September 1974. I was a third year medical student at NYU. My newlywed husband and I lived in a single room in the medical student dormitory. Fortunately, third year students received night calls, so on those nights my husband had the single trundle bed all to himself.
While family medicine and emergency medicine existed as defined specialties at that time, our medical school did not recognize them. Seven years later, as chief resident, I ran into Bellevue's first trained ER doctor (he was reading the EKG monitor and trying to interpret the rhythm of a patient with an open chest), and I yelled, ” My heart is in my hands, I tell you it’s fibrillating!” with some profanity in it) – but that’s another story, for another day. Our third year internships therefore concerned internal medicine, surgery, pediatrics, OB-GYN and psychiatry. We were the last class to train in “old” Bellevue; By the time we became fourth-year students, everything except psychology had moved into a brand new building.
At the start of my third year, I knew I wanted to become an internist. They were cool kids, 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 back on the ground. So I'll be really skilled when I get to internal medicine.
Joining a surgical team at Bellevue Hospital was like flying a glider into a hurricane. I was assigned to the trauma unit. Our chief resident hung around in the emergency room, waiting for trauma to occur. When he arrived, he took action. A page played over the hospital loudspeakers: “Trauma team, 4344 stat, 4344 stat! You didn't actually call extension 4344, which was the emergency room; you just ran there – hoping you weren’t the first to arrive. The team gathered around the patient, blood flowed in all directions and they left for the operating room. The patient either returned to the recovery room or did not return – by which time we had moved on to the next room. Morning rounds took us to the peaked roofs of old Bellevue as the sun rose over the East River.
My next internship was internal medicine. I remember our first day on tour – we started with a four-bed room occupied by three patients – a woman deeply jaundiced from terminal hepatitis (no treatment available), a rigid with Parkinson's disease ( no treatment available) and a Hispanic woman covered in metastatic squamous cell carcinoma nodules (primary unknown) 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 argued over who should be admitted at 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 talk about it! I passed, just barely.
Pediatrics? Well, I did that rotation at University Hospital (with a few weeks at a community hospital in Queens). NYU was (still is) a center for really unfortunate kids with Riley-Day syndrome (familial dysautonomia), as well as cystic fibrosis. In my memory, half of the children hospitalized suffered from Riley-Day and the other half from cystic fibrosis. They were deeply miserable and almost nothing could be done for them. We all wore white coats and they cried when they saw us arrive. The community hospital rotation was supposed to show us what pediatrics is really like. All I remember is seeing residents doing LPs on screaming infants with sepsis. I ran away.
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 elective in Spanish. The Aguadilla General Hospital had about 80 beds and I had carte blanche – along with another student. In the evening we went to the obstetrics department and said: “Tiene partos? (Do you have childbirth?), and sometimes join a more natural childbirth. But in New York, delivery tables were equipped with leather restraints. Not for me.
Psychiatry? I especially remember the dark underground tunnel connecting the usual part of the hospital with the psychiatric hospital, damp, dripping and (supposedly) home to feral cats. During my internship in psychology, I learned not to be afraid to ask anything from a patient, with good preparation. Thorazine was the only medication I remember. The biological bases of psychiatric illnesses were only just being developed. Cross another one off the list.
At the end of the third year, I evaluated my situation. By then we had moved into a one bedroom apartment. We slept in a double bed that had been abandoned by my in-laws. What luxury! I got an A in surgery and Bs in everything else. When a similar pattern appeared in my USMLE test scores, I took it as a sign from the gods, whatever the gods are. I had surgery and never looked back.
Carol Scott Conner is a surgeon.