Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 22: Career Day
May 18, 1990, Rutherford, Ohio
On Friday, I left the house very early so I could make it to Harding County High by 8:00am for Career Day. I arrived about ten minutes early and went to the Guidance Office as Mrs. Kopech had directed when we'd spoken.
"Good morning, Mike!" she exclaimed. "Or, Doctor Mike, I should say."
"Either is fine," I replied.
"Ready for the eager students?" she asked.
I chuckled, "I was one nine years ago, and unless something has radically altered the universe, most Juniors in High School aren't eager for anything to do with school!"
"When did you become a cynic?" Mrs. Kopech asked.
"Not a cynic; a realist!" I said with a grin.
Mrs. Kopech laughed, "There may be some truth that, but all three of your sessions will have the full complement of twenty, and your lunch was oversubscribed."
"How many at lunch?"
"Only six; those students won't be in the other sessions. If anyone is sick today or drops out of the lunch, I have five waiting. Those are basically the eleven who have a serious interest in medicine. The rest, I can't say."
"Is there any way to have all those students at lunch?" I asked.
"Unfortunately, no, because we have limited space, and the lunch is catered."
"Then, if possible, let me know who those five are, and I'll see them during one of the breaks between sessions. Obviously, those are the students on whom I should focus."
"I'll give you a complete list of the eleven with the six for lunch marked and the others marked with their session."
"That will help. Are the eleven all in the top twenty-five of the class?"
"Nine are. The others are just outside of that range. I know it's predictive, but I also know ACT and MCAT scores are much more predictive."
"That's true. What's the ratio of male and female?"
"About even," she replied. "Not like when you were here when it was about 70–30."
"Good. Who are the other big draws?"
"Ken Louden, who graduated with you, who's an attorney in Washington, DC, and Tracy Matthews, who graduated a year after you, who works for Apple Computer in Silicon Valley. Ken clerked for a federal judge in New York for a year before joining the firm in DC. I tried to get Dale Melrose, but he wasn't available to fly in."
"That's too bad," I replied. "I'd have liked to see Dale."
Jocelyn had turned down a request because she was struggling to meet her 'billable hours' as required by her firm. I knew from Melody how tough that could be, and between the baby and work, Jocelyn had almost as little free time as I did.
"The Juniors are in an assembly until 8:05am," Mrs. Kopech said. "You're in room 208. Can you still find your way there?"
I chuckled, "I think I can find the chemistry classroom! Thanks."
"There's coffee in the lounge next door. I'll write out your list while you get some."
"Thanks."
I left her office and went to the teacher's lounge, a place where I had never set foot during my four years at Harding County High. It wasn't all that different from our lounge at the hospital — a fridge, some couches, a table and chairs, a coffee machine, and a TV. I poured coffee into a twenty-ounce cup, put on a plastic lid, and went back to get the student list from Mrs. Kopech. I quickly scanned it and saw it was six girls and five guys, with the lunch being four girls and two guys. I thanked Mrs. Kopech, then headed for the chemistry classroom.
"Hi, Mr. Novak," I said when I walked in.
"I'd call you 'Mr. Loucks' for old-time's sake, but hi, Doctor Loucks."
"I go by 'Doctor Mike' professionally," I replied.
"You should call me Ken when students aren't around."
"OK. How have you been these past nine years?"
"Still looking for another trio of friends who battle to the final for that last point! Do you keep in touch with Miss Mills and Mr. Melrose?"
"I do. Dale is in Seattle and works for Boeing; he's married. Jocelyn is an attorney in Columbus; she's married and has a son."
"We all heard about what happened with you; my condolences. I understand you've remarried."
"Thank you. Yes, I did remarry, and my wife and I are expecting a daughter next month."
"Congratulations!"
The bell rang, and about two minutes later, students started filing in. The first thing that hit me was how young the Juniors looked. It was obviously a matter of perspective because they probably looked the same as the Juniors had when I was a Senior, but that was nine years in the past, which was a LONG time at sixteen or seventeen. In this group were two of the students who hadn't been able to sign up for lunch, and I made a mental note to invite them to stay during the fifteen-minute break between sessions.
"Good morning," Mr. Novak said. "I'd like to introduce Doctor Michael Loucks, who graduated from Harding County High in 1981. He's a trauma surgeon and is currently working at Moore Memorial Hospital in McKinley. Doctor Mike?"
"Thank you, Mr. Novak," I said. "Good morning! Ten years ago, I was sitting where you are, listening to Doctor Mark Winslow, who has since finished his Residency and is now a surgeon at Yale New Haven Hospital. If I leave you with one thought, it is that the study of medicine is the most challenging endeavor you will ever encounter, short of the Navy's Top Gun school or astronaut training. It requires complete and total dedication, and, as my fellow medical students agreed, medicine is a harsh mistress who brooks no other gods before her. None.
"During the first two years of medical school, you'll go to class and study a total of twelve to fifteen hours per day. During your clinical rotations in Third or Fourth Year, you'll work sixty to eighty hours a week, often on twenty-four-hour shifts. That does not include study time. Interns, that is, doctors who recently graduated from medical school, work anywhere from eighty to ninety-six hours a week, often on thirty-six-hour shifts.
"If you aren't prepared to do that, find another career. If you are prepared, you will enter one of the most rewarding careers, dedicating your life to serving society with the healing arts. People will look to you to literally save their lives, and you will. People will look to you to ensure children are born healthy and stay that way as they grow into adulthood. The white medical coat announces to the world 'Come to me and be healed!'.
"I'm positive the last thing any of you wants to hear is a lecture or a rote presentation. Instead, I'll give you a very brief outline of the steps to becoming a doctor, then take your questions.
"In short – earn top grades in High School and college; score well on the MCAT — the Medical College Admission Test; spend two years mostly in a classroom environment in medical school; pass the first step of the MLE – the Medical Licensing Exam; spend two years in clinical rotations, mostly in hospitals; pass the second step of the MLE; Match for a Residency; serve your Residency of two to ten years, depending on your chosen specialty; and finally become an Attending physician.
"My chosen specialization is, as Mr. Novak said, trauma surgery, a relatively new specialty that combines emergency medicine, that is, working in the Emergency Department or ER, and emergency surgery. I'm the first trauma surgery Resident at Moore Memorial. Now I'll take questions. When I call on you, stand and give your name first."
Several students raised their hands, and I called on the one furthest back in the room.
"The young woman in the red sweater in the back," I said.
"Penny Thomas," she said. "Those hours you gave are really true? Thirty-six-hour shifts?"
"Yes. A few hospitals have changed to set the maximum at twenty-four-hour shifts and eighty hours a week, but very few."
"That's crazy!"
I nodded, "It is, but as my friends and I all said, we wanted into the guild, and the current guild members decide the rules. Whether you like it or not, whether it's crazy or not, it is what you will have to endure to wear this long white medical coat."
"Is it OK to ask another question?"
"Yes. Each person can ask two questions, and then I'll call on someone else. We'll cycle back if there is enough time."
"What's the strangest thing you've had to do?"
There were smirks and chuckles, and I was sure they were looking for a 'something in the rectum' story, but I had a better one, at least from my perspective.
"I delivered a baby in the Emergency Department to a seventeen-year-old girl. That's never supposed to happen, but it did."
"If I might interrupt," Mr. Novak said. "How did that happen?"
"The OB/GYN department was shorthanded and overloaded. The paramedics brought in the young woman in active labor, and we should have had plenty of time to get her to OB, but the baby had other ideas! The combined circumstances led me to deliver my first — and hopefully last — baby! The young man in the R.E.M. T-shirt."
"Bob Cassidy," he said, standing up. "What's the worst part of being a doctor?"
"Having to tell someone that their loved one has died. A close second is seeing battered children."
"Were you at the hospital when the guy shot those doctors?"
"Yes. I was in the treatment room where the deputy was killed," I replied. "The two doctors who were shot are close friends. One is completely healed and back to work; the other is undergoing rehab for a spinal injury. The young woman in the royal blue blouse."
"Janet Brooks. Have you performed surgery?"
"First, I have to say it's almost unheard of for a PGY1 — that is, an Intern or First Year Resident — to touch a patient in the Operating Room. Because my training program is brand new, I've had opportunities most Interns don't have. I've done two appendectomies from start to finish and assisted on several other surgeries.
"More often, I do surgical procedures in the Emergency Department — pericardiocenteses, thoracostomies, and central lines. A pericardiocentesis is removing fluid from the sac around the heart with a needle; a thoracostomy is an incision to insert a tube into the chest to re-inflate a lung; a central line is a large-bore IV placed into a major artery in the chest, neck, or groin."
"When do doctors usually get to operate?"
"Usually during the third year of Residency," I replied. "The young woman in the yellow sweater."
"Alyssa Scott. What was the hardest part of medical school?"
"Anatomy class, where you do a complete dissection of a human body. That's during First Year, and about 15% of the class dropped out or were asked to leave before the end of the year."
"Because they couldn't handle it?"
"Some, but also because of the amount of material you have to commit to memory and be able to recall at any moment. It works out that about 30% of the students who enroll in medical school do not become practicing physicians."
"Almost a third?" she asked.
"Yes. In my class, we started with 129. Fourteen people had dropped by Thanksgiving. By the end of my Fourth Year, we had just over a hundred who graduated. Five of those failed to find a Residency slot. The young man in the blue Oxford."
"Joe Voight. What were your GPA and test scores?"
"I finished third in my class with a 3.975 GPA here at Harding County High, scored a 34 composite on my ACT, and 1560 on my SAT. I attended William Howard Taft and graduated with a 4.0 GPA. My MCAT score was in the 98th percentile. On the first step of the MLE, I scored in the 99th percentile. On the second part of the MLE, I scored in the 99th percentile. I graduated first in my class, and I Matched to my first choice of programs."
"Holy shit," I heard a barely audible male voice say.
"You might want to apply yourself more, Mr. Rollins," Mr. Novak said.
"Mr. Novak is not wrong," I said. "If you don't, you'll never make it through medical school. You'll also need to find an equally dedicated study group, and you had better like them, because you'll be spending at least ten hours a day with them between class and study periods. The young woman in the pink blouse."
"Melissa Corbet. Are you married?"
The entire group broke out laughing, some whistling, others hooting.
"I didn't mean it like that!" Melissa protested. "I was wondering because of the time he said he spent studying and working."
"I am married," I replied. "I also have a daughter, and one who will be born next month. To be honest, I don't have enough time for them. It takes a special kind of person to put up with the ridiculous demands medical training places on you, and it's tougher for women because medical training makes no allowances for having a baby. Most women who become doctors delay having children until after they complete their Residency."
"Excuse me, Doctor Mike?" a young woman said.
"Yes?"
"Vickie Johansen. Is what my sister said true?"
"Is your sister Violet?" I asked.
"Yes."
"What did she say?"
"That your wife died the day your daughter was born."
I nodded, "That's true. I was a single dad for about sixteen months, then remarried."
"Is it OK to ask what happened?" another girl inquired.
"Your name?"
"Beth Evans."
She was one of the ones who hadn't been able to reserve a spot at lunch.
"She had a congenital defect in blood vessels in her brain. It was undetectable with the technology we had at the time, and even if it had been detected, it could not have been fixed. It was, in effect, a ticking time bomb of which nobody was aware."
"You were in medical school then, right?"
"Yes. I had just started my clinical rotations during my Third Year a few months earlier. The young man in black."
"Johnny. Johnny Cash."
A number of students laughed, and I just smiled.
"Try again, Mr. Thompson!" Mr. Novak said.
"Pete Thompson," he said. "What's the funniest situation you've encountered?"
"First, Pete, do you play guitar?"
"I do."
"Me, too. I'm not sure if I'd call it funny, but you'll laugh – treating a dozen students from Taft after someone spiked brownies with Ex-Lax."
The students did all laugh as I'd expected they would.
"Again, not funny from the patient's perspective, but retrieving a 'lost' condom."
"Lost?"
"Work out for yourself where they lost it and from where I had to retrieve it and the very bad news I had to deliver."
There was laughter and some blushing.
"Oh, man, that would suck!" he said.
"It would pretty much ruin your whole day, that's for sure," I agreed.
"Was she pregnant?"
"I have no idea. And that's an important part of my specialty — I almost never know what ultimately happens to patients. My job is to treat them and release them, or to stabilize them and turn them over to another service. In the case where I release them, I refer them to their personal physician for follow-up. In the case where they're admitted to the hospital, they are no longer my concern because other doctors take over, and I have to focus on the next patient coming into the Emergency Department. The young woman in the white, long-sleeve shirt."
"How many people have you seen die?"
"Quite a few. I don't keep count. The challenge is not allowing it to interfere with your treatment of the next patient. It's tough, but you have to put it out of your mind and focus on your job."
"But how?" she asked. "I mean, seeing someone die? And just forgetting it?"
"I'll tell you what my mentors told me — if your personality doesn't allow you to simply set it aside and move on, you don't belong in the Emergency Department. I know it sounds crass, but if you present at the hospital in need of my help, do you want me focused on you, or focused on the patient who died?"
"Uhm, me," she replied.
"There are specialties where a physician encounters very few deaths — pediatrics, OB/GYN, internal medicine, and family medicine. In the Emergency Department, they're basically an everyday occurrence. Counterintuitively, the introduction of Fire Department paramedics and dedicated trauma centers has actually increased the number of people who die in the hospital."
"How?" she asked.
"Before EMS, many heart attack patients died where they had their cardiac incident, and many accident victims died at the scene. We absolutely save more lives, and fewer people die from accidents or medical emergencies overall, but more of them die in front of a doctor than in the past. The young man in the black and white rugby shirt."
"Mike Wilson. What hours do you work?"
"Right now, from 5:00am to 9:00pm, Monday through Friday. In addition, I carry a pager because I'm on-call at all times. That's actually a very good schedule for an Intern, and is the result of the confluence of a number of factors. In September, I'll switch to five twelve-hour days, but I'll still be on-call."
"What about vacations?"
"I could answer by asking, 'What are those?'" I replied with a grin. "At a minimum, there are no breaks once you start your clinical rotations — hospitals do not close for holidays or weekends. In addition, most Residency programs do not allow time off during your Intern year. McKinley Medical School is typical in that once you begin in August of First Year, there are no Summer breaks, and you typically have only a few days off at Christmas, as well as Thanksgiving Day.
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