Vegas Brown hasn't been this nervous since his first Pee Wee football game. This is it. This is what all the work has been for. Taking the advanced classes at Sarasota Riverview and graduating with high honors. Deciding that instead of being a physician's assistant, he would be a physician himself. Ignoring the University of Florida professor who told him when he was a freshman that his C in chemistry was going to keep him out of med school. Working. Pushing. Internships. Sleepless nights. It has all led up to this. Vegas Brown is going to start his life as a doctor.
But where it happens is out of his control.
When Vegas was a high school running back, his friends called him "Headquarters" – his big head didn't quite fit on his small frame. Now 26, he's filled out a bit, still compact but muscular, with a thin mustache and a scraggly patch of beard under his chin. The only parts of him that still looks disproportionately large are the bags under his eyes. But med students get a free pass when it comes to looking tired – especially during Match Week. At noon on March 17, graduating medical students across the country, including USF's Vegas Brown, were matched with the hospitals where they would spend the next chapters of their lives as doctors in residence. A paid apprenticeship that students must complete before they are licensed and can practice on their own, residencies mean long hours and low pay. But they're a step up – you're in a hospital full time, practicing medicine.
The National Resident Matching Program (NRMP) is a combination of college admissions, storefront fortune-telling and the NBA draft – it decides dreams, or crushes them, all in a matter of seconds. The process starts in the fall of medical school students' fourth and final year, when they tour the country interviewing at hospitals with residency programs in their specific fields. In January, the students apply to their favorites much like high school seniors apply to college, with stretches and safeties.
But instead of hearing back from the hospitals, students hear back from a computer. Both med students and hospitals send lists ranking their choices to NRMP, which plugs them into the computer. And over the course of a week in March, an algorithm spits out thousands of matches, deciding the course of thousands of lives.
The Match Day tradition at USF makes the already pressure-packed afternoon even more excruciating. What used to be a quiet affair in a lecture hall, where students read their letters alone at a desk, has evolved into a public event designed to emphasize what Associate Dean of Admissions Dr. Steven Specter calls "one of the most exciting days in a medical student's career."
For the past 12 years, the school has held Match Day in the sandy courtyard of Skipper's Smokehouse, the storied North Tampa music club. One by one, Specter calls the students to a makeshift stage in the middle of Skipper's sandy pit. In front of fiancés, parents and anyone else who has a vested interest in where they end up, the nervous MDs-to-be open their envelopes, lean into the microphone and announce their futures. The letters could say anything. What they say means everything. And everybody's watching.
It's an impersonal process with intensely personal consequences, one that can send a student halfway across the country or just down the street. On March 17, Vegas Brown was fervently hoping he wouldn't have to go away. He wanted the piece of paper in that envelope to say "Emergency Medicine, University of South Florida." He wanted to stay home.
Vegas' past is tattooed on his biceps – at least the part he wants to talk about. On his right arm is the name of his father's mother, Inez. On his left, the name of his other grandma, Lucy. Vegas grew up in the working-class neighborhood of Newtown in Sarasota, one of eight brothers and sisters scattered among four moms and two dads. Vegas' parents split up when he was 2, and he lived with his mom, Connie Williams, until he was 12. But when things got a little too hectic at home, he moved in with grandmother Inez down the block.
But Vegas doesn't think of himself as coming from a broken home. It would be easy for him to play that card, to harp on the adversity he's overcome. It would be easy to assume that Vegas Brown's story is a pick-yourself-up-by-the-bootstraps, hard-luck-kid-makes-good tale. And it might even be. But that's not how he sees it. He sees a family that was always there for him. His dad, an MRI technician, took him during the summers. His mom, an orderly, came to PTA meetings and football games long after her son had moved out. And Inez and Lucy, the family's backbone, took on extra jobs to help pay the bills.
Vegas Brown is "humble, almost to a fault," according to his mentor Dr. Ted Williams, associate dean for diversity at USF's College of Medicine. Newtown locals have told Vegas he is the first black man from the neighborhood to become a doctor, but you have to push to get that out of him. Even when talking to a reporter, he "forgets" to mention that he is president of his class and USF's chapter of the Student National Medical Association, an organization focused on issues facing medical students of color.
"Dude, I am not, like, the smartest person in the world," he says with a shy confidence, drawing out the "du" in "dude" as he leans back on a green metal bench near USF's medical clinic. "The only thing I got going for me is a good work ethic. Seeing people work two jobs, that'll teach you a lot about working hard."
"It's because of my family that I got here."
His relatives send the credit right back. "I always believed in Vegas," says Inez Austin, the woman who raised him from the age of 12, and still calls him her baby. She speaks patiently about her grandson, pausing between sentences and continuing softly.
When he was little, did she think Vegas would become a doctor?
"He wanted to," she says. "And once he puts his mind to something, he succeeds."
Just getting into USF's College of Medicine was a success. The medical profession and its schools are struggling to become more racially diverse (USF's campus is decorated with "Medicine celebrates diversity" banners), but there is still a long way to go. Vegas entered the school four years ago as the only African-American man in his class of 104. "It wasn't really a problem," he says. "But you'd like to have someone to identify with immediately."Not surprisingly, being the only black guy in a class filled predominantly by middle- and upper-middle-class white students presented some challenges. Vegas was always strong academically, says Dr. Williams, who recruited him to USF. But when he arrived, "he still had that shyness."
"I don't open up to people right away," Vegas admits. "When I got here, I was sorta guarded."
He went to school functions and eventually made friends, but Vegas kept most relationships on what he calls a "professional" level. He would turn down classmates' invitations to hang out in Hyde Park nightspots, opting instead to go to all-black clubs with friends from Sarasota and UF.
In addition to med school's constant rigor, the few enrolled African-Americans feel an extra pressure, says Dr. Williams, who was the only African-American in his 1976 graduate school class at Cornell. "[The student says] I must succeed for myself, and I must also succeed for those that come behind me."
"If I don't work hard, I know that my only option is to go back home and face the circumstances that I was in before," Vegas says. "And regardless, you know, nobody wants to work from check to check – I don't care who you are. Nobody wants to be in debt. Everybody wants to have a nice home, everybody wants to be able to go on vacations, everybody wants to be able to send their child to college."
The pressure wasn't constant, though – Vegas says he was often too focused on himself and his work to worry about anything else. But there were times – when a classmate said he wished he were black so he could get more scholarships, for example – when the cultural divide was too glaring to ignore. (Vegas received some financial aid, but says he's got about $120,000 in loans to pay off.)
And, no matter how many degrees he earns, Vegas says "some women will always clutch their purses when I walk by."
As with his childhood, Vegas would rather accentuate the positive about his med school career. The folks at USF, black and white, gave him the support he needed to succeed, he says. "If you come from a disadvantaged background and you work hard, everybody's cheering for you." Often, the socioeconomic disparities between Vegas and his classmates helped them learn how to be better doctors.
When students asked why a working-class patient with diabetes had let her disease deteriorate, Vegas would push them to think of possibilities other than negligence: Maybe the patient didn't have health insurance.
"Vegas has broadened [his classmates'] knowledge and understanding of other cultures, which will help them be better physicians," Dr. Williams says.
And they've helped Vegas.
"I probably came into school with some misconceptions about people with money," he says. "[My classmates] have taught me a lot." They've taught him how to invest and how to buy a home – good knowledge to have if you're going to become a doctor (especially if you're going to be almost $120,000 in debt).
"None of my friends [from Newtown] could help me with that."
Med students spend their first two years in the classroom and their third in the field, completing internships in family practice, psychology, pediatrics and other primary care careers. Their fourth and final year is for electives; students focus on the particular specialty that interests them to make sure that's what they want to commit to. Commitment is a big word in med school – some residencies can take nine years to finish, meaning students will have spent 13 years learning their trade before they are allowed to practice on their own. The match process is a hefty commitment itself. Once you send in your list, which can be as short as one hospital (if your grades are perfect) or as many as you'd like (if they're not so hot), the decision is out of your hands. There's no appeal – the match is a contract. You go where the computer tells you.
"We're all basically control freaks," Vegas says of his classmates. "And to get that [control] taken away from you, it bothers you." Some students don't brush it off quite so easily. In 2002, three residents filed a class-action lawsuit against 36 hospitals and institutions claiming that the match system forces residents to accept jobs with long hours and relatively low pay scales, which violated anti-trust laws. The case, which received national attention in 2002 and has since worked its way through Washington, D.C., courts and generated anti-trust arguments in Congress, was dismissed by a U.S. district court in January. According to the plaintiffs' website, savetheresidents.com, the three residents filed notice on Feb. 26 that they will appeal the decision.
Vegas applied to seven hospitals, including Duke, Stony Brook (Long Island), Wayne State (Detroit), and Jacksonville. But he put USF at the top of his list. "I'm a Southern boy," he says. "I don't like the cold." He wanted to stay close to his family and his beloved Bay area, too. "I want to be somewhere I can continue to grow roots," he said.
Vegas applied to be an ER physician (a three-year residency), because that's where he believes he can make the maximum impact. And that's where the action is. "I've always wanted to run the show," he says. In the ER, Vegas will be the initial point of contact for patients – identifying with them is often as important as treating them, he says.
Just as he brought a new perspective to his class at USF, Vegas wants to bring something fresh to an ER. "The knowledge-based stuff you can teach," he says. "But you learn how to work with people when you're growing up. I know what it's like to be unemployed, to have to take cold showers. I've dealt with that crap." And now, after four years, he'll be able to put that experience to work with his patients.
Somewhere.
A few hours before he will open his letter, Vegas is at a classmate's Hyde Park apartment for breakfast. Nine future doctors – surgeons, pediatricians, family practitioners, shrinks – sit around a well-decorated living room eating scrambled eggs and bacon, drinking mimosas and trying to keep down their swelling nerves.They don't look like doctors (can anyone eating bacon?) – they look more like college seniors who took a few extra years to finish. Dressed in jeans and green T-shirts (it's St. Patrick's Day, another reason to start drinking at 9 a.m.), the future MDs gossip about classmates, crack jokes and avoid too much Match conversation.
It feels like the hours before a college graduation. Something big is about to happen – you know that. But you're not sure how it's going to feel and you're not sure you're quite ready for it. The only thing you are sure of is that a beer would help.
Watch the initial reactions: that's the consensus. If you want to know whether a student got his first choice or his last, that first letter-opening moment will give it all away.
As Match Day approaches, people tend to guard their lists closely, revealing their picks only to a few close friends. That way, if you're assigned to your last choice, nobody will know.
Until you head off stage crying, that is.
Between wisecracks and planning that night's party, Jeremy Davis, a Tampa native, keeps glancing at his wrist. "I think my watch has been on 10:54 for the last 15 minutes," he jokes. A future pediatric surgeon, Davis will spend the next seven years at whatever hospital the computer spits out. Seven years, decided in an instant.
"It's here," he was thinking to himself. "It's inevitable. This afternoon I'm going to be headed somewhere."
Across the small living room, Vegas slumps on the couch, his eyes heavy. He only got a few hours of sleep last night; thinking about all the different possibilities – Tampa, Long Island, Detroit – was driving him crazy.
Thursday is one of those wet, overcast days that look beautiful through a window but are disappointingly bleak once you get outside. It's drizzling when Vegas arrives at Skipper's; the rain has turned the bar's sand floor into slick mud and forced the gathering crowd of a few hundred to huddle under a roof. At least that's where the free beer is. As he maneuvers through the crowd, people patting him on the back and wishing him luck, Vegas doesn't exactly look like the rest of his classmates. Not only is he one of the few African-Americans, but he isn't trying to hide his nervousness either. As the folks around him laugh and chat, pretending this is just another afternoon, Vegas retreats to the back, grabs a Coke out of a cooler and looks around, stone-faced.
"This is a crazy day," he says.
David Sella's crazy day is almost over. An aspiring radiologist, Sella has opted not to read his future aloud on the stage. His wife of nine months, Kathy, a second-year med student herself, doesn't want to break down in front of everyone if they don't get their wish.
So Dave got his letter from the dean early, away from the crowd, and he and Kathy have stashed themselves away behind the bar. He applied to USF, but if he lands anywhere else, thanks to the computer, he'll be split from his new bride for at least two years.
It's a powerful little envelope.
Sella asks his wife if she'd like to open it. "No," she says. "You do it."
Orlando.
David is off to Orlando for a year, then to the Mayo Graduate School in Jacksonville.
The couple leaves quickly after getting the news, just as the first students begin to read theirs to the rest of the class.
"It kinda sucks," says Kathy a few days later. She's in a tough spot now, scrounging for a roommate and considering a transfer. "It's like, 'Bye, Honey', I'll see you in two years."
The Mayo clinic is a great program for an aspiring radiologist, and both David and Kathy say the computer's decision will ultimately be for the best. But that doesn't make it a whole lot easier.
"It definitely put a wrench in the plans," she says with a laugh.
For the NBA draft, the top players are invited to New York to sit in a room offstage and wait to be chosen. Every year one or two guys don't get picked as high as the experts thought they would. The poor (though not for long) players are forced to sit in the room, twisting with anticipation, TV cameras in their faces, until their names are called and they get to don the lucky team's hat and shake the commissioner's hand.
For them, every spot they drop on the board means big bucks. But you get the sense, watching them sit on the edge of their seats, that they're not thinking about the money. They just want to know where they're going. They just want it to be over.
That's how Vegas Brown is feeling at Skipper's. As his classmates read their matches aloud, Vegas sits stiffly on a bench just a few rows from the stage. He gets up to take photos, or to hug and cheer when his friends make their match. But the pit in his stomach continues to grow. He needs to know.
A future neurologist bounds up the aisle in beat-up jeans, high-fiving his pals with one hand and holding onto a beer with the other. Another student sprints offstage screaming into a cell phone, his fist clenched in triumph like Michael Jordan after a buzzer-beater. But for others, it is all they can muster to crack a smile for the cameras before the tears come crashing down. No matter whose name is called, no matter where the hospital, the crowd erupts into hoots and hollers.
But not Vegas.
"The noise was building up like in a horror movie," he'd say later. His heart pounding, his mind racing, all he can do is wait. And worry.
Then it comes.
"Vegas Brown."
As the cheers roll in from behind him, Vegas stands up and exhales deeply. All the work. All the tests. All the people who told him he couldn't do it, and all the people who told him he could. It has all led up to this. Is he going to stay home? Can he finally buy a house in Tampa Bay? Will he still see his grandma every couple weeks? What has the computer decided?
He opens his envelope, holds the microphone to his mouth.
"Emergency medicine. Wayne State University. Detroit."
Vegas smiles, but just as his friends predicted, his first expression betrays him. The kid they called Headquarters, the Southern boy who hated the cold, is moving to Michigan. "Snow tires, man," he says once out of the spotlight, the air knocked clean from his stomach. "Snow tires."
Vegas' mood is better a few days later. The program at Wayne State had been at the top of his list at one point, and aside from the cold it's exactly what he wants – experience-intensive with little research. Since Match Day, he's heard from some first-year residents already in Detroit, a couple of whom are even from Florida. The jump to the cold isn't so bad, they say.And in Detroit, Vegas will get a chance to treat people – not just practice medicine. "Detroit's 70 percent black," he says. "I guarantee you 70 percent of the doctors aren't."
His family doesn't rebound quite so quickly. "I'm used to seeing him twice a month. Now I'm not going to see him but twice a year," says his grandmother Inez.
But just because her baby is off to Detroit doesn't mean Inez has lost sight of what Match Day means. She's called everyone she knows. Her grandson, she tells them, has officially become a doctor.
Much of Vegas' life as a resident won't be up to him. A supervisor will decide his hours, his duties and his vacation days. But he'll be able to choose what Detroit neighborhood he'll live in.
"I'm all in control now," he says. At least Vegas Brown got that back. Doctor Vegas Brown.
This article appears in Mar 30 – Apr 5, 2005.