Senior resident and AU alum Hamid Kargbo and his team at Johns Hopkins Bayview Medical Center (Photo: Jeff Watts)
For a university without a medical school, American produces hundreds of medical professionals who got their science start and shaped their career ideals at AU. Meet veterinarian Elizabeth Arguelles, senior resident Seema Thekdi, and OB/GYN Randy Fink.
Sam is about the same age Mr. Bear was when he passed away. He’s sprawled out on an examination table at the Capital Cat Clinic in Arlington, Virginia, where Dr. Elizabeth Arguelles is carefully removing a growth from inside his furry ear.
A domestic shorthair, Mr. Bear was Arguelles’s “special one,” the cat that gets the credit for her decision to become a veterinarian.
“He was born in my bathroom and lived to be 19,” says Arguelles, 32.
“I learned a lot about geriatric cat management from him. I think that there are one or two—at least I am hoping there are two—very special animals in our lives. There is a hole in my heart now that he is gone that I’m not sure will ever heal. But from birth to death, I learned from him.”
Wearing a headlamp, Arguelles uses a scalpel to remove one portion of the growth, which Sam has been clawing at. There’s so much blood in his ear that she and her team of assistants and vet techs remove it using a dropper throughout the procedure.
Sam, an Abyssinian mix whose light brown and white coat is shining after a deep combing, is sedated, so he rests peacefully.
This life was the farthest thing from Arguelles’s mind when she went off to Wellesley College to study economics and political science. She grew up in rural Virginia with dogs and cats constantly barking and meowing around the house, but she never considered veterinary medicine a calling.
After six unfulfilling months pushing papers in a K Street lobbying firm, she reconsidered.
“I hated being behind a desk, and I was daydreaming about a more active career,” she says. “I thought about walking people’s dogs for a living, but I thought, ‘I went to a pretty good school, I should probably aim higher.’”
So Arguelles quit and went to work as a receptionist at VCA MacArthur Animal Hospital in Washington. For the next two and a half years she took science classes through AU’s postbaccalaureate premed program (earning her certificate in 2004) and amassed the 500 clinical hours required to get into vet school. There are only 23 in the country, and they admit an average of just 100 new students each per year. Admission is hypercompetitive.
The grueling hours—classes at Virginia Tech met five days a week, from 8 to 5, for three years, followed by a calendar year of clinical work—and time away from her husband, who stayed in Washington while she studied in Blacksburg, are all worth it now. Last quarter she saw 500 patients. That’s 500 kitties, as she often calls them, and 500 owners whose lives she’s touched.
Capital Cat Clinic is a cozy, converted residential home with a sign above the main staircase that reads “If you want the best seat in the house, you’ll have to move the cat.” More than three-quarters of her procedures are dental surgeries. Cats’ teeth develop cavities from the inside out, in the opposite fashion of humans. It causes them great discomfort, which they’re adept at disguising.
“I’ve seen cats walk on broken legs,” Arguelles says. “They have a very high pain threshold.”
Hopefully, Sam won’t now have to endure as much pain. Arguelles removes more of the growth, farther down his ear canal, then cauterizes the incisions by burning them closed. At home tonight the only attention paid to his ear will be loving rubs from his owner.
It's 9 a.m.
Hamid Kargbo has been at the hospital for hours. For him, a “day” lasts up to 28 hours. A week is 80. It feels like he lives at the hospital.
Rounds begin. Kargbo and his team at Johns Hopkins Bayview Medical Center check in with a frail elderly woman, tiny in her bed. Kargbo leans forward and quietly asks, “So, how are you feeling this morning?”
She’s unblinking. “I just want to go home.” It’s a typical story.
With his team, Kargbo loops a well-trod path through the halls where he spends nearly all his waking hours. There’s a young mother, indignant to be admitted again. There’s the man who is gregarious and confused—last time he was in, he asked another resident to marry him.
One man hasn’t had a drink in two days and just wants released. “No offense, but this place is boring as hell.”
The chronic patients tend to loop through a rotation of illness, recovery, and relapse. Kargbo has seen many of this morning’s patients before. Not only is he mastering the practical skills of a doctor, he is also learning how a patient’s life can interfere with wellness.
Kargbo makes house calls. Rotating with John’s Hopkins Aliki Initiative, for a few weeks a year, Kargbo is part of a team that follows-up with chronic patients at home after discharge.
Often, doctors burdened with heavy caseloads “treat them, then street them,” and see the same patients reappear, sick again, within months. On house calls, Kargbo’s team has found sources other than stubbornness for noncompliance that leads to repeat hospital visits.
There was one patient who never seemed to take her medicine properly. Upon seeing her kitchen counter stacked with pill bottles, many expired, it became clear there was reason for confusion. Not only were there too many bottles, she couldn’t read the ones she had.
“Sometimes we prescribe what they can’t afford.” Kargbo remembers one woman who hadn’t filled an important prescription. She explained, “This medication costs $300. I just lost my job.”
Residency is about learning patient care. It’s also a matter of learning when to stand your ground.
There are hallway meetings outside patient rooms, debating management and divvying up work. There’s a “curbside” negotiation with a neurosurgeon about the risk of certain tests. Plans are made to explain a serious treatment dilemma to a patient and his family during visiting hours.
Kargbo seems to revel in the pressure—juggling science, medicine, teaching, and patient comfort.
It’s a life he dreamed of since boyhood, when he watched doctors at home in Sierra Leone care for cousins suffering from malaria and sickle cell. Many died young. For those who were spared, it was thanks to the physicians Kargbo admired. “They were so caring, so smart.”
The toll on his time and the emotions of caring for gravely ill patients are the challenges of every young doctor. Kargbo acknowledges the stress, but considering the labyrinthine path he’s taken to medicine, he describes himself simply, as happy.
It has taken some doing to get here. Between his post-bacc at AU and medical training that will end in a cardiology fellowship, Kargbo will have spent over a dozen years learning the trade. In all the hours in between,filled with sick patients and reams of physician’s notes, Kargbo has climbedto some of the top programs in the country, become a U.S. citizen, and fallen for another Hopkins resident.
Life has squeezed in to fill the empty spaces in his day. Kargbo stops for a quick lunch during a noon conference lecture and then he is off. If he’s lucky, after an afternoon of patient care, he’ll get his interns out the door before their 16-hour work limits and only spend a few more hours on sign-out and notes. If it’s a short night, he’ll leave by 9:30, maybe 10:00, and head to his other home—the one he sees for an hour or two on either end of brief sleep.
The mothers with young children are the toughest cases.
As a psycho-oncologist—a psychiatrist who provides therapy to cancer patients and their families—Dr. Seema Thekdi of the University of Texas MD Anderson Cancer Center in Houston treats many people with poor prognoses. Which is a nice way of saying they’re dying.
Yet where many other therapists are burned out by the experience, she’s invigorated.
“MD Anderson tends to accept particularly challenging and unusual cases from around the world,” Thekdi, Kogod/BS ’94, says. ”So we’ll get very young people who die of their cancers, and that can be very draining because we do become very connected with our patients. As their therapists we see them regularly for an hour at a time.
“But I actually find the experience more inspiring than draining. It seems like when people are faced with their mortality something comes over them. They lose their pettiness. They have a perspective that’s so wise, it’s so spiritual—I’m not sure of the right word—but their perspective is very inspiring because every single day I’m reminded of the big picture, of what’s important, and I see how they move forward under these very adverse circumstances with so much courage.”
Still, the cases of mothers with terminal cancer can be tough. The moms with young children know they probably won’t be around in a few years for their kids. So a big part of their therapy is preparing them to talk to their children about their prognosis. Using breathing and meditation exercises that help them overcome their anxiety, they can begin to plan for their children’s future and finally have faith that their kids will be taken care of after their mother is gone.
Even in such emotionally trying cases the human connection with patients is what attracted Thekdi to psychiatry.
“In other fields you rush around and you see many patients per hour, or if you’re a surgeon you may not even talk to your patient other than for a couple of minutes, and then they’re under anesthesia. But in psychiatry you really get to know people.”
So is she still glad she made the switch from business and finance to medical school—taking an extra year at AU to complete premed requirements?
“Oh, it’s much better than expected,” she says. “It’s an identity more than a job. If I won the lottery, I would still be here tomorrow morning because it really is quite exciting.”
Then she adds, “I’m sure I would be driving a better car, though.”
A few key scenes often define our lives. Take actor-turned-physician Randy Fink, SPA-CAS/BA ’89.
Kingston, Jamaica. As a sophomore at AU, majoring in political science as well as theatre, he takes part in a study abroad program. While volunteering at a clinic, he tries to help a pregnant young woman with a serious health problem. Her placenta has become implanted over her cervix.
“She bled to death while I was holding her hand simply because the system was not equipped to save her life,” Fink recalls.
Many years later, long after that semester in Jamaica led to a sense that someday he wanted to be a doctor, Fink chooses obstetrics and gynecology as his specialty, partly because of a helpless young woman he couldn’t save.
LA. The acting thing’s working out. He’s got an apartment in New York and a place in Los Angeles.
He’s had parts in Exorcist III and Look Who’s Talking Too. He does an episode of the Robert Stack TV series Unsolved Mysteries, a predecessor to America’s Most Wanted. He works in theatre, appearing at the Kennedy Center and the National Theatre and off-Broadway. He’s even played a doctor: in Philadelphia, he’s the physician in the emergency room “running code” on the Tom Hanks character after he collapses in the courtroom.
And that’s not all. He does commercials for Twix, for Little Caesar’s, for Tide and Kodak.
Fink’s success is no surprise to AU theatre professor Gail Humphries Mardirosian, who remembers his determination. “Even as an undergraduate, Randy had the drive, discipline, and focus that allowed him to continually refine his skills as an actor,” she says. In fact, while still at AU he landed roles in As the World Turns and a small part in the Woody Allen film Crimes and Misdemeanors.
But Fink’s success makes it hard to quit. He knows he needs to move on. If he’s going to med school, he’ll first have to complete a postbaccalaureate program. “What’s funny is I didn’t do a damned bit of science,” he says of his undergraduate years. “I probably did biology. That was it.”
So he finally pulls the plug. He sells the place in LA, sells the apartment in NYC.
Miami. After completing studies at the Medical College of Virginia (he started a few years shy of 30) and postdoctoral training, he’s now the managing partner of the Miami Center of Excellence for Obstetrics and Gynecology, a practice with 20 people on staff. One of those people is his wife, Stephanie, a nurse practitioner who’s also training to become one of the office’s midwives.
Fink is proud of the practice’s innovative approach to noninvasive surgery, and its approach to making patients comfortable by offering services such as massage for pregnant women.
He and his wife have two children, and he can grill in his yard in shorts and a tee shirt nearly any day of the year.
“There are moments that I’ll walk out and smell the air in the morning or hear a bird chirp that reminds me of what it was like in Jamaica and I say, ‘You know, I think I’m in the right place,’” he muses.
And yet, not a day goes by that he doesn’t think about what might have been if he had stayed in acting. “I’m very happy with where I am and with my beautiful family, and we have a well-respected practice and work very hard to make a difference. But it took a lot to get here. It’s a truly abusive process that just really sucks the life out of you in many ways.
“As my hair gets grayer and my ulcer gets bigger, all the while I’m thinking to myself, ‘Wonder what my house in the Hollywood Hills would have been like?’ But in reality you go where you’re called, and I really am a believer that when you have a calling there’s not a lot you can do about it. You just sort of have to answer.”
Just after he’s decided to quit acting to pursue his dream of becoming a doctor, his agent calls. He’s got the perfect part—the role of a medical student in a TV series pilot.
Fink says, “Look, I’ve made this decision. I’m moving on. I’m not coming back to audition for a pilot because who knows what happens to pilots? For every one that makes the air there’s another 20 that never get shown anyplace.”
The agent persists, but no dice. Fink’s done.
The name of the series? ER.
