Travel and training

A few days from finishing the first rotation of my fourth year, I feel I should pause and consider. I am finishing a month of family medicine clinic - which was really a lot of reading time and a little clinic - a schedule for which I am amazingly thankful. Because they allowed me some free days I have been able to study for boards, sleep, and go back to having a normal life.

I have also had the privilege of remembering why I really do love family medicine - the variety of ages, genders, family structures, pathologies. I can't get bored, which is good since I tend toward it anyway.

I continue to plan residency interviews - truly surprised at how many I have been offered. I admit to overwhelming underconfidence where this is concerned, but I didn't expect to hear so quickly. The first programs didn't wait for grades or all my letters of rec. I have scheduled at University of Minnesota (x3), Medical College of Wisconsin, University of Cincinnati, University of Pittsburgh, Tufts, Palmetto Health in SC and am waiting for dates at University of Louisville and Aurora Healthcare in Milwaukee.

Step 2 CK on Thursday and then I am free of exams until February (I think). One weeks until psychiatry AI. Looking forward to it.

And so it begins

I am now officially one week into fourth year which means, for anyone keeping track, that I am 75% doctor. What else does this mean? - Well, that I have eight rotations to finish in seven months, two boards exams to take in the next three weeks, residency to apply for, interview for, and try not to freak out about among other things in my non-medical school life.

First, third year. It's over. 'Nuff said. I am not going back to that, ever. I truly hated five months of it, the rest was actually fine. If I had to specialize in what I did those five months, I'd quit. Without regard for debt or self-worth. I would quit medicine. Without regret.

Luckily, I don't have to do either of them. Which brings us to residency applications. ERAS - the bane of fourth year existence. That which keeps fourth year from being quite the mythical promised land that classes before us have waved as taunts. I dutifully took time away from surgery studying to work through the application, find letter writers, write personal statements. Last weekend, I completed the mad dash through finishing it, so I could get the application posted. On Monday I submitted the application and on Wednesday morning I posted my personal statement (thanks to family and friends who obediently read not one, but two, drafts). Then I sat back to enjoy my family medicine clinic rotation and await November when my Dean's letter is submitted and the interview offers trickle in.

How laughably delusional and naive I apparently am. After submitting my personal statement at 10 am on Wednesday, I received an email about noon from one of my programs. I thought, how mice off them to let me know they got my stuff. WRONG! I mean, they did let me know, but then, THEY OFFERED ME AN INTERVIEW. Got that? Within three hours of finishing my application I had an offer. From a program I like. That has, by the way, been followed by five more since. I am stunned and completely excited. I have heard from three of my favorite programs. I can't believe it. Within four days of putting my application up. Wow.

The list so far (all categorical FM right now - I won't hear from the combined for a bit):

University of Cincinnati/Christ Hospital
Tufts University
Medical College of Wisconsin - St. Joseph's Hospital
University of Pittsburgh - St. Margaret's Hospital
Aurora Health - Milwaukee (I'm turning this one down - it's a funny subject for a later post)
University of Minnesota - I don't know which program yet

Neurosurgery

So, I just finished two weeks on neurosurgery. It was fun. Not nearly as much fun as general surgery, but I found something to like in it.I could have used a bit more guidance from the people in charge as to what to do and where to be, ah well.

Yesterday, during my last surgery on this rotation, the chief resident and the surgeon decided to actually be chatty. The surgeon wanted to make sure I understood that family medicine and psychiatry are both pointless because you have to talk to people and that patients are always failures at taking care of themselves so you needlessly ask the same questions over and over (are you taking your meds? etc.). Also, that there are two kinds of people in the world - those who want to be neurosurgeons and those who haven't realized it yet.

I told him, quite frankly, that I do not want to be a neurosurgeon and that he most certainly does not want me to be a neurosurgeon. Caught him completely off guard and he started laughing in the middle of surgery. So did the chief. Which led to a continued conversation in which we learned that the chief and I went to school together and know many of the same people. It got really pretty hilariously out of hand after that with the surgeon laughing at us both and the chief and I shooting the shit about everyone we knew in common from high school and where they are now.

I, also, got an evaluation this week that, among other things described me as "refreshingly candid and appropriately assertive." I have never heard such a good description of me.

Off to two weeks of ENT. Then finished with surgery and finally off to fourth year!!!

Worst fear....almost

The first choice that any medical student makes is usually medicine or surgery. And we joke that particular temperaments go with that choice. I knew when I started school that I would be medicine; I just don't see myself as a surgeon. I really do see myself as the doc who treats your chronic high blood pressure and heart disease and knows when your granddaughter graduates from kindergarten or the doc who delivers your baby, then takes care of mom, baby and dad besides. I never saw myself as wielding weaponry for the hack and slash of guts.

Here's the revelation. I love surgery. Who's surprised? Well, I was afraid of that - that I would find that I really like the OR, the cutting, the guts. I love the immediacy of patient relief after having a gallbladder out or the feeling of accomplishment when a patient's biopsy comes back showing you got their whole tumor out. It's a rush.

Now no worries. I am not changing my mind. I stand by family medicine/psychiatry. But if I were 25 or if I were single, I might change my mind right now. However, I took the time a couple years ago to really consider the type of life I want to lead and surgery isn't it. I can't stand the idea of five years or more of this schedule.

Besides, family practitioners get to cut! and deliver babies! and have long term relationships with their patients!

Whew - saved by the skin of my teeth!

Decision making capacity

Don't worryl I have not lost capacity. Nor have I lost sanity. Yet. But the big decision is looming. What to do with my life. Really the decision is made. Combined family medicine-psychiatry. I want to do both, hands down. I can't make up my mind.

Making that decision apparently causes everyone else in the whole friggin world to question my capacity. Not just "why do you want to do that?", NOOOOOOoooooo.

More like -

Why do you want to do family medicine?
Why do you want to do psychiatry?
Why do you want to do both?
Why not do internal medicine, med/peds, triple board....insert specialty here?
You don't need to study psychiatry - have my patients are head cases.

So here's the answers...

Why do you want to family medicine?

Because this, above all else, feels like the model of medicine that not only treats the whole person, but also considers the greater community outside. This is preventative medicine, acute care, peds, OBGYN, geriatrics, epidemiology, ongoing patient relationships. Because I adore children and old men and reproductive age women and teenagers and where else would I get to see all of those populations but in family medicine. Where else can I cut, counsel, prescribe, advise, recommend, befriend.

Why do you want to do psychiatry?

Admittedly, most doctors deal in some capacity with psychiatric issues. Some even spend time with med management. A lot fo pediatricians find themselves in the position of needing to be the main go to person for their patients psych issues. And I could do a lot of work with psychiatry as a family practitioner. But my desire to do psych is two fold. First, I love therapy and I think that people are reticent to try it when there is the possibility of a quick pharmaceutical fix. Who can blame them? Getting patients to do the work, find the introspection, change their lives to cope would be wonderfully fulfilling. Allowing patients the option to medicate appeals to me. Second, being able to treat my patients bodies and minds is highly appealing. A truly holistic approach to medicine.

Why do you want to do both?
Simply? I can't decide between them and I have the amazing opportunity to do both. More than that? Ultimately in addition to practice, I want to teach. I can think of nothing that would make me a better teacher than the combination of these two disciplines of medicine coupled with my experience as a teacher.

Why not do (insert specialty here)?

This is always a fair question. Only it never happens as an innocent query. Instead it is about pummeling me into choosing something else. Suck it up....

Internal Medicine - no kids
Med-Peds - no gyn
Triple Board - no adults, except in the psych part and three specialties in five years, scary
OBGYN - too much surgery for me
Neuro - um...you need to ask? we haven't spoken in more than a year
Surgery - it's awesome and I would if I were younger

I won't lie. Making this decision was difficult. Every time I eliminated something, I made pros and cons. Then I mourned it's loss (except neuro). Then I moved on.

Now there's applications, personal statements, letters of rec, work, school, interviews to be done. And life to be lived. Let's go!!

Internal Medicine

So one of my non-medical friends pointed out that all medicine is essentially internal medicine and wanted to know how Internal Medicine can be its own specialty. I know it is word parsing, but it is a good point. After four weeks of IM wards and a couple weeks of miscellaneous nonsense I have to wonder the same thing. Why do people choose Internal Medicine?

Perhaps for some it epitomizes the essence of doctoring. General care, chronic and scute illness. Perhaps for others it is the gateway to sub-specialization and more money. To me it is about disease focus instead of people focus. I don't get it.

For this reason, I am not loving that I have another eight weeks of it. I have only really disliked one rotation - and if I had to do that one for a living I would leave medicine. IM is coming close.

Maybe it's just senioritis.

Alive...

I am alive. I am busy! And I am not living at home. All of these combine to keep me from writing regularly. I have a lot to say. Hopefully, I will find some time this week to get in on paper (figuratively).