spotlight on specialties: anesthesiology

Sorry, I'm a little bit in remiss in that I didn't post this link up earlier, but here's a link to the AAMC article on the field of anesthesiology, for which I was interviewed along with a number of much more distinguished and accomplished colleagues. If you're interested in the field of anesthesiology, either as a potential career or if you just want to know what exactly it is we do all day, check it out.

An excerpt:

“Anesthesia is hands-on, fast-paced, and has tremendous capability to make a positive impact on our patients’ lives as anything else we do in the hospital,” says Dr. Au. “In my opinion, it's one of the most interesting, most exciting fields in medicine, and I firmly believe I have the best job in the world.”

I've said it before and I'll say it again here because it's appropriate: it's a difficult juggle to balance work and family, but it's all the more difficult because I do indeed love my job.  If I didn't love what I did at the hospital as much as I love what I do at home, my choices would perhaps be easier, though maybe not as satisfying.  So really, in the end we should be grateful for the difficult choices, and the chances we have to make them.

(And on an unrelated note: the above photo panel is from pictures I took with my phone during residency--isn't it amazing to see how far cell phone photography has come?  Wow! The future! hovercrafts that fold up into briefcases! And etcetera!)

then and now

So!  Match Day!

Match Day, for those lucky enough to not know, is the day that fourth-year medical students across the country find out where they will be doing their residency training.  Our Match Day was--oh lord, could it have been?--EIGHT years ago.  I was much more awake that morning than most of my classmates, who had been up late partying the night before at "Super Night," our name for the big annual pre-Match bash at the med school.  I'm sure a similar tradition exists at medical schools around the country, and though regional differences surely exist, there is one commonality of which I'm almost certain: the involvement of booze.

I myself was still recovering from a bout of peritonitis when my acute appendicitis in February was misdiagnosed and I subsequently developed a small bowel obstruction and a perforated viscus (TRUE), and so during Super Night I was on Flagyl and couldn't drink anyway.  It was still fun though, and basically ensured that I was not hung over the following morning for Match Day, enabling me to recall each nerve-wracking minute in crystal-clear detail.

I'd heard that in the olden days, Columbia had a tradition of holding Match Day in a giant auditorium, where one by one, students from the fourth-year class were called up to a podium and handed an envelope with their match results, which they were then to open in front of everyone and read aloud, into a microphone.  Of course, not everyone always matches exactly where they want to match, so this ritual (thankfully) came to be regarded as somewhat inhumane, especially in the already high-pressure environment that is med school.

So by the time Joe and I were cycling through in 2003, they had reduced Match Day down to a reception at the faculty club, with a table full of labelled envelopes off to one side of the room.  People could take their envelopes and leave, or open their envelopes there with everyone else.  Within this group, there were people who would open their envelopes and cheer, others who would open their envelopes and start crying, and possibly some that would open their envelopes and promptly punch one of the poor waiters who was trying to pass out shrimp cocktails on toothpicks.  One hopes against that last option, for the waiter's sake.

I am telling you this because the fact of Match Day, and the ritual of Match Day, is one that makes you think that Match Day is probably one of the biggest days in your life.  And it really seems that way at the time.  Hell, Joe and I were getting married about a month afterward, and I think I had put in more time, energy, anxiety and thought into Match Day than I had about the wedding.  It was a big fucking deal, this feeling that the rest of your life was hiding inside this one thin envelope.  It was a big deal, but also...it wasn't.

It was eight years ago.  This is what I can tell you now.  I matched at my first choice program, which was in a Pediatrics residency at the Children's Hospital of New York at Columbia.  Eight years later, I'm not even in that field anymore.  Joe matched in his first choice program too for residency, but for his transitional year, he got his absolute last pick, a fact which deeply dismayed him.  Didn't matter.  He had a great year, got excellent training, and he still has many fond memories of that institution to this day.  We had friends that failed to match at all, and who instead scrambled into spots in other fields, or in cities they never dreamed of living.  They are all successful, happy, healthy, and practicing the kind of medicine they want to practice today.  They have significant others, spouses, children, and they are enjoying their lives in medicine just as much as their lives outside the hospital.  They are happy.  It all works out.

Most of you are probably pretty excited today.  Some of you maybe aren't.  Some of you are dealing with hard choices, and I know that talking about this now doesn't make those choices any easier.  But if you went to med school, I know you have a long memory, so I'll tell you this: some day in the future--five, eight, ten years from now, you're going to look back on this day, this Match Day.  Then you're going to look to the present, at the life you're leading now.  And you might not be where you thought you would be when you were a medical student.  Hell, look at me, I thought I was going to be a pediatrician in academia, and now I'm an anesthesiologist in private practice.  You can't find two more different fields.  I couldn't have predicted it.  But it all works out in the end.  It really does.  You'll find where you need to be, what you need to do, who to go there with, and you'll get there.

So congratulations to all the fourth year med students in the Class of 2011!  Can't wait for you guys to graduate and join the team!

Now on to what's next.

it gets better

The lowest point in my residency was in January of my intern year.  I was a Pediatrics resident back then, doing a month-long rotation on "Team 2," which is what we called the general inpatient pediatric team, with a focus on the patients on our liver transplant service.

It was a very long month.

I'd get to work at around 5:45 every morning to pre-round, and invariably leave after dark every night--not difficult, considering that, in January, it seemed like it started to get dark around 3:30pm every day.  I was there much later than that, of course--most nights I'd leave around 7:00pm, unless I was on call, in which case I'd leave at around 10:00am the following morning.  We'd have pre-rounds and then rounds, then attending rounds and work rounds, followed by teaching rounds and radiology rounds, with time at the end of the day for sign-out rounds.  Twice a week we'd have Grand Rounds and Chief of Service Rounds.  How we ever got anything done with all this rounding, I'll never know.  How I ever got to spend time with any patients in between all these rounds is even more of a mystery.  It just felt like a day of endless, endless scut.  Losing the forest for the trees.  It would be a day full of writing down numbers and pagers beeping and phone calls and faxes and entering computer orders, and not nearly enough time practicing medicine or spending time with patients.  And then I'd go home and collapse and wake up at 4:15 the next morning to go in and do it all again.

It was shortly after this that I decided to switch fields, to Anesthesia.

But this entry is not about me and my switching residencies (though this is easily the topic that I get the most e-mails about--I think I've addressed it a couple of times on this blog, but for the most fully fleshed out explanation of when and how and why I switched residencies, I'd recommend you check out the book, it's probably one of the sections I spent the most time editing in order to get the details right), it's about something else that I want to talk about, which is this: residency can be deeply depressing.

And let's get this straight.  I liked residency.  Really, I did.  Yes, it was hard, and yes, I was tired basically all the time, but I expected that, and now that it's over, most of my memories are affectionate.  Residency, like medical school, was full of stories, and many of them, in retrospect, are funny--not at the expense of patients, but at my own expense, because lord, how serious and inexperienced and bumblingly well-intentioned I was!  But that first January of my intern year, I was very close to being clinically depressed.  It just all felt so grim and featureless and endless, and I felt more and more like I was just some kind of task-programmed automaton, not like the doctor that I thought I was supposed to be at this point.

 I wanted to quit.  Not just quit being a Pediatrics resident, but quit medicine altogether.  I was unhappy.  I didn't like my life.  I wanted to be done.  I know that this comic was intended to be a joke, but there were time, real times, when I passed by a Gap or a Starbucks or whatever, saw that they were hiring, and seriously considered stopping by to fill out an application.  At least they don't make you take call at The Gap, folding chambray button-down shirts at 2:00am.

Now I'm going to tell you a secret.  Everyone who has been through a residency has felt this way at some point.  Everyone.

Maybe you're feeling this way right now.  So here's another secret.  There's more to life than this.  Even though it feels like residency is your life, it's not.  There's more to life.  There's more to you.  And it gets better.

It gets better.

There's this great line from "A League of Their Own," which I adapt and quote often. "[Medicine] is supposed to be hard. If it wasn't hard, everyone would do it. The hard...is what makes it great."  However, don't get me wrong, I don't equate suffering with nobility.  Suffering is just suffering.  All I'm saying is that it's hard, but there's more, and you deserve to experience all of it.  Don't let your residency consume you, and don't let it make you believe that there's nothing else, or that there are no other options.  There's always more.  There's always what's next.  And you know what?  If you're really unhappy, and you want to leave medicine, there's always that too.  It's OK.  There's no shame in changing your mind.  The shame is hating your life, really hating your life, and doing nothing about it.  Who wins in that situation?  Not you, not your patients.

It gets better.  I know it's winter, and winter for a resident is long (oh lord, it's so long, it feels like you'll never see the sun again) but it gets better.  Just remember that.  Remember that you're a person--an intelligent, good person with free will, not just a cog in a machine--and I swear to you, the rest will follow.

the ketogenic diet of blogging

It's been a busy week, so shamelessly, I will continue to post old pictures, in essence living off my own fat stores.

After I decided to switch residencies from Pediatrics to Anesthesiology, I stayed on to complete one more extra year of Peds residency, which is exactly as excruciating as it sounds--a whole extra year of lame duck residency. I stopped doing clinic in the April of that year, however, and on my last day, I took my name plate off the door and retired it to its new and rightful home.




Yes, that's how small bathrooms are in New York. Also, this particular bathroom was located directly over the incinerator duct of the building, so the walls and tile floors were always warm. Which was pleasant in the winter, but less pleasant when you thought about where the heat was coming from.

In somewhat related book news, my editor sent me a .pdf of my book jacket today, and guys...it looks awesome. It looks like...I don't know, it just looks like a real book jacket, with the title on the spine and words on the back and my picture on the inside flap. Bananas! Hopefully I'll be able to show you next week.

switch-hitter

I'm almost done proofing the galleys for the book, and there's only been one part that has made me cringe--one part that frankly has always made me cringe--and that is the six or so pages in which I am explaining why I switched residencies.

Some background for the new kids, and a little explanation to the readership in general, since my residency switch is easily one of the most popular topics about which I receive e-mail: a long, long time ago, I was a medical student who didn't know what she was going to be when she grew up. So I thought I would go into Pediatrics, because I liked my Pediatrics rotation and I liked the residents and attendings that I worked with (read: they never yelled at me) and I thought kids were cute or at least easy to overpower. But about a year into my Peds residency, I realized that I had probably made the wrong choice. This is not a condemnation of the field of Pediatrics in general. Pediatrics is a fine and noble field populated with some of the best doctors with whom I have ever had the honor to work. But it is not for everyone, and as it turned out, it was not for me, much the same way that Orthopedics, Emergency Medicine, or Psychiatry are also not a good fit for my personality and interests. Basically, I thought I would be a good Pediatrician, and I was wrong. The field of Pediatrics did not fail me, I failed the field of Pediatrics. Luckily, I had a chance to correct that error, and I was able to switch from the Peds residency program to the Anesthesia residency program without too much fuss. And now you know the rest of the story.

However, reading over the few pages in which I detail the rationale of my switch, I keep feeling like I come off as a spoiled, squeamish ingrate. Like: Ugh, well-child visits, flu season, overnight shifts in the Peds ER? Get me the fuck out of here and back behind some surgical drapes, where I all my patients are unconscious and I can fastidiously rearrange syringes to my heart's content! And maybe the pages still read like that to me (after umpteenth rounds of revision--that was one of the more difficult parts for me to write, frankly) is because it all is to some degree true, and I just feel like it highlights some central failure of character on my part. Why couldn't I stick with Peds? Why couldn't I finish what I started? I love being an anesthesiologist, but does switching out of Pediatrics make me a quitter? Whenever I revisit the switch in my mind, no matter how much I know that it was the right decision, part of me thinks exactly that. You quit. You're a quitter. You left because it was hard, and then you found something else. Traitor.

(And then I push myself down, take off my own glasses and step on them.)

I am nothing but grateful for the two years of residency training that I received in Pediatrics. Those two formative years helped me become the kind of doctor that I am today, and provided a strong foundation upon which the rest of my training was built. I moved on, but I'm not ungrateful, nor do I bear any disrespect or animus towards the field of Pediatrics nor the people who took the time and effort to train me. Peds, I know from experience, is one of the most challenging specialties in medicine. But it's true, I just didn't want to be a Pediatrician anymore. And reliving that realization feels bad, like revisiting the breakup with your first serious boyfriend, or remembering the look on his face when you told him.

Has anyone else out there switched residencies? Switched careers? Was there any long-term guilt involved with that, even if it was the right decision in the end?