The Front Row Warriors

My fly was undone the entire day I interviewed at Stanford for a spot in their orthopaedic surgery department. I only know this because much later, Aaron – a fellow resident at U.C. Davis Medical Center where I did my training, and who had been in attendance on that breezy day – noticed the faux pas. You might be asking yourself why Aaron didn’t point this out to me and save me some potential embarrassment. To that I respond, “Welcome to the competitive world of medicine.”

Aaron is a great guy, really, and we became fast friends. I never held his silence against him; for, by that time I had been competing for admission into this world since junior high school, and was well aware of the tricks of the trade. When Aaron recounts this tale, as he has many, many times, I like to tell people that I did it on purpose as a protest for all of the rejection letters that Stanford has mailed me over the years – just a rite of passage for most academically driven young men and women who grow up in the Bay Area.

The Urban Dictionary lists several definitions for the word “gunner;” here is the one that I believe most accurately reflects the term’s meaning:  A person who is competitive, overly-ambitious, and substantially exceeds minimum requirements. A gunner will compromise his/her peer relationships and/or reputation among peers in order to obtain recognition and praise from his/her superiors.

What follows is my favorite (and most appalling) anecdote highlighting the behavior typical of a gunner. As a freshman, pre-med student at U.C. Davis, gunners were my peers. They walked among the rest of the student body, arriving early to every class, and crowding the front rows of the packed lecture halls. Their presence was never a furtive one; the cacophony of multi-colored “clicky pens” announced to all that the gunner army was in occupation. To imply that I was void of any gunner attributes myself would be disingenuous. Anyone striving for admission to a U.S. medical school requires a certain amount of competitive narcissism to complement his or her perseverance, intelligence, and deep pockets from which to supply endless payoffs to the mafia running the college textbook industry. Sometimes these funds are provided by subsidized loans from the federal government. More often, the exorbitant prices drain the checking accounts of hard working parents. Nevertheless, bearing witness to the obnoxious behavior of the gunners, I strove to distance myself from this particular clique.

Hence my location one chilly, fall morning in chemistry class, which was being held in the capacious lecture hall known as Chem 194. This auditorium seated over 300 sleepy students, a few dozen of whom were full-fledged members of the Gunner Nation. The latter group occupied the front several rows, strategically positioned to impress, interrupt, and sometimes correct the Professor. That’s right, gunners have no qualms about correcting tenured, Ph.D. scientists mid-lecture on such irrelevancies as spelling. I sat in the back third of the room, close enough to see the chalkboard, yet comfortably out of range of my more conspicuous peers.

Some of the front row seats were empty; however, it was made clear to any late arrivals that these seats were, in fact, unavailable. Gunners stick together in a pack and are aggressive in their defense of such prime real estate with admonitions such as, “I’m saving this seat.” Although not exactly prohibited, these rebuffs do represent a breach of etiquette within the college sub-culture, most of which is populated by adolescents and young adults who remain non-judgmental and supportive of those who stagger into an early morning lecture at the last minute, perhaps rebounding from a night of revelry or (less likely) an all-night study session. But gunners are somehow bright-eyed and bushy-tailed even at the repugnant hour of 7:30 a.m., and – like sentinels at the gates of a citadel – they remain ever vigilant in their crusade to save seats.

The main entrance to Chem 194 is behind the top rows, close to where I typically sat. There is a lower entrance, located about where movie theatre emergency exits are typically positioned, precluding the need to navigate stairs, and within view of all attendees. Around 7:25 or so, and through this lower entrance, a young lady emerged on crutches and wearing a bulky and cumbersome knee immobilizer. This orthosis restricted the student’s ability to bend her knee, thus making it utterly impossible for her to sit anywhere except the front row – where leg room was ample – or in an aisle seat. Considering her options, the temporarily disabled hobbler realized that attaining a seat on the aisle was a long-shot. Not only were most of these prime seats taken, reaching one of the few remaining chairs would require ascending stairs on crutches, a most difficult and perilous endeavor.

Her best option was clear: a seat in the front row. As I watched her approach “gunnerville” from my reclined position near the back, I did not anticipate the impending horror; for, although I knew of their protective, hive mentality, I assumed a certain level of empathy must be present. Recall, these pre-med students wanted nothing more in life than to become physicians – a profession where compassion is a core value.

But alas, as you may have guessed by now, her endearing plea for acceptance into the fraternity, even temporarily, was rejected. No assistance was offered, no backpacks removed. Not even an invitation to an alternative open seat was extended. The poor girl then had no choice but to navigate the clutter of backpacks blocking the stairs, and make a pathetic effort at gaining elevation. Encountering difficulty, crutches tangled in the array of book bags and coats cluttering her trailhead, and finally realizing the futility of her efforts as the lecture was about to begin, she pivoted on her one good leg, exhaled a sigh audible even from my lofty vantage, and settled onto the cold and dusty floor; wounded limb extended as if in a painful plea for nurturing.

The ensuing sound of the clicky pens, emanating from the furious fingers of the front row warriors, was particularly sickening on that day. Yet there I sat, disgusted and impotent. When I recall this event, I do so with regret and embarrassment. Because, as the brilliant Irish thinker, Edmund Burke professed long ago: “All that is necessary for the triumph of evil is that good men do nothing.”

O.K., that’s a bit dramatic. The students in the front row that morning almost certainly were not evil. They simply had yet to develop their moral compass; as I had not. Still, this story reminds me that, while there are good people in medicine, there are many others who aspired to become doctors but encountered rejection along the way. While some of these individuals may have been under-qualified academically, many whom I have known simply lacked the killer instinct – best represented by the gunners – to make their dream a reality.

My intention is not to malign the character of physicians. Some of my closest friends share my profession and I am regularly inspired by their acts of dedication, sacrifice, and bravery. However, most medical dramas on television (with the possible exception of House) seem to venerate doctors perhaps more than they deserve, and autobiographical works by physician-authors have seemed to me a little bit self-aggrandizing. Consider the possibility that your doctor might have been in the front row of Chem 194 that morning; or perhaps even worse, lounging many rows up, attentive enough to witness the events, yet unwilling to intervene. Then, please forgive us our trespasses and recognize that doctors are not saints, and we are not omnipotent. We have moral failings like everyone else. We make mistakes. Our knowledge is limited. As Hippocrates said, “Life is short, the Art long, opportunity fleeting, experience fallacious, judgment difficult.” Yet, like most who don the mortal coil, the best doctors strive each day to atone for our sins and evolve into – quoting Lincoln – “the better angels of our nature.”