SEAS AND MULBERRY FIELDS

Chapter 5:

I went to Medical School.

 

When I finished high school and passed the French Baccalaureat, it was quite a relief for my family and me. In 1965, military draft was fully enforced and whoever didn’t pass the high school exam to qualify for college had to be drafted into the armed forces. Draft of college students was deferred until they have completed their education. Medical school lasted 7 years, including one premedical year and six years of medicine. There were only two medical schools in South Vietnam: the Faculty of Medicine of the University of Saigon and the other Medical School at the University of Hue, founded much more recently and less selective.

Most high school graduates vied for a spot in medical school. The profession was well respected because of its doctoral degree, its humanitarian purpose and, at least to some significant degree, its relatively comfortable and stable income. There were also other practical considerations: medical students had their military draft deferred the longest (7 years) and there was a remote hope of outlasting the war. After medical school, even when drafted, a doctor becomes immediately a first lieutenant, much above the rank of warrant officer that a cadet earned at entry level after military academy. Their salary was also much higher than the salary of other officers of the same rank; there was a special bonus for the doctors that made their paycheck equal to a major’s salary. Their life was also less endangered by wartime’s standards, doctors died rather frequently as war casualties, but not at the massive rate of combat officers.

About two thousand candidates applied for the 150 spots at the Saigon Medical School. Female students made up about 20-30% of the total. Men did much better at the entrance examination than at graduation. I was 5th on the admission list, at graduation I had a much lower ranking.

The entrance testing covered Mathematics, Physics, Chemistry, French or Vietnamese (as primary language) and a foreign language. It probably was in favor of male students who usually were stronger in the sciences. I still remember the essay that I had to write in French, commenting on a famous saying by a French scientist, Louis Pasteur probably, “Science without conscience can only ruin the soul” (Science sans conscience n’est que ruine de l’âme).  The question in Biology concerned the different enzymes involved at different steps of the digestive process. There was also a quiz asking you about any thing, from mundane subjects like the current price of a bag of rice to test our connection with common daily life of the country, to esoteric topics that was not taught at school (“Who wrote Tao Te Ching?”}. The whole test probably was an inspiration from the MCAT test, of which for sure I was not aware at the time.

Foyer Alexandre de Rhodes

During my seven year of medical school, I lived in a hostel for students on Yen Do Street, run by a Jesuit priest, Father Henri Forest.

Foyer Alexandre de Rhodes was named after the French priest who came to Vietnam in 1642 and codified the different existing systems for phonetically transcribing Vietnamese language using the Roman alphabet. He was widely recognized as the father of modern Vietnamese writing system, chữ quốc ngữ, which replaced chữ nôm (an adaptation of Chinese character to transcribe Vietnamese vernacular) and chữ Hán (sinitic Vietnamese).

My brother was looking for a place where I could stay, have a good learning environment and without being exposed to bad per influence. The foyer was an ideal place for all that; only it was very difficult to get accepted into it. I have to give credit to my brother for being very patient and meticulous in preparing me for the interview with Father Forest. In my country, we rarely had to go to any face to face interview, application to most selective institutions was based solely on “blind” entrance exam, the decision being base solely on one’s ranking, or possibly backdoor bribing. My brother asked me to copy all my transcripts from high school, by hand, because we didn’t have easy access to a photocopying machine then. On the day of the appointment, he accompanied me to the Foyer. The Father, probably in his forties, talked mostly with my brother who spoke perfect French and was very articulate and persuasive. I got in, thanks to my brother thoughtfulness and to my good grades and recommendation from my high school teachers.

Foyer Alexandre de Rhodes turned out to be one of the most educational, formative and decisive in my whole life. There, I learned to live a life of an adult, to be aware of the broad range of societal issues that were affecting our country, outside the ivory tower of medical school, to think and act freely, yet within the framework of humanism and responsibility. On the logo of the Foyer, a needle pointed to the North, the ultimate aim: Esto Vir, Be a man, Sois homme.

Outsiders often described our Jesuit tradition elitism as a kind of snobbism in a poor country at war. However, as many years have gone by, the influence of our Father Henri Forest on our life in our most formative years have inculcated in each of us the basics of leadership and personal and social responsibility that, so many years later, are still alive in every one of us, the so called AFAR (Anciens du Foyer Alexandre de Rhodes/Alumni of the FAR).

We had an AFAR meting a few years ago here in Fairfax, at a friend’s house. Father Forest looked the same to me as he did in my student years, with his large eyeglasses and his silvery hair. Sadly, he has severe Alzheimer disease now and is living in Canada, his native country.

Medical Student.

I had my premed year APM at the Faculty of Sciences (APM= Annee Preparatoire Medecine). We were taught by faculty from the sciences section of the University of Saigon. In the French and Vietnamese system, faculty means a school or a division of the University. The State University of Saigon probably had about 20000 students and its facilities were spread out in different areas of the sprawling city. Around 1965, Thành C†ng Hòa (Republican Citadel), former quarters of the presidential guard under President Ngo Dinh Diem’s regime, was converted into the campus for the School of Pharmacy and the Faculty of Letters.  The medical school had more luck in that we got a completely new facility in a large campus completely funded by American foreign aid. It was situated on Hong Bang Street in Cholon, the Chinatown equivalent of our city. Multi-storied white and gray buildings enveloped in concrete screen were totally air-conditioned. The architecture probably was ordinary and typical of government buildings built with public money in the United States. Later one of my friends found the same architecture in another hospital in America and it reminded him with nostalgia his own school, which he had not seen again for more than 25 years. However, the school was a far cry from the small, obsolete building that was the Medical School on Tran Quy Cap Street in Saigon and we were very proud of being the first class to use it. As a footnote, it was rumored that because a large cemetery had to be removed for the new medical school to be built, the school would have a very unfortunate future. The following years in the new location would be marred by internal strife among its faculty, hostility between students and faculty, murders of teachers and students. However, it makes more sense now to blame it on the turn of political events rather than to explain it with a hex from exhumed Chinese ghosts. In fact, in a recent conversation with Dr. Nguyễn Sơ Ðông who had lived in the area even before the medical school was build, he told me that this cemetery story was a myth. A polyclinic had been located at the site before the medical school was built.

On the first day of our first year in the new school, the Dean, Dr Phạm Biểu Tâm, came to congratulate us in one of the air-conditioned, large classrooms dug below ground level. Dr. Tam was a legend among medical students and the general public as well. He had the reputation of being one of the old style gentlemen who would preserve their academic integrity and not concede to any outside political pressure. It was widespread rumor that years earlier he refused to bend to the pressure from the wife of the powerful brother and advisor of President Ngo Dinh Diem , Mrs. Ngo Dinh Nhu (or her husband?) Mrs Nhu reportedly wanted to have her daughter admitted to medical school even when she had failed the entrance exam. Dr Tam refused to comply and the girl had to go abroad to study medicine in France. As a historical footnote, Mr. Nhu died tragically in a 1963 coup by the military, his daughter later died decapitated in an automobile accident in France. Dr Tam emigrated to the US years after the communist takeover of April 1975 and died in California in 2000.

 

The premed year (APM) with its basic sciences depressed me with a lot of facts to memorize. The whole curriculum was done in Vietnamese terminology, which was the rule at the Faculty of Sciences. I think I had not been well prepared in high school for courses in chemistry and biochemistry and its laboratory rituals.  The whole year course of biology revolved around the study of the frog or the toad. I hated putting a pin through the head of the little creature to kill it. Sometimes, I had the feeling that I was not going to make it. However, there was no choice then. Earlier, I passed the entrance examination to the School of Pharmacy, but I dropped Pharmacy. Its requirement in memorization in botany, chemistry and pharmacology would have been much worse for me.

The first year in Medical School was more interesting though as always there was a lot of fact memorization. We spent three months in the study of bones alone, osteology as it was called, at the famous Institute of Anatomy situated about two kilometers from the new Medical School. We had to understand and remember things like the complex structure of the temporal bone and the many holes at the base of the skull, with the nerves and vessels that go through them. Fortunately, the French who invented most of those absurd requirements in the curriculum also provided us with manuals, which were good but expensive learning aids. Les Feuillets d’Anatomie for example were a collection of  about 20 tomes of drawings that gave us a good tri-dimensional view of the most important structures in anatomy. As with the other heavy French anatomy textbooks, I received them from my brothers who went to the same school 13 and 6 years earlier, respectively.

In other disciplines like physiology, embryology, pathology and clinical sciences, our generation was lucky to have American textbooks readily available though the help of the AMA at a very nominal price. Textbooks and visiting professors from American medical schools gave us a fresh outlook at modern, scientific medicine. It was a foretaste of American medicine and an escape from the old, tradition laden French medical system that we copied from our former colonial rulers. This American influence also helped de-emphasize rote learning and put more emphasis on a more comprehensive and integrated curriculum. I was also able to read a wide range of textbooks and journals made available to us at our student hostel by Father Henri Forest who would not spare any effort to enrich our private library with donations from American organizations and with books and laboratory equipments purchased from his trips abroad. Learning the pathophysiologic basis of diseases rather than memorizing a list of symptoms and sign was to me a very captivating approach.

The teaching hospitals

Our first hospital rotation was at Hồng Bàng Hospital, exclusively dedicated to the treatment of tuberculosis that was rampant still in our war torn society. The hospital was close to our medical school and I don’t know why they sent us there right on our third year (in a 6 year curriculum). There, hundred of people were having military tuberculosis, terminal hemoptysis (vomiting blood coming from the cavities in the lungs) and drug resistant disease. Many were in their adolescence, as there was a vulnerable period of increased vulnerability in that age group that coincided furthermore with a lot of stress from harsh school exams and not infrequently malnutrition among this student population. The professor in charge was a French old timer, Dr. Gauthier, who was famous not only for his dedication, his knowledge of this particular tropical disease but also his Gallic bluntness toward the students. 

We had rotations of internal medicine at Chợ Rẫy Hospital in Cho lon. Students followed the interns, who followed the professors during ward rounds. As a regular, unremarkable student, I was most of the time nearer the hallway than the patient under discussion and had a very vague idea of what was being discussed. Our young professor discussed a case presented in French by one of my pretty classmates, lecturing emphatically and eloquently as if he was reading from his “Vade me cum”  (a popular medical synopsis similar to the Merck Manual) while we were trying to take note as much as we could. My first patient was a young woman with a fever and a faint skin rash, which prompted me to quickly made the presumptive diagnosis of typhoid fever. I never knew whether it was correct. I don’t think I had any significant bedside tutoring, medical records were skimpy and any laboratory confirmation was lacking. Most significantly, there was a girl who developed blindness after a febrile onset. I was so moved by the patient’s situation that I wrote a short story about her.

‘-Ðèn đâu? Ánh sáng đâu?

-Con không thấy gì cả mẹ à..’

-Con tên gì?

-Con tên Hương’

-“Where’s the light?

-“I can’t see anything, mom”.

-“What’s your name?

-“My name is Huong..”

She was from the center of the country, like me. After the massive communist attack in the spring of 1968, she had to leave her native village and came to Saigon for more safety. Here, in that overcrowded and faceless city, her family joined the multitude of homeless people living out of mendicity, prostitution and petty crimes. She died, of meningitis probably.

“I waited for the traffic light, sitting on my Honda. The noises and the smoke from military trucks, American autobuses and motorbikes made me dizzy. I had a burning sensation in my eyes. Was it sweat in my eyes or was I crying? Was I crying for you, for myself or for all of us?”.

 

At the Hospital for Children (Bệnh Viện Nhi Ðồng), we had Dr. Phan Ðình Tuân as Chairman. He was a quiet, diminutive man from Hue, my native city. I did not have an opportunity to learn much directly from him, I only remember him as a  very dignified professor, with the demeanor of a Vietnamese mandarin. The two female professors were from opposite worlds. One was from North Vietnam, very thin, austere and still unusually single. The other was from the South, a graduate from Howard Medical School hence fluent in English, the wife of a wealthy banker and very eager to implement the American way of practicing medicine in our old hospital. 

A patient that I still remember vividly from that hospital was a child who was dying of meningitis, with his or her parents crying and screaming at the sides of the crib.  I also remember vaguely a baby that I tried in vain to resuscitate by CPR, probably my first case.

Bình Dân Hospital (‘’Hospital for the Common People’’) on Phan Thanh Giản Street was our main location for surgical rotation. Dr. Phåm Bi‹u Tâm was chairman of general surgery. He belonged to the old guard who had received their medical school education at the old University of Hanoi then their post graduate training in France, cumulating in the degree of Professeur Agregé or for only a very few Professeur titulaire (tenured professorship) rarely granted to candidates from the colonies of France like Vietnam. Among this exclusive club were Professor Trần Ngọc Ninh in orthopedic surgery (also professor and chairman of  pediatric surgery, and for a while member of the cabinet under Prime Minister Nguyen Cao Ky), Professor Ðào ÐÙc Hoành in Oncology, Professor Ngô Gia Hy in urology, Prof. Nguyễ Văn Út in dermatology, Prof. Nguyễn Ðình Cát in ophthalmology. They were prominent people among South Vietnamese intelligentsia and enjoyed even among the general population a certain celebrity status that they often used in their favor outside of the field of medicine, most noticeably in politics. In contrast to other hospitals like Nguyễn Văn Học  and Chợ Rẫy, Bình Dân remained a bastion of the old guard and received very little influence from the ‘’young Turks”, like Professor Nguyễn Khắc Minh in anesthesiology, freshly minted from American residency training system and eager to implement the American way of running things.

 We had our OB/GYN rotation at Từ Dũ Maternity, named after the mother of King Tự Ðức (19th century) who was widely admired as a wise and dedicated mother, venerated by his imperial son. It was a very large public hospital for women, under the direction of Professor Hồng, short, middle age man from the South. For our third year in medical school, we had to have at least 20 deliveries done, from the moment the women were accepted at admission, thru delivery, until they are carried with their babies to the wards. The student had to make sure that the woman under his charge didn’t lose her wooden shoes and that her plastic bag of belongings followed her when his himself pushed her gurney (brancard) on the way to the delivery room. He had to shave her pubic hair properly and without hurting (it was customary the, until years later, when a study showed that shaving did not help in any way with preventing puerperal infection). He had to suffer the bites that a suffering woman in labor inflicted on his arms or his hands. If he made a mistake or result was unsatisfactory, the following morning, he had to go to the Chairman’s office and answer to him. It was also at Tu Du Hospital that I had the most memorable months of my student life. I spent almost a year there as interne fonctionel, where I was kept busy day and night, delivering babies when a difficulty arose, doing surgery with senior interns like Chị Phượng (later she became a political, controversial celebrity under the communist regime), Chị Khen that I have seen again since and Dr. Nguyễn Bích Tuyết, who was very kind to me and helped me complete expeditiously my required thesis for a timely graduation by the end of 1972, right after I had to leave my civil life to go fight the war.

Fortunately, I also had the opportunity to study from a few excellent American teachers. Medical schools at American institutions like Georgetown and University of Texas were trying to get a foothold at our school (some would look at it suspiciously and call it cultural imperialism or even worse, intelligence in disguise). I was among the few students who were just bored and abandoned by our antiquated system and looked forward to something new an challenging. Dr Smith T in internal medicine, Drs Wasserwald and Benigno in OB, Dr. Lamblet in radiology and a couple of ophthalmologists (Dr McDermott and others) spent a lot of their time tutoring our small study group of students on how to understand signs and symptoms and how to solve clinical problems rationally.

The ophthalmologists even took other student volunteers and me along with them to a hospital in Vinh Long, a city in the Mekong Delta. There we had marathon-like week where we did more than ten eye surgical procedures a day, mostly cataract removal for people who had not seen light for years .One of the patients kowtowed before the surgeon to showed her gratitude when the dressing on his operated eye was removed. It was one of those few moments when I witnessed the miracle of medicine. I also had the chance to help with two cases of cornea transplants. I went with the ophthalmologist to the morgue to remove the cornea from both eyes of a dead man, probably a homeless person. The next day, we transplanted one cornea to a healthy female adolescent and the other one was given to a sickly, tuberculous young woman, probably in her early thirties. Ironically, the graft did well on the rather weak woman, and failed on the other patient. The surgeons and I spent our week in the same military living quarters; we drank milk , ate plenty of beacon and other staples of American food in the military cafeteria. We also went together to Vietnamese restaurants. It was wartime then, we rode a military Jeep and had to bring along M 16 rifles in case of terrorist attack.

Those American teachers were especially helpful to my quest for learning in very difficult times. There was less of a generation gap due to their rather young age, their open-mindedness to challenging questions and their willingness to help. I had very little direct, one to one contact with our own Vietnamese faculty; in part because of my own personality. I was rather too independent to fit in the patron-pupil system. I spent most of my adolescence away from home and that probably had something to do with my uneasiness in dealing with the old bosses in the faculty. I was more at ease and worked better with younger Vietnamese faculty like an OB /GYN female professor at the Tu Du Maternity who was an excellent teacher to me, who went to my wedding and for whom I still have a lot of respect and nostalgic feelings.

 

The whirlwind.

As noted before, by hex or by historical turn of events, quite a few traumatic events marked my medical school years. In my second year, Trần Quốc Chương, one of my classmates was assassinated inside the school itself. His arms were tied back and he was thrown down on the concrete sidewalk from the third floor of the Biochemistry building. He died a few hours later. We did not know who killed him and for what purpose. He was the son of a prominent lawyer and earlier had some political activity involving the other side. We did not now which political side he was on at his death.

Another assassination happened during my second year in medical school. Anatomy and Surgery Professor Trần Anh, the father of one of my classmates (Trần Anh Tuấn) and a handsome, eloquent man in his forties who had previous training in France and America was gunned down on the street while walking home from the medical school. . Huge processions of students took part in the two funerals. Another faculty member who taught us pharmacology {I still remember his lecture on fluids and electrolytes, I was the one who had to take the notes and edit them for printing) was assassinated in a dramatic car bombing by communist terrorists. He was a member of the cabinet at that time.

Into the sand and wind:

Chàng thì đi vào nơi gió cát

In 1968, our studies were interrupted by the Tết Mậu Thân, (New Year, Year of the Monkey) events when the communists launched massive, coordinated attacks on major South Vietnamese urban centers. They occupied Hue, my hometown for months. There was blood bath among the military and officials of the South Vietnamese regime caught prisoners by the rebels. South Vietnamese and American forces took back  the city only after months of fierce urban guerilla combat and massive destruction of a large part of the historic city. Fortunately, the house where my parents lived was left intact while most of the major buildings in other parts of the city were either razed down or heavily damaged.

At the time of graduation, most male students were preoccupied with getting into the military and were faced with a more uncertain future. Very few among them were allowed to stay for another year of internship in a specialty. For those few, because of their specialty training, a position at one of the military hospitals was assured. They did not have to go with the more risky Medical Corps units called Tiu đoàn Quân Y  that had to be mobile, going on combat missions with the divisions. When we got to the end of our seven-year study course, most of us had almost a fatalistic view of our future.

 So many preoccupations were in our mind besides getting good grades. Final grade ranking’s only usefulness was to get for each of us a better assignment position. 

 Most female students were still living under the roof of their parents’ home and had rather stable and assured positions at safely situated hospitals far from the front line. Most tried to get married before or soon after graduation. It was customary for women to get married before the age of 25. For some people, marriage in the early twenties was still considered late. Usually graduating doctors chose some classmate or someone who was a few years their senior. The most attractive ones married younger members of the faculty who had the combination of prestige, better life expectancy and better income.