Chapter 3: Medicine, The Match, and Mardi Gras
I’ve never questioned my desire to be a doctor, which is saying a lot considering every other area of my life has been second-guessed, turned upside down and inside out. I am so blessed to do what I do; I love anesthesiology. My practice is busy, challenging and rewarding but the road here was anything but straightforward.
I never wanted to be an anesthesiologist. I would have done anything but be an anesthesiologist. My father is an anesthesiologist. I always knew he was a very good doctor with a great reputation but as his career progressed he grew disenchanted with healthcare in the west and jaded about medicine. In retrospect I think it’s because he grew up in the era when being a physician was who you were and not just what you did. You were expected to be a pillar of society- strong and set apart. You were expected to be a role model in every area of your life; integrity, excellence and compassion buttressing the core of one’s character. I like that view. But the age of productivity-pressure, managed-care and frivolous litigation disenchanted him with the practice of medicine in America. I know now that he was deeply burned out. The income was stable and substantial but at the end the price was faith in the ideals of Medicine. He wanted me to be a businessman.
I’ve never been the smartest guy in the room. Most of the time I feel like an old IBM 64 KB RAM, 1981 computer. The computing power may be there but it usually takes awhile. My source of academic confidence comes from being a hard worker who is extremely organized. It is a bitter pill to swallow that my absolute very best is mediocre in certain company. I made a meal of that pill in medical school. Everyone in medical school was formerly at the top of their class in high school and undergrad. Everyone was brilliant, talented and motivated. My most earnest efforts to compete academically left me with only average grades. So I found myself smack-dab in the middle of my medical school class academically with no idea of what specialty to choose. All I could eventually figure out was that it had to be surgically related; I like to do procedures and I have good hands.
By my last year of medical school Elaine had already graduated law school at the top of her class. We married and she moved an hour away to Charlotte for a prestigious job. I commuted to see her on most weekends. It was time to decide on a specialty because I had to apply to residency. After a couple of weeks earnestly praying and fasting about it, I felt a leaning toward Otolaryngology otherwise known as ear, nose and throat (ENT) surgery. I was particularly enthralled with the treatment of head and neck cancers.
Head and neck anatomy is intricate, complex and beautiful. The surgeries done to treat cancer of the head and neck are long and creative; they are heroic and glorious. Those cancers are aggressive and grow in unpredictable patters. Cutting them out or “resecting” them while trying to leave important structures like major arteries, nerves and muscles is sort of like taking a bowl of spaghetti and trying to peel the sauce and meat from each noodle with tweezers and fine scissors. It’s a rough analogy of a delicate art. If the bowl represents the major defining structures of the head and neck, sometimes the cancer grows into the bowl itself and it becomes necessary to take bone and muscle from elsewhere in the body and reconstruct the “bowl’. It involves the ingenious problem solving of reconstructive plastic surgery. These patients literally have their whole face and neck splayed open and sewn back together and often, after they recover, you’re barely able to tell. I was captivated.
The only problem is that ENT is incredibly competitive and people with grades like mine don’t get in. I went on a campaign. I have never worked, studied or pushed myself harder. I attended every meeting I could and did as many rotations as possible. I was the first to arrive in morning and the last to leave in the evening. The feedback from everyone was very positive. In addition to everything else I picked up two research projects- one with the department chairman and another with the only other tenured member of the department at that time; a famous but eccentric voice surgeon: Dr. K. The content and quality of my resume essentially doubled in a few short months. I was hopeful.
During this time I also did two rotations related to Anesthesia. The first was critical care in the Intensive Care Unit, which I really enjoyed. The second was a general anesthesia rotation in the operating room. I was paired with an anesthesia resident and shadowed them around. I had little appreciation for the intricacies of the specialty at that time and thought watching someone watching someone else sleep was boring. Furthermore, my medical school has a very renowned Anesthesia department but I found them all to be arrogant and socially awkward. I kept my eye on the ENT prize and went into overdrive. When it came time to apply for an ENT residency position I borrowed some money for all the exorbitant application fees and applied to every program in the country.
Residency positions are achieved through a process called ‘The Match”. The Match generally works like a dating service or sorority rush but on a much larger scale. You apply, get some interviews, then fly around the country during the course of your normal busy academic schedule and at your own deeply indebted expense. Often medical students will fly and return on the same day so as to not miss “work”. After the interview season each candidate submits a preference list of programs and each program submits the list of their favorite candidates as well. A computer matches you up and voila! On the third Thursday of March the “matches” are revealed. As a participant, you commit to whatever program you’re “matched” with or else you are prohibited from ever participating in the Match in the future. Most medical schools make a ceremony of the process where students one by one proceed up to a podium in front of their peers and open an envelope to simultaneously discover for themselves and reveal to their classmates where they’ll be spending the next few years. It’s usually met with happy reactions from the candidates and cheers from their classmates. Every now and then someone gets surprised by not getting one of their top choices. You can witness the disappointment wash over their face or even spontaneous tears begin to pour as they’re forced to endure the humiliation of whimpering out the verdict up there in front of everyone. Personally I think the process is twisted.
I barely got any interviews in Otolaryngology. I had a folder of about 85 rejection letters. Of the few programs at which I did interview, I didn’t match. I didn’t have a residency spot. I was notified a few days prior to the official Match day. Panicked and humiliated I went through “The Scramble”. The administration office lends you a cubicle, phone, fax and a list of all unfilled positions in every specialty and you scramble to get a position in something…. somewhere. You spend a day calling programs and faxing transcripts through teary eyes. A close mentor told me to get to New Orleans because his best friend was a key member of one of the ENT departments there and perhaps he’d be able to open some doors for me. I managed to beg my way into a one year surgical internship in a New Orleans based program.
So that was it. Prior to all of this Elaine reassured me that we were married and she would follow me wherever we matched, except for Louisiana. Apparently their legal system is unique to the whole country and nothing she learned in law school in North Carolina really applied. For her to pass the Louisiana bar exam and get a job, she’d basically have to start from scratch. Nevertheless, amazing and brilliant Elaine was able to get a great job with one of the best firms in New Orleans. She’d have a year or two to take the Louisiana bar exam. I graduated medical school but stayed a couple of extra weeks to finish one of those ENT research papers. I kept the folder of rejection letters on my nightstand as fuel to keep working harder than I’d ever done before. While my classmates and friends were traveling or moving and settling into the next chapter, I spent the last summer break I’d ever have in our medical records department deep in the dingy basement of our hospital completing my work. After a few weeks I finished, packed up our stuff in a U-Haul and moved us to New Orleans.
I got pneumonia on the way.
I’ve never been sicker. Our first day in New Orleans entailed me fighting a raging fever, coughing up what felt like vital organs, and moving our furniture into our rental apartment- the upstairs of a beautiful home in the Garden District that had been made into a separate apartment. The house had been inherited by a young and friendly couple who lived downstairs on the first floor.
That first night was scarred by a typical, thunderous, tropical summer storm and a city-wide electrical blackout. Having barely any furniture set up, we slept in sleeping bags on the floor. Despite the summer humidity and heat, I barely slept from fever-induced shivering.
The blackout lasted into the next day. We finished moving in without A/C. After cleaning up we set out that evening to find a place to eat, which is only difficult because of the sheer number of excellent options in that city. We came back later having forgotten all our lights were left on from the power-out the night before. I noticed all the neighbor’s lights were off. We walked in to find no less than one billion bugs swarming around all the room lights. It was a furious hurricane of insects inside our new home. The beating of infinite tiny insect wings was audible. I thought they were moths. Frantically calling our landlords downstairs, I implored to know what was going on. He told me they were flying termites on their annual swarm, briskly commanding me to turn off all the lights, grab some brooms and start swatting. It was around this time while I was contemplating the hazards of what he’d just instructed us to do that Elaine had what seemed like a stroke. She just stood there, blank stare and mouth wide opened until one of the termites flew right into it. She barely coughed or puked but instead snapped back to life, spat it out onto the kitchen floor, spun around throwing her arms up in exacerbation and stormed out to the street. I was eventually able to coax her back into the house (partly by referencing New Orleans crime statistics) and we slept on the floor again wrapped tightly in sleeping bags despite the summer humidity. We could feel the bugs crawling all over our bodies. The only upside was that I barely noticed my febrile shivering this time.
The next morning brought more torrential rains and flooding. The water in front of our place was a few feet deep and people could be seen in suits with rolled up pants wading their way to work. There was a man in a canoe paddling his way down Napoleon Ave near St. Charles. We also made the discovery of cockroaches the size of small farm animals which invade homes in order to avoid flooding waters. This time Elaine was unable to abandon the mission and storm outside without donning a bathing suit or bringing along a floatation device so she instead opted to lock herself in the bedroom for a couple of hours to de-stress.
New Orleans welcomed us with all of its “charm” and like so many other feeble folk, left us ill, sleep-deprived and terrified. I remember at some point Elaine shaking me by both shoulders, pleading in desperation “Where the heck are we?! Where have you brought us?! What is this?! It’s the Apocalypse!” and then breaking into resplendent laughter. She was crying from laughing so hard. She grabbed me, wrapped her arms around my neck and kissed me. I could not have loved her more just then. We were in love and this was our adventure.
I took a one year position as an intern in surgery at Charity Hospital with the intent of reapplying to ENT and Anesthesiology as a backup. It was one of the busiest specialties at one of the busiest hospitals in the country. All the harrowing stories of internship are real. I’ve never seen and done so much. The hours were relentless and the work physically grueling. Home was just a place to shower, grab clean clothes, and head back to the hospital.
One time Elaine found me asleep in our foyer face down, still in my white coat. Weak and exhausted I literally crawled up the staircase to our apartment on my hands and knees and passed out on the floor, barely making it through the front door. My bag was still around my shoulders. I awoke to her frantically shaking me and screaming my name to wake up. She thought I’d passed out or died.
There was another time I came home to find Elaine, who was also putting in very long hours as a young attorney in a prestigious firm, in the kitchen cradling one of our decorative plants and weeping. I’d like to think that I can keep almost any sick and debilitated patient alive… at least for a little while. However, I readily acknowledge that plants are different than humans and I have the gardener’s thumb of death. I have tried and tried but alas, green things don’t fare well chez moi. Therefore almost all of the plants in our home are good quality fakes. We left one of them on a radiator near a window in the unabated Louisiana sun. It melted. As she pitifully sat there with this warped, plastic green thing in her lap, she somehow managing to laugh and cry at the same time declaring “Our home is so un-nurturing. We killed a plastic plant! How are we ever going to have kids?!” I couldn’t help but to hold her and cry and laugh along with her.
She was always so amazing in her love. I knew she was giving up so much and that I was providing very little emotionally. She never made me feel guilty. Her support was unwavering and so it became that I couldn’t and didn’t want to make any decision in life without her by my side. I couldn’t stand without my best friend by me. She was a constant source of encouragement and good counsel.
Despite the hard work and fatigue intern year was one of the best of my life. Perhaps it’s what people experience in war when deep bonds with fellow soldiers are forged in the trenches but all of us interns became brothers and sisters; suffering and supporting one another. We were so close in suffering and somehow having fun. I grew in my clinical confidence and realized that I am actually a good, honest, thorough and smart physician. I never felt that kind of confidence. Although my position was only a one year commitment my program asked me to stay on and complete a surgical residency. I still was applying to ENT and Anesthesia as my backup. It was a confusing time; unsure of what God wanted me to do. I really thought He had led me to ENT but every door seemed slammed shut.
Self doubt is a heavy burden. It’s an impossible task to have a fair and truthful assessment of oneself without the input of wise people who genuinely love you enough to be honest (Wise is the key word in that sentence). Some people are mired down by voices telling them they’re not good enough and they’ll never succeed. They are shackled to the ocean floor by insecurities. Others are over-inflated with conceit and arrogance that causes them to blow away in the wind. Neither are grounded. Both are lost.
And so during this season I learned that the best way to keep one’s feet on the ground is to be in a humbled kneeling position; to accept the gifts and talents I’ve been given with gratitude and to receive correction and instruction with enthusiasm. Some days you win and some days you lose and in both there are lessons to learn from the God who created us and knows us better than we know ourselves. It took me a long time to stop sleeping with the file of rejection letters on my nightstand. It was the last thing I saw before I slept and the first thing I saw in the morning. The fuel to redeem myself and conquer my embarrassment abated as I began to understand that paper folder to merely be the idol of my bruised pride and that my bruised pride was as useful to me as the 85 pieces of scrap paper it contained.
Eventually I came to a place in my life where I genuinely cried out saying “God, I’ll scrub toilets if that’s what you want me to do. Please just show me or lead me toward your plan for my life.” It didn’t happen overnight; hard answers rarely do but as the year went on I spent an increasing amount of time in the operating room and began to realize how much anesthesiologists actually do to navigate a patient through surgery. I came to understand that to take over and support a human’s most fundamental respiratory, cardiac and neurologic functions and maintain them through the insult of surgery is anything but boring. The sicker the patient and the more extensive the surgery, the more enhanced and rewarding the challenge.
It so happened that I interviewed for an anesthesia spot at Ochsner Clinic in New Orleans and then at the University of Florida. When I was at UF, Ochsner called and offered me a spot. The program director noted that she didn’t typically offer positions so soon and never over the phone but my ENT research really set me apart. Since we were already settled and Elaine was doing quite well in her practice, I accepted right then and there. I was outside of the medical school building at UF in Gainesville when I accepted my spot at Ochsner in New Orleans. Remember that fact. I only interviewed at two places for anesthesia. I was still unsure but decided to close the ENT chapter of my life. I think all the hard work I’d done to get an ENT spot served it’s purpose in getting me that anesthesia spot at Ochsner.
I started my anesthesia residency and hit the ground running. I was so fortunate to be there; it’s where I fell in love with anesthesia. It is a small but excellent community-based program. My mentors were phenomenal physicians and teachers that spent ample time teaching the practice and art of medicine. There was very little in my life that came intuitively or naturally but when it came to anesthesia, things just clicked. I loved it and was good at it. The endless array of patients and surgeries was never boring. There was a bunch of different types of procedures I was learning to perform as well. We would go from an eighty year old man undergoing cardiac surgery to a neonate having facial deformities repaired. Each time the medicine, thought process, procedures and administration of anesthesia were unique.
It was such a happy time for me. Furthermore, I also came to see that for a typical community based otolaryngologist (ENT) the bulk of their practice is very routine and consisted mostly of placing ear tubes and removing tonsils (Sorry to offend any of my ENT friends…. but it’s kinda true.) Although it was two years later then when I asked, the question for me was finally answered. I knew what I was supposed to do. I am so grateful for that time in New Orleans; it carried me through a very hard time that followed but I’ll get to that later.
One day during this time I got a call from Dr. K- the famous and eccentric otolaryngologist with whom I completed a research project in medical school. He was in New Orleans and wanted to take Elaine and I out to his favorite restaurant, the renowned Commander’s Palace. Allow me to paint a picture. The ENT department at my medical school is one of the most conservative departments in one of the most conservative hospitals in one of the most conservative parts of the country. I don’t mean to disparage them. They are phenomenal surgeons in their own right. However there is a definite good ol’ boy dynamic to the place. The only woman in that department arrived via gender reassignment surgery.
During my last year in medical school Dr. K realized he was in fact a woman and began pursing gender reassignment surgery. He attributed this to a hormonal contraceptive his mother took in the 60’s which “feminized” his brain. The gossip network in the hospital was ablaze. Not knowing all the nuances of the process I do understand that it is slow, well monitored and thorough. Before I graduated, Dr. K: a handsome, well built man in his 50’s- was still living as a man but had grown his silver hair out and was wearing make up and press-on nails. Although internationally renowned, the bulk of his practice served about 60 counties in western North Carolina and Tennessee; some real country folk. You can imagine the novelty of Dr. K. to these patients. At any rate, he continued his transformation and after almost two years, was near complete. Dr. K was in New Orleans as a part of that physical transformation process.
So we picked her up at her hotel. I was amazed at what an elegant lady she had become. Elaine was so gracious and insisted on sitting in the back seat of the car. After a short ride with fairly comfortable small talk, we arrived. Commander’s Palace is not only famous for its food but for its extravagant fanfare service. For brunch they typically serve a pre-set menu at specific seating times. We went to the 1:00 seating and had a lovely time. Toward the end of the meal Dr. K naturally excused herself to the restroom. After twenty minutes her absence was becoming acutely awkward. People were beginning to depart. After 35 minutes I asked Elaine to go in and check on her. She came back saying Dr. K was in a stall and said she was fine. After and hour we were the only ones left in the restaurant. They were setting up for the 3:00 seating. The maitre‘d asked us to wait in the waiting room. After an hour and fifteen minutes Dr. K came out, told us she must have eaten some bad oysters and walked on as though nothing happened. And that was it. Real life is stranger than fiction.
As it was, after a year of uncertainty and doubt, we entered a season in New Orleans of confirmations and celebrations. I was loving anesthesia, our marriage was solid and fun and things seemed to be on track. Even though things were tough and exhausting, they felt “right”. We were growing in all ares of life, making great memories and laying down paths based on our best plans. Eventually we could see through to the next chapter and began to plan for children, where we would settle and how our lives would look after residency. But just like God did so many other times, He drove home the lesson that we’re not in control of anything and our plans aren’t worth much. Little did we know everything was about to change.
I will continue with the story but I want to reflect on a few things. First, the overriding theme for me through those experiences was learning humility. Most people have a negative inference when they hear that word. I think they associate it with weakness, frailty or servitude. But humility is none of those things. It is the perspective of seeing the truth about ourselves the way we really are, realizing we are not in control of most things and not taking ourselves too seriously. I notice that when things are going our way humans tend to take all the credit and say things like “I knew I could do it. I deserve this. I did it my way.” But when life throws punches we are quick to blame the people and circumstances around us and cry out that the world and God are unjust. None of those things are true. We are but a breath on the face of the earth and the presence of darkness does not negate the power of light. Humility is accepting ourselves without inflation and without false pride and it is the precursor to adopting the willingness to change. It enables us to take responsibility for ourselves and our choices; especially the the poor ones. That is why a humble person is quick to accept correction and is therefore always improving.
I know I’m a smart guy who works honestly and hard. But that doesn’t entitle me to career satisfaction, a big home and a happy life. There are millions of guys just like me. It doesn’t mean people will treat me well or that my neighbor’s dog won’t shit on my lawn. Humility allows me to recognize that God gave me the undeserved gifts of intelligence and opportunity. It is my responsibility to make the most of those things. If He prospers it then it’s to His credit, not mine. Happiness is not an entitlement.
My job continuously humbles me. I may do everything right one day and all goes perfectly smoothly. The next day I may do everything right by the book again and disaster strikes; some unknown serious allergy or underlying cardiac problem or surgical misadventure. There is so much out of my control. I’ve learned in my heart to thank God when things go smoothly for reassuring my spirit. I’ve also learned to thank Him when they go poorly for the lessons of patience, preparation and perseverance.
For me Elaine is the most humble person I know because her sense of worth isn’t predicated on always being first or right. Her identity and strength doesn’t come from the gifts God gave her, it comes from knowing the giver of those gifts. What is more beautiful than a beautiful girl who doesn’t pride herself on physical beauty? Those are the ones who become even more beautiful as you get to know their personality. They are often the first to compliment the appearance of another. Elaine is like that. Because of her humility the good in her elevates everyone and everything around her. On the other hand, what is uglier than a beautiful girl whose source of self and identity emanate from the fact that she’s beautiful? She will be threatened when any other girl walks in the room because immediately that other’s beauty will make her feel less special, less unique, less worthy as a person. Often you will find her looking for ways to diminish by words or deeds the other.
What I’m trying to say is this- I really learned that I’ve been given many gifts in life: health, humor, intelligence and opportunity. But they are not there because I’m worthy or deserve them. I can do my very best, like when I was chasing ENT, and no doors open. God isn’t unfair. He used that rejection for a profound purpose- to get me to the point where I want His will for my life above all else. Back in medical school I would have never gone into anesthesia even if the angel Gabriel appeared to me with a big neon sign that said “Do Anesthesia.” I was too proud. I decided against anesthesia without really looking into it because I didn’t want to be like my father and because I didn’t like the anesthesiologists at my school. I thought I was better than both. God used what I thought I needed to get me to where I needed to be. It was my failure to match that took me to New Orleans, my ENT research that secured me a spot in a particular anesthesia program and my time in that particular program that carried me through a very tough season that followed. He humbled me and then I became grateful.
The second idea is that understanding and desiring humility helps me love people better. People are often reluctant to share the deep and dirty things in their life because they fear judgment. Most people may be intimidated by what they see as a perfect and immaculate house of someone else’s life and most people are happy to indulge the delusion that their house is in order all of the time. But the truth is that a house only gets clean by getting on one’s hands and knees, confronting the dirt and working hard to scrub it out. There is no dross in the soul that surprises me or is worse than mine. I am no better than anyone. Humility requires confronting one’s frailty, darkness and failures and humility allows you to accept the same in others. I can’t have a clean house until I acknowledge and deal with the dirt that’s accumulated in my house nor can I be useful to others until I begin that process. Dirt is dirt; mine and yours. I hope that really grasping this truth changed my demeanor and made it easier to connect with people. As I learn humility I hope the walls around hearts drop.
On the other hand, humility frees me from worrying about other’s approval or rejection because I’ve already accepted the truest and most unimpressive version of myself. I am critically flawed in so many ways and yet God still loves me. We love others because God first loved us. He loves us freely and not because we earned it or deserve it. It’s hard to reach out and connect with people if I’m worried about rejection all the time. But now I understand that there will always be those who disapprove of me. Even Captain America and the Pope have detractors and I am definitely not a superhero or a saint. It’s okay. It doesn’t make me less worthy as a person. There is a God in heaven who freely gives love and hope when we’re humble enough to accept it.
Finally, we can’t be grateful if we think we deserve every good thing in life and we can’t be happy unless we’re grateful. Humility opens the door for gratitude and gratitude is the foundation of joy. I’ve come to accept and find comfort in the fact that nothing in life is guaranteed; the outcomes of life are out of my control. The only things in my control are the choices I make but the outcomes are in God’s hands. Having the humility to accept a lack of control over the world around me and a lack of entitlement from life increases the capacity for gratitude in all the small wonders throughout the day.
I think God led me to ENT at first because it forced me to work harder and become better than ever before. I think the closed doors also served a profound purpose: to get me to the point where I wanted His will for my life above all else. I was humbled and from there grows gratitude and from gratitude grows happiness.
Perhaps this is Monday morning quarterbacking or looking for icons in ink spots but ultimately, does it matter? If reframing the past is done to provide meaning in a way that enriches life going forward, I see no downside. I think that’s the task of thinking and feeling people who want to live a purposeful life.
Well, in March 2005, Elaine and I went off birth-control thinking it would take about a year to get pregnant because of the type of contraception she had been using. Getting pregnant a year later would fit our planned timeline just perfectly. True to form, our plans weren’t worth much. It took only one month; she was pregnant by April. The weekend of August 27 brought us back to St. Petersburg, FL for our baby shower hosted by my parents. Hurricane Katrina hit New Orleans that Monday. After the first few days the medical residents were called back in teams to serve at Ochsner. I drove back to the city and served a couple of weeks. It seemed like a war zone in absolute devastation. The city was on lockdown. The military was everywhere. The water supply was contaminated. I knew we couldn’t have a baby there, especially since we were planning on moving to Tampa once I finished training. I called UF, where I had previously interviewed and they graciously opened a position for me, again citing all the ENT research I’d done. By October I was a full time resident at University of Florida with about a year and half left to graduate. So much for our perfect plans.
My transition was a difficult one. UF is a large and renowned academic program. A resident may go weeks without working with the same attending twice. It lacks the boutique-style learning environment in which I flourished in New Orleans. That coupled with very long hours and a general culture of “sink-or-swim” created a hostile work environment and a miserable training experience. Don’t get me wrong- I was extremely well trained. It’s an incredible medical institution with an esteemed Anesthesia department. I was just miserable during that time. I came to understand what it means to wake up every day and truly dread work. Each and every day I was fighting to prove myself; my worth. I was an academic refugee trying to re-establish my merit in a strange and hostile land. The confidence and personal growth I earned in New Orleans began to crumble.
I’ll go into more detail later but my son was born in January 2006 and ten days later my three year old niece was admitted into my hospital with a terrible brain tumor. So now I was a happy new father and loving uncle whose precious niece had a devastating and life-threatening brain tumor, hardworking but miserable resident, natural disaster refugee living in a bare apartment in Gainesville with a mortgage still to pay back in New Orleans. Later that same year our marriage shattered. Life came hard and fast and whatever challenges we’d worked through paled in comparison to what was about to come. The truth is I wouldn’t be alive today if not for these earlier lessons of humility, perspective and gratitude.