Tuesday, March 9, 2010

Medical School Through the Back Door

020301-N-3995K-011 U.S. Navy Recruit Training ...
For most of my entering classmates, March 18 is Match Day, when they'll learn where they can plan on spending the next four-plus years in residency training. That's the way it generally goes: four years of medical school and then graduate medical education. But I came in through the back door, having gotten a taste of residency before I'd even placed my order for medical school. The good thing is, I know what's coming, I just have to wait for it to arrive.

In 1996, I was a lowly psychology graduate student living in Boston, in need of an internship training site. As part of our education, we were required to get some practical experience, so I sent my resume to every hospital in the phone book that had a psychiatric department. I interviewed with two and one offered me a position in a non-existent psychotherapy internship program. The department had been considering developing something along those lines, the director (who eventually became my best friend) decided I looked like a good guinea pig, and I was more than happy to oblige.

As it turned out, since I was the sole intern, my "classmates" ended up being psychiatric residents, many of whom had already practiced as physicians in other specialties, a few in other countries. I was not only out-educated -- as far as medicine was concerned -- I was out-experienced from the first day and I remember my first day well. I got lost on my way to a seminar on Cognitive-Behavioral Therapy, walked in late and introduced myself to a dozen or so faces, some of which openly questioned what an intern was doing in a seminar for  doctors. I went home that night seriously wondering whether I'd made a colossal mistake and oversold myself.

The following week, in a conversation revolving around resignation, the director assured me that, being older and having gained real-life experience, I'd find a way to fit in and establish myself. "Just give it time," he said, smiling. I appreciated his confidence, but still, it wasn't easy. Medical school is like Marine boot camp and enduring (surviving?) it is formative. I was a civilian wearing fatigues who'd never spent the night in a foxhole. I had to prove, both to myself and everyone else, that I'd earned my stripes even if they came from a different branch of the service.

So, I made it a point to offer an answer to every question posed by the instructors, even if it was the wrong one. I tried to ask meaningful questions and act like I knew what I was talking about, whether I did or not. Eventually, one by one, the residents took notice. I worked hard, knew some things they didn't, and was interested enough in what they did, to learn about it. After a month or two, when they began reminding me of departmental lunches with pharmaceutical reps instead of letting me find out about them on my own, I knew I was "in."

Over the next year and a half, we shared the same office spaces, saw the same patients, and became friends. It's largely due to their faith and encouragement that I'm studying for board exams. They were the ones who said I ought to go to medical school and when I challenged them on the basis of my age, shrugged their shoulders and said not to worry, it was really an advantage. "Besides, you've already been a 'resident' of sorts. You may as well go all the way."

It's really unusual to have a learning experience like this and I was extremely fortunate. I don't think my hospital ever developed a formal internship program, which means I received something even rarer. It wasn't simply an opportunity to witness the life I had always wanted, it was a chance to live it, after a fashion. It's a life my classmates are going to begin in July and one to which I can't wait to return, picking up where I left off. It's made the back door the best door, after all.

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