CLIMBING THE MOUNTAIN OF MEDICAL SCHOOL (AND FINDING IT IS JUST SNOW AND ICE)

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"I'll tell you what it's like to be No. 1. I compare it to climbing Mount Everest. It's very difficult. Lives are lost along the way. You struggle and you struggle and finally you get up there. And guess what there is once you get up there? Snow and ice." — David Merrick

Every year, thousands of undergraduates who have worked extremely hard during college apply to medical school. It is a highly selective process and only the top students are accepted. While admission to medical school is the first step to a successful career as a physician, once students begin their studies, they immediately find themselves at the bottom of the rigid medical hierarchy. As such, they are subject to the whole host of indignities that the medical education system can inflict. It is a tough road, even for those of the strongest character. One of the favorite pastimes of residents in training and attending physicians alike is to harass and intimidate those on the lowest rungs of the ladder, and of course that is medical students.

Surgeons are particularly fond of abusing students, especially in the operating room. It is extremely uncommon for the students to talk back, because there is just not much percentage in it. To illustrate why, there is a story of my classmate from the East Coast with a New York attitude. He was once assisting a general surgeon who was performing a gallbladder removal in the days before laparoscopic surgery rendered a bunch of surgical assistants unnecessary. A student's role in the operation is minor, since he or she doesn't have enough experience to do anything important. Generally, it means holding retractors during the operation to give the surgeon better vision of the operative field while he identifies the organs. In this case, my classmate had to hold a large retractor pulling back the liver that covered the gallbladder. This job requires holding and tugging for a long time. It is boring, and your arms get tired. But the medical student must not let go of that retractor while the surgeon is identifying and removing the gallbladder. And in most cases, the student has to remain absolutely quiet. Speak only if spoken to.

That day, the surgeon was taking a long time and the student was getting fatigued and frustrated. His surgical mask covered his face, but beads of sweat collected on his forehead. Suddenly, the frustration boiled over and he broke the unwritten rule. He asked the surgeon, "Well, how are we doing?"

The surgeon, and everyone else in the room, looked up. They were stunned. A medical student talking — and not just talking, but talking with impertinence.

The surgeon, taken aback momentarily, regained his composure and continued operating. But he was not about to let the transgression pass unnoticed.

He shot back to the student, "What do you mean we?"

That was a clear signal for the student to shut up immediately. Perhaps it was his New York attitude, but the student ignored the cue and fired back with thinly veiled sarcasm, "I like to think I'm as much a part of the health care team as anyone."

The surgeon, now fully engaged, had never encountered such braggadocio from a medical student, and he was prepared to enjoy the back-and-forth.

Now he taunted the student, "Part of the health care team? You? You must be kidding. You are nothing. We could get a monkey to do what you are doing. You are nothing."

The battle was on. No longer feeling subservient, the student challenged the surgeon. "Oh yeah? I'm nothing? I'll bet if I let go of this retractor, you would have trouble finishing the operation." He made a point not to let go of the retractor, though.

The operating room was silent. The surgeon then decided it was time to pull rank.

"I'll bet if you let go of that retractor, you'd have trouble graduating."

Point, set, match.

A couple of days later in the surgical locker room, the student told me he just lost his head in the heat of the moment. I asked him if the surgeon retaliated in any way. No, he said, the surgeon actually liked him and didn't hold it against him. The student survived the battle, graduated, and became a successful physician in Manhattan. But not every surgeon would have been so gracious.

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When I became an attending physician, it was not my style to harass or bully the medical students. I tried to help or encourage them whenever possible, figuring they were having enough trouble without grief from me. Once a student of mine, an especially earnest one, wanted to impress me. So I gave him a difficult assignment: to draw blood from a hardened gang member. It was challenging because we needed to draw from an artery to test the oxygen level in the patient's blood, which a routine blood draw from a vein does not provide. It was a test of the student's skill.

The assignment was to draw blood at the patient's wrist, from the artery where you take your pulse. The artery is close to the bone, so if the needle misses the artery and hits the bone, it can be quite painful. And it's not a good idea to inflict unnecessary pain on a gang member, especially when you are a student. He went to draw the blood from the patient's artery, and it took fifteen long minutes. It must have been agony for the patient — and a different type of agony for the student. When the fifteen minutes were over, he had a sample from the patient, but unfortunately he had missed the artery and the blood sample was from the nearby vein, useless for the information we needed.

The student was disconsolate. Unaccustomed to failure in his academic career, he came to me knowing that he had failed and was worried that he had let me down. Besides that, we still...