Prologue
Some people held cups of coffee. Others held babies or the hands of spouses. David Kessler, the dean of the medical school, clutched a cell phone in one hand and a wireless e-mail device in the other. I clung to a small spiral note pad that listed family and friends we wanted to call when we got the news. And Stephanie, like every one of the other fourth- year medical students in the room, held an envelope.
The envelopes were brown and thin, each with a white label and a name on the front. A few minutes earlier, Dean Kessler had told the students to retrieve these envelopes by approaching one of the seven stations set up in the room. Although the students could pick up the envelopes, they were not to open them, he explained. "It's not time yet," he said, looking at his cell phone.
Stephanie had followed the dean's instructions and walked to a school employee sitting beneath a white sign that read a–ch. She quietly stated her name, "Stephanie Chao," and took the envelope handed to her. When she returned to me, she looked anxious for the first time that morning. "Let's get this show on the road," she whispered as she sat down. After holding the unopened envelope for a minute or two, she placed it on the table in front of us. Her long black hair, pulled tight in a ponytail, brushed against the back of her white sweater. She wore a bracelet of brown prayer beads on her wrist, "Buddha Beads," she called them, and it didn't hurt to have them with her on this day. Her mother had given her the bracelet when she was a teenager, and Stephanie put it on each morning when she got dressed. She didn't wear much other jewelry—if the prayer beads could even be called that. No rings on any of her fingers; just the bracelet, a petite watch, and a thin chain around her neck that I had given her after we started dating in college.
We sat inside the Golden Gate Room at her medical school, the University of California, San Francisco, on a March morning in 2006. A row of windows lined an entire wall of the room and through them, off in the distance, fog hid the choppy, uneasy waters of San Francisco Bay. To the left, the bridge for which the room was named towered above the low clouds and stretched more than eight thousand feet toward Marin, connecting the city to all possibilities north. To the right, the country unfolded east with Oakland, Denver, St. Louis, Chicago, Boston, New York—the real world, as my mother called it—lying just beyond the windows' frame.
Inside the room nearly 150 medical students and their loved ones waited. About half of the people sat at large round tables, while others crowded in the surrounding pockets of space. Almost all kept very still. One woman, standing in the corner, covered her face. Tears ran through her fingers and her body shook in anticipation. The man to her side placed his hand on her shoulder, but she didn't stop crying.
Most eyes in the room were fixed on Dean Kessler at the podium. The dean was a tall, thin man with a perfectly trimmed beard and hair neatly parted to the side. He checked the small screens on his cell phone and e-mail device for the exact time. During his tenure as the nation's commissioner of the Food and Drug Administration, Kessler had been a bit of a stickler, once overseeing the confiscation of more than two thousand cases of orange juice because the word fresh was included in the brand name, when in reality the juice came from concentrate. Now he wanted to make sure that UCSF's Match Day ran exactly according to the national protocol, and the fourth-year medical students gathering at school ceremonies across the country were not to open their envelopes until 9:00 a.m. Pacific Time, 10 a.m. Mountain, 11 a.m. Central, and noon Eastern. We still had five minutes.
Stephanie and I sat silently at the table. A year earlier, I had known nothing of this ritual. Foolishly, I had thought that if she and I decided to plan a life together, we would be able to pick where we wanted to live. She would apply for work and additional training as a doctor, just as I would look for a job after graduate school. We would weigh our options and make a decision. But for the past year, as I learned more about the Match and as it occupied more of my thoughts, I knew it wouldn't happen quite like that. Stephanie's future, which in all likelihood meant my own, as well as the futures of more than fifteen thousand fourth-year medical students across the country, would all be dictated at the exact same moment.
Although these students were still a few months from the crowning ceremonies in which they would officially be pronounced doctors, this day—Match Day—seemed a more important culmination. They had each selected a field of medicine, then spent months working on applications and interviewing at hospitals. After the interviews, they ranked an order of preference for the hospitals in which they hoped to have their first jobs as doctors during the post–medical school period known as residency. The hospitals made similar ordered lists of their favorite candidates. Then, in the final step of the process, a computer in a Washington, D.C., office ran an algorithm that paired each student with a residency position. Each year on Match Day, at the same time across the country, the graduating students are handed their envelopes. Inside, a fragment of a sentence on a single sheet of paper dictates their first job as a doctor—and thus, their careers. The right job in the right program might open the door to prestige, power, and happiness. The right city might make it easier for a spouse or partner to tag along. But the wrong words on that sheet of paper could lead a person down a path of heartache.
This is the ritual every year. But there was something unique about the medical students in the room with us on this day, and those across the country waiting for the same minutes to pass; something different from the gatherings that had made up Match Days in earlier years, and part of an evolving trend. While about 72 percent of all practicing physicians in the United States were men, the room seemed evenly made up of male and female medical students. Across the country the same statistic held true—nearly 50 percent of the nation's medical graduates were women. Entering a field in which they would be required to work years of eighty- hour weeks and multiple overnight shifts, these women were forced to consider how to balance their careers and any desire to have children—a desire they often felt the need to hide on residency interviews—all before their careers even began, all in advance of this one day. Such considerations were not completely new; the handful of women who had entered the profession in years prior had also faced these challenges. But medicine was deeply rooted in tradition, and with this new generation, the face of medicine was changing along with many of its ways.
Three minutes remained. As we waited for the dean's green light, I felt my heart step up the pace through my thick black sweater. I was neither a doctor nor a medical student, but I knew my future was at stake, especially as I debated proposing to Stephanie in the next year. When I had met her in college, five years earlier, she kept a shelf full of books on the MCAT, the entrance exam for medical school, and had no doubts about wanting to become a doctor. She also had about the biggest smile I had ever seen. Around the same time, I considered a career in journalism, though I had recently shied away from my boyhood idea of covering a baseball team after talking to a sportswriter about the 162- game season, half of which took place on the road. He was unshaven and a bit on the heavy side. I asked him how was it to be gone from his family for such long periods of the year.
"I don't have a family," he told me.
Oh, I said. Was it something he ever considered, or was it too difficult with the job?
"Listen," he told me. "I have to have a job. I don't have to have a family. I might as well love my job."
I wanted both. Stephanie said that she did too. She went straight from college to medical school with the understanding that she had a long road ahead of her and that if she wanted to have children, she had better get her training out of the way as quickly as possible. She loved how her own mother had been so present in her and her siblings' lives when they were young, taking them on excursions to the park and making their lunches for school. Family was crucial to Stephanie. But in the last few years she had also grown attached to the field of surgery. Balancing children with career was difficult for the few women in this demanding and predominantly male- populated specialty. Surgery would require a seven-year intensive residency at the hospitals she had applied to, followed by another few years of a fellowship if she chose to specialize, and finally, a lifetime of an allconsuming job.
Two more minutes.
I knew that some of the possibilities in Stephanie's envelope could mean a more difficult life than others. A hospital she had interviewed with in Boston was known for great training, but also for eliminating any kind of an outside life for the seven years of residency. Although the hours at one of the programs in California would not be much better, we had heard that at least some of its residents had families. Rumors swirled on the interview trails. One small program, we were candidly told, had a divorce rate among its residents of more than 100 percent. I asked how that was possible. Someone got married and divorced twice, a resident told me.
The nervous chatter in the room continued. We sat above the university's fitness center on the section of campus dedicated to recreation. A cafeteria bordered us on one side with a table-tennis room for students on the other. Across the street, separated from Match Day by two lanes of traffic, a circular driveway, and parked ambulances, lay the university's hospital. Nationally recognized doctors, overtired residents, nurses, therapists, and students swirled down halls and in and out of patients' rooms. Lives began.
Lives ended. In just over three months the halls would be filled with new interns—the colloquial term for first-year residents, the rookie doctors. My father, who had been a frequent hospital patient, had always warned me about this time. "You don't want to get sick in July," he said. A teaching hospital is a wonderful place to get care, and it's where you find the best doctors in the country, but in late June and July, you also find a lot of people who don't know what they're doing.
One minute remained.
In the months leading up to Stephanie's Match, I found myself fascinated by this process for pairing new doctors with their new lives, and by the challenges the next generation of doctors faced as the profession reshaped. But most of all, I wondered about how Stephanie's life, and thus mine, was about to change. The next year would be a trial of sleepless nights, beeping pagers, and demanding senior physicians.
We looked at the dean. We looked at the envelope. Stephanie turned to me. "Do you want to be the one to open it?" she asked.
Someone called time.
Excerpted from Match Day by Brian Eule.
Copyright © 2009 by Brian Eule.
Published in March 2009 by St. Martin's Press.
All rights reserved. This work is protected under copyright laws and reproduction
is strictly prohibited. Permission to reproduce the material in any manner or
medium must be secured from the Publisher.
