Dispatches from the Road
Notes from a life well traveled  ·  Tim O'Brien
Tim O'Brien at Jefferson Medical College commencement in 1991, holding infant son Timothy Jr. (Baby Timmy), with wife Nancy

Commencement  ·  Jefferson Medical College  ·  Philadelphia, June 1990

Philadelphia  ·  1986–1990

Learning to Heal

Medical school is not a place so much as a passage — a compressed, often brutal initiation into the science and art of human care. For four years, Jefferson Medical College in Philadelphia was the crucible in which that passage was made.

The photograph above is from the other side of that passage: commencement, June 1990. Academic robe with the green hood of medicine. Nancy at my side. Baby Timmy — Timothy Jr. — five months old, held aloft in a sailor suit, a small sailor launched alongside a newly minted physician. We had arrived in Philadelphia as a young couple in 1986 and were leaving it as a family of three, with an MD in hand and a residency at Wills Eye Hospital about to begin.

Jefferson, founded in 1824, is among the oldest and most storied medical schools in America. To understand the institution is to understand something essential about how American medicine came to be.

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A dispatch from Jefferson

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The Letter That Started It All

Acceptance card from Jefferson Medical College welcoming Timothy James O'Brien to the Class of 1990, signed by the Associate Dean for Admissions, pasted above a photograph of the Jefferson Medical College entrance.

Acceptance card  ·  Jefferson Medical College  ·  1986

The Moment Things Changed

Some pieces of paper change a life. This one — a small, cream-colored card from Philadelphia, embossed with Jefferson's seal in gold — was one of them.

The admission was through Jefferson's Physician Shortage Area Program, created to bring physicians back to underserved regions of Pennsylvania and the rural Northeast. A first-generation college student from Bradford, Pennsylvania was exactly the kind of candidate the program was designed for. The welcome was signed by the Associate Dean for Admissions in his own hand.

Years earlier, at Pitt-Bradford, a pre-pharmacy advisor named Dr. Thomas Gerteisen had told me I should go straight to medical school. I couldn't afford to take that advice at the time, so I finished pharmacy at Pitt, worked at Children's Hospital of Pittsburgh, and only then — armed with a profession, a wife, and some savings — applied to medicine.

The card is taped into an old scrapbook now, edges yellowing, next to a grainy photograph of Jefferson's front doors on Tenth Street. Looking at it, I remember opening the envelope in the mail at the kitchen table and not quite believing what it said.

A Day in the Life of Your Med Student Son

Philadelphia  ·  September 29, 1986

A few weeks after that acceptance card brought us to Philadelphia, I sat down to write home to Mom, Dad, and Danny. Rather than send the usual news, I walked them through one ordinary Monday. It starts at 6:30 in the morning, driving Nancy to her new nursing job so we could save $3.50 a day. It ends at 11:30 at night, with Nancy asleep on the couch in our apartment at the Brewery.

In between are the small details of first year: lectures on carbohydrate metabolism, biostatistics I found very boring, and the two salami sandwiches Nancy packed for my lunch. There is the crowded bus down to Jefferson, and the long nap before a night of studying. Much of the letter was written on the ride home through Center City, which is why it begins with an apology for the handwriting. It ends with a thank-you for the loan that got us started.

These are the four pages as I printed them on notebook paper forty years ago, ink smudges and all.

Handwritten letter, page 1, dated September 29th 1986, beginning 'Dear Mom, Dad & Danny: A day in the life of your med student son'
Page one  ·  Morning
Handwritten letter, page 2, describing the lecture auditorium, lunch packed by Nancy, and an afternoon lecture on the newborn infant
Page two  ·  Classes
Handwritten letter, page 3, written on the crowded bus home through Center City, then dinner, a nap, and statistics problems
Page three  ·  The bus home
Handwritten letter, page 4, closing with thanks for the loan and signed 'Love, Tim'
Page four  ·  Love, Tim

Click any page to read it full size.

Read a typed transcription

Spelling and punctuation lightly tidied for reading; the handwritten pages above are the original.

Sep 29th, 1986

Dear Mom, Dad & Danny,

A day in the life of your med student son...

Hi! It is 6:30 AM and time to give my nurse wife a ride to work. Actually, she drives and I drive the car home. It saves us $3.50/day. I drop her off and drive up 33rd, right on Spring Garden, around the Art Museum, over to 25th, up to Pennsylvania and down to 29th to our home, the Brewery Apartments. It's now about 7:00 and time to make the bed and get a shower.

In the shower, I think about the upcoming week and what I have to do. Monday–Friday are my longest days. Today I have 2 hours of carbohydrate metabolism, an hour of biostatistics. This takes up the morning classes and they are pretty boring. Then I have an hour and a half for lunch. I usually eat my lunch for ½ hour and go study in the library for an hour. This afternoon we have a 2-hour Medicine and Society lecture on the newborn infant. Then we have our weekly small groups class. Today one of our fellow students who has her PhD in psychology is going to speak to our group about her research in Alzheimer's disease.

Having thought about all of this in the shower, my water is getting cold so I decide to get out. I flick on the Today Show and make some toast. I read some of the Philly Sunday paper and pretty soon it is time to head out to the bus. Nancy has packed my lunch so I pack it and my books in my gym bag, put on my Walkman, grab two bus tokens and I am off.

The bus ride is pretty exciting as usual. There is no place to sit so I have to stand. It takes about 20 min to get to Jefferson so it's not too bad. I go to my mailbox and pick up the notes from last week, have a glass of ice water in the cafeteria and stop off in the locker room to drop my lunch off.

Class is in the same big auditorium every day. I usually sit in the back now because there is more room for my long legs back there. The first lecture is pretty fast-paced. It's about how your body makes sugars when it doesn't have any to use. The second lecture is in statistics, which I find very boring. A lot of kids don't even go. The next lecture is more biochem; more about the body's storage and breakdown of sugars. It's finally time for lunch!

Nancy has packed me two salami sandwiches, a peanut butter & jelly sandwich, some pickled tomatoes, and some macaroni salad. Pretty good eats, huh?! Well, lunch is over and it's time to go to the library to go over a few biostats notes. What a drag!

Well, it's time for class again. It's a lecture on the malformed infant given by a pediatrician named Olshin. He is what everybody sees a doctor as being. Class today is about the metabolic effects of the newborn infant like jaundice and phenylketonuria. The second hour is on the psychological aspects of infancy. I don't find this too interesting.

It's now 3:30 and time for our small group meeting. A girl in our group is talking about her summer research in Alzheimer's disease. It was pretty interesting, but I thought about Mr. C a lot. She found in her research that Alzheimer's patients have a decreased sense of smell and did a study to document this.

The bus ride home is packed. It is very muggy in Center City Philly but the bus has A/C. It makes the ride home more bearable. Pardon the handwriting but I am actually writing this as I ride the bus... a lot of stop and go. The bus is jammed with about 25 people standing in the aisle and all the seats full. I was lucky to get a seat to continue this action-packed letter. There is a cute little black girl (about 3 yrs old) and her father standing in front of me. As I look out the window there is traffic all around. You can have trying to drive a car in Center City. It is 5:30 and my bus is almost home. It will be good to get home and have dinner with Nancy. Plans for the evening are dinner, a nap (2–3 hrs) and study. The only bad thing so far is that you always have a test coming up and you always have to study.

Well, dinner was great. Nancy always has dinner ready for us when I get home. Today we had chicken, green beans, and rice. It was real good. We have found that since we don't have much money, we are planning our meals better and making our food go farther.

Had my nap from 7 till 9 and have spent the past two hours working on statistics problems. I think that some of it is starting to sink in. I'll probably read some histology and biochemistry and go to bed. I have a ½ day tomorrow so I can get a lot of studying done.

Well, it's about 11:30 PM and Nancy is sleeping on the couch. I think that she is slowly adjusting to her new job. It is real hard to go from a job where you know how to do everything to one where you are totally lost. I think that a lot of times she gets very homesick. I hope that she will be able to make friends like she did at Magee.

That's about it. This is definitely a different life than what I was used to. In school, you have more personal freedom but you can't leave your work at work; there is always something that you can be doing.

Better get going. Just wanted to say thanks so much for the loan. It really made our transition a lot easier. Thanks again.

Love,
Tim

Jefferson Medical College & Its Deep Past

Founded 1824

Jefferson Medical College was established in Philadelphia on January 19, 1824 — the same year that Beethoven completed his Ninth Symphony and Byron died at Missolonghi. It was chartered by the Pennsylvania General Assembly as an independent medical school, distinct from the University of Pennsylvania, and quickly became one of the most attended medical colleges in the nation. For much of the 19th century, it graduated more physicians than any other school in the world.

The Gross Clinic

In 1875, Thomas Eakins painted The Gross Clinic — a monumental canvas depicting Samuel D. Gross, Jefferson's most celebrated surgeon, performing an operation in the Jefferson amphitheater surrounded by students. The painting was called the greatest American painting of the 19th century by many critics, and it captures something essential about Jefferson's ethos: medicine practiced with unflinching rigor, observed, taught, and witnessed. The original hangs today at the Philadelphia Museum of Art.

Samuel D. Gross

Gross — the "Emperor of American Surgery" — defined Jefferson's reputation across the mid-1800s. A towering figure in surgical education, his System of Surgery was the defining textbook of the era. He was among the first in America to teach surgery as a clinical science rather than a craft guild mystery, insisting that students observe operations directly rather than merely read about them. Jefferson's tradition of clinical teaching flows directly from his example.

Philadelphia & American Medicine

Philadelphia has a legitimate claim to being the birthplace of American medicine. Pennsylvania Hospital, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond, was the first hospital in the colonies. The College of Physicians of Philadelphia — home of the Mütter Museum — was founded in 1787. Jefferson entered this environment in 1824 as a brash, independent alternative, and its graduates fanned out across a growing nation carrying its clinical philosophy with them.

Wills Eye & the Philadelphia Connection

Philadelphia was also home to Wills Eye Hospital, founded in 1832 as the first eye hospital in the Western Hemisphere. The connection between Jefferson and Wills Eye would become a defining thread in Tim O'Brien's own story — from medical school through residency and into a career in ophthalmology. The city's medical ecosystem made such trajectories possible: world-class institutions within blocks of one another, sharing faculty, patients, and ideas across two centuries.

Thomas Jefferson University Today

In 2017, Jefferson Medical College merged with Philadelphia University to form Thomas Jefferson University — a comprehensive institution spanning medicine, design, health, and the built environment. The medical school, now Sidney Kimmel Medical College at Thomas Jefferson University, retains Jefferson's name and legacy while operating as part of one of the largest academic health systems in the Philadelphia region. It continues to graduate physicians in the tradition established two centuries ago.

The Essay That Closed the Circle

Essay — The J. Woodrow Savacool Prize in Medical Ethics

Timothy James O'Brien  ·  February 1990  ·  JMC '90

I was born in the small town of Bradford in northwestern Pennsylvania. This country town provided me with a wonderful environment in which to live. The townspeople are very down to earth and cherish basic family values. As the oldest in a family of four children, I enjoyed a strong and happy family life. My father worked hard as a salesman and my mother stayed home to raise the family. I know within my heart that these early experiences with my family and community in Bradford provided me with a special ability to deal with patients on a very personal level.

As a high school student, I developed an interest in biology and chemistry and decided to attend pharmacy school at the University of Pittsburgh. As a pharmacy student, I found myself excelling academically and enjoyed counseling patients on drug therapy. I was also able to interact well with my classmates and served as their class president for three years. As a registered pharmacist I obtained a staff position at the Children's Hospital of Pittsburgh. I had the opportunity to teach students the art of pharmacy and enjoyed presenting topics on drug abuse to community groups. Although the practice of pharmacy was satisfying at first, it soon became clear to me that my real interest was in a more comprehensive care of the patient and at that point chose to pursue a career in medicine.

I was very excited about entering medical school at Jefferson and at the prospects of becoming a physician. I knew that here I could expand upon my knowledge of pharmacology and become more intimately involved in patient care. As I near the end of my medical school training, I have fondly found these goals to be achieved. I have not only begun to master the volumes of knowledge necessary to practice modern medicine, but have also cared for wonderful patients whose interpersonal relationships will remain with me throughout my career. I feel fortunate to experience first hand the physician-patient bond and how this bond makes the job of practicing medicine like no other.

Thinking back on my experience at Jefferson, I will never forget patients like "Mr. D." who was dying of hepatorenal syndrome but could joke with me about my size 14 shoe size. Then there was the family whose mother was being ravaged by carcinoma of the pancreas but who reminisced about what wonderful times they had spent hunting and fishing around my home town of Bradford. Then there were the days on Family Medicine, visiting patients in their homes with the home health nurse, listening to their medical problems, eating their homemade cooking, and drawing blood that no one else could seem to obtain. Each and every one of these experiences are very special to me indeed.

I feel quite honored that the committee has nominated me for the J. Woodrow Savacool Prize in Medical Ethics. I know that in these times of high-tech MRI, monoclonal antibodies, and patient physician mistrust, that the knack for interpersonal patient physician relationships gets lost in the shuffle. Awards, academics, and prestige aside, my interest in the patient, his life, and his problems are still what drives my interest in medicine.

Timothy James O'Brien JMC ’90  ·  February 1990

"Medicine is learned by the bedside and not in the classroom." — Sir William Osler

Jefferson's founding philosophy was Oslerian before Osler articulated it. From its earliest decades, the college insisted that clinical experience — standing at the patient's side, in the amphitheater, in the ward — was the irreplaceable core of medical education. This was not a given in 1824. Much of American medical education at the time was delivered by lecture alone, without systematic access to patients. Jefferson's insistence on clinical contact was radical, and it shaped a generation of American physicians who approached the human body as something to be observed carefully, not merely categorized.

The four years of medical school trace a recognizable arc. The first two are largely preclinical: anatomy, biochemistry, physiology, pharmacology, pathology — the fundamental sciences that make the body legible. The second two are clinical: rotations through internal medicine, surgery, psychiatry, pediatrics, obstetrics, and the specialties. The commencement photograph at the top of this page was taken at the end of all of it, in the small courtyard outside the Jefferson amphitheater where Eakins had once sketched Gross at work. By then the academic hood signified something earned rather than aspired to, and Timmy was along for the ride — a small passenger through the last semester, arrived into the world that winter.

Philadelphia in the late 1980s was a particular kind of education in itself. The city's medical quarter — Jefferson, Thomas Jefferson University Hospital, Wills Eye, Pennsylvania Hospital, and Jefferson's affiliated clinics — formed a dense constellation of medical experience. To rotate through those institutions as a student was to encounter pathology in its full range: the acute and the chronic, the urban and the suburban, the insured and the uninsured. The city did not shelter its medical students from complexity. It delivered complexity, at volume, without apology.

What Jefferson produced, at its best, was not merely a credentialed physician but a certain kind of medical citizen: someone formed by the Gross tradition of watching carefully, by the Philadelphia tradition of taking medicine seriously as both science and service, and by the particular discipline of having been trained in one of the oldest and most demanding medical environments in the country. The acceptance card, the Savacool essay, and the commencement photograph form a small triptych of that formation — the door, the vow, and the threshold crossed. Everything that came after — Wills Eye, Jamestown, Gateway Ophthalmology, thirty-five years of cataract surgery — traces back to the piece of cream-colored cardstock that arrived in the mail one afternoon in Pittsburgh, to the typed page that named what the work was really about, and to the quiet confidence of a young man in a green hood holding his first son up to the sun.