I turned 20 on June 19, 1979. Jimmy Carter was President, and in fact, I would have my first opportunity to vote in a presidential election over a year later. I had already dropped out of college, immigrated to Israel, and returned. I was dating the only woman who I've ever truly loved, and I knew that I really did want to be a doctor. Not because my father wanted me to be a doctor, but because I did. I decided not to go back to UC San Diego, but to live with my parents and go back to college at UC Irvine, with a major in chemistry, yet again. One of my defining moments occurred during the summer, where I was a research assistant at Cal State Fullerton. We were looking at ceruloplasmin in rats. I don't remember much about the research, but I remember a graduate student who was a bully. I ultimately made the decision to leave the summer job instead of accepting his bullying behavior. It's one of the moments in my life that always reminds me that bullying has always been one of my "hot buttons." I applied to medical school and didn't get in. Getting into medical school in California wasn't that easy, and I had made the unfortunate decision to apply only to schools in California. I had a choice. I could look at foreign medical schools. I could apply to a large number of schools and try again.
Ironically, I had been overconfident in my test taking ability when it came to Biology. In fact, despite wanting to be a doctor, I'd never really taken many biology courses. I thought that I could "wing it." I was wrong. While scoring exceptionally well on every other area of the MCAT, my Biology score sucked. I took the Stanley Kaplan preparatory course, improved my Biology score, and applied to about 35 schools, including Texas, which seemed to accept out of state students from California for some reason. In the meantime, I decided to apply for the PhD program in Chemistry at UC Irvine, being honest with them that if I got into medical school, I'd be leaving. I got accepted to the University of Texas, Medical Branch (UTMB), in Galveston, the oldest medical school west of the Mississippi. In the summer of 1981, I flew to Houston, and I remember writing a letter to my then-girlfriend (and now wife) and the ink was literally dripping down the page due to the humidity.
UTMB had a tradition of having all of their exams every six weeks, on a Monday. It was called "Black Monday," and it wasn't unusual for students to chill the rest of the week after Black Monday. During my first six weeks in Galveston, I certainly enjoyed my classes and new friends, but something was missing. Sherri and I had previously been engaged, but a variety of circumstances led to us calling off the engagement. My going to medical school in another state was somehow supposed to allow us both time to explore our lives. Unfortunately, since that moment in 1976 when I first laid eyes on her, I was smitten. The day after taking my first set of exams, I got on an airplane, flew back to Los Angeles, and proposed. Were we both ready to get married? Probably not. I was in medical school and she wasn't sure where she was heading. It's interesting as I look back 39 years and realize that life has a way of turning out ok if you let it. We were married at the end of my first year of medical school on May 16th, 1982.
My defining moment of medical school is still that moment while on my cardiothoracic surgery rotation, I would wake up an older woman every morning at 4:30am to start my rounds at St. Mary's Hospital. On the last day of my rotation, after having cussed me out almost every day for waking her up, she apologized to me. The feeling I had then I remember like it was yesterday. She had no reason to apologize. I was waking her up every morning! I genuinely felt bad that she felt the need to apologize. To this day, I dissuade anyone I work with from saying that a patient or family are "difficult." As physicians, we have a responsibility. It's not easy being the one who is ill. We must always be empathetic and demonstrate compassion. That very moment, standing at the door of her room, I had my first inkling that my future would be in the field of geriatric medicine.
The other defining moment that occurred during medical school happened when I came home excited to tell Sherri about "case" that I'd seen in the hospital. She admonished me for looking at the person as a disease, and not as a human being. That has stuck with me through my entire career and has guided me along the path that I took. We are taking care of human beings. As I say now, you can't deliver person centered care if you don't know the person!
I always tell medical students that there are two years in their education where they need to pretty much ignore everything else in their lives and give learning a 100% focus. That is the third year of medical school and the first year of residency, otherwise known as one's internship year. There was no year in my life that was comparable to my internship year, until over 30 years later when I took the helm of a very dysfunction nursing home chain. I had only applied to three residency programs, Dallas (Parkland Memorial), Cedars-Sinai, and Galveston. My grandfather told me that he'd had a talk with "the man" and willed me to getting accepted at Cedars, which was literally around the corner from my grandparents apartment. I will always remember my first patient, in some ways channeling the author of the book, The Intern, which I'd read as a kid, and was always in the back of my mind in relation to my decision to become a physician.
His name was Simon Grace. I don't remember much about him, which is sad, and I've tried to find information about him online, but to no avail. Simon was a young white male, who happened to be gay. He was admitted with a dry cough and what turned out to be pneumocystis pneumonia. As a 4th year medical student, we had learned about a new illness that seemed to be predominantly impacting young gay men. By the time I started my internship, this illness had a name, and that was AIDS. A former Cedars resident had gone on to do his infectious disease fellowship at Mass General, and had come back to UCLA and Cedars. His name was David Ho. He would become the Times Man of the Year in 1996 for his work on HIV/AIDS. I completed my first History and Physical, admitting Simon to the hospital. He would return intermittently as his condition declined over the course of the next couple of years. He would die during my residency. AIDS was a death sentence at the time. As I've gotten more in tune with the concept of "person centered care," I've often wished that I remembered more about Simon as a person. I still carry part of that experience with me to this day.
My Internal Medicine residency at Cedars quickly became a Geriatrics residency. I'd already decided that was my field of choice and I wanted to know everything about it. I sought out mentors, I read everything I could. I looked at each older patient as if they were a learning opportunity in my field of choice. The natural progression of this was to do a geriatric medicine fellowship, which I did at UCLA. The fellowship provided a perfect bookend to my third decade, which began dealing with a bully, and ended also dealing with a bully.
During my internal medicine residency, I began "moonlighting" at Kaiser in Woodland Hills, California. I still didn't know what direction I wanted to go in after completing my geriatric medicine fellowship, which was a two year program. Six months into my fellowship, the chief of internal medicine at Kaiser, Woodland Hills, made me a job offer. If I left my fellowship after one year, I could join Kaiser and start a geriatrics program. As during many of the defining moments in my life, I immediately knew the this was the path I wanted to take. While I've always loved teaching, and I enjoy the critical thinking of academics, I was also pulled towards both leadership and business. I decided to accept the offer. No sooner than I accepted and let my fellowship program know of my plans to leave at the end of my first year, than of the the faculty, an eminent internist and geriatrician, Dr. John Beck, told me that if I left the program, I couldn't get board certified in geriatrics. There were a few more "threats," but I had made up my mind. I researched everything that he had threatened me with, found none of them to be true, and suggested to the head of the program that I'd be engaging an attorney. I was told not to worry, that I should move forward with my life and that was just John's way. In reading his biography, I'd never know that he was in the Canadian army during WWII, starting as a private and moving up to become a company commander. It all makes sense now. John and I often tangled, as I was never one to submit to an authoritative figure. I also never took well to being bullied. I've often shared my story about this experience during leadership presentations, and I title it "Stand Your Ground." The willingness to stand my ground is something that has often defined me over my life.
While much of my third decade was defined by everything that went into my becoming a doctor, there were two personal moments that were also everything to me. First, as I already noted, was getting married. The second occurred on August 21st, 1987, when our first daughter, Raishel, was born. I remember that moment like it was yesterday. My wife was in labor for 24 straight hours and at the last minute required a C-Section. I sat in the corner of the operating room, as our baby was born. I was scared. I knew that everything would be ok, but I'd never felt so helpless as I did at that moment. Out of such a helpless moment came such a wondrous outcome. It's a good thing to reflect on from a life perspective.
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