to a physician. I could have met the same people just a few months earlier and thought nothing more than, Homeless man, and Elderly woman. Still I look forward to the next year, two years, six years, when I can utilize my knowledge for the good of others rather than just for my own satisfaction.

  Taking My Place in Medicine

  Antonia Jocelyn Henry

  FIVE WEEKS IN the operating room and not a black surgeon in sight. Walking the windowless corridors among masked faces and bodies shielded in scrubs, one can lose track of time, not just hours, but years. I knew other black surgical hopefuls had gone before me with success, but that reality took on a more nebulous character each day. For five weeks, the only black faces I saw were pushing brooms, stretchers, and cleaning carts. The job segregation is as obvious as the day is long. The blacks and Latinos who work as unskilled labor pass me in the halls without the cursory nod of acknowledgment common among our races. Maybe they expect me to be too arrogant to speak to them. Maybe they know more than a short white coat separates us. Maybe the fear and disorientation I feel inside translates into a stern and unwelcoming visage. Whatever the reason, the sense of isolation I feel from the only people who share my features does nothing to counter my insecurity in this alien environment.

  Down in the OR, eyes are truly the windows to the soul. Crowded around the OR table with the surgeon, residents, and surgical techs, everyone is clothed head-to-toe in sky blue and medicinal green. Hair covers, clear plastic eye shields, masks, gowns, and gloves sheathe bodies and faces. Body language is constricted and difficult to read. The flat, objective, and emotionless voices shield all but the slightest vocal inflection. But the eyes tell all. Rolling eyes and frigid stares convey all that needs to be said. Standing stock-still so as not to get in the way of the surgeons, carefully placing my gloved hands on the sterile drapes, and being excessively cautious to avoid contaminating the sterile field, I feel like the nuisance I surely am, even though I am the only one paying to be there.

  Occasionally the eyelids are not enough to hold back emotions. Above me on the totem pole, the OR techs and nurses, most of whom are white females, exercise their seniority over me by putting me in my place with indirect and direct insults. The situation is only amusing when I remember that this is a temporary relationship. In a few short years, I may be the surgeon taking delight in reminding them of their place. The cycle of hazing and hierarchy will continue to perpetuate itself. I can only imagine they see the future and are threatened by the possibility of a black female surgeon berating them for handing her the wrong size clamp. Not planning to be the kind of surgeon who treats others with such disrespect, I stand by mute as they get their jibes in. Responding would only give them cause to make the remainder of my rotation incredibly difficult.

  On the rare occasion a surgeon or another attending finds time to “pimp” me, I start out answering the questions correctly. But as the sessions progress, I become confused, and answers evade me. My temperature rises with my anxiety. I jumble my words. When it becomes clear that I no longer follow them and they have exhausted me with their favorite game of “guess what I’m thinking,” my confidence seeps away. I feel as if I am the least knowledgeable medical student they have ever encountered and the first two years of medical school have been for naught. I seek refuge behind my face mask.

  Sources of support are precious. My family has been an invaluable source of encouragement and love during this time. I crave the understanding of my fellow black medical students, as they are battling some of the same demons. But we are all taxed, attempting to keep one another afloat as we are pulled by the same undertow.

  Last week was especially trying. The pimping sessions during my week in anesthesia left me drained of reserve and full of self-doubt. I couldn’t intubate or place an IV in the hand to save my life or anyone else’s. Two months after taking Step 1 of my licensing exams, I was still waiting for my scores for a test I was sure I had failed. Questioning identity, purpose, and ability, I felt a sinking sensation deep in my gut. Yes, it really was that bad. And then I was saved. Friday morning, a black female orthopedic trauma fellow presided over my first case. She even invited me to spend some time with her in the OR after she found out I’d already rotated through the orthopedic surgery service before her fellowship began. In the afternoon, my second case belonged to a black male vascular surgeon. Although he did not ask me my name (medical students in the OR do not speak unless they are spoken to), he sent me a message later in the case. While the anesthesia attending was mercilessly pimping me about replacing blood products perioperatively, the baritone voice of the vascular surgeon rose over the din of beeping monitors. He said, “What did Charles Drew do?” referring to the black physician who pioneered blood transfusion. Although he did not acknowledge me in any other way, he made it clear that he was listening and looking out for me.

  When I got home, I found out that I’d passed my boards.

  God works in mysterious ways. I needed that day as much as I need oxygen to breathe. I’ve learned that these next two years will be as much about my enthusiasm for pathophysiology as they will be about my stamina to cope with changing environments, my ability to renew my strength, and my trust in a higher power. That day was the clarity I needed to remain on the journey toward taking my place in medicine.

  Identity

  Alex Lam

  THE RADIOLOGIST WHO SPOKE was an older man, a remnant of the all-powerful, all-knowing physician of the past. He wore a blue suit jacket and a red tie and had an aura of confidence about him that suggested that when he spoke, people listened. He was a seasoned doctor, the epitome of what it was that we were trying to become. I listened to him carefully, trying to discern and understand a small piece of that vast amount of knowledge that only decades of experience can bring.

  He sat in a chair
at the front of the small conference room, lecturing to the twelve students before him. He slowly rose from his chair, his knees protesting angrily in loud pops as his tall frame stood at the front of the room. His voice was a dry rasp.

  “Radiology can be difficult to understand,” he said. “You look at something, and it all looks the same. It looks the same the way they say every Chinaman looks the same … until you get to know one.”

  What he said next didn’t matter. I didn’t hear it. My mind focused only on one word: “Chinaman.” Everyone around me laughed uncomfortably. We looked at one another and exchanged puzzled looks. Did anybody say that anymore? It seemed so foreign to us. As part of the most diverse class in Harvard history, we were certainly accustomed to multiculturalism and had even taken it for granted. It was sacrilege to go against that system. He hadn’t even noticed or hesitated.

  I felt this sick sensation in my stomach. It reminded me of the same one that I had often felt growing up in eastern Washington State, in a small town on the Columbia River. It always followed some derogatory statement and grew more intense when the speaker added, “Yeah, but I mean, you’re not really Chinese anyways.”

  I knew this feeling. It was the one that I had the day I stood behind the local grocery store. Cowboys stood on one side of the alley, in Wranglers, with wide-brimmed hats and boots, flannels, farm-grown biceps. A line of trucks with KC HiLites, mud flaps, and empty gun racks, caked in dried desert mud, were parked behind them. On the other side stood two black kids, a couple of Mexicans, a half-black and half-white kid, a couple of Asians, and me, a biracial Asian American who had been mistaken for everything from black to white to Italian to Mediterranean to Puerto Rican to Native American to Hawaiian to Eskimo to anything but Chinese, desperately trying to fit in. In times like this, our color didn’t matter; we were all the same in that we were not like them. It had come to this because one of the boys liked a girl who liked a different boy, and so that boy had decided to call the other one a nigger.

  It was the feeling I had when I stood on the cruise ship with my new friend, who introduced me to his grandmother, who could only ask, “And what do you do on the ship?” It was the rumble in my stomach that I felt when my Mormon girlfriend’s parents didn’t seem to like me no matter what I did. It was a battle that I couldn’t win.

  In those days, I became angry and I would lash out. I would fight. I would scream. I would swing blindly at the invisible injustice that I believed surrounded me. I would let what people said get to me. I believed them. For a while, I wouldn’t use chopsticks. “Dad, a fork is just so much easier,” I would complain. It broke his heart.

  Gradually I went to the opposite extreme, taking offense at anything even remotely unflattering to Asians. I could not be comforted by my white mother’s comments. “People are just teasing,” she said. “Everyone has something to be teased about. The more you let it get to you, the more people will do it.” How could she understand?

  However, I was also not comforted by my father’s perspective. “You will be discriminated against because you’re Chinese,” he said. “Some people are going to see your name and immediately not like you, no matter what you do.” How could he understand? Neither of them was like me, I told myself.

  Somehow, though, I learned to use my identity as a gift that allowed me to function in every group and gain an insight into all groups. People would embrace my mysterious identity and accept me as one of their own, regardless of what that was. I heard things that Caucasians said in confidence, and I heard things that minorities said only in their own company. It taught me to have a wider understanding and compassion for multiple perspectives and to try to understand the things that brought people to those viewpoints. However, it was never easy getting there.

  Now I sat in disbelief and thought about the conflict I was feeling inside. Should I say something? As a medical student, what power and what right did I have? What would I give up if I was silent? What would I lose if I said something?

  I waited until after class, until the usual stragglers had left, then approached the eminent radiologist humbly. “Sir, can I talk to you?”

  “Yes,” he said. “What is it?”

  “I just wanted to let you know that I think you gave a great lecture. It was funny and interesting….,” I began. “But there was one thing, and I’m only saying this because I don’t think you even realized you did it, or maybe didn’t realize what it would mean.”

  “Really? What is that?”

  “Well, my father is Chinese, and when you said all Chinamen looked the same, I found it pretty offensive. I know you didn’t mean it like that, but I just wanted to let you know, it really bothered me.”

  He hesitated. He leaned over and looked at me closely, my much smaller frame standing before him. Then he put his arm around me. “I’m really sorry. I didn’t mean anything by that. I really didn’t. I was trying to make a point. It was in poor taste. You’re right; I shouldn’t have said that.”

  “Yeah, it’s OK,” I said. “I just thought you should know.”

  “And I appreciate the feedback. Say, what year are you?”

  “Third.”

  “What’s your name?”

  “Alex. Alex Lam.”

  He looked at me, as if measuring my character with his eyes. He smiled approvingly.

  “Alex Lam. Well, good to meet you. I appreciate the feedback. Take care.”

  He turned and walked out the door. The empty classroom was silent.

  I thought of that grocery store parking lot three thousand miles across the country, which lay so many years behind me. I turned to walk out of the room and smiled to myself. In that instant, I realized how far I had come.

  The Outsider

  Charles Wykoff

  “CHARLIE, BE SURE to bring some reading material with you to my clinic.”

  At the time, I did not understand, but after my first day with my obstetrics and gynecology preceptor (the doctor responsible for medical-student supervision and teaching) in her outpatient clinic, it was all too clear. About 50 percent of the patients did not want me in the room. It’s not that the patients did not want a medical student; if I were a female, they would have been happy to let me be a part of their checkup. It would have been easier just to post signs up around the office: MALES NOT WANTED, or MALES, GO AWAY!

  Of course, I can understand the patients’ perspective. In fact, in the past I have told my wife that I prefer she see a female gynecologist. But when it comes to my being the one standing outside the door as my preceptor turns to me and says, “Sorry, I’ll meet you in my office,” I am frustrated. No, I am more than frustrated; I am almost angry. I am bothered by the way the office assistants phrase their questions regarding medical-student participation. I am bothered by the fact that the physician supervising me does not do the asking. I am frustrated with the patients for not allowing me in the room even while the doctor takes the history. I am angry at the husbands and boyfriends in the room who interject to say that they are not comfortable with a male medical student’s being present for the exam of their wife or girlfriend (this happened to me twice in one day). Finally, I am angry at the situation in general: these patients know their provider works for a Harvard teaching hospital (or at least they should). If they want isolated, no-medical-students-involved care, they should go to a private physician. How do these people think the next generation of obstetricians and gynecologists is going to be trained?

  By the end of my first day of clinic, I feel apologetic for being a male and find myself profusely thanking the patients who allow me to stand in the examining room when they are interviewed. But it’s gone too far. I am here to get a medical education so that I can provide the best care possible to my future patients, and here I am, being deprived of the opportunity to really learn how to do a pelvic exam, not to mention how to take a gynecologic history. By the end of the already limited time in my ob-gyn rotation, I will be lucky to have done four vaginal exams and certainly wil
l not have done any rectovaginal bimanual exams. Hopefully my future patients will never have any gynecologic issues that need to be addressed.

  Obstetrics-gynecology appears to be a great field. It allows a combination of medicine, surgery, and long-term patient care that few fields can provide. It demands knowledge of the entire spectrum of life: from prenatal care, through adolescence, into the world of postmenopause. However, it is not an option for me, as a male. Obviously men do go into ob-gyn, and some hospitals are actively recruiting men into their ob-gyn residency programs because of the decreasing number of male ob-gyn doctors. But let’s be realistic. While some woman may not have a preference regarding the sex of their obstetrician or gynecologist, most women prefer a female. So I have to ask myself, why should I go into a field where I believe I will constantly feel like an outsider?

  Before coming to medical school, I was convinced that I wanted to go into pediatric oncology. My sister died of acute myelogenous leukemia when I was a child. Ironically, growing up in the shadow of her death, I never really thought about going into medicine. Not until I entered college and really began contemplating what I wanted to focus the rest of my life on did my experiences with my sister shine through. My career path was there in front of me; all I had to do was jump on.

  Once I arrived at Harvard Medical School and began looking closer at the day-to-day activities of the physicians around me, I realized that a surgical field might be the right direction for me. I have always loved working with my hands and have enjoyed sports that require a lot of hand-eye coordination. I’ve often thrived on experiences that take a large amount of planning and dedication. Also, most important, I have enjoyed my time in the operating room far more than I anticipated.