David Liu had it made at age 26.
With a degree from Stanford, a fun job designing software for Amazon.com and a big raise on the way, he lived an enviable life. A question nagged at him, however. Could he really feel he'd done something significant after a day spent perfecting the experience of online shopping?
"What I really care about is helping people," he said this week, seven years after deciding that the answer to his question was no. "It sounds trite, but it's that feeling of coming home at the end of the day and knowing that you've done something important."
The search for meaning brought him to medicine, a field he had run away from while growing up in a Los Angeles suburb as the son of a surgeon.
On Thursday, Liu and 96 peers at the Johns Hopkins University School of Medicine waited nervously to find out where they would begin their residencies in the fall. Across town at the University of Maryland School of Medicine, 153 students awaited the same big news. Thousands of medical students across the country would have their fates revealed to them at the stroke of noon — a ritual known in the field as Match Day.
Liu, now 33 with flecks of gray in his hair, was hardly alone in following a crooked line to the moment. At both Hopkins and Maryland, dozens of students tried something else (and often succeeded at it) before beginning the long and arduous path toward becoming doctors.
"I think it's a generational ethic," said Lisa Patel, a classmate of Liu's at Hopkins who studied forestry at Yale and directed water and sanitation projects in India before entering medical school. "It used to be that you would pick something in your early 20s and just do that forever. But our attention spans aren't long enough for that."
Patel and Liu expressed few regrets that they won't begin their post-residency careers as doctors until they are nearly 40 — more than a decade after friends settled into career and family routines.
Like many of her career-changing peers, Patel ended up in medicine because she craved the feeling of helping people directly. "I would go to these small villages," she said of her previous environmental research, "and people would say, 'What are you going to do to help us.' And I'd be like, 'Oh, I'm going to write a paper.' It felt horrible."
She compared those experiences to a two-month clinical rotation in Zambia this year, where she worked under a Hopkins-trained pediatrician who had eradicated malaria in a rural village. "That's what I want to do," she said. "To settle down in an underserved community and do preventative health. That made me feel that all of this has been worth it."
About half of medical students at Hopkins spend at least a year doing something else before beginning their training, said Thomas Koenig, associate dean for student affairs. In fact, the school hunts for students with rich life experiences.
"They bring a real commitment and maturity because they have tried something else and realized it just wasn't here for them," Koenig said, tapping his heart.
Nancy Lentz, who waited out Match Day at Maryland, recognized medicine was her true calling — and knew it came too soon.
The Bolton Hill resident enrolled at Harvard Medical School after she graduated from Hopkins in 1994 but dropped out in her second year.
"I went for about a year and a half before I felt I needed to have a life," the 38-year-old Wisconsin native said. "I needed to learn some things I wasn't going to learn in medical school."
She spent a decade teaching at private schools in Boston and Baltimore, including Roland Park Country School. But she began to get restless. Then, when Lentz was about to turn 33, a friend told her to give herself a present and take a look at some medical school websites. She fell in love with the idea of medical school, and particularly Maryland.
But it wasn't easy. Lentz gave birth to her daughter, Carmen Sofia, in November of her second year. For weeks, she had to catch lectures on the web in the two-hour gaps between feedings.
Being a parent and teacher has really colored her approach to patients, Lentz said. She definitely respects the time and effort required to get a child to a doctor's appointment, for example. "This is very stressful if you're a working parent," Lentz said.
Her daughter was there Thursday to help open the envelope revealing her match: internal medicine at Duke, her first choice. Lentz hopes to pursue a cardiology fellowship there.
Lentz and her classmates collected their envelopes at Davidge Hall, the oldest medical teaching facility still in use in North America. When their names were announced, they came down one by one to individually selected tunes, including the theme song for "The Price is Right" and "I Wanna Be Sedated" by the Ramones.
Each also dropped $5 into a University of Maryland piggy bank, and the pot was collected by the last student whose name was called.
"It's just a surreal feeling," Lentz said of reaching this point on her winding road. "Now this is it. It has really come to fruition."
Several career changers grew up in families where one or both parents were doctors. They thought they would strike their own paths and felt as surprised as anyone when the family trade called to them years later.
Despite obvious gifts in math and science, Liu avoided plans for a medical career precisely because he saw the toll on his family. His father left for work before the children awoke and returned late. In fact, when Liu revealed his thoughts about a career change, his father and brother, a radiologist, wondered if he had gone mad. "You have a great job," they told him.
It wasn't even like he could go straight from Amazon.com to medical school. He had to take pre-med classes at night for a few years, just so he could apply. He was seven years behind peers from his Stanford class by the time he finished all the pre-requisites. He applied to 26 medical schools because he had no idea how admissions officers would view his software dalliance.
Even after getting in, he wondered sometimes whether he had made the right choice. During his first clinical rotation, he felt like a helpless idiot. He missed family functions and the weddings of close friends. Was it smart to leave behind a comfortable life for all these sleepless nights of study?
But ultimately, Liu found the engagement he was looking for in medical school. "Everyone I talk to is so passionate about what they do," he said. "To be surrounded by people like that and to be pushed to meet their standards, it definitely feels right."
He liked Hopkins enough that come Match Day, he was hoping to learn that he would continue there as a resident.
At Hopkins, students made use of a calendar coincidence and built the nerve-racking ritual around St. Patrick's Day.
They dipped their hands into the plastic pots at the end of a rainbow made of balloons. The coins they pulled out were made of cardboard but bore secrets more precious than gold. Where would they spend the next three to 10 years of their lives?
"It's really kind of barbaric," said Patel, comparing the ritual to a group arranged marriage. "But I've been in Zambia, out in the middle of nowhere for two months, so I had plenty of time to be anxious. Now, I just want them to tell me."
She and her friends whooped when she got her first choice, the University of California-San Francisco.
"It's like I'm relieved," said a grinning Liu, who had just learned that he will stay at Hopkins, where his girlfriend is a medical student. "But it's going to take a little while to settle in."