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Rio de Janeiro

7

When I arrived in Rio de Janeiro’s Antônio Carlos Jobim International Airport (three-letter symbol: GIG, obviously), it had more of the feel of the tiny Treviso airport (trip to Croatia, Summer 2003) than one serving a city of 8 million. João was holding up a card with my name in the small receiving area — let the royal treatment begin! — and directed me towards my cab. I found it heartening that a country would name one of its biggest airports after a composer — namely, “Tom” Jobim, the man who wrote the lilting tones of The Girl from Ipanema (in Portuguese: A Garota de Ipanema). Can you imagine an American airport being named after Irving Berlin or Aaron Copland instead of some dead president? Ladies and gentlemen — I had officially arrived in a place that was Different.

There are shiny airports, and then there are not-so-shiny airports. Airports tend to reflect the rest of the city. JFK is marginally shiny. LAX is shiny. Amsterdam’s Schiphol is way shiny. Heathrow is gleaming. GIG is not shiny. And Rio itself is great, but shiny it is not. In fact, I got a feeling that it disdained shininess.

The drive through Rio immediately reminded me of Tehran, another vast metropolis with upwards of 8 million people, lots of culture, and great disparities in wealth (the absence of half-naked people running through the streets at all hours is a subtle difference between the two cities). As we drove towards our condominium in Ipanema — about as far from the airport and downtown area as you can get — we went through the favelas, the slums made famous by movies like City of God (Cidade de Deus). I had imagined these shantytowns to be made of makeshift plywood and barrels, plastic sheeting and corrugated aluminum. But from where I sat, it seemed like they were all solid structures with running water and electricity — a cheaper alternative to city living, apparently with its own alternative druglord government (NB: Apparently the slums do get quite decrepit and nasty, but I have no firsthand reports). We went over bridges crusted with rust, through tunnels greeting us with a smudge of fine soot. Kind of like Boston or New York, South American style. Of course, it thrilled me to no end that that the tundra that is Boston and New York in February was over 7700 km (4800 mi) away.

Rome’s nickname is La Città Eterna. Paris is La Ville Lumière, Los Angeles is the City of Angels (all in hiding, apparently), and Rio de Janeiro is A Cidade Maravilhosa, which I translate as The Wondrous City, since ‘marvelous’ (like ‘awesome’) has lost some of its zing in English. The title of world’s most beautiful city will probably go to some other place, but Rio de Janeiro — pronounced HEE-oo juh zhan-AY-roo by the locals (Cariocas) — is blessed with much natural beauty, and is certainly full of marvels and wonders.

Baile de Copa
The word ‘carnival’ (and its Romance cognates, carnevale and carnaval) has its origins in the Italian word carnelevare — literally, the lifting or removal of meat. So the idea is basically, “Hey guys, this total buzzkill Lent thing is coming around the corner — no meat, no wine, no harlots for a while. So let’s party our asses off, like, now.” And that is precisely what the Brazilian nation does for a good month and a half preceding Lent.

In Rio, as part of the run-up to the Samba Parades, there are a series of pre-Carnaval balls. The most lavish of those is the Baile de Copa, held at the Copacabana Palace, which is either Rio’s most expensive or most famous hotel or both. By the suggestion of my friend Shane, I had plunked down for the not-insignificant ticket price (which, incidentally, was about twice what I had paid for Burning Man and the Corpus Christi May Ball at Cambridge, the two previous record-holders), since this was apparently The Place To Be in Rio During Carnaval Season. We fretted over our costumes — this year’s theme was ‘Carmen’, so we had to go Spanish-style — and after much diligent research by Shane and Phil happened upon a professional costume store on the day of the ball. The lady who owned the store was very experienced at her craft and sweet as sweet can be. She decked us out in the requisite garb: two Spanish noblemen circa 1850 and one flashy torero were now ready for the ball.

Until we got there, that is. This was much bigger than we had imagined. The rumors about all the Brazilian bigwigs being present must have been true, since there was an Oscars-style crowd of hollering fans ten-deep lining the fence that ran along the 80 yards of red carpet leading to the ball entrance. Since there weren’t any celebrities detectable to our gringo eyes, we just assumied that they must have been there for us. And maybe for Quincy Jones, too, the legendary music producer, who was just in front of us in line. I was shocked, shocked that he didn’t recognize me, but we shook hands and had a brief but pleasant exchange about the geopolitical climate in the Middle East, neo-imperialism, the recent proof of the Poincaré conjecture, the physics of iridescence in the genus Morpho butterfly, and how preposterously hot his daughters are. He really liked that part.

Red Carpet
The red carpet at the Copacabana Palace

For better or for worse, the ball was indeed for Brazil’s upper crust, which meant that it wasn’t nearly as fun as an impromptu bloco party on the street. Sure, there was a samba band that would suddenly appear at the uber-sumptuous buffet and get everybody moving while noshing on blinis and oysters. There was unlimited free booze all night long, contortionists contorting and half-naked, buff dancers dancing flamenco and samba. But the median age was high and the zaniness subdued. I met some lovely people from Australia, London and Belgium, I did get a kick out of one of our companions’ having a dance with a striking individual of indeterminate gender (there are many, many of those in Rio for some reason), for which he will receive our eternal ribbing, hallelujah and amen. But we know that the height of the festivities would come some other time.

Impromptu samba
Impromptu dinnertime flamenco attack - note buffet in background
Girl -- or Un-Girl?
Girl — or Un-Girl? If you have to ask…

Life at the top of the food chain
Brazilian cuisine is relatively simple, composed of the starch and meat that the land provides in abundance. The classic dish is the feijoada, a stew made of vegetables, pig parts, sausage, what could be pig parts but you’ll never know for sure, and whatever’s left over in the kitchen from Tuesday night (it’s a traditional dish for Wednesday and Friday lunch, apparently). I passed on the two opportunities I had to sample the inchoate brown concoction due to the multiple UFOs (unidentifiable foodlike objects) in it.

However, I did partake of another authentic Brazilian food experience — the churrascaria. This type of restaurante (pronounced hest-ow-RUN-chee, the ultimate pronunciation test of Brazilian Portuguese) involves bringing a succession of yard-long skewers of grilled meat to your table, of which you can then accept or decline a juicy, dripping portion. The particular churrascaria we went to in Ipanema was a rodizio (prix fixe) place called Porcão — rather appropriately, a homonym for ‘poor cow’ and a near-homonym for ‘pork out’, which is exactly what we did.

The word itself means ‘big pig’, the aggrandizing -ão suffix in Portuguese being the equivalent of -one in Italian (e.g. porcone) or -on in French. The smiling Porcão mascot kept us company in the form of the initially cryptic coasters they had at the table with one side saying “Não obrigado” (no thanks) and the other saying “Sim por favor” (yes please!). The restaurant had a sumptuous all-you-can-eat buffet which all by itself would be more than sufficient to sate any bear: jumping-fresh sashimi and sushi, ceviche, oysters, salads, beets, hearts of palm, to name a few of the choices.

Of course, the mainstay of the Porcão experience is the skewered meat. Now, normally I don’t eat red meat at all, and since reading The Omnivore’s Dilemma by Michael Pollan, I’ve cut down on my intake of chicken and pork as well (you would, too — read the book). However, not eating red meat at Porcão would be akin to not taking the wafer at the Vatican Christmas Mass, or refusing ale at a London pub — a sacrilegious act. So I took the plunge and sampled nearly every cut of meat brought to us: flank; cheese-sprinkled flank; rump; sirloin; top sirloin; pork chops; suckling pig; chicken; cornish hen; baby back ribs; not-so-baby back ribs; chicken hearts; and a slice from that hump that some kinds of cows have on their backs. The nattily dressed waiters would come with the giant skewers and a very serious knife, announce the name of the cut, and proceed to slice off a sample and put it on your plate before you had a chance to refuse.

To this part-time carnivore, most of these cuts didn’t mean much to me. Luckily, I was sharing the meal with my travel companion Shane. Not only is he from Kansas City, where they take their steak very seriously, but his family has been in the cattle business for years. His uncle’s a butcher and his brother’s a cowboy. As such, he was eminently qualified to explain the subtleties of rump vs. flank vs. sirloin, “butcher’s cuts” (the less choice parts of the cow left over for the butcher to bring home), and the joys of eating one’s steak rare enough to hear the cow moo (”that’s when it’s got the most flavor”).

I must admit that as much as the dripping red meat did not appeal to my palate — way too chewy, for one thing — I did feel an atavistic draw to it. There’s something very elemental about biting into a hunk of cow on a skewer which appeals to that archaic part of the brain that knows that on the savannah, protein, fat and especially iron are rare commodities and should be reverentially consumed whenever found, so chow down that brown cow right now.

At some point I also became aware that these renamed and euphemized ‘cuts’ represented pieces of once-living animals. As one vegetarian friend of mine said, “all meat contains the energy of suffering.” He may have a point. At the same time, I take issue with fad diets like the raw food movement and veganism which seem to deny that, as omnivores, we have both incisors and molars, and that all animal life is sustained by consuming other life. And even if we only consumed plants, who’s to say they don’t have feelings, too? I discussed this briefly in the ‘Penguins’ post below, so if you already read the Kahlil Gibran quote from The Prophet there, you can skip over this iteration:

Would that you could live on the fragrance of the earth, and like an air plant be sustained by the light.
But since you must kill to eat, and rob the young of its mother’s milk to quench your thirst, let it then be an act of worship,
And let your board stand an altar on which the pure and the innocent of forest and plain are sacrificed for that which is purer and still more innocent in many.
When you kill a beast say to him in your heart,
“By the same power that slays you, I to am slain; and I too shall be consumed.
For the law that delivered you into my hand shall deliver me into a mightier hand.
Your blood and my blood is naught but the sap that feeds the tree of heaven.”

I do have a beef with beef, though. Corn-fed beef, specifically — 95+% of the beef sold in the US — is raised under inhumane, unsustainable and just plain unhealthy circumstances, as Michael Pollan makes clear in his book. You would do well to avoid it altogether for your own health and that of the greater ecosystem. Without getting into it too much, the cow’s rumen is a miraculous machine for turning grass into meat. However, it’s not designed for digesting corn at all, which is what the unsanitary factory farms feed the cows (in addition to fat supplements that come from the slaughterhouse — cow cannibalism at its worst). Corn acidifies the rumen to the point that it can ulcer and puncture, resulting in digestive tract bacteria getting into the cow’s bloodstream, necessitating large doses of antibiotics which eventually get into our bodies and help to breed resistant super-bacteria. Bad news. So — don’t eat corn-fed beef. Grass-fed is much more humane, healthier, and tastier to boot.

But back to the hestow runchee. Even though I did not consume the beefiest of the beef cuts, I did tally up a good number of members of kingdom Animalia in that one meal. In order of disappearance, they were: oyster, salmon, tuna, yellowtail, whitefish, some tasty nameless Amazonian fish, chicken, sheep, poor cow, and porcão.

On the way out, not ten paces from the restaurant, Rio reality hits you in the face again: a man of withered legs, no more than three feet tall, sleeping on the sidewalk with no earthly possessions in evidence other than the skateboard he scoots around on, which he is now using as a pillow. And a block away, a mother with two small children, trying to sell gum and candy. One night that I was locked out of the apartment, I wandered around my supposedly affluent neigbhorhood in Ipanema in the wee hours of the morn, and was struck by the number of people sleeping on the street: on chairs propped up against a storefront; at a bus stop; or just right on the sidewalk, with no covering and no piece of cushioning matter to intervene between soft body and hard ground. Moral outrage, especially directed towards oneself, is easy to summon in situations like these. But perhaps empathy and acceptance are even more empowering. As Lao Tzu said in Chapter 29 of the Tao Te Ching:

Do you want to improve the world?
I don’t think it can be done.

The world is sacred.
It can’t be improved.
If you tamper with it, you’ll ruin it.
If you treat it like an object, you’ll lose it.

There is a time for being ahead,
A time for being behind;
A time for being in motion,
A time for being at rest;
A time for being vigorous,
A time for being exhausted;
A time for being safe,
A time for being in danger.

The Master sees things as they are,
without trying to control them.
She lets them go their own way,
and resides at the center of the circle.

Formula 1 Cab Driving
Had anything prepared me for taking a ride in a Rio cab? Living in Tehran for over a decade was an adequate prelude, but the Carioca cabbies take urban driving to the next level. It doesn’t surprise me that legendary drivers like Nelson Piquet, Emerson Fittipaldi and Ayrton Senna are all Brazilian. For all I know, they must have cultivated their daring and utter fearlessness (tragic in the case of Senna) as cabbies on the streets of Rio.

There are some cities in which the lane markings have the status of a virtual wall. An unexpected or unannounced venture beyond the dotted line will very quickly earn you a disapproving honk in Los Angeles. In Boston, on the other hand, it’s more or less accepted that the lane markings serve as suggestion more than edict. In Rio, the markings pass from the realm of suggestion to mere decoration. The cab that brought us home from the airport straddled a lane line for about half the trip. He also demonstrated proper passing protocol inside a tunnel: get within inches of the bumper of the front car, flash your high beams repeatedly, then rapidly swerve left or right when you get a hint of an opening — and floor it, baby. Tudo bem.

That was in the daytime. My first night-time cab ride brought me another surprise: after sundown, stopping at red lights is entirely optional. In fact, if you do stop at a red light, you’ll get vicious honks from the road behind you. The guidebooks say that cars don’t stop at red lights at night because of the danger of carjacking and other crimes, and apparently there’s a lot of truth to that. But running red lights just seemed too consonant with the Carioca lazy-faire (ha!) spirit to have any reason beyond that. After the initial horror of your cabbie’s blowing through a dozen red lights at 100km/h, you get used to it, and start to think of it more as a blessing than a curse. After all, wouldn’t you love to be able to do that at home?

With Formula 1-style driving practiced by everyone on the road, optional traffic lights , and oblivious or suicidal pedestrians, you would think that there would be traffic massacres on Rio roads daily. Not so. During our 2 weeks there, we saw only one accident, and it wasn’t at an intersection.

There were also scary stories circulating: street gangs holding up buses at gunpoint and torching them with innocent passengers inside. Taxis in cahoots with the local police stopping at checkpoints where the cops ‘found’ drugs in the car, then shook you down for all the reais you had. Luckily, none of these things happened to us or anyone we know. As with any big city, Rio has nice places and not-so-nice places, and we tended to keep to the tried-and-true.

The Sambodromo
Carnaval in Rio is a Big Deal. There are 14 or so samba schools — which aren’t really schools but more like social organizations — that spend the better part of the year preparing for their big parade through the Sambodromo. And what is the Sambodromo, pray tell? Basically, if you took a gigantic stadium, snipped it in the middle and stretched it out, you’d get the Sambodromo (sam-BOH-dro-moo). It’s about a kilometer long and holds 100,000 singing, dancing, shouting spectators who are there to see the samba schools parade through.

And one hell of a parade it is. Each samba school has a theme, with 10-15 outrageous, over-the-top floats along the lines of that theme, and about 5000 dancers in indescribably complex feathered, mirrored, sequined and jewelled costumes. I’ll append some photos so you get a sense of what I’m talking about. Each school has 80min to get through the Sambodromo, so at the slow walking pace of 0.5-1m/s that the parade is moving, this makes each Samba school’s contingent about 2-4km (1.3-2.5miles) long. I told you it was a big parade.

My companions and I had arranged to participate in the parade of one of the more popular samba schools, Mangueira (literally, mango tree). The only way I can describe what I was wearing was Christopher Columbus meets Carmen Miranda crossed with a pineapple — gold brocade top, sheer breeches for the bottom, gold shoes, pink socks, big sash, green feather collar, fake-fruit handheld thing (never figured that one out), and 1-meter high lime-green feather headdress. The material was designed specifically to be unbreathable — some sort of bulletproof polyester, no doubt essential for the hazards of parading — which added an extra dimension of challenge to the endeavor: not to collapse of dehydration or heatstroke halfway through the 80min of dancing through the Sambodromo.

The theme for Mangueira was the mysteries of the Portuguese language and the origins of Brazil. We got ourselves to the pre-parade staging area at around 10.30pm for our 11.10pm start time, thinking we were mortally tardy, since the concept of ‘Rio time’ had not fully sunk into our consciousness yet. By the time we found our fellow Columbus Miranda pineapples, we had plenty of time to change, line up and meet the rest of the troops. Amongst the other travelers who had plunked down for the parade participation experience, there was a large Japanese contingent (perhaps related to Brazil’s having a large Japanese immigrant population). We were gratified by their preparedness, since they all had copies of the Mangeuira song, which we would all be singing about 3,578.4 times over the course of the 80min parade. My buddy and I crammed it and learned the first verse so as not to be completely left out. It goes something like this:

Vem no vira da Manguiera, vem sambar,
Meu idioma ten o dom de transformar
Faz no Palacio do Samba uma casa portuguesa
E uma casa portuguesa com certeza.

Which means something like this:

Come to the way of Mangueira, come samba,
My language has the power to transform,
Make in the Samba Palace a Portuguese house,
It is a Portuguese house for sure!

One fruity outfit
It may be a fruity outfit, but at least nobody saw me wearing it

12.30am rolls around (i.e. 11.00pm Rio Mean Time), and finally it’s our turn to boogie our way into the Sambodromo behind the monstrous float of men in authentic Native American garb (translation: basically naked) straight out of the movie Apocalypto, riding a dozen hobbyhorses. We dance as best we can under the conditions, remembering the crucial turn to the left (or was it to the right?) at the beginning of the song, and checking out the denizens of the various real estate in the Sambodromo. Even to the untrained eye, a class system was at work here: at the top of the Sambodromo were the private boxes very close to the parade, full of good-looking people and sponsorship ads. As you went along, the route widened, and it was more stadium-style seating. This is where we ended up after finishing the parade and disposing of our costumes.

Click here to see clip from Sambodromo Parade, Rio de Janeiro, Feb 2007

Not that our seats were cheap. We each plunked down $130 to be in the scrub section, which makes you wonder how much those celebrity boxes must have cost. This brings us to the whole question of the socioeconomics of Carnaval. The samba schools are all based in the favelas — the slums of Rio. As such, all of the floats, all the dancers, everything comes from the favela. Now when you look at the floats, you can tell that someone put a lot of time, effort and money into them. Ditto for the costumes (which from firsthand experience I can tell you are not free). The capital from this grand endeavor comes from three sources: government funding; bucks from adventurous gringos like yours truly and the Japanese crew (who typically pay even more); and the drug trade.

As a result, it made sense why many of the Brazilians we met were from other cities. A large part of the population of Rio escapes during Carnaval time, partially to avoid the mayhem and principally to avoid rubbing shoulders with the unwashed masses. Carnaval is a big coming-out party for the favelas, and one of the only times when the classes mix. In a society with a wealth distribution even more asymmetric than that of the United States, this is a big deal.

Let’s also put the price of the Sambodromo ticket in perspective. At $130, the ticket represents about 4% of the $3340 per capita income of a Brazilian (according to The Economist Pocket World in Figures, 2007 Edition). For an American with a $39,430 annual per capita income, this would be like paying $1500 for a ticket. So I conclude that if the Sambodromo is packed to the gills with the common folk, it must mean a heck of a lot to them.

So after taking our expensive scrub stand seats, we settled in to watch the remaining samba schools and their awe-inspiring floats and costumes. The lady with the fireworks shooting out of her skirt was particularly memorable, as were the Star Wars float with the Stormtroopers and R2-D2s, “Where’s Waldo?” (”Where’s Wally?” for the rest of the world), and the painting of Adam coming alive and his jumping out of a gigantic Book of Creation. Neato.

Sambodromo float

By 4.30am, we were all floated out, bedazzled by the artistry and over-the-topness beyond mortal capacity (the party would go on without us to a full stadium until 8am). So we left the Sambodromo and hunted down a cab home — no mean feat — only to run into a big street party and concert in Lapa, in the heart of old Rio. You only live once, so we disembarked, got our second wind and kept it up till dawn, when a new band was just about to come on stage and the capoeira dancers, lithe and sweaty, were still practicing their craft. Only in Rio.

A day in Ipanema
I like açai (pronounced a-sa-EE). It’s like a supercharged Brazilian blueberry. Every morning — or more accurately, early afternoon — when we dragged our carousing butts out of bed, we would mosey down to the suco (juice) joint a block from the beach — trickily named Beach Suco — and pound down our morning fuel. This consisted of a rotating cast of juices — tangerine, pineapple, and kiwi so alive it bit you — and Brazilian-style dumplings. But açai was always the star. The juice is so thick that you need to eat it with a spoon, and supposedly it is the most potent antioxidant food known to man. After a half-liter cup of the stuff, you are pretty much immortal, not to mention rustproof. Not a spot of rust on my person on this entire trip, so I must say it works.

If we weren’t on a tourist mission in the daytime, the default setting was to amble over to Posto 9 on Ipanema Beach. The hallmark of the Ipanema beach experience was thus: thou shalt not go unaccosted for more than 60 seconds at a time. In that way, it was a microcosm of our entire Carnaval experience. A procession of enterprising folk come to sell you soda, cold beer, knick-knacks, temporary tattoos, those godawful Globo snacks which I never did dare try, grilled corn on the cob (yum), and caipirinhas that the guidebooks warn against unless you are a fan of acute gastric distress, which is not cute at all. During our minute-long hiatuses, we would watch the most impressive array of rippling, active bodies I have ever seen — yes, even more so than in Los Angeles. The ‘cult of the body’ that I had heard about so often now made perfect sense. And yes, at any hour of night or day, there are joggers and cyclists along the beach path. Most intriguing was the physics-defying game of foot volley — basically like beach volleyball, but without using your arms at all. With ingenious use of their heads, shoulders, chest, knees and feet, these guys would not just keep the ball in play but set up plays, feint, and spike the ball. Maravilhosa indeed.

Upon our return, the streets were usually filled up with revelers. But hadn’t it been filled with revelers before we left? Yes it was. But the mix changed depending on the neighborhood, and our particular one seemed to be close to a gay nexus. As such, the sight of boys making out with boys, girls making out with girls, and occasionally, boys making out with girls, was fairly common.

That was one thing that was noticeably different about Brazilian street parties: people liked to kiss each other. A lot. This partially has to do with sexual mores in Brazil, which are decidedly different from the US, and also with the life-affirming nature of their culture. American culture seems to titillate while denying satisfaction. Thou shalt see the beckoning, scantily dressed woman in the ad, but thou shalt not want her but should rather want to buy more stuff. Thou shalt flirt, but desire for consummation shall bring you damnation eternal amongst fire and brimstone (what the hell is brimstone anyway?) not to mention immediate rejection and ridicule.

Not so in Brazil. It turned out that when a woman flirted with you and continued to flirt with you, she was actually interested in you. Crazy but true. And this interest could soon escalate into kissing or a night of grown-up entertainment, that same night or maybe the next day. I witnessed this time and time again, and my companions were the gratefully bewildered recipients of this straightforward largesse. Moreover, these women were genuinely sweet and caring in a way that I just haven’t seen in the States. While in the US, people busy themselves chasing down the symbols of joy — money, status, career advancement — while starving from a real lack of actual joy, the Brazilians, most of which have little access to money or status, were busy affirming life in all its dimensions, enjoying their food, their drink, their bodies, and their dancing.

The ultimate irony was that 10 days into the trip, all of us were ready to go back home. As Prince Hal said in Shakespeare’s Henry IV, “If all the year were playing holidays/ To sport would be as tedious as to work.” And as much as the culture of life affirmation enchanted us, the perpetual party ran up against my strict Protestant upbringing, and we needed to go work hard and produce, dammit, so we could properly deserve the next adventure. And every trip reminds me of these lines from the coda to T.S. Eliot’s Four Quartets:

“We shall not cease from exploration,
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.”

Cristo Redentor Atop Sugarloaf Mtn

Why you should not go to medical school — a gleefully biased rant

4

In the few years since I’ve graduated from medical
school, there has been enough time to go back to medical practice in
some form, but I haven’t and don’t intend to, so quit yer askin’,
dammit.  But of course, people keep on asking.  Their
comments range from the curious — “Why don’t you practice?” — to the
idealistic — “But medicine is such a wonderful profession!” — to the
almost hostile — “Don’t you like helping people?”  Since
it’s fairly certain that I will continue to be posed this question for
the rest of my natural existence, I figured that instead of launching
into my 15-minute polemic on the State of Medicine each time, which
could definitely end up cutting into my time sitting in
traffic, I could just write it up and give them the URL.  And
so now, unfettered by my prior obligations as an unbiased pre-med
advisor, here are the myriad reasons why you should not enter the
medical profession and the one reason you should enter it.  I have
assiduously gone through these arguments and expunged any hint of
evenhandedness, saving you time hunting for them.  And here
they are:

You will lose all the friends you had before medicine. 
No foolin’.  You’ll be so caught up with taking classes, studying
for exams, doing ward rotations, taking care of too many patients as a
resident, trying to squeeze in a meal or an extra hour of sleep, that
your entire life pre-medicine will be relegated to some nether,
dust-gathering corner of your mind.  Docs and med students don’t
make it to their college reunions because who can take a whole weekend
off?  Unthinkable.  And so those old friends will simply
drift away because of said temporal and physical restrictions and be
replaced by your medical compadres, whom you have no choice but to see
every day.  Which brings us to…

You will have difficulty sustaining a relationship and will
probably break up with or divorce your current significant other during
training. 
For the same reasons enumerated above, you
just won’t have time for quality time, kid.  Any time you have
will be spent catching up on that microbiology lecture, cramming for
the Boards, getting some sleep after overnight call and just doing the
basic housekeeping of keeping a Homo sapiens medicus upright
and functioning.  When it’s a choice between having a meal/getting
some actual sleep after being up for 36 hrs vs. spending quality time
with your sig-o, which one wins, buddy?  I know he/she’s great and
all, but a relationship is a luxury that your pared-down, elemental,
bottom-of-the-Maslow-pyramid existence won’t be able to
afford.  Unless you’ve found some total saint who’s willing to
care for your burned-out carapace every day for 6-8 years without
complaint or expectation of immediate reward (and yes, these people do
exist, and yes, they will feel massively entitled after the 8 years
because of the enormous sacrifice they’ve put in, etc etc).

You will spend the best years of your life as a sleep-deprived, underpaid slave. 
I will state here without proof that the years between 22 and 35,
being a time of good health, taut skin, generally idealistic
worldview, firm buttocks, trim physique, ability to legally
acquire intoxicating substances, having the income to acquire such
substances, high liver capacity for processing said substances, and
optimal sexual function, are the Best Years of Your
Life.  And if you enter the medical profession during this golden
interval, you will run around like a headless chicken trying to appease
various superiors (in the guise of professor, intern, resident, chief
resident, attending and department head, depending on your phase of
devolution) all the while skipping sleep every fourth day or so
and getting paid about minimum wage ($35k-$45k/yr for 80-100 hrs/wk of
work) or paying through the nose (med school costing about $40k/yr) the
whole while.  Granted, any job these days involves hierarchy and
superiors, but none of them keep you in such penury for so long. 
Speaking of penury…

You will get yourself a job of dubious remuneration and high liability exposure. 
For the amount of training you put in and the amount of blood, sweat
and tears medicine extracts from you (and I’m not being metaphorical
here), you should be getting paid an absurd amount of money as soon as
you finish residency.  I mean, you’re in your mid-thirties. 
You put in 4 years of med school, and at least 4 years of residency (up
to 8 if you’re a surgeon).  You even did a fellowship and got paid
a pittance while doing that.  And for all the good you’re doing
humanity — you are healing people, for godssake —  you
should get paid more than some investment banker soullessly shifting
around spreadsheet numbers, some lawyer defending a tobacco company or
some consultant maximizing a client’s shareholder value. 
Right?  Wrong.  For the same time spent out of college, your I-banking, lawyering and consulting buddies are making 2-5 times
as much as you are.  At my tenth college
reunion, friends who had gone into finance were near
retirement and talking about their 10-acre parcel in Aspen, while
80% of my doctor classmates were still in residency, with an
average debt of $100,000 and a salary of $40,000.

But wait, we’re not done yet.  Whom amongst these professionals
has to insure himself against the potential wrath of his own
clients?  The doctors, of course.  Average annual
liability premiums these days are around $30,000.  That goes
up to $80,000 for an obstetrician-gynecologist (who remains liable for
any baby s/he delivers until said infant turns 18) and into
the six-digit realm for neurosurgeons.   Atul Gawande
wrote a dynamite article about docs’ compensation in a recent (May 4,
2005) issue of The New Yorker entitled Piecework (http://www.newyorker.com/fact/content/articles/050404fa_fact) — check it out.

You will endanger your health and overall well-being
The medical profession is bad for you.  Just ask any current
doctor or med student.  You will eat irregularly, eat poorly when
you do get the irregular meal (unless it’s a drug-company
sponsored meal — god bless their generous hearts and bottomless
pockets), have way too much cortisol circulating in your system from
all the stress you experience, have a compromised immune system because
of all the cortisol in your blood, get sick more often because of the
compromised immune system (and the perpetual exposure to disease
– it’s a hospital, surprise), and be perennially
sleep-deprived.  If your residency is four years long, on average
you will spend one of those years without any sleep.  A whole year of no sleep.  Do you get that?  This is as bad for you as it is for patients (you’ve heard of Libby’s Law, right?  Check out http://www.newyorkmetro.com/nymetro/health/features/n_9426/). 
My good friend and college classmate James — a serious contender for
the title of Nicest Guy on Earth – had a severe
car accident one morning on the way to the hospital because he fell
asleep behind the wheel.  Luckily, his airbag deployed and he
didn’t suffer long-term injuries.  Everyone seems to know already
that medical care can kill patients (haven’t read The House of God
by Samuel Shem yet?  Go get it now – brilliant and
easily the funniest book I’ve ever read), but it’s usually news that it
can kill the docs, too.

You will not have time to care for patients and treat them as well as you want to. 
This is how the math works: Many patients.  Few of you –
usually one, unless you have florid multiple-personality
disorder.  So you have to take care of many patients.  And if
they’re in the hospital, that means they’re really sick, otherwise
they’d still be at home.  So you are scurrying around trying
to take care of all of them at once, which means that each individual
patient can only get a little bit of your time.  Which means that
you won’t have a chance to sit at the bedside of that sweet old vet and
hear his stories of Iwo Jima.  Or get to the bottom of why that
LOL (little old lady — medical slang’s been around way longer
than internet slang, buddy) can’t get her daughter to come
visit.  Or to do any of that idealistic stuff that you cooked up
in your adolescent brain about really connecting with
patients.  Get a grip!  This is about action, about taking
care of business, about getting shit done, about making that note look
sharp because the attending is coming to round in an hour and he’s a
hardass, and that’s the difference your passing and getting recommended
for honors, so get on it already and quit yakking with the gomer (which
is an older patient with so many problems you should have never
let him/her get admitted in the first place — stands for ’get out
of my ER’, and I didn’t make it up the acronym, so direct
your indignant wrath elsewhere, thank you very much). 
It’s about CYA — cover your ass.  For better or for
worse, you just start to treat patients as problems and illness-bearing
entities for the sake of mental efficiency (”55yo WM s/p rad
prostatectomy c hx CHF & COPD”), which does not do much for your
empathetic abilities.  Which brings us to…

You will start to dislike patients — and by extension, people in general. 
OK, so now you’re overworked, underpaid, underfed, and
sleep-deprived.  Whose fault is that?  Well, it’s not really
the hospital’s fault — it’s just drawn that way.  And it’s
not your boss’s fault, because somebody has to take care of patients,
and he can’t do it because he’s the boss, duh.  So whom to
blame?  Ah yes — patients.  It’s the patients’
fault.  They’re the ones creating all the work!  The ones who
get in the way of your nap, your catching your favorite TV
show, having an uninterrupted meal, getting together with your
sig-o for some therapeutic nookie.  How dare he have an MI while
you’re watching CSI?  Does she have any consideration,
letting her blood pressure tank to 40 over palp at 3.30am, while you’re
making out with Elle MacPherson on the shores of Bora Bora (assuming
you’re lucky enough to be actually asleep)?  The logic may be
twisted — patients, on the whole, don’t get sick voluntarily or
out of spite to you – but it is deeply ingrained
in medical culture.  Heck, there’s even a slang term for it:
a hit.  As in, “We got four hits on our admitting shift
at the ER today.”  Hit — the same way you would be struck by a
mortar, or a shell, or a bomb.  Getting hit is a Bad Thing. 
These aren’t people — these are potentially lethal disasters that
can explode all over the place and ruin your whole day.  “We got
hit again” — one more patient to take care of, says the
resident.  But really, is that resident blameless?  Or how
about Dr Hardass and his intransigent ways?  Hell, they’re at
fault, too!  Soon the circle of blame expands to the outer reaches
of the cosmos, and every potentially accountable organism from amoeba
to blue whale will be personally responsible for your misery.  But
lest you think we’ve forgotten you, patients, take heart –
it’s all still your fault.

You will start to be disliked by people who do not even know you. 
Once upon a day, in a time somewhere between the Cretaceous and
Triassic eras, physicians were held in awe and respect by the general
public.  Their seeming omniscience was revered, and TV shows like Marcus Welby MD
glorified their empathetic sangfroid and cool grace.  Heck, they
were even considered sexy or something.  I only noticed in recent
years that this ain’t the case no more, and doctors rank on the
contempt scale somewhere above meter maids and at or just below divorce
lawyers (but still much higher than I-bankers and other
invertebrates).  The average Joe and Janet are tired of the
ever-rising cost of medical care, tired of all the stories of
malpractice, tired of the perceived greed of the pharmaceutical firms,
tired of the heartless profit-focussed practices of insurance
companies.  But where do they pin their frustration?  To
whom can they direct their ire?  Insurance and drug companies are
nameless, faceless entities, as are hospitals.  We need a person
to blame, like a nurse or a doc.  Nurses are overworked and
massively underpaid, so it doesn’t really make sense to get mad at
them.  But doctors — those Mercedes-driving, Armani-wearing,
private-school using, golf-playing
arriviste docs!  By being the most visible symbol
of the medical profession, the doctor will have the dubious
distinction of being the scapegoat for all its
maladies.  Fair?  Hell no — we already told you
docs are overworked, underpaid, and often railing at the same
injustices Joe and Janet are.  Most of them don’t even play
golf!  But such it is.  Just letting you know which
direction the rotten tomatoes are flying so you can consciously
choose to stand at the ‘toss’ or ’splat’ end of
the trajectory. 

And the one reason why you should go into medicine:
You
have only ever envisioned yourself as a doctor and can only derive
professional fulfillment in life by taking care of sick people.
 
There’s really no other reason, and lord knows the world needs
docs.  Prestige, money, job security, making mom happy, proving
something, can’t think of anything else to do, better than being a
lawyer, etc are all incredibly bad reasons for becoming a doc. 
You should become a doc because you always wanted to work for Medecins Sans Frontieres
and your life will be half-lived without that.  You should become
a doc because you want to be the psychiatrist who makes a
breakthrough in schizophrenia treatment.  You should become a
doc because you love making sick kids feel better and being the
one to reassure the parents that it’ll all be OK, and nothing
else in the world measures up to that.  Or as my general
surgery resident put it, you should become a doc because “my dad was an
ass surgeon, my big brother’s an ass surgeon, and by god I’m going to
become an ass surgeon.”  But woe betide you if there’s
anything else, anything at all, that would also give you that
fulfillment.  Because your pursuit of medicine would preclude
chasing down that other dream and a whole lot more – a dream
that could be much bigger, much more spectacular, much more
enriching for yourself and humanity than being a
physician.  Just ask John Keats, Walker Percy, Sir Arthur Conan
Doyle, Giorgio Armani, or Michael Crichton (some of these
guys being more alive than others these days).  Or you can
just ask me a few years down the road, by which time I should have
a blog entry for that question, too.

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