Hopkins MedicineHopkins Medicine Winter 2004

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A Cancer Among Us
Ruminations on life as a medical student

By Dan Munoz
School of Medicine, '04

Dan MunozTonight, I got a disturbing phone call. “What’s wrong? What happened?” I asked Rudy, as I listened to his trembling and uncharacteristically soft voice. Rudy was upset. Earlier in the day, he’d endured a personal attack on his character. At the end of a month-long rotation on an inpatient service, two other medical students on his team had pulled him aside and unleashed a stinging array of accusations. They ridiculed his voluntary presence in the Hospital in the late evening or on “non-call” nights. They accused Rudy [I’ve changed his name] of not being a team player, of setting out to make them look bad to the residents and attending physicians. Finally they called him “two-faced.”

Hours later, his wounds were still fresh. He asked me to be honest with him, to help him understand what happened. What was he doing wrong? How could he have upset his classmates so, when he was only trying to learn as much as he could from a one-month clinical rotation? I felt him blaming himself. From his hurt grew my anger.

“Over the next four years, you will perhaps learn the most from your fellow students,” said Dean Herlong in the first days of medical school. And it’s true. Jenny has taught me the power of staying positive throughout the ups and downs of medical school. Kammy has reminded me of the importance of remaining human and maintaining a sense of humor. Alex has taught me the value of recognizing our obligations to the greater health care system.

There is, however, a disturbing trend within medical student culture, a cancerous way of thinking that threatens our training and our relationships. Maybe it results from the manner in which residents and attendings evaluate us on the wards. Maybe it’s from the early-morning alarm and all the demands on our time. Regardless, there is an unspoken backlash by some students against the demands of rigorous training.

To some extent, we’ve all been guilty of it at some point over the last few years: hoping for a canceled lecture, a light clinic schedule, a short surgical procedure, a small patient census. But that desire for a light workday can manifest itself in avoiding larger responsibilities and seeking an increasingly passive role in our already nebulous position as the students on a team.

The trouble arises when some students require collusion and complicity among all students to game the system. Implicit in this scheme is the sad belief that when one student is more invested, it can “ruin” it for the others. This stifling atmosphere discourages those with an interest in a particular field or patient from acting on their curiosity. It’s peer policing gone bad.

On a Friday night last winter during my month of studying for the boards, I awoke to the midnight chirp of my pager. Squinting at the display, I saw a Hopkins number and dialed what I was sure would be an errant page. My friend and classmate Dave picked up after one ring. “Hey Dan-o,” he said casually, as if it were any reasonable hour in the day.

“What’s going on, buddy? Is everything okay?” I mumbled.

“Yeah, sorry for the late page, but I had to share this with someone,” he responded, failing to conceal his excitement. Dave described his night. He had intended to leave at the usual hour of 6 p.m., but a young girl with lymphoma had been transferred to the pediatric oncology service late that evening. He had stayed, not at his team’s request, but out of a desire to learn and to help out.

Then, from a quiet, near-empty nurse’s station on CMSC-4, Dave shared a thought that capped three years of deliberation. “Dan-o, I think this is what I want to do.” On a night when he wasn’t technically supposed to even be at the Hospital, Dave had helped support a sick child and her family. Along the way, he discovered his calling.

I hung up the phone and peered out my apartment window. Despite the falling snow, the Hopkins kingdom remained an illuminated bump on the horizon. As I drifted back to sleep, I was proud of Dave, for his example and for his voluntary commitment to his patient. It’s what Hopkins is trying to instill in us—a keen attention to our passions, not to the clock. And that’s the very commitment for which Rudy was chastised.

What does it say about us as a group when we place our desire to get home early above our concern for patients, our collegial relationships and our drive to fill gaps in clinical knowledge? And then proceed to brazenly vilify fellow students who refuse to sign this contract of intellectual and professional disengagement?

Until we as students honor that sort of passion, rather than tear it down, we cheat each other and ourselves out of the education this institution aims to deliver. Those who subtly encourage the race that punishes passion and embraces mediocrity ought to ask what it is about being a better doctor that makes them feel so threatened.

Then, deal with it and move on. There should be no place for that here.