What Could Possibly Go Wrong? Leaving Medicine–The First Time

After the third month of my neurology residency in Chicago, I took a trip out to New Mexico and never came back.

No one leaves medicine. It’s just not done. Or rarely. There was the guy in my medical school who was so twisted, that even after repeated reprimands for being inappropriate with female patients and colleagues, he couldn’t get it together. Though not by choice, he left. Or the anesthesiology resident found dead of an overdose in his call room, a surreptitious IV catheter still taped to his ankle. He left. These were the role models.

I had fantasized about leaving medicine for years. By my second year of med school, I had the feeling that I had boarded the wrong train, but I kept on clunking down the wrong track, hoping things would improve as I passed into each new stage of training. Things would be better when I was in the clinical years. Clunk. Clunk. When I get to my internship. Clunk Clunk. I couldn’t find the strength to leave something that seemed so successful, even noble. Anyway, the ticket had been so exorbitant, and soon so many miles had flown by that getting off was simply not an option.

Fortunately, I had developed an arsenal of healthy coping strategies that allowed me to endure the ride, the cornerstone of which, sitting alone on the roof of my building drinking orange jubilee mad dog, invariably left me sharp and focused for the following day’s challenges.

Then something happened. I met Hatbox Louie during my internship. She was in graduate school in Santa Fe. Love made me confident and hopeful and things began to look different.

Three months into my second year of residency I had a two-week vacation and flew out to New Mexico to spend time with Hatbox Louie. On a whim, after knowing each other just a few months, we were married in the town of Espanola: the low-rider capital of the world. The courthouse was also the jail and the community center. We waited in line behind a guy contesting his DUI charge. The judge and our witnesses — the bailiff and the court clerk — all had the same last name. Driving back to Santa Fe we were giddy. We ate popsicles. We were crazy. It was fantastic. Together we could do anything. And right then I knew I could get off the train. Everything had changed, just like that.

I called the head of my neurology program back in Chicago to say I would not be returning. He seemed concerned that I had slipped into a very dark and insane place. No matter. I felt better than I ever had. Hatbox Louie and I wandered Santa Fe’s meandering streets under huge fluffy snowflakes. I shut my eyes and gorged my senses on the wafting smoke of piñon and cedar hearth fires. I felt alive. I was free. I was in love. What could possibly go wrong?

While in medicine I had always been plagued by a sense of life passing me by. My friends from college were in the Peace Corps or teaching English in the highlands of Peru. I saw others out there agitating for social justice, while I picked away at the rubbery sinews of my cadaver, and played yes-man to whomever happened to be one notch above me in the rigid hierarchy. I decided I would join what I saw as a young army of committed people determined to change the world.

I found an organization in San Francisco that sounded just my speed: The Action Coalition for Global Change. I couldn’t quite piece together what they actually did, but it sounded lofty. And San Francisco seemed a promised land of progressive action. I called the director and she agreed to meet with me when we got to California. It was all working out.

I arrived early for my interview. I paced outside, checking my watch every twenty seconds or so. When the time was right (leaving an extra two minutes in case of the unexpected) I entered the building. The ceilings were high, the corridors wide, the wood dark and good. It felt like an old courthouse and a bit like Cook County hospital. I found the office with the coalition director’s name on it. The door was open and the room was empty. I looked at my watch. I was exactly on time. Gazing across the hall, I noticed another room with a meeting obviously in progress. Ok, so she’s in a meeting. They’re planning the reparation of the globe. These things take time.

I slipped past the meeting room to find an inconspicuous waiting spot down the corridor. I stood next to a partially opened door and heard voices within. Peering through, I caught a piece of a sign: some sort of academy. Impressive set of offices up here, I thought.

We were living in a cardboard and stucco apartment at the ass-end of Berkeley below a simpering divorcé who banged on the floor if we conversed at even normal speaking decibels. On our first night in the new place, there was a knock on the door. Standing before me in a plaid nightshirt and trim beard, looking for all the world like he was about to announce that the British were coming, was our upstairs neighbor. “I hope that you will not continue to make those strange noises,” he said, smiling. Mystified, I insisted that he must have been hearing another apartment. But, time revealed that those strange noises were indeed ours; the utterances of a nice youngish couple at a volume comfortably in the normal speaking range.

No matter. We had love, a bit of savings, sixteen years of higher education between us, we baked our own bread, and I had one big toe on a new path.

As I stood quietly waiting for my interview, the voice from within The Academy clarified. A nasally screed whirred through the crack in the door. “Now let’s get one thing straight. Americans do not like vermouth.” An academy . . . of mixology. “And if they hate vermouth, why then do Americans order Martinis? Because–and listen closely folks–you are all about to become little David Copperfields. The conjurer, not the waif. With vermouth as your magic wand, you will help people maintain the illusion that they are not simply drinking huge glasses of gin or vodka.” I leaned back against the wall and shut my eyes.

The coalition director had repeatedly put off my interview. Week after week I waited to meet with this estimable woman. Meanwhile, a quick look around the Bay Area made it clear that this thing–this non-profit, world-healing thing–had better work out. It was rough out there.

We’d had to outbid four other couples for our apartment. They’d come with rental resumes and letters of recommendation for their pets. Luckily, we had cash. Hatbox Louie had been refused an interview for a job in a used paperback bookstore which reeked of cat urine, and whose shelves sagged under the weight of tattered bodice-rippers. Her master’s degree did not make muster. Even the guy slinging coffee at Peet’s had a PhD. After six weeks of cancelled dates, I was granted an audience. When the day finally arrived, I pieced together a presentable outfit, and took the train into San Francisco.

“When someone orders a dry Martini, they want you to pour out the vermouth before the gin goes in.”

A squeaking door hinge jolted me out of my reverie, and I stood bolt upright as someone emanated from the global peace meeting. I prepared to see a young, earnest, progressive do-gooder. But no. This was an old man. A quite old man. A few minutes later, another old man. Not even spry. Nursing home old. Then a third. This couldn’t be. Action . . . global change.

“When they ask for a whisper of vermouth, they want you to pour them a huge glass of gin and whisper the word ‘vermouth’ over the top of their glass.”

A blue-haired beauty slipped out from the meeting. She was so unsure on her feet I almost dashed over to help her. Then another frail old woman.

“The biggest tip I ever got was from an orthodox bishop from Estonia who had me pour him an enormous glass of Stoli while staring at a bottle of vermouth.”

Another old man emerged from the meeting with a woman who, though solidly in her seventies, seemed a mere slip of a girl: the director.

There she was: The Director. She caught my eye and brought me into her office. We talked. She mostly looked dumbfounded. She was presumably trying to understand why I would have left medicine to come out here for . . . what exactly was I trying to do?

A doddering old bitty stumbled into the office. “I left my bag,” she warbled in her quavering old-lady-voice. The director explained that her bag must be across the hall where the meeting had been held. She spoke in that cartoonishly loud-for-the-infirm way which, if used in our new cardboard home, would have had our divorcé on the phone to the police. And that sweet old lady, who seemed to have forgotten where she had been not ten minutes before, was probably the director’s most trusted, peace-forging lieutenant. What had I done?

In the end, I had not been asked to start Monday, at this ancient coalition for global change. Nor to shuffle off to another organization in this world of world-fixers where she was sure an idealistic young doctor could be of use. The director had however asked me for advice about her husband’s gout.

I left the meeting feeling oddly calm much like the gazelle who’s resigned to the inevitability of its fate in the jaws of the cheetah. Slowly making my way back down the corridor, I guess I should have been wondering what had just happened, and what on earth I was going to do next. But I wasn’t. I was thinking about bread. About Hatbox Louie kneading dough in our cardboard box. Is she making bread?

“Now, rum and Coke. Rum and Coke’s a different thing. There is a reason half the world is owned by a company making bubbly sugar-water. Americans like Coke. It’s that simple…”

Hatbox Louie had indeed been baking and the apartment smelled wonderful. As I entered the kitchen, she scanned me for any outward sign of how the interview had gone. Her eyes gently grazed the paper bag I was holding. I just smiled at her, moved wordlessly to the cupboard for a glass, pulled the vodka from the bag and poured a tall one. “That good, huh?” she suggested. I just smiled at her and replied, in voice so breathy even our dimwit upstairs couldn’t complain, “vermouth.”

Our savings were running out. In a last ditch effort to salvage our adventure, we headed north to Portland, Oregon, Hatbox Louie’s ancestral homeland, and one she remembered as a haven of good food, good coffee, good beer, and an easygoing lifestyle. Yes indeed. The problem is the Bay Area. Too expensive. Too much competition: PhDs working in bookshops, bidding wars on the stoops of apartments-for-rent. Not for us. We head north.

Portland. We got an apartment and felt somewhat renewed. The geographical cure is certainly a temporary fix, but it works nicely for a while. There is the novelty of the new place, the distractions of putting together a new apartment. Hope trickles down. It was mid-September, it was sunny, everything was green. A new start. I was feeling somewhat confident again. Sure, I had cut my training short, but still I was a doctor, that had to be worth something. Though I had given up on saving the world, I felt I could at least parlay my education into something I might enjoy.

Life took on a certain rhythm. Get the paper, circle the jobs: medical writer, hospital PR. There were trips to Kinko’s to make copies of my resume. I would stand outside for hours watching spiders spinning webs and hunting in the bushes by our front door. I invented salad dressings. My job search was floundering. I couldn’t seem to get anyone to call me back. I tried letters:

October 10

Dear Mr. Fitzpatrick,

I am responding to your ad for a Community Relations Coordinator . . . ability to offer both a clinical background and a real interest in community health . . . committed to meaningful work . . . asset to your program. Sincerely, Dr. Nostrum, MD

I began to see the world in a new way: “Hey, look at that guy power-washing the glass bus stop shelter. That could be Ok.” “Is it me or do mail carriers have it made?” “What about tree surgeons? That’s medically related.”

Then one day clouds moved in. They never left. I listened to the weather report each morning anyway. It was like playing with a sore tooth: I just couldn’t help myself. Like the Inuit and their scores of words for the subtle shades of snow, these Northwesterners would spin their invariably sodden condition. “Today: steady drizzle with periods of rain punctuated by heavy downpours. Misting overnight. For your extended forecast, please take today’s and multiply it by six months. Have a nice Wednesday.” My moods followed closely: Patches of despondency, with scattered self-loathing. Chance of overnight despair. Still, there was no choice but to press on.

More letters.

November 30

Dear Sister Kreskey,

. . . resume . . . teaching position in the biological sciences should one arise . . . while not Catholic . . . background prepares me ideally . . . Bar Mitzvah . . . Thank you for your consideration.

December 15

Dear Sir,

. . . ad for a loading dock associate . . . keen interest
. . . transportation of goods . . . opportunity . . . Sincerely

December 31

Dear Sir,

. . . ad for a plasma clinic supervisor . . . those compelled to sell . . . precious fluids . . . deserve competent supervision . . . empathy and care . . . one who can join them at the bottom of the barrel . . . Sincerely,

I received, after sending out about thirty letters, exactly two responses. One was a letter of rejection from Sister Kresky which, through some computer error, kept getting sent to me over and over for weeks. Things were very glum around our apartment. It was very grey. I had just about given up the fight. Hatbox Louie, fresh out of her Classics program, was working as a telemarketer. Besides making about seven cents an hour, Hatbox Louie is rather shy and likes talking on the phone to strangers, interrupting their dinner, about as much as cats enjoy inner tubing. At least she had a framework to understand her suffering. Her academic background had prepared her well to recognize one of Dante’s circles of hell. It was time for action. It didn’t matter what–I had to have work.

Pursuing the single positive response from my letter-writing campaign, I found myself walking hesitantly down a thick red stripe on the tarmac of a shipping warehouse. It was a vast open lot with a menacingly dark red pathway meant to keep people from straying as they came to fill out applications for work. It passed through an armed guardhouse, then led me into a building complex. I sat down with the other applicants: basically me, a few illegals, and a bunch of frat boys looking for some extra winter-break beer and rohypnol money.

The manager was young, he was a coolguy, his baseball cap was worn backwards, his goatee was tidy, his wrap-around sunglasses dangled on a green cord from his neck, he felt deeply empowered: “Ok. First off, the way you are going to succeed in this job is to be on time and to follow the workplace safety guidelines.” He flicked on a projector.

What had I done? I had been foolhardy and now I was being trampled by the world’s condemnation: “Who the hell are you? Do you know how many people would have loved to go to med school? Do you think your grandfather wanted to leave high school to support his family?” I must soldier on. An honest day’s work. Absolutely nothing wrong with that.

“Your eyes are your windows to the world, and they’re non-replaceable…” droned the predictably stilted and mind-numbing workplace safety film. The sound was bad, the actors self-conscious. It was like a porno movie with safety replacing sex, which may have accounted for the unexpected attentiveness of the frat boys. When it had mercifully ended, I sat down to fill out the application.

What a complicated set of feelings I experienced as I tried to jam my educational history into the tiny box they provided. As I shakily finished with “MD, University of XXXXX”, I decided it was just too much. I grabbed my application and headed back down the long red ribbon, if not running, then shuffling very quickly.

I tried to fly through the guardhouse, but they stopped me to confiscate my application. “You don’t understand. I’ve changed my mind. I’m just going to get rid of this.” I clutched the shameful document to my chest. “I’m sorry,” he returned. “No paperwork leaves the premises.” Glancing at his sidearm, I handed it over and dashed down the red stripe and home.

The next day I got a message on the answering machine from the coolguy at the warehouse who had apparently been given my contraband paperwork. “Dr. Nostrum, I would very much like to discuss…” I guess he figured even a degenerate doctor on the loading docks would be a boon for workplace safety. Degenerate. What else could he have thought? Had I been caught selling oxycontin from the trunk of my station wagon? Had I decided that a breast exam should accompany an evaluation for earwax impaction?

I sat silently on the couch for two days after that. On the second day, I rose to step outside. The rain had torn the spiders’ webs, and I watched them labor over the repairs as the drizzle or rain or precipitation or whatever thrummed against the hood of my poncho. I began to envy those industrious little insects. They had their job and they did it. There was no conflict — no soul searching. No choices. I grabbed the mail: my seventh rejection from the nun. I was beginning to think she was not interested.

I thought about my grandfather leaving high school to help support his family. Out of basic necessity he rode the New Deal out to Utah to poison prairie dogs and put food on the table. Then he was out on a coastguard cutter patrolling the North Atlantic for German U-boats. He just did what he had to do. Choice never entered into it.

Was he denied the possibility of reaching his full potential, or did he lead a happy, industrious life without the torture of trying to actualize himself. Now my little family was out of money. I had thrown away a perfectly acceptable career. I was out of energy, out of ideas. I was numb.

When Hatbox Louie returned from work on the second day of my sit-down strike, I announced that I was going to find a residency where I could finish my training. It was a job. It seemed the only one for which I was qualified. It is actually a pretty bad job. Eighty or ninety grueling hours a week. I think if you work it out, medical residents make less than minimum wage. It didn’t matter. It was something. I queried dozens of hospitals for openings in the second year of their programs.

Three days later, I got a message on my answering machine. It was a hospital in North Carolina with a second year position open due to an untimely pregnancy in one of their house staff.

I’ll be damned. All aboard. “Welcome back on the conventionality express! How was your trip? Oh, I’m sorry to hear that. Buckle up now, it’s going to be a bumpy ride.”

I was crawling back on my hands and knees. I had failed. The yoke was back on. Yet, I had a job, a respectable position, and it felt as if a crushing pressure had been instantly dissipated. Like a screaming in my head had suddenly stopped, leaving only that light ringing sound you hear after leaving a rock concert. I could support us and regain my self-respect. The skies began to clear. I was going to be a somebody again. I was back in the world’s good graces and by god it felt good.