Santiago

Richard Ferro, MS 4

Frank Netter School of Medicine

Quinnipiac University

THE FIRST QUESTION

There was little that Calvin Rollo loved more than a pristine desk. He took special care in polishing his large rectangular executive, carved from mahogany and inlaid with gold. He often joked with anyone who came into his office that the desk cost more than his daughter’s wedding. This wasn’t exactly true, but it wasn’t far off the mark, and what his son-in-law didn’t know wouldn’t hurt him. When he first received his position, the medical school’s office of the dean had offered over a dozen times to cover the expenses of the desk, but he insisted on paying for it himself. It was a choice born of Dean Rollo’s personal philosophy: never forget where you started, and whenever he worked up a sweat polishing the desk’s surface until it reached a diamond-like finish, he never did. The desk was lying between him and the applicant sitting in front of him. There were beads of sweat running down the young man’s forehead. He looked a little red in the face. But he seemed unshaken.

“Out for a run?” Dean Rollo asked, pointing to his own forehead, smiling.

“Got turned around earlier today,” he said, half-laughing.

Dean Rollo pulled a handkerchief from his pocket and offered it to him. The applicant took it happily and wiped his brow.

“Don’t worry, you’re not the first person to run across campus for a medical school interview. It’s a big campus. Can I offer you some water?”

“No thank you,” he responded.

Dean Rollo flipped open the envelope sitting on his desk. Inside were glowing letters of recommendation and an impressive list of volunteering experiences. However, he’d seen bigger envelopes, with more research and better grades.

He folded his hands over the desk’s leather centerpiece, careful that his class ring didn’t touch the surface.

“How did you get here, Mr. Alvarez?”

Before

It’s April 15th, 1996, and the truck clattered against a muddy pothole on a long dirt road. Maria Alvarez was sitting in the passenger seat with a young boy sitting in her lap, fast asleep. She stroked his hair and looked out the window, counting the stars. A rosary was held tightly in her hand, and she rolled a single bead along her fingers.

Honduras was a hundred miles in the rearview mirror.

She’d prayed for years, asking for deliverance from the world she’d been born into. She’d worked since the age of eight, lived with six brothers and sisters, surviving two of them. Between the long days and short nights she’d look out her bedroom window and count the stars as she did now. For each one she counted she made a wish. An animated movie she’d seen when she was younger told her about the power of wishing on a star, so perhaps if she wished on them all, one wish might come true. Then one day she made enough money to buy an old painter’s truck. Old, black, with spots of bright red in the truck bed where the paint buckets used to sit. She packed her things and she, her husband, and her two year old son left for los Estados Unidos.

The stars twinkled brightly that night on the road, and Maria smiled. She looked down at her son, and imagined a future where he could be whatever he wanted. She closed her eyes and made one last wish.

“No hay nada que no haría por ti, Santi,” she whispered.

There was nothing she wouldn’t do for her son.

After

Dr. Santiago Alvarez leaned against a wall outside his office, waiting for his first appointment of the day. Kathleen, the charge nurse, was sitting close by, checking her Facebook profile on her phone.

“Anything good?” he asked.

“My brother’s getting married.”

“The good one or the crazy one?”

“The good one.” She put the phone in her pocket and leaned in close. “Mikey’s been asking about you again.”

Dr. Alvarez walked over and took a seat beside her desk. “This the one who just started college?”

“Yeah, first year. He keeps asking about what you do, what your days are like and all that.”

“You know he’s always welcome to come by and follow me around for a day.”

Kathleen looked surprised. “Really? I was nervous to ask you about it, you’re so busy all the time.”

Dr. Alvarez shrugged it off. “It’s nothing. You have him send me an email and we’ll figure something out.”

“Thank you so much, Dr. Alvarez.”

“You’ve got to start somewhere, and there’s nothing I won’t do to help out a pre-med.”

There was a ping on his pager.

“Well, he said,” standing up and straightening his tie. “Time to get to work.”

Dr. Alvarez turned around and walked into his office. There were bookshelves heavy with textbooks, a wilting plant that desperately needed watering stood on the windowsill, and a medical school diploma hung behind an old weathered desk. The desk came secondhand, he’d bought it from an old colleague. After so many years, it’s surface was nicked with the pen marks a thousand handwritten notes, the back legs were scuffed by a thousand swings of a rolling chair. Despite how worn down the desk was, there was something he loved about it. When it was first delivered to the hospital, it was too large to fit through the door leading into his office. Initially, his department offered to put the desk in another room and reimburse him for his trouble. They would get him another desk, they’d said, a better desk. But Dr. Alvarez was stubborn. He didn’t want a another desk, he wanted that desk, and one way or another he was going to get it through that door. He took it apart in the lobby and brought it into the office piece by piece. He assembled it himself, and through all the sweat, swears, and splinters, he found himself loving the desk even more.

He took a seat and reviewed a patient’s chart before making a phone call.

THE SECOND QUESTION

The Dean leaned in closer. Santi stood up straighter. He felt like he were one of this man’s patients.

“As you know, part of the job of a physician is to be analytical. To look at someone, and to effectively diagnose them.”

“Yes sir,” said Santi.

The Dean took off his glasses and gave him a smile.

“What kind of inferences can you make about me?”

Santi was stunned. In all his preparations for the interview, he never once expected this kind of question. By the look on the Dean’s face, he had asked this same question many times before, with similar effect. Perhaps he knew how difficult it was to expect an applicant to answer this question, and would be lenient given the circumstances. How could anyone be expected to be critical of a person who held the key to their acceptance into medical school?

Santi thought a moment. He could say anything. You are the picture of health. You don’t look a day over thirty-five, you could live to be a hundred. But those answers seemed hollow, and the Dean didn’t seem a man that suffered fools or flattery. In that moment there was one thought –one memory– that crystallized in Santi’s mind.

Before

Santi was eleven, sitting in the back patio of their home. It was Sunday, after church. He sat on a plastic lawn chair next to Tito Alvaro while he smoked a cigarette, occasionally tapping it into a small ceramic ashtray shaped like a crocodile.

“Abuelo,” asked Santi, “why do you keep smoking?”

Tito Alvaro smiled and coughed. He thumped his chest and gave him a little laugh.

“The little doctor. Always going off on his patient.” He pointed to Maria, the cigarette held loosely between a pair of arthritic fingers. “Don’t you think he would make a good doctor?”

Maria nodded with a smile, without looking up from the book she was reading.

“Don’t change the subject. You should listen to him, Papi.”

Tito Alvaro took a long drag of the cigarette and crushed what was left of it in the ashtray. “If it bothers you, mijo, I’ll stop when I come to visit.”

Santi looked up at him, hopefully. “What about when you’re not here? Will you smoke when you’re at home?”

Tito Alvaro threw up his hands in exasperation.

“Ya, mijo. Can’t a man have some simple pleasures in life?”

And with that, Santi remained silent.

After

It was another day at the hospital. Dr. Alvarez passed through a set of automatic doors and waved to Kathleen, who was filling out paperwork from behind her desk.

“Morning, Kathleen.”

“Morning, Dr. Alvarez. Saw that your boys didn’t do so well last night.”

Dr. Alvarez shrugged. “Don’t rule the Steelers out just yet.”

Kathleen held up her hands and rubbed her fingers together. “Just know that when I win the Oncology pool, I’ll put your money to good use.”

“Paying my student loans?”

“You wish.”

“I’d really prefer it if my money was paying my loans.”

“I know, honey, I know. You have a patient in room one. He says he knows you. Insisted on seeing you, too.”

“Is that so?”

“Yeah, a Mister… Wait no, Doctor. Dr. Calvin Rollo.”

Dr. Alvarez stopped.

The Interview

Santi thought a moment. He clenched his jaw, carefully chewing the words before speaking them.

“Sir, you appear in moderately good health. There’s always room for improvement. However, what I’m most concerned about–”

He paused.

“Yes?” asked the Dean.

“Sir, what I’m most concerned about is your smoking.”

“I’m sorry?”

“I only say this because I saw you before entering the school earlier today. You were sitting on the steps outside the hospital. I’m not sure you saw me.”

Dean Rollo said nothing. He seemed stunned by the suggestion. Santi wondered if any applicant had ever said anything like this to him before. As if on cue, he let out a wheezing cough. He reached into his pocket to grab his handkerchief, only to remember that he had given it to Santi, who was still holding on to it. A tinge of red flushed the old doctor’s cheeks. He stammered a moment, and went on with the interview.

THE THIRD QUESTION

The Dean had stopped looking the papers. His eyes were now fixed on him. Santi felt like he was being X-rayed.

“When do you think you’ve ever dealt with difficulty or adversity?

This won’t be hard to answer, Santi thought.

Before

It’s 7:45 AM on the Interview Day. After three separate transfers between two buses, a train, and finally an Uber, Santiago finally stepped out of the car and made his way to the steps of the campus.

Finalmenta estoy aqui, mama, he thought. He pulled out his mother’s rosary and gave it a kiss before returning it to his pocket and making his way down the street towards the medical school. The campus was large, taking up several city blocks and made of several five-story buildings. There were large stone columns and statues of famous physicians. It looked more like a Greek temple than a medical school. He saw the hospital’s red cross in the distance, and heard the steady thumping of helicopter blades making their way to a rooftop landing pad. Santi looked to his left. In the shadow of an older building with a black tile roof, an old man in a white coat was leaning against a brick wall – smoking. The man was tall, with round wire glasses, and a thick gray beard. Santi looked at him a moment and moved on.

He began walking towards the building, then spotted another young man in a black suit walking in the same general direction.

“Medical school interview?” Santi asked.

The young man looked at a moment before saying anything. He looked down at Santi’s shoes, then up to his face. There was something like amusement in his expression.

“Good eye,” he said, offering a hand.

“Santi, nice to meet you.”

“Santi?”

“Short for Santiago.”

“Oh, of course,” he said. “Mexico?”

Santiago’s smile grew a little tighter. “Honduras.”

“Of course, of course. Know which way you’re going?”

Santi looked over to the hospital. “Not sure, I didn’t expect the campus to be so large. I figured somewhere over there, maybe?”

The applicant shook his head. “Nah, the academic building is on the other side of the school. I have to double back and pick up a few things, I’ll see you over there.”

They walked in separate directions. Santi followed straight along the road, passing the Emergency Department, then Cardiology, then Oncology. It seemed that Santi had passed the combined departments of every -Ology possible. But there was no sign of the medical school. He was getting nervous now. He turned to a pair of police officers standing by a hospital door.

“Excuse me, officer, where’s the medical school? I’m here for an interview.”

“When’s your interview at?” one of them asked.

“In five minutes.”

He hesitated a moment, sizing Santi up. He sighed and turned to his partner.

“Cover for me, will ya?” The officer walked over to his squad car, and opened the back door.

“Get in.”

“Why?”

“The med school’s way on the other side of campus, by the hospital. If you want to be there in time, stop asking questions and get in.”

Even with a police car ride across campus, Santi still had to race through the academic building. He reached the entrance of the admissions office with thirty seconds to spare. When he made it to the reception, he was red in the face. He took an interview packet from a smiling second year medical student and followed their instructions.

The other applicant –the one who’d sent him in the wrong direction– was in the Dean’s reception room. They were the only two people sitting there. He occasionally turned to look over at where Santi was sitting. Santi looked straight on, not looking at him once.

After

The X-ray was a mottled Rorschach blot test. Dr. Alvarez could see the outline of a dark spot sitting directly at the base of Dean Rollo’s right lung.

“There’s no sign of metastasis,” he said.

Dean Rollo said nothing.

“I’ve spoken with other members of the team. Judging by the lab values and the X-ray, I think you’re a good candidate for surgery.”

When Dean Rollo finally spoke, his voice was shaky, with a rattling wheeze, like the sound of an old pickup trying to start after years of sitting unused in a grass field. “Do you remember what you said to me, back when you were in my office?”

“I’ve been in your office a lot of times,” he said. Though he knew exactly what he was talking about.

“I should have listened to you then. I should have listened to my wife.”

Dr. Alvarez sat beside him, and put a hand on his shoulder. “Don’t blame yourself for any of that. All that is in the past now. What matters is what we do moving forward. Isn’t that what you always told us whenever we started class each semester?”

They took another thirty minutes to come up with a plan. Dr. Alvarez stepped outside the room. Kathleen was outside, looking concerned.

“That was a good catch with the X-ray.”

“Thanks,” he said.

“I’m sorry that Dr. Rawlins got mad at you back there,” she said.

“I knew what I was getting into when I went into her office,” he said. “Radiologists don’t want to be told how to do their job, any more then I’d like someone to tell me how to do mine.” He tried changing the subject. “I haven’t heard from Mikey yet. Did you give him my information?”

Kathleen’s face changed. She started frowning. “He’s been having some trouble lately with that. I don’t really know what he wants to do anymore.”

Dr. Alvarez took a seat on a small rolling stool, and offered Kathleen the office chair beside him. “What’s going on? Everything alright?”

She didn’t make eye contact with him, hoping that he wouldn’t notice she was fighting back tears. “It’s ridiculous. The teachers won’t put him in any of the honors classes, even though he’s got the grades for it. And the other kids…” She trailed off.

“I’m guessing they’re not helping?” suggested Dr. Alvarez.

“They keep saying he doesn’t ‘look’ like a doctor.”

Dr. Alvarez sat there a while, quietly. He thought about the man in the other room, who’d once sat across a desk and decided his future, who he’d once caught smoking while leaning against a brick wall. He thought about running through an academic building. Dr. Alvarez turned to Kathleen.

“Give me Mikey’s number, I’ll give him a call.”

“What are you going to do?” Kathleen asked, hopefully.

Dr. Alvarez gave her a warm smile. “I’m going to invite him to come by, and show him what a doctor looks like.”

The Interview

“I think there’s always going to be challenges,” Santi said.

“Yes?”

“Whether it was because of my experience, where I came from, or what I look like, there have been times when people questioned whether I belonged in a room where important decisions are made.”

Even the room directly outside this office, he thought.

“In those moments, regardless of that adversity, I do everything I can to make sure I get into those rooms. Because if I can get in, then one day when someone else steps in who looks like me, maybe they won’t have the problems I had.” He paused. “I’d like to think that if more people like me were sitting where you are right now, maybe some of those struggles could lessen, and maybe one day even disappear.”

THE FOURTH QUESTION

Dean Rollo twisted a bit of his bristled beard between his fingers. He thought about his next question carefully.

“I have just a couple more questions for you.”

“Of course, sir.”

He put a hand on Santi’s application folder. “There’s a lot be proud of in here. But I’m curious. What are you most proud of?”

Before

Santi sat dumbfounded on the steps of their home. Two years. Thirty-seven applications. No interviews. He’d tried twice now, and he still failed. His mother sat beside him, with a hand across his shoulder. There were tears in both their eyes.

“It’s ok, mijo,” she said. “It’s ok.”

“But it’s not,” he said, between sobs. “I keep trying and nothing works. I’m just so tired, mami. And I don’t know what to do next.”

She wrapped her arms around him and he pressed his head against her chest, letting the tears stain his mother’s shirt.

“Mijo, you know I’ll love you no matter what. If you don’t want to do this anymore, you don’t have to. But I want you to hear it from me, so escucha. I know you can do this. I hear the way you talk about medicine, and I’ve seen the way you talk to other people. You have a way of making them comfortable, Santi, no matter who they are. Tito Alvaro always used to say it, you remember? He’d say it was like you were shining, and people would come from miles around just to catch a bit of that shine. Think about that. Think about the patients you’ll help one day. Do you think they’d want a doctor who never faced a problem they couldn’t fix? I don’t know about you, but I’d want the doctor who had doors slammed in his face, the one who had to work harder than anyone to get where he needed to be. I’d want the doctor who had to smash doors down.”

That was all she said. It was all she had to say.

Santi sat there with her for a while, and then they went and got dinner.

After

Dr. Alvarez sat at the bedside with Dean Rollo. A monitor chirped out his heart rate, a tower of antibiotics, chemotherapy medications, and saline ran from a dozen different tubes into a single port that sat directly under his collarbone. He was skeletally thin, but there was still a light in his eyes that gave Dr. Alvarez hope. There was a bouquet of flowers sitting on the windowsill.

“One of your students?” asked Dr. Alvarez, pointing to the flowers.

“As a matter of fact, yes. A student who also happens to be my granddaughter.”

“You must be very proud.”

Dean Rollo coughed. “Oh I am. Couldn’t be prouder. She used to always say that I didn’t have to worry about seeing any other doctors. Once she got her degree, she’d be my personal physician, so I better get used to that.”

Dr. Alvarez nodded. “I used to tell my grandfather the same thing.”

They both laughed.

Dean Rollo’s laugh was interrupted by another cough, his voice trailed off and he looked from the flowers to the door. It was slightly ajar, outside a team of surgeons stormed by.

“She’ll graduate in another two years. I think our window is closing.”

Dr. Alvarez shook his head. “It’s going to be alright. I’ve known Dr. Hudson for years, she’s one of the best surgeons I’ve ever known. She’s going to take good care of you.”

“If…” He trailed off again. “If something happens,” he turned back and looked at Dr. Alvarez. “I want you to know that I couldn’t be prouder of you.”

The tears finally came. They streamed and curved along their faces like IV drip lines hanging from the bedside. The nurses came in, careful not to ruin the moment. They stood silently as the two men embraced one last time before he was pushed away and prepped for surgery. He rushed towards the door to stop the nurses from wheeling out the bed, and took Dean Rollo’s hand one last time. When he finally let go, there, sitting in the palm of Dean Rollo’s hand was a rosary.

The Interview

Santi didn’t have to think about this for long. His hand was on his leg, and through the fabric he could feel the beads of his mother’s rosary.

“I’m most proud of the fact that I haven’t given up. There were a lot of times along the way that I could have stopped. That I could have gone and done something else with my life. But I knew in my heart that I wouldn’t have been as happy or as fulfilled. So I kept at it, even when it felt impossible. I’m most proud of that perseverance, and because of that, I think I can apply that same perseverance with the people I take care of in the hospital.”

THE FINAL QUESTION

The Dean closed Santi’s folder. His eyes flicked over to the large glass clock hanging beside his medical degree.

“We’re just about finished here.”

Santi nodded. “It’s been a pleasure speaking with you, sir.”

“The pleasure’s been all mine. I must say I hate to see the time go as quickly as it did. Although, I do have one more question for you.”

Santi nodded. “Of course, sir.”

“As you know, our school has graduated some distinguished physicians. There are Nobel Prize winners, a handful of Surgeon Generals, leading officials at the NIH and AMA, even a handful of congressmen and women. They’ve all accomplished great things.”

Santi nodded again. However, he felt a pit forming in his stomach. He imagined the Dean asking him where he belonged in all this. Him. He remembered running across campus, racing in a police car, the person sitting across from him in the interview room. Once again, the feelings of adversity took hold. His mind unspooled at a question that hadn’t been asked yet. He felt as though he were blindfolded, silently suffering while the firing squad lined up and took aim. He pressed his hand on his pant leg and felt the rosary.

At last, the Dean spoke.

“Ten years from now, when you’ve graduated from this school, where do you think you’ll end up?”

Before

It was eleven o’ clock on a Friday night and Santi was in the library. He was twenty-four and studying for an exam, one of the last before he’d finish his Master’s program. He was in a cramped study nook with three of his friends. They all were studying different subjects, but focused on the same goal. Santi stopped and looked up at them. They noticed and stopped studying as well.

“What is it?” one of his friends asked.

“Do you think about what we’ll be doing years from now?”

“Yeah,” they said, “More studying.”

They all laughed.

“More coffee,” another added.

Santi laughed. “I just think that before we know it, we’re going to be doing things we never imagined doing. I don’t know, really cool stuff. The kind of stuff that makes me glad we’re here on a Friday night at eleven.”

And without another word, the four of them went back to studying.

After

The surgery took two hours longer than expected. Dr. Alvarez waited patiently as the techs, nurses, and surgeons filed out of the room and began tossing their bloody gloves into the biohazard bin. Finally, Dr. Hudson stepped out. She looked at him and gave a pained smile.

An eternity passed, and her face relaxed and her expression looked encouraging. “I think we got all of it.”

“Thank you,” he said.

Dr. Hudson nodded.

Dr. Alvarez met Claire Rollo in the reception. There was a book sitting beside her, the bookmark in the same place it’d been eight hours ago when he found her.

“What’s the news, Santi?” she asked, voice shaking.

“They think they got most of it,” Santiago said.

She began to cry and hugged him. “Does that mean he’s going to be ok?”

“I don’t know,” he said, “but I don’t think we’ll be disappointed.”

The Interview

Santiago didn’t speak a moment. He thought of where he had started, all those years ago. He thought about where he was now, sitting in front of a polished mahogany desk with a medical school’s insignia inlaid with gold on the front. He thought about where he’d go from here, the people whose lives he’d help change, the people who would change him. He thought about everything he’d learned and everything he would learn. He was at the neck of the hourglass, with the past in one direction, and time flowing in the other, towards the future. He looked at the Dean and smiled.

“Sir, I don’t know. But I don’t think we’ll be disappointed.”