Trained Monkeys

In addition to a general dislike for anything relating to physicians, there was little in my background that would have pointed to a career in medicine. As my youngest brother approaches his graduation from medical school, I started thinking of what led me to practice medicine.

This is my story ... Undergrad (Part II)

I am sure most everyone has experienced the feeling before.

I refer to the sense people often relate when arriving at some new destination or environment – and immediately feel at home. It makes one believe, “This is meant to be.” It could be an apartment, a home, a far flung college campus, or even a potential workplace.

From the moment I stepped into the frigid, sterile confines of a suite of operating rooms, I knew I had arrived.

My first wakeful exposure to an operating room came while a summer student at the Texas Heart Institute in Houston, Texas. Neither Marcus Welby nor any other television drama could have adequately prepared me for the excitement, tedium, and routine choreography of operating rooms that were to eventually become an integral part of my life’s work.

To my way of thinking, one unfortunate aspect of the "I want to get into Medical School" circus comes with a ridiculous mandate for pre-med students to work in some health-care related capacity prior to actually applying to medical school. While the notion is laudable, the requirement should actually come under the heading of “resume padding.” Many of my peers shadowed a beloved family physician or toiled at local hospitals drawing blood or carrying out other grunt work. I was always hard pressed to understand the degree to which most of us would actually form any valid conclusion about a future in medicine based on the experience of drawing blood or pushing patients around winding corridors. Regardless of my opinion, admissions committees at every medical school insisted on this vacuous demonstration of a serious intent to practice medicine from every applicant.

Pre-med students who could spend summers in the Houston area certainly had many options available to them which afforded the potential for truly eye opening experiences; some of these summer positions successfully offered more than a tangential sampling of the reality of medicine for medical wannabes.

The Texas Medical Center must surely be one of the largest in the world; from a distance, it appears to be a city unto itself. At last estimate, the complex employs well over 100,000, is home to two medical schools, a dental school, various nursing and allied health programs, world - renowned cancer and pediatric centers, one of the largest VA hospitals, multiple private hospitals as well as two world-class heart programs built by Dr. Cooley, and the late, Dr. DeBakey.

During the spring semester preceding my senior year of college, I learned that both of the heart programs in Houston offered highly competitive summer programs for prospective medical students. (A belated "Thank You" to Sally McDonald, (now) MD.) Having spent the majority of my college years immersed in Chemical Engineering studies, I was pretty much out of the pre-med loop and had no foreknowledge of either of the prized programs. I was beside myself with disbelief at my lack of prior initiative or insight; with the late date, I was clearly behind the eight ball and had to move quickly in order to realize any hope of securing one of these positions.

In a fortunate twist of fate, my parents “knew someone” who also happened to be a lifelong friend of Dr. Denton Cooley of the Texas Heart Institute. While a personal appeal to Dr. Cooley in support of my application was certainly helpful, my academic record would have to stand alone in order to support an appointment to the program.

Ask any friend who knew me during the interregnum after applying and each would probably cringe at the thought of my crazed anxiety as I awaited the decision. Like so many prospective medical students, I had somehow latched onto a notion that failing to secure this job could be a death blow to any future in medicine. (FACT: pre-med students are a breed apart.)

I was pleased and much relieved when a letter eventually arrived inviting me to be one of ten students who would spend the summer with Dr. Cooley and his associates. I would have liked to think my academic credentials propelled me across the finish line in good stead; when finally meeting my fellow summer students, however, I quickly learned many of them were the scions of referring cardiologists and other medical attending physicians, as well as family and business friends. For all my hard work in college, it had apparently mattered more that my parent’s physician/friend played college ball with Dr. Cooley. Beyond a moment of reflection, I doubt I gave it another thought.

It was very difficult as I bided my time through the completion of the term and finals, and then anxiously awaited a starting date of June 1st.

Following two days of orientation as well as an education in operating room decorum and hygiene, we were finally led down a winding staircase to the ten operating rooms which made up the heart of Dr. Cooley’s domain of old. Every day we were to consult a master OR schedule then make our way to an assigned room; we would remain in that operating room until all the work for the day was complete.

Imagine.

Dr. C and the Trained Monkey

It is 7:30 am. You walk into one of the ten operating rooms all of which are bustling with activity and a disarming ambient temperature of 55 degrees. All ten patients simultaneously have IV’s, central and arterial lines placed followed by the induction of anesthesia and intubation; the patients are then shaved, prepped and draped but only after foley catheters and rectal temp probes have been inserted; the activity reaches a pitched climax as a chorus of pneumatic saws in the hands of ten surgeons carry out midline sternotomies – throughout the oval of the suite, all ten chests are “cracked” in unison. The movements are fluid, precise and surprisingly absent any of the anticipated drama. As quickly as it began, the rooms palpably settle into the routine - even mundane - practice of open-heart surgery. To these seasoned professionals, this performance is a well-worn ballet of sorts, but to the myriad visiting medical professionals it is instantly a heady and memorable experience. Each of the fledgling summer students was immediately awestruck by the good fortune that had landed at our feet.

The ten surgeries were completed and, following fifteen or twenty minutes of turn-around time, the dance began anew. The cycle was repeated multiple times throughout the very long days until all of the scheduled cases were complete. As an example, within the Institute museum each of our names is permanently immortalized on the framed, faded surgical schedule from a day in July of that year when the Texas Heart Institute carried out a personal record of 52 open heart cases in a twenty-four hour period.

What were the duties of the summer students? Surely, we were instructed to stand out of the way of the professionals and observe?

Not a chance.

From the start, all of the students in their assigned rooms, scrubbed and gowned, were placed either at a patient’s chest or legs to assist the surgeons as they went about their work.

And we were quickly taught how to sew.

At that time, balloon angioplasty was still in its naissance and, as a result, formal bypass grafting was the norm – even for single vessel heart disease. Every patient who underwent a “bypass” had at least one of his legs splayed open and a segment of vein removed which was then used as the bypass conduit. After the vein "harvesting" was complete, the incisions were left for the summer students to close.

While there was certainly a learning curve for each of us, it gradually became the clear but unspoken goal of every summer student to outdo the next when it came to craftsmanship. It would not be an exaggeration to state that most of the surgeons, by the end of our stay, truly came to appreciate - often prefering the work of the students on loan for the summer. This notoriety became a source of great pride - as well as a few swollen egos.

As with other friends who also worked that same summer across the parking lot with Dr. DeBakey's team, each of us at the Texas Heart Institute was truly blessed with the opportunity to work with Dr. Denton Cooley and his associates. It is a real tribute to these surgeons that the medical community remains truly awed by their abilities; each of them somehow managed to make their work appear effortless – whether they were bypassing blocked coronary arteries, retooling or replacing valves, implanting mechanical left ventricles, or transplanting hearts.

In the years following medical school, I went on to complete a fellowship at the Texas Heart Institute. At our graduation service, Dr. Cooley introduced me to the audience as the, "summer student who never left." "Dr. Marvin was personally responsible for bankrupting our summer program; after he clocked in on June 1st, he never clocked out!"

Afterward, I reminded him of the axiom he taught us as our summer at THI came to a close; as we prepared to return to college, I believe he wanted to temper the naive assumption of many a student who may have somehow mistaken the ease with which the surgeons work and our new-found abilities, as he asserted,

“Any monkey can be trained to perform surgery. We spent the summer teaching a bunch of college educated monkeys how to close legs, hold hearts, and assist at the chest. The difference between you and me is that I have the knowledge and experience to know when surgery should be carried out.”

In four sentences he had aptly reined in my youthful enthusiam but also reduced my glorious (and lucrative) experience into the mockery that was, “How I Spent My Summer as a Trained Monkey.”

He laughed out loud and in a few minutes ended our conversation by offering up a true revelation:

If given the opportunity, what would Dr. Cooley choose as a surgical specialty today?

Without hesitation came a Graduate reply,

“Plastics.” Chuckling, he added, “Where is Mrs. Robinson when you need her?"

Slinging Mud

I spent one summer during college working as a roughneck on an oil rig. Please suspend your disbelief as it is completely true.

At that time, all students pursuing Chemical Engineering degrees were strongly encouraged to engage in hands-on research before graduating. During the summer before my Junior year, I stumbled upon a fantastic opportunity to work for one of the leading oil research companies at that time, Dresser Magcobar.

I spent those three months on a rig wielding 36-inch wrenches alongside full-time roughnecks in sweltering Texas heat, within spitting distance of Astroworld, while conducting mud flow studies for a prototype drill bit. It was extremely demanding work.

Most of the time ….. well, at least occasionally.

Our main responsibility as summer interns was to babysit the rig and flow apparatus during the studies. My research partner and I – mutlitaskers before the term had ever been coined – spent most of our time on the rig ably manning all the controls while simultaneously mining more sun (and money) than actual data. It wasn’t that we were lazy so much as the studies were slow and tedious; any given flow study took several days to produce usable data. If the cynic thinks less of the imprimatur of “roughneck” as it applied to our work, let it be written that we were at least always at the ready with our 36-inch wrenches. For myself, I also took the opportunity to read a lot of books.

By July, the workaday roughnecks with high tattoo to teeth ratios finally came to accept the two “college boys.” We eventually would routinely gather in one of the air conditioned offices during protracted lunch breaks to eat, rest, and generally “shoot the breeze.” It was during one of these sessions that I was first made fully aware of “tabloids” and the genuine sway they hold over thousands of readers.

Putting down my copy of Plato’s “Republic,” I was amazed to learn that many people actually read the tabloids so as to glean day to day information just as others might depend on the NY Times or The Wall Street Journal. My only prior exposure to tabloids had been while passing through grocery store lines, the copies replete with cover stories of aliens and soon-to-be-divorced celebrities. While I will admit to being lured to pick one up occasionally as a result of some salacious headline, our time together always ended abruptly so as to avoid anyone actually seeing me with the offending item in hand. My notion was that these “rags” were produced for the amusement of someone – haughtily, someone NOT me. Treading lightly given I was a mere guest for the summer, I distinctly remember listening raptly as two of these weathered roughnecks relayed the truths contained in the tabloids.

Skipping to the present, I still love to read. I am currently making the supreme effort to get through more of what someone has deemed to be the classics, but my tastes generally lean toward history, historical biographies, and some fiction. At any given time, I generally have two or three books at the ready, reading each of them in piecemeal fashion; I get bored.

Over the past few years I have added yet another category of books to my list of favorites: Current Events. This grouping of literature seems to center mainly on current political intrigue; I am not certain of the requisite timeline so as to be labeled “current,” but assume most of these eventually find a final resting place among the myriad tomes of history. What I truly love about this genre of books is that reading them affords me, a true political junkie, the opportunity to belatedly insert myself into their world; every page is a backstage pass to conversations, strategies, personalities, conventions, and – frankly – the intrigue which the political process engenders. Additionally, these books very often address unanswered questions which tend to vex me during and long after the election cycles end.

Game Change; Obama and the Clintons, McCain and Palin, and the Race of a Lifetime

The book covers the Democratic and Republican primary and general electoral seasons which culminated in the election of Barack Obama as the 44th President of the United States. (Just in case you didn’t know.)

The book presents a well constructed, understandable outline of the process each of the candidates slogged through on the way to victory and/or defeat. In the end, the two authors offered their version of the events thus providing me with yet another perspective of the main actors, their strategies, and the political timeline in general.

All told, it was a very good read.

BUT, (as in, however):

The first thought that crosses my mind on finishing the book is the old adage, “Familiarity breeds contempt.”

Not intending to make an indictment of the book, its credibility, or even the authors, but “Game Change” is heavily laden with page after page, chapter after chapter of prurient, gossipy re-enactments of private and not-so-private conversations, tantrums and tirades between all the candidates, their spouses, and members of their individual staffs.

And, I couldn’t put it down!

Throughout the book, there were also numerous accounts of all the candidates spewing epitaphs in every direction to one degree or another; a particularly crazed vignette has a respected candidate doubly flipping his own wife the bird(s) while letting loose with a fusillade of the F-word invective that – if redacted – would have closely resembled the Nixon Oval Office “Expletive Deleted” transcripts of old.

I am not naïve about politicians; I had the opportunity to witness, first hand, the impeachment proceedings against Bill Clinton. Most vivid to me was the day when the articles of impeachment were approved. Sitting in the public gallery, I was mesmerized by Democrats and Republicans performing for the C-Span cameras. Hour after hour, I watched as staunch allies came in succession to the defense of the President during two minute rebukes of particular members of the opposition. And, almost without fail, once the speaker was finished and out of camera range, the two foes would engage in conversation or even an embrace. It was pure theater.

All politicians are human – for good or for ill. The obvious may read as insipid, but I had to learn this on my own during the fall of the impeachment proceedings and the lesson is reinforced every time I immerse myself in the elections or read one of these books. There is, most certainly, a part of me that still would like to hold elected officials to a higher standard but life and reality seem to always get in the way.

On finishing the book early this morning, I went to bed and fell asleep only to be awakened shortly by my own voice uttering a clearly audible and sibilant “it.”

As I had drifted off to sleep, I remember reflecting on my carnal fascination with the various permutations of crazed political behavior manifested by every one of these political masters in the book. I was forced to ask myself if my interest is prurient in nature or if I read these books seeking a better understanding of the psyche of these immensely complex – if not, egomaniacal – people?

As I awoke with a start at my own utterance, I suddenly realized that my thoughts had turned to memories of my roughneck buddies and their insatiable appetite for the tabloids.

It then dawned on me that none of us had ever truly been as different as I may have originally thought.

If completely honest, there exists within most of us some fundamental appetite for – well, a little gossip or “dirt” from time to time. There has hardly ever been a day during my professional life within a given operating room or ICU when someone hasn’t stopped to pass along some “juicy” tidbit about one person or another. I am not sure what this says about us as people; I would assume it may very well be an inextricable component of our natures.

John Edward’s staffer, Andrew Young’s new book concerning his former boss’ tawdry affair is being pushed into the market early this Saturday as a result of the events of the past week. While a copy of the hardbound book will probably cost $30 or so, you can bet my old friends from the rig probably paid only a couple bucks for the same information and learned most of the details months or even years ago after passing through a grocery store line.

Go figure.

Medicine -- Undergrad (Part 1)

In addition to a general dislike for anything relating to physicians, there was little in my background that would have pointed to a career in medicine. As my youngest brother approaches his graduation from medical school, I started thinking of what led me to practice medicine.

This is my story ... Undergrad (Part 1)

I walked out of Moore Hill that first day to a brisk, sunny January morning not at all certain what the future would hold. By the time I had walked a mere fifty yards or so past Gregory, I began to feel at home.

I made my way along strange sidewalks to register for classes. Every corner and turn took me one step closer to familiarity with the campus that would prove beneficial in the months and years ahead. I had arrived at The University.

Given it was my declared intention to eventually be accepted into medical school, one might assume I would first make my way to the Pre-Med office to get the run down of classes required for admission. Not I.

No, I had decided to go in an entirely different direction; instead, I made my way to the Robert Lee Moore Building and the Department of Chemical Engineering.

I still wonder how it is most undergrads come to decide on a major when entering college. Some choices seem obvious: the artist might decide on architecture; a talented French horn player may elect to teach high school music. And I am forever in awe of those who simply seem to "know" what life has in store for them. I am writing about the rest of us; what happens along the way which helps to devine our future?

High School anatomy had granted me an education from Mrs. Whipple and the "cat." This practicum eventually bestowed an arrogant, ignorant notion that simply because I had successfully endured the stench of phenol as well as commendably memorizing copious details, I must surely be suited for a career in medicine.

But, was that enough?

Well, I had also grown to love Chemistry and gained a better than average facility with Math.

Good. It turns out these skills are also prerequisites for success in being accepted into medical school. So why didn't I just make a left turn past the Welch Chemistry building and walk up the hill to the Pre-med office that January morning?

Because I had been warned to avoid registering for classes as a "Pre-Med" student.

I am guessing Pre-Med students had been much-maligned for years; while only an assumption, I honestly didn't know for certain if it was a well-earned generalization or not. However respectful friends may have been of my career choice, many wasted little time advising me to, "grow an extra set of eyes in the back of my head," when dealing with "Pre-Med people."

So, it was that when considering the totality of (dis-)information I had gleaned, as well as an assessment of my academic strengths and weaknesses, I enrolled as a Chemical Engineering student who also intended to one day attend med school. While undoubtedly making the road more "interesting," my logic seemed sound: By earning a degree in Chemical Engineering, I would have an alternative career choice if med school never materialized.

Survey Classes, Gunners, and Grades

There is nothing quite like walking into a room ~ no, an auditorium ~ with 500 or so other students vying for top honors in a class like General Chemistry, notorious for being a "weed out" course. Chemistry marks the beginning of the end for many students; as a result, enrollment has the potential to bring out the best and worst in people.

I was soon introduced to the term "gunner." I came to hear the whispered phrase, "Oh, so and so is a gunner," and it certainly didn't strike me as praise. I don't recall if anyone ever sat down and explained its meaning to me; eventually everyone figured it out for themselves. To my way of thinking, a gunner was someone who would stoop to any level to get a good grade.

I initially felt many were being a bit hypocritical; after all, wasn't everyone then ~ at minimum ~ a "closet" gunner given we each had the same goal of doing our best while simultaneously outperforming fellow classmates? But I came to learn that to walk in the shoes of a gunner, one must be willing to visit a darker side of human nature; a gunner would screw a fellow student, step over the bloodied corpse and continue climbing the proverbial "food chain" with nary a moment's hesitation.

I unfortunately have distinct memories of a few of these students. They each seemed to be universally held in contempt as they really made no effort to conceal their intentions. On one occasion, I heard the brother of a now famous mogul intentionally mislead a fellow classmate regarding the date for a test. He then cavalierly admitted what he had done, all the while laughing hysterically. It was through my experiences with gunners that I came to better understand why many people held Pre-Med students in disfavor.

I soon learned there are other, less invidious, ways to find yourself in dutch with classmates enrolled in Pre-Med survey classes. I learned this lesson the hard way.

When eventually enrolling in Organic Chemistry, I was truly fortunate to land in the class taught by Taylor B. Jones, PhD, one of the rare professors who could teach anyone to love this touchy subject. But for all the praise I have for Dr. Jones and his acumen as a professor, his enthusiasm for students and their success held the potential for mildly adverse consequences.

I distinctly remember everyone nervously settling into seats the morning we were due to receive marks following our first exam. Dr. Jones entered the room, approached the podium and immediately asked if "Rob Marvin" was present. I hesitated then raised my hand with no small amount of trepidation; I had seen the "Paper Chase."

After acknowledging my attendance, he proceeded to go over the stats for the test and then went on to announce that I had earned the highest marks on the exam.

Was I happy? Of course. Dumbfounded is another word. Organic Chemistry may rank highest among those classes which destroy the hopes of many a potential physician.

I was also not blind. I quickly learned that singular notoriety has consequences especially among the ranks of gunners. With a few laudatory words of praise from Dr. Jones, the gunners turned and glared, telegraphing concern that this Marvin guy might actually inch his way past them and potentially stand in the way of them realizing their goal. Gunners are not in the habit of looking at the backside of anyone; they pride themselves in always having a clear path.

While a great moment for any college student, I understood my invisible position in the class had changed:

Not only was I now targeted by the gunners, I was also labeled one by others. It also marked the day I officially became engaged in Pre-Med warfare. By enrolling in an entirely different college, I had hoped to be beyond the scope of these dynamics; like it or not, however, I was now directly in competition for a valued seat in some distant med school class.

My perch at the top of that Organic Chemistry class didn't last ~ it seldom does for most of us. Thankful for my moment in the sun, I was equally grateful eventually having the onus placed on someone else's broad shoulders.

I eventually came to understand; up until that day in Dr. Jones' class I had not truly been engaged in the pursuit of my goal. Sure, I had gone through the motions: attended classes and labs; studied well into the night; had taken and passed exams. By calling me out, however, he forced me to come to terms with the fact that competition in college, and life, is an essential component to success. People who actively pursue a vaunted position must compete against great odds all the while potentially risking being vilified unfairly along the way.

Despite my enrollment in the College of Engineering, I officially became a Pre-Med student that day.

It isn't Pre-Med students people should hold in contempt.

No, I would say to keep your eyes open and on the lookout for the Gunners.