On a sultry June morning in 1976, wearing a starched white coat and tightly knotted tie, I entered the Massachusetts General Hospital. It was my first day of internship, the moment when I would become a real doctor after four years of medical school. I had been a driven student, intent on learning every fact and detail. In the lecture hall, I sat in the front row, furiously scribbling notes. During my clinical courses in pediatrics, surgery, internal medicine, neurology, and obstetrics and gynecology, I tried to gather all the information I could, recording the highlights of cases on index cards. Each night, I reviewed the cards, and worked to commit the salient points to memory. I believed I was creating a compendium in my mind of necessary medical knowledge, so that I would be prepared for the day when I assumed responsibility for another person’s life.
I made my way through the hospital’s labyrinthine halls to a conference room in the Bulfinch building. Dr. Alexander Leaf, the department chairman at the time, greeted us with brief remarks: as interns, we had the privilege to both learn and serve. Not stated but clearly implicit was that the internship program at Mass General was highly selective, the beginning of a career in which each of us would achieve important positions in academia and make notable contributions. After Dr. Leaf finished, the chief resident gave each intern his schedule.
I began on the wards with a fellow intern and a junior resident. The on-call schedule was every third night, shared equally among us. That first night was mine. Like all interns, I would be on-call alone, expected to care for all of the patients on the floor as well as admit new patients from the emergency room. Early the next morning, the resident and two interns would convene to review what had happened the night before.
As that first day edged into evening, my resident prepared to depart for home. He looked at me squarely and said, “Remember, be an ironman and hold the fort.” Only in the most dire circumstances was I to contact him for help in managing a case.
After the resident left, I reviewed the charts of the patients on the floor, and then went to introduce myself to a man I’ll call Mr. Morgan. He was in his sixties, African-American, with high blood pressure that was not well controlled with medications. Two days before, he had come to the emergency room with chest pain. The encyclopedia in my mind rapidly offered the fact that African-Americans have a high incidence of hypertension, which can lead to both heart disease and renal failure. The cause of his chest pain was still obscure: his initial evaluation did not suggest a blockage of a coronary artery.
Mr. Morgan was warm…
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