The Medical School Journey

It was September 1974 and the dean of the medical school was addressing my class on its inaugural day. I was already slightly intimidated by my classmates who, on average, were two years younger and star science students. I was an English major with minimal science background. I figured I charmed my way into medical school with the help of the dean of arts and science who wrote my recommendation letter. I was a novelty. I looked around the auditorium, which was modern for that time. The medical school was a relatively new building. The seats were full as the dean, a white-haired thin well-dressed man addressed us. There were 254 students filling the seats, many more women and Asians than in past classes.

“You are the crème de la crème of applicants. Everyone except four of you had a perfect 4.0 average.”

I cringed and slumped in my seat. There had to be a neon arrow flashing above my head registering my 3.65 grade point. Well, I guessed I had nowhere to go but up or maybe down three places. Either way, it set the tone for three years of hard labor and terror. The fourth year would be the start of my love affair with patient care and medicine. The adventure did not start until the following day.

Full of anxiety and excitement, I approached the light gray building on the far side of the University of Toronto campus. As I bounded up the stone stairs with my backpack over my shoulder, I met other new students. I recognized a few from high school. They had been two grades behind me. One of them had been the school basketball star. A few had been classmates of my younger sister. As we entered the building, I was overwhelmed by the smell of formaldehyde. We were attending our first anatomy lab.

I navigated the hallways and followed the smell until I found the lab. It was a large room with rows of gurneys. Each had white sheets spread over our cadavers. The students were divided into groups of six, three on each side of the gurney.  We all wore white lab coats. I felt like a scientist for the first time in my life. These anatomy groups would stay together through several rotations for three years. I knew two members of my group. Barry or Porcupine as he came to be known was a year ahead of me in my high school and married to a friend of mine. He had a degree in chemical engineering and was another outlier like me. As I stood by the gurney feeling faint, Porcupine entertained us with what would become his daily call to arms. “Calling Dr. Howard, calling Dr. Fine, calling Dr. Porcupine.” It came from an old three Stooges routine. (The three Stooges were a tv and movie comedy act starring Curly and Moe Howard and Larry Fine). Ironically, Porcupine had a mop of curly blonde hair. After a few days of the same routine, he earned his nickname. He would become my sometime study partner, our class president and lifelong friend.

The other anatomy partner, I had known previously, was Cliff. We had been competing since the last year of undergrad and continued through medical school. He was a tall, basketball playing math and science major. We were neck and neck in our undergrad organic chemistry and biology classes, but it was no contest in medical school where I felt I was holding on for dear life.  Sam, a funny good natured Korean American, Bill, a serious tall smalltown man from Northern Ontario and Beef (a nickname), a large bear -like orthodox jew rounded out our anatomy group. We stood eagerly waiting for our instructor’s instructions. I was becoming increasingly faint because of the smell and a new paranoid idea. My uncle Sam had just died, and he was a short barrel-chested man. The form under the sheet on our gurney had that kind of configuration. Could it be? I began to sweat.

The instructor was a tall Caucasian with huge hands, a long face and glasses. He resembled a Sasquatch. He gave us some preliminary instructions about dissection and then told us to uncover our cadavers. I became wobbly and in a tremulous voice exclaimed to my group: “Guys, I think the cadaver could be my uncle Sam. I’m feeling faint.”

The boys all had a good laugh and Porcupine said: “There’s only one way find out!” as he pulled the sheet away from the gurney. I gasped and leaned on the side of the gurney. “Oh, thank God, it isn’t.” The guys laughed some more. It was an inauspicious start to my career as a medical student. The cadaver was a very muscular male and we named him Charles Atlas after a famous body builder. He provided us with hours of study and information. Over the year, we became acquainted with human anatomy, essential for the practice of medicine.

I felt I had my hands full studying anatomy, but histology, physiology, statistics and biochemistry filled out my schedule. I was overwhelmed and didn’t know how I could handle all the information. After all, as an English major, I was learning a new language-science. I felt my fellow students had an advantage. My embarrassment in the anatomy lab set the tone for most of the rest of the year. I knew it was going to be an uphill battle to survive and I would have to outwork and outlast my peers. It turned out that the bell curve grading system and difficulty of the exams confirmed my suspicion. Many times, the average score on our exams was a failing one. They graded us by our position on the bell curve.

It must have been after our first or second exam. The results were posted on a bulletin board next to the medical affairs office. I casually walked up to the posted results after the area cleared of fellow students. I felt naked and exposed. My raw score was appallingly low, but I was on the top of the bell curve looking down at those who scored lower and higher than me. In other words, I scored the class average. On one hand, I passed and was relieved. On the other hand, since when was I just average? Like everyone else in my class, I was used to being a top student. I guessed there was nothing wrong with being average in a class of top students. Still, I was conditioned to expect more.

Near the middle of the year, I experienced the most nerve wracking and humbling of all exams, the bell ringer! As I entered the anatomy lab, I noticed 50 numbered anatomy stations or small tables. Each featured different parts of the anatomy.  The Sasquatch handed me a test sheet and pencil and assigned me to one of the stations. I stood next to it awaiting instruction and smiled at Porcupine across from me. Most of the other students seemed tense and primed. We were at the starting line of a race. My adrenaline levels were sky high. I was waiting for the starter’s pistol to go off.

The Sasquatch was standing in the middle of the room. He looked around and made sure everyone was standing at their assigned station and had their test sheets and pencils. When he was satisfied, he announced: “Okay class, pop quiz! well sort of. Each student will have 2 minutes to identify the pinned or colored anatomical part at their station. Then the bell will ring, and you will rotate to the next station. Note that your test sheets have 50 numbered lines for your answers. Remember we want you to identify only the pinned or colored part of the specimen. There will be no bonus points for identifying the whole specimen. We are looking for nerves, tendons, arteries, muscles, etc. not the appendages they are attached to. Any questions? No? At the sound of the bell, you may start. Move to the next station with each ring. Do not dally. There are 50 stations, and you have 100 minutes. Good luck.”

I didn’t notice the school bell in his hand until he rang it. A wave of nausea came over me. The specimen in front of me was an arm with a pin in a nerve on the inside of the elbow. Okay, that was easy. It was the ulnar nerve. I wrote it down and waited impatiently for the bell to ring. I had a race to run. The next specimen was more difficult. It was a thigh with one of the anterior muscles pinned. Was it Sartorius or the Adductor Longus? I wasn’t sure and took all two minutes to choose. I became more anxious. Fortunately, the next few stations displayed bony specimens with one-part colored blue instead of pinned. I could easily recognize the acromion on the scapula and the spinous process on the cervical vertebra. I relaxed somewhat but as the specimens became more complex, I became more anxious and rarely wrote my answer until the last second. Some nerves and tendons were buried deep in tissue. It was clear, the previous student had poked and prodded the specimen. The anatomy was distorted. I would try my best to orient myself to the pinned area in the specimen but often the bell rang before I finished. I was flustered. Finally, I encountered one station where a detached nerve was lying alone next to a hunk of ‘meat’. It had been handled and examined by 20 previous classmates and was sitting, detached, next to what looked like a trachea by the time I rotated to that site. Come on—a detached nerve—how was I to come up with anything other than a guess! By the time I raised my hand in protest the bell rang and I had to move on. I tried to get the attention of the Sasquatch, but he dismissed me with a wave. Maybe medical school was meant not just to educate but to harden us neophytes so we could handle any situation.