In the fourth Year the book About the book

At the end of his fourth and final year of medical school, Brian felt the story of his medical education burning to be told. Not for the grotesque or curious scenes one sees in medicine, or even the tragedies one becomes a part of, but for the magic that occurs when a doctor discovers the stories behind his patients. This is termed the humanistic side of medicine, contrasting the usual treatment of man as a biological machine, while under-appreciating the social, cultural, and historical elements to illness and disease. Brian discovered that his role in medicine was to pierce that humanistic side. Living & Dying in the Fourth Year is the story of this revelation.

Living & Dying in the Fourth Year is also an international travel adventure. Living out of a backpack, Brian moves from one clinical rotation to the other, staying in a New York City hostel one month and with a Dominican immigrant the next. With intrepid curiosity, he moves onto the Crow Indian reservation in Montana, where he is adopted by a Native American family. Brian’s next adventure is a leap beyond all comforts of language, culture, and geography. He flies off with a group of classmates to Kenya, East Africa, spending two life-changing months at Moi University Hospital in Eldoret. Brian finishes the year in Beer Sheva, Israel, graduating from The Medical School for International Health (MSIH) and discovering the role he wants to pursue in the field of medicine.

The Medical School for International Health, is a fascinating collaboration between Columbia University in New York City, and Ben Gurion University in Beer Sheva, Israel. Students live in Israel for three years amidst a largely immigrant population from Russia, Argentina, Morocco, and Ethiopia. The MSIH student matures in this milieu of cross-cultural medicine from day one. During the fourth year, students do required clinical rotations at Columbia University hospitals, as well as a culminating International Health Clerkship in a developing country. Choices include India, Peru, Ethiopia, and Kenya among others. The MSIH experience and the fourth year especially, is an opportunity to learn medicine, travel the world, and become experts in cross-cultural patient care. Brian’s story, which is shared by all graduates of this medical program, is a story worth telling.

The writing of Living & Dying in the Fourth Year began in the final months of medical school and continued throughout internship and residency, serving as a form of therapy for one caught square in the middle of the biomechanical side of medical practice. Internship is an unforgiving time where the crushing demands of 30 hour shifts trump the development of personal relationships with patients. Fortunately, Brian attended residency at the University of Virginia Family Medicine Residency Program, a place that shared and nurtured his philosophical approach. Brian completed the manuscript before graduation from residency in 2008, three years after it began.