I’m deep into my final clinical rotation: Pediatrics. Peeds, for short. Not my favorite. Or as my dad says, “Little people, little dollah!” But that’s not why I don’t love pediatrics. Treating a child is like treating Fido. The patient has no clue why he or she is here. Why is that mean person in the white coat hurting me? And after the mean person in the white coat hurts me, why does he give me a sticker or a milkbone?
Today I have the joy of spending nine hours straight in the outpatient pediatrics clinic. Hour six. My thirtieth patient of the day arrives. Timmy. A three-year-old linebacker with a blond Mohawk. And he doesn’t exactly arrive. His mom carries him in, kicking, screaming, scratching, and howling. Par for the course. I’ve spent this entire rotation wrestling three-year-olds to the ground so I can look into their ears with my otoscope. Fun. And because I’m both obsessive and curious, I’ve kept track of the number of patients I’ve seen and/or wrestled during the rotation so far. Timmy makes 531.
I size Timmy up. He snarls, lunges. I back up. I’m not worried. I’m pretty sure I can take him. Pretty sure. He does have an advantage. He’s built low to the ground and he has long nails. His hands look like claws. I wonder if he has a lot of teeth. The last kid I went for sank his baby teeth into my forearm and locked his mouth there for thirty seconds before I could escape. My arm looks like a pin cushion.
Most medical students choose pediatrics because they love kids. At least that’s my guess. And most pediatricians are by nature calm, nurturing, and nonviolent. They start by trying to connect to the kids on their level. Meaning, bribery. They wear dorky cartoon-character ties and offer sheets of stickers up front. They tell corny jokes that the kids hate. They talk in high pitched cartoon voices, which usually scare the kids rather than soothe them. As a last resort, they lie. They tell the kid that Mickey Mouse has moved inside the kid’s head and Doctor Happy wants to look at Mickey and Minnie’s new condo.
Like any kid is going to buy that. Especially a kid like Timmy who resembles a midget ultimate fighter. No way I’m going the Mickey Mouse route.
“Okay, Timmy,” I say, bending over him with my otoscope. “I’m going to find Nemo now. Did you know he just moved inside your head?”
He slams his palms over his ears.
He glares at me. I regret the Nemo move. Fair enough. The idea of a Disney character lodged inside my skull would freak me out, too, even more than knowing I had an infection. I decide to go for total honesty.
“Timmy, okay, Nemo does not live inside your skull. Nobody does. All I’m going to do is take a quick look inside your ears to make sure that you don’t have any bad yucky gross gunk growing in there, okay?”
I step toward him.
He backs up.
I move left, he goes right. I circle right, he spins left. I fake left, go right.
I take him down. I scramble for my otoscope. Timmy squirms, but I’ve got him pinned.
Wait a minute? Have I lost my mind? What am I doing? He’s three.
So I’m straddling three-year-old Timmy’s chest. Somehow I manage to squirrel over and peer into each of his ears.
Damn. I was hoping for either beige or lobster red so I could call his ears clear or infected. Now I’m undecided. Worse, the glance into each of Timmy’s ears leaves me vulnerable. He grabs my stethoscope, holds it up to his mouth, and screams. My eardrums explode. I howl and loosen my grip. That’s all the daylight Timmy needs. He wriggles away and streaks toward the door. I reach from the floor, a conga drum sound pounding inside my head—bambada bam bambada baaaa—snag Timmy’s ankle and reel him back in.
“Timmy, I just want to see if you’re all right,” I say, the words banging against my head like a rap song. “I want, to, check, your, vital signs. It won’t hurt a bit. I promise.”
I try a reassuring grin.
Timmy growls and kicks me in the throat.
“Grrragh,” I moan. I fold my arms under his knees and wrestle him back down.
“Fun times, huh?” I say. “Okay, I’m going to count your heartbeats. You want to count with me?”
“You’re hurting him.” A tortured voice from across the room.
“I think it’s the other way around,” I say.
“I doubt that,” I mutter. “Kid’s a midget wrestler. A pro.”
I try my best then to hear his heart and lungs. Between Timmy’s wailing and the mom’s repeated complaints, I can’t hear a thing. I try to locate his pulse. Can’t. Resigned, I lean back and look at Timmy. The kid certainly seems lively, no sign of lethargy, even though I can’t track any vitals. At least not yet. I won’t give up. Two reasons. First, I’m in medical school and I’m extremely conscientious, bordering on dogged. Second, I don’t want to get marked down.
“Tell you what. Let’s take a five. Go to our neutral corners. Then you let me listen to your heart and lungs. Because if you don’t, I’m not allowed to give you a Lightning McQueen sticker when you leave.”
Timmy glowers. He stands at attention and gives me a serial killer stare. Then he sneaks the ace out of his sleeve. He drops his pull up, grins, and grunts.
“What? Oh, no. NO!” I yell.
“Timmy, don’t! Timmy!” The mom skids into view, her arms flailing toward Timmy’s tossed away training pants.
Code brown. Boom. Right on the exam floor.
Yeah, forget pediatrics.
Believe it or not, one of the more challenging hurdles we faced in writing IN STITCHES was coming up with a good title.
According to our brilliant publisher and editor, the right title means only everything.
A good title seduces you. It lures you to the book, commands you to pick it up and caress the cover, urges you to flip the cover over and read the luscious flap copy on the attractive jacket, then sucks you in and gets you to read a paragraph or two before closing the deal… convincing you to plunk down a mere twenty-five bucks and take the book home.
Or ordering it on Amazon for less.
Or downloading it on your E-book for even less.
All because of the title.
Because a good title elicits an emotion.
A good title is evocative; it reveals the nature of the book… the book’s tone… in potentially two words or less.
Our first title?
Short White Coats.
No, said our publishing team. Not good. Short White Coats? What is this, the memoir of a Good Humor Man?
We dumped that title and came up with the following—
So many, in fact, that it will take up two blog posts.
Read ‘em and weep.
And please don’t think less of me.
Here then, a few of the ones that didn’t make it and why:
-DR. T AND THE WOMEN
-SUPER SIZE ‘EM
-CODE BLUE: ELECTRIC SHOCK-OR-TWO (can anyone guess what this is from?)
-OOH, I WANNA STITCH YOU UP!
-LIKE A SURGEON: CUT FOR THE VERY FIRST TIME
-DOC AROUND THE CLOCK
-I LIKE D CUPS AND I CANNOT LIE!
-P-P-P-POKE HER FACE!
Reminds me too much of other books:
-TALES OF A MED SCHOOL NOTHING
-THE POKY LITTLE MEDICAL STUDENT
-DOCTOR IN THE RYE
-PORTRAIT OF THE DOCTOR AS A YOUNG MAN
-SWEAT, PRAY, GLOVE
-THE BOY WITH THE SERPENT AND STAFF TATTOO
Trying too hard to be funny:
-FUNNY BONES: LAUGHING, CRYING, SCREAMING MY WAY THROUGH MEDICAL SCHOOL
-EVERY DAY IS A SICK DAY (THANKFULLY)
-PANTS ON THE GROUND
-THIS WON’T HURT AS MUCH AS THE BILL
-THE FIRST TIME EVER I SAWED YOUR FACE
Just too Seinfeldian:
-AND THEY’RE SPECTACULAR: LIVING LARGE IN MEDICAL SCHOOL
So… we all agreed to go with IN STITCHES as our title.
It spoke to us. It seemed…
Provocative. Catchy. Memorable. And loaded with subtext. Says in two words that this is a book about a doctor—most likely a surgeon—and it’s funny.
Amazing that we struggled so long and so hard to find it. Especially with all of these wonderful suggestions that just didn’t quite make the cut—
Too movie related:
-THE 40 YEAR OLD SURGEON
-I SEE DEAD PEOPLE (AND OTHER MED SCHOOL ADVENTURES)
-I READ PLAYBOY FOR THE PICTURES
-THAT’S A STETHOSCOPE IN MY POCKET AND I’M HAPPY TO SEE YOU
-TALES FROM THE SILICONE VALLEY
-PLAYING DOCTOR: THE NAKED TRUTH ABOUT MEDICAL SCHOOL
The rest of these just don’t quite work:
-FUNNY BONES: LAUGHING, CRYING, AND SCREAMING MY WAY THROUGH MED SCHOOL
-CUT UP: FROM MEDICAL SCHOOL ZERO TO PLASTIC SURGERY HERO
-FOOL ON THE PILL:GETTING A CLUE IN MEDICAL SCHOOL
-THIS WILL HURT A BIT
-WARNING: THIS BOOK HAS BEEN DOCTORED
And one last one which ALMOST made it:
-TRUST ME, I’M ALMOST A DOCTOR
And these are the ones I dared allow myself to print!
Well, if there’s a sequel, an IN STITCHES 2, at least we’ve got a couple dozen titles to start with—and reject.
Unless you have a suggestion for a title that’s even better than IN STITCHES. Or for the sequel. What might it be? Let me know!
A word of advice.
In med school and in life, it’s good to know who’s in charge.
Year three. Clinical rotations. The hospital.
In my short white coat, I pick at a questionable Chinese chicken salad in the hospital cafeteria with Dr. Yomama (a made up name).
“So, Tony,” he says, dabbing at some mustard that’s clumped and hardened at the corner of his mouth like a mole. “Who’s in charge?”
I have no idea what Yomama is talking about but I don’t want to seem like your typically clueless third year so I stall. “By in charge, you mean what exactly?”
“By in charge I mean in charge. In the hospital. Who’s the boss? Who runs the place?”
“Oh, sure,” I say. “Well, okay—”
I clear my throat, stall some more. Is this a trick question?
“You have no idea, do you?”
“Yes, well, no.”
“This is important, Tony. You have to understand the hospital hierarchy. Take a shot. How do you think it goes?”
I lean back in my chair. I study Dr. Yomama’s face, looking for a tell. He’s not giving me anything. I decide to go for it. “Well, obviously, at the top of the food chain you have the attending physicians, you guys, the gods, the kings of the mountain.”
“Nice,” Yomama says. “Keep going.”
“Then you have your resident physicians, gods-in-training.”
“You’re on a roll.”
“Then comes the interns, followed by us, the medical students. Below us you have the nurses, then the pharmacists, unit secretaries, nurses’ assistants, pharmacy students, cafeteria workers, and the cleaning crew.”
“Wow,” Yomama says. “Impressive.”
I beam. “Thanks.”
“Impressive. And totally wrong.”
I blink in disbelief. “Really? I’m off?”
“You’re not just off, you’re barely in the same hemisphere.”
“Well, who runs this place?”
Dr. Yomama balls up his napkin and shoots it like a foul shot into a trash receptacle ten feet away. “Come on. I’m gonna introduce you to the boss.”
I ride the elevator with Dr. Yomama. The doors hiss open at the third floor and Yomama springs out and sprints down the hall. I match him stride for stride. He pulls up at the nurses’ station. He smiles at a woman on the phone. She wears lime green designer glasses and her short cropped silver hair peeks out of a raised white hat that makes her look like a head chef. Her nametag reads: “Victoria Zwirko, Charge Nurse.”
She nods at Dr. Yomama and holds up her index finger. She finishes her call, folds her hands in front of her. “Hello, Doctor.”
“Hello, Vicki. This is Mr. Youn. Third year. He’s curious. He wants to know who runs the hospital.”
“Oh.” Vicki shrugs. “Me.”
I fight back a smile. Yomama and Vicki are obviously playing me.
“Well, to be more specific, the nurses,” Vicki says.
Yomama hits me now with a different smile, a smile that says, I am being real. This is how it really is.
He turns back to Vicki. “Help me out. I don’t know what to do with the patient in room two fifteen.”
“Lasix twenty milligrams.”
“Great. Take a verbal order for Lasix twenty milligrams and I’ll sign it later. Thanks for having my back.”
They fist bump.
Nurse Zwirko cradles the phone receiver against her ear and waves at Yomama. We head down the hallway.
“So she’s in charge?”
“Yep. Most of the time nurses hit us with pages that are rhetorical. They know what to do but they need our blessing. Doctor, would you like to give the patient a stool softener? Come to think of it, I would, yes, thank you. Doctor, would you like the patient to have Ibuprofen? Yes, exactly. Many interns are too full of themselves to ask a nurse what to do. Big mistake. They learn the hard way.”
“The nurses run the hospital,” I say, trying it on.
“Make it your mantra.”
“So, the hospital hierarchy, can I give it another try.”
Yomama grins. “You’re gonna need a little help. May I”
“Top of the heap you have your benefactors, the people with more money than God, who have buildings named after them. Then you go to the hospital administrators, the people who decide what to do with the money the benefactors give the hospital. They make all the important decisions, decisions that may not always be in the best interest of doctors and patients. Your turn.”
I tick them off on my fingers. “Attending physicians, nurses…”
Yomama nods vigorously. I continue. “Residents—”
“Then pharmacists,” Yomama says.
“Then interns,” I say. “Unit secretaries, then med students, right above nurses’ assistants, the other students, cafeteria workers and cleaning crew.”
“You got it,” Yomama says slapping me on the back.
“The nurses run the hospital,” I repeat.
“Never forget it.”
I never have.
For those of you who may wonder, yes, I did go to medical school.
I attended Michigan State University College of Human Medicine, the setting of much of IN STITCHES. Why Michigan State? Well, for one reason, they let me in.
Actually, I applied to several medical schools and got accepted to most. There was one school, though, that I applied to and received neither an acceptance nor a rejection; I never heard from them at all. Just as well. I didn’t want to go there anyway. Too far from home, too rigid a program, and the medical school interviewer freaked me out. Here’s that interview.
Oh, the school? I can’t tell you. Let’s just call it Case Eastern Reserve.
I can’t get over this guy’s cred—the wall of his office is plastered with diplomas, awards, certificates of excellence, framed yellowed scientific journals containing articles he wrote, and pictures of him shaking hands with four different Presidents. You’d think he’d rate a bigger office. This is the size of a closet, dingy, dominated by a cruddy old desk, one visitor’s chair with the stuffing spilling out, and a lone smudgy window overlooking a dumpster.
We’re four minutes into the interview and so far all he’s talked about is himself, his career, his accomplishments, spoken in a mumbled garbled voice as inviting as someone trying to clear a throat full of phlegm. I felt nervous for the first two minutes, now I’m bored and planning my escape.
Then I notice his eyes. They go off in opposite directions. His right one’s looking at me, his left one’s looking out the window. Where do I look? I alternate and feel like an idiot. I choose the wall behind him where I focus on a photograph of my interviewer, much younger, shaking hands with a confused, stone-faced President Ford.
Finally, he speaks.
“Hmpf,” he says, rustling through a folder that I assume contains my application. “So then, Mr. Young.”
“Youn,” I say. “It’s Youn.”
“Ah,” he says. “Hmpf.”
Is it hot in here?
The interviewer yanks off his glasses and drops his head an inch above my folder. He squints at my transcript.
“Hmpf,” he says. “Your GPA. 3.94. Impressive.”
I whistle out a breath. The interview is turning around.
My friends were right. You have to relax during your interview. The application process is a crapshoot and the interview is only a small part of that process. It’s unlikely that these fifteen minutes are going to make any difference, unless you’re a superstar or a freak. You are only guaranteed admission if you’ve discovered the cure for swine flu, escaped from a communist country in a small boat when you were four years old, won the Gold Medal in figure skating at the Olympics and you only have one leg, or your father paid for a couple of buildings at this particular med school. I’m sitting here 0 for 4, so I might as well relax.
“Unless you’re a star, don’t stand out too much,” my friends have said. “Fly under the radar. Appear hard-working, sincere, and personable. Interviewers are screeners. They’re looking for a red flag—applicants who shout obscenities, political slogans, or drool on their shoes. So be cool and try not to piss the guy off.”
“So, 3.94, huh?”
“Yes, sir,” I say.
“Top five percent of your class.”
I smile modestly. “Only two B’s in my entire four years of college.”
“What happened there?” he grunts. “Why not all A’s? Why not a 4.0?”
My smile sinks.
Dr. Evil slaps my folder. “And your MCAT scores. An 8, 9, and 10. Are these right?”
“Um, yes— ”
“Did you actually study for the MCAT?”
“I thought I did. I bought several review books.”
“Maybe you should’ve considered taking a review course.”
“Apparently,” I mutter.
“Well, a lot of people do poorly on standardized tests,” he says. “Few of them become doctors.”
He folds his hands and leans across the desk, one eye staring at me, the other looking off into space.
“So, tell me, Mr. Young, how do you plan on serving humankind?”
It is hot in here.
The interviewer blinks. Well, one of his eyes blinks. I can’t see what the other eye is doing. He waits for my answer.
“I’ve thought a lot about how I want to serve humanity,” I say, leaning in, meeting his stare with a grave look of my own. The truth is I’ve been preparing a list of key touchy-feely responses to this question for weeks. I let them fly. My mouth starts moving and I hear myself blather “family practice,” “rural,” “Appalachia” “the less fortunate,” “the homeless,” “inner city,” “free clinic,” and, my favorite, “I have a need to give back.” I stifle the voice in my head, the one I use with friends when we satirize this very moment, the one that threatens to blurt, “prescribing privileges,” “six figures,” “nice car,” “hot chicks,” “won’t accept Medicaid,” and “breast augmentation.”
Dr. One Eye keeps his one eye trained on me.
“You have a need to give back. A need.”
“Well,” I say, “A desire. Maybe that’s more—”
“Allow me to peruse your personal statement.”
Great. This guy hasn’t even read my application. He rifles through my folder, nods at a page, finds my photograph affixed to the corner and compares that face to mine, confirms that the photograph is indeed me, lowers his eye and begins reading—for five full minutes. I squirm in my chair, my eyes tracing the veins on his bald spot as he labors over the most dreaded part of the application. Took me hours to write the personal statement. As cautioned by my friends who applied last year—you have to become noticed without going over the top. You want to appear memorable, in a good way. If you’re up for a Nobel Prize or climbed Mount Everest, be sure to squeeze that into your personal statement, but always connect it to medicine. As I reached the summit of Everest, I thought about this unfortunate handicapped child I met while volunteering at the clinic—
“I find the personal statement the most telling part of the application,” my inquisitor says without looking up. “Ah, yes. Hmm.”
Hmm? I crane my neck to see what’s caused him to hmm.
He raises his head and looks at me with the slightest hint of a smile.
“Fascinating,” he says. “So you were a Candy Striper.”
“Yes, ah ha, for two years, in high school.”
“Two years.” He slowly closes the manila folder of my application as if shutting a door.
“Hmpf.” My aging wall-eyed interviewer frowns and waves a hand in front of his nose as if he’s smelling a carton of milk that has turned. “Do you have any questions for me?”
He tips his head to one side doubtfully, his right eye focused on me, his left eye staring at the ceiling.
“I do,” I say. His mouth flutters in surprise.
Thanks to my friends, I’m more than ready for this one.
“They always ask you if you have questions. We know that you don’t care if the medical school has opportunities for you to conduct bench research on mice. We know that you don’t care if there are volunteer positions available to work at indigent clinics during holiday breaks. We know you don’t care if there is a medical student suture lab. We know that like most med students you care only about passing your classes, eating, sleeping, and getting laid. Pretend you care. Prepare a question.”
I Googled this guy last night and found out that his research specialty is liver enzymes. I ask him about his research. That’s all it takes. He’s off and running. Dr. One Eye waxes rhapsodic about abnormal aminotransferase levels and alkaline phosphatase elevation for what seems like an hour. If a kitchen timer doesn’t beep in his battered leather briefcase, he’d still be going.
“Well, hmpf,” he says. “I have so much more to say on the subject but I’m afraid that annoying beep signifies that our time together has lapsed. I believe you’re scheduled to have lunch now with a second year medical student who will give you the real inside scoop. Ha. Well, it has been a pleasure, Mr. Youn. You are an impressive applicant.”
He pumps my hand as if I’ve just offered to fund a new wing in the administration building. Whew. Talk about completing a Hail Mary pass as time expires. I’ve aced this interview in the last possible second while learning an important sociological lesson:
The sweetest sound to anyone—even to an egomaniacal blowhard, especially to an egomaniacal blowhard—is the sound of his own voice.