Tuesday, August 23, 2011

Memories of Medical School: University of Wisconsin, Madison 1966-1970

UW Hospitals (now replaced by a beautiful new hospital on the western campus)
The medical sciences buildings were  connected behind this hospital building. Today
many medical departments have expanded to fill this old hospital with medical science labs.
   
  I don't know why, but lately I have been thinking about my decision to go to medical school. Looking back, I am surprised that I made this decision. I was the only girl in my family to even go to college, let alone medical school.  I was a good student in high school, and I studied hard in college. I started out in the course work for becoming a medical technologist. I thought I wanted to do some sort of medical research since I loved science so much. But as I thought about the work of a medical technologist, I realized I would be doing what someone else told me to do; I wouldn't be doing my own research. Since the course work that was required for the first two years of medical technology was the same as premedical studies, I decided I would keep taking pre med courses and see how I did. So I piled up biology, chemistry, organic chemistry lecture and lab, quantitative chemistry, vertebrate embryology, microbiology, calculus, and genetics courses in addition to the requirements for a Bachelor of Arts degree. When senior year came, I decided to apply for medical school and see what happened. Everything I did at this stage of my life I did with serendipity. If it works, great! If not, so I tried, and I would move on in a different direction.
     I took the MCAT (medical school entrance examination), and filled out applications to Universities of Iowa, Minnesota, Illinois, and Wisconsin. Well, Minnesota requested that I take the MMPI (the Minnesota Multi Personality Inventory) not once but twice. I don't know what I answered on these questions, but Minnesota turned me down right away. Iowa personally interviewed all applicants and they were so slow in calling me for interview, that I was accepted at Illinois and Wisconsin before I was ever called for the interview at Iowa.
     My folks took me to see the medical school campus in Chicago where I would go to school if I accepted the selection at Illinois. It was right next to Cook County Hospital. As we all sat in the car at a stop sign right at the edge of one of the medical school buildings, a panhandler came up and knocked on my mother's passenger side car window, hand covered with a glove with holes in it. That freaked my mother out right then. As we drove around the buildings, I noticed a walkway that was covered by a barred passageway, without glass. So it was not there to provide cover from the elements. It went from one building to another and it was clearly meant to keep those outside of it outside of it. We parked the car and went into a building. Just inside the door, was a uniformed security guard sitting at a desk and he had us sign in. This was in 1969. I regarded this as a bad sign. When I got back to Iowa, I told my microbiology professor what I had seen. He told me that he had been offered a wonderful job at University of Illinois Medical School. He said they had lots of grants and lots of equipment and the job paid well. But he asked, "What if I have to take some experimental readings at 2 AM. What should I do?" The interviewer said, "Well, if you have to do some work after 10 PM at night, you probably should just stay all night." Did I want to live for 4 years like this? Trapped inside medical school buildings, and walking beneath iron bars from my dorm room to my class buildings? I didn't think so. Therefore, it was Madison, Wisconsin, University of Wisconsin -- here I come!
    
   The Wisconsin medical school found me a job  for the summer before I started medical school, in the entomology department, using my B.A. in microbiology. This lab was trying to find out if microorganisms would decompose or degrade pesticides that were introduced into the soil. We were working with fruit fly maggots. My job was to grind these little critters up, culture the resultant mess, and identify what bacteria and fungi grew out. I'm sure later the idea was to see if these identified microorganisms would break down certain pesticides. Sounds like an exciting summer job, right? But the lab people were great and I made lots of new friends. And as an added perk, the entomology lab was right across from Babcock Hall in the Ag department, where they made ice cream everyday. The only problem was that my Iowa undergraduate roommate Pat had come with me to find a summer job, before she took off for a teaching job in California.  The only job she could find was selling encyclopedias door to door. That was an evening job, mine was a day job, so we never saw each other all summer. We rented an efficiency apartment on Orchard Street south of Regent Street. I had quite a walk from this Orchard street address over to Russell Labs. Because I never saw my roommate Pat, I often walked in the other direction to the Student Union and spent my evenings along Lake Mendota.
Russell Laboratories, home of the UW Entomology Department, 1600 Linden St.
Built in 1964. So it was only 2 years old when I worked the summer there.
    For the fall I had found a second floor apartment on Breeze Terrace across from Camp Randall Stadium. I don't even recall how I found this apartment. It must have been advertised. A lady medical student classmate of mine also found the same place, and we ended up sharing a room. There were 3 other women in the apartment. I believe two were graduate students, and one was an art student. Our apartment walls were decorated with her paintings. There was one huge green and orange painting of a female nude which graced our living room. It was quite shocking. But I guess we liked it for that quality. We shared the kitchen and refrig and did our own thing for meals. There was a lot of late night studying in that living room. Marla and I booked it really hard that first year.

Here is an aerial view of the football stadium, Camp Randall in Madison. My first
apartment was on Breeze Terrace, the street running vertically to the left of the
photo. My apartment was next to the church at the top of that street. I studied
through many a Wisconsin football game with the noisy celebrations going on
outside my window. Wisconsin lost most games then anyway.

        Medical school opened during the last week of August. There was a day of orientation and then we all gathered in the gross anatomy lab, and were introduced to our 3 lab partners for the first semester. AND we were introduced to our cadaver. I don't remember being grossed out by the cadaver, but a few were. Indeed, there were a couple of students that left medical school that day. To me, that indicates something wrong with the application and acceptance methods. These individuals should have never gotten that far. I was most intimidated by my lab partners. One fellow had served as a medic in wartime (Vietnam, I think). He was eons ahead of the rest of us and sort of took over the dissection. The other two fellows were quiet and shy, but you never knew where you stood with them. I was somewhere in the middle, I think. That was quite a semester. You worked for long hours in the lab making the dissections. No matter how much you washed your hands, they always smelled of formaldehyde. When you were home at the end of the day and you put a sandwich to your mouth, the formaldehyde odor entered you nose. Needless to say, it was difficult to separate the lab from your day to day life. You soon learned that part of your success depended on what kind of cadaver you were lucky enough to get. If you drew an obese one, your dissections would take 2-3 times longer. We had been fortunate. Our fellow was neither cachectic nor obese. He was sort of medium and was amenable to fairly good dissections. I think things have changed some now. I think a lot of the dissections are done for you or at least started to save time. At that time the task was all ours guided, of course, by the anatomy instructors.

Bardeen Medical Science Laboratories, 1215 Linden St.

SMI  (Service Medical Institute) 470 N. Charter St.
These two buildings housed the medical school in the 1960s.
They still house many of the medical school departments.
     Another memory that stands out from that first semester was the anatomy exam. Part of the exam was written, and part was a practical in which dissections were set out with certain structures marked. The student had to name the structures that were marked. This was harder than you think because your individual dissection never looked exactly like the perfect anatomist's dissection. And every human body is different and as a cadaver looks different. Then there was the oral part of the exam. That is what struck fear into most of our hearts. There is something about being tested orally. One of my lab partners and I were assigned to Dr. Petersen, the head of the anatomy department. We were exceedingly lucky. He was a great guy. He told us: "Look, I know you are nervous. But I know you two and I know you know this stuff. Just relax and show me that you know it." And he began to ask questions. Just as he said, I think we both relaxed and breezed through the exam. Dr. Petersen was still there teaching when my son went to medical school. We have a photo of all three of us at my son's graduation reception. Quite an interesting accomplishment for us all.
     I really don't have a huge number of memories from the 4 years of medical school. I think I was so overwhelmed by the whole process that I blocked out many memories just out of self preservation. I also know I was sleep deprived most of those years and that might have had something to do with not recalling too much.
     I do recall the histology lab second semester and neuroanatomy. There were literally thousands of histology slides that had to be mastered. I don't recall spending as much time as some people did in that lab pouring over slides through the microscope to learn how to recognize the various tissues. The competitiveness of my classmates came out in this class. Certain students would brag and broadcast how far they were in the slide box and it was always enough to make me feel guilty, that I wasn't doing enough. But when it came time for the final exam during which we had to identify the tissue through the microscope, I did OK. So I guess I had spent enough time.

     During the summer after my freshman year, three new things happened to me. In June, I got married to my interesting Israeli born husband. I met him that first summer at the Student Union. That is a whole different and interesting story for another time. Secondly, I found a job working at the State Lab of Hygiene on the medical campus. Here again I was using my microbiology B.A. Primarily I worked in the enteric bacteriology lab, streaking out stool specimens (Yes, you read that correctly), looking for Salmonella, Shigella and a few other enteric pathogens. The people in this lab were very nice also. Although the director was a stickler for procedure and I had a small amount of fear of her, fearful I would make a mistake and misidentify the organism. She took great pride in her lab always being correct. The other workers had BA degrees also and we all got along well. Again this building was a short walk from Babcock Hall so every afternoon about 2 PM we all took a walk down the small hill and bought some ice cream cones. You see, everyday there was a different flavor at Babcock, so part of the fun was being surprised by the flavor. Then, of course, after the ice cream, back to the lab to work with stool specimens. Sounds terrible doesn't it? Most non medical persons will be totally grossed out here. I was not grossed out, though. I guess I was hardened to these tasks from the beginning. I worked at the State Hygiene Lab during the summer after my sophomore year as well.

Babcock Hall, built in 1951, has recently gotten a grant to renovate and update the interior.

     Babcock Hall is still there and is still selling ice cream. In fact their selling has expanded to a complete dairy store which also has a breakfast and lunch menu. Many of the items on the menu in addition to the ice cream take advantage of the fact that the dairy milk is produced right behind Babcock in the Ag Department stock barn. In fact here is a documentary film showing the cows being milked behind Babcock and the ice cream being made and packaged in Babcock. Babcock Hall, built in 1950, is home to the UW Food Science Department and the Wisconsin Center for Dairy Research. On campus, it may be best known for its famous Babcock Hall Ice Cream (made in the campus dairy plant), but off campus, around the state and nation, Babcock Hall is renowned as a vital teaching and research hub. It boasts a collection of world-class researchers whose work, training, trouble-shooting and product development skills have helped revitalize Wisconsin's dairy industry

     The third thing that happened was the SDS (Students for a Democratic Society), a leftist war protestation group, organized many demonstrations that turned into riots in the summer of 1967. After we got married, I had of course moved in with my husband who had an existing apartment on State Street, the center of the nightlife part of campus. When I first started seeing my husband, there were mob activities but they were called panty raids on the women's dorms. They were generally harmless. But these mob activities took a violent turn in the summer of 1967. The anti Vietnam war rallies would start during the day on the Library Mall up the street from our apartment. By the night, the groups still going strong would become destructive and had to be broken up. The demonstrators claimed that they were peaceful and just staging a sit in protesting the presence of Dow Chemical on campus conducting recruiting interviews (they manufactured Napalm gas) Which ever side is correct, tear gas was used to break these demonstrations up. We had a canister or two of tear gas thrown into our stairway that led up to our apartment. Our living room windows looked out over State Street so we saw the surging crowd moving back and forth. It was frightening when I was sometimes there by myself.

Our apartment was in one of these buildings across the street here and our living room
windows were on the second floor facing State Street.


View of the State of Wisconsin Capitol building at the other end of State Street.
In the above photo, Bascom Hill would be right behind us, with Bascom Hall
perched on top of the highest point.
A recent year, State Street on Halloween night. This is generally a
peacful crowd having fun, but imagine crowds like this in protest. Scary! Our
living room windows are right above the red awning on the other side of the street.

Here is Bascom Hill topped by Bascom Hall during the late 1960 protests. The crosses
represent graves of the soldiers killed in Vietnam.


     So our education at UW, Madison was punctuated by very historical demonstrations and riots. Madison was one of 5 or 6 leading protest sites around the US. 

     For two years, I walked to medical school classes by leaving our State Street apartment, walking up and over Bascom Hill, past the high rise Van Vleck classroom building, then down the other side of Bascom Hill, past Sterling Hall, and into Bardeen at the bottom of the hill. Sometimes winter winds made that walk quite uncomfortable but I did it every day. I stayed in the medical school buildings all day, attending lectures or labs, or sometimes studying at the new Middleton Medical Library building. I usually finished medical classes about 4 PM and would walk back to our apartment. My husband was still working at his physics lab in Sterling Hall. Sometimes I took a short nap in our apartment. Then I headed over to Lowell Hall, a private girls' dormitory on Langdon Street, where my husband had a meal job that would feed both of us dinner. He took care of the swimming pool at Lowell Hall. We would meet in the employees' dining room for dinner. I felt I was very lucky to have this meal job because it meant I didn't have to cook for the two of us. We just needed to buy some snacks and soda to have in our apartment. The evenings were mostly devoted to study for both of us. My husband's English required some effort and some of the time I spent helping with English for the papers he had to write for his course work. We were both up late studying. The last thing before we went to bed, he would head back over to Lowell Hall to clean the pool and check the chlorine levels. That was our typical day for those couple years.



I walk by this sign every day on my way to medical school.


Bascom Hall, which I walked by every morning on my way to the Medical
School behind it.
      Among the classes during the second year there are a few instances that I recall quite well. Physiology class had one lab session where we were to study each other by having one member of a 3 or 4 member team volunteer to swallow a nasogastric tube and submit to testing of the stomach acid levels. I hung back in our group and someone else volunteered. At the time I was amazed that they would ask us to do this. But I was even more negatively affected by another physiology lab during which our teams each had a dog which we anesthetized and studied various physiological responses to various drugs. I will never forget walking into that lab and finding all the dogs tied to the lab desks. They had been given some  premedications to calm them and partially put them to sleep, and treat any pain. But this had made them vomit and defecate where they were tied. Some were whining and a few were barking weakly. It was a terrible site for any dog lover. But our team did what we had to do. We took all the blood pressure, heart rate, and cardiac output readings that we were supposed to take. Then our job was to plot all this info on graphs and try to explain why these changes occurred in response to the drugs we gave.

     Other courses were pathology and pharmacology. I recall our pathology professor who was quite graphic. He loved to pull out various preserved organs that had been affected by various diseases. He would show them around the group and ask a student to take the organ and feel of it. Some were kind of reluctant to do this. These organs had been in preservatives for eons and were kind of disgusting. But if anyone showed this reluctance Dr Lalique would say: "Oh, Mr. Smith, common, take it. I am going to turn you into something other than a psychiatrist yet."

     Also during sophomore year we began to learn how to take a patient history and do a complete examination. Real patients were found who wanted to volunteer for this. It usually meant that they would be tied up for several hours during an afternoon. Now I think for some parts of this learning, there are professional patients that are hired to submit to these interviews and examinations, particularly for example for the female pelvic examination.

     During the junior year, we continued to learn about taking histories and physicals from real patients. Sometimes if the patient was stable clinically, the junior clerk was the first person to get to take the patient's history. We now had rotations of clerkships in various specialties and while on those clerkships we actually participated on the team that cared for the patient. The junior student was the lowest member of the team, next the senior student, then the intern and then the junior resident. A senior resident oversaw this whole group and we rounded on the patients together and with a member of the faculty. We were sometimes assigned minor procedures as well that needed to be done, such as starting an IV, taking an arterial blood sample, placing a nasogastric tube, or doing a spinal tap to diagnose encephalitis or meningitis. The rule here was that as a student, you would see one, do one, teach one, the one being the minor procedure. This was a very stressful rule for me and for many medical students. This meant that an intern or resident would for example do a spinal tap that needed to be done on a patient. Maybe a couple days later, another patient would need a spinal tap and now I would have seen one, so now I would have to do one. There was always  someone to watch and guide us but we were still in charge. We had to know how to lay out all the equipment, how to use each piece and what it was for, how to scrub up and glove up, how to clean the skin, then how to draw up the local anesthetic in a syringe and deaden the area, then how to attach a manometer that would take the pressure in the spinal fluid, then place test tubes beneath a stopcock and fill 4 or 5 of them, recording what each tube of  fluid looked like. Of course, all this had to be done to a patient and you wanted to at least appear that you knew a little bit about what you were doing. All of this was very stressful, but you just forced yourself to go ahead with it and learn it. You had to.

     I must put in my memories of Dr. William Middleton. He was a legend at UW. He became faculty at UW in Madison in 1912 and was renowned for his teaching until he died in 1975 with only an 8 year hiatus when he was asked to head the Veterans' Administration in Washington, D.C. from 1955-1963. He received multiple UW and national teaching awards for his service at UW Medical School. If you are a student at UW today you will find his name on various buildings and heading the titles of various programs still today. That is how respected he was. Well, for us lowly medical students, our view was a little different. We were afraid of the man. He had some notorious idiosyncrasies when it came to his mentoring of medical students. Perhaps looking back they were done with tongue in cheek for humor's sake but to us, it was our greatest fear to be caught by one of his chastisements. When I was at UW, he was teaching at the Veteran's Administration Hospital which by the way is now named after him. We would have various conferences where medical students, interns, residents and staff would gather to discuss cases, or to listen to a didactic lecture on some disease process or new treatment. Well, as I have said before, medical students and for that matter house staff of interns and residents are always sleep deprived. So turn the lights down to view some projected slides and commonly someone would nod off. Dr. Middleton and his famed Derby hat were waiting. He would sit in the back of the room and as soon as he saw a head nodding, he would fire that black Derby like a frisbee at the head of the sleeping student and whap -- that student woke up and didn't fall asleep again, at least at that lecture.

      I had the questionably good fortune to be on his service for one rotation at the VA when I was a junior. Now you must realize what the typical exhausted and overwhelmed medical student usually looked like. He hadn't had time to wash his white jacket and it was badly wrinkled and sagging, his stethoscope haphazardly around his neck, and his pockets full of notes, and various little notebooks with his assignments of patients, his lists of what needed to be done, and his cheat sheets for the cases or disease that he was currently studying, as well as one of the many published manuals for new interns that could be available at moment's need to look up some minute detail that he would need during his day of patient care. All of these things in the pocket would drag that wrinkled white coat down to his middle thigh. He/she was a pretty forlorn looking person. Well, Dr Middleton would not have any of that. He demanded white jacket pressed, the pockets fairly empty and on rounds as you were standing in the hall outside the patient's room, you did not lean against the wall. You did not put your hands in your pockets. You stood up straight, and looked the part of a Doctor. I recall one particular morning at rounds when Dr. Middleton was in particularly good form. He started out on one student member of the team and began criticizing his wrinkled jacket. Another member of the team had made the mistake of wearing a yellow short sleeved dress shirt under his white jacket. It was clean and crisp but Dr. Middleton didn't like that color. "What is that shirt you are wearing? Are you studying to become a bartender?" he quipped. Then to my dismay he turned toward me. "Young lady, he said. It looks like you slept on your hair." I was fortunate that that was all I got. But our fear was palpable that morning. 

     Here is a website from the UW site which tells of Dr. Middleton's career. http://www.med.wisc.edu/education/md/resources/learning-communities/middleton-house/662

      I remember very vividly another junior clerkship. It was in general surgery and I was assigned to the kidney transplant team as the junior student. Kidney transplants were just starting to be done with some frequency. During the surgery to place a donor kidney into a patient, the old diseased kidney was taken out. This surgery is done deep in a hole in the patient's abdomen, and actually you are going behind the abdominal cavity to get to the kidney. I had scrubbed in and would be assigned to hold a retractor to keep the organs out of the surgical area. I really wouldn't see much myself because the surgeon and his direct assistant would have to be in a position to see what they were operating on. This transplant surgeon wa not a gentle person. He positioned my retractor attached as it was to my hands, and said, "Now, Ms Brauer, that is the position you need to maintain. Do not move. If you move at all, this patient could die." Then he proceeded to lie right across my arm so that he could get better exposure. And there we were for about 20 minutes while he did the vascular part of the surgery. This experience scared me to death and I was very happy to be done with this clerkship. I knew for sure I would never be a surgeon.

     There was another professor at UW at that time who was notorious. But her teaching and demands did not have that little hint of humor that was there with Dr. Middleton. Dr. Helen Dickey was notorious for picking a young man in her cadre of students. She would then work to just about break that young man. She could be very vindictive. You must realize that as students we often felt about 1 inch high. Our knowledge was so minimal and yet we were constantly being put on the spot, a process called "pimping." The attending or even the senior resident would ask questions of the those beneath him on the team, questions that it was likely the poor student didn't know the answer to. When this happened again and again, day after day, the poor student would begin to doubt his ability to learn or know anything about medicine. That was the state of all of our minds. Then a few of us might be put on Dr. Dickey's service during one of our rotations. She would practice this style of teaching called "pimping" or belittling the lower people in the knowledge scale, but she would decide one student in the group needed this process more than the others. And she carried it much further than other faculty. She would tell the student things like "You are nothing but a farmhand. You don't know anything. You will never make as a doctor. etc. etc." Many a poor, usually male, medical student came off her service in a state of mind that in today's world would require counseling to get over. Yet, Dr. Dickey also received many teaching awards. Unfortunately this was the respected and copied method of teaching in those days. I think you can get an idea of this style from watching the TV show "House," today. These methods did really exist and perhaps in some places still do today. Though I think it has lessened. I was at least fortunate that I was never on Dr. Dickey's service. 

     Some of my other clerkship rotations were a little strange. I had a pediatric rotation at the Children's Hospital which was right next to the University Hospital. This was a tertiary referral hospital for kids. So the patient types were not typical at all. My junior pediatric experience included 3 patients for which I did the admission history and physical. Their diseases were Wiskott-Aldrich syndrome, hereditary telangiectasia, and another rare "funny looking kid" genetic syndrome. When you do the admission physical, part of the junior workup has to include a research of everything there is to know about the disease -- its typical presentation and course, its symptoms and physical findings, and its treatment. Even if I became a pediatrician I would never need to know about these very rare diseases, but this was what I had to learn about as a junior student. I would have preferred to see a typical childhood pneumonia, or meningitis, or some other typical disease that affects children much more commonly.

     During my junior year I ran into a problem. My husband had finished his masters studies in physics and now was looking for a job. He had an offer from Eaton Company in Milwaukee and a job offer at Los Alamos Labs in New Mexico. In either case I would need to switch to another medical school. This was not done frequently as in undergraduate studies. But during the year before me, a similar situation had arisen for another female medical student. Her husband had taken a residency in Colorado and she was allowed to finish the last year of medical school at that medical school and still get her MD degree from University of Wisconsin. A precedent had been set so I was allowed to do the same thing. It would either be senior year at Marquette School of Medicine in Milwaukee or senior year at the Medical school of New Mexico which was just graduating its first class from medical school in Albuquerque, NM, quite a distance from Los Alamos. Due to the uncertainty about where we would live, my husband accepted the job in Milwaukee. He commuted twice a week for the rest of my junior year and I rotated with the Marquette seniors for my final year. This actually worked out rather well for me, because my pediatric and my obstetric experiences in Milwaukee were much more practical than what I would have had in Madison at the University Hospitals. I made friends with the Marquette seniors that I continued after I graduated and took my internal medicine residency at Mount Sinai Hospital in Milwaukee. 

     There are other memories from medical school that are less prominent, for example the first time I got drunk after celebrating after final exams, freshman year. I went to one football game in all that time in Madison. I went to a couple symphony orchestra concerts with my husband, due to his pushing me to go. Otherwise, it was just work and study. That is the definition of medical school, I guess. Still I am glad I did it. I enjoyed my life as a physician and determined that it is really an honor to serve in such a profession. I would advise anyone who is willing to work hard, really hard, to take up this profession if they are a lover of science and the workings of the human body.

Library Mall: State Historical Society on left, and Student Union in center
across the street with the high arched porches.

5 comments:

  1. Going to be entering UWSMPH this fall. Thanks for posting and the advice!

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  3. Good luck and best regards on your soon to be changing life at UW Med School. I know things have changed since I was there, but it will still be demanding. I am now writing a post on my on call memories. Look for that soon on my blog. Let me know how that first day in the cadaver lab goes. You may be like my son who loved it so much he repeated anatomy in the form of surgical anatomy and became a professor of surgery. Quite the accomplishment for the son of this "flea" (an internal medicine doctor) who was scared stiff by her first surgical rotation.

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