The Yale Journal for Humanities in Medicine

Remnants of Yale: the Medical School Ligature

William Houghton
puck1595@worldnet.att.net

The roar of jet engines wipes out all thoughts of my life back in Milwaukee.  I land in Hartford, Connecticut, like a blank CD, ready for recording.  I always go back for medical school reunions although often I wonder: why?  The experience is wrenching in truth--difficult, sweet, and bitter.  No one would do it unless there was a nugget inside.  In the end, it's usually worth it.  This time, I’m back for my 40th!

I lived in New Haven for eight years, have visited often, but it is both strange and familiar as I spin down off the Interstate 91 ramp and all but grind to a halt in the crush of traffic on Chapel Street.  The Green in the center of the city was always grander from a distance, but up close today it looks scruffy with vending carts and hangers-out.  New Haven was a blue collar industrial town long before the university came, I recall.

So why do I always come? I ask myself. "Reconnect with your colleagues" is the standard answer, of course, but that’s a cliché and facile, doesn’t illuminate the truth within.

Yale Medical School is most vain of its new medical research center, the Anylan Building, which looks like a truck chassis factory covering four square blocks on College Street.  This is “DNA research central,” I know, and despite the school’s reassurances, I wonder how much Wall Street money is swinging its weight here.   I am more interested in the wood frame duplex on Willard Street in the leafy suburb of Westville under West Rock, the lower middle class Italian neighborhood where I lived when first married, the house in which my first daughter was conceived.  Already it is becoming clear to me that this visit may be more to reconnect with parts of my personal life, not only the school and my colleagues.

I am staying at an old motel on Chapel Street, a relic of 60's elegance and many football weekends, now much scuffed and worn.  The beloved basement beer-hall is gone, replaced by a Thai restaurant.  The same for the old Chinese restaurant run by a doctor who couldn’t get his license in America, and the classic stainless steel rail-car diner---these were the low-cost places I hung out at when I could afford to eat away from the dormitory.  The cooks are gone and the buildings have changed to other uses.  Everything swirls in a cloud of change.

The agenda is full.  The school puts on a day of lectures, tours, and a New England clambake with huge tables of lobster and shrimp.  (No expense too great for potential donors.)

Alumni Day always comes the first weekend in June, right after the extravaganza of graduation.  When I lived here year round, I recall the frenzied excitement of graduating seniors.  Then they disappeared for five or ten years.  Some never returned.  (In my stint as class agent, I learned that some grads left no forwarding address, were never heard from again.)  The weekend after graduation, these crippled old codgers came, attended by smiling “nurses,” then after that the long summer where the streets were dusty and bare.  The school was capacious enough to accommodate all of this dizzying change, and the faculty rotated through at a slower but steady rate too.  I remember thinking how efficient the school was, itself always in motion.  It had one famous name but was made of multiple diverse parts.  The essence of the institution, I suppose, was in organizing these permutations.  It is like a body whose cells are always dying off at a furious rate, and new ones springing up, or like an army of ants on the march making a bridge for their colleagues.  This isn't a totally nice picture or favorable prospect for an individual cell or ant, of course, but there it is.

The series of lectures in the auditorium of the Anylan building make me proud to be an alumnus, and recalls for me the intelligence of the faculty and the students in my day.  There is a geneticist, one of the leaders in linking twigs of the genome with diseases, who speculates on certain sequences, trills of amino acid notes, and cardiovascular disease.  Another geneticist and bio-ethician glibly questions why there should be any limit on the ability of parents to design their child (far beyond our imagination on Willard Street).  Dr. Thomas Duffy says the technology of molecular medicine and the economics of mass delivery are destroying the last vestiges of the doctor patient bond, the old macro medicine the human body seems equipped to comprehend.

So obvious it knocks my socks off!  That’s the real world I live in.  The audience listens attentively, raises complex questions, and absorbs all viewpoints.  This is why I came here.  How bracing to realize I came from this--at least my birth as a doctor was here.

At the wine bar reception after the lectures, I see my old classmates up close again.  "Old classmates" is right!  These guys are amazingly ancient and decrepit, wrinkly, bent, and hobbling.  I'm surprised how energetic and articulate their speech is.  I never think of myself as this age, but meeting them again, I am forced to realize I am 66 years old.  My spontaneous thought is usually that I’m in my mid-30’s, or adolescence on the good days.  This is one of the unpleasant shocks of coming here this weekend.  I truly am this age.  (Is that one of the reasons many don’t come?  Ten of my classmates have showed up out of a class of 80.)

Joe tells me George died.  He and two others he names had hip replacements.  Bob and Lyall--whom I recall as a callow wiseass freshman--return with distinguished moustaches and the mellifluous bedside manner of experienced physicians.  Also, they're retired.  I work full-time and seldom think of retiring.  I notice that most wear shoes that are classier than mine, well polished while mine are scuffed and dull.  Experienced, retired, and from their clothes, shoes, and allusions, obviously well-off.  I feel shabby and poor in comparison (with some pride in that).

Everyone is friendly and glad to see each other. There is the initial shock when you are confronted with a strange person.  Sometimes I lunge to grab a look at a name tag. Then the magic of facial recognition patterns takes over and I grasp the personality I knew better forty years ago.  It is a relief that everyone is able to recognize me (I am ready to proffer my name) and glad to see me.  Bob is eager to see me and recalls a triumph I had in answering an obscure question.  Lew brags about his book.  Tom tells me Tony’s hospital was sued and Tony took it personally (that’s probably why he isn’t here).

After a while at the cocktail party people clump in the pattern of groups that existed before.  Jocks with jocks (though none as agile now).  Nerds with nerds (some have got prizes now).  The eleven-o'clock-guys-at-the-library with the other eleven-o'clock-guys (some distinguished professors now).  The comics and wiseasses with their kind (some serious words now).  This reminds me that in my medical school days there were always cliques.  The competition under the surface was intense, and I worried about making it, being accepted, passing the social tests we faced, and moving on to the next stage. Here at the reunion, I feel some of the old scramble that used to consume me.  It was not rare for me to feel lonely and hard pressed back then.  All that was before I got my degree, got married, and moved on to the practice of medicine, the family I wanted to make, and my real life as a grown-up.

Medical school was no walk on the beach.  I went as a callow 22 year old.  At the class dinner there is a display of thumbnail photos of the whole class in the first week of school.  We look like fifth graders--eager, mischievous, without a clue.  I wasn’t sure I wanted to be a doctor then.  In the first month, I discovered that my knowledge of physical chemistry was way behind the majority of my classmates.  The school philosophy and all of our professors insisted on treating me as a respected colleague.  Teachers told us with enthusiasm what was exciting to them, and I was swept up with their curiosity and determination to figure things out.  There was a modicum of questioning in the classroom, but little or no tendency to humiliate students (as I later heard happens at many medical schools), and no tests other than the National Boards.  Teachers talked up to us.  In addition to the lectures, seminars, and labs, within a year we were meeting patients.  These were real people, and this was real life.  By that time, I knew I wanted to be a doctor and the best I could.

I knew my classmates were a snooty competitive bunch, in a graceful way.  Some had ambitions for publication and grants that were far beyond my comprehension.  Others sought wealth or social status that was foreign to my background.  We were no homogonous bunch.  I realized that I did not belong securely in any dominant academic group of the class.  Nor with the hard drinking jocks.  Still I had my friends and in the general freemasonry of the school I could do what I wanted and be accepted.  In the third year we went on the battlefield, the wards, and became the junior members of the team that fights disease.  I have learned to question the medical and pharmaceutical industry in many ways since then but still feel an allegiance to the men and women who have taken on that experience, especially my classmates.  I joined the fraternity of physicians.  The principles of good medicine and the art of medical ethics do not derive from a code on paper, not even the Hippocratic Oath, but come most strongly from our sense of how our colleagues would act, and how I want to be a part of that group.  I am not so much afraid of breaking the civil law, or even being sued, as I dread being so foolish or selfish that I could not face my peers.  Finding that out, feeling it in my bones, may be the strongest reason for me to come to reunions.

The weekend winds up with bedraggled good-byes and the old sadness at leaving returns.  With jet travel I am soon back in Wisconsin and facing the intricate challenges of the work week.  The details of New Haven fade quickly but the core reason to go back persists.  That’s how I got from being a boy to where I am now.

Published: July 8, 2007