Learning the Language of Anesthesiology
words by Mary Ann Littell / photograph by John Emerson
s a young child, Nancy Scott dreamed of becoming a doctor, but she didn’t think her dream could become reality. Scott, who is black, grew up in a predominantly white neighborhood where there weren’t any black doctors and she thought maybe her dream was unattainable. “I didn’t think black physicians existed,” she says.
When she was 9 years old, a chance encounter opened her eyes. “I wasn’t feeling well, so my mother took me to a local clinic,” she says. “I was treated by a black female physician. I was in awe watching her. My mother nudged me to stop staring so intently. At that moment I had an epiphany and said to myself, ‘I can do this.’”
Fast-forward 25 years later, and Scott, now 34, is a third-year resident in anesthesiology at UMDNJ-University Hospital. She’s achieved her goal, but her career has turned out very differently than she expected. “I envisoned having my own office, seeing patients, even making house calls. But that vision of medicine wasn’t right for me. So I went in another direction.”
Scott grew up in Garfield, where her interest in medicine was also fueled by visits to her family physician, Dr. Hyman Jaffee. “Whenever I went to see Dr. Jaffee, I would pepper him with questions,” she says. “I was only 4 or 5 years old. He always took the time to explain everything to me. I wanted to be just like him. I guess he was my first role model.”
In high school, she was an excellent student. “My mother wouldn’t have it any other way. She was always on us to study.” Scott’s sister, who was seven years older, enrolled at Fairleigh Dickinson University, but returned home when their father passed away. “At that point, my mother and sister focused all their energy into seeing that I went to college.” Their efforts paid off. Scott is the first person in her immediate family to earn a college degree. She graduated from Georgetown University with honors, majoring in psychology.
“I didn’t declare pre-med as a major because I was interested in so many different things,” she explains. “I had roommates who were going to law school and making other exciting plans, and I decided I wanted to explore my options.” She also took pre-med courses and briefly considered getting a PhD in psychology someday.
After college, Scott went to work at the Association of Academic Health Centers (AAHC) in Washington, D.C., a nonprofit organization, to earn money for graduate school. “My mother worried that once I started working, I’d never get to medical school, but this job turned out to be the best thing in the world for me.”
Scott’s boss, Dr. Roger Bulger, was president of the AAHC and also a physician. On her first interview, Scott told him she was interested in medicine. “Once I started working for him, he became my mentor and took me under his wing. Whenever I had questions or didn’t know what to do, he advised me. He and his wife treated me like I was their own daughter. I was so fortunate to know them.”
Scott stayed at AAHC for five years before applying to medical school. She was accepted at several, including her first choice, Howard University in Washington, D.C. She explained her decision to attend Howard: “I grew up in a white town, attended a white high school and then went to Georgetown, where there were few minorities. I chose Howard because of its history of educating minority physicians and my desire to be surrounded with people whose experiences were similar to mine.”
At Howard, Scott formed such close bonds with her fellow students that “we were like a family. Our class was very small. It was a unique experience that I doubt I would have had at another medical school.”
While at Howard, a “devastating” experience made Scott reassess her career goals. As a third-year student doing a clinical rotation in oncology, she encountered a patient with metastatic ovarian cancer. “The attending oncologist told me she was difficult and non-compliant and probably wouldn’t cooperate with me, but suggested I take her on as my patient. Of course, that made me very interested in trying to help her. At first she wouldn’t talk to me, but I pestered her until she came around, and we bonded.”
Six weeks later, the patient’s condition deteriorated and she died. “I cried — I took it so hard,” she says. “Of course, I knew patients died, but I didn’t realize how that would affect me. I wondered how I’d cope with the pain of losing patients throughout my career. As a person who gets emotionally attached to people, I thought I’d better find a specialty where I don’t take my cases home with me.”
Scott says anesthesia is such a profession. However, because it is not part of the typical medical school curriculum, students have limited exposure to it. She was pointed in this direction by another of her mentors, Dr. Bonnie Simpson, a black orthopedic surgeon who is a member of the Howard faculty. “At a meeting, she sensed my ambivalence about my interest in internal medicine and suggested I think outside the box and consider other specialties.”
Simpson introduced Scott to an attending cardiac anesthesiologist at a Washington, D.C. hospital. Scott shadowed him for several weeks. “I observed several cardiac and general cases and found the work to be very exciting,” she says. “I felt I’d found my specialty, and I liked being part of the OR team.”
Following her graduation from medical school, New Jersey beckoned. Scott missed her sister and wanted to be near her. She applied to the anesthesiology residency program at UH, interviewing with Ellise Delphin, MD, chair, Department of Anesthesiology, and Melissa Davidson, MD, program director. “I liked them right away, and I was really impressed that this department was run by women. You don’t see that very often.”
After a one-year internship in internal medicine at Christiana Hospital in Delaware, Scott began her residency in July 2006. The first month focused on didactic sessions and lectures, with residents also spending time in the OR, paired with mentors. By the second month, residents spend all their time in the OR.
“Those early OR experiences were stressful, and it took me some time to get used to it,” Scott admits. “When you start in anesthesia, you’re learning a new language and working with equipment you’ve never seen before. At the same time, you’re holding someone’s life in your hands. Initially I was nervous about making mistakes such as giving a patient the wrong dosage or the wrong medication.”
As she gained experience in the operating room, her confidence grew. Now, as senior resident, she works more autonomously, administering general anesthesia for everything from trauma to obstetrical cases. Over time, she says she’s gotten used to the pressure in the OR. She says, “One of the things I like about anesthesia is that it encompasses many aspects of medicine, especially pharmacology and physiology. It tests all your knowledge.”
While Scott has encountered prejudice and occasionally comes across patients who are surprised that a black woman is their anesthesiologist, “most patients, black and white, just want good medical care. I’ve had black patients who initially ask, ‘You’re the doctor?’ and go on to express how proud they are of me. And I get a lot of support from my hospital colleagues, even those who are not physicians — from nurses to the transport staff and people in the labs. They tell me they’re glad to see that a black woman can become a physician.”
Just as her mentors have helped her, she’d like to serve as a role model for others. “There aren’t enough minorities in medicine, and very few in anesthesia. I’d like to see that change. It’s important for black children to see successful black professionals. We have to go back and mentor them so they can see beyond their immediate environment to what they can become.”
At the end of her residency in June 2009, Scott plans to seek a position as an attending anesthesiologist, preferably in an urban hospital. At this point, she doesn’t plan to do a fellowship. “I’m eager to go out and start practicing on my own.”
Scott believes anesthesia is the perfect field for her. “You get to see patients before their surgery and tell them what’s going to happen, and you see them postoperatively, and then you move on. At the end of the day, you may have had a case that was stressful, that tugged at your heartstrings, but you can leave it at work. You’ve done your job and given patients the best care.”