May 24, 2012

The Hunger Games

An funny email exchange between the (very tired) intern class of 2011-2012 (names have been anonymized):

"Dearest colleagues,

A very serious matter has come to my attention. On Sunday night I left
an unopened milky way bar on my nightstand in the girls' call room.
Today, I arrived to find it half eaten and still in the wrapper! Why I
ask you? Who stole it? Who enjoyed the delicious taste of the caramel
and milk chocolate?!

I must admit though I am secretly pleased because I would have eaten
it. And I need to lose like 20 lbs before I wear a bikini on vacation in the

Intern #1

"It wasn't me.  But I did think about it."
-Intern #2 (me)

It wasn't me, but by the time I got to my naps shift it was already open and half eaten and I was tempted to finish it off.
-Intern #3

"To add to the intrigue,

Two chocolate bars went missing from my personal clear plastic drawer several months ago. Far be it from me to suspect a fellow intern so I ran through other likely suspects. Dr. Attending?  She works like a machine and never seems to tire. It has to take tremendous energy input to keep her going.  What if an idle unguarded candy bar was simply too much temptation?  But no, she would have already bought dinner for us.  Dr. Doctor? I pictured him peeking carefully around the doorway, left and right, before emerging and running hastily down the hall, chocolate in hand, white coat tails trailing in the breeze, to devour my treasures out of sight.  But no, he doesn't move fast enough. He would have been spotted.  What about one of the pregnant upper level residents?  The curse of the cravings of pregnancy respect no boundaries.  Even the level-headed Resident1 or even-handed Resident2 may have succumbed.  But no. Even at the height of their pangs of hunger, I could not imagine them betraying one of their own fellow residents.

In the end, after observing the subtle body language of various employees of the hospital I have come to the firm conclusion that it could have been none other than Dr. ProgramDirector himself.  He has the perfect alibi. Who would ever suspect him?  Who else would be cunning enough, and daring enough, not only to take my candy bars  leaving no trace, but to eat HALF a candy bar, leaving the remaining evidence of his misdeed in broad daylight, sure that no one would suspect him.  I submit it could be no one else.

For the time being we must keep this to ourselves."
-Intern #4

"There was candy?  Where?"
-Intern #5

"Not anymore.  Dr ProgramDirector ate it."
-Intern #6

"F**** *&^*(*& a*$$*(*"
-interns 2, 3, 5, 6, 7, 8

A Brief History of St. Jude Children's Research Hospital

I recently visited with my mentor, Dr. Pinkel, and had the privilege of hearing his stories about the inception of St. Jude Children's Hospital, a place that has changed the lives of millions.  He tells me about getting cards from his patients who now have their own grandchildren!  The pride in his voice and love for his patients, even those he had fifty years ago, is so obvious. He is 87 years old this year, suffers from post-polio syndrome (he nearly died from the disease as a resident), and won't be around forever, I know.   I am so pleased to hear these stories, and share them here.

Danny Thomas recruited Dr. Pinkel to be the medical director of St. Jude, as he had started a pediatric cancer center where he had done his residency, in Buffalo, NY.  He refused.  He didn't want to move to Memphis, and Memphis didn't want the hospital there anyway.  Danny continued to call him, and he finally accepted the job after receiving some advice from his own mentor: "You're young.  If it flops, you can always do something else."  Don Pinkel accepted the job under two conditions.  The first was that the hospital would accept all patients, regardless of ability to pay.  The second was that it would be fully racially integrated, from the patients all the way up to senior staff.  A pretty controversial demand, for a Southern state in 1959.

As I sit talking to him, his wife, also a pediatric hematologist/oncologist, tells me she is preparing to go to Memphis for the 50th anniversary gala to represent him as he is unable to travel now.  The gala, which many celebrities attend, is to celebrate the hospital's first opening it's doors in 1962, and is specifically honoring the first five medical directors, of which Dr. Pinkel is the first.  He tells me in detail about the other four, who is still living, who is coming to represent each.  He tells me about the influential researchers he recruited to come to Memphis, how he wouldn't get off the phone with one young man- for seven hours- until he agreed to come.  How another man, a virology researcher, was eager to come to Memphis and study cancer after losing his wife at age 34 to a particularly virulent breast cancer. (At the time, they thought ALL came from a viral source mutating DNA.  Keep in mind how new of an idea DNA was in the late 1950s).

I am amazed by this history.  I'm laughing at his mentor's comment, that if it flops, he can always do something else- knowing the global presence of St. Jude's in 2012.  The thought that a virus caused leukemia.  The realization of how significant racial integration was at this time.  Everything he said, fit into the framework of today, realizing how different our framework might be had he done something else with his life.  

And I secretly wish I could go to the gala to represent him too, because I am so proud of him.  And also to meet Gwyneth Paltrow and Jennifer Aniston.  I just know we'd be friends.


I didn't want to see Dr Pinkel the last time I went home. It was October, and I was four months into my residency, struggling with this troublesome truth:

I wished I hadnt become a doctor.

Honest to God, if I could've taken back my four years, thousands of notecards, and literal house of debt, I would have.  It was so hard, and so unrewarding, and I was so unhappy. I remember hiking around the time of my graduation, looking at the green hills and flowers, excited about the new growth in my own life, the direction it had taken. I hiked the same trail again in October, and all the grass was brown and dead, the flowers were gone, and I was staring at the hills, resentful of how the flora reflected my life once again.  I wondered why I had done this, why I had thought it was such a good idea and the only direction my life should go.  Because it didn't seem now like it was such a good idea anymore.

And I didn't want to see Dr. Pinkel, disappoint him with this news that he had been wrong. He had seen a good doctor in me at twenty-one years old, had written a glowing letter of recommendation for me, and happily gave me a graduation gift of more money than I'd ever received at one time.  I respected him more than just about anyone I had ever met- this elderly man that had a career including finding a virtual cure for acute lymphoblastic leukemia and being the founding medical director for St. Jude Children's Hospital.  And now I was in town, and avoiding him.  I'm really sorry, I thought, and went back to work a few days later.

I just got back from visiting again, now in May, now  eleven months into my training.  I called him up the minute I got into town, and visited him the next day.  We had a nice lunch that turned into a three-hour chat.  I told him about my patients, my surgeries, all the things I can do now that I couldn't do the last time I saw him.  He told me about how in his time, GYN surgery was a fellowship from general surgery, and obstetrics was a very separate specialty.  Interesting.  He also told me about some pearls from his own training, like this story:

In the 1950s and prior, it was hospital policy that parents were only allowed to visit their children for a few hours each month.  It was thought that the families had made children sick, so they were limited in seeing them while inpatient.  In his medical school training, he watched families wave to their children through a window, standing outside.  As a resident, he let in parents and grandparents as much as they wanted, and paid hell for it, but eventually changed the hospital's policy.   He tells me about his graduating class, how there was not one woman at commencement.  They started out with six, he tells me, and five had a child and dropped out in their first year.  One made it to the senior year, and the professors/attendings/other students teased her for it.  But, she got pregnant too and left school before graduating.  How very different from today, where my class was split 45/55, and we intentionally have to look for men to join our OB/GYN program.

He also tells me about the inception of St. Jude Children's Hospital (this was so special, I thought it deserved it's own post.  More on this to come).

I am amazed by his history, realizing how he has indeed changed history.

And he tells me my life is important too.  That he is glad I became a physician, because we need more doctors like me.  What a compliment.

I go hiking again after I leave his house.  The spring growth is back on the hillside.  I am glad I became a doctor too.