I’ve been trying to not be a doctor ever since the week before medical school.
California raised and schooled, I’d squeaked into the University Of California, San Diego in the waning hours of the summer of 1994, weeks before matriculation. I remember the call home when my mom told me the news. The squealing of metal on metal, costumed grown men with whistles, brass buttons on polyester petticoats, Italian suits hurrying, driven eyes focused forward, mothers with children in tow, youthful couples glowing, holding hands. They all bustled in a seeming chaos that was more a dance, each character with a place and purpose. This was before humanity’s enrapture with the smart phones that shrunk their circles of awareness, when the pulse of humanity’s collective was still palpable to the hive. I had filled my obligatory post-graduate European sojourn with Notre Dames and Michelangelos, but the interactive art of humankind in this dance has stuck with me over the years.
A European train station to an American is mind numbing in its frenzy and confusion, mind blowing in its infinite interconnectedness. Rolodex boards of flickering letters clicked overhead, eventually spelling out names of enchanted cities like Rome and Berlin, Amsterdam and Prague. Platform 2 lead to the black and white film reels of Hitler’s armies marching with outstretched arms and the communism of which Ronald Reagan had warned me. Platform 4 stretched South to Aristotle and Plato and men in robes who built vomitoriums with great pillars to circumvent the physiologic confines of hedonism. I had thought my world had expanded when I first arrived at Berkeley from an insulated suburban SoCal indoctrination, still pink and 17, as I happened upon a spirited maverick atop an overturned 5 gallon bucket on Sproul Plaza preaching of the first Persian Gulf War as a ruse, money and oil the true impetus, not some altruistic liberation of a besieged Kuwait. Now, the infinite possibility of man compounded that mind expansion, the boundless realm of choice, the hugeness of history’s past, the limitless potential of arrival in a new moment, a new world all around. The power of such infinite choice filled my young spirit, now 21 and armed with a backpack, a Eurail pass, and a canvas as open and vast as the realmless void that existed before the universe was born.
I sat with my baguette and bottled water, trying to make sense of the madness, to recognize the patterns, to garner some nidus of a clue that I could take in and build my yet-to-crystallize self around. Life, you see, for me perhaps more than others, has always been a puzzle to be solved, not enjoyed. And while the stated exigence of the trip was celebration (with perhaps an unstated one of courting one of the myriad international beauties that populated the youth hostals), the undercurrent was one of decision. I was as free as a human soul could be, a satellite floating unencumbered through space. But no soul is completely untethered, not while confined to the vessel that is the human form, at least. I felt it as a gentle tug, magnetic, a compass needle yet to lock in to North. But whose hand moves the Ouija across her board? Certainly not mine, it seemed at times.
As the plan stood, I was to become a physician, start medical school at the University of Chicago in the fall. It had been ranked number 2 in the US News and World Report, and such seemed a fitting feather for the hat of the straight A perfectionist who had graduated with high honors with a Bachelors degree in Science (Psychology) and had broken the curve for most of his pre-med classes. I had been groomed to be a doctor epigenetically, my Jewish uncle who liked to tell the story of the patient who walked into his office with a hatchet buried deep in his skull, my Depression-era father whose Bubby had taught him that money is the sun, my grandmother and aunts and uncles who thought there were only two choices of career in this world, lawyer and doctor.
“What happened to the man with the hatchet in his head?” I had asked, eyes wide and hopeful after such a dramatic build-up.
Uncle Stan’s timing of delivery was practiced to perfection. He was one of those humans who performed well-honed one-liners that would later define him. His late-stage multiple sclerosis added to his comedic character, slowing down the pace of the rising action before the crescendo. He looked me hard in the eyes as he laughed with such force his weakened body would jerk about in his wheelchair.
“He died!” the wholeness of his weakened body laughing, convulsing.
Another one of Uncle Stan’s schticks was to hold up a one dollar pill and snap it tight between his two hands such that George Washington’s bust would alternate between taco-ing and staring me straight in the face. SNAP. Taco. SNAP.
“See this, Steven?” I did. “This man here is your only friend.”
I’m thankful Stan was only my uncle and such lessons came but a few times per year. But the apple and the tree and all that, and this was my dad’s side of the family. Perhaps the Jewish version of the Old Testament includes a chapter by a prophet who was also an accountant or financial advisor, a book my mom’s Presbyterian church was not privy to.
Whereas these external forces were shaping me, I had also come from the factory with my own unique settings. Looking back, I see them now as perhaps playing the greatest role in my eventual demise. You see, for better or for worse, I enjoy the feeling I get when others are pleased by my actions. Their happiness, somehow, is of greater value than my own. Sacrifice is one consequence. Following others when perhaps I should be leading is the other. These traits explain how the nurture side of the doctor-building of Steven went down from an early age. Of course there is a picture of me at 2 years old holding a stethoscope. And I remember the anatomic chart of the neurologic system pinned to my wall from the earliest of ages. These forces were external. But from within… I remember standing on my bed amongst the clutter of cap guns and stuffed toys, my finger tracing the long yellow lines that stretched from the motor cortex of the homunculus to the tips of the toes and every place in between. The fascination was from within. Even now, I cannot imagine anything but awe by any man, woman, or child who contemplates the infinite connections, the well-charted explanation of it all, the Latin names of the medulla oblongata and corpus callosum, the miracle that is the human body.
These are the place-fillers, the pictures and images I can see when I look back, trying to explain how I got here, the frist choice that lifted me so high before dropping me into this abyss. When and why did I choose this life for myself?
It is the pride I remember most. I recognized it in the widening eyes and broadening smile of the adults so filled with reward and judgment when I answered the ubiquitous question, the one to which the other kids answered fireman and policeman. Pride resonated uniquely with me, the eternal pleaser. Never mind that the answer came from same boy who moments before had shaken a log of poop down his right pant leg and left it on the floor as an alternative to sitting on a shared toilet. Choices are funny like that. It’s hard to separate the conditioning nature of the past, the bell from the bone. The dog only knows to sit and all will be good.
Truth be told, I had never really decided to become a doctor. What I had told myself as I registered and subsequently aced Biology and Chemistry, Organic Chem and Calculus, was that I’d keep the doctor option open. I chose not to live with Adi and Aguirre and Binn and Chad in my senior year of university not because I didn’t want to turn the college experience up a notch and live in North Berkeley with my buddies, but because the MCATs, the entrance exam for medical school, were to be held that semester, and I figured the ubiquity of bongs and barley malt would prove as daunting deterrents. I applied to 20 schools, as was the norm, and had received less thick University emblazoned envelopes in the mail than thick ones. Number two sounded the best, given my programming and the poor judgment of whoever number 1 was at the time. But something the University of Chicago pathologist had said in our interview still haunted me,his back to the window with the majestic blue of Lake Michigan filling the room.
“Why would I not go to school here?” I had asked, intoxicated by what I had seen that day.
“Well,” his voice trailed off, “from September to May it can get pretty grey and cold.”
Enough time had passed since that interview for me to have done the math.
The screech of metal on metal, tracks so long they stretch beyond the horizon, before all time. Here I was, figuring it out. Life. Choice. The future. I had grown so much since that little boy shaking poop down his pant leg. And yet, decisions never resolved to come much easier. Perhaps this place had the answer… the Old World, the Renaissance artists, the ancient cathedrals, this train station. Everyone here had a place, the petticoat whistles that orchestrated the dance, the businessmen whose watches kept time and whose engines propulsed progress, the mothers and their eternal umbilical cords, nourishing and unconditional, young lovers full of life and passion, presence. Where did I fit? I tore off another chunk of bread from the huge loaf and chewed. I watched the children and lovers moving light and free, the mothers and suits burdened by their luggage, a painting of Jesus carrying His cross, beads of sweat, furrowed brows, necks hunched, the Mediterranean in August and all of her scents. Each man, each woman, seemed at once their own universe’s center and a necessary piece of the dance, a cog in a machine whose purpose I had yet to decode. Loudspeakers with cities and times and platform numbers, nearly translatable, their volume maxed out beyond the capacity of the tiny triangular speakers’ amperage. I strained my ears to make sure it wasn’t my city’s name crackling through the noise.
Life is so sweet in its simplest moments. This far away from the gravitational forces that had long since pulled at my core, I could not tell if I remained in orbit or had shot off on a tangent, a free vector travelling through space and time. To not miss my train was my life’s sole priority. The scent of coffee, cigarettes, chocolate, a distant vat of boiling grease, the cry of a baby, voices in languages I could not recognize, impatience, the incessant screech of metal on metal, a clock ticking loudly above.
I lifted the receiver and punched in the numbers from my prepaid calling card. My mother was the second star that still tugged at my being, the first being my career’s calling. The force of her gravity will remain long past her time in this universe.
“Where are you?”
The question annoyed me. How dare she ask, this blessed and perfect saint of a mother. I both loved her and felt repulsed by her for all of her self-sacrifice and pedestal placing, the golden child on his final jaunt of freedom before the dungeons of medical school would swallow me whole. Had I not accomplished enough? Phi Beta Kappa in my junior year at Berkeley, an achievement bestowed upon only twenty of a class of over 5000, a 4.2 GPA before that, a would-be valedictorian were it not for a coke-snorting boss where I delivered pizzas who gave me a B in work comp? Here I was, locked and loaded to enter the University of Chicago in a few short weeks and continue on my path of making her so proud. Maybe if I had gotten into number 1 she would have trusted me in my choices, my whereabouts and safety.
“Florence,” I yelled over the chaos. A train’s throaty whistle from the track adjacent to the pay phone blew so loud I nearly dropped the receiver. Were I to reach out I could touch the beast as it slowed to a stop, brakes shrieking and hissing, the grime of its distant past black on my fingertip.
“Are you having fun?”
“Ya, it’s great.” This too annoyed me. Here, it was the imperfection of words. How ironic as I sit here in the second chapter of this book, attempting with words to explain it all, the rise and the fall, the transmutation of God and the Devil, the culpability of death and the twin suicides of man.
“Ya, it’s great,” I hear my words echo in the delayed connection, the type of phone call that made both my mom and me start and abruptly stop our would-be sentences simultaneously, both frustrated to lose communications’ unconscious cadence. I’d just seen Michelangelo’s unfinished sculptures in which polished perfection seemingly crawls from blocks of half-chiseled marble, haggled with shopkeepers on the Ponte Vecchio with it’s medieval stone arches that in its 1000 year existence had been destroyed twice by flood but had uniquely survived Hitler’s bombing only because Hitler had an eye for it’s beauty, flirted with a Swiss girl at the Uffizi where we stared at Da Vinci’s and the swollen bellies of Botticelli’s, our thoughts unspoken. “Great” seemed a regrettable choice for translating this experience to my overprotective mom who had never owned a passport.
The frustration of the shotty connection was simmering to exasperation, leaving the pleasantries of small talk unfulfilling at best. On to the business at hand.
“UC San Diego called this week,” she said. “You got in.”
A pause. Happiness?
“What do you want to do?”
A crashing. Weight.
There is a feeling of ecstasy when a backpacker finally unslings his heavy pack from his shoulders and hips and drops it to the ground, sweat dripping, breath panting, the arduous climb now behind. This was that feeling’s opposite.
“UC San Diego is ¼ the cost,” my mom added, uncomfortable like me in the silence.
Another pause.
“From September to May it can get pretty grey and cold,” the words echoed in my head, in this cavernous station. It was the way the doctor had drawn out the word pretty that had haunted me. As if there was a hidden meaning lurking in the way his voice inflected conspicuously more treble, a truth and an untruth told at once, like when the eye winks or the fingers cross. What months did that leave? Exactly June, July, and August.
September would come in two weeks. My flight home was in one. August 23 was a date that haunted me more than those distant words in a room filled with the majesty of the Great Lake. The majesty of the Pacific Ocean.
“UCSD,” I heard my voice say.
“UCSD” said the echo, in a voice I almost recognized as my own.
I have mentioned already that I am not a believer in the concept of choice. Momentum, inertia, the heaviness of the past and it’s gentle leaning, the weighing of probabilities, the specter of opportunity lost, regret, programming, conditioning, emotional duress, trying to please them all, a release of the burden of choice… those are concepts to which I can testify.
My flight from Rome to LAX through London was uneventful. I hugged and kissed my mom when I finally saw her amongst the masses, patiently waiting outside of customs.
I looked skinny, she said.
It was great to see her, I said.
I spent the next 6 days spreading my backpack’s belongings all over my childhood home, claiming space like a city-raised apartment dog who finds himself relocated to the wide expanse of the country. My essential belongings that had once fit into a single backpack had grown into a dozen or so cardboard boxes that I stacked like Tetris bricks into my step-dad’s bronze Dodge van that was already pointed South. I spent the 104° San Fernando Valley days floating weightless in the pool, staring up at the same pale blue that filled DaVinci’s dreams of flight and inspired Gaudi’s impossible spires of Sagrada Familia. I was acutely aware of the finity of time, the knocking on the door. On the 7th day, exactly one day before our planned migration, I was struck by the most intense pain in my right lower quadrant. I had a low grade fever, diarrhea, nausea and an intense aversion to food. These were the symptoms I would later equate with appendicitis, the diagnosis I was given that evening in Kaiser’s Emergency Room.
I remember being wheeled on my gurney as the fluorescent lights scrolled from top to bottom, the squeaking of the metal wheels on waxed tiles, the clack clack clack of the joints between and the masks that covered the faces of the nurses and hovering above.
“There is really no choice in the matter,” one masked doctor explained.
Choice. The concept compelled no emotion through the morphine’s fog.
“Do you have any allergies? Medications? Drugs?” he asked next.
My mother was amongst the angels as I looked up through the fever. Hers was the only face not veiled by mask. So much emotion is translated by the mouth, the subtle angles drawn up or left slack, the weight of the lips, heavy with fear. I saw despair in her countenance while I pondered the consequences of not copping to that joint in Barcelona or the space cake in Amsterdam. Would the drugs combine with the anesthetics to create some kind of deadly side effect? The mouth and those eyes, such hope, such potential.
“A little pot…” I paused, weakly, “and maybe some mushrooms.”
I studied her face carefully. If there was disappointment, she masked it well. Or perhaps fear is more dense than sorrow, a mother’s for her son.
In these 20 years of watching the human body as it flows back and forth between optimal health and the brink of death, I have come to appreciate the power of the psycho-spiritual energy at the core and the unconscious power it exerts over the physical body. I have witnessed fear transform a conversant patient to breathless and gasping as his understanding of my scientific explanation of a heart artery clotting is realized. I have triggered extreme panic attacks by broaching topics that patients would rather keep safe from the piercing light. I have failed time-and-again at righting the course of the distraught women whose complaints met criteria for fibromyalgia or chronic fatigue syndrome, traipsing through every known functional medicine test, treating Lymes and Epstein Barr and mold and mercury toxicity, righting hormonal dysregulation and mitochondrial dysfunction, when an underlying thorn lurked beneath their psycho-spiritual paw, an abusive father or a thief that had forced a no into a yes. From migraines to chronic back pain, depression to eczema, sometimes the body has a mind of it’s own, it’s cognition not measured in thought or logic but in intuition and instinct. It is like the body is a voodoo doll and the psyche holds the pins.
UCSD would forgive the faultiness of my physical body. They would allow me to miss the first week of orientation and begin classes as scheduled after my one-week delay. What a tragedy to imagine the alternative, my acceptance into medical school being withdrawn, all of the hard work, the all-nighters spent studying, each afternoon in the great hall of Doe Library when my buddies were drinking oversized beers at the Bear’s Lair or playing pool in the basement of Larry Blakes or whatever filled their afternoons, the months of MCAT preparation, passing up on the experience of living with my best friends in my final year at Cal. Sure, this was all billed as a methaphorical door to be kept open. But to imagine its closing was unthinkable. I never have been good with missing opportunities.
I was grateful that UCSD accommodated my situation after my mom or me, I can’t remember which, had asked.
Nor am I sure it was the right question.