Living and Dying in Brick City (25 page)

My adrenaline soared as I instructed the technician to grab the EKG machine and told the clerk to order a portable chest X-ray. My senior resident sensed the escalating crisis and jumped right in, instructing the junior resident to get the equipment for intubation. Within seconds, the junior resident had her equipment in hand and began the process. The senior resident stood over her shoulder to monitor and offer support.

In anticipation of the next step, Mike, the clerk, paged a respiratory technician, who would be needed to put the patient on a ventilator to regulate the rate and volume of oxygen flowing to her. My intern stood at Mrs. Santos’s waist, inserting a large bore intravenous line through the leg to the femoral vein in the groin area. My role was to make sure the patient was receiving the best care as quickly and smoothly as possible. I moved toward the young man standing nervously in a corner of the room, presumably the patient’s son, to find out what had happened. He started talking as soon as I was within earshot.

“Doc, I found her passed out in the middle of the floor this evening when I came home,” he said. “When I left this morning to go to work, she was fine. She was sitting at the table having breakfast and reading her paper. I was at the counter, fixing my coffee, and she was talking about all she had to get done today.

“She asked me to drop some clothes off at the cleaners because she had to go to the bank, the supermarket, and the doctor. That was the last time I talked to her until I got home. I can’t believe she was lying at home, possibly all day, without being able to move or call for help.

“Doc, what do you think is going on? She only has high blood pressure, has never smoked or drank a day in her life.”

Wait. High blood pressure. “Is she on medication for the hypertension?” I asked.

“Yes,” he replied. “But she doesn’t like taking it. She says she doesn’t like the way it makes her feel groggy and sleepy all the time. She says her pressure never makes her feel that bad, just a headache every once in a while.”

Right away, I knew she’d probably had a stroke. Mrs. Santos was being rushed off to get a CAT scan, and the respiratory therapist was at the head of the bed, pumping oxygen through a bag to deliver the right amount of air to keep her vulnerable organs alive. In my mind I predicted what the scan would show: a large injured
area in the brain from the stroke. But for her and her family’s sake, I hoped I was wrong. I hoped she would pull through and I’d have a chance to explain to her how crucial it was that she took her medication. Her son’s face showed disbelief. His eyes seemed to ask: How could this be? How could a cheerful “good morning … see you later for dinner” end up here? I braced myself for what I knew would be his next question: “Doc, what are her chances?”

“Well, we just have to wait and see the results of the CAT scan,” I told him.

“Doc, you don’t understand. I can’t lose her. She is my world.”

His pain was raw, and I wanted to do all I could to make things turn out right for him. But this was truly out of my hands. I excused myself and told him that I would return as soon as I had the results.

“Dr. Davis, pick up on 7240,” a voice over the intercom said a few minutes later.

I reached for the phone. It was the radiologist calling with the results. The news wasn’t good. Mrs. Santos had a large bleed with herniation of the brain and compression of the brain stem, explaining her low heart rate. She was basically brain dead. The life support machine was breathing for her. I returned to the room and pulled up a chair next to her son. With elbows resting on his knees, he leaned over his mother, who lay completely still in a hospital bed. The rhythmic breaths of the machine seemed louder in the silence. There is no easy way to tell someone the worst possible news about a loved one.

“I’m so sorry to tell you this,” I began.

My words punctured him. I could see his hope deflating as I explained that the machines were the only thing keeping his mother alive … and he would have to make the painful decision of whether and when to disconnect her from them.

“Doc, you told me you would save her,” he replied—wanting, at this moment surely needing, to believe that I’d actually said that.

This was grief talking. I let him vent.

“You told me she had a chance. I want you to bring her back to me, the same way she was when I left her this morning.”

I took a deep breath and tried to offer some comfort. “I’m so sorry, sir. I know this isn’t easy.”

He dropped his head in his hands and wept.

R
henita Oglesby was a single mother in her second year of medical school in New Jersey the day we met in 2003. She had just finished reading the memoir I’d written with Rameck and George, and she wanted to tell me her story. After a book event, I noticed her waiting patiently to speak to me, and as she introduced herself, tears filled her eyes. My success had given her hope, she said, because, like me, she had failed the first part of the state board exam that all medical students must pass to stay on the road to becoming a doctor. She had overcome so much in her life to get into medical school, but after recently failing the test, she felt her dream slipping away. I knew immediately how she felt. The memory of my own failure on the same test a few years earlier was still fresh—the panic that welled in my throat as I sat in the dean’s office and received the news, the feeling of worthlessness, and the fear that all my hard work would land me short of my goal. The carrot (a medical career) was right there, dangling in front of my eyes. I could see it, smell it, and almost touch it, but I’d stumbled in my first attempt to reach for it.

My first thought: I had to help this woman. My second: Camille had been right.

I smiled to myself as I thought about Camille, a good friend and
fellow medical student who had shared an apartment with Rameck and me the first year of medical school. I’d felt so alone after learning that I’d failed the state board exam that I isolated myself even more from both of my roommates, as well as from George, who was a short drive away in Newark, attending dental school. None of them could understand what I was going through, I thought. But during one of my worst moments, Camille told me: “You might not understand it now, Sam, but God allowed this to happen for a reason.”

Though I appreciated Camille’s attempt to comfort me, I’m certain I didn’t believe her right then. She had passed the test. It was easy for her to think that God had some grand master plan for me that included what in the moment felt close to torture. But looking at the hurt in Rhenita’s eyes years later, I felt instantly connected to her, and my own struggles finally seemed to make more sense. She was a stranger, but no one knew what she felt better than I. “I know what you’re going through because I’ve been there,” I told her. “And I can help you get through this.”

It felt good to be able to say that to her and to stand as an example that one failure didn’t have to be the end of the road for her. We exchanged contact information, and I later shared with her the advice that two of my trusted college advisers had given me to help me refocus my thoughts and energy. Before I had any chance of passing, they’d said, I had to find a way to reduce my stress. I’d been so worried about passing the test that I’d defeated myself mentally before I even sat down to take it. My advisers’ words prompted me to reach back to my childhood kung fu lessons, when I’d first learned how to clear my mind through meditation. Then, slowly, I crawled out of the doldrums and began a daily routine of meditating, working out, and studying vigorously, breaking the material I needed to know for the test into digestible parts for each study session. I shut out the negative thoughts and reassured myself
several times a day that I was smart enough to become a doctor; I just kept repeating the words to myself until I really believed them. The second time around, I passed easily. The same routine helped me pass the next two parts of the state board exam on the first try.

I shared with Rhenita the study routine that had been helpful to me, and the two of us met about once a week at the library, at Beth Israel, or at the medical school she attended. We discussed time management, outlined a plan of study, and stuck to it. We talked about the importance of her believing that she would get past this hurdle. When Rhenita took the exam a second time, she passed. Her victory felt almost as extraordinary to me as my own had. She now practices family medicine in New Jersey.

Time and time again, I found myself drawn to help other smart and hardworking young people facing some kind of challenge to their dreams. I knew something about struggle. My own struggles—and finding a way to work through them—had taught me about fortitude and endurance.

After I passed my exams, and just weeks before my medical school graduation, I thought I had survived the worst and was on my way to a rewarding career, then there I was again, sitting before a grim-faced dean with more bad news. None of the teaching hospitals I had applied to had chosen me for their residency programs. Like every other medical student about to graduate into the real world, I had researched the teaching hospitals that offered residencies in my desired specialty (emergency medicine) and identified the places where I wanted to work. I’d sent out forty applications, and thirty hospitals had responded, inviting me for an interview. I’d narrowed that list to a more manageable eighteen and spent every penny I had traveling to interviews in New Jersey, New York, Washington, D.C., and Maryland, as well as in Atlanta, Cleveland, Chicago, and Philadelphia. I couldn’t afford to
take the train or plane to most places, so I drove to the East Coast hospitals and stayed mostly with relatives, friends, and friends of friends. I’d even schlepped through snowstorms to get to a couple of the appointments. I had just one suit, a cheap but stylish dark blue one that I’d picked up at a discount store, but I made sure it was clean for every interview. I dressed it up with a nice shirt—sky blue one time, baby blue the next. When I ranked my top choices in the National Resident Matching Program’s computerized database, I was sure that at least one of my favored hospitals on the East Coast would choose me, too. But when the hospitals entered their chosen candidates into the same database, and the computer spit out the matches linking the students and hospitals, none of the hospitals on my list had chosen me. Once again, I was devastated and filled with self-doubt.

Emergency medicine is a super-competitive specialty with far more qualified applicants than slots, but I had done well academically. I couldn’t help wondering:
What’s wrong with me?
I will never know for sure why I didn’t match, but my medical school advisers suggested that my response during a particular part of the interview certainly hadn’t helped my chances; sometimes, one small detail can separate two good candidates. When questioners had asked me what I wanted to do for extracurricular activity, I’d talked about my desire to do community service. I saw more than a few puzzled looks as I sought feebly to explain the connection to medicine. I may have made a stronger impression, my advisers suggested, if I’d expressed an interest in taking classes or seminars exploring the latest in EKG or ultrasound technology, the merger of the Internet and medicine, or methods to increase patient satisfaction—all popular areas of study.

In the last-minute scramble to land a residency, I took the dean’s advice and applied for a position in the more expansive field of internal medicine. I hastily accepted an offer from the University
of Maryland. It was a reputable program, but I had zero interest in internal medicine. My fate seemed sealed, and I was miserable. I just kept thinking that there had to be another option, another emergency medicine residency program out there somewhere. There was no way I had come this far to be this miserable. I asked myself repeatedly:
Where do you want to be? Where would you have the best chance to shine?

That’s how I ended up a few weeks later doing another computer search of emergency medicine residency programs in New Jersey. Suddenly, Beth Israel popped up on my screen. It was the first time in all of my research that the program had surfaced. Excitement shot through me, renewing the hope that had disappeared weeks earlier. The website showed that each of the hospital’s six residency slots was filled, but I didn’t care. I had to know more. When I called and introduced myself, Jacquie Johnson, the hospital’s residency coordinator, explained that the residency program had been revamped, expanded, and newly advertised, which was why it hadn’t shown up in any of my previous searches. By the way, she added, the website had not yet been updated, and the expansion had created two additional slots in emergency medicine. I could hardly believe my ears. God had opened up the heavens and dropped this starving dog a bone. I sank my teeth in and ran with it. I immediately faxed my application and followed up with a telephone call. I got a good vibe from Jacquie. She seemed impressed that I’d grown up in Newark, and we clicked over the phone. When she told me that she would make sure to put my information into the right hands, I believed her. Sure enough, within just a few days, I was invited for an interview at the hospital.