|
 Experiencing
the Humanities
My decision
to pursue a graduate degree in the medical humanities began as a sort of
subsidiary consideration. I had long intended to go to medical school –
from high school I chose to attend Baylor University, in part based on
the strength of its premedical program, and throughout college I
remained steadfast in pursuit of this goal, taking the required
premedical coursework and making sure to do all of the other things
necessary to get into medical school. However, as I grew closer to
achieving this goal, I became cognizant of a lingering and increasingly
distracting disturbance in the back of my mind. Medical school, and a
career as a physician alone, would not, could not be enough. Coincident
with my premedical preparations, I had also become aware of a new, and
at times overwhelming, passion at Baylor – the liberal arts. It was my
inability to set aside my love for literature, philosophy, history, and
the like as mere hobby that ultimately convinced me that I must find a
way to make these other dimensions a part of my professional life. I
became convinced that a full professional life for me could only be one
that split time between medicine and the humanities. I became determined
to find a way to do both.
However, as
I embarked upon the medical school interview trail, I realized that my
wishes might be more difficult to satisfy than I had previously
believed. Almost no school, especially among the several I was visiting
in Texas, possessed a combined degree program of the type for which I
was searching. Some of those affiliated with undergraduate institutions
suggested that I might be able to create something that might meet my
needs, most likely on the side, an extracurricular endeavor, but these
promises often seemed sort of empty. I do not believe I was being
intentionally deceived – those interviewers all seemed excited with my
enthusiasm and were eager to inform me of the many opportunities their
institutions likely possessed. However, they also conveyed that such an
independent undertaking would likely be an arduous one, time-consuming
and difficult to arrange. I left many of these schools conflicted,
excited to have potential opportunities, but dismayed to have no more
guarantees of these possibilities than the assurances of interviewers
who may or may not have truly appreciated the reality of these options.
When I
interviewed at UTMB, I expected to find similar circumstances – a school
that would be eager to try to accommodate my unique needs, but one that
may have difficulty meeting such good intentions as well. I thought this
right up until the moment when Dr. Ron Carson, the Director of the
Institute for the Medical Humanities (IMH), addressed the body of
interviewees at our orientation that morning and revealed the existence
of an MD/PhD Program in Medical Humanities. Later that day I returned to
Baylor encouraged, reluctant to get my hopes up until I knew that I had
been accepted to UTMB’s medical school, but also relieved that that
which I had longed for and sought after really existed. I ranked UTMB as
my first choice, and, when I was accepted the following spring, made
immediate preparations to pursue entrance to the graduate program as
well. Medical school without the humanities seemed impossible to me;
discovering UTMB and the IMH meant I would not have to make such a
choice. When, over a year later, I was finally accepted to the MD/PhD
Program, I was elated. The essentials of my life were falling into
place, as they had to if I was to continue down this path at all.
For me, entrance to the MD/PhD Program was an all or nothing event;
either I would be admitted or else I would have to completely reevaluate
my professional direction. Fortunately the former occurred, allowing me
to continue to where I am today.
I am now beginning my sixth year here at UTMB. My first two and a half
years were spent in medical training, and I have been in graduate school
at the IMH for these last two and a half years.
The first two years of the PhD curriculum at the IMH consist entirely of
formal coursework. During these years I took the following courses:
Humanism and the Humanities, Bioethics and Law, Religion and Medicine,
Humanism and the Medical Humanities, Literature and Medicine, American
Doctor-Writers, Foundations of Bioethics, Clinical Ethics, Traditions of
Health Care in the U.S., Practicum, Narratives of Illness, Nature and
Genetics, Ethics of Scientific Research, Traditions of Medical Ethics,
Philosophy and Medicine, Narrative Ethics, and Ethics of Health Policy.
And, as occurred during my undergraduate training, a few primary areas
of interest emerged during these years. These include narrative and
medicine (literature and medicine, narratives of illness, and narrative
ethics), clinical ethics, the history and practice of moral medical
education, and the practical work of doctoring. It is in these areas
that I foresee doing the majority of the scholarly work in my career and
upon which I focused my qualifying examinations and will focus my
dissertation work.
The
specific topics of my five qualifying examination questions included
narrative ethics, narratives of illness, virtue ethics, moral
imagination, and the history of ethics education in medicine. Qualifying
examinations at the IMH are a rigorous undertaking. Students typically
allow a semester or so to prepare, studying with their committee
members, developing topics and formulating reading lists, and becoming
sufficiently comfortable with the material to undertake the final
examinations. The exam itself consists of two parts: a written exam,
during which students have five days to answer five questions as
formulated by their advisors, and an oral defense, which occurs after
the written exam and allows the student and his/her committee members to
further discuss the topics, challenging assumptions and further
developing ideas and thought processes. The purposes of the examination
are many, but of primary import for me was the opportunity to hone my
areas of interest and to allow an extended and self-guided time during
which I could explore these topics. The exams provided an amazing
introduction to my dissertation work by allowing me to undertake an
extended, organized, and rigorous investigation of my own personal
medical humanities. Having just completed these examinations a few
months ago, I am now working on my dissertation, a process that seemed
unfathomable before my qualifying exam preparations.
The
beginnings of my life at the IMH required orientation to a certain
degree of culture shock. Having just arrived from the rigorous,
regimented, and pragmatic world of undergraduate medical education, I
had grown accustomed to a certain way of thinking, of believing, of
acting. My formal humanities education threw all of this into disarray
and uncertainty, forcing me to reconcile medical and humanistic frames
of mind that often seemed in direct conflict or competition. Primary
among these reconciliations was an increasing comfort with ambiguity, an
understanding of the plurality of values at stake in the medical
relationships between health care professionals, patients, and families,
and an appreciation of the various ways in which problems could be
contextualized and approached.
As I
expected when I set out upon this path so many years ago, the humanities
have become and will always be an integral part of my life as an
academic and as a health care professional. My work was a doctor will
always be irrevocably informed and affected by my education and the ways
I’ve come to think. I also intend to teach and write as a strict and
academic humanist, although I know that this too will also be shaped by
my education and career as a doctor. For me, the medical humanities have
become far more than the mere application of the humanities to medicine,
and/or vice versa. Rather, they are inextricably linked, and, for me,
one cannot really exist without the other. It is for this reason that it
was essential to undertake these dual degrees simultaneously. Alone,
they might not have yielded the symbiotic effects for which I now value
them both so highly. I am thankful for the opportunity I’ve been given
to be an MD/PhD student. I cannot imagine my education and professional
development otherwise.
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Jing-Bao Nie, BMed
(tcm), MMed,
MA, PhD
Graduated
May 1999
The Flying Time with Joys of Learning:
Experiences of a Foreign Student at the Graduate School of UTMB
“Time flies when you
have fun” was one of English phrases I learnt at Galveston. I actually
experienced what it says in 1993-1998 when I received my PhD training at
the Institute for the Medical Humanities (IMH) of University of Texas
Medical Branch (UTMB). According to Confucianism,
we are not
born, but learn to be human. Learning, a never-ended process at both
individual and collective levels, is the starting point of humanity, a
source of happiness, a root of culture and morality, and a way to the
highest good. Few
joys that human beings can have are comparable to these of studying and
learning. Learning with right people and at a right place, such as those
at UTMB Graduate School of Biomedical Sciences (GSBS), makes the
studying time more enjoyable and flying even faster.
Academically and
intellectually, the major reasons for me to choose UTMB over other
graduate schools lies in the multidisciplinary or interdisciplinary
feature of its medical humanities program. In the early 1990s, when
surveying the possible places to pursue a PhD degree in humanities and
social sciences as related to healthcare, I knew IMH through some
publications by its faculty members and The Peterson’s Guide on
Postgraduate Studies in North American. I could hardly believe that
at a medical school there exists such an Institute whose faculty members
have such a diverse academic background: history, philosophy,
literature, law, arts, theology and religious studies. At any of other
programs throughout North America, one would have to be “disciplined” in
either of the history of medicine, medical sociology, philosophy of
healthcare, or bioethics. Only at IMH would it be possible to pursue all
these fields at one place.
The interview
process greatly helped me to become more attracted to UTMB by knowing
directly the physical and intellectual environments of IMH. The Moody
Medical Library, especially its collections in the medical humanities,
is splendid. The “Old Red,” on whose second floor IMH is located, is such a
magnificent architecture that survived the
horrible hurricane in the first year of the twentieth century and that
my underage daughter later referred as “the palace”. Meeting in person
the prospective teachers and fellow postgraduate students at the
Institute definitely assured me that I would have a challenging but
rewarding time in Galveston. As a result, as soon as I received my
letter of acceptance from UTMB, I declined other options.
The pre-candidacy
course work was extremely heavy. By requirements and choice, I took 18
courses in total: including literature and medicine, the history of
American medicine, ethics and healthcare, medical ethics and law,
humanism and medical humanities, religion and medicine, arts and
medicine, gender and medicine, and humanistic gerontology. Looking back
at the curriculum, I am not sure whether one should take that much
course work. But I am sure that these courses altogether gave me a solid
and broad intellectual foundation from which I continue to benefit ever
since. It was indeed fascinating to learn the different approaches of
several academic disciplines to the issues related to illness, health
and healing.
Among the great texts we read were Giambattista Vico’s On
Humanistic Education,
Matthew Arnold’s Culture and Anarchy, Friedrich Nietzsche’s
Beyond Good and Evil, George Eliot’s Middlemarch,
Leo
Tolstoy’s The Death of Ivan Ilyich, Franz Kafka’s The
Metamorphosis, Thomas Mann’s The Magic Mountain, and Albert
Camus’ The Plague and Alexander Solzhenitsyn’s The Cancer
Ward. We
were also exposed to practice and reality in various ways, including Dax
Cowart as a guest lecturer about his case, visiting AIDS patient at
home, and attending rounds in the wards in hospital. Writing course
essays was a very effective way of learning research skills, exercising
critical thinking, and formatting independent judgements. Besides, I had
learnt a lot from my teachers on how to teach.
The qualifying
examination—writing about 100 pages in five days for five different
questions—was demanding intellectually and psychologically. But this
constituted a good preparation for the forthcoming research as one
became more familiar with the subject areas directly related to the
proposed dissertation topic.
Regarding my
post-candidacy experiences, I must say that it was one of my greatest
fortunes and honors in my academic life to have Professor Harold
Vanderpool as the primary supervisor, Professors Ronald Carson and
Michelle Carter as the departmental members of the supervisory
committee, Professor Susan Weller from the Department of Social and
Preventive Medicine as the outside departmental member and Professor
Arthur Kleinman from Harvard as the external mentor. Writing the
dissertation under their supervision, an intellectual labor became a
much more enjoyable proceeding. Without their encouragement, guidance,
and enormous concrete help it would be impossible for me to complete the
dissertation, which won the 1999 dissertation award of GSBS and led to a
book entitled Voices behind the Silence: Chinese Perspectives on
Abortion (Rowman & Littlefield, in press).
IMH created a
wonderful environment for learning. All faculty members at the
Institute, including Professors Anne Jones, William Wislade, Chester
Burns, John Duart, Ellen More, Mary Winkler, and especially then
director of graduate program Professor Thomas Cole, are all easily
accessible and always helpful. The productive learning environment was
also due to the cheerful support from and efficient work by
administrative personnel at IMH and BSBS, including Mss Sharon Goodwin
and Lewis Ray, with whom I had very positive experiences.
My follow
postgraduate students were simply superb. They were my teachers too.
Especially, no words can describe sufficiently how much I had benefited
from my friendship with now Drs Kirk Smith, Faith Lagay, Lex Bambas and
others. They had helped me with so many different matters in so many
different ways, to mention only a few, improving my English language in
writing and speaking, enriching my knowledge of American culture and
social life by travelling with them and visiting their families and
friends, and solving concrete problems a foreigner often encountered in
a different country.
Basic financial
security is always crucial for enjoying learning. Stipends and financial
support continuously granted to me by IMH and PSBS were essential for me
to study at UTMB and for my family to live with me at Galveston.
Meanwhile, the rewards and competitive scholarships constituted the
encouragements and honors that urged me to do my utmost. In addition,
with the generous help from Professors Carson (the Director of IMH) and
Vanderpool and others I also successfully obtained a one-year full
doctoral fellowship and the funding for the field work of my
dissertation research project from external sources. It turned out that
the importance of the skill of grant writing could never be
overemphasized for the later development of my career. I am glad I
learnt it at UTMB.
One of the wonderful
features of UTMB was the commitment and actual financial support of IMH
and PSBS to the participation of the graduate students in national and
international conferences. Presenting papers at academic conferences not
only contributed directly to my professional development but also
resulted in publications as journal articles and book chapters.
As a student from
China with training in traditional Chinese medicine and several year’s
teaching experience at a Chinese medical school, with my Chinese
colleagues I organized several China-U.S. academic exchange activities
held in China. These extra-curriculum activities were so enjoyable due
to the active participation of some faculty members as well as my fellow
students at IMH.
In short, as a PhD
student at UTMB I had a great time. Galveston was, is,
and will continue to be special for me:
the faculty
and staff members, the classmates, the friends, the conversations, the
classes, the brown bag seminars, the Old Red, the cadavers up the floor
of IMH, the sunlight, the sea wind and waves from the gulf, the walks on
beach, the vast field, the country fairs, the parties, the beer and
wine, the Mexican food, even the long and burning summers. Galveston is
also special for my family and our youngest family member was born there
at the hospital. Taking advantage of
writing this essay, I would like to
publicly thank all the teachers, friends, fellow students and many
others in North America, especially those at IMH, who had kindly
supported and helped us.
In the late 1960s
and the first half of the 1970s, as a village boy and a son of “class
enemy” at the somehow remote area in Southern China, the world beyond
the hills surrounding my home village was far beyond me even in the
wildest imagination of mine. When I decided to go to North America in
the late 1980s, to
significantly expand my intellectual horizons and life experiences, was
my dream. With
my time at UTMB, together with one and half years
as a MA student in sociology at Queen’s University in Canada and one
year as a postdoctoral fellow at the Centre for Bioethics of the
University of Minnesota, I certainly realized
my dream. My
present career is consistent with my plan before I went to UTMB.
Actually, living and working in New Zealand realized a dream I never
though could come true, i.e., undertaking academic works at a beautiful
and peaceful countryside location. What I had learnt at UTMB well
prepared me to conduct original multidisciplinary or interdisciplinary
research, to teach effectively in New Zealand and China with students
from medicine, law, sciences, humanities and social sciences, and
especially, to continue to learn with joy.
Jing-Bao Nie, BMed (tcm),
MMed, MA, PhD
Senior Lecturer, Bioethics Centre, University of Otago, New Zealand
Visiting Professor, Wuhan University, China
Undergraduate institution: Hunan College of Chinese Medicine, China
Age: 42
Gender: Male
Nationality: Chinese
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Alison H. Rutledge, PhD
Graduated
May 2005
 Neither
Past Nor Future, But This Moment
Live neither in the past nor in the future,
but let each day’s work absorb your entire
energies,
and satisfy your widest ambition.
—William Osler
Everything I can say about my UTMB graduate
school experience — from the first step, taking
the GRE on a wintry day in Iowa, to writing my
dissertation now —seems different from the
experience of my fellow graduate students. Of
course everyone’s situation is unique, and of
course every essay will tell a different story.
But I seek a second Ph.D. as a woman in
her fifties and a former psychologist; that
makes my story unusual, I suspect, by any
standard.
As a returning student I have been teased about
many things: being insane for embarking on such
a masochistic exercise; trying to revert to
childhood by assuming the student role; avoiding
a real job in the real world. Other people’s
choices often look strange from the outside. But
for the person making the choices, sometimes it
feels like the path of life has narrowed and
narrowed until there is one door left to go
through. You open that door because it is the
only one. In my case, I opened the door to the
Gulf of Mexico, brilliant flowers, dolphins and
pelicans, hard and wonderfully satisfying
intellectual work, and a southern hospitality
that must be felt to be believed.
No one embarks on a late second Ph.D. without a
long and probably traumatic backstory. Mine is
fairly gruesome in its particulars, but like
most such stories it generically involves loss,
betrayal, illness, struggle and repeated
failures to adjust to change, and ultimately
waiting quietly, and sadly, for the future to
unfold and present me with expectations. In a
way, it didn’t seem to matter what I did. But I
knew I could no longer practice clinical
psychology.
In this ordeal I was deeply fortunate to have
loving family support, and I flew from Iowa to
Houston to visit my brother for a week in the
spring of 1999. I had never been south of Kansas
City, at least not in the Central Time zone. I
was amazed by the green, the warmth, the silky
air, and the friendly people. In the Midwest,
people are known for their niceness,
helpful-ness, and politeness—but not
friendliness. I soon realized that in Texas you
cannot stand in any line, anywhere, without
somebody striking up a conversation and sooner
or later calling you “honey.” It took some
getting used to, but I liked it. In Galveston, I
especially loved the ocean and the architecture,
and I wondered what it might be like to live
there.
Back in the cold Iowa April, I used my novice
Internet skills to find out more about
Galveston. Not until then did I realize the big
buildings on the east end of the island—farther
east than my brother and I had driven during our
two visits—were not more hotels, but hospitals,
and that Galveston was home to a large medical
school. Intrigued, I investigated job openings
and academic programs at UTMB. By accident I
landed on a page describing the Institute for
the Medical Humanities (IMH), and I read with
interest about this remarkable group of
dedicated scholars and ethicists. Then I learned
the IMH had a graduate degree program; finally I
saw the list of courses, and I was riveted.
There were courses on medicine and philosophy,
history, literature, law, humanities, and
religion, with titles like “The Ethics of Health
Policy,” and “Narratives of Illness.” These were
areas I was deeply interested in as a
psychologist and citizen. My stressful job in a
large state hospital was raising many questions
for me about the development of an ethical
culture in the workplace, and the most
compassionate ways to provide high-quality care
to vulnerable populations.
What did I have to lose? I sent off for the
application materials. I mulled them over for
some time, and then figured I could take the GRE
(for the second time, but the first time was in
1973!) and if I failed, that would be the end of
it. So a snowy December day found me in a
cubicle on the Iowa State University campus
answering multiple-choice questions on a
computer. I didn’t fail, so I sent the scores
off to UTMB—when I hit that computer button, it
was a portentous moment, as if I were committing
myself to who knew what—and went home to pull
together the rest of the application materials,
which were many. Official transcripts, some
thirty years old; forms to fill out; letters of
recommendation, including one from a certain
former professor who was still alive; a writing
sample; a statement about what I wanted to do.
That was a bit of a problem because I didn’t
know what one actually did as a medical
humanist, so I called the IMH admissions
director to ask, and she and I had a nice talk.
Months went by, and then one day I got the call.
I was offered a slot in the fall of 2000 as an
IMH doctoral student; would I accept?
At this point I became consternated. My
application had been a pipe dream, more to see
if I could get accepted than to really turn my
life upside down. I realized I had no money to
live on if I were to become a full-time student
without a job. I realized I could never afford
out-of-state tuition. I hadn’t written a term
paper in decades. I was not willing to get by
without good health insurance. I didn’t know a
soul in Galveston. I said all this to the IMH
admissions director, and that I would think
about it and get back to her. She seemed
disappointed. I told her I was thrilled, but . .
. I had to be realistic too.
Three or four days later I got a call from the
IMH graduate program director, who offered me a
four-year package: a graduate assistantship with
a small stipend, in-state tuition, and good
health insurance.
The universe, it seemed, had come up with some
expectations for me.
I dithered and dallied for awhile, but at heart
I knew I truly was going to go to Texas. The
next few months were full of arrangements. I
remodeled part of my house to make it more
attractive for rental, found a property
management company, got an apartment in
Galveston via a real estate company online,
decided what to take with me and got a storage
unit for the rest of everything I owned, and
took my cats to a friend’s farm. I ended up
caravanning down Interstate 35 in a U-Haul with
my adult son, and his fiancée and her parents
and brother and sister in another car. What
could have been a doleful, lonely business was
made festive with an overnight stop at fiancée’s
grandma’s house in Topeka, and the next night
dinner at a great BBQ joint in Keller, Texas,
where I tasted my first (and far from my last)
Shiner Bock.
Of course the day came when my traveling
companions went back to the Midwest, and I was
in a one-bedroom apartment in a complex like a
rabbit warren and not even a cat for company.
But I developed a sort of fierce stoicism.
This is no worse, I said to myself with
gritted teeth, than what you have been
through before. I walked to campus, went to
orientation, registered, and finally started
classes on a hot day in September. And then the
world opened up in a new way.
Taking a history class taught by a brilliant man
who loves his subject and loves teaching is an
experience I would wish for everyone. Dr.
Chester Burns is a master. He treated us
students with a respect we could not help but
return. He was formal yet warm, direct yet
tactful, solemn yet funny. I worked hard to keep
up with the reading, participate in class
discussion, take my first in-class midterm in
ages, and write the final paper. One day I was
sitting on the floor in the Moody Medical
Library between shelves of medical journals,
doing something I remembered from the past:
taking down one journal after another to leaf
through the tables of contents to see if I could
find something interesting. Like most libraries,
the Moody Medical library smells good. I had
that pleased, fresh feeling of starting a new
semester and exploring new territory. It struck
me then, on that floor with a tall stack of fat
journals next to me, that I was happy. There was
nothing in the world I would rather be doing at
that moment.
I had other classes, and the graduate
assistantship was interesting but not too
demanding. I was asked to read essays and grade
them, read books and talk about them, help
facilitate POM meetings, go to morning rounds
with the Family Medicine Department residents,
and photocopy reams of syllabus material. There
were colloquia and grand rounds and brown bags
to attend. I had worked in hospitals and been
part of medical care teams before, but never at
a teaching hospital. My first two years of
coursework and assistantship work were quite
marvelous. It was a whirlwind of satisfying
intellectual stimulation. In addition, the
second year, I got a part-time job working with
a grant in the psychiatry department. They
needed telephone interviewers to talk to people
all over the country about their mental health
or illnesses. Even though I was no longer a
psychologist, I knew I could have a meaningful
telephone conversation with someone about his or
her history of depression. This job led to a
part-time job in another department where I sit
face-to-face with patients and give them
batteries of neuropsychological tests. This work
is technical and exacting, but not stressful or
emotionally draining, and I find the contact
with patients very rewarding.
I had to check with Mr. Bennett in the Graduate
School about moonlighting while I had an
assistantship. Mr. Bennett was a good friend to
me. He never failed to help with procedural
details, and he knew just where to find the
answer to any question I had. He told me that as
long as I kept up my grades and satisfied the
requirements of the assistantship, there was no
problem with making extra money on grants. To be
cautious, I kept the number of neuropsych
batteries down to two a week as long as I was
still taking classes.
Periodically my advisor would mention that the
comprehensive exams lay ahead. I only dimly
remembered them from my first Ph.D.; as I
recalled, they were unpleasant. I told my
advisor that I simply could not think any
further ahead than the next class, the next
assistantship assignment, the next brown bag.
Like a dissertation, like finding a job after
graduation, comps were just too far away in the
future to seem real. Having a foreshortened
sense of the future can be one of the sequelae
of unresolved loss, and I seemed to have that
symptom to a great extent. (That first fall, I
had not even realized there would be a Christmas
vacation until some point in September when I
studied the academic calendar. I remember the
shock of relief I felt when I realized I could
go home and see my sister and my son and friends
again, at Christmas.)
Meanwhile there was a lot of activity. I went to
Nashville one year and Baltimore the next, to
the annual meetings of the American Society of
Bioethics and Humanities. I presented papers
twice to the IMH Student Colloquium. I had a
long creative period of writing poetry, and I
got some of it published. I wrote a proposal to
present a paper at a Poetry and Medicine
conference at Duke University, and it was
accepted. I have been asked to work on other
grants involving psychological testing, in
various departments on campus. I built warm
friendships with other students, support staff,
work colleagues, and through a writing group,
Quaker meeting, and the Unitarian Church. My
brother and I visit often, and to my
astonishment my son and his (at last) wife moved
to Houston in late 2002. My cup ranneth over.
Comprehensive examinations were indeed difficult
when I finally got ready for them. I wish I
could say they were a challenging and fulfilling
experience, but I found them just terribly
stressful. For IMH comps one writes an essay a
day—between twelve and twenty pages—for five
days, on subjects one has more or less prepared
for by having discussions with one’s faculty
committee members along with extensive reading.
The most I can say now is that they are behind
me and I am glad. It took me a long time to
recover and feel like working on anything more.
I did learn one valuable lesson from the ordeal:
if you can write fifty indifferent pages in one
week, you have no excuse not to write an
adequate dissertation in one year.
I had written a dissertation before, of course,
but it was a based on a quasi-experimental
design in clinical/social psychology. In the
social sciences, dissertations follow a rigid
template and the writing style is academic and
dry. I had to continually suppress myself to
meet the requirements and turn in a piece of
work dull enough to pass muster. All I wanted to
do, really, was finish and get out into the
world so I could practice psychology and do some
good for very sick people. I enjoyed my
dissertation and thought it was pretty good, but
I had no wish to publish it or work any part of
it up for publication. Now I am working on a
dissertation that has more meaning for me, in a
(slightly) more lively and impressionistic
writing style. When I feel unenthusiastic, it
calls me; my friends tell me to get back on it;
I watch the pages add up in wonderment. It has
taken on a certain worth in its own right and
demands to be worked on whether I feel like it
or not.
In my impulse to use this essay to express
gratitude for all the learning experiences and
fortunate connections I have made during this
unexpected phase of my life, I do not wish to
sound altogether like a Pollyanna. I have had
hurtful interchanges with professors and
occasional unpleasant experiences at work. I
have written proposals to give presentations at
national conferences and been turned down. I
have applied for scholarships and not won them.
I applied for a job in my new field that seemed
perfect for me, and received only a form letter
saying I was not what they were looking for.
Being fortunate enough to have the opportunity
and time to study and learn is no buffer from
ordinary life stresses and fears about the
future.
Here arises an obvious question: What am I going
to do with this degree? At first I had fantasies
about teaching at a university or working at a
medical school or a think tank in an ethics
program. I thought about the pleasures of doing
research and publishing articles and writing
books—a very fulfilling way of life. Alas, I am
sure it is, but it is not to be had for the
wishing when one is advancing toward the second
half of one’s fifties. I have found from bemused
experience that medical schools and universities
are rightly anxious to hire young, eager, and
energetic aspiring scholars who have the
starry-eyed ambition to get tenure, to publish
mightily, and to make names for themselves in
the field. I am more of a nondriven but seasoned
professional who looks for a niche both to
contribute to and appreciate the state of the
art in Medical Humanities. There is no way to
predict if such a way will open. As before, I
wonder what will be expected of me in the days
and years to come.
For now, I work three-quarter time doing
neuropsychological evaluations and clinical
interviews with patients with AIDS for three
different grants. When I got the job, I was
happy to resign my assistantship so another
student could benefit from the same generosity I
experienced in the IMH. I work on my
dissertation, an exegesis about first-person
published narratives of mental illness. I have
not strayed far from psychology after all. I
remain interested in the ethical aspects of
long-term care for the psychiatrically disabled;
the psychology of unethical research-ers; the
meaning of the insanity defense; the treatment
of animals in research; and ethical responses to
the exigencies of managed care in psychiatry. If
I ever imagined that my identity as a
psychologist was something I could step out of
like a coat, I was wrong. Now I have blended
parts of psychology with parts of the study of
ethics and medical humanities. It feels like a
happy merger, whatever happens.
Oh, and I tend to call people “sweetie” when I
am standing in line. And outside my window as I
write this, a lime tree is heavy with beautiful
fruit.
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 I
spent my teens and early twenties deciding to
become a doctor. Years of soul-searching,
volunteering in hospitals, talking to family and
friends, and comparing visions of possible
alternate futures lead me step by step from
extra biology classes in high school to the
white coat ceremony. Looking back now, the
decision to attend medical school took up a
substantial part of my life. I struggled with it
and the process is necessarily now part of who I
am.
I decided to attend graduate school in minutes.
I happened upon a link to the Institute for the
Medical Humanities while looking through UTMB’s
website in preparation for a medical school
interview. I remember finding a list of graduate
courses offered at the IMH – Narratives of
Illness, Traditions of American Medicine,
Clinical Ethics, Interpretation of Texts. By the
time I had read to the end of the page I knew I
would apply. It seems like, and was, a
relatively huge change of plans. Yet I had such
an easy time making the decision that it didn’t
seem then, and still doesn’t, seem like a
decision at all. It was love at first site.
There was no decision to be made.
“What do you plan to do with a degree like
that?” I heard my father trying to decide what
tone of voice to take. I knew what he was
thinking. God, she’s almost there – I thought we
were done with this. I remembered all the times
I’d expressed doubts about medical school. I
really wanted to be a teacher. I really wanted
to go into law, or policy. I really, secretly,
wanted to write. These felt like confessions to
me, like somewhat subversive hobbies I would
necessarily have to give up to do what I
ultimately felt called to do – practice
medicine. After all the years of struggling I
felt that I wanted the instant, personal, face
to face reward of making a difference in an
individual’s life. Yet I still felt strongly
that I could, perhaps, contribute something to
the field of medicine outside of the clinic –
something more abstract, more lasting. I felt
like the things that drew me to medicine were
issues that needed attention in the surrounding
social and political context before they could
ever be translated into better care at the
bedside. And although I had already given myself
to medicine, I still anticipated the
claustrophobia of the examining room. A graduate
degree felt like an open window into the world
of research, policy and education, and thanks to
the option of a combined MD/PhD program, I no
longer had to leave part of myself behind in
choosing a career.
I don’t remember if I had any strong feelings
one way or the other about UTMB as a candidate
medical school before I found the IMH. I was not
searching for graduate schools at the time, and
I didn’t apply to any other graduate program. I
came to UTMB to work with the faculty in my
department, and although I’ve since had many
valuable experiences with other things that the
campus has to offer, I still think of the IMH as
the reason I’m here.
To my knowledge, UTMB offers the only MD/PhD
program in the Medical Humanities in the
country. Other schools with strong bioethics or
humanities departments have rumored to allow
medical students to work toward graduate degrees
in these fields, but not within the framework of
a structured, funded, combined degree program
such as ours. If this option did not
exist at UTMB, I feel sure I would not be
working toward a PhD. I’m looking ahead toward
my fifth year in the program now, and I still
feel grateful for whatever karma or serendipity
led me to that web page so many years ago.
Although I can’t speak for the other students in
our department, I feel fairly confident that our
collective experience in the GSBS at UTMB
differs significantly from that of students in
the natural sciences. For one thing, we have our
own curriculum and rarely, if ever, take courses
outside of our department. Although we operate
with a relatively small faculty that can, due to
logistics, only offer a few courses each
semester, the scope and depth of our coursework
more than adequately prepares us for the
dissertation process and the issues we may face
in the field. The true strength of the graduate
program at the IMH, in my opinion, is the
individual and collective commitment on the part
of the faculty to education. As a student I have
consistently received their support and
professional courtesy, and have never felt
trapped by excessive direction or abandoned to
my own devices. Even despite the additional
burden of my status as an MD\PhD student with an
odd schedule and commitments to other schools,
I’ve never experienced anything other than
respect and competent, professional
smoothing-out of the inevitable administrative
tangles.
As I look ahead to comprehensive exams and my
dissertation, I’m struck by the extent to which
the combined degree program has shaped my
academic development both in medicine and the
humanities. Having spent a year in graduate
classes reading about the history of medicine
and clinical ethics, I entered medical school
with an eye toward professional and social as
well as clinical issues. Now back in graduate
school, I recognize that the perspective I
gained in medical school, in classes but
especially on the wards, has not only shaped my
research interests but heightened my awareness
of the importance of these issues. Although at
times I feel as though I live in two worlds, or
even that I’m two different people, I’m also
unable to separate my medical and graduate
academic development. These two aspects of my
intellectual identity have grown and changed
together and in reaction to one another.
A significant issue for many MD/PhD students
seems to center around the way they plan to
split their time between two relatively distinct
activities: practice and research. I’ve heard
some of my classmates express their conviction
that one person can’t possibly do both things
well, and that many clinician researchers end up
spending most of their time in the lab,
regardless of whatever good intentions they had
to practice medicine as students. Of course I
can’t speak for my colleagues in the natural
sciences, but as I begin to imagine my own
career more clearly, I see myself actively
engaged in medicine and research. I hope to
enter the field of adolescent pediatrics, which
I believe fits my interests clinically as well
as provides a rich context for exploring the
ethical and social issues surrounding children,
parents, teenagers, and health care. Of course I
believe that my graduate degree will make me a
better doctor. But that’s far from all it will
do. By exploring the issues facing my patient
population through theoretical and empirical
bioethics research, actively participating in
policy debates, and leading premedical and
medical students through their own exploration
of these issues, I believe I can do more than
care for my patients individually. I believe I
can advance the field through careful and
rigorous scholarship.
University of Texas at Austin
Age 27
Female
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