In 1976, I began a sub-internship in Surgery at The Kings County Hospital Center in Brooklyn, NY. I was a fourth-year medical student at SUNY Downstate at the time, and I already knew by then that I wanted to be a surgeon of some sort. So they offered us these "sub-internships", which would substitute for your 4th-year electives. You would endure the daily grind and abuse of a real intern, and learn on the job without even having earned your MD degree yet. As a reward, if you performed well, and if you stayed at Downstate-Kings County for your full training, they would count that year towards your total training requirement. It was a way, I guess, for the school to keep more of its graduates in Brooklyn, where they would hopefully settle for good and provide care to the needy. And it was a way for a graduate to "jump-start" his or her career.
King's County is as close to a war zone hospital as you can get in the States. It serves mostly an African-American population, poor but proud and in desperate need of quality medical care. To train there at that time was to see every phase of an illness, from its earliest symptom to its incurable end-stage, on open wards that held dozens of patients in conditions that would be considered worse than unbearable today. But it was a bonanza for a student of medicine. Simple breast lumps at a Manhattan hospital would present as fungating masses that had perforated the skin and nipple at Kings County. Uncontrolled diabetics would present as comatose medical enigmas in the Kings County ER, a smorgasbord of pathology and illness that could confound and mystify even the most astute clinician. Needless to say, I learned a lot that year. Gun shot wounds, stabbings, motor vehicle accidents were as common as toothaches and tonsillitis. I had never encountered anything like it, before or since.
They started me out for the first three months at the Brooklyn VA, where I could potentially be out of the way and "do no harm". The VA was one of our sister hospitals, a place that was, to say the least, a short distance but a world removed from the County. More on the VA later.
Next post, I will re-print a short story of mine that was published in The New Physician in 1977, a year after my time at Kings County. It will provide a little flavor as to what it was like there, and I will add some stories to it as we go along. I will say, though, that more than anything, my year as a sub-intern in Brooklyn exposed me to the raw differences in medical access from one part of the city to the other; to people who had no insurance, no money and no information, and who only came into the hospital when they were so bad off that they couldn't stand up any more. It taught me that I, who had been born and bred not more than five miles away in Bay Ridge, had more to be thankful for than I knew.