During the first year of my residency in family practice in Maine, I came home to Los Angeles for Christmas. The climate switch in the seven-hour cross-country journey, from minus 10 to 86 degrees, didn’t trouble me as much as the prospect of getting together that evening with friends I had not seen since high school As my brother John and I drove south toward the floor of the San Fernando Valley, I posed the unsettling question.
“Since before I went to medical school, do I seem different to you?”
He reflected a few moments. “You have joined a kind of fraternity. You have been places the rest of us haven’t. There’s a part of you that the rest of us don’t know and may not understand. That puts some distance between you and us. But you still seem pretty much the same to me.”
More than 3700 college graduates had applied to enter UC San Diego’s School of Medicine class of 1989. UCSD invited 230 to spend the next four years at one of the finest schools in the country; 122 of us accepted the offer and arrived in La Jolla in September 1985.
Why were we chosen?
I had wanted to be a doctor since graduating from elementary school; I never seriously considered anything else. I did not have any doctor role models in my immediate family, but my chain-smoking, wisecracking, New York-bred pediatrician impressed me, as my mother trusted her more than anyone. For example, my inability to consume an entire cookie at age eight concerned my mother, as I was quite skinny then, even more so than I was upon entering med school, but Dr. Mont’s advice reassured my mother. So, in the manner of a great many premedical students before and after me, I had applied myself in a focused fashion to earning the Greek and Latin distinctions (Phi Beta Kappa, magna cum laude) and high numbers (3.8 GPA from Pomona College and a 10, two 11s, and three 12s on my Medical College Admissions Test) that would allow me a chance to obtain my M.D. To eight schools I had presented my credentials, my slender six-foot, four-inch frame (befitting my Dutch heritage), my similarly lengthy convex nose (Jewish ancestors contributed this), and my sincerest pledges to benefit mankind. UCSD extended the invitation and now, at age 22, my time had arrived.
Accompanying me was a diverse collection of individuals, including carpenters, philosophers, athletes. Mormons, Muslims, Catholics, Vietnamese, and Iranians, from places like Stanford, Harvard, Yale, and UCLA. We shared a common trait, which had written our admission ticket to UCSD: our proficiency as test takers. We had mastered the “art" of absorbing huge quantities of information in a short time and regurgitating it onto an examination paper. One might hope that, since we would become some of the most trusted members of society, whose daily decisions would profoundly affect people’s lives, we would also have distinguished ourselves with our honesty, reliability, and sound judgment.
Well, we had not and did not. Once during the first two years, our faculty announced they knew some of us were cheating on exams. They had us fill out an anonymous survey that asked if we had ever witnessed our classmates cheating. I never had, but after one exam my roommate, a test-taking star among stars who seemed out of sorts that day, confided that someone had looked at his answers. The faculty tried from the beginning to downplay competition, emphasizing that they considered each of us an “honors” student, and therefore all courses were graded pass/fail. (From this, we students derived “The Golden Rule of Medical School”: P = MD.) They shot themselves in the foot, however, by including “honors” and “low pass” distinctions in each course, which ensured that the incurably competitive would compete. Many of us competed just within ourselves. Others argued heatedly with professors during post-exam reviews about the fairness of questions answered incorrectly. Some, apparently, resorted to other means to improve their chances. I don’t think the faculty ever caught or disciplined anyone for cheating.
In many ways, we first-year students acted no differently than our undergraduate counterparts at UCSD. In fact, their professors provided almost all our first-quarter lectures in biochemistry and molecular biology. Our corner of the campus, its expansive, lush green lawns surrounding the gray-and-white concrete walls that enclosed our lecture halls, labs, and library, stood apart from the rest of the campus but did not particularly distinguish itself.
Our approaches to learning differed. Some of us attended every lecture, which during the first quarter meant eight hours of class three days a week and four hours the other three days (Saturday included), while others never attended unless it was mandatory. Many who showed up every day bored whoever would listen with complaints of long study hours; others would go to great lengths to hide the number of hours they spent over the books. The quantity of material we had to memorize required that we all work hard, but most of us found time to enjoy life in San Diego. I took a sailing course at Mission Bay in the spring, and many classmates pursued similar outdoor interests. We played intramural football, soccer, basketball, and softball and always finished at or near the top of the standings. Those of us just out of college threw parties, where we drank heavily and danced to “modern rock” (e.g.. Clash, Talking Heads, New Order).
I spent much of my spare time with a few single men in my class doing what they enjoyed doing: going to bars (the Elephant Bar, Carlos Murphy’s, the Belly Up Tavern, and others) to drink, dance, and pick up women. The latter, for me, was always a vicarious experience, because I never succeeded in picking up anyone at a bar (I stopped trying in 1986); several of my friends almost never went home alone. This was pretty frustrating; I remained a virgin until December 1987, narrowly averting a celebration of a quarter century of celibacy at my birthday party three months later. But my experiences in the bars of San Diego helped when I began my hospital clerkships at the start of my third year, because as frightening as a cross-examination by an attending physician could be, it never intimidated me as much as the women in the bars.