September 1974. I was a third-year medical student at NYU. My husband and I, newlyweds, lived in a single room in the med student dorm. Fortunately, third-year students took night calls, so on those nights, my husband had the single pull-out bed all to himself.
If family medicine and emergency medicine existed as defined specialties at that time, our med school didn’t acknowledge them. Seven years later, as a chief resident, I would butt horns with the first EM-trained attending in the Bellevue ER (he was reading the EKG monitor and trying to interpret the rhythm of a patient with an open chest, and I was yelling, “I’ve got the heart in my hands, I’m telling you it’s fibrillating!” with some profanity laced in) – but that’s another story, for another day. So our third-year clerkships consisted of internal medicine, surgery, pediatrics, OB-GYN, and psychiatry. We were the last class to train in the “old” Bellevue; by the time we became fourth-year students, everything but psych had moved into a brand-new building.
Going into my third year, I knew I wanted to be an internist. They were the cool kids, the smart kids, and renowned diagnosticians. Everyone knew surgeons were just animals. I started my third year with surgery because it didn’t matter, and I could get my feet on the ground. So I’d be really slick when I got to internal medicine.
Joining a surgical team at Bellevue Hospital was like flying a glider into a hurricane. I was assigned to the trauma service. Our chief resident hung out in the ER, waiting for a trauma to come in. When one arrived, he sprang into action. A page went out over the loudspeakers throughout the hospital, “Trauma Team, 4344 stat, 4344 stat!” You didn’t actually call extension 4344, which was the ER; you just ran there – hoping you weren’t the first one to arrive. The team swarmed around the patient, blood flew in every direction, and they went off to the OR. The patient either came back to the recovery room or didn’t – by that time, we were on to the next. Morning rounds took us across the peaked roofs of the old Bellevue while the sun rose over the East River.
My next rotation was internal medicine. I remember our first day of rounds – we began with a four-bedded room occupied by three patients – a woman deeply jaundiced due to end-stage hepatitis (no treatment available), one rigid with Parkinson’s disease (no treatment available), and a Hispanic woman covered with nodules of squamous cell carcinoma (unknown primary) metastatic to her skin (no treatment available). A single bare light bulb hung from the high ceiling, and the windows were densely covered with soot. Residents squabbled over who was due for the next admission: “You are! Not me, you!!!” At 3 a.m., our resident said, “Let’s talk about congestive heart failure,” and I said, “Let’s not!” I passed, barely.
Pediatrics? Well, I did that rotation at the University Hospital (with a couple of weeks at a community hospital in Queens). NYU was (still is) a center for truly unfortunate children with Riley-Day syndrome (familial dysautonomia), as well as cystic fibrosis. In my memory, half the children on the inpatient unit had Riley-Day, and the other half had cystic fibrosis. They were profoundly miserable, and virtually nothing could be done for them. We all wore white coats, and they cried when they saw us coming. The community hospital rotation was supposed to show us what pediatrics was really like. All I remember is watching residents do LPs on screaming infants with sepsis. I fled.
OB-GYN? I had spent six weeks in Puerto Rico the summer before my third year (the summer we got married, when any normal woman would have been preparing for her wedding) as part of a medical Spanish elective. Aguadilla General Hospital was an approximately 80-bed general hospital, and I had free rein – along with another student. In the evenings, we’d go to the OB ward and say, “Tiene partos?” (Do you have any deliveries?), and sometimes join a more natural kind of childbirth. But in New York, the delivery tables were fitted with leather restraints. Not for me.
Psychiatry? I mostly remember the dark underground tunnel from the regular part of the hospital to the psych hospital, dank, dripping, and (supposedly) home to feral cats. I did learn from my psych rotation not to be afraid to ask a patient anything, with proper preparation. Thorazine was the only drug I remember. The biological basis of psychiatric illness was just being developed. Cross another one off the list.
At the end of the third year, I assessed my situation. By then, we had moved into a one-bedroom apartment. We slept in a double bed that was cast off from my in-laws. Such luxury! I got an A in surgery and Bs in everything else. When a similar pattern emerged from my USMLE test scores, I took it as a sign from the gods, whatever gods there be. I went into surgery and never looked back.
Carol Scott-Conner is a surgeon.
