Physician, Heal Thyself

I've got friends in low places

Where the whiskey drowns

And the beer chases my blues away

And I'll be okay

I'm not big on social graces

Think I'll slip on down to the oasis

Oh, I've got friends in low place

- Dewayne Blackwell and Earl Bud Lee

Working an Iowa football game from the luxury boxes

I love being an Emergency Medicine Physician, but if I had it to do over again I would do something different. Financially, spiritually, and emotionally the costs of getting here were too high.

When the bottom dropped out of the energy industry in 1999/2000, I was working for an oil exploration company. For every day I worked offshore and overseas, I earned a day off and my entire job description involved offshore and overseas travel. I would work for 6 weeks, then have 6 weeks (or so) off. The company paid my travel expenses and didn't care when I traveled to my destination as long as I was at the designated airport on-time to catch a helicopter out to the ship. If I wanted, they would fly me in a week or two early and I could travel in-country before getting back to work. I saw lots of South America, Alaska, and a little bit of Africa this way. When I was in the U.S. I would work at a bar as a bouncer ... better to be standing outside the door earning money than inside spending it.

As the price of oil dropped and the business got lean, I survived the first 2 rounds of lay-offs but didn't think I would survive the next one. I left Big Oil and went to work full time in the bar. I was racing triathlons and earning a little money at the bar, but mostly surviving on my oil stocks. Being youthful and financially naive, I didn't understand the concept of diversification. All my assets were tied up in energy stocks. For a while I was Duke Kahanamoku riding the big surf. I ended up losing it all.

Speedy triathlon wheels

Having to re-invent myself, I decided to go to medical school. I set about picking up pre-requisite classes and took an MCAT prep course. A year later I was applying to medical schools but I was offered few interviews and received no acceptance letters. One of the criticisms of my applications was the lack of medical experience, so I used some of my rugby contacts and volunteered at a skin bank. My job was to procure skin from cadavers and process it for medical applications (wound and burn care).

On my second go, I was wait-listed at two schools. Med School A was a prestigious program in the U.S. northeast associated with the school where I had obtained my undergraduate degree. Med School B was in the same town in Texas where I was already living and working. Late that summer, I received a phone call from the Dean of Admissions at MSA. They were putting together a short list of 3 students they could call at the last minute and asked if I was interested. Since MSA was in a town I knew well and where several friends had moved back to, I knew I could get there within 24 hours of a phone call and have a place to stay, so I said "Yes". I did tell the Dean that I was also wait-listed at another school. "If they call you," he said, "they will give you about an hour to make a decision. Use part of that hour to call me."

Sure enough, about 4-5 days later, I got a call from the Dean of Admissions at MSB. It was just after 11 am and they asked if I could be there at noon. I was working the bar at the time and told them so. "If you can't be here by noon, we'll call somebody who can." I should have known just from that sentence what the next four years would be like, but I was too blind to see it. I did call the Dean at MSA but he was out of the office for the day. I explained the situation I was in to his office manager and asked if there was any chance of them offering me a position. "I know if there is a position for you here or not, but I am not allowed to tell you. That has to come from the Dean." I thanked her for her time and asked her to pass on to the Dean that I was going to accept the offer from MSB. A couple days later he called me back, asked if I had accepted the position, and when I said "yes" he paused and finally said "congratulations". Maybe it's wishful thinking, and I read too much into that pause, but I would like to think they were going to offer me a position. I wish they had.

Rett - mascot for my undergrad alma mater

Having obtained undergraduate and graduate training at well respected universities, led a team of divers at NASA during the build-up to the International Space Station, worked my way up to a lower management position at an international company, and managed a small business, I had high hopes and expectations for medical school. I thought it would be the height of professionalism. Instead, what I encountered was the petty, fragile egos of weak academics. There were a few sympathetic kindred spirits among the faculty and my fellow students, but overall I found the entire experience soul-crushing. If not for the $250K debt I had accrued in the process, I probably would have quit and gone back to managing bars.

I had a goal of becoming an Orthopaedic Surgeon, focusing on either Trauma or Hand surgery, but railing against the system and those who run it is not a model for success. I bucked and fought for four years, suffering set-backs and failure in ways I had never done before. I finished medical school but not without bumps and bruises, and definitely without the grades and recommendations to become an Ortho doc.

The rugby team ... some of my best mates from my years on the Rock.

Not having matched into Ortho, I took a preliminary position at a General Surgery program. Through Gen Surg I could still do Trauma and there was a narrow pathway to a specialisation in Hand Surgery. The program I went to had a reputation for being particularly malignant, but I didn't have a whole lot of options at that point. I quickly discovered that I was a poor fit for either that particular program or possibly Surgery as a specialty. The two years I spent as a Gen Surg resident were some of my darkest days. I was angry and bitter all the time; hated my patients, hated going to work, and didn't want to go home to a new screaming baby and a wife I felt I had failed. I was drinking too much, not eating properly, and hadn't exercised in months. Fortunately, I self-identified before any issues arose and I made a plan to get out. I quit surgery and applied to Emergency Medicine programs.

 

Med school and Residency weren't all bad ... I met my wife and we had an awesome daughter together

My surgery program granted me time to travel for only three interviews. I looked at the program where I was doing my surgery training, a program in Texas where we had the support of family, and a flier based on the recommendation of a friend. I have no idea what Kari thought when I told her we were moving to Iowa, but she never batted an eye and set about making it happen.

There is a famous line from Field of Dreams in which the character of Shoeless Joe Jackson asks "Is this heaven?" and Ray Kinsella answers "No, it's Iowa." I'm not saying Iowa is perfect, but it turned out to be the perfect place for me at the time. Recently, I got to sit down with my faculty mentor from those years and in describing me, he said "Grant came to us broken." I was like an abused dog that is trying to figure out where the kicks are going to come from next. I brought to Iowa a solid skill set earned during my surgery program but there were also huge gaps in my knowledge base. The faculty and staff at the University of Iowa Hospitals and Clinics, especially those in the Emergency Medicine Residency program, didn't fix me. What they did was provide a safe, supportive environment in which I could learn, and grow, and heal myself. They gave me the gift of time and understanding. All of my successes as a physician can be linked directly back to them. As for my remaining faults, they tried their best. I left Iowa reluctantly, driven out by the ice, snow, and -40F winters. I left happier, more relaxed, and having established life-long friendships.

  

Digging out from an Iowa snowfall

 

 

EM residents hard at work.

  

Playing hockey for the "Shockers", a bunch of old guys from the St Luke's Emerg Dept.

 

 

Flying physician with UIHC AirCare

While medical school and surgery residency are memories I would rather not have made, I emerged from those experiences with a handful of good friends to whom I will be forever grateful. Since leaving EM residency I have caught up with a few of my professors in the U.S. and recently my mentor, coach, and friend came to New Zealand. He was here to visit a friend from his med school days but we made the time to hang out for a day. Half way around the world my family is building new bonds and forming new memories and it was amazing to share that with a familiar face. Azeem is four years younger than I am, but I look up to him like an older brother. I am forever in his debt for helping me forge my path ahead.

Old friends and new: Mike Takacs, me, and Nate Jones - Myrtle Beach, SC

  

Azeem came all the way across the pond to check up on me ... I hope I did him proud - Palmerston North, NZ

Not much NZ in this post, but the visit made me nostalgic and made me want to put my story out there. Thanks for indulging me.

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