Reunion

 

We graduated when we were 26 years old and now 51 years later, about 40 of 90 graduates of the Cornell University Medical College convened at the University Club, in New York City, for dinner.

Each graduate, and if present, each spouse, was asked to get up and summarize his career, fate, life since we last saw each other. (I can use the proper "his" because there was only one woman graduate and I'm sure she'll forgive my antiquated grammar.) Dinner was getting cold, waiting to be served.

A man at my table had returned to Montana/North Dakota, become chief of Obstetrics at the then new North Dakota medical school where he still serves today, although he stopped delivering babies at age 70. Along the way he bought and sold a few banks, built hundreds of homes and office buildings as a sideline.

Another became plastic surgeon to the stars in Hollywood.

A few did most administrative stuff: one had organized the government's efforts to deal with HIV, as he worked first at the CDC, and later in the American program to fight HIV globally. Another reshaped medical school curricula, and helped organize and found a new Canadian medical school.  Someone else made an infectious disease career in the diabetic foot, but that took him to a professorship at Oxford and he authored numerous books and papers. Two others became founding fathers of Emergency Medicine--when we graduated there was no specialty of Emergency Medicine--one in Arizona and one in Washington State. The latter organized a company to sell Emergency Medicine groups to hospitals and today many hospitals contract out their ER departments to his organization, which is the largest employer of ER doctors in the country. The same guy got an MFA from the University of California and made a documentary about ER medicine. 

There was an astonishing story about the one woman: She was the wife of a Cornell first year, and she was attending NYU medical  school, and she wanted to join her husband and she was told that because one of the 5 women in the class was leaving, there was now a "woman's spot" available. Looking back at the classes since 1945, there had always been either 4 or 5 women in every class of 90. During the war years, the classes had 50 women but then reverted to 5 after the war ended. The men who ran the admission committee had no qualms about quotas. Until the 1960's there were only 5 Jewish names and 1 Black. When you think about the ills of "affirmative action" you have to consider how many years there was affirmative action for White Christian males.

As it happened, I was the last doctor to speak and all I could say was that I was inspired to go into Endocrinology by a pediatric endocrinologist named Maria New, who everyone there knew, and Maria, having come from a family of professional musicians, realized that unless you are the very best, there is no point in trying to be a musician, so she chose medicine because that's a field where even if you were mediocre, you could still do a lot of good and make a decent living. (Of course, coming from Maria, that was funny, because she was among the very best of pediatric endocrinologists, and did several ground breaking studies.) So, I said I had practiced endocrine, first in private practice, and now for a corporation, and I presided over a mediocre practice, although I've gotten progressively better at it, but after more than 50 years of practice I've probably done more good than harm, in a mediocre sort of way.

What was more impressive to me than the curriculum vitae of those who attended, was the fate of ten classmates who could not attend because they were dead. Some died young, one from suicide, one from an accident, others from causes unknown. Several of their wives, who I remembered clearly from medical school days, had died young, one from breast cancer at age 39. 

Most had made enough money for beach homes, pied-a-terre apartments in New York City, and only one I could identify practiced, as I do now, in an underserved area with patients who are at the bottom end of the economic strata. 

There was a lot of talk about how we were taught to provide the best type of care--the importance of laying hands on the patient, of establishing a connection with the patient, all things which are now considered mere "theater," things which are unnecessary and self indulgent, because, after all, you can see a thyroid, examine a thyroid way better with a sonogram than with your fingers, so why bother touching a patient's neck?

A neurologist spoke of having patients presented to him by young doctors who never bothered with a physical exam, once so essential to figuring out where the brain tumor was, but instead now they present the brain CT or MRI, and never mentioned whether the patient was hemiplegic. 

One doctor told how he had been told to evaluate a patient at Cornell, as a student, and he had done what he thought was a complete history and physical exam but after he presented the patient to his professor, the professor asked if he knew who the patient was, or what she did in life and he had to admit he did not. He knew she had pneumonia. And the professor said, "The patient is Aretha Franklin. Next time don't forget to do the 'Social History' (SH) part of the work up." (It is the SH where you ask where the patient was born, grew up, got educated, what kind of work they did and marital status and where they live now.)

Now, of course, that "Social History" is given short shrift, and young doctors refer to it dismissively because it takes time, and when you are trying to see 30 patients in eight hours, that means roughly 15 minutes a patient and there are a lot of labs and imaging studies to review during that time.

When I arrived at my job in New Hampshire, I found there were no examining gowns. How was I going to examine a woman's heart without an exam gown?

"Why would you want to listen to her heart?" I was asked. "You're an endocrinologist!" 

I really had no answer, other than that's the way I always had practiced medicine, the way I learned it, and I really could not remember why. 

Well, now I know why: because that's the way I was taught. I might be the only doctor to see that patient for a year, and why miss a high blood pressure, atrial fibrillation or a melanoma because you were supposed to focus on just her thyroid, and then move the patient on to the next doctor--who she would likely never bother seeing? That in the flesh encounter is your last  chance to actually do the patient some  good.

At least now, I know where I got most of my bad, inefficient, self indulgent habits.