This is a ramble about the period of time in August and September that I spent doing my Internal Medicine rotation—my first rotation—in my third year of medical school.
Life can change fast. Three years ago, it was not out of the question for me to go to bed with beer, french fries and smoke on my breath at the 5:30 in the morning—the same 5:30 that today finds me showered, dressed, and on the road towards the hospital. I’m sure I’m not the first former 21 year old to say this, but to me, three years ago might as well be a separate universe from the one I inhabit today.
Driving down Route 18 at 6:00 in the morning is a nice metaphor to explain the life I left behind in undergrad and the transition to my new existence. From New Brunswick I drive towards Neptune, New Jersey, listening to my music or the news, trying really hard to not fall asleep behind the wheel. At dawn, I see the sun rise over the tops of trees, the cosmos resting over a vibrant, green horizon. Some days, the body and rays of the sun are a gentle orange, and the light streaming through the windshield calms me, taking my mind away from the noise of what yesterday was and what I need to worry about today. Other days, if there is one less cloud in the sky for the sun to veil itself behind, damn—I am totally blinded at 65+ miles per hour, freaking out enough to bust an artery because I can’t see the road and, simultaneously, still dreaming, my body simply refusing to release the adrenaline needed to clear the morning coma that a five hour sleep routine gives you.
I get to the hospital, alive, by 6:30 and enter my new universe. Anyone who’s ever worked in a hospital knows that it is in fact a sovereign country, replete with its own language, culture, customs, heroes, villains, wonders, and inescapable, ugly realities. Welcome to Jersey Shore University Medical Center, aka JSUMC. I’m not the only foreigner here: this hospital is run by immigrants with H-1B visas. The majority of the residents in the Internal Medicine program are internationals: Armenia, India, China, Nigeria, Jordan, Egypt, Pakistan, Thailand, Colombia, Romania, all here. Almost everyone is nice and at the very least, interesting to talk with, and it’s a great pleasure to have the company of people from all walks of life who are enjoying and enduring the same, intense experience together. We sit together at lunch and joke and laugh and reenergize ourselves for the hours to come. I wonder to myself if these experiences at all have a semblance to the vibe at Michigan State University in the 1980’s, where my parents made their life together in a community of international students.
As a third year medical student, I’m basically analogous to a resident alien with a J-1 visa, and I’m trying hard to keep a smile on my face, hustle and learn as much as possible, and not piss off anybody who could affect my existence. I wear a white coat over a shirt and tie, plus shiny shoes. I also have a beeper which vibrates periodically, so I fool some—and I said some—sick people into thinking that I am a competent physician. In terms of health education, they do more for me than I could ever do for them. With my mediocre grasp on both the science and the art of medicine, I am no doctor.
However, I am learning. I have connected with a lot of people in need of a friend as well as a physician. I have experienced moments that I knew right then would leave a lasting impact on my life, and am pretty sure that I know how to manage atrial fibrillation under a couple of different circumstances. And I do think that generally, most people like it that there’s this guy who comes into their room, asks them how their night was, and listens to them before launching into an examination of every surface and crevice that they normally keep hidden from the world.
Probably one of the most valuable and difficult aspects of my education has been the daily realities that I encounter on the job, the struggles of all types of individuals: people who don’t have health insurance and don’t get the care that they need, patients struggling to get more than 3 minutes with their doctors, young women and men who come in feeling healthy and get told that they have HIV, wives that lose their husbands of 57 years in front of their eyes, old ladies all but abandoned by their families, left to die in the hospital. I have seen these things, and some experiences have definitely shaken my faith in the supposedly sacred ties that bind human beings to one another.
As for managed care, I have already had enough experiences with this issue in the past few years to know what to expect (the worst), so no surprises here. My editorial: the failure of America’s health system lies in putting citizens before the profits of insurance corporations. As a physician-in-training, you see numbers, insurance status, and insurance company preferences enter the treatment equation and influence it drastically every single time. For example, physicians are assessed on how they operate within “systems-based care”, a large part of which revolves around knowing how to distribute healthcare resources as these companies see fit so that you stay out of trouble; what you as a doctor think is appropriate is secondary.
Don’t believe for one second that healthcare in America is a service—it’s an industry. Many, many good people work hard and long hours every day to heal the sick and wounded. And many people work hard to make money for insurance and pharmaceutical corporations too. That’s just where our inefficient, irrational, unjust health system is at, the reason being simply that it is built on a fundamental conflict of interest.
And if you work 6 days a week, donate to charity, keep your kids out of trouble, participate in improving your community, but can’t afford insurance, you’d better not get sick, because this system is set up not to keep you healthy, but only to keep you from dying in the hospital that has to deal with your broke ass once the damage has reached critical levels. Dr. Martin Luther King, Jr. said “Of all the forms of inequality, injustice in health care is the most shocking and inhumane,” but differential medical care based on socioeconomic status, ethnicity, health literacy and other factors is a reality in America.
Family and friends are huge. I try to call my family, my girlfriend every day. I need their support more than ever, and I get it; for that I am grateful. Everyone has their own life to deal with. I know that most of the time, I’m the myopic medical student who has to try really hard to get out of his dark little tunnel to begin understanding someone else’s life. Overall, dealing with life outside the hospital reminds me of how unremarkable my efforts are, relative to the way other people whom I admire handle their obligations, passions, and ambition; I hope to learn from them.
People are changing all the time. I see friends and acquaintances going through their own trials, worrying about who they’re supposed to be and what they’re supposed to be doing, stuck with some decisions and afraid of making others, worried about consequences—one of the shittier hallmarks of early adult life, it seems—but you also see some being totally badass and reaching for their dreams. I am trying to be like that.
My life is changing, and so am I. The decisions that I made in undergrad, when I used to pass out after a night of partying or a marathon of NBA Live, have shaped the direction of my life in ways that I still struggle at times to understand. I am still fumbling with how to reconcile my expectations with my limitations, and the flaws that I come to notice in my habits and behaviors are harder to eliminate than I would like them to be. But I also know I am the same person who got stung by a newly broken nest of angry bees, ran away, then ran back to get his bike, the kid who read Greek Myths over and over and still would if the book was on this table I’m typing on right now. And I know that one comes to know where he is going through starting down the path. Of all the knowledge I have accrued in these past few months, the realizations that I have come to about myself have been as invaluable as the clinical pearls I have learned on rounds in Internal Medicine. And so for the first time since prom weekend, I thank Jersey Shore for the memories.