I find a lot of doctors socially retarded.

Helene Spergel is currently doing a fellowship in general internal medicine and working on a master's in public health at Columbia University. She is a thirty-four year old, married woman, pregnant with her first child.

As a new nurse I really did not want to work on a hospital floor. I looked to work in an emergency room where I would have more autonomy, and get ambulatory care experience. Most of the hospitals did not want a new grad in their emergency room but Martin Luther Hospital took me on. Quite honestly I see now why they did not want a new grad coming straight into the emergency room. It was a bit much, jumping in like that. I was overwhelmed.

The nurses I worked with seemed competent and confident with themselves. Some of the nurses I worked with were Vietnam combat veterans. These women were amazing. Comparing myself constantly to these veteran nurses, I always found myself coming up short. It was frustrating. Even though I made a couple brilliant diagnoses and got great admiration from the doctors, I myself never felt I was as good as those other nurses.

There was one case where this man came into the emergency room complaining of back pain and I had a bad feeling about him. I remembered hearing that an MI can mimic back pain, so I immediately put him into the cardiac suite and it turned out that he ruled in for a myocardial infarction. The physicians were impressed that I had acumen, and they wanted to send me off for advanced training. But I wasn't interested in staying there.

The GI endoscopy suite wanted somebody from the ER to volunteer to help out. None of the other nurses were interested, so I took the opportunity to work there. I enjoyed working one on one with the physician and the patients, so I started scouring the want ads, looking for different opportunities. I found a position in San Diego at the University Hospital in research and GI endoscopy. For about a year and a half I worked in GI research, which I enjoyed.

Working there, the physicians encouraged me to go on to medical school. I had my name on a publication and felt that I had a good shot to get into medical school so I started pre-med classes. By that time I had the maturity to handle the hardcore course work. I started from scratch, basically, learning the hard sciences my high school didn't really prepare me to do. It took two years and I did home nursing on a periodic basis.

I never did well on standardized tests, so the MCAT was my big hurdle, because I got straight A's in all the pre-med classes. My father is a physician and my parents encouraged me to take the MCATs a year early without having any of the physics and none of the organic chemistry. So I took the MCAT and did not do well on it. A lot of schools were extremely interested in me when I first applied, but as soon as they got my MCAT scores the rejections started pouring in, except for one school, Mt. Sinai, which was interested in me despite the scores.

My interview there went very well. They looked at my long work record--working as a nurse and doing research--and I had a great GPA. So they put me on their waiting list. I kept calling and asking what the status of my application was. I got in the day classes started, basically. They saved me from having to take the stupid MCAT over again.

Medical school was smooth sailing. Nursing gave me a better appreciation of why I needed to learn some things when the other students were probably moaning, "Why do I need to learn this crap?" In nursing school we took a very basic physiology course. A lot of times they would say, "We don't really need to go any further than this. The doctors take care of the rest of it." The clouds were always thick over my head in terms of understanding what was going on as a nurse. In medical school you go into such detail that finally I felt the clouds parting and I could really understand all that was going on.

During the medical school clinical years I resented being treated like a child. Medicine is extremely hierarchical and as a medical student you're at the bottom of the ladder. Here I was older than a lot of the residents teaching me, who treated me like I was a moron. Probably I was technically skilled, not in treating the patients medically, but I knew what was going on. I got along fine with the patients; it was just my colleagues who were difficult.

I find a lot of doctors socially retarded. They slide through college, and through medical school, and they never deal with the real world their whole lives. Suddenly--whammo! they're deposited at the top as physicians. They're very "me" oriented: my career, my medical education, etc. Suddenly they're confronted on the floors with having to work as a team. That concept has never crossed their minds, particularly working with the nurses. It's very difficult working with people whose focus their whole lives has been "me first." Now it's "Let's work as a team, let's do this together for the patient's sake." Quite frankly, most of the physicians never make that leap.

I was originally interested in family practice. Mt. Sinai is twenty years behind in terms of what's really important for the nation. California is much more family practice oriented than New York. At Mt. Sinai their goal is to train sub-specialists. I was extremely discouraged by all the faculty from going into family practice.

Then I thought about obstetrics and gynecology but the lifestyle really did not appeal to me. I considered pediatrics. Finally I settled by default on internal medicine, not out of a great love for it but it seemed an acceptable alternative to family practice and provided me with an area of at least some expertise in treating the medical problems of adults.

In retrospect I probably would have been extremely happy in family practice. That's not to say I don't enjoy internal medicine. It's nice focusing on one segment of the population. But in family practice I would have gotten more training in doing procedures, like colposcopy or flexible sigmoidoscopy. I did not get that training in internal medicine. They leave that to the specialists. I'm not sure I'll ever have time or find a place that would accommodate me in learning those skills.

At the time I had to apply for residencies, my future husband and I were just dating. I wasn't sure where that was going, but he was certainly the best guy I had ever met in my life. Originally I wanted do a primary care internal medicine residency in California. It was a real dilemma whether I'd go back to California or stay on the East Coast and see how it happened with us. I interviewed all over the country and I ranked programs all over the country.

I ranked Seattle number one and Pennsylvania number two and Sinai number three. So I stayed at Mt. Sinai for the three years of residency, and they were probably the most unhappy three years of my life. The work schedule was horrendous. I was sleep-deprived. I'm the kind of person who needs eight hours sleep. Without that I function poorly.

I developed lyme disease and I was in a wheelchair for a while. I was extremely ill and had to get IV antibiotics and did not have any support from the fellow house staff whatsoever. I suffered severe depression. Plus my interests were not the same as all the other house staff officers. They were all "me" oriented, working extremely competitively to get into that coveted cardiology or gastroenterology fellowship. They were going to stab you in the back or make you look bad so they could get into that fellowship of choice.

There was very little camaraderie; I had just a couple friends in the group. There were plenty of people who were happy as clams there, but I didn't fit in. There was no support from the top, and for somebody who was having physical problems it was a horrible place to be. My husband was instrumental in getting me through the residency. If it weren't for him I wouldn't have made it. He's an astronomer, so he's not remotely related to medicine. I prefer that.

Mt. Sinai has an affiliate hospital which was like a little oasis for me, the City Hospital of Elmhurst. There are some truly dedicated people there who are not in it for the money. I loved going there. Being at Mt. Sinai was miserable. A lot of full-time attendings there only care about making the big bucks.

I was interested in general internal medicine and dedicated to primary care. That was one of the original reasons I went into medicine, that and clinical epidemiology. Now I'm doing a fellowship in general internal medicine and getting my master's in public health at Columbia University. I was going to get a master's in public health whether I went into medicine or not.

I'm interested in taking care of the underserved, preferably in a city hospital or a city institution. Right now I'm expecting a child, so I'll probably work part-time for the next couple of years, and hopefully take on a faculty position at a city hospital affiliated with a medical school, do some clinical research, take care of patients and do some teaching.

The nurses were always happy to see me on the floor because I was the only one who would actually round with them and go over the patients with them, and try to clue them in. When I was a house staff officer none of the other residents spent time with them. But I made it a point to round with the head nurse each day or every other day, to see what was going on from a nursing perspective. Sometimes it was extremely helpful, really critical.

The nurses were generally very upbeat and excited that one of their own became a physician. I never experienced the "Why did you betray us?" kind of thing. Nurses can be hardest on each other. Physicians will sometimes stick up for each other, but nurses don't. In medicine there's this old boy network that's been in existence for decades, and nurses don't really have that.

The demands in nursing are as great if not greater sometimes than medicine, because in medicine you see the patient once a day, whereas a nurse has to deal with them continuously. You're there for your shift and you can't leave. I found that far more stressful than medicine. That's not to say I don't find medicine stressful, because I do.

In nursing school we spent an inordinate amount of time on doctor-nurse relationships and how to deal with them. There was never one mention in medical school of that, never once, on dealing with nurses. There was very little, other than psychiatry, on dealing with difficult patients. Nursing school spent much more time on communication in health care, dealing with colleagues, dealing with doctors. It was much more focused on that than medicine.

At the beginning of medical school during the introduction to medicine overview they could have fit it in, but they didn't. They could have offered it as an elective and they didn't. Maybe in California or some of the other states, which I think are much more progressive, there would be some classes on that. They've got a long way to go with the medical establishment, which is like moving an iceberg. Hopefully with more women going in, people will become a little more open-minded than medicine has traditionally been.