It was the final night of the second year show, a musical written and produced each year by the second year medical students to spoof our professors, our classes, and ourselves. Ours was a four-hour epic. This performance culminated a creative process that began last July and developed into marathon rehearsals that consumed every free moment and dominated every conversation for the three weeks preceding the show.
Putting on the show-besides being fun-gave us the opportunity as a class to identify some of the issues we have struggled with over the past two years and to reflect on the experiences that have defined our time at Harvard. In our songs and skits, we also revealed our fears about the future and our insecurities about becoming physicians.
The opening scene reveals that Harvard Medical School has gone bankrupt. The school no longer has funds to provide financial aid for medical students. When Tori Spelling applies to HMS, her TV mogul father, Aaron Spelling, offers to buy the medical school and turn it into a TV network in exchange for accepting his daughter. Dean Federman agrees to sell out. But when he suffers a near-fatal accident, the directors decide to kill him to improve ratings. At the last minute, Tori recognizes Dean Federman's genetic disorder and cures him. But because ratings have plummeted, Aaron pulls out of Harvard, leaving HMS financially bereft again. In a deus ex machina finale, one of the renal professors is able to generate enough money to keep HMS running for 25 years through his counter-current multiplier model of urine concentration.
Our first song heralds the "Age of Indebtedness," our remake of "Aquarius" from the musical "Hair." We do, of course, worry about our economic futures; many of us will owe at least $100,000 by the end of our four years, and we wonder if the new "market" for physicians will allow us to repay our loans. But, in our song, our deepest fears are about the power that business and government will assert over the care of patients:
"When the Newt is in the Senate House, and HMOs are on the rise,
MBAs will mold health care, and welfare's swift demise,
This is the dawning of the Age of Great Poverty, can't you see? Poverty . . . "
Moreover, in our show, medicine changes rapidly, arbitrarily, and unpredictably. As Dean Federman succumbs to Aaron Spelling's financial influence, the school sacrifices science for glitz and academics for appeal. Similarly, we worry that HMOs will sacrifice good medicine for profits. We wonder how we will function in a financially constrained atmosphere that will seek to dictate our medical practices.
In the final lines of the show, a medical student named Billy struggles to keep up with the rapidly changing face of medicine. "But, what am I going to do now?" he asks. "I've wasted all my time studying to be a television doctor. Now how am I supposed to start learning real medicine? At this rate, I'm never going to be a star on 'ER.'"
Like Billy, we worry that we aren't prepared for the medical-political environment that is changing how medicine is practiced in America.
Issues of identity and transformation provided a more subtle theme that ran through the show. As doctors-in- training, we have assumed a role and power dynamic that we do not yet feel comfortable with, and we are struggling to learn how to behave within the confines of this new patient- doctor relationship. We wonder who we are.
We often feel that becoming a doctor is like adopting a facade. There is a sense of masquerade to the whole enterprise. In our show, Dr. Beverly Wu tells the students: "The sanctity . . . of the patient-doctor relationship is symbolized by the white coat, the mantle of respect for our profession and of our responsibilities. Yet what is truly remarkable about the coat, she adds, "is that underneath it you can hide who you TRULY ARE - your naughty side."
The white coat covers our discomfort. While it identifies us as physicians, it also disguises us. We are imposters. And so we borrow from Madonna's "Vogue" to sing: "Wear the coat/Let the patients think you're a doctor [think you're a doctor]/ Hey hey hey/ Put on, coat/ Never let on that you don't know [that you don't know]/ You know you can do it."
In some ways, the show marks an ideological boundary between the preclinical classroom years and the clinical hospital experience. There are several more hurdles, such as boards, that we must achieve before we really end this half of our medical school experience. Nonetheless, this is our way as a class to achieve a sense of community and closure before we go our separate ways. And through our show we revealed how deeply uncertain we are about the future that lies ahead for us.
