Since I was 7, my goal has been to become a doctor. But life had other plans. I grew up in a blue-collar family in Levittown, N.Y., in the 1950s and ’60s, so it often felt like the world ended in Jersey. When I landed in Lansing, Mich., to attend Michigan State, I expected the Rocky Mountains to be visible. I ended up getting a degree in nursing, but I always had another goal: to become an M.D. This year, at the age of nearly 73, my dream will finally come true. Soon after, I will start my residency in family medicine. My perspective on medical school and medicine is unique not only because I attended late in life, but because it came after more than 40 years as a nurse practitioner. After I got my bachelor’s in nursing, the NICU became my home. I took premedical classes in the evening. Then, a new neonatal nurse practitioner program opened in Southern California, offering me a then-rare opportunity to practice in a medical role. I attended the program, graduated, and returned to Michigan in 1981. At that time, nurses in my city, Grand Rapids, Mich., had not been permitted to place an IV in a pediatric or neonatal patient. No nurse there has been responsible for leading the resuscitation and admission of a critically ill infant. No nurse had been responsible for the procedures involved in this care, including intubation, chest tubes, umbilical central lines, lumbar punctures, ventricular taps, and more. The NP program provided education in the pathophysiology of neonatal medicine. There were many opportunities for skill development. For four months, I spent every third night in-house on 24-hour call alongside pediatric residents. But there was much more that the program did not provide: advanced anatomy, physiology, genetics, biochemistry, microbiology, and histology. (Some doctoral programs in neonatal nursing do offer this coursework now.) I devoted time to filling the gaps in my basic science knowledge. The medical library was a second work “home.” I thought that understanding histology, microscopic anatomy, and evidence-based best practice was essential in the role. The University of Florida College of Medicine has a certificate program in medical anatomy and physiology, which provides the medical courses lacking in many Master of Nursing NP programs. In 2016, I completed that program, which was the perfect foundation for me to proceed to medical school in 2022. You may be wondering: Why did I wait so long? Well, life! As soon as I finished undergrad I wanted to apply to medical school and began my additional premed requirements. I married, had two children, and became a neonatal nurse practitioner. At 35 I divorced, took the MCAT, and applied. I was granted an interview by Michigan State University, but I had not finished my organic chemistry, and my scores reflected that. I was told I was a good candidate and to please complete my organic and reapply. At that same time I met my second husband. We married with the hopes of having our own children, and I planned to attend medical school when I was 40. But God has other plans, and we had infertility as a couple. My youngest child was born when I was 49! At 50 I assumed my dreams were done. Then, in 2020, a life-threatening accident almost took my husband. Post crisis, we sat down for a serious conversation about what we wanted to do with the life we have left. He stated, “I want to travel.” I stated, “I still want to go to medical school.” He replied, “I will visit you!” So at 69 I applied to St. James School of Medicine Anguilla campus. Anguilla is a wonderful Caribbean island. We snorkeled, swam in the ocean, and watched beautiful sunsets for two years of my basic sciences. My husband visited 14 other Caribbean islands while I studied. I completed my clinical rotations in Chicago, West Virginia, New York, and south Texas. We traveled and I completed my M.D.! A lifetime of clinical skill, self-study, and research on neonatal topics, plus 45 years of academic neonatal medical rounds, taught me a great deal. But I still learned a lot in my four years in medical school, including about the difference between being a nurse practitioner and a physician. Now that I have traversed both paths, I can honestly say that there’s a great deal of overlap between the roles, but both educational journeys are missing some important elements. I believe that the neonatal nurse who later becomes a practitioner is the best provider — if their education includes the advanced medical sciences. Two years minimum of bedside neonatal nursing experience offers an education you cannot get in school. A pediatrician or neonatologist does not have that history. They go through a longer and less focused path: four years of medical school, three years of pediatric residency, and two to three years of neonatal fellowship with a focus on research. They don’t get the experience of bedside management of critically ill newborns, which teaches us how to assess the patient who cannot speak for themselves. Not unlike a parent’s intuition that something is off, this clinical time teaches how to recognize those changes. A prime example is feeding intolerance. The bedside nurse does not just see volume in, but also subtle changes in clinical response to that feeding. This enables the early recognition of possible necrotizing enterocolitis. Medical school and residency do not teach this. It is experiential. The current neonatologists depend on the nurses to alert them to further investigate. What if the neonatologist had that experience? My two years of clinical coursework in medical school was very interesting but not at all focused. Not unlike the clinicals in a BSN program, it included adult critical care, emergency, surgery, internal medicine, pediatrics, obstetrics, and psychiatry. My electives were again very engaging, but if my ultimate goal was to become a specialist, these would be time-consuming and not improve my expertise in neonatal medicine. Our current health care educational paths make little sense. Medicine is no longer the general practice of 1940. Medical school curricula have essentially not changed since that time, yet the knowledge and evidence-based data have escalated to levels unimaginable when these curricula were developed. I went to medical school at 69 to learn what I did not know. It enlightened me as to the need for contemporary health care specific preparation. We need a reduction in duplication and a focus on today’s knowledge, especially with the internet and advanced technologies. I start residency on July 1 and turn 73 on July 7. I will let you know what I learn. I hope to contribute to not just patient care, but also how we educate our providers. Dawn Zuidgeest-Craft is an incoming resident in family medicine in Michigan.
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