I was accepted to medical school because of sex change surgery. It’s that simple. Yes, I passed some tests and jumped through the required hoops, so getting in wasn’t completely out of the question. But then, Dr. Doug Ross showed up. That’s right, roguishly charming George Clooney staggered into County General’s ER, and suddenly everybody wanted to play doctor. As audience temperatures rose, medical school applications skyrocketed. NBC and the stethoscope-clad cast of ER had effectively obliterated any chance of my becoming a doctor.
Am I prone to exaggeration? Perhaps, but in 1994 when ER first aired, 77,000 applicants, all dreaming of evaluating urinary output shoulder-to-shoulder with Dr. Doug Ross, competed for just over 17,000 available seats in medical school. Unfortunately, that was also the year I applied. When ER went off the air, applicant numbers dropped to half that number. So, I’m not joking when I say the only reason the school accepted me—a broke, liberal arts educated, river-rafting guide and flailing environmental entrepreneur—was quite literally due to gender altering surgery.
As ER gave mouth-to-mouth resuscitation to medical schools’ previously diminished applicant pools, the school selection committees became more discriminating about whom to let in. Medical schools started expecting applicants to pass the required pre-med classes, do well on the MCAT, and demonstrate an interest in medicine.
I happily graduated college without achieving a single one of those requirements.
During my undergraduate years at Georgetown University, I studied American Government (I was living in D.C. after all), and English (a language I spoke relatively well), and did not take a single pre-med class. My favorite classes included Acting, Shakespeare in Performance, and a screenwriting elective. I harbored no thoughts of a medical career. In fact, my only exposure to medical school was witnessing a group of swaying drunks holding each other upright while belting out Sweet Caroline in The Tombs, a popular college bar where I worked. The bartender informed me that this boisterous crew had just graduated medical school. You sensed their chortling and toasting were more than your typical end of school celebration; rather, the backslapping camaraderie and booming laughter befitted a company that had survived some hellacious endeavor together—an endeavor I had no desire to experience.
Early on in college, I had told my career advisor that the only thing I did not want to be was a doctor. I was not a fan of sick people, disliked the smell of hospitals (still do), and the idea of lugging massive pre-med textbooks across campus made my back hurt. An answer, however honest, that was unlikely to get me admitted to medical school.
To this day it’s troubling to explain why I applied to medical school if I wasn’t really sure I wanted to be a doctor. Why go through the trouble, the cost, and the years it takes to complete medical training? Truthfully, I was a bit uncertain what to do after college. So many careers looked appealing, even medicine looked interesting. Several doctors then advised me, if you can imagine anything else you might want to do with your life, do that, only be a doctor if there’s nothing else you want to do. I thought, well that’s stupid, I can imagine lots of things to do…there were infinite appealing experiences and careers to choose from. And at 21, with life immortal, there was an eternity patiently waiting ahead to do it all. (Ah, to be immortal again!)
I did eventually justify to myself that medicine would be a purposeful career; one I could use anywhere in the world; with a possible shift-work schedule that would allow me the freedom to pursue my real dream (making movies) while simultaneously fulfilling some Freudian need to please my parents.
I freely admit a few months of therapy would have been a far more efficient means of dealing with my insecurities.
Regardless, my uncertainty later proved to be quite awkward because unsurprisingly, “Why do you want to be a doctor?” is a pretty common question the medical schools ask during the application process.
I want to help people, or, I’ve wanted to perform heart surgery since pre-school, are typical responses.
“I’m not really sure I do,” is not what you say to impress the admission committee.
To be fair, I’m not the only person to question their medical career choice. I know more than a few students and residents bumbling down hospital hallways on Saturday nights, missing their family and friends, wondering, “Do I really want to be a doctor?” To the frustration of many supervisors, friends and family, I just happen to be very open about questioning my decisions in life.
So how did I actually decide to apply? The answer, oddly, lies in France.
Up to this point I had chosen to pursue a dependable career in law with a focus on environmental issues; however, after a few college summers working in law firms, my legal aspirations dimmed. Nonetheless, after graduating college, I took the LSATs, worked in a corporate New York City law firm, and then, to honor a signed blood pact (which I still have and, yes, drinks might have been involved), went to live off my very meager earnings, credit cards, and occasional payments for illegally guiding skiers through the French Alps. I journeyed with my college friend, Scott, who, far smarter than me, did eventually go to law school, and will appear in multiple hospitals later on.
Trust me, this is leading somewhere medical.
That February, in order to escape the many avalanches crashing down around us in the Chamonix valley, we hitchhiked to visit friends in Italy, during which respite I caught a fever after swimming in the winter sea. When I began coughing up blood-tinged mucous, I decided that a doctor might be more appropriate for my care than my college friends. The aging Italian doctor however, in between huffing and puffing on cigarettes, was coughing up thicker brown mucus than me. I had no desire to catch something more dangerous than what was already infecting my lungs, so I left his office without being seen, which led to a fortuitous meeting.
Back in France, still sick and coughing, I went to the Argentière town clinic and met Dr. Lacoste. He diagnosed me with bronchitis—at least I think he did, my medical French was pretty laughable—and gave me some bottles of pills. We spoke for a few minutes and I found his lifestyle quite intriguing: As I understood it, he treated patients in the morning and skied with his daughter every afternoon. We then discussed Médecins Sans Frontières (Doctors Without Borders), the physicians and assistants who volunteer in war-torn regions to care for the sick and injured.
I suddenly became fascinated by the idea that perhaps this was the life I was searching for: living in a mountain ski town; working mornings; skiing in the afternoons; and helping disadvantaged populations the other half of the year.
Now, it’s equally possible that given my disastrous French language skills, I completely misunderstood Dr. Lacoste, and what he actually told me was that he despised medicine for taking him away from skiing with his daughter, and that his wife had run off with some feckless fart from Médecins Sans Frontières. That very possible translation error does make the reasons for my upcoming career choice appear mildly ridiculous. Well, misinterpreted or not, I decided to go work and travel with Médecins Sans Frontières.
But to join Médecins Sans Frontières, one needed to be a doctor and I was not. In order to be a doctor, you had to go to medical school, which I had not. I was living on cans of stolen green beans, so the mere idea of paying for medical school was ludicrous, let alone getting in.
Even with my vivid imagination, I knew I would never sneak past a medical school admission committee with that tangential, doctors without borders and tobacco inhaling, sputum spewing, Italian doctor by the sea, rambling of happenstance. Not to mention several outstanding deficiencies on my medical school application stood firmly in the way—such as not taking a single pre-med class or the required MCAT.
That summer, with medical school dangling like a pipedream, I worked as a river rafting guide in the southwest Utah desert where there were no pre-med classes to be found for several hundred miles. There was, however, a required wilderness first aid class for river guides. We spent two afternoons listening to an instructor trying to speak over drunken veteran river runners sharing their favorite stories of injured passengers. No, not much that qualified as a pre-med class. So I moved to San Francisco with a few friends, figuring I’d work during the day to pay for evening pre-med classes.
That first night in the Bay Area, lying on the hardwood floor of our shared apartment, pondering the cost of classes and rent, the time required to study, lack of any cash to buy a bed, and the need to work full-time—my unraveling plan to become a doctor triggered some stress—stress that caused an intense pain first in my back, and then my stomach.
I rapidly deployed my two afternoons of wilderness first-aid river guide knowledge and diagnosed myself with appendicitis or food poisoning (wrong on both counts). Whatever it was, the discomfort clouded my ability to think properly, so I called my mother because her husband was a doctor.
Several months prior, upon hearing that I was considering applying to medical school, he had laughed, told me I couldn’t apply, that I wouldn’t get in, and that if I did, I couldn’t afford to pay for it anyway. I should have listened to him and stayed in the Bay Area right before the dot-com boom struck; I could have made billions, lost everything in the crash, and been happily planting grapes for minimal wage right now instead of still paying off medical school loans twenty years later. Once again, a bit of therapy would have saved me a lot of time and money.
His recommendation was that I go see a doctor. Well, no kidding, I could have figured out that brilliant bit of medical advice by myself if I wasn’t so uncomfortable. I hung up dissatisfied (mostly because he was probably correct) and decided to go to a hospital. It was 4:30 in the morning. I didn’t own a car; Uber didn’t exist; and my roommates were at their respective girlfriend’s.
I sheepishly telephoned Joslin (Scott’s girlfriend) feeling every bit the pathetic friend interrupting their sleepover by getting appendicitis. By now the ache was so intense, I was praying it was my appendix, and not just bad gas, which would have been really hard to live down. Fortunately the two of them were gracious enough to rush over and take me to the hospital.
When we arrived at the hospital a team of doctors, residents, interns, and first-graders (for all I cared), rushed to push on my stomach and ask questions relevant to my dire situation. I begged the doctors to quickly knock me out, or shoot me, whichever was more convenient for them. Instead, I was sent to get a urine sample; and when I returned, proudly displaying my cup of dark yellow liquid, noticed something was amiss.
All my new caring friends had dispersed. My mother was on the phone and had requested I go to a different hospital where her, you’ll-never-get-into-medical-school husband knew the Chair of Staff, or Chief of Strep, or some guy that had donated money—I didn’t care, I couldn’t think strait, I was in pain, and I didn’t want to leave the safe environment of compassionate people in this hospital to go somewhere else.
I lost that argument.
Minutes later I was painfully waddling down a city sidewalk in an ass-exposing hospital gown holding my cup of urine. Welcome to San Francisco.
As Joslin and Scott drove me to the next hospital, the pain intensified to the point that I was trying to rip the seatbelts out of the car in agony and then… relief.
A nasty bugger of a kidney stone had completed the painful journey to my bladder. By the time we arrived in the ER waiting room, I was relatively pain-free. I eventually fell asleep on an X-ray table, only to be woken by a cute technician rubbing warm jelly over my abdomen for an ultrasound. She told me that kidney stones were supposed to be as painful as childbirth. Here was a woman being nice to me—things were looking up in the Bay Area.
After that wonderful jelly rubdown, I was left alone in an exam room until I eventually met the ER physician in charge. She was a super-friendly woman who once upon a time had been a fashion model, and before that, a diamond hunter in Africa. After those exotic adventures, she became an ER doctor, and now informed me it was time to perform a rectal exam—and proceeded to do so. Welcome, again, to San Francisco.
The episode served as a reality check: If I continued living, working, and studying in San Francisco—a triad that gave me kidney stones—it would take several years for me to complete pre-med studies. The time and cost were prohibitive, and my only brushes with medicine were likely to be stress-induced illnesses. I pushed down my ego and asked my mom if I could move back home to New York and attend a nearby SUNY school and community college for my pre-med classes.
Meanwhile, Scott stayed in San Francisco where he was eventually arrested for bungee jumping off the Golden Gate Bridge. Not really a surprise however, it was not the first time that Scott’s joie de vivre had attracted Johnny Law. When we lived in Chamonix, the Gendarme had arrested him for disturbing the peace, dropped him off in Italy, and told not to come back to France for several days. With all that first hand legal experience, it’s no surprise that Scott went to law school. While I, plagued by French bronchitis and a kidney stone, tried to get into medical school. Who would you rather party with in Vegas? That’s right, Scott.
I will leave the riveting tales of my state school biology, chemistry, organic chemistry and physics classes for a light novella. I passed the classes, took the MCAT, moved to Utah, and applied to medical school.
I had one final school application deficiency to complete—the sticky point about proving one’s interest in medicine. Most of the 77,000 other applicants all seemed to have found an extra lifetime to discover DNA sequences, publish groundbreaking research with Nobel Prize candidates, or at the minimum, provide nursing care to an aboriginal tribe for ten years. Not to mention they had all double majored in Micro-Cellular Biology and Organic Chemistry.
During my past few years on the planet I had worked as a paralegal, a ski guide, a river-rafting guide, a bagel baker, a blundering entrepreneur promoting environmental products in Eastern Europe, a ski-store salesperson, and had taken acting classes. I scoured my brain and found no practical way of whipping those experiences into a remotely convincing desire to practice medicine. My only hope of admittance was to slip in under the well rounded “liberal arts education” title for which I had convinced myself there must be one opening.
Medical schools, however, insisted on some hint of interest in medicine. I had never done anything medically related beyond injuring myself and getting a kidney stone. So I applied to volunteer in the University of Utah hospital’s ER and discovered that even being an unpaid ER volunteer was a competitive position requiring an interview. Two weeks later though, having beaten out fifty other volunteer candidates (go John!) I was standing in the ER where a nurse handed me a two-sizes-too-small, poorly tailored, baby blue “volunteer” blazer with a nametag announcing that my name was “Sam.”
My ER duties involved carrying test tubes to the lab and wheeling patients to the radiology department for X-rays—work that undeniably confirms one’s interest in medicine.
One ER story is worth mentioning, however, as it was the one medical lesson I learned during my almost seven hours of volunteer work. Around 3 a.m. on my second and final night of volunteer duty, a patient was brought in strapped to a gurney with a host of policeman and medics holding him down as he cursed, bitched, kicked, bit, and invented several truly creative word combinations. Nobody knew what party drinks or drugs he had actually ingested as he swore he had injected and inhaled every recreational drug known to man. But how trustworthy could this guy really be?
The ER team needed to know precisely what, beyond spiteful venom, now flooded his veins, so that they could administer the appropriate treatment protocol. Herein lies the rub—they were going to need a urine sample for an accurate assessment of the night’s poisons.
A brave nurse attempted to coax him into sharing a urine sample. She returned in tears. Next they asked if I, the new volunteer, wanted to place a Foley? I had just learned that placing a Foley catheter meant inserting a tube into this maniac’s penis. I politely declined the enviable role. Unable to proceed, the nurses summoned the coolest people in the hospital—the Air-Med helicopter rescue team.
The helicopter team had a call room attached to the ER where they waited to fly off and save lives. They would saunter into the ER, backlit and moving in slow motion to inspirational 80’s glam rock tunes. Men, women, babies, puppies—all stopped to admire this crew and their gorgeous hair blowing in the breeze of some unseen hospital fan, as they chuckled over an inside joke. They looked pretty cool to a volunteer kid in a baby-blue blazer.
An Air-Med flight nurse named Steve—a square-jawed, GQ-cover type who will show up later in these books, as he, too, goes to medical school—was called to help us out. He strolled into the patient’s room carrying a plastic cup and a piece of a PVC piping.
The patient flung a barrage of curses at Steve, who patiently waited for him to run out of breath. Then Steve smiled and calmly informed the guy, “Look, you can either pee in this cup or I’m going to stick this big tube in your dick. What do you want?”
Five minutes later the guy had urinated in the cup and was sitting un-restrained in a chair in the middle of the ER apologizing to everyone for his insolent behavior. This was a great lesson that stuck with me: Humor and a calm demeanor is a much better way to handle tough patients than being stressed, frustrated, or threatening.
My volunteer experience lasted two nights. Time enough to demonstrate an interest in medicine? Not really, but my application would only state that I had volunteered in the ER, not the actual length of time (several hours) or what my duties (carrying test-tubes) had entailed. In reality I doubted I would even be granted a medical school interview.
But unexpectedly, I was…
I showed up at the University of Utah Medical School smiling in a jacket and tie. My interviewer was an Asian OB/GYN who smiled back, looked over my application, and chuckled. “Where’s this place you did your pre-med classes? Some state school in New York? Never heard of it.”
I started to explain that I’d lived at home and worked part-time so I could afford to take the classes.
But he was on a roll and piped up with an impressive level of sarcasm, “Wow, you got A-plusses in your classes? You must be super smart. Come on, what kind of school gives an A-plus? A joke school? You’re kidding, right? It’s a joke, right?”
But it wasn’t. I had stayed up past 2 a.m. studying almost every night for a year knowing I was applying from a sneered-upon state school and needed perfect grades to compete against candidates from top-notch universities. I had taken the same board exams as those candidates. I had studied the same textbooks as them with the goal of not getting a single answer wrong on any test that entire year. I did every extra-credit offered. The professors saw my perfect exam grades, added in my extra credit work, and generously gave me an A+. Joke or not.
But before I bumbled out that pathetic explanation, he told me, “You’re white, male and not applying from in-state. You’re not going to get in.”
He let that statement sink in, then added, with a spreading smile, “How does it feel to experience reverse discrimination?”
Not great. I can still hear that conversation years later. Never shared that embarrassment with anyone until now. And to top it off, he was right. I didn’t get in.
I was waitlisted.
So, I waited, waited, and waited, and felt further humiliated by the school’s eventual rejection. I should have walked away. But my ego was bruised and sometimes we do stupid things to sooth ourselves, like texting drunk or re-applying to medical school.
Retrospectively, those previously mentioned months of psychotherapy would have been such a good idea on so many levels. But I was not the wise doctor I am now and rashly applied again to smother my feelings of rejection and shame.
Wasted emotions aside, I accepted that I was not becoming a doctor that year, and moved to Poland with a business I’d started to promote environmentally and economically beneficial infrastructure products—a minor economic blunder quickly surpassed by attending medical school.
When I received my surprise invitation to once again interview for medical school, I was still living in Poland, despite a lack of business experience beyond playing Monopoly. If I could unsuccessfully feign my way in a country where I didn’t speak the language and had no training in what I was doing, then how much more difficult could it be to convince a medical admissions board of their need to help me fulfill my destiny with Médecins sans Frontières?
I traveled back to the U.S., borrowed a car, drove to Utah, walked up the same medical school steps, armpits sweating, fingers crossed, fervently praying that a different doctor would interview me than the smiling OB from a year ago…
My interviewer that morning turned out to be a highly touted, very kind, and very elderly surgeon—too elderly, I suspected, to be safely operating on live patients anymore. I think he was some Emeritus school royalty who had been tucked away in a large office several floors and many corridors away from the hospital operating rooms in the hopes that he wouldn’t wander inside wielding a scalpel.
For our entire interview he entertained me with stories about his career and, most importantly, how he became the very first surgeon trained to perform sex change operations in Utah.
He talked about sex change surgery for forty minutes and I never said a single word. Finally, he glanced down at my application.
I waited tensely for the humiliating questions about the state school and community college where I had done my pre-med work and received joke grades…I waited for derogatory questions about why I was wasting time river guiding, or living in Poland, if I wanted to be a doctor…
But instead, shockingly, he applauded my time in the ER. “Volunteer work? Now that demonstrates an obvious dedication to the field of medicine. You’re going to make a fine doctor.”
A few weeks later I was accepted to the University of Utah School of Medicine.
Thank you gender-altering surgery.
Do not take the above tale or what follows as a roadmap for getting into or surviving medical school. But be inspired that if I made it through, then certainly so can you. And there is no secret, really. You show up. You do the work. You do it well. That’s what it takes to be a professional in all aspects of life.
Let’s go to medical school…
 To be fair, I did enlist several college students to help me break him out of jail (where we assumed he had been taken). After mistakenly storming a hotel lobby, however, we called it a night and went to eat crepes.