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Rapidly Aging After Decades in Medical School

photo of calendar pages flying into the airFor a long time, I didn’t feel as if I were getting any older. Because I’ve been at Einstein since 1975, I’ve always been surrounded by the people who educated me. Though my teachers and mentors have undoubtedly aged, to me none of them seems much older than they were when I first met them. And since for most of those years our student-teacher relationship has remained unchanged, when I’m around them it’s as if I’m still a student or a resident. My sense of perpetual youth ended, though, when during a small-group session, reality finally seeped through.

It was October, and I was sitting at the front of a classroom precepting a small-group clinical case conference on diabetes. Surrounding me were 20 relatively eager first-year students (it was still early in the academic year) who’d arranged their desks in a circle. After introducing myself and describing how the topic fit into the section of the Molecular and Cellular Foundations in Medicine course they were then taking, I asked for a volunteer to begin presenting the case described in the handout they’d received. Lev, one of the more-eager students, accepted my request and began to speak.

The case involved a 58-year-old man who, after a bout of pneumonia, had developed polyuria, polydipsia, and polyphagia. While Lev read the man’s history, I scanned the room, looking at the students’ faces. My attention was snagged by the young man sitting directly to my left. As the last one to enter the room, he’d been forced to take the last seat available, next to me. Unlike the others, he’d neglected to put out his name card, an identifier designed so that the preceptor could call on students when their eagerness to volunteer began to wane. I had the sense that I knew this young man; there was something familiar, something that made me think I’d seen him before.

As Lev continued, I tried my best to place the young man sitting next to me. Had I interviewed him when he’d applied the year before? I didn’t think so. Had he come up to speak with me after one of the lectures I’d given earlier in the semester? No, I was pretty sure his image wouldn’t have sunk into my consciousness so indelibly after such brief contact.

Setting aside my reverie, I tried to refocus on the case conference. Interrupting Lev’s presentation, I asked, “Does anyone have any idea what the significance of this man’s excessive drinking is? And if he’s been eating as much as he says he has, why has he lost eight pounds?” When a few seconds had passed and not a single student raised a hand, I began to scan the roster of names I’d been given for a “volunteer.” As soon as I saw the name “Aaron Small,” a bell in my head began to ring.

*       *       *

It was autumn, exactly 20 years before. I was in the living room of an apartment in one of the housing towers on Eastchester Road. As coeditor of our class’s yearbook, it was my responsibility to take photos of my classmates. During my rounds that evening, I took pictures of Jonathan Small and his family.

Jonathan was one of the few members of our class who had a child; his son, Aaron, was then about a year old. For the photo, Aaron had been dressed in a navy-blue sailor suit. While I shot the picture, Aaron sat contentedly on his mother’s lap while Jonathan, seated next to his wife on the couch, cradled the boy’s legs.

Was it possible that the little boy in the sailor suit had become this young man sitting in this classroom? Could it be that a son of one of my classmates was old enough to be a first-year medical student at the medical school his father and I had attended? It seemed impossible: after all, at that time, I still felt like a medical student myself. But as I sat in that classroom 20 years later, I did some math and came to the realization that not only was it possible, it was probable.

*       *       *

Having been blown away by this epiphany, I found it difficult to go on without interrupting the small-group session. Luckily for me, Jennifer, one of the other students in the room, had begun to answer the questions I’d posed before I’d drifted back in time and, although I hadn’t been paying attention, it seemed as if she’d offered a cogent response. When she finished, before another student could begin to speak, I asked (knowing the answer before the words were out of my mouth), “Who’s Aaron Small?”

As expected, the young man to my left raised his hand. “Are you Jonathan Small’s son?” I asked.

“Yeah,” he responded. “Do you know my dad?”

“We were classmates,” I answered. “I remember you as a little boy. I took your picture for our class’s yearbook.”

“The one of me in the sailor suit?” he asked, and I nodded my head. “I hated that sailor suit,” he continued. “My mom used to make me wear it all the time, whenever I had to get dressed up. It made me look like a real geek.”

“No, you were cute,” I said. “And now you’re an Einstein student.” He nodded.

There followed an uncomfortable silence. I realized that I had to do something to get us back on track. “You guys don’t understand the significance of this moment,” I said, addressing the whole group, unsure of where I was heading. “Seeing me, you all probably think of me as an old fart.” (There was some snickering.) “And I probably am an old fart.” (The snickering intensified.) “But because I’ve been at Einstein for my entire career, I have this weird sense that I’m actually your contemporary. But because Aaron’s in this class, I must accept that I’m not a first-year medical student anymore—that I’m old enough to have a child who’s a first-year medical student. That’s pretty sobering.”

The room was uncomfortably silent again and I wasn’t sure what to do. Thankfully, Lev spoke up, saving the day: “Dr. Marion, now that you’re done with your midlife crisis, should I go on with the case?” I smiled and nodded, and he continued presenting the case of the 58-year-old man with diabetes.

The presence of Aaron Small in that class forever shattered my twisted impression that I was somehow still a contemporary of first-year medical students. In the years since that small-group session, I’ve managed to move on, accepting that I’m no longer young. But even today, as I cruise around campus, sitting in my old classroom seat, walking through the library, or visiting the lab I used to work in, an image or a smell may trigger a memory. And then, for just a second, it’s 1975 again.

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Robert Marion, M.D.

Robert Marion, M.D.

Dr. Marion is professor, departments of pediatrics and obstetrics and gynecology and women's health, Albert Einstein College of Medicine and a member of the division of genetic medicine, The Children’s Hospital at Montefiore. He is a past chair of Einstein's committee on admissions and a current co-chair of that committee. 

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  • Byravan Viswanathan December 25, 2018, 8:34 PM

    Wonderful story to read. I am eighty and graduated 1963 and practiced for 45 years and see doctors as young as my own children and grand children. They are a projection of myself but better than in the science of medicine but the art ? I am not sure.

  • Bill Silver December 25, 2018, 10:39 PM

    Funny about stories like the one you told it reminds me of an old friend of mine, Les Marion who had a kid brother who was too small to play basketball with us and he is now a professor of medicine. Talk about making some one suddenly feel a lot older. I guess that’s what happens when your colleagues age at the same rate as you and it’s tough to remember them when they were younger. Give my regards to Les. Nice article.

  • Carmine cerra December 30, 2018, 3:15 PM

    Teaching pathology in second year after 35 years of very active practice
    I enjoy the idea of being a student again but
    I realize I need to be a student in order to help then succeed
    They have so mych they need to kearn
    Ciao!
    Carmine

  • Carmine cerra December 30, 2018, 7:02 PM

    I think all of us who teach mefical students sense this
    Its a way to convince ourselves wr are young with a long career ahead
    Are value is in passing the torch in a graceful and professional manner
    So that some day these young students can do the same

    Happy New Year!!!!
    Carmine J Cerra MD
    Stroudsburg Pa

  • Mary Sayers January 24, 2019, 5:41 PM

    Hi Bob! You’re the best doctor ever and NO you are not an old fart.

  • Beth Pletcher January 24, 2019, 7:37 PM

    Bob, I too have these frequent jolts to remind me of my advancing age while continuing to be embroiled in teaching here at the med school. One student’s uncle surprisingly was a groomsman ar our NY wedding in 1989, one student’s father was also one of my students here at the med school, and finally all of my doctors now seem to recognize me as they are palpating, percussing and prodding they announce “ Dr. Pletcher, you were one of my professors!”. I knew something good would come from teaching here.😎

  • jo herzog md February 4, 2019, 9:39 PM

    Dr Marion,

    I love your story. How lucky we all are to have you teaching through generations of students. YOu were at Einstein when I was a student(1980-1984) and I read this story because I was excited to see that you were author. I have two kids in residency and one about to apply to medical school but I still feel like I was at Einstein a couple of short years ago ands am still loving what I have learned and what I am doing. Thanks for still being there for our youngsters.

  • Itamar Salamon February 5, 2019, 8:36 PM

    My favorite story in this regard: I did my psychiatry residency at the University of Rochester Strong Memorial Hospital from 1960 – 1963. My daughter Peggy was born in 1962. She took her OB-Gyn residency at Strong Memorial Hospital and she told me that, during a surgical procedure, she turned to the attending and said, “You know, Dr. Fullerton, you delivered me!” Dr F realized that he was not a student any more.

  • Joshua Chesir February 9, 2019, 7:29 PM

    Hi Bob,
    Great story! I still have fond memories of you being our go-to person at Einstein during my residency (you were an attending ) for any genetics question, and remember learning a tremendous amount from you. I think I still have the novel you wrote around that time!
    I personally can’t believe that many of the kids that I took care of are now parents themselves, and trust me with their kids! But, we are not getting older, just them!
    Best wishes, Josh