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an online version of the magazine Spring/Summer 2007
A Kind of Calling, photo of Mary Cutler
Former chicago street cop Mary Cutler holds to the credo, "It's never too late to be what you might have been."
  Meet four medical students who never started out to be doctors.

By Jim Duffy

Mary Cutler was a rookie working a beat on Chicago’s tough west side the night she got in a foot chase with a drug dealer. She'd lost sight of her veteran partner—he was in a car, rounding the block and coming to her aid—when the suspect fled into an abandoned building.

“It was one of those moments: Should I go in? Should I not go in?” Cutler recalls. “I went in. It turns out the guy ran right through the building, and we found him in the next yard over.

So it wasn’t a big deal. But when I went in there, that was the moment when I realized that I could be a good police officer.”

Stepping into that dark unknown, Cutler also conquered self-doubt that went beyond the police work at hand.

“It made me realize I could do a lot of other things, too. It’s funny, the way so many of the things you might choose in life seem really, really hard. Then you see other people doing them. Somewhere along the way, you get to the point where you think you can do them, too. That night did that for me.”

Cutler patrolled the West Side for two years, then landed a desk job serving as departmental liaison to the Metropolitan Chicago Healthcare Council. That work got her thinking about medicine, the career linked in her mind with the lessons she’d learned from Catholic school nuns during her childhood about serving the poor and combating social injustices.

About the time she made detective, Cutler enrolled in a post-baccalaureate premedical program. Knowing that life as a full-time cop and part-time science student would be hard, she borrowed a motto from George Eliot, the Victorian writer: “It’s never too late to be what you might have been.”

Cutler, who finished up at the School of Medicine in March, just days before delivering her first child, a daughter named Tessa Lorraine, will go on to do her residency in psychiatry at Johns Hopkins Hospital. “It’s a very hopeful field to me—one where I can make a real difference in the lives of my patients,” Cutler says. “I was enjoying being a police officer, and I was doing well at it. But it was never what I really wanted.”

So much has changed in medical education today. Classes once made up predominantly of white men now include a mix of genders, races and ethnicities. And classes once filled with students straight from undergraduate classrooms now include rising numbers of students in their late 20s or early 30s. At 34, Cutler, in fact, is a decade older than the traditional student.

“Diversity has increased so tremendously,” says cardiologist James Weiss, associate dean for admissions and academic affairs at the School of Medicine. “But it’s not just about gender and ethnic background. It’s true for socioeconomic background. It’s true for age, for the number of universities we find in each medical school class.”

During his own days as a med student, Weiss himself qualified as an oddity, having worked after college as a professional oboist. Today, 45 percent of students at the School of Medicine arrive with a measure of nontraditional experience, whether in a professional setting or through service projects like the Peace Corps. Once they’ve decided they want to be doctors, many—like Cutler, who majored in Latin American studies as an undergraduate at the University of Chicago—sign on for a post-baccalaureate program that gives them the solid grounding in science courses that they’ll need for medical school.

According to David Trabilsy, who spent 13 years in admissions at the School of Medicine before launching Hopkins’ own post-bac program on the Homewood campus in 2000, these older students can motivate and stabilize a medical school class. With workplace experience already in their backgrounds, they arrive with a degree of determination, experience and maturity that other students notice. “One of their basic characteristics is usually their humanism,” he says. “Some of them are leaving very lucrative professions. They’re not looking for more income or a better standard of life or, for that matter, prestige. They’re looking for ways of serving humanity.

“And each one of them,” he adds, “has a story to tell.”




. . .
Cesar Briceno  
> CESAR BRICENO: “I had never stopped before to consider the social side of things until I found myself alone in the lab at 3 o’clock in the morning.”

It was late in the game when Cesar Briceno fell out of love with basic science. He’d already committed to an undergraduate major in molecular and cellular biology at Harvard and almost finished his research into how protein signaling drives movement in cytoskeleton cells.

“Then I saw that this was going to be lonely work,” Briceno says. “I had never stopped before to consider the social side of things. When I found myself in the lab at 3 o’clock in the morning, I started to notice how the whole building was empty.”

Briceno worried that the demands of science would conflict with his family life in the future. And so, instead of moving into doctoral studies as he’d planned, he took a job with a consulting firm that did strategic planning for pharmaceutical firms. It was socially engaging, mentally challenging, lucrative work.

“But at the end of the day, it felt like I was making binary code,” he says. “We made these huge Excel spreadsheets with all these color-coded things that went into these fabulous PowerPoint presentations. They’d get shown to someone who might or might not care. And then it’d just sort of sit there in someone’s hard drive.”

It wasn’t that Briceno disliked the pharmaceutical business. Its bottom-line emphasis on profit margins could leave him uneasy, but the companies he consulted for turned out products that bettered the lives of millions of people. “But what I really wanted to do was to make an impact on an individual level,” he says. “I wanted it to be one on one. I wanted to look someone in the eye and say, ‘I’m going to take care of you.”

Even this need, Briceno admits, has an element of selfishness to it: It’s his own longing to help others that he’s focusing on—his need to add meaning and purpose to his own life. “But you need to be true to yourself,” says Briceno, who graduates this May. He’ll eventually specialize in ophthalmology and do his residency at the University of Southern California’s Doheny Eye Institute. “To be productive, you should find something you like to do.”

Over two-plus decades in working with prospective medical students, Trabilsy recognizes two core motives among them. One is commitment to service. The other is a hunger for human interaction. Students who choose medicine are actively seeking the emotional immediacy of the doctor-patient relationship, he says. “That’s what they’re coming to medicine to find.

“We hear, of course, about physicians who may not have good bedside manner. But I see this over and over again: People going into medicine regard this humanistic aspect as a kind of calling.”




. . .
Ariel Green  
> ARIEL GREEN: “I can’t think of one classmate who's made me think for even a minute that they were in it for the money.”

Both of Ariel Green’s parents are physicians, but they didn’t complain when she decided not to follow in their footsteps. Green studied English at Harvard, then moved to Little Rock to work as a reporter for the Arkansas Democrat Gazette.

When the health beat opened up, it seemed a natural fit. But the work sometimes left her feeling constrained by the reserve and objectivity of daily newspaper journalism. One such story involved a campaign to find a bone-marrow match for an African American man battling multiple myeloma.

When I interviewed him and his wife, I was so struck by this couple,” Green says. “They were young, and he had such a horrible disease. His wife was so hoping for something to make him better. I could see how committed his doctors and the hospital were to finding a way to help them.

“It made me want to be on the other side. It made me want to have more of a direct impact on people.”

Like so many of her fellow students, Green searched for a way to make that impact even during her studies. She worked with gerontologists at Hopkins Bayview to start the Adopt-a-Grandparent program, in which med students work with elderly Baltimoreans who lack family and social supports. More than 20 students signed on in the program’s first year. This past year, Green earned an M.P.H. from the Bloomberg School of Public Health. After completing her fourth year of medical school next spring, she intends to start specializing in internal medicine.

“I’m interested in geriatrics—combining clinical practice and public health research,” she says. “I aim to use my medical and public health training, and my love of writing, to document [patients’] stories and work toward policies and programs that can improve people’s lives.”

Looking back at her decision to go to medical school, Green is more certain than ever that she made the right choice. “I have been moved again and again by my patients,” she says. She pauses, then adds, “I can’t think of one classmate who’s made me think for even a minute that they were in it for the money. Medical school is too hard. If what we wanted was prestige and money, there are definitely easier routes.”




. . .
Shannon Shea  
> SHANNON SHEA: “I had to get over my aversion to blood, my aversion to dirt and my aversion to bugs very quickly.”

Shannon Shea’s childhood dreams about a medical career were dashed the day a dog bit her brother and the sight of his blood left her weak at the knees. She eventually studied accounting at the University of Notre Dame, then moved to Atlanta for a job at Coopers & Lybrand (now PricewaterhouseCoopers).

That’s when the letters began landing in her mailbox from places like Guatemala, Africa and inner-city New York. They were from college friends who’d signed on for service projects.

“I was three years out of school by the time I decided that I’d always regret it if I didn’t do one, too,” Shea says.

Arranging to work for a year in a Bolivian orphanage housing 100 girls, she was the last volunteer to arrive, so she got the last choice of duties—the infirmary.

“I had to get over my aversion to blood, my aversion to dirt and my aversion to bugs very quickly,” she says.

“Because that’s about all you’d see all day long.”

Another of Shea’s tasks was shepherding visiting American physicians through the orphanage and into neighboring towns. When one of the doctors asked if she’d ever considered a career in medicine, she confessed that it was suddenly very much on her mind.

Since entering the School of Medicine and enrolling in a joint M.P.H. program, Shea has been back to Bolivia three times. Her understanding of the complexity of the country’s needs continues to grow. For her last year of medical school next year, she plans to return one more time to conduct a survey. It will examine whether projects aimed at employing Bolivian women ultimately result in improved health and education for their children.

How can one person best make a difference in the face of such a bottomless supply of need?

“In the orphanage, I had some small impact on the girls’ lives, but I couldn’t adopt them all, you know?” Shea says. “But the doctors who came down, they had very tangible skills they could apply. They really made a difference.”

In the end, there are as many different roads to medicine as there are medical students. Whether the journey begins on the streets of Chicago, in a frantic emergency room or in a remote corner of Latin America, it leads to a place where the common instinct seems to be, Medicine can make a difference.

“Among our applicants, this sense of altruism is a common theme,” James Weiss says. “A love of service to the community is what this is all about for them.”*


Jim Duffy is a freelance writer based in Cambridge, on Maryland's Eastern Shore.

The Doctor Draw

doctor with a studentMedicine is far from perfect. Tune into the national news and hear horror stories about uninsured patients, malpractice lawsuits and out-of-control health care costs. Dig deeper and you’ll discover a snarled system of mix-and-match third-party payers and government reimbursements. Look into going to medical school and you’ll learn that by the end of the four-year program, you can expect to be carrying a six-figure debt load.

Still, no other profession gets more respect as a career choice. Recently, the Association of American Medical Colleges (AAMC) released the results of a survey showing that American adults advise young people to become a doctor above all other professions. Another AAMC survey then ranked medicine as the top pick among U.S. teenagers.

None of this comes as a particular surprise to pediatrician Henry Seidel, who has dealt with his share of medical students. He served two stints as dean of students at the School of Medicine, one from 1968 to 1971 and another from 1977 to 1990. In the years since, teaching duties have put him in close contact with 10 or so students a year.

“These people come to medical school knowing what the external environment is like and how much it's changed,” he says. “They simply are not intimidated by it. I have to say that overall, I'm boggled by how good they are.”

Across time, four basic motives weigh in the decision to pursue medicine, Seidel says. There is the wish to do good works and serve people in need. There is the draw of intellectual challenge and curiosity. There is the desire to win social prestige. And there is the need for long-term financial security.

“It's probably fair to say that there are elements of all four in everyone's decision,” Seidel says. “But I'm convinced the most powerful by far are the wish to do good and the drive of that intellectual curiosity. That was true in the past, and it remains true today.”

 Ten Years at the Top
 Just Say 'Ah'
 A Kind of Calling
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
Class Notes
 Back to the Future
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2007