Intern (6 page)

My thoughts were already dominated by the towering hospital off
the highway, not by the medical school building half a block away. In my lowest moments that first year, when information was being sprayed at me as if through a fire hose, the hospital came to represent my emancipation from the classroom. My classmates embraced the curriculum, discussing it excitedly in the cafeteria or at parties on the weekends, which only deepened my sense of alienation. Their attitude seemed immature to me. I prided myself on having seen more of the world—even though it had been a rarefied sphere I had wanted to escape. In the formaldehyde-ridden anatomy lab, the humor was dark. When we were dissecting the heart, my partner took the organ, rested it precariously on our embalmed cadaver's forearm, and said, “This guy really likes to wear his heart on his sleeve.” But despite the occasional light moments and the protection from any real responsibility that the classroom afforded, I almost immediately grew impatient with the coursework. I had been a student all my life; it was all I had ever been. The lecture hall didn't present any fundamentally new challenges. The hospital, on the other hand, represented the real world, the world I had lost touch with during my years in academia. To succeed there was going to require skills I wasn't sure I even possessed: communication, observation, empathy. What if I went blank interviewing a patient? What if I broke out in nervous laughter? It seemed there were so many opportunities for disaster.

As first-year medical students, we were required to take a course called Introduction to Clinical Medicine. Once a week, we attended a desultory lecture on history-taking and physical diagnosis—where we learned, among other things, the oft-quoted clinical aphorism that about 80 percent of medical diagnoses are made (correctly) on the basis of a patient's history. Afterward, we headed off to the wards of the hospital to practice on patients. I was in a group with four other students. Our instructor was a gangly, awkwardly mannered hematology fellow in his early thirties who, like many doctors I would encounter in the coming years, was clearly ambivalent about the value of the skills he was teaching. Of course, he dutifully taught us the mechanics of medical interviewing and physical examination—palpating for lymphadenopathy,
performing a comprehensive neurological exam, and the like—and he uttered homilies about their importance. But the emphasis at our weekly sessions was on normal findings—the “soft-nontender-nondistended-abdomen-with-no-organomegaly” shorthand we would become accustomed to scribbling in patients' charts in the coming years. To the fellow, it seemed, the course was a platform for teaching a new language, not a tool of discovery. Once, in response to a question, he scoffed that it would take two days to perform the physical exam described in our textbook. Even as he taught physical diagnosis, he seemed to be dismissing it as a waste of time.

My first encounter with a patient that year did not go well. There I was in my stiff khakis and bulging white coat, standing at the bedside of an elderly man who was watching television. His gray, curly hair ended at the base of a protuberant forehead, and he had deep creases around his eyes. I asked him if he would be willing to talk with me for a few minutes. Without turning away from the TV, he readily agreed, even offering me a chair. He seemed glad for my company.

Aside from his unwillingness to look me in the eye, he was pleasant and cooperative. I glanced at my note cards detailing the “review of systems.” Any depression or anxiety? I asked. No, he replied. Any problems with hearing? “What?” he said, and I laughed politely. Any ringing in the ears? No. Any problems with smell or taste? No. Any vision problems? “What do you mean?”

“Flashing lights, double vision, that sort of thing,” I replied. “Not since I went blind,” he said. Again I laughed, but this time it was no joke. He was totally blind; I hadn't noticed.

Second year was busier than the first, with exams covering entire textbooks of material. The daily routine was stultifying: study, eat, study, eat, sleep. The tests were long and depleting; you wanted to put your heart and soul into them, but there was only so much you could do before feeling sick. In graduate school I had never learned to memorize. You could always look things up; even final exams were often open-book. But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory.

It was during second year, buried in books and still unsure about whether I even wanted to be a doctor, that I first thought seriously about quitting medical school and doing something completely different. One option I considered was becoming a reporter. Journalism had always been a passion of mine, one that my father, a news junkie, had unwittingly fostered. On Sunday mornings, the voice of David Brinkley was as familiar as my mother's urging us to come to the table for her potato
paranthas
. In middle school, my father and I would go to the UC Riverside library to read
The New York Times
or books and news-magazines on politics and foreign policy, especially nuclear arms control, which was a special interest of mine. For my thirteenth birthday, my father gave me a book of famous front pages from the
Los Angeles Times
: “Peace,” “Walk on Moon,” “Nixon Quits.” Later, we always watched
Nightline
together after the rest of the family went to bed. Though he always encouraged his children to keep up with the events of the world, my father made it clear that journalism and writing were never to be considered career options because they offered no security. “Nonscience is nonsense,” he often said.

At the end of graduate school, I had come across a flyer for a science journalism fellowship sponsored by the American Association for the Advancement of Science. On a whim, I applied, and, to my amazement, was one of 13 people selected out of a pool of about 250 applicants, all doctors and scientists with advanced graduate degrees. I was placed for the summer—the summer before starting medical school—at the Washington, D.C., bureau of
Time
magazine.

The summer at
Time
was perhaps the most exciting of my life. My first week there, I was sent to the U.S. Capitol to get a quote from Bob Dole about the working poor. He spent most of the day on the Senate floor, so my plan was to accost him when he went to the bathroom. When I got my chance, I froze, mumbling what must have been gibberish as he strode past me on the marble floor. Later that afternoon, dejected that I had failed my first journalism assignment, I ran into Dole's press secretary and asked for an interview with the senator. He was in the midst of dismissing me when the senator walked up. “This is
Sandeep Jauhar,” Dole announced. “He's working on a story about the working poor. Set up a phone interview with him tomorrow morning.” I was speechless. The next day, I got my quote. I had been promised five minutes, but Dole and I ended up talking for fifteen.

At the end of the summer, before getting a flight back to Berkeley to finish my Ph.D. thesis and pack up to drive to St. Louis, I asked Dan Goodgame, the
Time
bureau chief, for some names of journalists I could call on in the future. He mentioned a few editors he knew at reputable newspapers:
The Tampa Tribune-Times
,
The Miami Herald
, the
San Jose Mercury News
. “Yes, but what about
The New York Times
?” I said. My presumptuousness must have amused Dan, but sure enough, he had a contact there, too.

One afternoon in medical school, then, I called the office of Gerald Boyd, a senior editor at the
Times
. When his secretary answered, I introduced myself, mentioned Dan's name, said I was calling from St. Louis, and asked if I could speak with Mr. Boyd about journalism opportunities. Before I knew it, he was on the phone. I'm sure he thought I was a journalist because he started asking me about the
St. Louis Post-Dispatch
. I explained that I was not a reporter but a medical student interested in writing about science for the
Times
. He brusquely told me to set up a meeting with him the next time I came to New York.

When I got off the phone, I did what any aspiring journalist might do. I picked up the phone, dialed American Airlines, and booked a flight to New York. Then I called up Boyd's assistant and asked her to set up a meeting. “Who are you again?” she asked.

I told her that I was a medical student.

“And Mr. Boyd wants to meet with you?” she said.

In New York a few days later, I took a taxi to the newspaper's headquarters on Times Square. The security guard called up to Boyd's office, but there seemed to be some confusion about the purpose of my visit, so I waited in the lobby for half an hour before finally receiving a pass and directions to the third floor. Starry-eyed, I walked through the newsroom where the Pentagon Papers had been published, where Sydney Schanberg had written about the killing fields of the Khmer Rouge,
where James Reston and Tom Wicker had tapped out the editorials I'd read as a kid. Boyd's assistant showed me into his office and went to get him. On the walls were pictures of him with politicians and dignitaries, including an autographed photograph with a former president. I wondered if perhaps I had overreached.

When he marched in, a tall man with the build of a football player, any hopes I had had of a relaxed conversation were immediately dashed. “I have five minutes,” he barked, sitting down. “What do you want?”

“Well, sir—” I stammered, and then I went on to explain my situation.

“Show me your clips,” he said impatiently.

“Well, sir—you see, unfortunately, I don't have any clips.” I explained how at
Time
magazine interns didn't usually get the opportunity to write stories. He asked to see my reported pieces. I didn't have any of those either. But I did have some story ideas. I took out some loose-leaf sheets from my backpack.

He looked at me like I was crazy. “You can't work here!”

A wave of heat washed over my face. “Why not?”

“You're not qualified.” He said it like it was the most obvious thing in the world.

“Well, do you have any internships?”

“You're not even qualified for an internship. Our interns usually have several years of newspaper experience.”

He picked up the phone. “Tell Libby to come in here.” We sat together in awkward silence. After a couple of minutes, a small woman with curly hair and a friendly face entered. It was Elisabeth Rosenthal, a medical writer. “Libby, this is”—he had obviously forgotten my name—“a medical student who wants to be a journalist. Please talk to him.” Then he got up and left.

Libby Rosenthal and I talked for about half an hour. She told me about her own twisting career journey, going to medical school and finishing a residency in internal medicine before becoming a full-time reporter. “If you want to write for a newspaper,” she said encouragingly,
“try the one in St. Louis.” She told me to send her my clips and to keep in touch.

Back in St. Louis, I got an internship at the
Post-Dispatch
. Twice a week, when second-year classes were done, I took Highway 40 to a run-down section of downtown and parked in the paper's weed-strewn parking lot. I wrote stories about wasps, fires, and wild turkeys in Forest Park, and I mailed them to Libby. Though I learned some valuable skills, like writing on deadline—rarely did I get more than four hours to report and write a story—the assignments I received, mostly overflow from the city beat, didn't much interest me. My mentor at the paper told me that I'd have to write stories like these for years before getting to do what I really wanted. So by the time the internship was finished, I had set aside the idea of becoming a journalist, resolved to focus once again on medical school.

The hospital off the freeway still beckoned. By the end of second year, I was obsessing about the clinical clerkships coming up, when I would get my first sustained exposure to hospital medicine. I yearned for work, not more scholarship, and I fervently hoped that third year, which had us rotating through all the major medical specialties, would provide fulfillment. There were three months devoted to adult internal medicine, three to surgery, two to obstetrics-gynecology, one to pediatrics, one to psychiatry, and one to neurology, leaving one month for vacation. Whenever I complained about second year to Rajiv, he assured me that things would change drastically once I got to the wards. He said that most of what I was learning in class was useless in clinical practice. He said that the preclinical years were simply a rite of passage. He told me to adopt the medical student mantra: P = MD. It was through practice that one learned what a doctor should do and be.

WHEN I FINALLY MADE IT
to third year, I had narrowed my choice of specialty to internal medicine or psychiatry. Since I was planning on short-tracking, I had to make a decision quickly if I was going to send out residency applications in the fall. Though psychiatry had always
appealed to me because of the creativity of its ideas, it quickly became obvious that nurturing my interest at medical school was going to require a thick skin. Many professors openly expressed disdain for psychiatry and psychiatrists. My mentor, a young gastroenterologist with perpetually startled eyes, told me that psychiatry residents came in two types: those from the bottom of the class who could not compete for more prestigious residencies, and those from the top of the class who were mentally ill. “Do internal medicine,” he advised. “It will close the fewest doors.” Rajiv agreed, calling psychiatry “mental masturbation.” After all the effort I had expended to finish a Ph.D. in physics, I couldn't imagine choosing another career that didn't meet with my family's approval.

Of all the medical specialties I had been exposed to, internal medicine seemed the most grounded in the fundamental physiology I had learned in class. In some ways, internal medicine was like physics: rigorous, intellectually prestigious, vast (encompassing ten different subspecialties: cardiology, pulmonology, gastroenterology, nephrology, hematology-oncology, endocrinology, rheumatology, allergy-immunology, infectious diseases, and geriatrics). There was something deeply attractive about a field that was so immense and varied. (And popular, too: roughly a third of my class was applying for an internal medicine residency.) But as with everything in my life, I had doubts. Internal medicine was indeed complex, but it seemed to require rote, algorithmic reasoning. Where was the beauty, the creativity? Seventeen thousand medical school graduates every year—roughly a third of them future internists—and all of us trained to treat patients the same way. What was the difference between an internist and the mechanic in La Crosse who diagnosed that whirring sound in my car engine? He used a stethoscope, too. Wasn't this the cookbook medicine I had always disdained?