This issue’s packed with M.D.s flying high in midcareer. But what about the rookies and the veterans? To find out, we dropped in on a fourth-year medical student and a retired neurologist to learn what’s new, what’s old and what’s unchanged
By Katie Beth Ryan
Photograph by Katherine Bish
On a blazing hot afternoon in mid-June, Noopur Gangopadhyay (pronounced Gang-go-PUD-eye), dressed in a navy track suit outside of Café Oasis in the Central West End, is enjoying what remains of her two-week break from the Washington University School of Medicine. The 24-year-old recently finished her first clinical year at Barnes-Jewish Hospital; just ahead is her fourth and final year of medical school.
Gangopadhyay’s journey to the operating room began in her hometown of Beckley, W. Va. She received her undergraduate education at the University of Virginia and developed an interest in practicing medicine during childhood. While traveling around the state with her sister and mother, who was a social worker, she saw and interacted with patients who had various forms of disabilities or limitations. Trips to her parents’ home country of India, where she observed an overwhelming need for healthcare amid poverty, provided additional motivation to make medicine her life’s work.
When she finally did reach medical school, Gangopadhyay settled in for a consistently heavy load that had its annual changes. “There comes sort of a big split at the end of second year,” she says. “The first two years are spent mainly in the classroom, where you’re going to lectures in the mornings, then doing small groups and labs in the afternoon. You do have some clinical experience—you shadow, you have some interaction with patients. But really it’s not until your third year when you get fully immersed into the clinical experience. You have to really integrate the skills you’ve been developing all along.”
It is also during that third year, Gangopadhyay says, when you have to be responsible for your own education. “The free time you might have spent at the gym or going to the movies, you sometimes have to give up to study. If I were on a medical rotation, I would put in 12 hours or so and then read up about my patients, go to the gym and then go to bed. If I were on my surgery rotation, sometimes I’d get there at 4:30 in the morning and not leave until 7 p.m.”
Gangopadhyay says that this non-classroom work has been critical to her development. “There is this urgency to get into the hospital and start to learn from doing. I think I’ve retained the most by actually doing the procedures myself and interacting with the patients and taking on clinical duties.”
At this stage, Gangopadhyay has her eyes set on either pediatric otolaryngology or pediatric reconstructive surgery. “I have a great love of science,” she says, “but I also enjoy the fact that with surgery, it is a way to fix the problem, versus putting patients on medications. It’s very gratifying when you can say, ‘Well, I’ve corrected whatever the congenital or structural abnormality is.’ So in that regard, it’s more of a quick-fix satisfaction than some other areas of medicine.”
As she prepares to close out her med-school years, Gangopadhyay brings with her not only the textbook and O.R. knowledge, but also the wisdom of her elders. “A few of my surgeon mentors have said, ‘As tired as you are after coming back from the O.R., and when you just don’t want to do anything, just sit down and make sure you read for 30 minutes to an hour every night, just on the things you’ve seen that day or things you’re supposed to expect to see tomorrow.’ Additionally, one of my medicine physicians would often tell me to stay calm and to just count to 10 when I want to respond to a patient in a way that maybe is not appropriate. Patients have very human emotions. Something a patient says may make you enraged or upset, but they’re coming to you for a service, so you have to be professional at all times.”
For her part Gangopadhyay is ready to have the M.D. behind her name. She’s eager to apply both her classroom and clinical experience to patient care—and to finally be the one in charge. “When you’re in medical school and in residency, it’s nice that you have someone supervising what you’re doing and looking over your shoulder,” she says. “I don’t think you’re truly independent in your actions until you become an attending physician. It’s the endpoint. We’ve been looking forward to going to medical school, to going to residency for probably 15 to 20 years, depending on how early in life you decided you wanted to go into medicine. It’s nice to be able to achieve that goal.”
t’s been 50 years since Dr. Eli Shuter graduated from Cornell University and first entered Washington University’s medical school. The motivations at that time were not unlike those Gangopadhyay and her peers experienced. “Everyone was interested in the service aspect—providing a necessary service,” he says, stroking Heidi the cat in the sunroom of his St. Louis home. “I’m sure that there were many who had a financial motivation also. And of course, there were a number of medical students who were interested in research rather than practice, both because of an interest and because they felt that was a way they could be of service to humanity. My own motivation was initially to do scientific research, specifically in psychiatry. Over time, that changed to neurology. Both dealt with the nervous system and human behavior and function.”
Shuter recalls his first two years of medical school as being primarily classroom and laboratory work, “including gross anatomy, in which we paired off and two of us shared a cadaver.” The second year brought the study of diseases, as well as an introduction to clinical diagnoses and physical examination. “We started out examining one another,” he recalls, “and then they turned us loose to go into the hospital.”
More practical experience came in the second half of Dr. Shuter’s medical education, in the form of clerkships. Over the course of three- to six-week intervals, “the medical students would be assigned services in the hospital, such as surgery or obstetrics and gynecology, and the medical students would usually be the first ones to interview and examine patients.”
The time for Shuter to have patients of his own was fast approaching. He graduated from the medical school in 1960, interning at New York Hospital, Massachusetts General Hospital and Cleveland Metropolitan General Hospital. Over the course of his career, he served as an attending neurologist at Saint Louis University Hospitals and Christian Hospital Northeast-Northwest, as an assistant professor of clinical neurology at both SLU and Wash. U., and as a doctor in private practice.
The days were long, and working with patients suffering from dire illnesses proved difficult. “The most serious challenge,” he says, “was taking care of the severely ill patients with life-threatening illnesses, such as severe cases of meningitis and severe strokes.”
Over the course of decades, Shuter dealt not only with patients, but also with the changing landscape of medicine itself. One issue of increasing concern for Shuter has been the “financial pressure physicians are under,” specifically the rates maintained by insurance companies. “This puts tremendous pressure on physicians to raise their payments,” he says, “and this does not match the increase in personal expense. So physicians are having to work longer and longer hours and see more and more patients—which I don’t think is good for physicians.” On the malpractice issue, Shuter’s philosophy was a simple one. “My attitude was, the defense for malpractice suits was to practice good medicine,” he says. “If you practiced good medicine and took care of your patients, you would not be guilty of malpractice.”
One development that Shuter welcomed was the initiative taken by his patients in the early days of the Internet to learn more about their illnesses online. “I found that the patients who were using it would research their diseases themselves, using sites set up for patients,” he says. “They would bring me articles they had pulled from the Web, and that gave them questions to ask about the disease. I didn’t object to that. I think it makes the patients much more aware of the disease.”
Shuter, who retired from his practice in 2000, is part of a generation of doctors who lived and worked within the newer and older worlds of medicine. Yes, he’s online, but—unlike Gangopadhyay’s class of 2008—he made occasional house calls. “Whether doctors of another generation will do that, I dont know,” Shuter says. “I could never figure out what it is worth, so the fee was a piece of pie and a cup of coffee. That’s what I charged."
