Assume the Position: Memoirs of an Obstetrician Gynecologist (7 page)

     Women were complex and interesting for me, but they certainly had minimal presence on campus from Monday to Friday.  Princeton was still an all male campus until my junior year when the university finally became coeducational and opened its doors to the better half of society.  Long held patriarchal beliefs were changing on campus, albeit slowly and with resistance from the old guard.  Weekends on campus women appeared out of nowhere like manna from heaven.  There were still ‘parietal hours’ on campus, which meant women had to be out of the dorms by midnight, kind of an arbitrary hour since if one were going to do anything  ‘illicit’ it certainly could happen before midnight.  One night during a raging dorm fire around 2AM the first 30 people who came out of the dorm were women. Although chivalry wasn’t dead on campus, it was clear that parietal hours were.   The event was captured in the Daily Princetonian on the front -page photographs.

     There were other strange ‘rules’ on campus.  Young men were required to wear coats and ties to the dining halls on Sunday evenings.  So we did.  But that was all we wore one Sunday evening.  Strictly speaking we complied with the rules. Fortunately for me there were no cameras to capture that event.   That rule, too, went by the wayside. Humor did have its place on campus.

     In those days there had been unspoken quotas at Princeton for acceptance of Jews and blacks. With only a few other Jewish students on campus we had no place to congregate in those days.  When I graduated there were 25 black students in my class of over 800 people. A point was made at our graduation ceremony to inform everyone that there were more black graduates in my graduation year than in the entire previous 225-year history of the university system.  Change was slow in those days, and has now been rectified in regards to Jews, blacks, women, and all minorities.  Princeton is now a better place with the changes in favor of gender and social equality.

    Princeton required all of its students to write a senior thesis, one of the few undergraduate institutions in the country to have this graduation requirement.  My senior thesis was entitled the “Sociological Revolution in American Medicine”, a thorough and well-researched treatise on the history of Medicine and the curriculum of medical schools that had remained unchanged over the preceding 60 years. It was my thesis that the then current standard medical school curriculum was serving the needs of current society poorly by not producing the kinds of physicians that were needed to make these societal changes necessary to improve our less than stellar national health care statistics.   Compared to other highly industrialized societies, by almost any criteria one viewed, our healthcare statistics were poor. I proposed changes in medical education so that our country could begin to improve its health care delivery system, produce more primary care community minded physicians and emphasize less the need for basic science researchers.

     I had a thesis advisor assigned to me in the Sociology department whom I had met only once during the yearlong writing of this tome. I had two campus jobs, four tough upper level courses each semester, each course with extensive reading lists, examinations, small precepts or classes with the professors, papers to write, and sociology departmental oral examinations for which to prepare.   I just didn’t have the time for more interaction with my thesis advisor. I knew the deadlines and the requirements of how to have it bound and when to have it submitted.  I wasn’t interested in his critique and ideas anyhow, a poor decision on my part, but from the eyes of a 22 year old stressed to the academic maximum and overwhelmed, at the time it seemed logical to me.  About three weeks before the thesis was due I got a call from my Dad.  The Dean of the College had just notified him that I was likely not going to graduate with my class since I had not been working on my thesis and had not been in contact with my advisor, as far as they knew.  It seems like it would have been easier to get in touch with me first, but then I was in the bowels of the library for months on end, so no one knew where I was anyhow. Then again I also should have been in touch with my advisor.  I turned the bound thesis in on time and received a one-letter comment from my advisor on a 12-month project, one hundred plus page paper with over 100 references.  “A”.  Not a single other word.  I deserved both the grade, and the lack of discussion.  No wonder then, that all through my years of medical school I would have a recurring nightmare that I had never graduated from Princeton, only to convince myself upon awakening that since I was already in medical school it really didn’t matter.

    When I graduated from Princeton, my proud parents were in attendance. Both sons had graduated from Princeton, and my brother was now at Harvard Law School. My medical school applications to what were considered top schools all over the country were still pending.  Ultimately I received rejection notices from every school with the exception of one which put me on a wait list, and ultimately I was rejected from there as well when no openings occurred by the start of the academic year.  The common theme was that they weren’t sure I could handle the science load.   I only had the bare minimum college sciences and majored in Sociology and Science in Human Affairs, the very things I had effectively argued for in my thesis that I perceived were needed for the future of medicine in this country.  It was a blow to my ego, and a very unsettling and emotional time.  All the hard work and dreams I had for myself, and my core beliefs about medical training and medicine as a career for me, were being tested. It was the first time in my life I had doors shut in my face, and it was not a good feeling.  I needed to regroup, and figure out a plan.

     Dejected, I spent the summer in Philadelphia living with my girlfriend of several years.  I worked at a day camp for rich kids from ‘Main Line Philadelphia’, as the rail system was known that snaked through the upper crust suburbs of Philadelphia.  I was the Nature Man at day camp.  I had fun with the kids for a few months and developed a life long love for peanut butter and jelly sandwiches, and the outdoors.  We hiked, fished, boated, played games – in general, a great way to decompress before tackling life again.  After a restful summer with the kids, I found a job selling insurance and worked as a room service waiter in the evenings and weekends at the Marriott Hotel Philadelphia to supplement my meager funds. My parents, from a different generation, did not approve of my living arrangements with my girlfriend, so I financed my own life at this point.  They had paid for my time at Princeton, for which I was forever grateful, but I had jobs all four years while on campus because I could not ask them to finance my social life, nor did I feel like explaining to them what it was like since I knew they would not approve. Besides, I was motivated to be on my own and was exploring life as I saw fit. Not to mention the great fried shrimp they served at the Marriott restaurant, and the loads of athletes and celebrities I served in their rooms from Maury Wills of the Dodgers, to Stevie Wonder on the keyboard, and Joe Frasier shadowboxing in the mirror while I served him.

    In the fall I enrolled as an undeclared major in the graduate school at Villanova University in suburban Philadelphia, by enrolling in one graduate level course in Biochemical Genetics, which although not easy I seemed to master quite well.  If the medical schools weren’t sure I could do well in advanced sciences because I majored in sociology, I would show them otherwise.  This time I was more thoughtful and applied to every school in Pennsylvania, my home state, rather than all across the country.  I was called in to Hahnemann Medical School in downtown Philadelphia for an early interview.

(Hahnemann Medical College and Hospital, now Drexel University School of Medicine.)

As luck would have it the professor from the admissions committee randomly chosen to interview me was a biochemical geneticist.  After some brief background discussion he asked me to explain to him the difference between DNA and RNA, the intracellular basis of all biochemical genetics that makes us each unique.  Fresh off my final exam in biochemical genetics, I couldn’t have been better prepared. The acceptance came a few weeks later.  It was an exciting time.  I felt like my persistence, hard work, and commitment to a lifelong dream had been met.   I withdrew all other applications in deference to those who might have been kept on a waiting list as I once was. I could ‘feel’ for those who might have been in the same position as I was less than one year earlier   I was going to be a doctor and would spend the next 8 years of my life in City of Brotherly love.

     Hahnemann Medical College and Hospital, as it was then known, now known as Drexel University Medical School, was located on Broad and Vine streets in downtown Center City Philadelphia.  It had a very strong clinical reputation, a 150 year history, and an excellent basic medical science and clinical medicine faculty. I was one of an unusual class of young and old, men and women, from all walks of life, including a nun, engineers, basic scientists, even one of our PH.D faculty members in Physiology going back to get his MD degree.  My first year was immersion in all the basic medical sciences; anatomy, histology, physiology, pathology, pharmacology, biochemistry, genetics.  The second year we were immediately thrown into the clinical aspects of medicine on the wards of the hospital where the underprivileged and uninsured were cared for in row after row of beds in long hospital wards.   We assisted surgeons at surgeries, learned how to remain sterile when entering an operating room and how to take a medical history and perform a physical exam. Night call in the hospital was mandatory.  We performed “scut” work at night, which meant starting IV’s, putting in catheters, drawing blood and performing arterial sticks for blood gases. 

     During my subsequent clinical rotations through the medical specialties, I was most interested in Obstetrics and Gynecology and Psychiatry.  I had done two clinical rotations in OB GYN, one at Reading Hospital in Reading, Pennsylvania, an affiliate of Hahnemann Hospital; the other at King’s County Hospital, the county seat of Brooklyn, New York.  This hospital was what was affectionately called a zoo.  Babies were born in the hallways, in the elevators, all over the place and for some strange reason usually in silence.  It was a cultural thing for these women many of whom were Haitian.  But what a great six weeks I had. I was hooked. This was for me.  Although I enjoyed immensely the intellectual challenge of psychiatry, for me it was too passive.  I needed movement and activity, surgery, constant active challenges.  I needed to work with my hands and fingers and move with my feet. OB GYN was all of this and more.

     OB-GYN patients were for the most part young and otherwise healthy and happy.  The outcomes were usually good, or at least expected to be, and not depressing as much of medicine can be. The specialty had wide variety including reproductive medicine, obstetrics, infertility, gynecology and gynecologic surgery, office care, oncology, endocrinology, contraception, and counseling.  The physician was placed in the middle of people’s lives. It was an exciting, emotional, and interesting time and place to be.

     Aside from medicine my personal life was full, interesting, and challenging.  I was on hold with long-term personal relationships at this point in my life. I simply did not have the time for a commitment to anyone other than medicine.  One-night stands were preferable because they required no commitment from me, admittedly not a good way to enter any relationship with a date.   It was the era pre HIV-AIDS, and after the introduction of birth control pills. Let’s just say that Hahnemann Hospital in those days was much like the well-known soap opera  ‘Peyton Place’. Venereal disease was spreading through the medical staff, from the Chief of the Cardiac ICU, to the cardiology nursing staff, to the residents, and worked its way down to the medical students.  It had no respect for the length or starch content of one’s white medical coat, prestige, or stature.  Gonorrhea was endemic in Philadelphia at the time. Hospitals and their medical personnel were certainly not immune, although I managed somehow to dodge the bullet.

     The year of my medical school graduation, the 1976 Olympics saw Franz Klammer and his epic downhill ski race win him a gold medal at the Innsbruck Olympics.  I watched this event live on TV.  Little did I know I would have occasion to meet him later in life.   To watch him go up against Mother Nature like that was most impressionable at that point in my life.  Literally on the edge, seemingly in control and out of control at the same time was often the same thrill and feeling I had in my chosen profession, and often on a daily basis.  The trick was learning how to master it and when to bail out!