I live in the hood: away rotations and the deceptive allure of leaving home

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Baltimore

Photo courtesy of Reddit on /r/Baltimore

“What did I get myself into?…..”

These words echoed through my head, reverberating off of what must have been the empty walls of my cranial vault. That is the place where my brain should be. I’ve never head my head CT scanned, so I seriously wonder if I have some atrophy or I’m missing a lobe or something. In the midst of the pings of that regretful sentence, little shards of fear were blowing around, slicing sharply at wherever my brain should be. I parked my car on a dimly lit street in Baltimore. I hadn’t seen “The Wire”, but I imagine this is a place where it takes placed based on the brief synopsis I read once on my friend’s HBO GO. 

It took the courage of about 5 minutes and a firm grip on my obnoxiously powered flashlight and razor sharp knife before I turned my engine off. She said the keys would be in the lockbox, but is this even the right place? It had just turned to dusk, thanks to 2 hours of standstill traffic on what was already a 9 hour drive from Indiana. There were shadowed figures sitting on a stoop to a house that I prayed wasn’t the one I was going to. A dilapidated “LIQUOR” sign flickered on the street corner. The mini mart across the street had bar on its windows and doors. I swallowed whatever fear I had, being over 500 miles from home, and stepped out of my car. The door seemed to slam shut even my delicate touch. I checked for the fourth time that the address was right: 625. Yup, this is it. It was a three story townhouse style building, squeezed in between five others of the same kind. As I walked up, I noticed the one I was going to actually had some living plants out front. It can’t all be death and despair here, I thought to myself. 

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I checked my texts one last time for the code to a lock box that I found inside the inner door. It felt like I was breaking into this house, a capacity for crime that I knew a suburban-raised child like me just didn’t have. I punched in the code and eureka, it worked! Two silver keys fell out into my hand that I then used to unlock the door and step inside. It was a narrow, dimly lit hallway. “1R” and “1S” were plastered above the doors to seemingly separate rooms. A light was on upstairs, although I couldn’t hear anything coming from above. My room was in the basement; the message from the landlord says to go down the stairs straight ahead to the left. I found a narrow set of stairs leading down, and subsequently hit my head on the ceiling. Although a normal thing for me, I made a mental note to avoid that the next time I went down. Ouch. I found myself in a small, few foot hallway that had 4 locked doors. I put my keys in the one farthest from the stairs, turned them, and was greeted by complete darkness. Thank God for the flashlight, I thought, as I blasted it across the room. The site of a paisley (or whatever that color combination is) bedspread hit me, with toiletries and toilet paper sitting out on the nightstand. I found a lamp, turned it on, and surveyed the pale green walls around me. “Well, at least this room is cozy…” I opened the door to the outside, and I had a small set of stairs leading out to a concrete porch area, that was run down. I look to my left, and a freaking pigeon coop greets my eyes. A mangled chain link fence surrounded what I believe was supposed to be my porch. “What did I get myself into?….”

This is the story of how I arrived in Baltimore, Maryland, after a journey headlined by a rock cracking my windshield, a lot of Taylor Swift covers, the hills of Pennsylvania nearly overheating my engine, a brief 5 minute foray into West Virginia somehow (because evidently that state’s border got drunk and is totally messed up), and getting stuck in a traffic jam for so long people got out of their cars….only to pass a semi that had literally melted; the engine was sitting in a pile of black dust which used to be the actual front of a tractor trailer. Because I enjoy doing things at the last minute, all of the rooms that fellow med students at the University of Maryland were swapping out had all been taken, so I took to Airbnb to find a place to live. I found a “small 1 bedroom crash pad” for a cheap price and took it. I now understand why it was so cheap. And I now very much understood I was no longer in Indiana anymore…

Each and every year, thousands of medical students go through what might be the most ridiculous process ever in order to do an “away rotation” at another medical school for the month. Each school has some archaic process for applying: some let you only send things via snail mail, others require peeing in cups, and in general filling you spend a lot of time filling out multiple forms of your immunization records because being standardized would be too easy. These away electives are essential for some specialties, such as orthopedic surgery, ENT, or emergency medicine; these each encourage students to do anywhere from 2-3 away rotations in order to be considered competitive. Other specialties like family medicine would probably look at you like this and try to fathom why you would ever do an away rotation if you’re applying to family medicine.

General surgery (aka the specialty that I want to one day consume my life) sits somewhere in the middle. It’s not unheard of for a student to do an away rotation, but it’s not necessarily the norm either. My decision came down to a few simple things: I wanted to go to a place I was considering for residency, I wanted an experience I wouldn’t necessarily get in Indiana, and I wanted to go somewhere fairly far away and out of my comfort zone. I’ve lived in Indiana for the better part of 20 years, and now was a time to get a good taste of another area. My search narrowed down to academic programs in decent sized cities that had electives open for July or August, had an elective in trauma surgery, and had a residency program I would consider going to. I applied to Rutgers, Washington University in St. Louis, and the University of Maryland; I thought of applying to more, however, I ultimately did not. These places all had sub-internships (basically 4th year electives) in trauma surgery.

I ended up rejecting the WashU elective because it turns out that it’s a top 10 surgical program in the nation, AKA pretty likely to not even have my application make it past the initial review of USMLE scores and transcript. Even though they offered me an elective, the likelihood of me going there was about the size of thimble. A mouse’s thimble. Whatever that means. I also rejected an offer from Rutgers because I’ve watched enough Jersey Shore to know what going there would mean (not really, I still love you Rutgers and will probably be applying to you. I even really liked Jersey Shore to be honest. I’ve seen all the seasons!).

This left the University of Maryland. The thing special about UM is that they have the world famous R Adams Cowley Shock Trauma Center (henceforth referred to as “Shock Trauma”), which single-handedly revolutionized the management of trauma patients. Trauma and critical care is an area of general surgery that I could see myself specializing in, so this would be a prime place to spend some time. It evidently produces 10% of the fellows in trauma and critical care surgery nationwide, according to one of the attending surgeons here. Which is a lot for one center. I unfortunately didn’t get a position on their trauma surgery team due to the fact that students from UM take all the spots (darn them!), so there aren’t any available for visiting students. They did offer me a spot in their Trauma surgical ICU. This was going to be waaaay outside of my comfort zone, about 600 miles to be exact, as it was both far away and in intensive care, which is pretty complicated.

As the deadline to accept the offer was approaching (and by that I mean one day away, par for the course of my life), I went to surgery grand rounds, where one of our surgeons who did his fellowship at Shock Trauma gave a presentation on its founder, R. Adams Cowley. It all seemed to be some sort of sign that I was supposed to go, so I went full Drake YOLO mode and accepted the offer. I was planning on doing a surgical ICU month anyway, so this would both fill that requirement and allow me to see another city. Most of all, it would let me see what medical training was like at another institution in an intimate way, much more snuggled and cuddly than simply visiting a place for two days for a residency interview. We’re talking Snuggie + Netflix and chill levels of intimacy. That’s intimate.

My first day involved me waking up and getting on my bike to Shock Trauma. Seeing my street for the first time during the day, I realized that over half of the homes were boarded up and foreclosed. It’s 625 N Fulton Ave, Baltimore, MD if any of you want to look it up. Google maps makes it look a lot less run down than it is. It only has about 1 boarded up home on the street in that street view. Not sure when that picture was taken, but it seems like it was approximately from when Jesus was born. I set off with Shock Trauma punched into my GPS and proceeded to bike down streets that made Indianapolis look like it actually repairs its roads (hint to get the joke: it doesn’t). Even with GPS, I never thought I would be so happy to own a watch with a built in digital compass. Call it nerdy, but that thing was so useful when either my GPS was down or if I wanted to quickly orient myself either inside or out of the hospital. It’s also my paranoia backup in case I some day get lost in the desert, as it would allow me to head in one direction without walking in circles. I digress.

The thing you should know about me is that I was literally raised in the textbook definition of “White privilege, USA” in the city of Carmel, IN. It is routinely voted among the top 10 places to live in the US. As my high school economics teacher described our school,

It’s the whitest high school in the nation by size and percentage” – Master Bates (yes, we called him master. Yes, it was hilarious)

And people there are generally of very, very high socioeconomic status. While I didn’t live in a multi-million dollar home, my bus ride to school passed both the owner of Conseco and the guy who invented voicemail, both of whose houses you couldn’t really even see from the street.

Baltimore, specifically the area that I found this “one bedroom crash pad”, is exactly the opposite. It’s blatantly obvious that this is an area of lower socioeconomic status, at least on the West side where I live. I pretty routinely pass drug deals, the streets are pretty dirty and haven’t been paved since probably before I was born, and there are a ton of destroyed houses and graffiti everywhere. I’ve seen multiple people high on drugs or drunk in the street at both 6am and 6pm, and have almost been hit by them while I’m biking by.

The other thing is that I’m the only Caucasian person I see until I get within about a half mile of the hospital. That’s not to be racially disparaging in any way, it’s just the fact that when I bike down the street I stand out like a sore thumb. I’ll be open in saying that if I wasn’t a large male, I’d feel a lot less safe here. And to back it up numerically, evidently this district is among the worst neighborhoods in Baltimore and Baltimore is the #7 most dangerous city in the US according to Forbes, and that’s not even accounting for certain areas being worse than others. I think this map from Reddit also lends to the point, as where I live is smack dab between “The Wire” and “Drugs and Prostitutes”. I’ve always felt like I’d never even be able to figure out how to buy drugs even if I wanted, but the abundance of people conspicuously standing on street corners lead me to believe that “Buying Drugs for Dummies” could shoot an entire informational video here. A ton of the windows and doors have heavy iron bars on them, and just in general I feel like I really should have made a concerted effort to look somewhere else for housing. As a sidenote: after 3 days I have yet to find where the nice are of Baltimore is, but I think it’s somewhere East. I’m going to drive around this weekend in an attempt to find it. I have to believe it exists.

All of that said, I was going to try my best to make sure it didn’t mar my impression of the University of Maryland and their medical training. And from the minute I walked in the hospital and got up to start rounding, it all felt right at home. The other students were super nice, the fellows and residents seemed to be very nice to me, and they all seemed to be very welcoming to me as an outsider. While ICU medicine still overwhelms my surgery-minded pea brain, I’d like to think that by the end of this month I’ll have the hang of it. Shock Trauma has pretty much the largest volume of trauma in the entire nation, and that was overwhelmingly evident from the day I started here. While the jury is still out on whether I would want to train here for residency, I would at the very least entertain the idea of a fellowship here, as it would be for a much shorter time.

All of this being said, I can at least say I’m proud of doing something that is this far out of my comfort zone. It’s a good experience to do something a little crazy, and now is the time to do it. I even found out that supposedly there are medical residents that live in this house when they are rotating through. Although, I have yet to meet anyone except the permanent resident who lives here when I accidentally unplugged the internet. He seemed pretty nice at least. His name was Will. He scared the crap out of me when he knocked on my door. The dove coop right next to my back door still seems pretty creepy though.

And while I might not leave my tiny little basement room at night, there is a much greater lesson to be learned here: living in the environment that a lot of my patients come from. It’s no secret that things like gunshot wounds and trauma in general are associated with lower socioeconomic status, and a lot of my patients found themselves on the wrong end of a bullet. This is the kind of place that these people live in, work in, and ultimately get shot in. I was never poor growing up, and never had to feel like I was unsafe even at all odd hours of the night. Frankly…this is eye opening. Regardless of what happens during the next month (which hopefully won’t involve me ending up as a patient at Shock Trauma), this has given me a new appreciation for the city of Indianapolis, my upbringing, and the incredibly lucky life that I have led up to this point. It is also giving me an idea of what things to look for when I go to interview at residency programs during this fall and winter. I never quite realized how good I had it back home, and maybe my idea of wanting to leave for residency is a little less solid than it once was. More so than that, it is going to help me bring an extra bit of empathy to my patient care going forward. This way, when I see that person who overdosed on heroin or is bleeding out from multiple gunshot wounds, I will remember there is a lot more that goes into a trauma victim than meets the eye. While my situational awareness will be dialed up to eleven for my time here (thanks, martial arts), it is going to be one hell of a month.

I have a feeling I’m going to be writing a lot from my room in order to pass the time. It makes me feel a lot less alone.

-Brandon

This week’s song is To U by Skrillex & Diplo Ft. AlunaGeorge, as I can’t wait to get back to U, Indianapolis, in 25 days. 

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