The Match

Towards the end of Gary’s third year of medical school, we were thinking about next steps. Though graduating from medical school is a significant milestone, it isn’t close to the end of the journey. Internship, residency and, likely, fellowship remained to be completed. And, before he could begin, he had to go through a process called ‘the match.’

Medical students choose a specialty and then apply for programs in that specialty. Gary chose internal medicine. The way it works is that he fills out an application, which includes his transcript, the scores on the different medical boards that are taken along the way, and references. I don’t recall all the specifics, but after the initial application, you would be invited for an interview if the program was interested in you. During the 4th year of med school, about four weeks were set aside so that the student could travel around for those interviews. Then, the student ranked his/her preferences from top choice to places they would accept. At the same time, the programs ranked their choice of students, as well. The two sets of rankings were fed into a computer and voila! – a match was made.

So much went into this process; so many decisions along the way – from choosing the specialty to deciding what part of the country we wanted to consider. Although we enjoyed our time in Pittsburgh, we wanted to be closer to family so Gary focused his attention on programs in the Northeast – mainly New York (upstate and the metropolitan area) and Philadelphia. He scheduled the interviews and we created an itinerary. The Toyota Celica we had when I first came to Pittsburgh had died, we got tired of pushing it downhill to pop it into gear and donated it to a local vocational school, and we were without a car for a while. We were fortunate that Gary’s brother Steven bought a new car at that time and generously gave us his old one – a car way too cool for us, a Pontiac Firebird with a t-top. We gratefully accepted his gift, it would make the interview process so much easier and less expensive.

Gary left Pittsburgh early afternoon on a Sunday in early November to make a grand tour of Pennsylvania and New York, with his first stop in Syracuse. I would meet him at the end in Brooklyn for Thanksgiving. We said our good-byes, I wished him luck and he went on his way.

He was driving on the Pennsylvania Turnpike, not that far out of Pittsburgh (but far enough), when the engine light came on. Neither Gary nor I were knowledgeable about cars. He drove for a bit, thinking he’d get off the next exit. But, exits on turnpikes aren’t that close together. To make a long story short, he had to pull over onto the shoulder when he saw smoke wafting from the engine. A state trooper luckily came upon him quickly. The car got towed to the nearest service station.

At that point, I got a collect call from Gary, explaining that he was in Breezewood, Pennsylvania and was being told that the engine had seized. The car would be out of commission for quite a while, even if they were able to find a replacement engine. Gary was in something of a panic, his interview was scheduled the next day at 8:00 am in Syracuse. I went into problem-solving mode. We decided I would deal with the car. We got off the phone so he could look into transportation back to Pittsburgh and I would figure out how to get him to Syracuse.

A number of things fell into place: he was able to get a bus to Pittsburgh very quickly, then he grabbed a cab to the airport. I found and booked him a flight to Syracuse and arranged for a rental car. It looked like we would be able to pull this off in time to make his interview. It also meant that we spent hundreds of dollars we couldn’t afford, but that’s what credit cards (and parents, if you are lucky) are for.

The rest of his travels went well. When he finished all the interviews, we had some decisions to make. I put my policy analysis skills (I knew I’d find some use for them) into action to help sort things out. The task of figuring out how to rank the programs was overwhelming. Without going into the gory details, we made a matrix – yes, a matrix! The elements that were relevant to the decision were listed on one side (quality of the program, quality of life for us, closeness to family, affordability, etc.). I think we had something like 7 factors. We gave a weight to each factor (quality of program got the most weight, and quality of life was second). Then we ranked each program according to each factor and came up with a score. Much discussion went into this, as well as many hours of thought. While the matrix was helpful, it wasn’t an exact science. Ultimately, Gary ranked Columbia (in New York City) first, Albany Med second, I think one of the Philly programs was next and I don’t remember after that (maybe Gary does). I know he ranked ten programs

One of the considerations in this equation was what each program offered in the way of experiences. The sad reality was that this was in the midst of the AIDS crisis, before any viable treatment options were available. When Gary visited NYU (located in Manhattan) and Downstate (located in Brooklyn), the combination of the huge number of AIDS patients, their suffering and not being able to offer much to relieve their symptoms, was devastating. All hospitals were challenged by this crisis, but the internal medicine programs in those two locations were simply overwhelmed. I don’t recall if Gary included either of those programs on his list, or if maybe he ranked them at the bottom.

All the paperwork and interviews were done, now it was up to the invisible, giant (in my imagination anyway) all-powerful computer to do its magic. Match day was March 19, 1986.

The way it worked was that all the students gathered in a large common room in the medical school at the appointed hour – I think it was noon. I took off from work to be there to get the news hot off the press with Gary. Each student’s name was called and they were given an envelope. Inside was a computer-generated letter that indicated the program.

Our hearts were thumping. I believe names were called alphabetically – it was good to be a Bakst. Gary went up and got the envelope and quickly made his way back to me so we could open it together. He ripped it open, our eyes scanned the paper and found…Albany. I looked at Gary to see his reaction – after all this was his second choice. I did not read disappointment. I felt a small let down and maybe a bit of surprise. Of course, I had no idea what would happen, and had no reason to assume he would get Columbia. We compared results with our friends – it seemed that everyone was happy with their placement.

We knew our families were waiting to hear where we would be going. We went over to the pay phones to call them. As we made the calls, and processed the outcome, we got more excited. Then we joined friends and went out to celebrate.

We would have a few more months in Pittsburgh, and then start the next phase of our lives together…in Albany, New York.

When We Went to Medical School

Sometimes I slip and say, “when we went to medical school.” Of course, I know that I didn’t go. In fact, when I would meet Gary on campus, we would take a short cut that went through the anatomy lab. I kept my eyes tightly closed, held my breath and he guided me through as quickly as possible. I wasn’t cut out for blood, guts or formaldehyde. But, I still feel like I went through it. Maybe because it was so intense. Maybe because our lives were totally consumed and structured by the demands of Gary’s schedule. Whatever the reason, now and again the phrase still slips out.

When I joined Gary in Pittsburgh, one of the things I was struck by, and people will be pleased to know this, was how seriously Gary and his fellow students took their learning. I don’t know if it is like this in other medical schools, but at Pitt, with a few exceptions, students were committed to learning all of the material. There was concern about grades, too, but the focus was actually on learning. They took their responsibility very seriously. Not only were they studying for a given test, they were trying to retain the knowledge beyond that test. Certainly, this was true for Gary and his circle of friends.

This was a contrast from my experience in graduate school, where my fellow students at Columbia were present and worked hard, but didn’t display that level of commitment, not even close. The med school students saw a connection between what they were learning and the quality of care they would later provide patients. I found it very reassuring.

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These were some of the thick books Gary lugged around.

The first two years of medical school were comprised of traditional classes. Gary lugged huge, thick texts on biochemistry and anatomy and physiology to and from the apartment – sometimes to one of the libraries on campus, more often downstairs to a room in our building. Ruskin Hall, where we lived, had a lounge on the first floor that was good for studying. There was a long wooden table with sturdy chairs and some more comfortable chairs against the walls. It was never terribly crowded, but there were always some people studying there. When he wasn’t in class or lab, that’s where I’d find Gary. It became a routine: every evening around 8:00 I’d bring him a cup of Maxwell House International Suisse Mocha (the instant mix). We’d touch base for a minute or two and then I’d go back up to the apartment, watch t.v. or read and go to sleep. I didn’t know what time Gary came up.

It could be lonely for me. Other than Gary, I didn’t know a soul in Pittsburgh. It took a few months for me to find a job, but even after finding one, it was hard to make friends. I was an outsider at work, being so young, a New Yorker and Jewish (I wrote about that here and here). My colleagues were married, with children and in a different place in their lives. Though it was fine for work, for the most part, I couldn’t make a connection that went beyond a celebratory drink during the holidays.

We did have a circle of friends from Gary’s class, which included some women. I did become friends with one who was in a similar situation, she worked while her husband went to med school. She was a copy editor at a publishing company. But her life took a major turn when she got pregnant and had a baby during the second year of medical school. We remained friendly, and we socialized as couples, but she, understandably, was preoccupied.

I tried some different things to network and branch out. I joined a group called Women in Community Development and edited their newsletter. I enrolled to get my PhD in Public Administration at the University of Pittsburgh and took a few classes, while working full time. I joined a gym near work. None of those efforts led to the kind of connection I wanted. Looking back, I think my loneliness and sadness were more about my general melancholia, not yet treated with medication.

I muddled through, trying to be as supportive of Gary as possible, while simultaneously leaning on him to fulfill all of my emotional needs (perhaps a contradiction in terms). The third year of medical school brought new and different challenges. Gary began rotations in the hospitals, each one exposing him to another specialty. Most med students, early on, made a choice: medicine or surgery. There were many specialties within each of those two branches, but the two areas called upon different skill sets. Surgeons tended to be action-oriented, take-charge, fix-it kind of people. Internal medicine drew problem-solvers, relationship-focused, detail-oriented folks. There was some trash talk between the two groups, with those choosing medicine disparagingly referred to as ‘fleas.’ I don’t recall a pejorative assigned to surgeons, but the general idea was that they wanted to operate first, ask questions later.

Gary chose medicine, not surprisingly. As a result, the medicine rotation loomed large for him. He was determined to ace it. It was the longest rotation, lasting almost three months, taking him to different hospitals with a long stint at the VA. The hours were brutal. Gary would leave the apartment at 6:00 am and get home around 9:00 pm, if not later, and then he would read/study. I don’t recall him having weekends off, and if he did, they were spent studying. There was just so much to learn.

One night, tired of eating dinner alone and feeling resentful, I asked Gary if he had to keep these hours. “Can’t you cut back a bit? Does everyone do what you’re doing?” Gary carefully explained to me that this was time-limited, the rotation would end. He felt he needed to go all out because it would be important for future choices. If he wanted to get a residency placement of his choosing, the better he did in this rotation, the more options he would have. I didn’t know it then, but this argument would become a recurring theme in the first ten years of our marriage: me questioning whether Gary’s long hours were necessary. This time I told him I understood, and tried to suck it up.

I don’t know how he did it, I barely made it through the ordeal. I have this unfortunate tendency when in a dark period to feel like it will never end. I find it a challenge to see light at the end of the tunnel. Fortunately, that isn’t a quality Gary shares – he certainly wasn’t seeing much light, literally or figuratively. It was the fall, he left in the dark and came home in the dark and spent most of his time in the dim fluorescent light of hospital wards.

Finally, the rotation came to an end. I arrived home from work and found Gary already in the apartment. This was a major step forward, he was never home before me. I hung up my coat, went to the bathroom and came out to greet him. He was standing by the kitchen sink, taking a glass of water, but looking quizzically at me.

“What?” I asked, feeling like I must’ve missed something. Turned out I had.

“Did you go into the bathroom?”

“Yes, why?”

“Go in there again.”

I was perplexed but I did as he asked. I looked up and taped to the mirror was a piece of paper. I don’t know how I missed it the first time, though I do try to avoid mirrors. I recognized the format – it was the end of rotation evaluation. Gary got honors in Medicine! I screeched and jumped up and down. I threw my arms around him. We danced around the apartment. I later learned that Gary was one of only four students (out of 140) to achieve that distinction. Gary was well on his way to leaving his ‘imposter syndrome’ behind, and hopefully getting a choice residency when he graduated.

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The form that was taped to the mirror.