Being a medical student or resident is hard enough, but what if you have a disability that adds to the challenge?

One medical resident with a physical disability was about a year and a half into training when the medical institution finally installed an automatic door he needed. Another student faced frustrations when arranging accommodations for taking tests, with it seeming like the medical school was “making up rules along the way.” When another resident with a disability first sought support, the disability representative was allegedly unfamiliar with the Americans with Disabilities Act.

These firsthand experiences are documented in a report issued Tuesday by the Association of American of Medical Colleges and the University of California, San Francisco about the accessibility and inclusion of students and doctors with disabilities in the medical field. The culture and the environment surrounding disabilities varies across the board, it found, with some places doing far better than others.

About 1,500 medical students in the U.S. have disclosed a disability and receive formal accommodations. That’s about 2.7 percent of students, according to the report, and represents a lower percentage than other undergraduate programs, which average at about 11 percent for students who have disclosed a disability. The report found that in medicine especially, many students hide their disability out of a real “fear of judgment, bias, and skewed perception of ability.”

Medicine is an incredibly tough and competitive field where, historically, doctors have been viewed as superhumans, operating at the highest physical and mental capacity at all hours of the day and night, performing miracles and saving lives. There’s an expectation of perfection.

But doctors are human, too.

A lack of understanding about disabilities can create big challenges for otherwise qualified and talented future doctors, says Lisa Meeks, co-author of the report and a disabilities expert at the University of Michigan Medical School. Yet some schools may not even be aware of what they could be doing to foster a more inclusive environment.

“I don’t know of a school that doesn’t want to do the best practice,” says Meeks, who is also co-founder of the Coalition for Disability Access in Health Science and Medical Education, adding that schools might just not have the tools.

For Dr. Geoffrey Young, AAMC’s senior director for student affairs and programs, the nearly 100-page report is a much needed blue print for medical institutions to better understand policies and perceptions of those with disabilities, whether that be the easily identifiable physical kind or lesser seen invisible ones.

“I think we have to do a better job of educating those in the field about what the potential is for those with disabilities, verses what is consumed or assumed to be an automatic inability,” Young says, adding that the culture is shifting in medicine. “We are having this conversation in a very open way.”

The report identifies very clear barriers and considerations schools can take in response. That includes everything from the way disabilities are discussed in the admissions process to having a person within the institution who is well versed in both disability access issues and medical school requirements, to help future doctors better navigate their training.

For Dr. Lina Mehta, associate dean for admissions at Case Western Reserve University School of Medicine in Cleveland, improvements start with changing attitudes and approaches at the onset. Case was sited in the report as an example for the disabilities language it has adopted in its materials.

“In admissions, we sort of dictate the face and function of what medicine is going to look like by virtue of who we bring in,” Mehta says. Having a more diverse future physician population, one that includes those with disabilities, improves the field’s ability to understand and care for patients, she says. “It’s critical we bring in a group of learners and future practitioners who will mirror patient populations that they’re taking care of.”

This story is part of a reporting partnership with NPR, WHYY’s health show The Pulse andKaiser Health News.

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A San Francisco fertility clinic says that a problem with the liquid nitrogen in one of its storage tanks may have damaged thousands of frozen eggs and embryos, triggering calls and letters to more than 400 concerned patients of the Pacific Fertility Center.

The nitrogen level in one tank fell very low, according to Dr. Carl Herbert, the fertility clinic’s president. Herbert told ABC News that an “emergency filling” immediately took place, and that the tank’s contents were then transferred to a fully functioning tank.

The problem struck on March 4 — the same day that a similar cryogenic tank failure was reported in Cleveland, where the University Hospital Fertility Clinic is investigating “an unexpected temperature fluctuation” that jeopardized its tissue storage bank, where liquid nitrogen preserves eggs and embryos. That incident reportedly affected some 700 patients.

In San Francisco, Dr. Herbert said the clinic is working to determine the effects of the tank failure. Herbert said a “substantial number” of the clinic’s patients had stored embryos for around 8-10 years, according to ABC.

“The good news is, we have viable embryos — we’ve proven that from that tank,” Herbert said. “So my hopes are that for my patients, they’ll be OK. But because there’s an unknown, it’s extremely stressful.”

The clinic’s price for freezing eggs starts at $8,345, and in-vitro fertilization is $11,595, according to its website. The annual cost for tissue storage is $600.

Emotions have run high during calls with affected patients, Herbert told The Washington Post.

“Anger is a big part of the phone call,” Herbert said. “Our goal is to provide all the patients we see with some kind of a family. . . . We need to think: If this tissue doesn’t work, what are the next steps, and have you not feel defeated.”

The Pacific Fertility Center is located in San Francisco’s North Beach region; in the past, it has said that its patients include families of employees at Facebook and other tech companies, many of which pay the costs of fertility treatments as part of their health coverage.

After the Cleveland incident, the American Society for Reproductive Medicine released a statement saying that the cryogenic failure and “potential loss of eggs and embryos at University Hospitals Fertility Center in Cleveland is a tragedy.”

A family that lost embryos in the Cleveland hospital’s nitrogen tank failure has filed a class-action lawsuit, the AP reports.

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It all began with a single X-ray.

It was 1974, and surgeons had been doing total hip replacements for a dozen years.

“Total hip replacement is an absolutely magnificent operation,” says Dr. William H. Harris, “and we were able to do remarkable things to restore mobility and relief of pain and the joy of life to countless individuals.”

As chief of Massachusetts General Hospital’s joint replacement surgery service, Harris was sent a mystifying patient, a prominent lawyer from San Francisco whose hip replacement had gone badly awry.

“I had never seen anything like this before,” he recalls. “The bone around his prosthesis, around his total hip, had been completely destroyed. It was just astonishing. And I thought it had to be cancer.”

But under the microscope there was no cancer, no recognizable disease of any kind. It was something much stranger.

So begins the twist-filled backstory of disaster averted that Harris tells in his new book, Vanishing Bone: Conquering a Stealth Disease Caused by Total Hip Replacements.

Now 90, Harris holds an endowed professorship of orthopedic surgery at Harvard Medical School. He was chief of joint replacement surgery at MGH for 30 years. And he’s one of the doctors and researchers that grateful recipients of artificial hips may want to thank.

Those patients are legion: At least 3 million Americans have artificial hips, and millions more around the world.

Back to his tale: No visible cancer. The only type of cells to be seen on the ruins of the bone were a sort of cleanup cells, called macrophages. And they were stimulating another kind of cell, called an osteoclast, which means “bone-eater.”

“This was the only cell in the body that could eat bone and it was actively and aggressively eating the bone,” Harris explains. “It became a medical detective mystery: What in the world is this disease and how does it come about? Why is it there?”

The question quickly became even more urgent, because soon it wasn’t just one patient or two whose replacement hips were being attacked by this bone-eating disease. It was thousands — then hundreds of thousands. The longer people had their replacement hips, the higher the risk. In some, their bones became so weak, just walking could make them snap.

“Over time, it began to involve so many people that around the world there were a million people with this condition,” Harris says. “By 1990 it was clear that it was the No. 1 problem in total hip replacement surgery and the No. 1 cause of failure.”

One of the first possible culprits to come under suspicion was the “bone cement” — the glue used to affix the artificial joint to the patient’s skeleton. Tiny bits of the cement seemed to be triggering the odd response by the cleanup cells and the osteoclasts.

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One kind of cell “was actively and aggressively eating the bone,” says Harvard orthopedic surgeon Dr. William H. Harris. “It became a medical detective mystery: What in the world is this disease and how does it come about?”

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So Harris and others devised techniques to replace hips without using cement. And they heaved a sigh of relief, he says, thinking they’d solved the problem. Only to find, when he reviewed his first hundred cases of a cementless hip replacement — “Bingo, the very same disease.”

But they were on its trail. The problem wasn’t just the bone cement, they realized, it was that tiny bits of plastic could eventually trigger the osteoclasts to eat bone. And those bits of plastic were coming from the inevitable wear on the plastic at the replacement joint as the patient logged millions of steps.

“This caused a big shift in our thinking, and the problem shifted from being a problem of medical detective work to find out what in the world is going on, to innovation — material science,” Harris says.

Harris and other researchers needed to figure out how to make an artificial hip joint that could take a load of hundreds of pounds, for millions of steps, without wearing down enough to release the particles of polyethylene plastic. And to do that, he decided, he needed a machine that could simulate what happens to hips in the body.

It took three years and plenty of frustration to build an accurate hip simulator. Meanwhile, his team gained a pivotal insight from using a powerful scanning electron microscope to look at the replacement hips of patients who donated them back to his lab after death: It was the process of walking that modified the polyethylene.

The polyethylene plastic on the hip implants was an extraordinarily long molecule. Harris compares it to a very, very long, very, very thin string of spaghetti. And normally, the plastic is like a bowl of spaghetti that is unorganized, with the strands going in all different directions. But not in the hips from the deceased patients.

“We found that all of the strands of the polyethylene were lined up in a row,” he says. “The polyethylene molecules had been changed in their position. They’d been modified by the fact that gait simply goes back and forth, and forth and back. And that lines them up.”

Harris turned to his friend Ed Merrill, a professor emeritus of polymer chemistry at MIT, and asked if he could stop this reorientation from happening.

“He said, ‘Sure,’ and I said, ‘I love it, that’s wonderful, tell me about it. How are you going to do it?’ ‘Well,’ he said, ‘we do that for a lot of molecules. We get them to be fixed in their position by putting in energy, and that energy then links one of the molecules to the next one.’ “

It’s a process called cross-linking, used on many materials. Merrill suggested using an electron beam to cross-link the polyethylene in artificial hips. When Harris and his team tried it, they ran into a few problems at first, the most striking of which was that the plastic exploded.

“Sometimes it didn’t explode, sometimes it just caught fire,” Harris says. “And at other times it simply melted. But clearly we were in a difficult spot. It took a lot of work to figure out what that problem was.”

The problem turned out to be a matter of too much energy. They needed to slow the electron beam down so it wouldn’t “overcook” the plastic. Once they figured that out, they could test it. The results: “We could detect no wear at all. Zero wear. We thought it might reduce wear, it might make it better. It made it almost perfect.”

There’s a lot more to the story in Vanishing Bone. It wasn’t enough to invent the new plastic; it had to be patented and licensed, approved by the Food and Drug Administration, and manufactured — all of those steps involved additional challenges. But in late 1998, the first patient got a hip made with the new plastic.

Fast forward nearly 20 years, “and there are probably now 7 million people around the world walking on this material in total hips and in total knees,” Harris says. “The disease is virtually gone.”

So that’s certainly a happy ending, but what’s the moral of the story? For Harris, it serves as an example of contemporary medical science — “how it works, warts and all, the complexity, the need for persistence.”

And, he says, it highlights the special joy of being a doctor and a scientist: “I loved taking care of patients and I loved going to the operating room, but I also hate failure. And my own failures in the operating room would lead me to say, ‘Let’s take this failure up to the laboratory and see if we can’t unscramble it, unlock it, and find a way to do it better.’ “

So, at age 90, has he replaced a hip?

No, he says, but if he needed to, he’d feel quite relaxed about it. Because he’d know that his new hip could be made of cross-linked polyethylene.

The first version of this story appeared on WBUR’s CommonHealth. Carey Goldberg, who covers health and science, is the host of CommonHealth.

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