Today's post receives the fifth place prize, a $100 Amazon gift certificate. This essay about bartending and health care disparity is by Samuel Joseph McMillen, an MS2 at The University of Missouri School of Medicine and exudes the idealism that drives people to spend a decade of their lives learning to care for the sick and injured without much thought of monetary compensation.]
It’s a Friday night after a long day in the library, so I invite a few classmates over to taste my latest concoction: a play on the standard old fashioned with a homemade vanilla simple syrup, black walnut bitters and a rosemary garnish. Pinkies up, time to taste. They seem to enjoy it, but the mixologist in me questions the rosemary. Seven years of bartending between college and medical school turned me into quite the critic.
As we continue sipping our drinks while venting about the financial tribulations of medical school, one of my friends asks if I’m paying tuition with the money I earned in my off-years. I instantly spew my drink everywhere and choke for air.
Turns out that was just a piece of rosemary. Close one. But equally to blame was my shock at her notion that a “non-traditional” student like myself would have a medical school fund. What my friend may not realize is that the time between undergraduate and medical school, to which I facetiously refer as my “gap decade”, was less than lucrative. Upon graduation, I struggled with the important decision of a career path. I knew I wanted to work in medical sciences, but the idealist in me couldn’t quite figure out in what way. Do I practice? Do I pursue medical theory? Or is there a way to combine both?
My resume covers quite the range of drinkeries. From P.F. Chang’s to a rave night club. From a craft whiskey cocktail speakeasy to an underground leather bar. You name it, I’ve probably served someone a drink there. Each one with its own crowd of people, often times just looking for a conversation with a stranger.
This was the appeal for me, an endless flow of stories, events, dreams, tragedies, successes and struggles. Countless hours with countless strangers inevitably incites a forgiving perspective on our differences; yet relating to an individual can be as simple as letting them tell their story. Some people hated that part of the job. As an eternal optimist, I considered it practice as an uncredentialed, underpaid, underqualified mental health professional.
The side bar gigs helped instill a strong value for hard work, but the important part of the past seven years was in my health-related day jobs. In my perpetual search for the perfect professional fit, I obsessed over what was missing. Turns out, the key wasn’t in what was missing, but what was consistently there. I loved all of these jobs, and they all had a similar motif: medicine, patients, and the intersection of bringing them together. Thus, I made the decision to pursue medical school.
Suddenly, real life hit me as unexpectedly as when they turn up the lights after last call. I have no money. I’m 30 years old and I can’t even spell 401K. I realized the past 7 years of exploring came at a cost; while I value hard work, and consider it a strength of mine, it has yet to pay off financially. Cut to my best friends from high school, college, and beyond. Also in their 30’s, most of them started climbing the corporate ladder straight out of college. Their texts from Santorini seem to mock my weekend at the free comics exposition. Keyword: free. In truth, I don’t envy them; professional manifestation of passion and purpose will never concede to money in my lifetime. I’ve already spent my twenties working at least two jobs at a time, yet here I am signing up for debt that is thicker than the double White Russian my favorite bar regular had every night (obviously, against my medical advice). So, what really is the sacrifice in accepting that I will not have expendable funds until my 40s? My friends seem to think I’m crazy. Are they right?
While cleaning up after my very last bar shift before moving here for medical school, a co-worker said something that still resonates with me. “Congratulations, you found a way out”, he said, as we clinked our glasses for a night cap. It’s a common sentiment because that much time in the service industry exposes a person to some major struggles in life: inconsistent work, unpredictable pay, unemployment in the blink of an eye, not to mention the schedule. And you can forget about health insurance. The cost without benefits simply isn’t an option for most of my co-workers, despite working tirelessly at odd hours for usually more than 40 hours a week between multiple jobs; a reality faced by so many working adults.
I craved a way to immediately translate this concern into practice. Upon starting school, I was selected as one of the new directors for our student-run free health clinic, MedZou. With a patient population that is 100% uninsured, we provide free primary and some specialized medical care to folks who have pervasive chronic illness and no other options. This year-long position is extremely demanding, especially given the rigor of the first year of medical school. Such a major volunteer commitment immediately dismissed the option of bartending at the local college watering hole to minimize loans. College students are notoriously bad tippers, so maybe it’s not a loss. Nonetheless, my experiences before med school prepared me for this type of position and professional continuity of service in marginalized spaces was worth every second.
I came to medical school without an idea of where it would lead me, with one major exception: I know I want to share in the responsibility of debunking the critical state of health disparities. In my opinion, this goes beyond tangible resources: social theory, medical linguistics, cultural motivations, trauma, personhood, identity, health literacy, power dynamics, the list goes on and on. Despite the reality that theoretical medicine isn’t exactly a lucrative field, if even employable at all, I look forward to the challenge of elucidating the invisible wall that seems to keep my friends in the bar industry ostracized from medical care.
Taking on this type of challenge may mean a lifetime of financial sacrifices. It’s okay, my twenties weren’t so bad after all. Maybe debt isn’t the best word for it, since in all honesty I’m paying for the opportunity to do exactly what I want to do. Just like every past patron, every future patient will present with something they need in the context of a larger story. No amount of “debt” could scare me away from my chosen path. Nonetheless, the harder I work to keep cost down now, the more I’ll be able to commit to professional ventures that might not have a billing code. I have to trust that it will all work out in the end. And if not, I can always pick up shifts at the local dive bar.
What do you think? When was the last time you felt this idealistic about medicine? How would your practice or career be different if you had not started it with six figures of debt? Did you have a gap year (or decade)? What did you do with it and how did that help you? Comment below!