Residency Letter

A little prologue might be necessary.  Between 1980 and 1981, Jenny Jamison, an LVN, was alleged to have murdered children at Lion County Hospital in Pleasantville.  She allegedly carried her spree to the nearby town of New Heidelberg where she worked in the pediatric office of Dr. Nancy Germany.  

Everything in this letter is true in the way I remember it.  I changed the names to protect myself from the guilty.  I’m sure if you dig deep enough you can figure it out.

* * *

This letter has been a long time coming.  I don’t want to relive old memories; I’ve already done that, and it’s too painful.  Nor do I want this epistle to devolve into a loathing, self-pitying screed, which it inevitably must or else you won’t get the point; it’s just that I think you should know a few things.

First, I was almost there.  I missed it by one year, but I know enough and felt enough to understand the situation.

The year was 1982, July 1st of 1982, to be specific, and I was beginning my pediatric residency at Lion County Hospital.

Pediatrics was not my first choice; it was something I fell into.  I thought I wanted to be an emergency room physician, but God had other plans for me.

Since I didn’t match in emergency medicine, I could choose any program anywhere in United States. So, I figured, if I can’t do what I want to do, I may as well live where I want to live. 

Because I lived in Mexico for two and a half years, where I was going to medical school, I had  traveled through Pleasantville on my way back to Philadelphia where I had grown up.

The clean look of the city had appealed to me.

After doing my first years of medical school at the UDEM in Monterrey, the remaining medical school years in Kansas City, Kansas, and having suffered the brutal winters there, I decided warmer weather was for me.  

When I saw that a spot was open in Pediatrics in Pleasantville, I took it.

Quite frankly, I couldn’t have cared less if I ever saw a snowflake again. I grew up shoveling driveways.

So I wanted to come to Pleasantville.  I loved the city as much then as I do today.  My dentist is still there, and I like to visit from McAllen where I live today.

After having lived in P-Ville for thirteen years,  from 1982-1994, I am an official visitor there now.

As for living there?  No, I’ll never do that again. For while I liked the city, the city didn’t like me back.

Truthfully, much of it was my fault. I had an attitude problem.  I still do but only for abusers.  

After my grueling experience living in Mexico, the ritual beatings and humiliations in medical school at KU, leaving scars that I’m sure many fellow physicians share, I wasn’t in the mood to take any guff let alone snide commentary from some unenlightened, rude professor. You see, the worst they could do to me was fire me. So what? They couldn’t take away my medical degree.  

Besides, they had the deal of a lifetime.  For working eighty to one-hundred hours per week for fifty weeks a year, I received, drumroll, $13,400 a year.  I was making less than minimum wage, but I thought I was rich.

Graduating from medical school is like being an adolescent again. You have a little power, and you think you’re some somebody, but you’re really not.

I thought I was somebody. The professors soon let me know that I was not.  

I suppose some people have a natural ability to take abuse and smile; I was not born with that ability.  I was ready to fight back and let them know what I thought. I had plenty of opportunity to do that.

Let me begin first by saying that there are two divisions within patient care in a residency program. Inpatient and outpatient.

Outpatient medicine for me was like a dream come true. The work was hard and rigorous, but I enjoyed it. The professors were excellent.  People like  Billy Canada and Vickie Visigoth were patient and helpful. They were firm but fair. They were never cruel.  Debbie O’Reilly’s voice annoyed me but she was never as confrontational to me as I was to her.

It’s too bad as much cannot be said for the inpatient doctors, particularly those who work the ICUs.  Surgeons aside, intensivists and cardiologists have generally fancied themselves the supermen of medicine.  I suppose bold action rather than prevention confers upon the healer a sense of omnipotence and pride.

These traits were not lost on Doug Blade who ran the PICU.  Doug Blade, you may recall, was the man who ran the PICU during Jenny Jamison’s, should I say alleged, reign of terror in 1981, one year before I began my residency.  I did not know Jenny Jamison, nor did I work with her, but I worked with many residents and nurses who had.

The Jenny Jamison incident was spoken of vaguely when I was an intern.  I learned what had generally happened, the deaths at the PICU, and the events in New Heidelberg under Dr. Nancy Germany.  I once asked a nurse who had worked with Jenny if she felt Jenny had committed these alleged murders, and the nurse nodded while replying with a roll of the eyes, “Oh, yeah, she did it.”

One of my professors told me that after the deaths in the PICU a consultant was brought in to evaluate the program and the PICU.  The professor vaguely hinted that the consultants felt that Dr. Blade had contributed to the climate which enabled Jenny to carry out her crimes.  Beyond this I heard little. 

Of course I didn’t need a professor’s off-the-cuff opinion to think that there might be substance to this.  I had felt it.

A few months ago I mustered the strength to review the articles that had been written about the Jenny Jamison incident.  I was surprised how many professors, residents and nurses I remembered.  They were all there as if it were 1982 all over again.  I couldn’t read too much though; too much would be too dangerous to my soul.  I had been unsuccessfully trying to forget those years; there isn’t a day that goes by that I don’t think about the abuse that Doug Blade and others doled out. 

Words about Dr. Blade’s rounds don’t quite capture the terror.  

The PICU in those days was a very small ship physically; rounds were in the early morning, so it was usually dark giving the unit a claustrophobic feel.  Contributing to the closed-in ambience was the seemingly huge number of people attending the event; and it was usually sold out.  If I said the event was sitting room only, you might get the wrong impression.  Because the unit was so confined, extra attendees would sit in the center of the nurse’s station.  There was no more room to stand.  People who had no reason to be there at all, allergy fellows like Bill Bug and Dave Roach, were there nearly every day to watch and enjoy the bloodletting.  I called them Blade’s Dobermans.  Tension was so thick you could grab a piece from the air.  When a doctor presented, a dreaded dead calm projected itself; you could hear a pin drop.

What kind of individual, save a sadist, would come back for a repeat performance?  You didn’t feel uncomfortable for just yourself but also for others who were being skewered.

It was a circus, and Doug Blade was its ringmaster.  Doug Blade not only inflicted wounds; in my opinion, he enjoyed it.  He reminded me of Trevor Howard as Captain Bligh in Mutiny on the Bounty.  Cruelty with a purpose.

Suzy Disciple, a physician who was doing her fellowship, would affectionately refer to Dr. Blade as Dougbo.  Suzy was evidently one of Dougbo’s supporters.

Well, I’m sure Dougbo thought he was giving tough love, helping doctors be better doctors.  And if he thought that, he wouldn’t be alone; there are far too many professors who buy him into this flawed philosophy of teaching.  It seemed to be an endemic problem in the Pleasantville pediatric program.  Doug Blade was not alone.  Professor Johnny Bullman was a fellow believer in Dougbo’s tactics. He twice humiliated me in front of a group of people.  Another professor, Larry Flowers, a know-it-all cardiologist, upset and embarrassed that one of his patients crashed the night before he told the parents the child was to go home, specifically invited me into an ambush in the PICU.  Great men like Dr. Flowers can not possibly accept responsibility.  This is the same Larry Flowers who as my supposed mentor during my elective in the PICU spent not one minute teaching me anything about cardiology; and I’m being generous when I state one minute. 

To the best of my knowledge, Larry Flowers was not working in the PICU when Jenny Jamison was doing her thing. 

Larry Flowers was what I call a guest educator.  He was in private practice but evidently felt that he had enormous gifts to bestow upon medical residents.  Thanks but no thanks.  So sure was he of his prodigious gifts that he took it upon himself to counsel me one day.  He said to me:  “I hear you want to go into emergency medicine.  That’s the wrong field for you.  You need to go into research.”  Thanks, Larry. How long have you known me?  Did you spend any time with me, Larry?  Did you teach me anything?

Such a genius.

Okay, Larry, I get it.  I had a tough time with pediatric cardiology; but so do many students and residents as evidenced by the fact that so many of you pediatric cardiologists keep writing books trying – unsuccessfully – to explain it.

If you think my experience is unique, you are most decidedly incorrect.  As a medical student at KU, I did a one month preceptorship in a small town in Kansas.  One day my preceptor, we’ll call him Dr. Kind, related a  story of a humiliation he had received from one of his professors at least a decade earlier.  He told the story as if it had happened the day before.  Evidently the scars ran deep.  I must say that I couldn’t relate at the time because I myself had not been whipped sufficiently by a medical cat-of-nine-tails, but I was learning.  Indeed, on those days, I was always a bit mirthful.  “Why are you always smiling,” one classmate asked me.  “I don’t know,” I responded.  What I should have said was this:  “Because I haven’t had the shit beat out of me by ignorant professors who don’t bother to do their job.”  

Years later I discovered that Dr. Kind, who had been suffering from psychiatric problems, had given up his license. I wasn’t surprised.

I can’t speak for how residency programs are run these days, but in 1982 it was the blind leading the blind.  The professor was rarely there; most of his or her time was spent in a lab.  But why would that be?  To understand  we have to look back at how medicine evolved.

The best way to do that is to tell you about the day my father died.  He died on the kitchen floor in front of me.

I don’t need to give you every detail.  It was a Wednesday in late August, the 21st if you must know, and the year was 1968.  He came home from work and collapsed on the kitchen floor.  I was siting right next to him as we waited for the ambulance.  They came and put oxygen on him; that was it; that was state-of-the-art emergency medical care in 1968.  The ambulance looked stylish, though.  It was red and white, shaped like a hearse and had fins.  I have to believe that Henry Ford got together with the medical leaders and concluded:  “Well, since we can’t do shit for the patients, we may as well look good.  Let’s build stylish ambulances.”  And they did.  They were beautiful, nonfunctional and appropriate for the 1960s.

Ambulances with fins?

Let us flash forward 15 years, and the year is 1982. I’m in an ambulance, speeding up the highway to Lion County Hospital.  The ambulance looks like a small truck, what your modern ambulance looks like today, and we can do IVs, intubate, give epinephrine, do CPR and any other number of things.  

In fifteen years medicine had changed dramatically.   What we could now do was miraculous.  The complexity of medicine had exploded.

In the first part of the 1900s a doctor would be stressed out because there was little he could do for a dying patient save hold his or her hand.  In the latter part of the century a doctor became stressed out because he could do things.  With progress comes demand and expectation.

A doctor was no longer asked to help; he was expected to save lives.  Failure was not an option.  The technology had advanced immeasurably.

What didn’t change in those fifteen years between 1968 and 1982 was the basic structure of the residency program.  Residents were so named because they resided in the hospital.  The professors came during the day and went home at night.  The resident worked all day and all night and got sleep when he could.  As medicine advanced, due to a massive influx of government money, much of the professors time became invested in research rather than education.  Residents were expected to do the bulk of the work, then and now.  What became different and mandated a change, in this author’s view, was the complexity that high-tech devices introduced into medicine.

It would no longer be acceptable for a resident to work with little sleep.  The technology and greater expectations of preserving life mandated that change.  Sadly, no change was forthcoming.  Even bus drivers knew better.  I knew that because I traveled by bus when I attended medical school in Mexico.  You get to know the bus driver when you spend forty hours on a bus.  Did you know they can’t drive more than eight hours per day?  See if your genius academic knows that. How could he?  He’s too busy looking at himself in the mirror imagining himself holding up his Presidential Medal of Freedom.  Or he’s oiling up his cat-of-nine-tails.

Additionally, it would not suffice anymore for a professor to sit at home and then come in screaming the next day.  This was the standard methodology for teaching in the early 1900s.  It was akin to whipping a horse to get it to run better.

Professors, particularly surgeons, reveled in their ability to debase.  The stories told of these men are legend.  Compounding this was the machismo of the profession itself. 

Machismo is cultivated religiously in medicine.  Never admit you’re wrong.  Pretend that you know it all.  Never ask a stupid question.  These are wrong traits to promote, and it is the structure of group rounds itself that contributes to this.  Roundsmanship is valued in healthcare.  The professors encourage it by insisting on group rounds.  Group rounds suits their ego well.  I suppose they imagine themselves as a weird fusion of Aristotle and George Patton walking down the halls, their robes flowing as they dispense pearls of wisdom.  The problem is that the pearls are in short supply while the insults are plentiful. 

The problem with insults is that they hurt, and they are of little value.  The idea is to stimulate the student to learn much as George Patton thought he could make that shell-shocked soldier in Italy better by slapping him.  It’s an errant methodology without one ounce of support or evidence.

As they were doling out their beatings through flippant remarks such as, “I would expect someone at your level to know this,” I wondered why these professors who took so much care in their research cared so little when delivering their meritless comments and evaluations.

Since they were rarely there on the ward, they had no no idea who was working and who was not.  They had no idea who was Machiavellian and who was not.  They had no idea who was an ace bullshitter and who was not.  Consequently, their evaluations were without value.

It occurred to me early on in my training that none of them had been trained in the psychology of teaching, and even fewer cared.  For example, suppose Person A with an insecure personality admits he doesn’t know at a knowledge index of 90 (out of 100), whereas Person B with a superiority complex admits he doesn’t know at a knowledge index of 25.  Person A will always appear to be the stupid one.  Are the professors aware of this?  Do they care?  Not in my experience.

This was what rounds were like in the year 1982.  I have no reason to believe that things have changed.  It was a humiliating experience.  And it was so unnecessary, for none of those beatings made me a better doctor.  Everything I can do well in medicine is because someone gave some personal attention to patiently explain things.  Everything I can’t do well is because some professor thought screaming and insults were a superior method of education.


Many years after I finished my residency, a friend remarked to me that it was a shame that doctors didn’t get any education in finance while in medical school.  Putting aside the harsh reality that medicine and moneymaking don’t always mix, I replied, “Well, first they have to teach us medicine.”  Okay, gratuitous insult acknowledged.

I think this would be the opportune time to ease your burden of these unfortunate truths I am laying upon you.  Truth hurts, I know.

You see, the professor does not have the time to either educate or evaluate properly.  I came to realize this early in my career while at KU.  I had just arrived back in the United States in January of 1980.  My first rotation was in Pediatrics.  The first two weeks went fairly well.  The next two weeks were spent at an outpatient clinic in Kansas City.  At the beginning of the rotation, I was told by the Associate Dean that I would need to get the school an official copy of my full transcripts from the UDEM in Mexico. Without those transcripts I would not be able to graduate.  The problem I was facing was that the government of Mexico had passed a law forbidding the release of transcripts for foreign medical students until a course in Mexican History and Geography had been passed.  It was a test a third-grader would take.

This test was a good idea – I think Americans should learn about other countries, especially the ones in which they go to school – but it was a hindrance to my progress.  I needed those transcripts.  It just so happened that the UDEM was giving this particular test on the last Friday of my rotation at the outpatient clinic.  So, staring reality in the face, I informed my professor in Pediatrics that I needed to take this test.  I asked her if this was okay, and she responded in the affirmative.

I drove  –  I was poor – twenty-four hours from Kansas City to Monterrey, Mexico, pretty much non-stop.  I left on a Wednesday morning and arrived one day later.  I had one day to study for the test.  It was quite a test. I had to know the states of Mexico, their capitals and their chief exports.  I also had to know the important people in Mexican history and, of course, El Padre de la Independencia.  That would be Miguel Hidalgo.  I will never forget that fact.  

I passed the test, got my transcripts and left Mexico a few hours later.  I arrived back on Sunday.  This time I stopped to rest. On Monday morning, the Associate Dean called me into his office. He showed me the evaluation that my professor, the one who had given me permission to leave, had written. The evaluation was laced with scores of 2s and 3s out of 10.  She wrote specifically that I had taken off to go “gallivanting around Mexico.”

Yeah, I even took in a bullfight.  Me, Ernest and John Dos Passos.

After thinking about the evaluation, I realized that with the scores she had given me it would be near impossible to pass the Pediatric rotation – there was still one month left to go.  I had to make a strategic decision.  I decided to withdraw and take some time off.

During that sabbatical, a professor, who was supposed to be my mentor, tried to convince me that I had emotional problems; he wanted me to join his support group.  When I replied that he was not a psychiatrist, but an endocrinologist, and therefore not qualified to make such an assessment, he became upset and called me a loser.  I had never been called a loser before, and that night was when I began to question labels and their value.  

I might have lost it completely, and I did, sort of.  I wept, I admit it.  I probably would have quit right then and there, but, you see, there are good people in the world.  Prior to my decision to withdraw, I had spoken to the Dean of the Medical School.  His name was James Lowman, and he came from a regular school.  Prior to a student withdrawing, the Dean likes to hear you out; and so I told him everything that was going on.  I told him that I had just moved to Kansas City three weeks ago and that I was still living in the Holliday Inn.   

Dr. Lowman patiently listened to me and then asked me one question:  “What’s your support system here?”

“What do you mean,” I replied.

Dr Lowman: “Well, your family?  Do you have any family here?  Any friends?”

I shook my head in silence.  

When I walked out of the Dean’s office, I knew that Dr. Lowman had taught me everything I needed to know to be a good doctor and that, with all due respect, there wasn’t anything KU or any other university could teach me that was more important than what he taught me in that brief conversation.

You have to listen to people and ask the right questions.

* * *

I remember well the immediate days before Doug  Blade left Pleasantville.  They had a farewell party for him on the ward, and I was dragged to that party by Suzy Disciple.  “Come on,” she said.

Reluctantly I went.  

To tell you the truth, his farewell party was three years too late.  He should have been fired the first day he humiliated a resident on rounds.  

He had admirers, though, and still does today.  Don’t kid yourself if you believe otherwise.  Many doctors, I suspect, have internally justified his abuse and the abuse of others. “He made me a better doctor,” they might feebly say.  I doubt that, but these doctors are there, and they repeat this unsupported nonsense. I can assure you this false belief exists today.

I met Nancy Germany once around 1987.  She was covering the nursery at Santa Cora and had come down to the ER to help me with a difficult intubation. I never spoke to her about Jenny Jamison; it wasn’t my place.

After reading the old issues of Texas Monthly, though, I found it intriguing that it was Doug Blade who told Nancy Germany to not hire Jenny Jamison.  Others had seen no problem. So why did Nancy Germany not listen to Dougbo if she thought highly enough of him to solicit his advice.  After all, Dougbo was the King of Pediatrics.  What gives?

I’d be willing to bet that Nancy Germany herself was psychologically abused by Doug Blade when she was a resident at Lion County Hospital and had rejected his advice out of a subconscious resentment of having been so abused.

Perhaps not, but the phenomenon exists and helps illustrate why abusers make such poor and effective leaders.  The toxins they spill clouds people’s optimal functioning and better judgment. A toxic environment then multiplies upon itself.

A toxic environment is what existed in Pleasantville in 1982.  It wasn’t just Doug Blade.  As I say there were many others who were of his mindset and who acted similarly.  If they didn’t act as badly as him, they certainly looked the other way. 

What about professors like Johnny Bullman who, by the way, was my attending physician when Dougbo was abusing me in the unit?  Dr. Bullman did try to help me by teaching me to present patients better, but what he should have done was stop Dougbo from “teaching”.  What about the Pharm D. professors?  One of them was there nearly every day.  How about the chairman of the department?  There were many others.  They witnessed this carnage for three years?  Did they say anything?  Did they do anything?  They should have known better.

I had to laugh when I read in Texas Monthly that Bryce Prince, the cardiovascular surgeon at Lion County Hospital, was upset at the deaths in the unit.  Well, you were there, Bryce.  You saw what was going on.  You saw how Dougbo ran his rounds.  What did you expect?  Why didn’t you speak up?  If you weren’t aware that abuse and humiliation demoralizes a unit, then you shouldn’t have been in your position in the first place.

The reason why none of these doctors spoke up was because they had too had suffered or seen abuse when they were residents; they had come to accept it as normal.

It was this tense environment which emboldened Jenny Jamison to make her move, to appear the hero. Perhaps she became addicted to stress; or perhaps she felt the need to enhance her own prestige.  After all, a hierarchical ladder of good doctor versus bad doctor had been set within the unit by Doug Blade.  Good doctors got praised; bad doctors got lacerated.  Good people went up the ladder; bad people went down.  What better way to go up the ladder than to rescue a child in distress?  

Jenny was one of Dougbo’s favorites.  She wanted to go higher.

From what I have read, Jenny was very intelligent.  Being a bright LVN in the midst of doctors who may have been not as bright must have been incredibly frustrating to her.  Over the years I have encountered many LVNs and RNS who should have been doctors.  Perhaps Jenny felt similarly about herself.  Since attending medical school at her age would entail too many years of sacrifice, an important position in the PICU might suffice.  And, hey, Doug Blade liked and trusted her.  

What do you think, doctor?  

Patients ask me that question all the time, and more often than not I say to them, “Well, I was going to ask you the same question.”

Let’s mull that over.  It’s important to listen; no matter how smart we think we are, we’re not.

Doug Blade, from what was told to me, felt he had been screwed after the dust had settled, and to a certain extent he was right.  He was only a symptom of a toxic process that gets reinforced in academia.  You see, these people in academia believe that there exists such a thing as a good doctor and a bad doctor.  This doctor is good; that doctor is bad.  This doctor is competent; that doctor is incompetent.  You hear that a lot in the snake pit of academia.  

My response to that is this:  comparing what and compared to who?  It only takes a little time outside the poisonous confines of the Mecca, as they like to call it, to realize that there is no such thing as a good doctor or a bad doctor.  What exists are doctors with strengths and weaknesses.  When doctors and people are viewed under this light, hope exists and remediation is possible.  When silly labels are employed, no hope is possible.

It is this belief in the good doctor versus the bad doctor that gives rise to these so-called high-powered programs of which Doug Blade was an attendee.  He trained at Johns Hopkins, and, in the silly world of academia, this pediatric program along with CHOP (Children’s Hospital of Philadelphia), Toronto and Baylor, are considered high-powered programs. Academics revere CHOP above all; they talk about it constantly ad nauseam.  You would think Jesus himself had done a residency there. Fuck CHOP.  I’m sure Doug Blade bought into this nonsense.  So did many others.  They still do.

Check out CHOP’s website, and what you’ll find is a lot of bragging.  CHOP is affiliated with the University of Pennsylvania, founded by Benjamin Franklin.  Well, I’ve read The Autobiography of Benjamin Franklin; and in it, Franklin’s advice for a young man or woman is to imitate Jesus.  

“First Hospital … dramatic firsts … saved countless children’s lives … come to CHOP from all over the world … earned us a spot on the U.S. News & World Report’s Honor Roll of the nation’s best children’s hospitals?”  That doesn’t sound like humble Jesus to me.  

No wonder its graduates think they’re all that.

In my book, pediatricians who do great things can come from nowhere and anywhere, and doctors who come from so-called prestigious universities can commit the most boneheaded mistakes.  The high-powered program is a myth and a dangerous one at that.  It gives a false sense of prestige and omnipotence to its graduates.  The handbook of your particular religion will tell you that; unfortunately medicine has drifted from far its moral base and now more or less follows the dictates of the Third Reich.

Not surprisingly, Larry Flowers taught at The Hospital for Sick Children’s in Toronto.  It must have been a heady experience.  Johnny Bullman came out of Vanderbilt, another one of these high-and-mighty programs.

The concept of  greatness is seductive, and the result is what you got in Pleasantville from 1979 to 1982.  Is this what you want?  If it isn’t, then you better get moving for the seeds of the next catastrophe are there.

There exists today in Pleasantville a group of doctors, self-anointed, who very much buy into the nonsense I have described above.  They fancy that their shit does not stink, and they stride around confidently and smugly that they are the good doctors.  I know a few, and they have no problem freely eliciting their foolish judgments.  In a way they are like that clique of cool kids you knew in high school – strutting around like they own the place.  They think they are all that.

After my residency, I felt like a beaten dog. I worked downtown across from El Mercado, then for a short spell at the emergency room at Santa Cora where Nancy Germany bailed me out one night on a difficult case.  I got my first lawsuit about that time.  I was devastated.  It was a minor lawsuit, a nuisance suit the lawyers called it, but it only reinforced all the negative shit those professors had heaped upon me.

A colleague of mine, Devon Maximus, told me at the time:  “Look, Arch, there are only two types of doctors, doctors who have been sued and doctors who are going to get sued.”  

Good advice.  Let’s tell academia.

I took a year and a half off to write a book which admittedly was a piece of shit, went nearly broke and made the slow climb back out of the abyss. I began working again, and what I discovered slowly was that the patients liked me.  I never got that sense while I was at the Mecca because professors don’t care about that kind of stuff.  What they care about are doctors who fit into their bullshit Nazi paradigm of spitting out a lot facts, presenting flawlessly and eloquently, and pretending that you do know when you don’t.

One of my fellow residents was an expert at roundsmanship.  He would never say that he didn’t know; he would cleverly say, “I can’t answer that.”  That’s pretty cool, right?  That aside, the three most important words in medicine are:  “I don’t know.”  All knowledge begins with those three words.  

Quick, someone tell academia because they will chew you up if you tell them you don’t know.

They don’t like honest people at the Mecca.

What I would say to a young doctor today is this:  “If they don’t like you in academia, it’s probably because you’re a very nice person who actually cares about people.  Don’t worry; you’re going to do just fine when you get away from them.”

Fuck them, and fuck the doctors who support them.  The doctors in private practice who support these academics are worse. They are like the Poles in WWII who inflicted more damage on the Jews than the Germans.  Even the German soldiers were astonished.

So after working my way back into medicine, I worked in different towns for ten years for different people.  I had a blast, and I enjoyed every place I worked.  I worked in Tyler, Corsicana, Houston, SA and most cities of the Rio Grande Valley.  I worked at Wilford Hall and at the PRIMUS clinics in Killeen and Copperas Cove right outside Fort Hood.  I lived in motel rooms, and the Gideon Bible was my best friend.  Along the way, I developed Crosley’s Law which states that your quality of life is directly proportional to your distance from the Mecca.  I guess it takes time to work stuff out.  Along the way I gained enough confidence and contacts to start my own practice.  I shouldn’t have had to do that though. 

Ten years is a good chunk of one’s life. 

Part of a training program’s job is to build you up, not tear you down.  But they do tear people down and not just while you’re there.  They are the gift that keeps on giving.  Six years out of my residency program, I worked at Wilford Hall for about nine months in their Pediatric clinic.  I would have finished out the year, but I had a minor dispute with a colonel who one day flipped an Amoxicillin prescription I had written on my desk.  He said to me, “I don’t want you writing this anymore.” He was an old-school guy who believed that kids should only get penicillin for strep throat. He didn’t believe in broad-spectrum antibiotics for strep throats.  Well, to begin with he’s not even allowed to tell me how to practice medicine; that’s the law.  Number two, he was rude.  I decided I didn’t need that kind of attitude, so I informed the agency who hired me that I wasn’t going to work there anymore.

The guy who ran the agency told me, “Look, we had to fight for you to get this.  They didn’t even want to hire you.”  

“Oh really,” I thought.  “Well, you should have told me and I wouldn’t have even bothered to work there.  I don’t go anywhere where I’m not wanted.”

A year later, I related this experience to two colleagues who I met up with in New Orleans.  They said to me:  “Well, you know where that came from, don’t you?”

“No,” I replied, “I would have no idea.” 

“It came from the school,”  they added.  

One of them then proceeded to tell me her own horror story of a professor at the school who had trashed her career.   

Well, as it turns out, they were either correct or very close to it.  Time has a way of outing people.

I should not have been surprised, though.

When I was a resident, I was in a room with a specialist as he was interviewing a patient. The patient’s parents explained that they had visited another doctor. They mentioned the doctor by name.  My attending specialist then replied:  “Oh, we know her; she’s no good.  We know; we trained her.”

Yep, these professors don’t get it that when they trash their trainees, they indict themselves.

Okay, you get the point.  You’ve heard enough and you want to know what good can come from this. What are you going to do about it, Crosley?  What do you propose?

Why, I’m glad you asked.

We can begin with replacing numerical evaluations with a personal investment in time by the attending physician, a dedicated teacher, who will have the time to patiently explain what does work and what does not work in the real-world practice of medicine.

If everything I as a pediatrician do well is because someone took the time to explain it, then it makes sense that the more personal time I receive, the better a pediatrician I’ll be.  And it would help immensely if the teaching physician was schooled in how to teach, what works in teaching, what doesn’t work and why students have particular learning difficulties.

If a student asks a question, it’s because he needs to know the answer.  Telling him that he should know this already, or that the question is stupid, doesn’t solve the problem.  Students need help, not abuse.  Additionally, students must emphatically learn that the three most important words in medicine are:  “I don’t know.”  It’s always better to know.

If the teacher can’t subscribe to that philosophy, then he should be directed to another profession.  Students must have recourse and a Bill of Rights that removes them from an injurious teacher.  

Here are some suggestions.  I’ll dress it up with a little comedy so that you’ll read them.

  1. Every school needs an independent ombudsman who is specifically there to represent the resident or student should he or she be suffering psychological abuse from a professor.
  2. Let’s draft a ‘Bill of Rights’ for residents and medical students which specifically states that a professor does not have the right to humiliate.
  3. Professors must attend classes on the science and psychology of education.
  4. We need full-time educators who do NOT do research. There is no place in a medical school for a dilettante.
  5. A specific ban on professors from making the following comments:
  • I would expect someone at your level to know this.
  • You have a poor fund of knowledge.
  • You are a loser.
  • You should know this.
  • That’s a stupid question.
  • Well, I think we need more database here.
  • Well, I think we need to back up here.
  • Well, I don’t think you’re asking the right question.
  • The Boards likes to ask this.
  • You have to know everything.

If a student asks a question, it’s because he needs to know the answer.  There are no stupid questions.  And nobody cares, Mr. Professor, what you think somebody should know.  I took a course once where the professor stated literally after every arcane and esoteric fact, “The Boards likes to ask this.”  Well, let’s see, Mr. Professor, you’ve stated this 5,000 times already; how can this be if there are only 250 questions on the Boards?

Here are some other suggestions:

  1. Replace the current monthly evaluation with personal attention whereby the professor MUST spend individual time with the student in conversation discussing patients, diseases and how to manage those diseases.
  2. Mandate the professor to spend his full time on the ward.  That’s where he works.  He has no other responsibilities.  He’s not an administrator, he doesn’t present conferences at grand rounds, and he sure as shit isn’t a researcher.
  3. Ban the professor from wearing a coat and tie; otherwise he might think he’s somebody. Forbid him from accepting any awards or any attending any cocktail parties with politicians or other people of self-importance.
  4. Ban all researchers from even showing their face on the ward under penalty of death. Their unsolicited snide comments will no longer be welcome.
  5. Ban the local doctor from acting as an attending.  He has no training and is 100% unqualified to teach.  If you think he does, then I’ll get a guy off the street to perform an appendectomy on you.
  6. Eliminate group rounds which brings out the worst in people.  There is no reason why the professor can’t do individual rounds with everyone; after all, he’ll be there.  He’ll have PLENTY of time.  I’m willing to bet that customized education tailored to the individual will result in better doctors.
  7. Ban researchers from interviewing or selecting prospective medical students, or else we’ll get a bunch of cruel, Machiavellian brainiacs just like them.  Who we want in medical school are compassionate, honest doctors who can relate to regular people.
  8. This one’s for fun but not really.  Any professor who buys a DeLorean (or its modern equivalent)  or personally monograms their own shirts may be more interested in themselves than the student’s welfare.  It might be wise to keep an eye on these guys.
  9. In education, respect must replace bullying.  Whipping someone into shape is a lazy substitute for teaching. As Benito Juarez, a former President of Mexico, once said, “Respect for the rights of others means peace.”
  10. Young physicians must have the following drilled into their hearts, minds and souls:  The three most important words in life and in healthcare are “I don’t know.”  It’s okay to say these words to yourself, to your professors and, most importantly, to your patients.

Finally, you may ask, how will full-time educators be financed?  Well, we have too much half-assed research and only one half-ass of education.  Figure it out.  Half the researchers aren’t needed.  The grant money and set asides for research will be better spent on education.  The professors can retrain and teach.  If that doesn’t suit them, hasta la vista, baby.  When it’s all said and done, we’ll get better research and better education.

How’s that sound, soldier?

Wives of the dear old professor need not respond.  Yes, I know he’s a good family man and a loving father.  I also know about the seventeen grandchildren and seventy-eight great-grandchidren.  Spare me.  Hitler too bounced toddlers on his knee.  

But let’s be fair.  Hitler was a product of a pernicious environment; if it hadn’t been Hitler, it would have been somebody else.  

You may find the Nazi analogy a bridge too far, but I use it specifically to illustrate a point.  Historians will affirm that the German Army during WWII possessed superior armaments.  Too, there was never a shortage of German brains or work ethic, and yet they lost.  They lost because we live in a moral universe where how you treat people is important.  Humility counts.  The Germans created a toxic environment where titles, power and prestige became more important than caring for people.

Ultimately, Lion County Hospital and its affiliated university placed their own power and prestige above that of the patients.  Their first duty was to the patients, not to themselves, not to their own glory, not to future lawsuits, not to the sanctity of their reputation.  What they lacked was humility.

It was the toxic environment of our medical schools and the errant values that are passed from one generation to the next that inevitably caused these doctors and many others to behave they way they did.  It was this same toxic environment in which Jenny Jamison operated and thrived.  If it hadn’t been Jenny Jamison, it would have been someone else.  And it will be someone else.

Values are important.

If we can change those values and emphasize compassion and humility, we can prevent the calamity that occurred in Pleasantville from ever happening again.  

Archer Crosley, MD
McAllen, TX 78501

Copyright 2022 Archer Crosley All Rights Reserved