Massachusetts General Hospital, Harvard University
December 2, 1959
They had advised me, the #3 student at Marquette Medical School in Milwaukee, Wisconsin, United States of America, to seek a broadly based background in medicine; in fact, a medical internship was advised. Broad medical training would be better than focusing narrowly on a technical specialty such as surgery. This was expert advice, which I heeded, to the extent of seeking the most broadly based, and without question, the most highly regarded surgical internship then extant.
When I was travelling with Joe Geenen, my best friend and studying partner, also in quest of the highest and best in medicine (myself in surgery and Joe in internal medicine), we had expected, of course, the intimidation of the East Coast but we accepted it because of the extraordinary chance to just be interviewed, even though they would treat you like shit, asking you about esoteric enzymes in a large, ancient boardroom with wood paneling everywhere you look. The professors would be in grey suits, pinstripe, with vests, looking down over their half glasses.
We respectfully requested to speak with some actual peers – some interns and residents who were presently at work in order to ask them questions which had been prepared by our advisors from the Midwest.  On the fourth floor of the hospital, I introduced myself and shook hands with George Forker III.
“Don Laub, Marquette, Milwaukee.”
He was cordial, helpful, and actually a bit personable. I learned that this place was in actuality the best place and my thoughts were I would be lucky to come here. George answered my questions candidly and in positive fashion.
“Thank you very much, hope to see you next year.”
“BTW, tell me again, what year at Harvard are you in?”
“I said before I was from Marquette in Milwaukee.”
Words I will never forget then came, “Yes, I’ve heard of it. I’ve always liked Minnesota.”
I laughed heartily at this insider type of joke (Milwaukee is, of course, in Wisconsin). But, it wasn’t a joke at all. I stopped laughing.
“My best friend George Smith went out west to intern. Have you meet him?”
“No, where did he go?”
In those three seconds, I realized that even though I was near to being #1 in Mudsville, aka Milwaukee, I was near to being in last place in the center of the world’s establishments in medicine. I was not put down, I was astonished: It’s like it is in the movies; this is a new definition of provincialism. Damn it to hell.
My friend Joe had the same treatment in the Department of Medicine. We had both received a good dose of Boston arrogance. It was oneupsmanship played out most expertly and effectively. The treatment was just what the Midwest people talk about; the arrogance of the Boston mind, but experienced as an individual person. They are sorry, very sorry to hurt your feelings, but not very sorry that their mind doesn’t go West of Albany and Baltimore and Washington. And they do feel that California is so hot because, after all, it is 3000 miles from the Atlantic Ocean. Also, they feel that the most ideal way to get to California is through Lowell and not through Cambridge.
Now, mind you, we were not humbled the least bit because we felt that when we stopped at New Haven to interview the next day, it would be at least 100 degrees different in the compass bearing, much more civil and perhaps even much nicer. And the management of that situation was with a Midwest tactic. We fled to the bar and ordered Plan A, not Plan B. Plan A was two double vodka martinis up. And so, with anger in our hearts, and revenge on our minds, we concocted a different Plan B: to drive up to the very top Harvard Hospital at midnight, Peter Van Brigham, up to the pillars in front of the entrance, and urinate on them. A full bladder’s worth.
Our method had trumped their method. We thought that perhaps we had won in oneupsmanship. And we merrily and hopefully piled into Geenan’s generous black Lincoln Continental and drove south several hours to Yale. It simply must be different; it had to be, because it could not have been worse at Harvard.
This act was the first act of our life of learning with the process of free will, making our own decisions. Learning with experiential encounters, not just what we had been told and written down in the notebook. And not one of you readers has to guess that our previous learning, that of learning from the role model, did not prepared us for what we had to do that night. This was from our own free will, and we even forged a new axiom. 
Life at Yale
The computer gave the results of the match. The matching compared the various hospitals’ ratings against the ratings of the candidates. And thank you, Mrs. Computer, for your selecting Yale, because Yale was my Heaven.
The pay was 99 dollars for a month. Laundry, food, and parking were free. And so were the mandatory white shoes. We were truly residents, actually spending most of the time in the hospital, not in the townhouse that we had rented. Work started at 5:15 AM: personal rounds to draw bloods, review the charts to gain the ability to answer questions from the Chief Resident at morning rounds. When the page operator called on the loudspeaker Dr. Laub stat to the emergency room and you knew that it was a ruptured abdominal aneurysm, a six-hour case; you rushed to the cafeteria to stoke up and prepare for survival. You are on all day and all that night and all the next day and all the next night, and on that third day, you go home after last rounds and charting at 9:30 PM. Your dreams were filled with thoughts of how to stop bleeding, where the best veins were to start the IV’s on the next day, and being thankful that you are the physically strongest intern, able to run up and down the stairs with the latest EKG and chest film and lab results to get them on the chart quickly. And the cases were thrilling: post-ureteral obstruction diuresis of 40,000 mL per day, oneupsmanship with Nuland regarding who performed the first frontal lobotomy, my first inguinal hernia repair with a full professor assisting and directing me, ulnar nerve repair, the all-night vigils with the post-op open-heart operations ready to quickly remove by hand the wire sutures in the sternum and perform open cardiac massage to save a life!
In actuality, there wasn’t much of a difference. The East coast attitude was always there, but at Yale, it was at 7.0 strength rather than 8.5 in Boston. The step away from Harvard to Yale was the first step of my many steps in a longish journey – from Stanford, California, all the way to Mexicali in the Northwest Mexican desert. The journey was long as judged in an academic way. It was long in physical distance but not different at all psychologically. This was where the action was. The Mexicali project was wonderful, full of human life, and full of stimulation. It was indeed Many People, Many Passports.
 How much surgery do you actually do?
Do the professors and the attending surgeons personally interact and teach you?
What is the quality of the library?
You like it here?
How are the hours of work?
 There is some psychological theory to back up our actions. Eric Erickson, psychologist: “Everyone needs to make a voyage in teenage, or soon thereafter.”