Jay's Anatomy

"Hey, Adam," she says, leaning against a desk and picking up Obley's cell phone later that evening. "If I stop opening beer bottles with my teeth in front of you, can I have this?"

Obley chuckles, eyes the door.

"Don't you have a patient?" atasha Steele is looking for shaving cream and telling anyone who will listen that she has absolutely no idea what she's doing.

At the end of the hall in the last exam room, a middle-aged man has stacked his camouflage ball cap atop his gray Grumpy T-shirt and stretched out on the exam bed. His lab work shows high levels of potassium in his blood, suggesting possible heart trouble. Steele, a second-year, has been tapped to shave the patient's chest and administer an EKG.

In the hallway, her eyes dart between two doctors looking over the jagged lines on the printout. When Steele returns to the exam room, she's flanked by a doctor who tells the patient he has an irregular heartbeat. The man says he already knows that. In fact, he was on medication for a while.

"But it was rat poison," he adds with the gruff chuckle of a lifelong smoker.

Steele peels the sticky pads off the man's chest as he continues to ramble about rat poison. The doctors decide that he needs to go to the ER.

Steele isn't the only one to point out that, as med students still at the start of their education, sometimes the Jay Docs don't really know what they're doing.

During their first two years at KU Med, students take basic science courses to prepare for their first national board exam. That first test behind them, students move on to clinical clerkships, where they get hands-on experience at various clinics at the Medical Center during their third and fourth years. If they get past a second national board exam after their third year, graduates apply to a discipline-specific residency program that will take up the next few years of their training.

Last semester, KU Med counted 2,615 enrolled students and 786 faculty members. In recent years, as many of 130 of the 170 incoming first-years have volunteered at Jay Doc, getting clinic experience before it's required. During the day, they take classes introducing them to the basics of medicine, such as Human Anatomy I and general pathology. But at night, they treat patients, some of whom have unusual conditions.

Harmon, now in his second year, admits that some of his tasks here are beyond what he has learned so far. To sign up patients for drug assistance programs, he relies on a black binder with page after page listing available medicines. But the alphabetized prescriptions are still Greek to him. "I don't know what 90 percent of these are," he says. "I haven't taken pharmacology yet."

That's why the Jay Docs depend on volunteer doctors.

Problem is, not many doctors are willing to help them out.

Among the 49 doctors on the list of volunteers (almost all of them physicians at KU Med), only eight have consistently taken shifts, says second-year student Ashley Robertson, who is in charge of finding doctors.

"Often times, the doctor won't show up until 7 or 7:30, and the patients have been here since 5," Harmon says. "We've had people say, 'I see you back there doing nothing, screwing around.' And it does look like we're screwing around. But all the rooms are full, and we're waiting for the doctor."

Sometimes even a full roster of doctors can't help.

"Obviously we can't do major surgery here," Harmon explains. "Anything more major than a regular office visit, we only have the resources and relationships to send them elsewhere. But when someone needs an MRI or a high-level X-ray, those are expensive. We found one place where they give MRIs for $500. That's a steal. But $500 for most of our patients is not realistic at all. That's when it really hurts."

It's also not uncommon for the Jay Docs to send their patients to the emergency room. Co-director Claire Zeigler remembers when a volunteer at the clinic sent a patient with a possible intestinal abscess to the hospital. The doctor called ahead, suggested that the patient needed a CT scan, maybe even a procedure to have the abscess drained. Instead, the patient was dismissed.

No matter how many grants the students get to expand their services, no matter how many phone calls they make trying to coax a specialist to see one of their referrals at a reduced rate, the moneyed system always seems to block their efforts. edical school doesn't just turn kids into doctors. It makes businessmen out of them, too.

"Most of our students went into medicine because they want to make the world a better place," says Joshua Freeman, chairman of the KU Department of Family Medicine and a faculty advisor to the Jay Docs. But, he admits, "The system does tend to beat it [that idealism] out of them as they go through the four years into residency."

Classes focusing on the business aspects of becoming a doctor are vital preparation for the next generation of physicians anchoring private practices and staffing major hospitals. Rigorous study schedules keep them busy in the evenings as they cram to make the grades and secure an impressive residency that will launch their careers.