Archive for April, 2009

Learning to Fly . . . But I Ain’t Got Wings

April 26, 2009

I’ve always had a thing for the view from the dining room in my parents house.  There is something appealing about sitting alone in the quiet, darkened room, with the lights stretching out below me.  It’s a good place to sit and reflect.

I’m headed back to school (well, more like my house near school, but you get the idea) tomorrow, with a little less than a week to go before my class and I officially start our third year of medical school.  The last several days at home, I have been visiting with the family and friends, tying up loose ends, getting knick-knacks that will (hopefully) help me in the coming year.  Got the car smogged, bought and setup the iPhone, found some comfy (bodily fluid resistant) clogs, ordered some books, that sort of thing.

It’s that same sort of fear and excitement of facing the unknown of a big trip; you kinda know where you’re going, but really have no idea what you’re going to find there.  You’ve done the best you can to pack, but no matter how carefully you’ve done so, you’re always gonna be running into a situation you didn’t plan for.  But that’s part of the thrill.  Nothing to be done for it but have confidence that you can handle (and enjoy!) those unforeseen curve-balls that are inevitably waiting for you.

It is generally agreed that third year is the hardest of medical school.  Making the jump from the relatively objective classroom learning I’ve been dong for the last 18 or so years of my life, into the hospital and clinic, where people’s impressions of you matter just as much what you’re carrying around between your ears.  But more than that, from here on out (in some form or another) we’ll be spending the majority of our time doing what we applied to medical school to do.  That is, take care of patients.  On one hand, that’s a totally thrilling thought.  Finally, we get to do what we signed up for!  But on the other, I think it can be quite intimidating.  I’ve wanted to be a doctor for so long, and now it’s finally Go Time.  But what if I’m bad at it?  What if, after all this work, I learn I’ve only got what it takes to be a mediocre doctor?  Worse yet, what if I find I don’t like it?  Because now, after all that hard prep-work, it’s time to see what we can do, and how well we learn the actual profession of being a physician.

And on top of all that self-doubt of whether or not we’re gonna end up making good doctors, there are the patients themselves.  My very first day of my very first rotation is to be on the pediatrics hematology-oncology ward.  In other words, I’ll be helping (in my very small and ineffective just-barely-third-year way) to take care of kids with cancer.  After months of studying this stuff from course syllabi and power points, I’ll be examining these (real!) children, and talking to their parents.  I am sure that some of these kids will get better . . . and I am sure some of them will not.  Most of the ascending third years I’ve spoken to have had at least one of ‘their’ patients die.  But on the flip side, they’ve gotten to watch a lot of their patients get better too.  I guess what I’m saying is, with things so much more personal and individual now, the whole emotional aspect of this business is gonna get kicked up about half a dozen notches.  And I suppose it will be interesting to see how we all deal with that.

And that’s just the emotional stuff.  I got my beeper in the mail about a month ago, and I took it out of it’s wrapping and set it on the table (think about those weird car commercials with the stack of money and the googly eyes).  Me and you, I thought, we’re gonna be rather close companions for the next two years, and it is likely that it or one of its cousins is gonna be bothering me at inconvenient times for the rest of my career.  On many of the services, we’re expected to work six days a week, to arrive to take care of our pre-rounds at 6am and say ‘until you’re done’ (which, I am given to understand can mean anything from like 2pm all the way into the late evening).  And those are the nights we’re not taking call.  There’s a new computer system to learn, a constant stream of new teams with their different personalities, different wards, different nurses and different sets of expectations to get used to.  And every time you’ve got one just about figured out, it’s time to move on to the next.

This is going to be a crazy year, and I’m sorta disappointed that I feel this entry isn’t quite doing my roiling emotions justice.  All the same, I just want y’all to know this is some scary exciting shit, and there are sure to be more entries about it as things really get rolling.

Chasing That Golden Pretzel

April 24, 2009

My class and I are just now finishing our studying for/taking the USMLE Step 1.  This means time to party, drink a lot of EtOH (alcohol, for the medically uninitiated), sleep in, see old friends and do fun things . . . and then steele ourselves for third year beginning in a few weeks.

One of the big reasons I got into this business is for the intensity and challenges it offers.  I didn’t want a droll nine-to-five, and so I chose this.  But medicine is a big entity, and there are a lot of ways for it to be practiced.  The spectrum includes primary care doctors, trauma surgeons, psychiatrists and neurologists.  All involve caring for people, but each has its own unique way of doing so, with its own unique set of pros, cons and challenges.  Despite the fear of being too archaic (and populistically out of touch), I recall a quote from early Gray’s Anatomy, where the Asian intern (Christina?) declares that surgery “is the Marines!” arguing that of all the specialties, surgery is the most-est of all of them; the hardest, the most intense, the longest hours, the most taxing, the most rewarding.  Whether or not it’s true, I think it begs the question, how far does one chase that intensity, and how much of your life are you willing to surrender up to it in its pursuit?

I’ve always felt that if you are going to do something, no point in doing it half-assed.  But where does one draw the line?  When is it ok to stop clawing your way up to the next level?  The personalities that end up in medical school aren’t the ones that like stopping when things are “ok.”  They keep going until they’ve totally blown the goal out of the water.  But there can always be some other goal to chase, some intense adventure to seek.

For me the conundrum has presented itself as a choice between Emergency Medicine and Trauma Surgery as my future career path (granted I’ve had very little concrete experience with any field of medicine, but I’m gonna speculate anyway!).  I am afraid what choosing a career in Trauma Surgery would mean for the rest of my life.  Yes, I’d be the guy wielding the scalpel, cracking chests in the ER and sticking fingers into bleeding arteries, but at what cost to the other aspects of my life?  Would I still have time for a family, meaningful relationships, travel?  Can I still keep an identity separate from doing this crazy job, or will I sink so deep that I won’t even care if it becomes the only thing that matters in my life?

I feel that in Emergency Medicine, when you’re on you’re on, and when you’re off you’re off.  And it’s a schedule laid out months in advance.  You don’t work as many hours, and as such it isn’t as all-consuming as other specialties like Trauma can be.  It seems like it is much easier to keep a life separate from your work.

I don’t know.  At some point, one needs to be able to strike that balance between seeking the next challenge and being content.  I suppose it is an admirable way to spend a life, chasing one mountain peak after another, but it makes one wonder if perhaps there is more to life than simply seeking the most intense experiences you can find.  At some point, I feel like you’ve got to crest your last summit, look up at the next one and say, “I really don’t need to climb that next mountain.  Let someone else do it, I’m happy here.”  I agree that there is a thrill to the climb, to the struggle and the hard won success, and it can be addictive.  And I fear that that is a big trap in medicine.  One can become so involved in the challenges of your work, wanting to get better, to ascend to the next level, that you allow other parts of your life to languish.

And so on one end sits Emergency Medicine, with its ample excitement and consistent hours, and on the other Trauma Surgery, which offers crazy highs and lows, but also long and unpredictable hours which can threaten an independent life.

This really isn’t a fully formed entry.  It’s just me mulling about one of the upcoming choices and I promise you, it will likely not be the last blog on the subject.  Anyhow, hope you enjoyed it, and hopefully more to come in the future!