The Pact

by Sampson Davis

  One of the best things I did for myself was to seek counseling from advisers I had come to trust, mainly Carla Dickson and Geoffrey Young, Assistant Dean of Student Affairs on the Piscataway campus of Robert Wood Johnson. I didn’t tell Rameck or George.

  I needed to understand why I had failed and what I was supposed to learn from it. I also sought to understand my purpose in medicine. I had reached that point in life where I asked: What is my purpose? What role do I play? Where do I belong?

  My counselors suggested that I find a way to relieve some of the stress. I began meditating each morning the way Reggie had taught me during kung fu lessons a decade earlier, and I worked out during my lunch break. I came to understand that I had defeated myself mentally even before I took the exam. In my mind, the exam had become insurmountable.

  I had to change my thoughts.

  During meditation, I reminded myself that I was smart enough to pass this exam, and I tried to regain my inner peace. I focused on clearing my mind, just relaxing and focusing on the rewards that life had brought me thus far. I wasn’t happy, but I had to make the best of the situation.

  When test time rolled around again, I went to bed early the night before. On the morning of the test, I tried to stay calm.

  “I can do this,” I kept repeating in my head.

  Answers to the test questions flowed more freely. Before I was even halfway done, I knew I would pass.

  When I went to Dr. Mehne’s office to get the results this time, his smile told me what I wanted to hear: I had passed.

  Thank God, I could move on.

  I resumed my clinical rotations, but the feeling of sheer elation didn’t last long. I continued to feel out of place, especially when my peers talked about the invitations they received to play golf with residents at the hospital or to have dinner at the home of the head doctor. I was never included.

  But no matter how uncertain I felt about becoming a doctor, I knew that returning home to my old life was not an option. Seeing an old friend again one day reminded me of that.

  It was summertime, and I was visiting my mother at home. Whenever my old friends saw my car parked outside, they would stand in front of my house underneath my bedroom window and yell, “Yo, Marshall,” until I came out. Every day, I walked over to the projects to visit Will, Noody, and my other friends. There one day I encountered one of the guys who had participated with me in the robbery. At fifteen, he had been the youngest in the group. When I saw him again, he was in his early twenties and had just been released from jail after serving time for another crime.

  We hugged each other the way guys do.

  “Man, I ain’t seen you in a long time,” he began. “You don’t stay down here no more, huh?”

  “Naw, man, I just been doing this school thing,” I said.

  “How long you did?” he asked.

  He figured I was still out there banging and had spent some time in jail. In our neighborhood, you don’t just walk away from the streets. You keep hustling until you either get too old or too sick, or until you get knocked.

  “C’mon man, that ain’t me,” I responded, trying to be vague.

  Staying vague kept them guessing and protected you.

  “Well, hey, don’t get caught out here. Let’s get together and catch up.”

  “Cool,” I said.

  He wished me well, and we parted ways. We never got together, and I knew we never would. I had become a different person. Seeing my old friend again reminded me of just how much my life had changed.

  I spent my third year working eight-week rotations in pediatrics, surgery, psychiatry, internal medicine, family practice, and obstetrics/gynecology at Cooper Hospital. As students, we mostly shadowed residents, and the head doctor lectured us once a week.

  I made High Passes in most of my courses in my third year and passed the second state board exam the following summer with no problems. My academic performance was just as good in my fourth year.

  During the fourth year, each medical student got to choose an area of specialty and work a rotation either at Cooper Hospital, which is next to the Camden branch of the medical school, or out of town. I decided to give it a go at another hospital. The six disciplines I had studied in my third year had not intrigued me, but I wanted to try emergency medicine. I chose Hahnemann Medical College of Philadelphia. I had heard that it had a good training program in the field, and I figured I could gather the practical experience to determine whether I wanted to pursue emergency medicine.

  I drove forty minutes each way daily for two weeks that summer to a small community hospital affiliated with the university. The head doctor, Dr. Carol Hart, made me feel like part of the emergency-room team, as we evaluated patients and determined the appropriate treatments. This was the first time in all four years of medical school that something had felt right to me.

  Rameck and I decided to go together to Atlanta to explore the program at Emory University. One of our friends, Jerry Filmore, had done a rotation the year before and was now a first-year resident in emergency medicine. The two of us were stationed for four weeks at Grady Hospital, a large medical center that serves mostly city-dwellers. We stayed in an apartment building owned by the hospital. I worked in the emergency room, and Rameck worked in gastrointestinal medicine. The size of the hospital alone was intimidating, but I caught on to the fast-paced rhythm pretty quickly. I liked the variety of problems we treated—from simple muscle strains to heart attacks; from minor lacerations to gunshot wounds. The work required an ability to think quickly in developing strategies for medical treatments and interventions, and I excelled at that. I’ve always been good working with my hands. This was what I had been waiting for.

  When the time came to apply for a residency, I decided to pursue emergency medicine. But I started the process late because I was still trying to decide whether that was truly what I wanted to do. About 16,000 medical students throughout the country apply for residencies each year through the Washington, D.C.–based National Resident Matching Program, which uses a computerized database to match students with teaching hospitals. Students do research to find hospitals with their specialties, apply for those positions, and then rank their top choices in the computerized database. In the end, the hospitals list their student choices in the database, and the computer sorts the matches. During an annual event called Match Day, medical students throughout the country learn simultaneously where they will spend the next years as a resident.

  An Internet Web site helped me identify the hospitals that had slots in emergency medicine, and I applied to about forty of them. I was invited for interviews at hospitals in New York, Chicago, Baltimore, Atlanta, and Cleveland and spent at least $2,000 traveling to those cities.

  But I didn’t realize that emergency medicine was so competitive.

  Two days before Match Day, the dean called me into his office for more bad news: I had not matched in emergency medicine. None of my top choices of hospitals had listed me among their top choices of students. The dean gave me a list of hospitals that still had residency positions available in various disciplines. Most of my classmates had matched at hospitals on their lists and would find out on Match Day where they would be going. But along with other students who had not matched, I spent an entire day on the telephone scrambling to find a position.

  I knew Rameck had listed the University of Maryland as his first or second choice and Robert Wood Johnson Hospital as the other. He had kept changing the order of his top two picks until the deadline arrived for submitting our lists. The University of Maryland still had a residency slot available, but the position was in internal medicine. I called, and the resident coordinator asked me to submit my application via the computer. The program there was reputable, but I had no interest in internal medicine. Time was running out, though. If I didn’t find a slot, I would have to wait another year to reapply.

  The day before Match Day, I was offered the slot at the University of Maryland.

  Just befor
e noon on March 18, 1999, I met with my peers in a lecture hall at the hospital for the Match Day ceremony. Dozens of bottles of champagne were lined up across the stage. Each student was handed a sealed envelope bearing the code that the computer had used to match us. At exactly noon, the dean instructed us to open our envelopes. Medical students across the country were opening their envelopes at the same time.

  Rameck and I ripped open our envelopes. He had matched at his top choice, Robert Wood Johnson Hospital. I was happy for him, but disappointed. I already knew what was inside my envelope. Since Rameck wouldn’t be going to the University of Maryland, I would have to go there alone.

  The room quickly filled with shrieks of excitement. My peers hugged one another and rushed around the room to find out where their colleagues had matched. I stood back and observed quietly. I was in no mood to celebrate. I again felt disappointed. I had no idea—and still don’t—why I hadn’t matched in emergency medicine. I had the grades. Maybe I had begun the process too late, or maybe it was my lack of comfort during interviews at the hospitals. All I knew was that the match process, like everything else in medical school, had come as a surprise.

  I had heard about it for the first time just before it was time for me to go through it. No one had ever sat me down and explained step by step what to expect in medical school. I was always finding out about courses and events the day of the deadline or just days before, which left little time to develop a strategy for success or even to prepare myself mentally.

  I signed a letter of intent, committing myself as a resident at the University of Maryland. I knew immediately that I had made a big mistake.

  I was tired of fighting.

  I couldn’t understand why everything had been such a struggle for me. I told myself that I had fulfilled the pact. I had finished college and was near completing medical school with George and Rameck. But graduation would be the end of this road for me. I had never promised my friends that I would actually practice medicine. Maybe I would be happier doing something else. After trying so hard and giving so much, I at least deserved to be happy.

  Business still interested me, so I thought that perhaps I could use my medical background to find a position with a medical insurance company or health maintenance organization. I also considered enrolling in business school to earn an MBA. I called the Wharton School of Business in Philadelphia and requested an application. I wasn’t sure how George and Rameck would react, so I decided not to tell them right away.

  I did, however, tell a friend from college named Patrick, who lived in South Jersey, and he said that his mother—the chief executive officer of a drug rehabilitation center in Atlantic City—might be able to help. I called her, and she promised to put me in touch with the head of a Preferred Physicians Organization there. The next time I talked to her, she had arranged an interview for me in Atlantic City.

  I drove forty-five minutes to Atlantic City, and the two of us had lunch with the PPO executive. It didn’t take them long to figure out that I was suffering from burnout. The executive showed me around his company, but both he and my friend’s mother tried to encourage me to go ahead with my residency. They said it would be a mistake to quit before getting a feel for what medicine was really like.

  I spent one day in Atlantic City. Before I left, the executive offered me a job as a billing manager making about $30,000 a year, a position I think he knew that I would turn down. Still, I wasn’t persuaded to take a residency that I did not want.

  In April, just weeks before graduation, I called Carla Dickson.

  I met her at a restaurant in South Orange for lunch one spring afternoon. After lunch, we went to a park and sat on a bench to talk. She knew what I had gone through in medical school. This was it, I told her. I was done with medicine. The sadness in my eyes told her that I was serious. For the first time, she didn’t have an answer.

  After a few seconds, she said: “If you don’t want to go to the University of Maryland, just call the representative and tell her you’re not coming.”

  “But is that the right thing to do?” I asked.

  I was afraid to back out of the University of Maryland position because I had signed the letter of intent. The match process is practically as binding as the NBA draft. It was almost unheard of to back out of a match after signing a letter of intent. When I had complained about not wanting to go, my professors and colleagues had warned me not to change my mind. It could wreck my career, they said. And further, I could be held legally liable.

  But what Carla said next brought clarity.

  “This is your life, Sam,” she said. “You have to do what’s best for Sam. What does Sam really want to do?”

  I knew then I was not going to take the slot in Maryland.

  But there was still a part of me that didn’t want to give up on emergency medicine, a part of me that didn’t want to be defeated. The next week, I decided to search the Internet to find out how many emergency-medicine programs there were in New Jersey. I was shocked by what I found. Beth Israel Hospital in Newark had a program in emergency medicine. The hospital hadn’t been listed among the programs I’d found when I did my initial computer search before the match process. The computer was now showing that all of the hospital’s resident positions had been filled. I decided to take a long shot and call the hospital anyway.

  I took a deep breath, picked up the telephone, and called Jacquie Johnson, the resident coordinator there. I hit the lottery. She said the hospital had expanded its residency slots that year and had not filled all of them. She asked me to send my application. A few days later, I was invited to the hospital for an interview.

  I can’t describe how comfortable I felt when I walked through those doors. I felt immediately that I was home; that I was where I belonged. I reminded myself to stay calm and answer the interview questions from my heart. I felt surprisingly at ease and connected to the doctors interviewing me. When the interview was finished, I knew things had gone well.

  I was invited for a second interview. Then the resident director called and offered me the slot. I wanted to accept right away, but first I had to notify the University of Maryland that I wouldn’t be coming. I still anguished over making that telephone call and had kept putting it off.

  Finally, I called. I explained that my heart was set on working in emergency medicine and that I would not be happy there. I shared how difficult the decision to back out of the agreement had been for me. When I finished talking, I expected the worst, maybe even the threat of a lawsuit. Instead, the woman on the other end was understanding. She said the university didn’t want me there if I wouldn’t be happy, and she wished me well.

  The fear and frustration I had felt for weeks slid off my shoulders. Something mystical—I believe the power of God—was at work here. I was about to return as a doctor to the same hospital where I was born.

  I was going back home.

  Sam on

  PERSEVERANCE

  Medical school was one of the roughest periods of my life. Something unexpected was always threatening to knock me out of the game: family distractions, the results of my first state board exam, the outcome of my initial search for a residency. But through determination, discipline, and dedication, I was able to persevere.

  I call them my three D’s, and I believe that they are the perfect formula for survival, no matter what you are going through.

  Determination is simply fixing your mind on a desired outcome, and I believe it is the first step to a successful end in practically any situation. When I made the pact with George and Rameck at the age of seventeen, I was desperate to change my life. Going to college and medical school with my friends seemed the best way to make that happen.

  But, of course, I had no idea of the challenges awaiting me, and many times over the years I felt like giving up. Trust me, even if you’re the most dedicated person, you can get weary when setbacks halt or interfere with your progress. But determination means nothing without the discipline to go throug
h the steps necessary to reach your goal—whether you’re trying to lose weight or finish college—and the dedication to stick with it.

  When I failed the state board exam, the light in the tunnel disappeared. But I just kept crawling toward my goal. I sought counseling when I needed it, and I found at least one person with whom I could share the range of emotions I was experiencing. If you’re going through a difficult time and can’t see your way out alone, you should consider asking for help. I know how difficult that is for most guys. We’re raised to believe that it’s a sign of weakness even to display emotions, let alone ask for help. But reaching out to counselors I had come to trust over the years and talking to my roommate Camille helped me unload some of the weight I was carrying. Only then was I able to focus clearly on what I needed to do to change my circumstances.

  I’m grateful that I took kung fu lessons as a kid, because the discipline I learned back then really helped me to stay consistent once I started meditating, working out, and studying every single day. It wasn’t easy, but those were the steps required to get where I wanted to be. Concentrating on getting through each day kept me from feeling overwhelmed. And reflection helped me to see that I had overcome tremendous barriers. In the beginning, during a trying adolescence, I’d felt like I was a good kid caught up in a bad situation and truly had to work diligently to overcome obstacles. You can’t choose the circumstances that you’re born in. However, you can use your insight and hunger to push forward. Life’s challenges helped me to maintain my focus and remain humble.

  Family matters—my brother’s injury, my sister’s diagnosis, my mother’s financial struggles back home—sometimes competed for my full attention. There is no one-size-fits-all way to handle family issues. Everybody’s family and circumstances are different. But I realized that to remain focused on my goal I couldn’t focus so much on my family, especially when the energy I expended worrying about them didn’t change a thing.