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).

Death and Taxes

On Saturday, J's brother texted (?!?!) to let us know that one of their friends was dying. A shock to be sure. We knew that things were amiss so to speak, but this was stunning. So we waited for the news which came on Sunday morning. J heads home tonight with another friend for the funeral.

Men their age are simply not supposed to die, especially suddenly and unexpectedly. He leaves a wife and daughter. I am so sad for them and for his parents and brother. We know them all. Ick.

My plans for Saturday had included filing my taxes, which I went ahead and did. Albeit, I tried to file with my SSN typed incorrectly, so they were rejected. I felt like a moron.

They say the only things in life that are inevitable are death and taxes. They shouldn't come in the same day. Ever.

Kids DO Say the Darndest Things

I would rather poke red, hot needles in my eyes than pay attention to anything but the commercials during the Super Bowl. So here I am.

Tomorrow I start my family medicine month. Apparently, I volunteered to serve my month at a local practice, so I am going to be out on the other side of town. This means I will not be back at UK until April. Three months of being away from my school!! Yippee!

I learned a few things about myself during my peds months. First, kids rule. I haven't spent much time with small children since I ended my neighborhood babysitting monopoly in college. Kids are great! They are generally healthy, so it isn't super depressing (even on inpatient). But mostly they say hilarious stuff. For instance -

9 yo Pt: I heard that there are hospitals where, if you have a third ball, they can take it off.
Dr. Q: Do you mean testicle?
Pt: You know, balls, like down there.
Dr. Q: I have never seen a patient who has that.
Pt: My uncle does.

At this point, rather than bust a gut laughing I look at pt's mom who confesses that it is HER uncle who has the rather prolific reproductive anatomy. The doctor assured the pt that problems like that can be corrected. Then I left the room to laugh. I couldn't help it. The kid knew what he was doing. His mom didn't say anything about it. Hahahahahahahaha.

I have also learned that the biological clock is a real thing. Ugh. I know too many pregnant people and have seen far too many cute babies in the last two months. Save me.

Mostly, I have learned that I will not be practicing medicine that doesn't include children.