Chapter 03: Deciding to Practice General Internal Medicine

Chapter 03: Deciding to Practice General Internal Medicine



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Dr. Escalante explains how she chose to attend Nicholls State University in Thibodaux, Louisiana (BS, Chemistry 1981). She notes the lack of direction she had in making choices because of her own inexperience and the lack of informed support in her family and the small town where she was raised and educated. She also talks about the concern with money at the time. She worked throughout college and asked her family physician about jobs. She eventually worked as a ward clerk in a local hospital and Dr. Escalante explains how this experience added to her understanding of what medical practice involved. She also explains that she majored in chemistry, as opposed to biology, because she was attracted to the “rigor and challenge” of chemistry. She notes that she always had to work hard to excel, but wanted to distinguish herself.



Publication Date



Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; Professional Path; Character, Values, Beliefs, Talents; Personal Background


Tacey Ann Rosolowski, PhD:

So tell me about that move [unclear]. So you went to Louisiana State University.

Carmen Escalante, MD:

Yeah. I had been accepted or I’d been put on an alternate. I applied in my third year, in junior, to medical school, because back then you could. They didn’t take many people. And I ended up an alternate at Tulane University, which is the other private university, but there was no dropouts.So then in my senior year, I was accepted to Tulane and LSU. Tulane had a very good reputation, but it was very expensive, because it’s private, like, [demonstrates]. Now it’s probably outrageous. Back then, what I paid for at LSU was very small compared to the tuition. And the only way I would have been able to go there would have been to, like, join the army or one of these kind of programs, and I didn’t want to do that. But they accepted me first. I got into the state school afterwards. And they’re right next door to each other with Charity Hospital was in the middle, so we both trained at the same place, but one’s private and one was public.So I went to LSU because of the finances. I think if money wouldn’t have been a problem, I may have gone to Tulane, but it was a major issue for me. And what I found was you were no longer the cream of the crop. There were a lot of very smart people in that class. You were competing with a bright group of people, and there were some people that didn’t have to work very hard and did very well. I ended up probably in the middle part of the class, the upper middle part of the class. I wasn’t the smartest kid anymore, you know. When I grew up, it was a very small community, I was always the smartest one, but now I wasn’t the top student, and that took some adjusting, you know.

Tacey Ann Rosolowski, PhD:

Wow. Now, did you find your confidence shaken? I mean, what was the impact?

Carmen Escalante, MD:

Well, I had always studied, so studying wasn’t a big issue, but I’d always studied and I’d make very high grade. And sometimes now I studied and I wouldn’t make the highest grade or I wouldn’t make near highest grade. I might make a B. And I put a lot of effort and I may not have been the—you know, the outcome wasn’t the same. We had volumes of material to study, but I was always very serious about doing it. But it took a little while to kind of readjust to how to study and, you know, how to prepare for the test and to be okay with not getting the A-plus and to be okay that you’re not going to be on the very top level of the class. So that was adjustment.

Tacey Ann Rosolowski, PhD:

So how did your interests evolve during this time? Because you ended up going into general internal medicine.

Carmen Escalante, MD:

Internal medicine.

Tacey Ann Rosolowski, PhD:

So how did that happen?

Carmen Escalante, MD:

Well, you know, really in your third and fourth year of medical school is when you start rotating into the different services, and the very first thing my third year was surgery and we had to go to Charity. One of the rotations, because they farm you out sometimes, but my first rotation was at Charity Hospital as a junior medical student, and I was assigned to the Pediatric Surgery Service, which wasn’t as bad as some of the others, but the surgery residents were very—the faculty and residents were back in that time where they were very intimidating, especially to students. I mean, they treated you terribly. And I was getting up at three in the morning because we had to be there and write all the notes and be ready to round with the team, the residents, before surgery started, so, you know, it might have been like at four-thirty, five in the morning that we were getting there, and you had to round and then they would go off to surgery. If your patient didn’t go to surgery, you just sat around, you know, and waited for them, and you could wait all day to round.And they expected back then we’d—Charity was a public hospital. It’s closed now, but it was an old hospital built during the Depression in the thirties, and we had to go and pull all the x-rays, find the x-rays, and we put them under the mattress of the patient. There were big wards, there were no separate rooms, so you had ten people in a ward all next to each other, no privacy at all. And you would find their x-rays, and you couldn’t bring it back to x-ray because they would get lost, so you would put it under the mattress. And that was a medical student job, to draw the blood, because the phlebotomist may or may never get to them, and make sure the blood got to lab, because if you just set it down, it may never be picked up, and get the x-rays and put them under the mattress so if your resident or fellow wanted to see them, you could pull them out, because they got very upset with you if you didn’t do that. And then you had to write a note on the patient, you know, make sure they were doing okay, and if your patient went to surgery, you had to go with them. So after doing that, and then you had to go to this—they called it the pit. It was where the surgeons on Saturday morning, early Saturday morning, you had surgery rounds. And the head of surgery, who was very strict and very intimidating, a student would have to present whatever cases he picked for that Saturday. So one of mine was picked, unfortunately, and I was a nervous wreck. My residents, of course, they wanted me to do good because then it reflected on them. He wasn’t too bad to me, but he could be really nasty, and no one liked doing that.So, you know, you can imagine, I left that rotation saying, “I never ever, ever will be a surgeon.” I hated the hours. I hated the way they behaved. I thought there was no thinking in the surgery, you know. It was like you do this little procedure. There was no real intellectual stimulation. Now my surgery colleagues would kill me if they heard me talking this way about them, but I figured it was not for me.Then, you know, you rotate through all of them. Psychiatry was another one where I was assigned to Charity Hospital in the psych ward, where all the criminals were. I mean, these were the really bad cases. And I had a woman for a resident, and one of the first people we had—the first thing she tells me is, “When we go interview these people, you always have to sit on the side of the table nearest the door so that you can get out if they start misbehaving.”So one of the first patients was this huge man, in cuffs because he was a prisoner, and we’re interviewing and he starts hitting on the table. And I mean, she was pretty tough. She apparently had been with these. But it was like, “Oh, gosh.” It was an awful experience, and so I said, “No, no, I’m not doing this.”And you go through all these, and then the one I thought that gave me the most opportunity and I thought most stimulating was internal medicine. You got to think and kind of work through different diagnoses, and you kind of took care of the whole patient. And just like a little piece like ENT, we had to rotate. Well, you only look at this part, you know. So I liked doing that. I mean, I liked gynecology/obstetrics. We got to deliver babies. I delivered, like, sixty babies on my own, because we went to Charity Hospitals. But, you know, I didn’t like the lifestyle of always being on call. It was a happy time, though. So I settled on internal medicine, and I’ve been very happy with that choice.

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Chapter 03: Deciding to Practice General Internal Medicine