I learned about medicine from that: But... But....."Aaron has the broken arm!"

Body-snatchers

“I have no idea what you are talking about
Your mouth moves only with someone's hand up your ass” - Radiohead

In the fall of 2007, Radiohead released In Rainbows. I download the album to my mp3 player, and relished it. I listened in the car, on the shuttle, and walking to OB-GYN rounds, as a 3rd year medical student. I was rotating at a suburban hospital staffed by UChicago residents and my days began at 4:15 am, when I would wake, grab a coffee, and begin my commute through Chicago’s icy streets.

Back then, Ob-Gyn had a reputation for unpleasantness. Faculty verbally abused residents, who verbally abused students. Shit rolled downhill. Everyone was stressed, and I felt the doctors took it out in their stitches— loose and sloppy.

Once, I was 5 minutes late to rounds, because my car swerved on the highway and I almost lost control. The chief resident read me the riot act. Better to have died on the highway than be late.

It wasn’t like she needed me. I provided no value other than waking poor Spanish speaking women in the early hours to peek under their gauze dressings. Disculpa me, perdona me, I asked for permission and begged for forgiveness. I didn’t even know what I was supposed to be looking for, but figured I would know it if I saw it.

Perhaps it was a two way street. The residents were bitches, but we students certainly liked to bitch. University of Chicago medical students were, by no means, docile and agreeable. Many were cranked up high-achievers, demanding and insufferable. There was an arms race between burnt-out residents and gunner students.

The OB-GYN department had just escalated when we started the rotation. The Department instituted a “you cannot change your grade once given” policy. The rule was simple: at the end of the rotation, you would get a grade. Whatever the grade was— there was no debate or discussion. It was yours.

No, you would not get to appeal it, or ask for a do-over or anything silly like that. No, we would not be meeting for months with the Dean of Med Ed. Take your grade, and shut up. As someone with no interest in Ob-Gyn, I didn’t have a problem with it.

How the sausage was made however was different. The department gave us a set of evaluation cards to pass out. You had to pass out 12. If, at any moment, you had a positive interaction with a faculty member, you had to lean over and say,

“Oh, hey, this is a little awkward, but I think we just had a nice moment, and I was wondering if you would evaluate me?” and then you passed them a card, if they signalled interest. It felt like dating. I was strategic with passing out cards, and shoved them deeper in my pocket when someone seemed angry with me. Oh, sorry, I am all out of cards, I would lie, if they asked for one.

At the end of the rotation, we sat around a conference table, and received our grades.

“Daniel… Daniel” shouted Simone, the clerkship coordinator

Daniel, a white, 6’2 man, with brown hair, rose and grabbed his grade.

“Vin—- EEE— Yak… Vine…. yard, Vin-Jack?”

“Coming,” I said without correcting her. Twenty years ago in medicine, no student assumed we even deserved our name, properly pronounced.

And on it went.

The grade report had a final grade, and then a series of comments:

“Vinny was an excellent student. He retracted for hours without making too much noise.” I can’t remember for certain, but I think I got an A, Honors. I had passed my cards out skillfully.

Daniel however looked pained. His face was contorted. I was surprised because it was well known he was going into neurosurgery, so what did he care about Ob-Gyn.

“Excuse me, Simone?” he began.

“Is it Daniel? Yes, what is it? Let me remind you however of the no changing of grades policy before you begin.”

“Right, I get that, Simone, but the issue is, this isn’t my grade. It is someone else’s grade.”

“Daniel, I am sorry. No, no, that is your grade. There is no doubt about it. We accept our grades here.”

“Simone, I understand that, but I am sure this is not my grade.”

“Daniel, I am sorry, but I am going to have to report this. We have one clear rule here. You accept that grade.”

“Simone, let me just read one thing: Daniel was an excellent medical student however I could only evaluate him 4 out of 14 days because he was out with a broken arm.”

Simone stared at him seething.

“Simone, as you can see, I have two working arms, and Aaron has a broken arm!” Daniel said, pointing down the table.

A white, 6’2”, brown haired, broken arm’d student looked up, smiling at his grade report.

“Daniel, I am sorry. We do not change grades.” Simone said flatly.

*

Twenty years later, I ran into Daniel when he visited San Francisco. We decided to drive up to Marin to hike in the Redwoods. In Rainbows played on the stereo.

“So, did you really get a C (Pass) on ObGyn because of your broken arm?”

“I never had a broken arm. Fucking ObGyn”

I learned about medicine from that. In fact, I learned more about medicine from that than I ever would have guessed. If you think the rules we have in medicine are sensible— the policies and administration reasonable— you are wrong. The rules are capricious, and they can be enforced with unflinching cruelty and stupidity.

You can break your arm, miss work and get an A, or have two functioning arms, work your ass off, and get a C. And I have yet to find a better metaphor for working in health-care. They might as well frame that and hang it above the door.

“They got a skin and they put me in
They got a skin and they put me in
Oh, the lines wrapped 'round my face
Oh, the lines wrapped 'round my face
Are for anyone else to see
Are for anyone else to see
I'm a lie”

-Radiohead

The author, 2007