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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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Comments on this entry are closed.

  • Gerry Olomi December 13, 2018, 12:51 PM

    Thanks for good presentation made me reflect where am I going.

  • Paul December 13, 2018, 4:06 PM

    Great story. I’ve realized that I’ve aged, but like you, don’t want to believe it. You’re actually lucky that you can remember 1975.

  • Roger Duvivier December 14, 2018, 8:04 PM

    Bob Marion is the embodiement of the Einstein academician-clinician-educator-scientist. He will remain ‘for ever young”; inevitably aging in years but clearly, still very “young at heart and at mind”. I hope that for many many years to come, it will still be 1975 again for him, over and over… perhaps for more than just a second.
    May generations of Einstein students continue to benefit as immensely as in the past from his “sense of perpetual youth.”.

  • Matt Grabowski December 22, 2018, 9:40 PM

    Funny how the time goes by when you are doing something you enjoy.

  • Edward Adickes December 22, 2018, 11:20 PM

    Dr. Marion,
    I appreciate your comments. Our backgrounds are similar (medicine) but different, pathology/neuropathology. The neuropath was sometimes dismal, but the neural plasticity that we learn now is exciting.

    I had my last small group last spring, 40 years in pathology and teaching. I always found the students engaging and energetic…. as a pathologist we taught the case reviews which kept me engaged in clinical medicine.

    We transitioned from black and white photos in Boyd’s pathology textbook to holographic images, from chromosomes to target molecular testing. You, in your practice, order and use the laboratory tools to care for your patients. I respect you, and it gives me appreciation for our profession. What a magnificent journey!

    At age 70, I have worked long hours with passion and intensity. I am retiring in a week; with no regrets.

    We have lived through and have enjoyed multiple generations of thinkers. My mantra has been if I can teach one student (resident or fellow or colleague) one element of medicine one time in my career, I truly hope that I have been successful. I believe that I have done that.

    I will express the concern of a youthful comment of “midlife crisis”. Humane sensitivity and all communication in medicine is level, person to person, NOT up or down or lateral based on title or prestige. I hope that your young student focused on didactic medicine develops sensitivity. It need not be for you, but the 58 year old diabetic……

    Thank you!

  • Karin Berg MD December 22, 2018, 11:24 PM

    Loved this article. Thank you Dr. Marion.
    First year med stud…errr…55 year old physician, lab director, mentor, former researcher, old fart, Karin D Berg MD, MS

  • Rainer Sachse December 22, 2018, 11:41 PM

    Compliments for this beautifully written essay and the contained valuable message

  • Victor G ETTINGER December 23, 2018, 1:12 AM

    Happens to all of us. However as long as we continue to think young, we remain so. Age is only a number but ‘youth’ is what truly keeps us young.

  • greg hall December 23, 2018, 6:14 AM

    I was drawn to the title, but have a little different point of view. I have been out of the teaching hospital for over 30 years and have drifted far from the excitement of the new student to the grind of seeing 30-60 patients a day.. I recently saw a photo of me holding the sister of someone I work with now, and it takes me way back. Her mom wrote my name in the photo margins from being part of the birth. (Yep, an actual photo in an album…) Clearly the only way anyone would have known it was me and not something that was done very often I bet..

    So a different point of view. First knowing I am approaching the end of a career and remembering there were special moments along the way. A message sent from the past and a good Christmas present.

  • andrew m norris December 23, 2018, 7:38 AM

    Thank you Dr Marion,
    I still get together with my medical school buddies now 35 years later about once a year. We have a great time together (we could not afford the things we do together now, 35 years ago) reminisce and feel like the kids we were in Medical School again, for about 4 days.
    Yes, the realization that we were once there and this is now sometimes hits us hard in the face. It is both bitter and sweet.

  • Kirk Rossiter December 23, 2018, 7:40 AM

    I enjoyed this piece. Didn’t know where it was going or that a physician was writing about his own personal experience either. You are definitely a talented author. It definitely kept my attention.

  • stan sujka December 23, 2018, 8:18 AM

    We are so busy that we don’t look in the mirror to realize how life is racing by. My realization came when I was talking to one of my nurses and she told me her father’s age which happened to be two years older than me. Then I looked in the mirror and who did I see, it wasn’t me, it was an image of my father.

  • Daniel Golshani December 23, 2018, 8:18 AM

    Having a love for what we do on a daily basis , being totally engaged with a frame of mind to heal, teach, and help others has the ability to slow time, even to a stand still. Einstein himself would have been proud. Thank you for sharing.

  • bill FENTON December 23, 2018, 9:28 AM

    Most Americans see this as a type of Rip Van Winkle story but it is far older. I share your amazement at the passage of the last 20 years. Perhaps we need more variety in our lives? //In the tenth chapter of his book Lives and Opinions of Eminent Philosophers, the third-century AD Greek historian Diogenes Laertius relates the story of the legendary sage Epimenides of Knossos, who was said to have been a shepherd on the island of Krete.[9][10] One day, Epimenides followed after a sheep that had wandered off and, after becoming tired, went into a cave under Mount Ida and fell asleep. When he awoke, he continued searching for the sheep, but could not find it, so he returned to his father’s farm, only to discover that it was under new ownership. He went home, only to discover that the people there did not know him. Finally, he encountered his younger brother, who had become an old man, and learned that he had been asleep in the cave for fifty-seven years.[9][10] According to the different sources that Diogenes relates, Epimenides lived to be 154, 157, or 299 years old.[11] Multiple sources have identified the story of Epimenides as the earliest known variant of the “Rip Van Winkle” fairy tale.[9][10][12][13][14]//

  • Jerry Wishik December 23, 2018, 9:58 AM

    I read your blog with profound appreciation. Although I own and operate a walk-in medical clinic for the past 33+ years, a path somewhat different than yours, I graduated medical school in 1979 and can well appreciate your message. I was accepted to Northwestern, University of Florida and Einstein for medical school in 1975. I chose the sun instead of the snow and ultimately became a Gator fan. I too feel like a first year medical student at times but serving as a preceptor location for my own son who has now moved on to a dermatology residency in Chicago, age has shown its relentless power. Your academic accomplishments are impressive and your students have likely kept you young. My clinic and my wonderful patients and staff, as far as I can tell, have kept me young as well. Keep teaching and keep practicing. Your patients and your students need you more than ever as medicine evolves.

  • Richard Lipton December 23, 2018, 11:44 AM

    I love this story, and I completely relate. I’m an Anesthesiologist and trained at Einstein/Monte finishing in 1989. I have three daughters, one a brand new Anesthesiologist, one a senior CRNA student. If not for the fact that I helped raise these children I wouldn’t believe what comes from their mouths, all good things about our field!! Shocking, where does the time go. I look back on my training with great fondness. You are very lucky to have remained in that environment. Thanks for your story.

  • Raymond Paltoo December 23, 2018, 2:40 PM

    Been there. If you stay where you are all your academic life you have this impression because your colleagues are growing old with you. You have really never left the womb of the University. You life is bounded by Grand Rounds, papers for publication, and things that will advance your academic career. You have very little contact with the real world. My wife forced me away from that lifestyle and I cannot thank her enough! I was offered a fellowship with a world famous Urologist at end of my residency. I came all excited to tell my wife and she said, “After six years of residency,why don’t you get a real job?” I never regretted my decision to leave academia although sometimes when I would meet colleagues who were my juniors, at conferences, I would wonder if I had missed out on something more. Nah! My kids turned out well.

  • Sandra B. Gee December 23, 2018, 5:10 PM

    Dr. Marion,

    Chronologically, you are old. But, contrary to your body, it sounds like you have a young soul… It’s the soul that makes the person.

  • Tom December 23, 2018, 10:09 PM

    When my physician father turned 70 my brothers and I took him on a trip. At dinner one night I asked the typical question,”Do you feel old”? He answered, “Only when I look in the mirror “. Keep teaching, it’s great what you are doing.

  • Robert Epstein December 23, 2018, 11:31 PM

    Get over it. You’re entitled. My residents are mostly retiring. Shouldn’t stop you from joining rounds etc. if you are interested. Keeps you young.
    Just not only that! Bob Epstein