Defining Moments: My Third Decade

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.

Defining Moments: My Second Decade

We moved to Cerritos as I entered the sixth grade, which actually brought me into junior high school.  For some reason, I decided to run for Treasurer of the student body.  I was shy, relatively introverted, and definitely a nerd. But I was already putting myself out there.  By the time I was in the seventh grade I had decided to run for student body president.  I wasn't popular, didn't know that many kids, but I remember giving my speech.  One of the teachers told me it was an excellent speech.  I lost to the popular girl.  I liked to play basketball, although I wasn't very good.  School was boring to me, and I learned to speed read.  This allowed me to read books in 10 minutes and write decent book reports.  

Near the end of seventh grade, I decided that junior high school was a waste of time and I came home one day and told my parents that I wanted to skip the eighth grade and go right in to high school.  It's funny, I don't really remember much about that decision.  However, my drive to push forward has always been strong.  I really didn't feel like the eighth grade had much to offer me.  We decided that I'd take a couple of classes at the high school that summer, and if I did well, I could skip the eighth grade.  The two classes turned out to be Oceanography and Ecology.  My teacher for both was Mr. McNally.  He was also the Chemistry teacher at the brand new, not even built yet, Cerritos High School.  

I have vague recollections of a field trip with older kids, but that I somehow managed to fit in.  I was the smart kid. Fortunately, I'd had a growth spurt, which meant at least I wasn't too short or slight.  Summer school went well and in September of 1972 I started high school.  Ninth grade was actually in the afternoons at Gahr High, as Cerritos High wouldn't be built until the following year.  I often rode my 3 speed Sears bike to school.  Some mornings I attended the morning minyan with the old men at Temple in preparation for my Bar Mitzvah.  My Bar Mitzvah speech became controversial as I wanted to talk about social justice issues and the rabbi resisted my efforts.  I won out, if I recall correctly.  I don't know what happened to that speech, I'd love to read it again.

I'd already set my mind on graduating high school early, but during the summer after my second year I changed my mind.  Maybe I realized that I wasn't quite ready and that I might as well "enjoy" the full four years of high school.  

September of 1976 brought what is arguably the most defining moment of my life.  It was the week before starting classes at UC San Diego.  I was in my dorm room in Discovery Hall when one of my suite mates brought a girl upstairs to meet us.  Her name was Sherri. I could have been Michael Corleone in The Godfather as I was literally struck by a lightning bolt. There was something about her.  In fact, the first thing that I thought was that she was way out of my league.  She had long hair and was wearing overalls.  My heart definitely skipped a beat.  Who would have known that six years later we would be married, and 44 years later we would have two wonderful daughters and two grandchildren.

During my second year of college I became confused in regards to what I wanted to do in life.  I changed my major a few times.  I stopped studying and focused on practicing and playing intramural floor hockey.  It was in the spring of 1978 when I realized that I was failing all of my classes.  I went to the Deans office and asked what my options were. They told me I could withdraw.  Even today, I remember thinking,"you're kidding me, that's all?" I took the opportunity to withdraw, knowing then that my record would only show that I withdrew.  My grades would never be known.  I also made a momentous decision. I would immigrate to Israel.  This was something that had been swirling in my head for some time.  I'd always felt a connection to Israel, especially after I visited during the summer before starting college.  

Before I left the country, I visited Sherri.  We had broken up earlier in the year, but something made me want to see her before leaving.  We had a nice visit and I hugged her in the driveway of her parents house before getting in my parents Ford station wagon to drive home.  For a moment, I hesitated.  There was still something there. But, I was destined to travel across the world for an experience that could impact my life in many ways.  

In Israel, I lived on an Ulpan (a Kibbutz where new immigrants stayed), where we were to learn Hebrew, and work part-time.  My work was in the dairy, where I learned to milk cows, though I mostly cleaned up after them.  One day, I visited the Kibbutz library and happened to see a thermodynamics textbook that I'd had in college.  Something clicked and I realized that I didn't want to milk cows for the rest of my life.  I also knew then that I really did want to be a doctor, something that I'd decided when I was nine years old (hmm, maybe should have listed that in my first decade of defining moments).  I flew home after having been in Israel for 3 months, and one of my first calls was to Sherri.  We started dating again shortly thereafter. 

Defining Moments: My First Decade

One year ago, I wrote about a defining moment in my life.  At the time, I noted that I'd write about other defining moments another day.  Today is as good as any.  The moment I wrote about a year ago was Ironman Chattanooga in 2014, where I achieved my best Ironman time ever, and my best age group placement ever at the time.  I've subsequently had better placements in my age group, but I've never gone faster.  Rereading my race report reminds me of what that day felt like and sets its own bar for defining moments.  The past 7 months has been a defining moment kaleidoscope. though I think I'll keep these months out of my reflections until I get through my first six decades on this earth.  Today, I'll start with my first decade of life.

I've always had a good memory, especially visual ones.  My first recollection of life comes from around the time that I was 3 or 4 years old.  We were camping and it was raining.  I remember eating hot dogs.  Since It's my first recollection of life as a human being, I'll consider it to be a defining moment.  Going forward, I'll try to hone in on moments that have stayed with me my whole life and serve to define me.  I have a feeling that the concept may evolve as I write about it, but that's what this blog is for!

When I was around five years old, one of my neighbors, Ray Lippert, ran into me with his bicycle.  I'll always remember the scab on my chest.  Ray wasn't the nicest kid, and years later my wife would actually be his middle school classmate.  Apparently he committed suicide in college.  Odd how the currents of our lives pass.  

When I was in the third grade, my teacher Mrs. Kantor, told my parents that I was preoccupied with the war in Vietnam.  While that preoccupation was clearly influenced by my father, I definitely had a predilection for both worrying about world events and wanting to make a difference in the world.  In 1968, at the age of nine, I wrote a letter to President Johnson, asking him to end the war.  I am definitely my father's son.  As I look at the rest of my life, I've written letters to Jimmy Carter, Menachem Begin, Ronald Reagan and Bill Clinton.  I've written other letters to advocate for something that I believed in.  I've written Letters to the Editor.  It all seems to have begun in the third grade.  I'm not sure that my first decade was spent like other kids, but I've rarely followed the path of others.  

 I was also enthralled by the space program.  I actually took a polaroid of Neil Armstrong's first step on the moon.  I'd wake up early in the morning to watch the blast off of the Apollo rockets.  I'd exaggerate a stomach ache in order to stay home from school to watch the World Series between the Tigers and the Cardinals.  Those exaggerated stomach aches got me a trip to the hospital for a barium enema.  Now, that was a defining moment!  I'll never forget going to the bathroom after the procedure. It seemed like the barium would never stop coming out!  I think my stomach aches were cured as well.

I believe that I read Martin Eden for the first time in the fourth grade.  As was to become standard for my whole life, I'm not sure how much I really understood, but I always set the bar high.  I would always reach to do things that were beyond my capabilities...until they weren't.  Over the years, each time I would read Martin Eden, I'd gain a new understanding.  

June 19, 1969 would be the end of my first decade of life.  My Side of the Mountain was one of the most viewed movies that year.  I loved that movie! A thirteen year old runs away to live in the mountains.  I connected with something.  Perhaps it was the need to be different from everyone else.  Perhaps it was the need to be an individual.  In some ways that movie was emblematic of my first decade.