Meeting Gawande

Tuesday, May 24^th 2016

My alarm went off at 4:00am, a loud, obnoxious, quacking sound that never failed to wake me. I lurched up and grabbed my phone and quickly re-checked the screenshot from last night of the Metro North train schedule. 5:15, arriving at Grand Central at 5:50. Enough time. I rushed through a shower and tied my hair up.

Although it was raining and the train was a few minutes late, the trip to Grand Central was without incident. The bus to Boston was fifteen minutes late, but I still had a two-hour window, so I remained unfazed

I’d overslept, it was raining, and the bus was late, so when I realized I’d lost a button on my dress, I could only smile. During my four years in clinical research in Manhattan, there had been no room for lamentations, only solutions. Every day in clinic, our mantra had been, “Nothing is the end of the world, except the actual end of the world.” In my first year of medical school there had been even less time to be overwhelmed by anxiety. And so, now, I decided to just take off the button matching the absent one. Solutions.

I reviewed my map to Ariadne Labs in Boston on my phone, and took a screenshot in case I ended up without a phone signal. Pulling up my Spotify app, I chose my Hamilton playlist. It seemed appropriate for my six-hour journey to meet Dr. Gawande, a surgeon, writer, and public health researcher. Six hours for twenty minutes of his time. It was very well worth it. I couldn’t believe that I would soon be meeting the man who had articulated so clearly my thoughts on medicine, on healthcare, on life, on dying, on perfection and on success. The drizzle outside had slowed, and the city looked clean, glistening even. New. I was staring out the window, listening to the story of the first immigrant, Alexander Hamilton. As an immigrant myself, I could not help the appreciation I felt of his story. I was captivated, inspired, brimming with restless energy. There was an audacity in Hamilton that I admired, and one I sometimes emulated. This meeting, in fact, was the result of that audacity.

“I called his office, and said I was a medical student who admired his work.”

I told anyone who asked how it was that I was meeting Dr. Atul Gawande. It was the truth. My incredible advisors such as Dr. Michael Postow, my mentor counseled, “You never know until you try.” You certainly did not. And what did it say, of Dr. Gawande, that he was willing to meet me, an unknown student from a medical school in Upstate New York? Great things, certainly.

When I arrived in Boston, it was just as I left it. I had taken all my post-baccalaureate classes here, and I sped through the station, navigating the crowd with the grace of a practiced commuter. I was getting closer now, and I quelled the butterflies in my stomach with water from my thermos.

The Landmark Center was large, and I felt conspicuous in my navy sailor dress – sans two buttons – walking across the parking lot.

“I’m going to Ariadne Labs,” I told the man at the front desk.

“Elevator, third floor,” he said, with a smile.

Okay, this was it. Two deep breaths, a mental debate about removing my jacket, which ended up over my arm, and I was on the third floor. A woman at the front desk directed me around two corners, to an open space. The walls were glass and the sun shined brightly through the room filled with pod: desk spaces arranged in circles around pillars.

Dr. Gawande was standing several feet from me, in conversation with a woman, while two men waited some ten feet away. I resisted the nervous urge to turn around, smiled at the two men and introduced myself. We chatted briefly, until the woman who had been talking to Dr. Gawande came over and led me over to a couch.

She brought me a water, and then left me alone. I checked my watch, and then he came up to me right on time.

“What can I do for you?” He asked, after leading me into one of the transparent offices that lined the walls of the lab.

“I want to work with you,” I let out, after a series of circumventions that mostly consisted of, in retrospect, embarrassing gushing.

It was my object, I had finally decided, after much thought; my purpose for traveling the six hours. Well that, and to talk about his writing. When did he realize he could write, and how had his writing evolved? My actual question was less refined, punctuated by hand gestures, because I’m a hand-talker.

He gave a summary of his early work for Slate – the online magazine for which he first began to write. It began as a series of sketches – at the request of a friend of his, Jacob Weisberg – which highlighted milestones through his surgical residency.

“Well it turns out my friend was a very good editor,” he observed.

The benefit of a very good editor could not be overstated, it seemed. That fact was something I’d come to appreciate as I myself developed my writing on medicine.

Our conversation turned to his work in his lab, Ariadne. “What I like most is the research,” he said, when I expressed curiosity about his process in completing a project. These projects often spanned a broad range of topics, from healthcare disparities to medical efficiency.

“We do a lot of work on racial disparities,” he continued, when I mentioned my current summer project – an investigation into the role racial disparities in cancer clinical trials. “But what we also do, is take the next step…we look for solutions.”

“The surgeon in me wants to go in and fix it,” he added, with a laugh.

I joined in, and then our meeting came to a satisfied, sighing, close. At which point, I asked for a selfie. He acquiesced.

I could barely believe it was over, as I made my way to the train station and rechecked the selfie – proof. On the ride back, I was struck by one aspect of the interview in particular: the topic of solutions. It was not enough to identify the problem, or to diagram its pathway. The next step, of developing resolutions, was certainly more critical. If that was not part of the plan, what then was the point of searching out the problem in the first place? In our first year in medical school, we’d learned that it was one of the key factors for determining the use of a screening test: having a plan for the results. It was the last section of our NBME (National Board of Medical Examiners) patient history and physical examination notes. It was the culmination of every test and every diagnosis for every future patient we would encounter. What do you plan to do to address this problem? And soon after, what do you plan to do if your first plan fails? If my meeting had clarified anything, it was that the art of medicine is one of anticipation, investigation, evaluation, and resolution. It’s about next steps and moving forward. It’s about perseverance in spite of, and perhaps because of, failure. It’s about courage, about care, and about conscientiousness. It was another reminder that, although I was done with my first year of medical school, I still have a lot to learn!