Third year. Clinical rotation five.
My last one.
Pediatrics.
The rotation that changes my life.
My attending physician, Dr. Jay Pyle, wears his silver hair long, either flowing down to his shoulders or knotted into a ponytail. His face, lean and red from a lifetime of too much sun and red wine, is cut with kindness and laugh lines. His nose, sharp and strong, veers crookedly to the left, the result of blocking a punt in high school with his face. He played cornerback and ran back kickoffs and made All-City. When he smiles, which is often, he squints and his pale blue eyes twinkle. He was raised in Manhattan, and his accent comes at you hard, with a touch of a patrician lilt; he was a kid of both the Harlem playgrounds, where he played street ball, and the halls of Dalton and the brownstones of the Upper East Side.
We hit it off the first day.
“You’re good with your hands,” he says, a smile panning from cheek to cheek. “The word’s out.”
“Really?”
“Oh, yeah. I may have to take advantage of you. Isn’t that what I’m supposed to do? Take advantage of my third-years?”
“Absolutely. I’m here to serve.”
He grins again. “I’m liking this. All right. Let’s begin a little rounding. Watch out for room 223. Baby with strep. FLK.”
“FLK?”
“Take a shot. You won’t offend.”
I picture the letters. “Wild guess. Funny-looking kid?”
Dr. Jay Pyle steps back. “Tony Youn, you have a future in medicine.”
He slings an arm over my shoulder.
THREE WEEKS IN.
One morning I arrive a half hour before rounds. As I sign in, the charge nurse tells me that Dr. Pyle is already in with a patient on the ward.
“You should get down there,” she says. “There’s going to be a spinal tap. Something to see.”
I enter the room and find Dr. Pyle sitting with a young, frightened couple. The dad holds the mom’s hands. They are nodding numbly. Their faces have gone the color of chalk.
“We have to take a sample of the spinal fluid,” Dr. Pyle says. “It’s the only way to test for meningitis.”
The parents look up as I step farther into the room. I half-smile, wave. The parents sit up straighter, wave back.
“There he is,” Dr. Pyle says. “So I want to explain what he’s going to do. I want you to know exactly what to expect. No surprises.” More nodding. These poor people look as white as mimes. “He’s going to stick a four-inch-long needle into your baby’s back, right between the bones of the spine, and he’s gonna draw out a small sample of spinal fluid. We send it right down to the lab, they do a culture, and we’ll find out what’s going on.”
Wait a minute.
He’s going to stick a four-inch needle into your baby’s spine?
He as in . . . me?
“How you feeling, Tony?”
“Good. Great. I feel great.”
I think I’m going to be sick.
I feel warm and my head is spinning.
I’m actually doing this?
My first medical procedure ever is going to be a spinal tap on a four-month-old?
What doctor in the world would trust a third-year medical student to perform a spinal tap? Dr. Pyle has to be nuts. If I were a doctor—when I’m a doctor—would I ever let a medical student do this? Hell, no.
“Tony is unbelievable,” Dr. Pyle says. “He’s gifted. You’re in great hands. I’d trust him with my own kid.”
My emotions begin to swirl, switching back and forth. Simultaneously, I’m—
Nervous as hell. Immensely proud. Nervous as hell. Incredibly excited. Nervous as hell. Unspeakably thrilled. Nervous as hell. Amazingly pumped. And—
NERVOUS AS HELL.
“Let’s scrub up and do this. It’s all you, Tone.”
Dr. Pyle puts a charge of confidence in me that I have not felt from anyone. It fills me up, seeps into me, pushes under my skin.
I’m still a wreck.
I have no time to picture the procedure in my head, to see myself inserting the needle, drawing out the fluid. I have no time to prepare.
Okay, what’s the worst that can happen?
I can miss, puncture a blood vessel or hit a vertebra, causing permanent paralysis—
This is not helping.
I feel light-headed. Dizzy. Nauseated. Like I’m going to faint. Yep. I’m going to pass out. The medical student doing the spinal tap is going to fall, boink, right onto the floor. Perfect. Dr. Pyle is going to look like a total and complete jerk. And I will end up failing out and sharing a shrink practice with Tim.
Tony, get ahold of yourself. You can do this. This is your moment.
I look at Dr. Pyle.
He grins. I want to say to him, “Seriously? You trust me to do this?”, but the look on his face tells me everything. He has no doubt. I think about Frank Fremont and how I convinced him to have the surgery that saved his life, and I think about suturing up the episiotomy and practicing for months before that with a pig’s foot, and I know I’m ready. I know I can perform this spinal tap, that I can perform it well, and that I will perform many more procedures in my lifetime; this is merely the first. I no longer feel flush and unsteady, and nervous as hell leaves, replaced by a sort of adrenaline-pumping nervousness bordering right on the edge of something I might actually call . . . a rush.
Dr. Pyle holds the baby. He lays his tiny body down in perfect position, and I insert the needle into his back and pull it out, and the fluid we see is clear, and the baby is crying, but I’m grinning and Dr. Pyle shrugs proudly, as if he had no worries, none, ever, and all I feel is total and complete exhilaration. I want to shout in triumph, but I see the terrified looks on these young parents’ faces, kids really, only slightly older than me, people who might someday be me, and maybe Amy, too, and all I hope for is that the culture comes back clean and shows no meningitis and that their baby will be all right.
And when the result does come back negative, I feel for one fleeting moment as if I’m on the team, as if I belong.
AS SOON AS my shift is over, I call Amy and tell her about my surprise spinal tap and the rush I felt. She whoops into the phone, then after we talk for a while, she goes silent and I can tell she’s crying. I want to celebrate with her, but I know she has a brutal PBL domain exam on Monday and an inhumane amount of material to digest before then. Been there. With a day off, I decide to fire up the old Ford Tempo, hit the road to Greenville, and spend some quality time at home with the ’rents.
The truth is that while I’m flying high at this moment, overall, I feel lost. I’m in the middle of my fifth and final clinical rotation and I have no idea what kind of doctor I want to be. Our school designs the rotations to allow us to sample the possibilities, to set us on a path so that in fourth year, we can “choose our own adventure.” But I’m more confused now than ever.
As I drive, I consider my options again, for the millionth time.
Pediatrics? My father’s voice blasts through the car’s speakers: Tiny people, tiny dollah! I love working with Dr. Pyle, but I’m not cut out to be a pediatrician.
Surgery? I hear my father’s voice again, but this time he’s pushing me: One proceejah, big dollah! But the road to specialized surgery is so long, grueling, and intense. I’m not made that way. And clearly, I’m not orthopedic-surgery material. General surgery? I refuse to end up like Dr. Z or Dr. A, fifty-five years old, sleeping in the hospital, stumbling out of the call room at three o’clock in the morning to deal with a trauma. I will burn out if I don’t first flip out.
Obstetrics and gynecology? No.
Internal medicine? I can’t see myself spending my life investigating the secretions of the pancreas. As fascinating as that may be.
Psychiatry?
I’M COMING HOME WITH YOU, PRETTY BOY!
Tim, have fun.
I don’t see myself in any of these fields. I feel stuck.
I suppose I could go into family practice. It’s so easy. Three-year residency, and the last year is a walk in the park. You’re essentially done in two years, no pressure, and you’re left with a ton of free time. I like to dabble. I can get more serious about my guitar, maybe join a band. Maybe I’ll even get an MBA on top of my MD. True, you don’t make a lot of money at first, but my other interests could lead to more money coming in. When I measure money versus lifestyle, money doesn’t always win. Why not take it easy? I think I’ve found it. Family practice. Perfect for me.
Great. I have a plan.
I’m going into family practice.
I know that my father desperately wants me to become a surgeon. Sorry, Dad. I’m a grown man. I make my own decisions. This is my life.
Isn’t it?
WE’RE AT HIS tennis club, batting balls back and forth. It’s been a while since I picked up a racket, probably not since high school. I played so much back then that I could hit winners with my eyes closed. No more. Today I’m a hacker. Balls slice off the rim of the racket, squirt out of bounds. I whack my forehand with so much power that balls sail over the back line and bang off the back wall, or I turn my wrist too far over and balls whap into the net. My dad, quicker and stronger than you’d think, takes his tennis seriously. He lunges at balls you swear he’ll never get to and returns them with nasty topspin. He’s ferocious. With him, there’s no such thing as a simple volley. You always have to be on top of your game. We don’t keep score, we just hit. Words to live by.
I remember once when I was a kid, twelve or thirteen, my dad asked me to hit some balls with him one Saturday afternoon. I didn’t refuse—I’d learned that lesson—but I volleyed with no enthusiasm. I jogged after balls he lobbed, I didn’t run. I served lazily. I hit a few underhand. I didn’t want to be there, so I didn’t try.
After one rally in which I whiffed at a ball and then laughed, my dad stopped and stared at me across the net. He snorted. He picked up a handful of balls, turned his back to me, and began hitting balls to himself off the back wall. He hit the balls to himself again and again as if I weren’t there. I stood alone on my side of the court and waited for him to return to volleying with me. He never did. He hit a bucket of balls to himself, then turned and walked to the car. I ran alongside him. He didn’t speak to me until the next day. I learned two quick lessons. First, no matter what you do, do it well, with enthusiasm and heart. Second, respect your father.
Now, over ten years later, we hit to each other. I’m in every rally, or trying to be. I’m stinking, but I’m trying. He knows I am.
“You rusty,” he says, not unkindly.
“I know,” I say. “Frustrating.”
“No time to practice. This good, though. Good workout.”
“Yep.” I grunt through a serve, which finally zips into the corner of the server’s box and past him for an ace.
“Ah!” my father yelps, points the racket at me happily.
“Dad,” I say. “I’ve been thinking about general surgery.”
“Good field,” my father says. “Transplant better. Or vascular surgery. Or neurosurgery. Or cardiothoracic surgery. Or colorectal surgery—”
“I know. And I like surgery. It’s just that—” I can’t finish.
“What?”
“I’ve been seriously thinking about family practice.”
“Family practice? Instead?”
It feels as if the temperature has suddenly dropped thirty degrees.
“Also. In addition. In addition to general surgery. Keep my options open.”
“Family practice, you make no money.”
“I know. But the lifestyle is good. I think, you know, it’s what I want.”
The words hang out there, refusing to fade. My father tips his cap. The bill falls over his eyes. He scratches the back of his neck furiously. He pulls his cap back in place and walks to his position at the baseline.
“Your serve,” he says.
THE REST OF the evening is chilly. We sit at dinner, the three of us, Dad, Mom, and I, passing one another bowls of food my mom has made, the only sounds the slurping of soup and the clicking of chopsticks. My mother tries to get the conversation rolling. She asks about my roommates, my house, and casually wonders if I’ve been seeing anyone.
“No,” I say, staring into my soup. “Nobody.”
Yeah, that’s all I need on top of the family-practice disaster. If I ever bring up Amy, mention that I have a girlfriend—a white girlfriend—I might as well start interviewing for another family.
“Plenty of time for girls after finish school.” My father’s mantra since fifth grade.
“You do have to concentrate on your studies,” my mother says.
“Oh, I know Tony,” Dad says, smirking, about to tell the punch line to an old family joke that nobody finds funny, least of all me. “He gonna marry a blondie.” He roars at his own joke.
Of course, it is no joke. It’s a thinly veiled threat.
So, how am I doing this weekend? Let’s check my vitals.
I’ve rejected surgery.
I have a girlfriend.
Who is not Korean.
But hey, at least she’s not a blondie.
I’m on life support.
I CAN’T SLEEP. I lie in my bedroom in my parents’ house, the bedroom where I grew up. My mom has left everything in place here, like a room cordoned off in a museum—my books on the shelves, flanked by high school awards and trophies, my posters on the wall, clothes I will never wear still hanging in the closet. It’s my room, but it feels as if it belongs to a stranger.
I bring my covers up to my chin, toss and turn in my twin bed, more uncomfortable even than my threadbare mattress on Flower Street. Maybe it was a mistake to come home. I felt homesick, yet whenever I come home, I regress. I’m a third-year medical student. I’m going to be a doctor, but within five minutes of being home, I become twelve. I want to please my parents, I want them to be proud of me. But at a certain point, you have to grow up. You have to make your own decisions. I’m sorry if my father is disappointed. I will have to accept that. And when I finally tell them about Amy, they’ll have to accept that, too. If it means they kick me out of the family, so be it.
Two A.M. Still wide awake. My ankles hang over the bed. I’m tangled in my covers. I can’t find a comfortable position. I feel claustrophobic in my own room. How did I sleep in this bed for so many years?
Three A.M. Finally starting to fade. Each one of my father’s surgery suggestions dances in front of me, pounding like a drum—transplant surgery, vascular surgery, neurosurgery, cardiothoracic surgery, colorectal surgery.
I lose myself in my father’s voice. My eyes slowly close. I start to float away—
I hear something at my door.
A scraping. A clawing. The door creaks open. My eyelids flutter. I’m coming out of the twilight state between dreaming and being awake.
Someone is coming into my room.
I half-open my eyes and catch a glimpse of the clock: 5:13 A.M.
“Move over.”
My father. Standing over me. He’s fully clothed. His breath, warm and smelling of green tea, brushes my face. “Move over,” he says again. “Daddy needs to talk.”
Obediently, I scoot to my right, sliding over as far into the wall as I can. My father lies down next to me, his weight making the twin bed sag. He folds his hands on his stomach. He says nothing. We both stare at the ceiling.
“Tony.”
I swallow. “Yes?”
“Daddy has been . . . thinking.”
I wait.
“If you want to go into family practice, it’s okay. Daddy understands. You do what makes you happy.”
“Daddy just wants you to be happy.”
“Thank you. That means a lot.”
“You go broke. You probably have to move back home. But.” He sighs, sniffs. “That’s fine. If it’s what you really want, it’s okay.”
“Thank you,” I say again.
He reaches over and touches my hand. “Daddy,” he says, his voice cracking, “is very proud of you.”