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P&S Journal

P&S Journal: Winter 1996, Vol.16, No.1
"Welcome to Medical School. Life as You Know it is About to Change." From Moving in to Getting Oriented to Meeting Cadavers, First-Year Students Begin a New Life

By Doug Brunk

Evan Garfein'99 walks into his new room in Bard Hall and scrambles to see if the telephone company activated his line as promised.

He picks up the receiver and listens. His b oyish face crinkles.

"No dial tone yet," he says.

A heavy sigh follows as he drops the receiver.

"It's supposed to be working today. Oh, well."

It's the second day of orientation week for first-year P&S students. Mr. Garfein, 25, dressed in a black polo shirt and tan khakis, sits on the edge of his unmade bed and reflects on the beginning of a new era in his life: his decision to become a physici an.

"After about six months of working on Wall Street I thought it would be better to go into medicine," says the 1992 Princeton philosophy graduate. Princeton memorabilia hang from the walls.

The look from behind his wire-rimmed glasses turns serious.

"There are a few doctors in the family, and it was something I had always thought about," he says. "My dad (Oscar Garfein'65) went here. He always thought a great deal of t he school, and I was happy to jump at the offer to attend."

As he embarks on a new career, Mr. Garfein seems calmer than many of the 87 men and 63 women who make up the class of 1999. Maybe this is an easy adjustment for someone who grew up in New Jersey and whose father is a physician (and a P&S faculty member). But many of Mr. Garfein's classmates not so used to the pulse of New York or to hanging around the medical-minded find themselves swept into a frenzy of anticipation. Like brides and groo ms with the pre-wedding jitters, they long to know what lies ahead.

While routine activities like enrolling with student health services, registering for classes, and picking up keys for microscope storage lockers are staples of orientation week, these few days also are chock full of low-pressure opportunities for first-y ear students to get to know each other. It's also a time when second-year students and other members of the medical center do their best to make their new colleagues feel welcome.

Day 1: Moving in

One hopes for the best on move-in days, but things don't always run smoothly. Jason Wickens'99 lived without electricity for the first three days in his apartment just north of Ba rd Hall. At night, he maneuvered flashlights and candles like a coal miner.

"I just laughed about it, actually," recalls Mr. Wickens, who moved from Salt Lake City, Utah. "My alarm clock didn't work, so subsequently I was late to most of my classes. But even now that I do have electricity I'm still late, which is something I can't figure out."
Moving into Bard Hall

Mr. Wickens may have lived without electricity during his first days, but at least he had furniture, unlike his classmate, Mark Griffin, and wife Jolie. The moving company they chose took two weeks longer than planned to deliver their posse ssions to Bard Towers from their former home near Stanford University in California.

"All we have is what we brought in suitcases," Mr. Griffin said a week before their possessions arrived. "Apparently their driver had a heart attack or something like that, and the driver hadn't told them for three days. The story is really fishy."

"We have no dishes or anything to cook with, so we're eating Ramen noodles out of a pot that we borrowed from someone else," Mrs. Griffin said at the time.
One night the Griffins didn't have to worry about cooking was Monday night of orientation week, the traditional barbecue on the Bard Hall roof hosted by second-year students. "I felt like I was back in freshman year, drinking beer out of plastic cups," Alice Sondheimer'99, a graduate of Swarthmore, says of the event.

Barry V. Sandoval ponders the finer details of moving in.

Curbing Stress

Members of the Student Success Network, a group organized by second-year medical students to ease the worries of newcomers, shared survival tips during a seminar on time and stress management. "People have trouble adjusting to study habits," Julian Clarke -Mackay'98 told the audience of intent listeners, many leaning forward in their seats. "Don't stress out because someone else is studying 12 hours a day and you're not. Find out what works for you, stick to it, and you'll be fine. Make it a point to talk to the second years about what they found helpful."

After the seminar ended, Ms. Clarke-Mackay recalled the initial fears she felt as a first-year student. "I remember when I sat through this lecture a year ago thinking, 'Here I am in an auditorium at Columbia University as a medical student,'" she said. S he folded her arms and glanced thoughtfully into the empty seats in Room 401 of Hammer Health Sciences. "I remember feeling gung ho until the speakers started talking about stress management. That made me start feeling stressed."

James Mojica'99 said at the time that he looked forward to getting under way with studies. "It's going to take a lot of work, but at the same time it's stuff that I'm really interested in doing," said Mr. Mojica, who was born in Puerto Rico and grew up in Colombia.

"Some nights I think, 'Once I finish I'll go back to Colombia or Puerto Rico and work there,'" he said. "Or there's a program with the World Health Organization that I'm interested in applying for later on in my life. They do eight-month rotations in diff erent countries all over the world that need medical service. Who knows what's going to happen? Two or three years from now maybe I'll want to specialize in cardiology or neurology."

A Cruise with Classmates

A social highlight of orientation week is a three-hour evening Circle Line cruise around Manhattan for first-year medical and first-year School of Dental and Oral Surgery students. By the time this Thursday night event rolls around, faces become more fami liar and students feel a little more at ease.

The scene onboard resembles an ad for The Gap. After all, first impressions are important. With the towering Manhattan skyline as a backdrop, groups of students and their guests mix and mingle.

"If medical school could be weeks and weeks of this kind of socializing, it would be great," remarks Richard Rhiew'99, a Detroit native who graduated from Johns Hopkins. "I'm a big Yankees fan. That's why I came to New York."

Standing by the railing of the Circle Line boat with classmates Mark Eldaief and Eric Chang, Mr. Rhiew proudly points out the white No. 7 that he stitched with a needle and thread onto the back of his navy blue Yankees cap in honor of the late slugger Mic key Mantle.

"I poked myself doing this," Mr. Rhiew says. "Mickey was my favorite player."

Mr. Chang, a Yale graduate dressed in a white T-shirt and blue jeans, seems star-struck by the thought of medical school. "I think a lot of people are intimidated," he says. "The realization that we're going to be doctors is stunning. It hasn't really hit me that I'm a college graduate. I just graduated three months ago."

Ronit Friedman'99, a Princeton graduate who majored in art history and architectural theory, speaks highly about her first days. She holds onto the side railing as the boat gently sways.

"I grew up in New York, and I was excited about returning," Ms. Friedman says. "I saw that I wouldn't be happy in an art career, so I decided to try this. I've been doing research for the last couple years on diabetes insulin action."

She continues after a brief pause.

"I like the program that the second years have been running, trying to give us advice beforehand and allay our fears and anxieties," she says. "They've kept us pretty busy. I've had chunks of free time, but I think they're doing a good job orienting us."

As the line for beer forms downstairs, the band Too Loud For Leslie takes the stage upstairs under white floodlights in a corner of the deck. This band of students from the class of 1998-Martin Dolan, Mathew Hart, Stu Levine, and Doug Rusnack-packs a stea dy punch that causes heads to bob and bodies to wiggle. It plays an eclectic two-and-a-half-hour set that includes music by Simon and Garfunkel, Pearl Jam, The Clash, Men at Work, Green Day, and Ozzy Osbourne. When the boat nears the Statue of Liberty, To o Loud For Leslie launches into a respectable refrain of "The Star-Spangled Banner." The crowd cheers.

About a half-hour into the set, students cleared away several rows of chairs for a makeshift dance floor. Dozens danced until the boat reached port around 11:30. The crowd spilled onto Pier 17 and dispersed.

"I have to say I'm impressed by the energy level of our classmates," one student remarks breathlessly.

Swearing in

At the White Coat Ceremony, Dr. Herbert Pardes, vice president and dean, congratulates David Bomback.

The next afternoon marks the ceremonial highlight of orientation week and perhaps the most memorable event of one's medical school experience: the White Coat Ceremony. In the presence of family and friends gathered at Alumni Auditorium, incoming students receive white lab coats and recite the Hippocratic oath, which is traditionally sworn at the close of a medical school education.

"This nation unfortunately is somewhat short of heroes and short of individuals in whom people can have trust," Dean Herbert Pardes tells the crowd. "We feel that the physician should be one individual whom people can go to, that people can speak to openl y with confidence that they will be heard, that their privacy will be respected....If we can wish one thing, it's that these new physicians in training will bring that kind of bearing along with the excellence of knowledge that we're sure they'll have whe n they graduate from this school."

Dr. Arnold Gold greets Michael K. Tracy at the White Coat Ceremony.

This year's White Coat Ceremony keynote speaker, Dr. June Osborn, professor of epidemiology and of pediatrics and communicative diseases at the University of Michigan Medical School, talks about the many challenges that lie ahead for her new colleagues.

"You are about to embark on a journey of a lifetime," she tells them. "I'm sure you're uneasy about what it is you're leaving behind....You will get very tired sometimes. Not only will you see much anguish and suffering, but there will be painful experien ces of your own, both of trying to learn more than you think your head can hold and of trying to absorb more sadness than you think your empathy can tolerate."

The crowd is quiet.

"But believe me, as you stretch and grow to cope with those challenges it will be worth it," Dr. Osborn says.

Cracking the Books

With a week of orientation under their belts, the pomp and circumstance ends for the Class of 1999. Students attend first lectures for Science Basic to the Practice of Medicine, Clinical Practice, and Gross Anatomy. By week's end, many comments focus on s eeing a cadaver for the first time.

"We 'met' our cadaver on Monday, and on Thursday we got to open it up," Alice Sondheimer says of her first days in Gross Anatomy. "It was a bit of a shock. When you watch TV and see everybody fainting at the site of a cadaver, it doesn't feel like that. B ut it was a shock being intimate with the dead. I guess you sort of get used to it."

"I realized what a privilege it is to see the inner workings of the human body," says Eric Chang. "It's a privilege that maybe medical students take for granted but shouldn't."

Some students find themselves developing routines by the end of the first week. Others find themselves adjusting to new sleeping and eating patterns.

"The biggest adjustment for me is being in class for so long every day," says Anna Bjoring. "Sometimes I want to doze off. We've had some time off, but the classes are much more concentrated than I'm used to."

Jason Wickens, an avid mountain biker and hiker who frequented parks and trails near his former home in Salt Lake City, is adjusting to different environs to continue his athletic interests. He says he traded the mountains near Salt Lake City for the New York skyline.

"All of a sudden now I can't go out and do all the athletic things that I did before," he says, a tone of regret in his throaty voice. "I'm having to make time for exercise still, but I'm having to put my studies first. There are so many changes."

He sighs.

"I'm meeting so many new people and learning so many exciting things and have so many emotions running through my head," he says. "It's just a matter of finding a pattern that will work for me."

David Klemer, 38, the oldest incoming student and formerly a tenured associate professor of electrical engineering at the University of Texas at Arlington, says the opportunity to train at Columbia is beyond his wildest hopes. "My first few days here I wo ke up and had to convince myself I was really here, that this was not just a dream. I've gotten into the routine now, and it's going along fine."

However, he finds that getting used to big city life takes time.

"Here, you can't buy more groceries than you can afford to carry back to the residence hall. When I was in Texas, you go to the grocery store and load up the trunk of your car," he says. "Living in New York requires quite an adjustment. But I'm glad I'm h ere."

When Problems Arise, Students Help Each Other

If anyone understands the challenges facing incoming P&S students, it's Father Daniel Morrissey, assistant clinical professor of public health. Father Morrissey has counseled hundreds of students since he moved into a 12th floor apartment in Bard Hall nin e years ago.

"There's an awful lot thrown at people right away," Father Morrissey says. "The students are told, 'You have to learn this, and you have to learn it correctly. Somebody could die, or you could be sued for every penny you have. There's a right way and a wr ong way to do things. Don't be innovative. You have to know the objective criteria established for the national board exams.' Yet at the same time the students are reminded, 'Don't become a machine. You must be an individual.'"

Sometimes medical students get sidetracked in their attempts to find balance in their lives, Father Morrissey says. A program he helped to form, Addiction Intervention: Multiple Solutions, provides a resource for medical students or others struggling with chemical dependency, substance abuse, alcoholism, abusive relationships, eating disorders, and other compulsive behavior problems.

Nine students and nine faculty meet regularly to oversee general program issues and to plan outreach activities. The program also serves dental and nursing students and students in occupational and physical therapy programs.

Father Morrissey admits he was skeptical when Dr. Linda Lewis, dean of students, approached him about joining the medical school to launch the addiction intervention program.

"Who's going to want to come and see a Catholic priest who's telling you, 'Don't drink too much. Don't use drugs,'" he remembers thinking. "But I agreed to try it."

Part of the agreement was that Father Morrissey live in Bard Hall to be accessible to students. Once he moved in, he says, he was surprised at the number of students who came seeking counsel.

"I think they came for two reasons," he says. "One was the need for total confidentiality. I was clearly not speaking on behalf of the administration. I was living in Bard. People could get to know me and form their own opinions about whether they could t rust me."

The second reason was the need to explore the metaphysical or spiritual dimension of their physical problems. "For example, someone might say, 'My father wouldn't be gambling our money away if he loved us more.' That's a problem someone wants to talk to t he clergy about," says Father Morrissey. "My job is also to triage them into appropriate medical therapy."

These days Father Morrissey says he's fascinated by the pace of life at Health Sciences and the questions tackled by its faculty, staff, and students.

"The people on this campus have to face the question, 'What is life all about? To be or not to be?'" he says. "I like to be around people who ask the questions, live the questions, and take the questions seriously. It keeps me on my toes."

Class Hears from Alumnus who has"Been There, Done That"-and Would Do It All Over Again

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If the Class of 1999 needed inspiring, this year's opening exercises speaker provided words of wisdom. If the class needed reminders about the power of the medical profession, the speaker offered several examples.
And if members of the last class to enter P&S this century needed to be reassured about their career choice, Dr. Eric Rose shared insights that should have left no doubts in their mi nds. Dr. Rose, a 1975 P&S graduate and now professor and chairman of surgery, gave remarks titled "The Power of Irrational Optimism," excerpts of which follow:

"Twenty-four years ago I sat in this very Alumni Auditorium as a new first-year medica l student with sensations of excitement, awe, anticipation, and more than a bit of apprehension. I want to state emphatically that I'd gladly repeat the journey that brought me here today and to convey my firm conviction that despite the seeming obstacles that our complex world presents, there has been no better time to embark on a career in the art and science of healing, and no better place to do it than Columbia. Many would judge these convictions to be the product of an irrational degree of optimism. They look back to a past that was seemingly simpler, kinder, and gentler, a time when the field of medicine was unquestionably venerated and unfettered by economic or political concerns, a time when medicine was more personal, less technical. Many would s ay it was more humane. Yet, it is easy to be distracted by the warmth of nostalgia for a world we used to live in.
Dr. Eric Rose

"We also cannot deny the myriad problems that surround us: the AIDS epidemic, the emergence of antibiotic-resistant bacteria, the continuing scourges of heart disease and cancer, the challenges of caring for the urban poor. It is certainly justifiable to conclude that these ills may be incurable, and it would be foolish to predict that we can reach a utopian state. But it is equally foolish to view these problems as hopeless.

"With the skills you will acquire and the motivation provided by what you can achieve, I don't find it at all far-fetched to say that your generation will battle AIDS, heart disease, cancer, trauma, and autoimmune disease far more successfully than we, yo ur predecessors. New challenges will surface, but you and your successors will be amply prepared to respond. Why will you be prepared? Because the mechanism for our own professional reproduction has been institutionalized in the form of the aca-demic medi cal center. And there is no finer example of an academic health sciences institution than the Columbia-Presbyterian Medical Center.

"While many would argue that our location in a complex urban environment is a liability, I submit it is one of our strongest assets. We have the opportunity to continue to demonstrate how to apply the benefits of modern medical care to all strata of socie ty, a goal which cannot be accomplished from a distance.

"Can our society afford to continue to support institutions such as ours? I claim no special expertise in economics, yet the challenging economics of modern medicine are not unique. Not too long ago, it was predicted that oil would cost $500 a barrel by n ow instead of its present $18. Between increased efficiencies of use and finding new sources of supply, the so-called oil 'crisis' of the 1970s is now a distant memory. Cost-effectiveness is a relatively new pursuit for us, and it will certainly require u s to make some seemingly difficult adjustments. I am convinced, however, that we will prove at least as resourceful as the oil industry in meeting these challenges, and that society will continue to value our accomplishments.

"Let's look at some fundamental measures of our progress. Average life expectancy in the United States was 47 years in 1900, and will probably exceed 80 years by the time of your graduation. Clinical smallpox has been eradicated from the planet. Diphtheri a, pertussis, tetanus, polio, rubella, and measles are now preventable and rare. Tuberculosis, syphilis, Hodgkin's disease, and acute leukemia are now curable. Acute rheumatic fever has been virtually eliminated in the United States, while the heart valve complications of rheumatic heart disease are correctable with reparative or prosthetic replacement surgery. Mortality due to heart attack has fallen from 250 to 110 per 100,000 Americans.

"Sufferers of painful arthritis are now relieved by powerful anti-inflammatory drugs. Tens of thousands have been restored to painless functionality with prosthetic replacement of their hips, shoulders, and knees. Correction and rehabilitation for athleti c injuries has kept us playing football, basketball, hockey, rugby, and baseball and allowed us to continue swimming, jogging, climbing, kayaking, and roller-blading.

"Infected teeth are preserved with root canal procedures, while degenerated teeth are replaced with elegant implantable prostheses. Death due to extension of dental infections to the brain has virtually disappeared.

"This progress has touched virtually all of our lives. My own family experience with one now simple medical problem is illustrative of how much has changed for the better. In 1935, my mother's 8-year-old sister died due to acute appendicitis. Only now do I fully understand the fears of my parents and grandparents when I underwent an appendectomy as a 4-year-old for perforated appendicitis in 1955. When my stepson, Adam, was riding the school bus on a bright fall morning several years ago, he developed abdominal pain which his school nurse correctly diagnosed as acute appendicitis. She expedited his transfer to the hospital for an uneventful appendectomy. He was home in three days and back to school within a week. The same disease that killed my aunt, that threatened my own life, and made me ill for more than six months had become an almost minor nuisance. Yet the progress did not stop there. Many appendectomies are now done through a laparoscope with minuscule incisions and video guidance, while newer ant ibiotics may obviate the need for an operation altogether in many patients.

"Based on this progress, you will acquire the skills to use the most powerful diagnostic, pharmaceutical, surgical, nutritional, and rehabilitative tools ever developed to prolong and enhance the quality of human life. These skills will empower you indivi dually as a nurse, physician, dentist, psychiatrist, surgeon, occupational therapist, physical therapist, or researcher to have major impact on the lives of others.

"In closing, I feel obligated to torment you with some brief words of advice. Preparation, diligence, compassion, and the ability to listen will assure you a great sense of personal satisfaction in your successes, as well as provide you with the fortitude to weather the storms and disappointments which real life brings you and your patients. Ask questions relentlessly, regardless of how silly or ignorant they seem.

"Before me I see arguably the finest incoming classes in the Health Sciences schools in our history. I hope that you, too, will share my delight in the fact that your successors will be better physicians, dentists, nurses, surgeons, psychiatrists, physica l therapists, occupational therapists, and researchers than you. That is the ultimate power underlying my irrational optimism."

copyright ©, Columbia-Presbyterian Medical Center

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