This is a reprint of a short story that was published in The New Physician Magazine in 1978. It was based on my experiences as a sub-intern at Kings County Hospital from July, 1976- July,1977
To Be Continued.............
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.
The title of this post, and this blog, refers to a completely innocent remark my cousin made not too long ago, when we were at a party and he introduced me to one of his co-workers. "This is my cousin Steve," he said. "He used to be a plastic surgeon."
I winced a bit as those words came out; they pierced my ego and penetrated my pride like the scalpel I no longer wielded. I felt at once demoted, compromised, almost ashamed, as my cousin's friend shook my hand and held it for a second, as if to console me for my loss.
Later, I thought about those of us who retire from whatever our chosen profession was. Were we all "used to be's"? Did we disengage from our fields so permanently that we had lost all rights of connection and identification with our former working selves? He "used to be a baseball player"; she "used to be a lawyer"; she "used to be a judge"; he "used to be a teacher", he "used to be a cop", and on and on. How odd it is to hear it said about you; much more so than if you said it of yourself.
Then again, is a retired judge really still a judge? Is a former president still a president? Is a former thief always a thief? A retired priest? Rabbi? A surgeon??
These, of course, are rhetorical questions. I don't know if I am still a plastic surgeon. I know I no longer operate. But I still know how, goddammit! I know that my back infection and herniated discs forced me to retire a good ten to fifteen years earlier than I had planned to. I know that I miss being in the operating room and taking care of patients, every day. I know that many of my dreams are set in an OR with me as the surgeon, or the assistant, or sometimes even the patient, with various scenarios and outcomes from good to horrifying. I feel that after all the studying, the work and time, and the days and nights in the hospital, that I'd like to keep the title just a little bit longer, maybe until I'm cremated, if that's OK with everyone.
One day though, when my hands are shaky, and I cannot stand upright at all, when I am too feeble to hold a fork, let alone a pen or brush, I will meet someone and be introduced thus: "He used to be an artist."