“Man . . . cannot learn to forget, but hangs on the past: however far or fast he runs, that chain runs with him.”
— Frederick Nietzsche
|Lab coat and scrubs. Photo by Samir. 2006. Via Wikimedia. CC BY-SA 3.0.|
What follows is a description of different aspects of studying medicine at an old, highly regarded Catholic university in Europe a half-century ago.
For Americans, a college degree and success in an easy French language course were adequate for admission to the medical faculty. Tuition my first year (1969) was the equivalent of US $20, or $140 in today’s money. By the seventh and last year (1976), tuition had skyrocketed up to $200, or about $1,000 in today’s money.
Examinations were never graded “on a curve” as they are in many American schools. Here, everyone might deserve an “A”, or everyone might fail. Therefore, there was no competition between students.
The people whose bodies we dissected in anatomy lab had specifically left their bodies to the university for that purpose. A notice board containing their written requests was at the entrance to the dissection room. When our gross anatomy course was over, a mass was held for the souls of these men and women. We students considered it a duty, even a privilege, to attend.
Finally, many of the Americans in my class were Jews. An exam had been scheduled for a major Jewish holiday, and some of these students had planned to attend a synagogue in a nearby major city. They explained this dilemma to the professor who was planning to give the exam, and he rescheduled it in a flash.
Of course, life is not perfect. Here is a group of events that were problematic, starting with the least serious.
I went to one of my many oral exams in June, in the required suit, white shirt, and tie. I picked a card that had the three questions I was required to answer and sat down to use the twenty minutes allotted to prepare an outline before my oral presentation. It was hot, and I took off my suit coat. The professor hurried to my side to tell me that when I presented my answers to him, I would need to have my jacket back on.
For one of our ophthalmology lectures, the professor brought in a patient who had a large port-wine stain on the side of her face, involving the upper and lower eyelids. She likely had Sturge-Weber syndrome, a feature of which is epilepsy from the presence of meningeal hemangiomas. The professor asked the class, “What do you think this woman has, among her medical problems?” An American student raised his hand and when called on, correctly answered, “Epilepsy.” The professor glared at him and said coldly, “Yes, she has E.” In other words, it was taboo to say the word “epilepsy” in front of a patient who had that condition.
In the US, medical students wear short white coats. In Europe, waiters wear short white coats and medical students wear doctors’ long white coats. A handful of American students came to the clinic in short white coats, and the doctor running the clinic told them they looked like waiters.
We did an experiment in which we exposed the cerebral cortex of live rabbits and observed the electroencephalographic effects of various chemicals applied directly to the cortex. Some American students apparently decided that the experiment was cruel or unethical and refused to participate. The lab director called them “cretins.”
Women first-year students in medicine, as well as in all other faculties, had to live in supervised dormitories called “pedagogies.” To enter these buildings, a non-resident had to explain to the nun who guarded the front door what business one had there. The women students had to sign in and out. Men, including fathers and brothers of the students (forget boyfriends), were not allowed above the ground floor. They could sit at a table with the female student they were visiting and talk, while observed by a “Sister.”
One of the anatomy professors was said to have grown up in financially impoverished circumstances. When a student sat before him to present his oral exam, he would look closely at the student’s watch. If he thought it was an expensive watch, he demanded to know, “How could a student afford such an expensive watch?” Clearly, no matter how brilliantly the student’s presentation might unfold, the interaction started off on the wrong foot, and with a shaken student.
To finish this category: The women medical students learned to examine the male genitalia by visiting, as a group, a psychiatric hospital and examining the patients. A classmate had such a disturbing interaction with a male patient that she phoned her parents, told them she was through with this university (I was with her when she called them), and was returning back home to Frankfurt. She obtained a place in a medical school in Germany and eventually completed her education.
|Belgian frites shop in Brussels. Photo by Zorro2212. 2014. Via Wikimedia. CC BY-SA 4.0|
During the course of an oral examination, the professor of pharmacology was so displeased by a student’s answers that he told them to drop out of medical school and “start selling frites,” that is, the Belgian national snack food of French fries.
The most frightening and, to my thinking, unethical behavior demonstrated and taught to us concerned revealing the diagnosis of cancer. One day on rounds we were introduced to a patient who was asked to tell us about his problem. He was almost skeletal and his skin was bright green. “Well,” he told us, “the doctors say I have a little cyst [here, he demonstrated “little” by holding a thumb and index finger about one centimeter apart] on my pancreas.” Even as fourth-year (of seven years) students, we could not think of much other than a pancreatic carcinoma as the man’s diagnosis. He had not been told. He had been lied to.
In our “Cancerologie” course, our professor told us of a patient, a Jesuit priest. When he told him he had leukemia, he jumped out of a window. Therefore, we were told, you do not tell a patient he has cancer. You can tell his family, and let the family decide what the patient should be told.
All in all, I am grateful to my university for permitting me to study medicine and have a rewarding, interesting, and useful profession.
HOWARD FISCHER, MD, was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.