A Blessing in Disguise
One sweltering summer day, I was driving to the Navy’s regional recruiting station, windows down, with the radio tuned to The Ride. My parents gifted me their well-worn Ford Freestar minivan as a college graduation gift for my move to Charlotte, North Carolina, and eventually to Madison, Wisconsin. The AC had broken years ago, making my car one of the hottest rides in town, albeit not the fastest. In fact, a crack in one cylinder caused “knocking” if one accelerated too fast.
On this particular drive, I kept smelling this burning gasoline-oil smell, and hearing a high-pitched squeak at intersections. I looked to my right and I chuckled at a woman’s old sedan next to me. She turned right. Yet, I kept hearing and smelling signs of car trouble from what I thought had to be her car.
Then it hit me in a moment of epiphany: it had been my car all along. We are most blind to the failures and unintended consequences of our own actions. As the immortal Eric Clapton once opined: “Before you accuse me/Take a look at yourself.”
This gentle reminder focused my thoughts on a simple question: How will my decision to go to medical school affect my family down the road? Eighty thousand dollars for four years followed by a three- to five-year residency before even beginning to pay down principle. The prospect was nothing if not daunting. As a formerly active investor and institutional trader, I envisioned my debt rising relentlessly as the wonder of compound interest tirelessly worked against me. As Albert Einstein noted, “Compound interest is the eighth wonder of the world. He who understands it, earns it … he who doesn't, pays it.”
Fear of taking on so much debt led me to explore the Navy’s Health Professions Scholarship Program. Under the program’s terms, the military pays for one’s medical education and residency training in exchange for service afterward as a physician caring for active-duty military personnel. Money brings you to the table, but it is not what makes you want to reach across the table and sign the papers. I learned about all the extraordinary opportunities in Navy Medicine as I spoke with active duty and retired military doctors. One detailed his 2007 involvement in turning around the decrepit state of the outpatient center at Walter Reed Medical Center. The rundown condition was having a demoralizing effect on the wounded warriors and soldiers overseas fighting in Iraq and Afghanistan. Navy Medicine became my calling. My recruiter said, “You are a sure-thing. Look at these test scores! I’ve even put you down as an ‘IN’ for our office quota.” Yes, everything was going great. Until the physical.
The echocardiogram a week later at Walter Reed revealed that I had a dilated right heart with pulmonary hypertension. The Navy’s recruiting standards only cared about the pulmonary hypertension. Like any engineer, I did the math: a .03 mm decrease, or less than a two percent change, in the traced tricuspid regurgitation (“TR”) jet profile would have allowed me to slip through the Navy’s 25 mmHg standard. I would have been in the Navy, and this incident would have been forgotten.
Instead, a cardiac MRI six weeks after my first day of medical school, ironically during the cardiopulmonary block, revealed that I had a rare congenital heart defect called partial anomalous pulmonary venous return (PAPVR, an effective left-right shunt). Rarely is this condition diagnosed at my spry, asymptomatic age of 23. Typically, patients are diagnosed in their late thirties or forties due to the sudden onset of right heart failure symptoms from prolonged volume overload. Surgical intervention at that juncture can prevent more damage, but does not repair the damage done. I kept envisioning getting this news just after completing my residency, sometime in my thirties, with two small children in tow. There wouldn’t have been a great medical solution at that point, apart from perhaps a heart transplant. Thanks to the U.S. Navy, I was given the opportunity to repair my heart. I elected to get the surgery in the short break between the first and second year of medical school.
I am writing this piece two weeks after my open heart surgery. I am not eligible for the Navy. I have come to terms with this; some dreams are not meant to be. But, I am blessed. I am blessed that this defect was discovered before permanent damage to my heart occurred. I am blessed that modern medicine offered a cure for me. I am blessed that the surgery was successful, and that I am not expected to need any additional interventions in the years ahead.
So why do I merit this scholarship? Well, you see, this money would be used to support the very audience of The White Coat Investor. Every dollar would go straight to paying the medical bills pouring through the door from cardiac surgery and a weeklong hospital stay, on top of the astronomically high medical school tuition.
What do you think? Have you ever received a blessing in disguise? What was your MEPS physical like? Did you run into medical problems in med school? Comment below!