After my interview I head back to the hotel, change into more comfortable clothes, and take a stroll around town. Street jazz bands play while the warm breeze gently caresses the city. People take it slow down here in the South. Today during the interview a woman stopped our group, "Y'all should know I'm the survivor of a pul-mow-nary em-bow-luss. Thanks to God Almighty and to y'all wonderful doctors, I'm still here today to speak with you. God bless". And she continued upon her way, a smile on her face.
An Irish pub with cheap Guinness beckons, and I sit at the bar with a few NASCAR fans. One offers me some chicken tenders, which I politely decline. Eventually the conversation turns round to jobs. The guy next to me, Budweiser in hand, with a flannel shirt and a trucker hat, speaks up.
"So, buddy. What brings you all the way out here from the southwest?"
Slowly, drinking my beer, I reply. "ER residency, actually. Your hospital out here is one of the best in the nation."
"Now, that's a job I can respect. Me, I roof houses." He pauses, catching a quick glance at the cars flying around the track. "You seen people die? And there ain't nothin' you can do about it?"
"Yep," I reply, "it can be pretty rough."
"So what makes it worthwhile? I think I'd up and quit the first time someone died on me."
I pause. This is the most honest question I've gotten on the interview trail, and it isn't from an attending, a resident, or a program director.
"I suppose," I slowly say, "I suppose it's when you can help people that makes it all worthwhile. When you can look someone in the eye and tell them they'll be ok."
He smiles quietly, as though I said just what he expected to hear from a doctor in the making. I smile too. We clink glasses and toast, then sit back and watch the cars race around the track in comfortable silence. This is a good place for me.
So in a week I start 4th year, and I'm debating whether or not to do Radiology first, or switch it out for ENT (ear/nose/throat surgery). Youtube is a fantastic resource for budding young surgeons, as you can watch whole surgeries from the comfort of the home. Bonus: you don't have to stand in the back of the OR looking bored!
Let me talk you through my thought process. As a quick warning, none of the links in this post are safe for children. Or adults. Or really anybody, including doctors. I'm not sure I can do ENT any more.
Zac (thinking): I wonder if I should look in to some sort of surgical field again? Honestly, I like procedures a lot. What about Urology? Nah, I don't really want to stick my fingers up dudes' butts all day long.
Another Med Student: Hey, man, look in to ENT! They do some really cool procedures.
Zac: Cool... lets just go ahead and YouTube some ENT stuff... lets see, this'll do. Endoscopic Dacrocystorhinostomy.
Hey, nice nose, man. They do this while the patient is awake? That's pretty cool, you can do it in-office. Neat-o, this is a pretty nifty, delicate procedure. Wait... wait, he's using a "chisel"? And the guy is awake? He's going to chisel through his nose while he's AWAKE? Oh, god, you can hear the bone breaking. Huh, that's kinda neat, though, he just removed all that bone and now there's a "sac" protruding. Wait, wait, wait... he's cutting open the sac. Oh, no - please no - now there's stuff draining EVERYWHERE... ugh, it looks like it's all going down the patient's throat. I think I'm going to vomit.
Zac (nauseated): OK, ok, I can do this. That was just one surgery. How about this one... Nasolabial Cyst Excision.
Hm, that's funny, that guy has really terrible teeth. Surgeon is getting ready to cut... nice incision, doc, strong wor- WHAT THE FUCK, WHAT THE FUCK IS THAT OH MY GOD ITS ALL DRAINING TOWARDS HIS THROAT!!!! THE IMAGE HAS SEARED ITSELF INTO MY BRAIN AND I WILL NEVER GET IT OUT... OH SWEET JESUS THAT MAN JUST SWALLOWED PUS EVERYWHEREOH GOD THE SURGEON IS MILKING THAT STUFF OUT LIKE ITS A COWS UDDER
Well, it's struck again, the dreaded apathy.
It's interesting, as I look back through my med school career. At first I remember being totally excited to learn, to understand, to really study our coursework. Anatomy, neurology, physiology... that was the stuff I loved in college, and being able to study it and apply it to other people? What an honor, what a privilege!
The grind slowly caught up with me. I studied too much, took the "work hard, play hard" mantra too much to heart. I would sit on the couch with a beer, a sleeping pill, the TV blaring, and my computer fired up simultaneously just to relax. I started making jokes that I used coffee as an upper in the morning and beer as a downer at night... but I wasn't joking.
I finished Boards - god knows how - and thought to myself finally the long hours, the stress, the constant feeling that I should be doing something productive would stop.
3rd year rolls around and you realize that for all the studying you may have done during years 1 and 2, you still don't know shit. Attendings pimp you on arcane knowledge from their specialty they've been practicing for 40 years and are shocked when you don't know it. End-of-rotation exams are brutally hard and require you to diagnose, treat, and manage 100 patients in about 120 minutes.
On top of it all is the knowledge that everyone you work with... interns, residents, attendings... are all going to grade you subjectively on how well they thought you did. So you put on your smiley face, pretend like ophthalmology is the most awesome field EVER and go to work every morning, starting on average at 6AM and finishing around 5PM.
It is brutal, and exhausting, and sometimes honestly I wonder if it wasn't a huge mistake to go to medical school. I'm not asking for sympathy here, by the way, but instead hoping that some of you nod to yourselves while reading this and go "yeah, I know where he's coming from. I've thought the same thing to myself from time to time".
Listen, sometimes you get that patient who comes along and just makes it all worthwhile. But sometimes you punish your body, mind, and soul for some asshole who treats you like crap and expects you to FIX EVERYTHING WRONG WITH ME even though he's not fixable.
I'm a person too, folks. I like sleep, and food, and friends, and family. I've lost a lot of that these past 3 years... and sometimes the field of medicine just isn't rewarding enough to make the sacrifice worthwhile.
I suppose the reason I write this now is that I have really, really been enjoying internal medicine- I like the diagnosis, the management, the primary care aspect. But I see my interns and residents getting no sleep every 5th day (and if you aren't a meddie, imagine that for just one second. No sleep every 5th day for the next 4 years of your life... plus little sleep the rest of the time) and frankly, I don't know if I want to do it.
So, here I am again, thinking about the decision between doing what I love and doing something where the lifestyle doesn't suck. There's a damn good reason people go into pathology, anesthesia, radiology, and dermatology. You work real people hours, and you get paid a decent salary.
After all this time and energy, don't you think we deserve that?