As you may know, I took the stage at a bookstore with two Park High friends and classmates: Mary Dunnewold and Wendy Webb. I presented my novel “Fergus Falls,” and they presented their work. Mary’s book, “Fine, Thanks: Stories from the Cancerland Jungle” is an inspiring memoir of her ordeal with breast cancer, and she has inspired me to share my story concerning the same disease. That story is part of my experience in medical school, and is a difficult tale to tell. (Are any cancer stories easy?) So read on if you dare.
Spring, 1988, I was struggling through a three-month rotation on surgery wards. The struggles worsened from one week to the next. The first month was at a local private hospital, where medical students were something of a rarity and the atmosphere for them a little relaxed. One of the attending physicians liked to talk and I enjoyed listening, so we got along quite well. The second month was vascular surgery at the veterans’ hospital, where the patients were old soldiers losing their legs to diabetes. In the 1980s, horror movies were being filmed at veterans’ hospitals. The buildings were aging, run-down, and unpleasant, and thank goodness the government has replaced them.
Then came the third month, which brought me back to the university hospital. Half the patients were middle-aged women with breast cancer in various stages. In hindsight, the disease seemed to expose all my weaknesses as a prospective doctor. My only strength—and as only-strengths go, it wasn’t a bad one to have—was connecting with the patients on a personal level. I sailed through pediatrics because it was so enjoyable to hang with the kids and cheer them up as well as I could. However, with women facing breast cancer, none of my go-to tricks and foibles were of any benefit to anyone, including me. The result was that I was a lost soul on those wards—nothing to offer, no knowledge to share or advice to give or jokes to make—I felt even more useless and inept than usual. And God forbid I should examine these patients. I don’t think I ever did.
If you know me from my life either before or after medical school, you might find it odd that I claim my strength to be interpersonal relationships. In high school, I was (ahem), “Joe Berman”, a name brand, a straight-A student and academic stalwart. That continued at Stanford University, although cracks were beginning to show.
To prove my worth to admissions committees and to myself, I studied like a mad fiend for the MCAT (Medical College Admissions Test). I wound up with the highest scores that anyone had ever seen.
That test proved the last time I excelled academically at anything.
From the first month in med school and onward, I struggled with even the simplest tasks of being a student. Reading the textbooks was a huge challenge. Compared to anything in college, those books had smaller fonts, longer paragraphs, words that were less comprehensible. Above all, none of it made any sense, and my concentration kept on waning. In my previous life I had made my mark as a master of equations, as well as explaining anything that could be explained by equations. But medicine was about memorization, an overwhelming jumble of factoids, many of them in Latin, and all of them (it would appear) equally important.
Eventually did come the math and equations—respiratory capacity and coronary output, kidney function and the clearing of drugs and toxins—but I was pretty lost with that stuff, too.
“This is not,” as I explained to my mother, repeatedly, “how I am used to thinking.”
For two years, I managed the curriculum. I got through it, my standing was above water. But my shit, as it were, was a lot cooler than I hoped or expected it to be.
One way to look at the experience was that medical school was speaking to me. Quietly at first, then gradually louder and more insistently, until the message was so loud and obvious that even I could recognize it. The message was very simple, and always the same.
“Get out. You do not belong here. Get out now!”
Such analysis, however, dishonors the actual people who represented the actual medical school and who spoke to me kindly with much help and support. Many of the professors and doctors, some of the residents and interns, a few classmates who befriended me—they were wonderful people. I must single out the school counselor, Dr. Owens, who remains the singularly most wise and insightful listener to whom I ever poured my heart out. She offered support and advice of which I remind myself to this day.
They all understood, to various degrees, what I was going through. Wrestling with medical school is nothing new. You are not alone. Keep doing your best and don’t expect perfection. You need a little success under your belt, which will help you gain confidence.
The medical school people even supported me during my darkest moment as a student, which occurred during that third month of surgery rotation. The patient did not die, she was more inconvenienced than harmed, but that was the best one could say about the outcome. The event is now 35 years in the past, and it still surprises me with sweat and shudders when I think of it, and I cannot bring myself to codify the details. BUT EVEN AFTER SCREWING UP SO ROYALLY, everyone from the attending surgeons to the junior interns offered me nothing but support and encouragement. We all make mistakes, we learn from them, we go on. It happens in every hospital.
Even Dr. Twirling Scissors, a surgical resident, was forgiving. He gave me one quick talking-to and then never brought up the incident again. I should mention that none of us liked Dr. Scissors. Imagine the stereotypical obnoxious surgeon, a commanding and capable actor in the operating room and one obnoxious prick outside of it. He was that guy. Or so I analyzed at the time. He may or may not have been so bad.
So here we are at the breast cancer story.
I proved terrible at remembering the information I was supposed to remember, like the names of drugs and the connections of the splanchnic nerve, but to this day I remember the names of certain patients, such as Vicky O. I could tell you the last name, which still means something to me, but conceivably she’s out there in the world and might not appreciate her inclusion in my memoirs.
Vicky O. was about 40, she was a mom and a professional, she spoke with a language and cadence that suggested a good college education. She was admitted to the hospital quite convinced that her breast tumors had returned, which sure enough, they had. She had undergone a lumpectomy before, and needed a mastectomy now, and was facing the event with a stoic resignation that struck me, then as now, as my own response to Things That One Must Do.
And she was my patient. Which meant that I was the medical student assigned to her case, which meant that….well, if I ever knew what that actually meant, I have forgotten so now. What does it mean for a scared, depressed, struggling medical student to be assigned to a scared, depressed, struggling sufferer of breast cancer?
So I approached the room where Vicky O was lying on a table. She was alone, she was bare from the waist up, and she was crying quietly to herself. I looked at her for a moment, and I did the only thing that made any sense to me at the time, which was to inch out of the room and go away.
I should have kept going away. I should have returned to my awful little apartment, packed my belongings into the yellow Datsun, and headed back to my mother’s house, where I could hide indefinitely in a dark room. But no, I kept at. Not for much longer—my last day as a medical student would come a month or so later. But I should have left that day.
The July 4th recess marked the end of my three months of surgery. Driving back home on the freeway, I think I recognized that I had undergone a transformative experience. I had begun it as a borderline-competent medical student, no great shakes but functional, someone who conceivably could come shining through at the end. Three months later, I had emerged as a hot twisted mess.
I was hoping the long weekend would prove a useful respite from my troubles. Instead, it was the beginning of their acceleration. Which is another story.
Fast forward to present times, and to my novel, “Fergus Falls.” I wrote it long after my medical school years, but the echoes still wormed their way into the narrative. All of the echoes came from those months of surgery. One of the vascular patients was an endearing old Italian with either no legs or on his way to no legs, he had a thick accent and a doting daughter who brought us a cake with spoiled frosting that made us all throw up. I renamed and recast him as Francis Mingalone, the bombastic mayor.
Dr. Scissors is in the story, too. See if you can find him!
I do not know how to end this little essay. I’m writing from my office on the second floor of our house in Massachusetts. My teenager is in Boston for the day with his friends from school. The five-year old is downstairs with his mom and the dog. The dog is 17 years old and not well at all, and this likely is his last week. It shall be a sad good-bye, but we will feel grateful for the dog and remember him, and we will move on.