Change of mind, not change of heart

Thursday, May 21, 2009

It has come to my attention as we make the round, saying goodbye to friends and family prior to our big move, that many are unaware of the change in my career path.

The majority of people still think (or thought, prior to being corrected) that I am going into pediatrics.

And when I tell them that, no, I'm actually going to be an anesthesiologist, there is the unavoidable explanation.

I'm always met with variations of the same conclusion.

"So, now you hate kids?"

I thought I would take this opportunity to explain why I changed my mind.

When I first went to medical school, I thought that I was going to be an anesthesiologist. For all of two weeks.

We had a lecture series for first year medical students that taught us about different specialties. I was very excited for the anesthesia lecture. But the physician giving the lecture ruined it for me. He kept saying how great it was because you got to be a doctor, but you didn't have to talk to people. I knew that I wanted to interact with people (if I hadn't wanted this, I could have just stayed in my plant lab.) So I left the lecture and never thought about anesthesia again.

After my first pediatric rotation, I was sure that I wanted to be a pediatrician. I loved the children. And the normal hang-ups that people have about pediatrics didn't bother me. Sick children didn't depress me. Demanding parents didn't irritate me.

(Okay, I also really wanted to be an OB/GYN for a while. But I had vacation right after my OB/GYN rotation, and realized how much I liked my time off.)

I also strongly believe in primary care. Being the portal into health care and the first point of interaction, continuity of care, and care of vulnerable populations all appeal to the idealist in me.

So, I created my schedule to best prepare me for pediatrics.

I took pediatric neurology and pediatric IV team. Then I took my pediatric sub-I. (Background: a sub-I is an opportunity for a fourth year medical student to act similarly to an intern (or first year resident) They get more autonomy and more responsibility.)

My sub-I was the most miserable experience of my entire medical school. I was abused by the other interns. I never got to sleep on my call nights. I was told that no one would cover my patients if I went home early on post-call and "golden days" (paperwork only days.) I was so emotionally beat down that I was close to a mental break down. I told my friends, my adviser, and my family that I was going to quit. I couldn't see any end in sight to the emotional disaster that my life was becoming.

One day, near the end of my rotation, I was rounding on a patient that had a severe intestinal condition. His parents had been at the hospital with him every single day since he had been admitted 13 days earlier.

I suddenly realized that I was envious of those parents. Yes, their son was sick. But at least they got to see him. I hadn't seen my children awake in over two weeks.

I came to a realization right there that I liked my children much more than I would ever like anyone else.

I knew that I couldn't do pediatrics. But I didn't know what else to do - besides quit.

About a month later, I rotated in anesthesia. I immediately was drawn in by how happy everyone seemed. Yes, they worked hard. Yes, the work was stressful and demanding (but honestly, in medicine, what isn't.) But they didn't have the same beat-down, lifeless look to them that other residents had. And they had a life outside of medicine. Residents and attendings would talk about movies during cases. Residents had time to see movies?!

And at the end of one day, when I was told that I could go home, I was shocked by how fast the time had gone. I hadn't been constantly checking the clock. I wasn't resentful of the time I had to spend at the hospital.

A week later, Hubster asked me what rotation I was on. Anesthesia.

"Well, you should do this. You haven't asked to drop out for weeks!"

Since then, I have completely fallen in love with anesthesia. The procedures, the physiology, the pharmacology. Everything was intriguing.

When I first told some of my classmates that I was going into anesthesia, there was disbelief. "But you have such wonderful bedside manner. It will be wasted in anesthesia!" "But, what about your feelings on primary care?"

I still get to talk to patients. The better the bedside manner, the fewer sedatives required before surgery. I'm the last one they get to talk to about their fears before going into the OR. I'm the last face they see as they fall asleep.

And I realized although I love the idea of primary care, it wasn't the right avenue for me. I may not ever practice in a small, rural clinic, taking care of people no one else would otherwise, but I still get to be an advocate for my patient. I can make suggestions for better pain control, for better nausea prevention, for faster recover.

I can still be there for them.