I was so excited to begin medical school I could not sleep at all the night before. Day one of medical school was very interesting and I can remember it 47 years later like it was yesterday. My new classmates came from colleges all over the country and everyone was very excited to begin our training to become physicians. The basic science building, which was to be our home for the next two years, was the former home of a large insurance company. It was a huge building and I would become quite familiar with every inch of it over the next year. I was a member of the third class to start in this private medical school. It's parent institution was Seton Hall University, a well-known Catholic college in New Jersey. As a matter of fact, I had come very close to going to college there four years before.
It took most of the morning to register and the last hour before lunch we were taken to the infamous anatomy lab where we were assigned our individual cadavers. It was quite a traumatic event for most of us but a necessary part of our training. The lab was a very cold, large room filled with approximately 25 cadavers laid out on tables and each was covered with a white plastic bag. Each cadaver had four or five students assigned to it. It was cold for the obvious reason to minimize the decomposition of the bodies. It also had a horrendous smell to it, one that we would become quite familiar with over the next year. This pungent smell, a combination of formaldehyde and other body odors, would seep into our clothes and our skin and a trip home at night wound up with a mandatory shower. I still have a distinct memory of that smell. We gently unwrapped our cadaver from the plastic bag and we discovered what appeared to be a middle-aged black female. I guess it was my first step towards becoming an obstetrician/ gynecologist. We were given a brief introduction by one of the professors who reminded us that the cadavers were to be treated with absolute respect at all times. I stared at the body and wondered what her life had been like. Externally she appeared quite normal, but it took a little time before I could actually touch her as I had never seen or touched a dead body before. As we began to briefly examine the body, one of my teammates suggested we call her Nellie. We would get to know Nellie very well over the next year as we dissected every system of her body. Of course there were no names on the bodies, but there was a brief medical history and a cause of death on a tag around one of her toes. Nellie was 43 years old and had died from tuberculosis. I didn't know much about tuberculosis, but I now knew it could kill you and I hoped I would not catch it. I did, later on in medical school, test positive for tuberculosis and I have always wondered if that is where I was exposed. At that point our morning session was over and, after gently re-wrapping Nellie, we adjourned to the cafeteria for lunch. Perfect timing that lunch would always follow anatomy lab. Someone in scheduling either had a sense of humor or a cast-iron stomach or both.
Well, I don't know how any of my classmates could eat lunch because I couldn't and many didn't look like they were feeling very well. We discussed the morning sessions among ourselves, especially anatomy lab. That solemn introduction to medicine will forever remain in my mind as the start of my medical career. I would also like to express my thanks to Nellie as she was my very first patient. She taught me quite a bit of my basic knowledge of the human body and she will always have a special place in my heart. To this day I can still remember her face and although we did not know her real name or her family, I want everyone to know she was always treated with the utmost of respect. Someone had committed her to be used to advance the education of four future doctors and, for that, we will be forever thankful.
After lunch we returned to the main amphitheater to be introduced to our other professors who would each outline their particular courses. It soon dawned on us that two students were missing. And although I did not know why they left, I'm sure anatomy lab was right up there as the main reason. It was a shock to launch our medical education that way, but everything that we were exposed to I am sure was aimed at weeding out those who did not have what it takes as quickly as possible. Well, that was sure pretty quick that two of us were already gone. I am not surprised at what happened that day because, frankly, I don't know why it wasn’t several more of us. Besides basic Anatomy the remainder of our courses for the first year were Physiology, Pathology, Biochemistry, Ethics, and Statistics. It was quite a daunting curriculum for the first year, and it would test everyone's ability to the max. The remainder of the day we spent getting to know our new friends and classmates. They came from quite well-known institutions and I imagined that they were all pretty bright and, indeed, it wouldn't take long to verify my initial impression of them. We were the newest members of the medical profession and were about to find out that it would take a tremendous effort to complete the next four years. Once again we were told to look around because many of us would not survive the process. We would become quite close over the next four years and, as a matter of fact, I am still friendly with several of them after almost 50 years.
Before the day ended, we were given our white lab coats. These well-known symbols of the medical profession made us feel like such important persons. We were beginning to look and feel like real doctors for the first time. We quickly began strutting around without a clue of what lay ahead. We, like all our predecessors, would have to earn the privilege of wearing it. It is the symbol that young doctors are very proud to wear and it still means something special to wear it today. So we had quite a first day filled with new faces, smells, buildings, and finally textbooks filled with thousands of facts which we would commit to memory over the next year. The first year is consumed with memorization. The understanding of all the new facts would come much later but first we had to fill our brains with all the new terms and vocabulary. There was very little thought process involved at this point. We just had to learn all the building blocks upon which we would expand our knowledge at a later date. I was exhausted at the end of the first day and I am sure so were my new found friends. I looked around at these very bright people from around the country and wondered if I could compete with them. I knew I wanted to, but I had my doubts and I found out much later that we all had pretty much the same feelings. Would we be good enough to compete with the guy or girl who stood next to us? Just a side note, we would find over the years that the brightest did not go on to become the best doctors. It takes a lot more than knowledge as we all were about to find out. So the hard work was about to begin and I was just thrilled and very proud to be there. I thought how lucky I was to be a medical student and I was determined to give it my very best effort and just hoped that that would be enough.
My college roommate Harry and I had found a small studio apartment near the school which we had crammed with our belongings. Harry was a great guy and we had developed a good friendship in college. He was very bright but fun-loving as well. We had some great times together in college and I was sure we could help each other in the years to come. He was from New Haven, Connecticut, and I had visited his home several times. My parents were very happy that we were able to get together both from the standpoint of our friendship and also another person to share the cost of the rent. Knowing each other so well made it one less new thing we would have to adapt to and we both appreciated it very much. Harry's father had been killed in World War II on the beaches of Normandy during the D-Day invasion. I had the extreme honor of visiting his father's grave a few years before and brought him back a picture of it that he was most appreciative of.
Our new home, Jersey City, was quite a place to live. In its early days it had been a very nice area but, with time it had deteriorated quite a bit, both in its surroundings and its inhabitants. It was quite dirty in some places and the medical school, which was adjacent to the medical center, was in the middle of the poorest section of the city. The crime rate was very high and we soon learned to always travel in groups, especially at night. Some of us unfortunately had to find this out the hard way. Several students were robbed at gunpoint but fortunately none were seriously hurt. My first exposure to an inner-city area was quite a shock coming from my nice, middle-class suburban neighborhood. I wouldn't refer to it as a ghetto, but it was close and robberies, murders and drug abuse were everyday occurrences. I would learn about the real ghetto when the school moved to Newark in my second year. It would prove to be a move from the frying pan into the proverbial fire as far as the neighborhood was concerned. The medical center was built in the days of the political bosses and it was a monument to their power and influence. It was replete with marble floors and beautiful architecture, but it had deteriorated over the years. Those places were not the nicest areas to live in, but I would quickly learn that they were very best places to learn. Between Jersey City, Newark and Greenwich Village in New York City, I would pretty much see everything there was to see, both in and outside of the hospitals.
Over the next few days and weeks, we began to settle into a routine. Morning lectures would be followed by long hours into the night working in the anatomy lab. Just imagine yourself in the lab with 25 cadavers, the pitch black of night outside and yes the pungent smells. To me this was the real definition of being scared. But with time all of it would be ignored as we were consumed with hour after hour of working on Nellie. As I said before, my high school days did not consist of much studying. I thought that I began to develop good study habits in college and I spent a lot of time studying in the libraries. In medical school, studying is not confined to a few hours in the library. First of all, we did not have a library so we would have to find other places to curl up with our books. Once we completed our long days at the science building, most evenings would start out in the anatomy lab for extra work to keep up with our dissection of Nellie and then back to our apartment for the real studying. That often went into the wee hours of the morning, then up at 6 AM to get to our first lecture. The time involved was incredible and I don't know how I did it. We were so focused there was little time to think of anything else. On the weekends however we would take a break from the books and go out to my parents house for dinner. That would prove to be our big event of the week during that difficult first year. My mother wasn't what you would call a gourmet cook but, compared to what we ate at the apartment, it was like going to a five-star restaurant. We kept our apartment well stocked with peanut butter, jelly, mac and cheese and a healthy supply of pasta. We ate food that was simple to prepare, cheap, and easy to consume with a book in one hand and a fork in the other. Time management was of the utmost concern. I ate many peanut butter and jelly sandwiches because it was quick and easy. At this point in my life I can’t stand to even look at one any more. There was no such thing as sitdown meals. Most of us began to look like survivors of a concentration camp and like them we too were doing what we needed to do to survive. We had no time to contemplate what we were going through and, I'm sure if we did we would probably seriously consider another profession. How many nights would I fall asleep with my textbook copy of Gray’s Anatomy on my lap? We all came up with ingenious ways to cover that book to minimize the exposure it would have to the foul liquids in the lab. I still have that book to this day even though it has an awful smell to it. There is no way I could ever part with it. But we knew why we were going through this torture. We wanted to be doctors and we were beginning to get used to long hours with lack of sleep and poor eating habits. I wondered if the girls in our class did any better in the food area but I doubt it. They had the same time constraints as we did and they looked as malnourished as the guys did. I had no idea what this was like beforehand and I just kept telling myself it will get better. Someday you will be a doctor and this will all have been worth it. I repeatedly told myself that day after day, but it was a hard sell for sure. Despite my reassurances, I seriously wondered if I would live that long. Many a time I thought to myself “is this what you really want to do”? “Is it really worth it?”
By far the hardest part of the first year was anatomy lab. The time and effort that went into it was enormous. No one outside the medical profession can begin to fathom what an effort it takes, but I think you will have a better feel for it after reading this chapter. This would be the very foundation onto which our medical careers would be built. If we did not understand the human body and all its complexities, there was no way that we could begin to understand what was to come next so, unlike other subjects, it was not knowing 70% that was good enough, we would have to strive to know as close to 100% of the material as possible. As I looked at Nellie for the first time I could not imagine how complex she was. Her external body was just a shell below which was a maze of interconnected systems and organs. Just as then I cannot wait to begin to relive my experiences. It was such an interesting part of my education but I hated and loved it at the same time. I think more than any subject that is the one physicians probably remember the best about medical school. Years later the movie Fantastic Journey brought me right back to my memories of medical school. It was a movie about traveling through the human body in a miniature submarine. How cool it would have been if we could have actually learned the human body that way. Of course, it would have been a nice touch to have Raquel Welch as our instructor instead of some of the menacing people we did have.
I can remember the first incision I made into Nellie’s body as if it were yesterday. How many more I would make in my career I had no idea. As we opened the abdomen for the first time, we were entering a place only few had the privilege of going. It was on that day that we lost another of our colleagues. He just passed out at the sight of his partners making an incision into the cadavers body. So now we had lost three of us and we were still in the first week of medical school. That was another traumatic day in our lives and, unfortunately, one of us would find it too much to handle. Although I cannot remember his name, I can clearly see his face and I felt so bad for him. His dream of being a physician had been crushed. I remember wondering what else could lie ahead and which one of us would be the next victim. The students at my table were interesting people, to say the least. Besides myself, there was a boy from Massachusetts, one from Connecticut, and one from upstate New York. We were all from different colleges and backgrounds, but we would come to know each other like no one else. The challenge we were entering into was one that would push each one of us to the max and, believe me that's what it took. I am only going to identify a few of them out of respect for their privacy and hope not to offend anyone by not including them all. I am sure that most of them will probably be able to pick themselves out and each I cannot begin to thank enough for their friendship, assistance and understanding.
So after the first incision we would come to find that the different layers of the abdominal wall were comprised of many things like muscle, fascia, blood vessels, and nerves. We probably spent a week or more learning the names of all those structures. The other thing we would learn was that medical terms could be very complicated and confusing. Many of the terms went back to ancient times and at first they were tremendously complex and seemingly without meaning or at least did not make much sense at the time. We were learning a new language from scratch and each day we are adding to our vocabulary; terms like rectus abdominus muscle, inferior epigastric artery, vagus nerve and other structures with equally strange sounding names. I remember a surgeon I had in my residency years who would say “I can't remember the name of this artery anymore but it's there every time I do this operation so be careful not to cut it or it will bleed like hell.” Well, because our patient was not alive anymore there was thankfully no bleeding as we worked on her. That would come much later on in our training, another unpleasant site we would have to overcome. Unfortunately we could not be as glib about the names of these structures as he was when we were starting out. The detail which we went into each body part was incredible. How could I ever remember all of this? Those of us who went on to become surgeons would later on appreciate that part of our training very much. It was in the lab that many of us would form the initial thoughts about being a surgeon and others would decide it was not for them. That day, of course was a long way off, but it was a start. Not that we knew what being a surgeon was all about, but we were learning the basis upon which our future careers would be built. Surgeons must know the area the body that they operate on to a T. It is such an immense body of knowledge that specialties arose because one person could not know every part of it that well and, on top of all that, the diseases that could affect it. So, from day one, our careers were being formed whether we knew it or not. To most of us, we didn't see the plan, but it was there nonetheless. Later on when we looked back as I’m doing now, it would all finally make sense. But while we were going through it, there was a lot of “why are we doing this, I'll never use it again type doubts.”
The other challenging course in the first year was Biochemistry. It deals with the functioning of the body on a cellular level. Our professor was a tiny middle-aged woman who had a voice that was like nails scraping on a blackboard. She was the epitome of the medical school professor. She was extremely bright but cold and aloof. The world revolved around her subject and, to succeed, we would have to not only endure her and her little quirks and mannerisms but know and understand the information she was passing along. Although Anatomy was very grueling I liked it and felt it was interesting at least in many ways. Biochemistry was a different subject all together full of formulas and different pathways that the body used to get and store energy. I’m sure everyone who has studied medical biochemistry will remember something called the Krebs cycle. Also known as the tricarboxylic acid cycle (TCA), the Krebs cycle was discovered in 1937 and named after the German biochemist Hans Adolph Krebs. He won the Nobel Prize for medicine in 1953. It constitutes a complex series of chemical equations that results in the major source of energy in all living organisms. It produces carbon dioxide and a compound called ATP or adenosine troposphere. This provides cells with the energy required for the synthesis of proteins from amino acids and the replication of DNA. Sounds like something you could really sink your teeth into doesn’t it? In high school and college we studied chemistry and now we were applying it to humans and how they function. Nonetheless I found it as interesting as watching grass grow. While I liked chemistry very much our professor managed to make this course as uninteresting as possible. She would not be the only professor who would manage to make me struggle with the course they taught.
Those of you who know anything about Jersey City will realize that it has always been mired in politics. The medical school was no exception and the local politicians tried to exercise control over the school and Seton Hall University did not like it one bit. There were a lot of rumors that the medical school would have to close if the city did not continue to rent space to them in the Jersey City Medical Center. So besides the usual pressures, we also had concerns about whether our school would continue or not. We even heard plans were being made to possibly transfer all the students to different medical schools around the country if the school did close. But as students we had far too many other things on our minds to worry about the politics. Drowning in debt, Seton Hall finally succumbed and the medical school was fortunately taken over by the state and as a result, midway through our first year we became students of New Jersey College of Medicine and Dentistry (NJCMD). How many times would I use that abbreviation over the next four years? Since it was the only medical school in New Jersey at that time, thank God the state leaders felt it was important enough for the school to continue its existence. One instant benefit of the takeover was that our tuition was reduced by about half for state residents. That was a big relief financially for my parents. We didn't know exactly how well the state would run the school, but we were relieved that somebody cared enough about us to take it over and save our school. Many of our professors stayed on to continue our education. This would end up supplying New Jersey with countless physicians to this day who stayed in the state following graduation to practice medicine. Politicians with some foresight, now there’s a contradiction of terms.
Lest you think I hated every subject in the first year, the third major course was Physiology and I finally found something I really liked. It is the study of function in living matter. Medical physiology was the study of function in human beings. In human physiology, we attempt to explain all aspects of function in the human being, including the chemical reactions that occur in cells, the transmission of nerve impulses from one part of the body to another, the contraction of muscles, reproduction and even the transformation of light energy into chemical energy to excite the eyes, thus allowing us to see our world. The textbook we used was authored by Arthur Guyton, another giant in medical education. This textbook rivals Gray's anatomy in size and is divided into 80 chapters. We starting to get a little closer to understanding what medicine was all about, or at least it seemed like the knowledge was getting more relevant. We were now taking our knowledge of anatomy and applying it to how humans function. I enjoyed the course very much and I did exceedingly well for a change. My confidence was coming back and I was starting to believe I was going to make it. Once again our instructors were mostly PhD's but they seemed to be more interested in getting us to understand how the human body works rather than memorizing a lot of names and forgetting them 30 minutes after exam time. There was one instructor who had just received his doctorate in physiology and I got along with him very well right from the start. Dr. Frank was in his late 20s and filled with a fresh desire to teach. I spent a lot of time in his lab and, at the end of the first year, I applied for a research fellowship with him which I was granted. It afforded me an opportunity to make a little money on my own to offset the cost of my education. My parents had been very generous with me, but it was nice to have a little mad money in my pocket. It also gave me something to do besides drive a truck for my uncle, which was the usual way I spent my time off between school years.
So as the first year finally came to a close, we prepared for our final exams. How would we ever be able to remember everything we had been taught all year? Nerves were tense, tempers would occasionally flare, and many would even skip meals as we crammed to find extra time to get every last bit of facts straight and fresh in our minds. As we looked around at the upperclassman, we knew that some of us would actually survive so the mentality was, hopefully, I would be able to do just a little bit better than the next guy. I still don't know how I got through it, but I did and, when the exams were completed, we had a few days to ponder our fates. When the marks finally came out, we went around to each of the department offices to get our results. Our grades and fate for the next year hung there for all to see. I think that was when I began to develop coronary artery disease. Why did it need to be so difficult? Wasn't there an easier way to train our future physicians? As we stood looking for names and scores, some wept, some sighed, and others smiled. Fortunately, I was in the smiling group but we all felt sad for the ones who had not done so well and probably would not be returning with us next fall. I cannot begin to tell you the relief I felt that the first year was over and I had survived. All the hard work had paid off and we could relax and enjoy the summer before returning for the next round of our training. I think looking back that it was easily the most difficult year of medical school and probably one of the most difficult years in my entire training process. I hope I was able to give a little taste of what it was really like and that you can understand the pure joy and satisfaction of completing that first year.
I hardly had any time off before I began my summer job with Dr. Frank. Now the pressure was off and I began to settle into the research job with him. He also had completed his first year at the medical school and I could see he was relieved too. We sat down together and planned out our project. I knew nothing about doing research, but he made it very easy for me and I assisted Dr. Frank in his research study of the mammalian dive reflex in animals. I even got to co-author a paper entitled “ the cardiovascular response of the mammalian dive reflex." When mammals submerge they are able to slow their heart rates down to decrease their metabolism in order to remain there for long periods of time. Dr. Frank had begun this research while he was studying for his PhD degree. The animal we were to study was called a nutria. Women will recognize the name as it is famous for its pelt, which is used for fur coats. While its pelt is quite nice, its appearance is that of a giant rat with large teeth and a deep growl when cornered. Well, I was in charge of the care of the animals which was quite scary. I rationalize that doing anything for the advancement of science is noble work but this really was a little dangerous. Well the animals and I really did not get along very well. Suffice it to say we were equally frightened of one another. Our experiments involved anesthetizing the animals and placing them on a platform which was slowly submerged into a large cooler filled with ice and cold water. I’m sure Coca-Cola had no idea their cooler would be used for such experiments. It was up to me to figure out the logistics of attaching the animals to the diving platform, no easy task because they had to be well secured before submerging them. As you can imagine, there was a little trial and error process involved with it and a few of the animals managed to escape. This was both frightening and amusing at the same time. Fortunately, we were in quite a small enclosed area as I chased these very angry animals around until I could corner them and get the noose around their necks. It's a good thing for them that I had a lot of respect for life, but it crossed my mind several times that a few of the animals might meet an early demise. And of course, I am just kidding because even at that time there were principles that had to be maintained for how the animals were cared for in medical experimentation. How lucky that was for these little beasts. Besides feeding the nutrias, another tricky feat, my job also involved getting them from their cage with the noose then anesthetizing them and placing them on the diving platform. I came up with some novel ideas of getting them out of their cages as their huge menacing teeth were capable of biting right through the broom handles with the noose I used to snare them. After they were anesthetized, pressure gauges and wires were then attached to different blood vessels and nerves to record the animal’s response to diving. And once they were asleep, I was actually operating on a live animal for the first time and I instantly knew that it was something I really enjoyed doing. Even the bleeding did not bother me. I remember thinking to myself that maybe someday I might possibly become a surgeon. That summer was very interesting and I would like to thank Dr. Frank for giving me the chance to work with him and forging my first steps towards becoming a surgeon. All too quickly the summer break was over and it was time to return to classes for another difficult year of study.
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