The first day back consisted of the confusion of orientation and the pain of paying my tuition. I stared at the $10,000 check my parents had worked so hard to pay. It was also hard to believe that we had to pay for the torture we were being subjected to. For many of us, the sacrifices our families had to make were tremendous. Scholarships were not readily available back in the 1960s so it was pay-as-you-go or no go at all for some. Several missing students that year were related to finances and that was a real shame. The cost involved with a medical education is so high it's a wonder anybody can afford to do it. But my parents were able to make the sacrifices to keep me in school. The relaxation and fun we had from the summer was abruptly over. As we greeted our old friends, the missing were counted and then the grind began all over again. I guess that's kind of the best description of what we were going through. It was a grind from beginning to end. The books were now more expensive than ever but seemed to be not quite as big as previously. Of course that turned out to be only a false sense of illusion. The work would be just as hard, but we were a little more savvy at how to deal with it, or so we thought. We are about to enter the worlds of Pathology, Pharmacology and Microbiology. By the second semester, we stopped carrying books and traded them for our “black bags" and stethoscopes. Very few physicians carry black bags any longer but, back then, it was a real status symbol. The black bag contained our stethoscopes, blood pressure cuffs, tuning forks, reflex hammers, and other equipment we needed to do a complete physical examination on a patient. It meant the medical student was getting closer to the clinical years when we would wrestle with caring for real-life patients instead of microscopes, textbooks and cadavers. We were introduced to physical diagnosis where we, once again, made another big step towards becoming physicians. Besides the fact that we were beginning to look like physicians, they actually were calling us doctors for the first time, but we all knew we were far from being one. Our first year consisted of learning the normal; now we would be called on to study the abnormal and how disease affects the human body. I neglected to touch on in the first year about our trusty microscopes. We peered through them for so many hours that our eyes actually hurt. I remember back just before starting the first year my mother took me into New York City to buy one. We looked through several stores trying to find the best one at the cheapest price. Used versus new, top-of-the-line versus the basic all were taken into consideration. As usual, my mother always went for the best for her only child. She knew she would have to work a little harder, but she never complained about it. Nor did my father. Although it was mom who actually worked extra time to pay for my education, they both sacrificed very much to get me through. I am sure I was one of only a few who came out of medical school not having one single loan or debt to repay other than a tremendous thanks to my parents. Vacations for them were nonexistent in those years as every extra dollar was put towards my education. It would be impossible to ever repay them for their sacrifices.
Pathology is the study of the causes of disease and the changes they make in different organs of the body. Our Department Chairman was a tremendous teacher and someone we all respected very much. He was strict but fair and, although he demanded the best, it was in a way that encouraged you to do it. Lectures went on for hours at a time and then it was off to the lab to see everything as it appeared under the eyes of our microscopes. Although it was a subject that demanded attention to details, it was more related to actually being a physician. We were finding out when someone got sick just what was happening to his or her body. It was fascinating to me and I loved every minute of it. Everything was starting to become more relevant to our goal of being a physician. We were learning to recognize and understand how different diseases would affect the body. Several of our instructors were actually pathologists at the hospital. They were real physicians and we were happy to be mingle amongst them. They had gone through the same things we were enduring and had made it. So it was possible there really was a light at the end of the tunnel. The main part of their job involved rendering diagnoses for biopsy specimens sent to them by surgeons from the operating room. I guess that further tweaked my interest because it involved a field of medicine related to surgery. Now, you must understand it takes a certain type of individual to peer into a microscope for most of the day. And also you have to realize that their patients are not alive. Another big part of a pathologist’s job involves doing autopsies to determine causes of death. I had struggled through the previous year with our cadaver, Nellie, but somehow assisting at autopsies of people who had recently died really got to me. My stomach did not agree with the sight of swollen bodies of drowning victims, also known as “floaters,” and this was especially difficult for me to deal with. However, just as with Nellie, I managed to put aside my visceral reactions of dealing with the sight of a dead person. I wanted to care for people and keep them from dying. But studying what had caused people to die was still an important part of our education. Many people only get to see what a pathologist does when it comes to determining a cause of death in high profile individuals like President Kennedy, Nicole Simpson, and Anna Nicole Smith to name a few. To most of us, that is sort of creepy business but important nonetheless. That is such a small part of their job, and an unfair characterization of what their specialty is all about. Well, we had some real characters as instructors and it was quite interesting dealing with their peculiar quirks, jokes, etc. Their morbid sense of humor, pun intended, was quite in line with their work. Dealing with dead people is not what most of us would characterize as an enjoyable lifestyle, but there is room for all types in this profession. Fortunately we have these people because it is an important part of medicine and we learned a great deal from them. But I quickly found out pathology was not my cup of tea. So being a pathologist was not going to be on my short list of what to do after medical school.
Second year also brought us into the study of pharmacology. It is the study of drugs, their sources and properties. Also it involves how the human body reacts to different medications. It is an exhaustive amount of material which, over our careers, would be constantly changing. New drugs would be continuously released, but we were learning the basics to which we would add as new drugs came along. For each drug we prescribed, we needed to know what it is, how it works, what the doses are, what are the contraindications to its use, what drugs may interfere with it, and what side effects it could cause. I think in all the years of my private practice it was the most common thing that patients did not understand. All drugs have potential side effects and we must always weigh the risk of the problem versus the risk of the medication. Naturally, many patients think that they will be the one in a thousand that will suffer a particular side effect. I have often heard patients explain how they will always be the one to have a problem with anything they take. Over 40 years, however, I can honestly say I have only seen a handful that have had serious side effects from a drug I prescribed. We were taught how to write a prescription and, no, we were not taught how to make it too illegible but many of us just naturally have that ability. A prescription frequently uses Latin symbols whose roots go back to the early days of medicine. They were not meant to confuse the patient so they could not understand it, as many still think. I always had pretty good handwriting and I have heard from many patients "Gee, you really write very well for a physician." Actually it came from several nuns who used to crack my knuckles with a ruler if my handwriting was not neat. My mother also was very strict about my handwriting. There is an incredible amount of knowledge to know for each drug we prescribed. The future of medicine is computer-generated prescriptions which print out legible scripts and can even be sent automatically to the pharmacy. I have one in my office today and it is designed to minimize the chance of making mistakes from not reading it properly or lessening the chance of interacting unfavorably with another prescription the patient may already be taking. Dosing errors are also decreased. Those are probably the biggest cause of errors in medicine today, so it is a welcome addition to the practice of medicine. It is physically impossible to remember all of the information but, rest assured physicians are very familiar with the common medications they use on an everyday basis. So that is what we were taught in medical school about the drugs we would use to heal our patients, but it was only the beginning and, more importantly, we learned how and where to find the information we would need to know if a drug is not in our memory bank.
I would also like to talk about the role of females in the medical profession. My class had 70 students who received their doctorate of medicine in 1970 and, out of them, only three were women. How medicine has changed over the years as now half or more are women in our medical schools. We also only had two African-Americans in my class. Back then it was probably related purely to the costs of our education, but I'm sure there was some element of racism also. Fortunately the ability and means of paying for our education much more reflects our population in general, but we still have a way to go. The women in my class were all extremely bright, but they had an uphill fight because they were at a time when they were looked upon as invading a white all male-dominated society. They had a tough road to break into and be accepted, but they did and they did it the hard way by working their, excuse me, butts off. They would go on to blend their professional lives with their private lives of being wives and mothers. I still wonder how they are able to do it, but they are the ultimate multitaskers for sure. One of the two African-Americans in my class was one of my best friends. Art also knew he was representing his race in a predominantly white profession and he did it with absolute grace, hard work and intelligence. I know he was given a hard time by some, but he never let it affect him or complain. He just let his work speak for himself and it was both loud and clear. And several of my friends were also pretty good athletes and, to blow off some steam, we formed a basketball team that traveled around to the local high schools to play about once a week. My good friend Bill, who is now a dermatologist in Toms River, and I really enjoyed getting away from the books from time to time. Only a few of the students were married, which the others thought added a little more stress to their lives. Divorces later on were common and probably a result of all the pressures we went through. There were many parties after exams and were a much-needed means of relieving tension. We had a good time but, believe me, it was nothing like the soap operas or medical TV dramas would portray. So it was not all misery, we managed to squeeze in a few moments of pleasure and we had some wonderful times together. Going through something like we did could never be done alone and friendships were needed and very much appreciated. We found ourselves in a unique situation that bonded us together like few others would, or could, even realize. That is one of the reasons I have for writing this book. I want you to know what sacrifices it takes and I want everyone who has gone through it to enjoy reliving it again along with me. Of course, many of us may not want to, but I want them to be proud of what they have accomplished, if not at least amused by some of the stories that I and they have shared.
The most difficult subject in medical school for me was Microbiology. That was the course that was feared most and for good reason. The chairman of the department was a stern looking man who had a reputation for failing students that far exceeded all the other subjects combined. We all heard the rumblings before we started his course like “ I'm praying just to get a D." Of course, the material was very difficult but he managed to make it impossible for some, like me. It is the branch of biology that deals with microorganisms and their effect on other living organisms. Again, it involved lectures and labs but the lectures were not as detailed as other subjects and much was left for the student to get on his own. We struggled with bacteria, fungi, viruses, parasites and anything else that was alive but could only be seen under the microscope. Most of us would pay any amount of money to get notes from upperclassmen. We needed all the help we could get and then some. His exams always seem to be different. The material was no harder than the other courses, but his exams always had a different form of questioning that was meant to confuse and it certainly did for me. The material itself was interesting to me, but the manner it was presented was not. From the day I met him I knew it was not going to be a pleasant experience. Maybe I had myself psyched up from the start because I had never come up against anything like that before and I was having a difficult time dealing with it. No matter how well I thought I knew the material I just could not translate it into a good score on the exams. My only consolation was that there were others who were having as difficult a time as I was, but that wasn't going to get me a passing grade. For some reason that man was allowed to fail more students year after year and no one was able to do anything about it. He was notorious with all the other professors and they just shook their heads when his name would come up. Numerous times I went for extra help from his instructors and I had the feeling that even they were not happy with his tactics. It almost seemed that he was the subject rather than the teacher, but he was not. The gift of good medical professors is how well they can pass on the required information to students. It should not be a contest of how difficult they can make the subject. I absolutely hated the whole experience. I struggled my way through and hoped the final exam would save me.
The subject of physical diagnosis was our real introduction to becoming physicians. Finally we had gotten to the point where we were dealing with real-live patients. Our first patients were waiting for us and we were very excited. What a thrill that was for the first time! We began to use the tools of our trade, namely the instruments found in the notorious black bags. As we walked around in our new white uniforms, we were making another step forward in our careers. But what a big step it was. We now looked like physicians in training from our white tunics to our white buck shoes. But learning how to be a physician was a lot harder than looking like one. Physical diagnosis was one of my best subjects and I really started to believe that medicine was for me. In it we learned how to interview and examine our patients, many of whom at first were our own classmates. We endured having them do things to us like taking our blood pressure, listening to our heart and lungs, doing a neurological exam and the final insult of a rectal exam. Our professor was a wonderful old gentleman who was the epitome of a physician. He was a dapper looking gray-haired man who was wise, kind, and had a way of making us relax which we would learn to pass along to our patients. Learning how to get a patient to relax and confide in you their innermost problems was difficult for some, but I felt it came naturally to me. The subject was not difficult at all for me. It was a pure pleasure and I was doing what I have been yearning to do for many years. Because our school was now in an interim phase between being located in Jersey City and Newark, we did a lot of traveling to different places to learn how to perform the many different types of exams that were necessary. And we had jokingly referred to it as medical school a go-go as we never knew where we were going to next. We had no home base as we constantly traveled around to different hospitals, but we loved it because we were beginning to act like real doctors. It was one of the most enjoyable parts of medical school and it made all the hard work leading up to it worthwhile. It was a bridge into the clinical years ahead and we got a small peek into what we would be doing not just for the next two years but for the rest of our lives. We began to size up some of our future instructors and many of us were beginning to form ideas of where we would fit into the different branches of medicine. It was an exciting part of our training and one which I will always treasure. But first I would have to get through Microbiology.
As final exam time rolled around for the second time, I had only one thing on my mind and that was to just pass that dreaded subject. I spent as much time studying it as I could without completely ignoring all the other subjects. But no matter how hard I tried, I never felt comfortable or confident. The day final results were posted I went around to every office to review my marks and I specifically left Microbiology for last. When I saw that I had not passed I was in complete shock. I asked myself is my dream over? What more could I have done? Why did this happen to me? Instead of believing that I had failed, I truly believed that that man had failed me. For the first time in my life I really hated someone. There were four other students in the same situation and they were equally shocked. Part of life is dealing with and learning from our failures and we were about to embark on a difficult road. At first we all thought that it was over and we would be dismissed like others who failed subjects in the first year. We were all told to report to the Dean's office to find out our fate. I was naturally last to be interviewed so I sat waiting and prayed I would not be let go. The first of my classmates came out with sort of a smile on his face and said he would have to repeat the course. Wow, would we all be so lucky? As I walked into the interview my hands were shaking so much I could hardly open the door. Inside, seated at a long table, where the professors who would decide my fate. There were three people, two of which I had come to know pretty well. The chairman of the Pathology and Physiology departments were men that I respected very much and I prepared to plead with them to stay. The other professor was the chairman of the Biochemistry department. I did not know him as well as the other two. I was told to have a seat and they each opened my file for review. The Dean and chairman of the Physiology department I had known from day one as he was the one who interviewed me when I first applied to medical school. I was literally scared to death. He began by saying that they did not understand how I had done so well in everything else but Microbiology but that they had decided to give me another chance. My heart suddenly began to beat again and I took a deep breath. I would have to take a repeat exam at the end of the summer and, if I did not pass it, I would have to repeat the whole second year. I was tremendously relieved with their decision and I thanked each one of them profusely. I told them I would make sure that they would not regret their decision. As I walked out of the room, I had tears in my eyes but a smile in my heart. All of us were given the same opportunity. I was relieved for all of them also because I knew they were good people. My dream was not over, it would be just delayed a little.
That summer was filled with anxiety as I restudied all the material again. I still felt that I knew enough to pass, but would I? I was more determined than ever and a couple of my classmates who stayed in town were kind enough to tutor me. My parents were also disappointed but, as usual, encouraged me as much as they could, but it was a battle I would have to endure myself. In addition I married my first wife that summer. In hindsight I should have known better than complicate things but the decision was made before Microbiology was over. As the summer drew to a close, I retook the exam and the results, unfortunately, were the same. The same was true of the others in my situation. Later I learned that almost no one passes one of his retests. Almost everyone who fails his course winds up repeating the second year. I didn’t know if I could stand this man for another year as my hatred grew for the subject and the professor. It was, by far, the hardest subject in medical school and I am convinced to this day that man enjoyed making it so difficult. I would have to repeat the entire second year to continue but, at least, I was being given a second chance. That was one of the most difficult times of my life and I still feel the pain and embarrassment. I remember wondering if I was just wasting my time for another year and my parents money or did I really want to do it all over again. I had very mixed emotions, but I was not a quitter so I decided to go ahead and repeat the second year. I really didn’t know what else I would have done at that point anyway. My other classmates also decided to return for another year. We developed a bond with each other like no others. When we graduated those were the first people I celebrated with besides my family because we alone knew how hard it was to continue in the face of that defeat. We were going to show that man we had what it takes and no one was going to deter our dreams.
I won't make you relive the second year again with me. I do think it ultimately was a good thing for me. It gave me a chance to really cement my knowledge in those subjects and I don't look upon it as a loss but a tremendous opportunity. It was a long year, but I was doing better on the exams in Microbiology and I was feeling more confident as the year went along. I think the extra time I had in Physical Diagnosis was also a big plus for me. That course on the basics of interviewing a patient and how to do a physical examination would stand me in good stead for the years to come. I made friends with my new classmates, but I missed those in my original class. I kept up with most of them but, no doubt, it was not the same. It especially hurt when they graduated and I was not with them. During that year I moved from Jersey City to Elizabeth to be closer to the school. The entire medical school was now located in Newark. We had gone from the giant medical center in Jersey City to trailers across the street from Newark City hospital. It was also a difficult time for all our professors, but they and the administration worked very hard to build the new institution into what it finally is today, the Medical and Dental School of New Jersey. I was part of that building process and I am very proud of it. I want to thank all of them for their hard work and dedication. They truly saved our school. Without their hard work, New Jersey would not have the caliber of physicians it has today. In fact, New Jersey would probably be experiencing a physician shortage as most of our graduates remain in the state to practice medicine. Many of my current colleagues are also graduates of the school. Well, I struggled through the year and, in the end, I finally passed Microbiology. I can't begin to explain what a relief it was for myself and for my family. So now it’s off to what is known as the clinical years. The difficult basic sciences were over. We now had the tools necessary to be molded into physicians but, make no mistake, there was still a lot of hard work to go.
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