I began my fourth and final year with great excitement but also a little trepidation. I was determined to make the most of it. I had a sense of urgency that if I did not learn as much as possible I would somehow bring those deficiencies along with me through my career. I struggled to fill in as many of the gaps in my knowledge as I could. Once again we studied individual diseases but in much more detail. All of our prior lessons were beginning to gel into why they were so important. They were no longer individual pieces of information. They were now part of the integrated database we would call on to care for our future patients.
I am not going to go through all the specialties one by one again. Instead I want you to experience how I felt as that important training period was coming to a close. It would not be the end by any means because my education continues to this very day. I was accepting the fact that a physician’s education is really never over. New advances in medicine take place every day, but we were solidifying the foundation to which we would be able to add to in the future. The framework had been established to enable me to move on to the next step. We delved into each specialty in more detail and were given more responsibility in patient care which was becoming so satisfying. More and more of us were selecting which specialty or branch of medicine we would go into. That is what I remember best about our final year. It was time to make decisions that would affect the rest of our lives. Did I want to be a teacher, a researcher, or do I want to care for patients? Did I want to be a general practitioner or a specialist? Where did I want to go for internship and residency or, better yet, who will take me? Those were tremendously important decisions and were not taken lightly. But slowly over the year I began to formulate a plan as I launched my professional career. All of the people and experiences I had been exposed to over the years were now helping me to formulate those decisions. Was I making the right decision and more importantly would I be happy? And lastly, would I be capable of living up to whatever branch of medicine I chose. I watched as my classmates also wrestled with those decisions. I was surprised by some and others I knew they were doing the right thing for themselves. I saw in them the professors, the heart surgeons, and the general practitioners of the future. We had come so far from that first day of medical school and, yet, we still had such a long way to go, but we were about to close a big chapter in our training and it felt so good. No longer would I mumble under my breath when someone addressed me as doctor," yeah sure." We had earned the title through the long hard hours, days and years we had endured. The studying, the sleepless nights, the " gentle" prodding by our professors, the constant examinations, living with my first failure, the years of doubt were about to come to an end Thank God. But yet, in a way, it was a little sad to be leaving the security we enjoyed while still being a student. To this point no one’s actual life depended on us. It was also sad to leave behind all the wonderful people who had contributed so much to our education. And then there were some people, only a few, we would be thankful to never see again. What emotions we were going through. The sense of accomplishment was tremendous and it was a time in my life I will always treasure.
As the year began to come to a close, we prepared for the second part of the National Board of Medical Exams. One more exam to take before we went out the door. But that would give us the ticket we needed to get our licenses to practice medicine in whatever state we chose. There was no way to study for that exam because, if you hadn’t acquired the basic knowledge by then, it was time to finally put an application in to bus drivers’ school. We also began to think about where we would ultimately decide to live and practice. Decisions, decisions, boy it was beginning to look like being a student wasn't such a bad thing after all. We also had to deal with the matching program for internships. Where would we go and, more importantly, who would take us and how were we ever going to live on what they were going to pay us? The stark reality of what an intern was going to make really hit us. How was I, even in those days, going to live on $7,500 a year? Everyone had always told me that doctors make a lot of money. Well, that might be so, but it sure doesn't happen right away. So I hope that mom and dad wouldn't plan on retiring just yet.
Choosing an internship program was based upon our class ranking, what institution we were interested in and, ultimately, who would be interested in us. We had to list, in order of preference, where we wanted to go and hope that they would select us. In a way, it was like applying to medical school all over again. Many decided they were going to stay at our medical school because they were comfortable there. Others went for the high-price institutions like Johns Hopkins, Columbia, or Mass General. Others decided which one based on where they wanted to live. It was one more decision we thought we were going to make and yet someone else was making it for us. As for me, I had decided I had had enough of the big medical centers for a while and I wanted to go to a community hospital to see what went on in the real world. So I selected St. Elizabeth's Hospital in Elizabeth, New Jersey as my number one. I had spent a lot of time there on different rotations in med school and met a lot of doctors who really inspired me. When the list came out, I was very excited to find out that I had actually got what I had chosen. For a change I had made the decision of where my career was going next. So my next year was set but, first, it was time to celebrate.
The last week before graduation was filled with fulfilling our final rotation obligations and planning to celebrate our great accomplishment. My last rotation was on the medical service and ended with one of the strangest nights I have ever had on call. I received a call from the emergency department that they were planning on admitting a patient with asthma and I was to be the admitting student. I had hoped it was going to be a quiet night, but it was to be anything but. As I went towards the elevator to see my patient, I heard screaming coming from it. As the door opened, the nurse accompanying the patient was screaming for help as she performed CPR on the patient. I ran to help her and she explained that he had stopped breathing on the way up to the floor. Before long we were joined by the rest of my team as residents and interns fought to save our patient in a full-blown code. That is the designation for a medical emergency that is used to summon a response team in a hospital to deal with a life-threatening situation. None of us knew the patient who appeared to be a male in his early 20s. Unfortunately the team was unable to save him and, after several attempts at trying to shock his heart into beating again, the most senior resident said to stop, that “he was gone”. What an end to my medical school training! Besides Christine's death that was the only other time I had actually seen a person die. I couldn't believe that was the way I would depart medical school. Although I did not have a chance to become familiar with that patient I felt a sense of loss again like with Christine. I had trouble understanding why that happened and why we could not help that young person. Unfortunately it is all part of our training but, as I would see as my career progressed, it was something that we all had to accept but would never get used to. We could not help everyone and I was learning the hard cold fact that death was an inevitable reality of life. Each time we would become a little more hardened to it but, believe me, every time a doctor loses a patient it takes a toll. So here I was getting ready to celebrate the end of my long ordeal and that had to happen on the very last day. Little did I know that another event that night would help me forget the deep sadness I felt.
Later that night I was involved with another patient who had a case of pneumonia and was rapidly worsening. The intern who I was working with told me to arrange for a portable chest x-ray to be done to evaluate his condition further. I don't remember the floor we were on except that it was one of the higher ones in the building. The intern went back to bed and instructed me to call him when the x-ray was done so we could review the films together. I entered the order in the chart and brought it to the nursing station where it was noted and someone from the x-ray department would be summoned. The nurse looked at me kind of funny like she knew something I didn't, but she didn't say a word. I then went to the doctor's lounge after I had asked the nurse to call me when the x-ray was done. A little while later, I heard a commotion in the hall outside the lounge. As I opened the door a large man was running towards me screaming "where is that so and so who ordered a chest x-ray at 3 AM?" I could not believe what was going on, but I was convinced the guy intended to physically hurt me so I immediately took off down the hallway heading for the stairwell to go up to the next floor where the intern was sleeping. I was pursued by the crazy person who was now screaming four letter words at me and that he was going to teach me a lesson. I wasn't sure what that meant but, when I saw the knife in his hand, I knew it was not some prank my classmates had arranged for my last night on call. I couldn't understand why ordering a chest x-ray even in the middle of the night would provoke this person to attack me. I decided there was no time to wake the intern up, so I ran as fast as I could for the stairwell at the other end of the hall and ran down several flights of stairs until I got to the ground floor and exited into the parking lot to where my car was located. As I got into my car, I looked back and, fortunately, I could see that the maniac was nowhere in sight. I could not believe that was to be the way that my medical school career was going to end, but I knew I was not going back in the hospital at least not that night. I really felt that, not only was medical school over for me, I had narrowly missed ending my entire life. So I returned to my home and called the intern and explained what had happened. I told him I was sorry to have left, but I was very scared that if he had caught me I'm sure he was going to seriously hurt me. My track background saved me and I can honestly report that my body has never traveled that fast again. He said don't worry, everything was okay and that he would report what had happened to the security personnel. The next day the security people asked me to supply an incident report which I did. I never heard anything else about the incident but it sure was a crazy ending to my last night on call. So my formal days of medical school were over and and it was time to party and party we did. Almost every night was another celebration and, by the end of the week, I was beginning to think that my liver looked like some of the autopsies I had seen of alcoholic patients. We ended the week with what had become a tradition called Skit Night where our professors were invited to be roasted. I was to have a prime role in it as Carnac the Magnificent of Johnny Carson fame. His routine involved receiving an envelope from his partner Ed McMahon containing a question that corresponded to an answer Ed gave to him. One of my classmates played Ed McMahon to a T and we proceeded to do a job on our school, our professors, interns and residents and anyone else we had come across in our training. I managed to get in a few zingers about my Microbiology professor that gave me great satisfaction. One example was; answer - cruel and heartless, question - what qualities does it take to be chairman of the Microbiology Department? As I looked at the target of my jokes, I could see he was not laughing but I couldn’t have cared less. The entire class and myself were laughing hysterically. Finally that man could do nothing else to ruin my life. Paybacks are you know what! It was a terrific night and I don't think I have ever laughed as much in my life again as I did that night.
So we had reached the big event, the day of our graduation. The ceremony was held at the Garden State Arts Center. I remember that day very well as it began with a rather torrential downpour from a thunderstorm. But nothing was going to take away from the satisfaction and pride that we were about to enjoy. My parents met me before the ceremony and I could tell they were just thrilled to death. Without them, I could not have made it to that special day. Many dignitaries were present, including the Governor of New Jersey. His opening speech was an appeal for us to pay back to New Jersey for its role in saving the medical school. He hoped that as many of us as possible would ultimately wind up practicing in the state and that would be a fitting reward to its citizens to be cared for by the people they had supported in their education. Little did I know at the time that I would ultimately return to New Jersey to practice medicine. I would be one of those students who gave something back to our state for saving our school just a few years before. The Dean gave a speech encouraging us to the high ideals the teaching staff had tried to instill in us. My fellow classmates and I were filled with pride in our accomplishment. Individual rewards were given out to the outstanding students in different areas of study. I was given the award for the top student in Obstetrics and Gynecology. Then it was time to take the solemn Oath of Hippocrates.
The modern version is as follows. I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
What I always have remembered about this oath is that above all we are to do no harm. This is why you will see in the malpractice chapter that I found it so abhorrent for a physician to be accused of doing harm, especially me. As we stood to pledge our lives to this noble profession, I saw tears in the eyes of many of my friends and, indeed, I had to wipe away a few tears in mine also. It was so hard to comprehend that our medical school days were finally over. Then it was time to receive our diplomas which acknowledge that finally we were really Doctors of Medicine. As each one of us was called to receive it from the Dean, you could see the pride and joy in each and every one of us. The smiles on everyone's face were priceless. I did, however, for a moment think of those of us who didn't make it to that day. I hope that they found something equally rewarding to do in life. I can remember receiving my diploma with trembling hands as I then raised it in joy over my head before returning to my seat. We were finally challenged to provide the best possible care to our future patients and wished well in our further pursuit of knowledge. It was finally over but what a trip it had been full of hard work, sacrifices and yes some disappointments but, in the end a pride in the knowledge that we had achieved a tremendous accomplishment. The dream of the young man in high school had been achieved. No one could make fun of us anymore by sarcastically calling us doctor. When the ceremony was over, I joined my family and gave my parents a heartfelt hug and thank you for the opportunity they had given me. My mother presented me with a framed graduation picture of me with a newspaper clipping that she had put over it that said "today call him my son the doctor." How overjoyed she must have been to see her only son become a physician. I still have that picture and remember fondly that wonderful day. It also reminds me of the tremendous sacrifices my parents made for me. I know that was one of the most memorable days in their lives and I was proud to have been able to give them that wonderful experience. As I look back on that day, it takes on more and more special meaning for me. It has been almost 50 years to the day, but I still remember it like it was yesterday. So many times there were doubts about whether I could do it. Doubts in other people's minds and indeed in mine. There were so many little bumps in the road to overcome, but I did it and it was one of the most rewarding and fulfilling days in my life. I had accomplished something that I had worked extremely hard for and the satisfaction was immense. So all the schooling was over and I could actually begin to experience what a doctor really does which is to help others. I did pause for a minute to thank all those who had imparted all their knowledge, guidance and help to me. I was finally ready to be able to practice all the things I had so meticulously been taught. On that wonderful day my dream of becoming a doctor had finally come true. It was no longer a dream, it was real. I was finally a doctor and no one could ever, ever, take that away from me.
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