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Am Fam Physician. 1998;57(1):166-168

June 30, 1985. Seated behind the wheel of a three-ton truck, I crossed the George Washington Bridge, heading for the West Coast, where an endocrinology fellowship awaited me. I had just finished five years of training that covered three different internships and a pediatric residency. I looked back one last time at the Manhattan skyline and thought with relief: “No more night calls, ever.” How wrong that thought turned out to be.

Driving westward, I had plenty of time to think about the road I had traveled so far. It seemed like eons since I started medical school at the Technion-Israel Institute of Technology in the northern port city of Haifa. It was the winter of 1973, shortly after the October Arab-Israeli War. Most of us were still in uniform, reservists, spending our first several months of medical school shuttling between the university and our units, personal weapons slung over one shoulder and medical books slung over the other. Most of the medical students, having spent several years in the service, were married and had families to support. We had seven years to go—six years of study and a one-year mandatory rotating internship. Fortunately, as a former professional musician, I could combine work with play by performing in concerts and clubs and finding a quiet spot to study during performance breaks.

In 1981, right after my internship, I took the required U.S. entrance examinations and moved to New York City, where I began a surgical internship in a Brooklyn hospital. My most vivid memory of that year is the skyline of Manhattan in lights. Working from dawn until dark, I rarely saw the city in daylight. It was a lucky Saturday night when I was able to get away and perform music with friends. One of those performances led me to the woman who would become my wife.

It was during the year of my surgical intern-ship that I realized I missed the ongoing interaction with patients and their families. I envisioned pediatrics as the right field for me and entered a pediatric internship and residency program.

My personal interest in growth and development eventually led me to an endocrinology fellowship at Harbor-UCLA Medical Center in Los Angeles. I bid New York a fond farewell and eagerly hit the road.

The fellowship in sunny Southern California was in striking contrast to the previous years. Life took on an entirely different pace. The intense, sleepless nights of a single resident in a big, cold city slowed down to a quiet, laid back, warm existence. The rumbling sounds of the New York City subway trains were replaced by the soft lapping sounds of the waves on the beach.

I started a private pediatric practice after I completed the fellowship. As adult patients began to consult me on a variety of maladies, my practice evolved into general primary care. I kept up with medical developments and regularly attended CME workshops in family medicine. Yet, something was missing. Strongly motivated to become a fully qualified family practitioner, and influenced by the market trends, I decided to make my next move.

After a decade in practice, on the eve of our 10th wedding anniversary, I asked my wife if she would be willing to drastically cut our income, take our daughters out of private school and move into an apartment. I had decided to take the ultimate CME course—a family practice residency. Luckily, having an adventurous spirit, she required only a brief resuscitation and was willing to adjust to a new life. My medical partners thought I was kidding, if not crazy. But I knew that anything short of a family practice residency simply would not suffice.

The nationwide search for a residency was on. I had already begun to imagine another cross-country trip, only this time with a family—my wife, two daughters, a dog and a cat—and a much larger truck. On the verge of flying to the Southeast for an interview, a last-minute phone call to the family practice residency “hot line” tipped me off to an opening at the USC/California Medical Center, just minutes away from my home.

I was accepted into the residency program. We would not have to move, but several other issues concerned me. How would I withstand the long hours, the stress and the new challenges of residency? One way was to improve my stamina. I began by modifying my diet and taking extended early-morning bike rides into the hills.

The reduction in our income was also on my mind. Since we had decided to stay in our home and leave our children in school with their friends, we expected significant financial difficulties. My wife started working longer hours, and we instituted a strict budget. But staying at home also meant that I did not have to give up the small recording studio that I had built and that had been a great source of relaxation and creativity over the years.

June 30, 1995. Exactly 10 years after my last residency, I became an intern again. The night calls that I thought had ended forever were about to begin anew. As it happened, the transition was not as frightening as anticipated. Because of the camaraderie of the family practice residents and the openness of the faculty, my integration into the program was an easy one despite my age and background.

In July 1996, I became one of two chief residents. The opportunity to help the interns and residents resolve personal issues and cope with the challenges of training has been especially rewarding.

This midlife metamorphosis has been one of the most positive learning experiences of my career. As the end of my residency approaches, I am grateful to my family for the hardship they endured and gratified to know that the risks that I took to become a family physician were well worth taking.

This quarterly department features essays written by medical students and family practice residents. Contributing editors are Amy Crawford-Faucher, M.D., a family practice resident at the Fairfax (Va.) Family Practice Residency Program, Sumi Makkar, M.D., resident representative to the Family Practice Editorial Board and Terrence J. Joyce, student representative to the editorial board.

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