HELLO. Thank you for reading – it’s been a minute (Months? A year?). Since the start of the pandemic it’s started to really sink in just how allusive the human conception of time is. Scrolling back through the log, it looks like there is mention of a race and there is a clear absence of cloth over my face in a public venue, and it looks like summer…so we’re talking at least a year. Well – what a year it’s been! And what better to do on a Sunday morning (it could honestly be any day of the week the salience of time has been abolished) as a 4th year med student, with residency interviews completed and my application submitted, than to digest, reflect, and verbal (is it verbal if it’s written?) diarrhea the product of this exercise for us to enjoy. How’s that for a damn sentence. I’ll spare expounding details of current events other than to say maybe the rapacious nature of late-stage capitalism did not, in-fact, prepare America’s public health infrastructure for a global pandemic. And maybe, just maybe, America could have a little less police-state and a little less prison-industrial complex, and a little more reparations for its most exploited minorities. Maybe. Who knows. I digress. Let’s start a few weeks after my last race.
One of my best friends got married last fall. I was a groomsman. It was awesome. And there’s something to be said about a Lutheran wedding service, even from the perspective of an atheist (I’m digging this term ‘optimistic nihilist’ however – it at least alludes to spirituality and using the term makes me sound like a smug jackass, so it’s right up my alley). They are quick. And there’s nothing more enticing to an infinitely distractible mind than a short ceremony, punctuated with actually funny commentary from the priest.
It’s difficult to write, sometimes, when there is an audience. Even if it amounts to the dozen people subscribed to something I update apparently once a year. It can sort of unconsciously change the flavor or the content of what I put down. Or very consciously change it. Though I will say, there are as many parentheticals in my written private journal as there are in this. So, I clearly do just make myself smile at stupid ways of writing all the time. But I will write, even if it requires some deconstructing heterosexual norms, that I love my old friend Eric and was elated to be in his wedding. And of course I love his wife too. Hell, if the only thing I knew about her was that her first reaction to watching him break his wrist on a basketball court was to laugh, I would be sold. There’s a solemn happiness to see one of my oldest friends be happy. An appreciation of other people’s joy not sown unless you develop just a modicum of maturity, which hopefully now being much closer to thirty than twenty (!) affords me.
Fast forward a few months from this wedding. I had a sort of epiphanic realization that changed my career intentions in medicine, earlier this year. Rather than try to (re)elucidate all of the points I’ll just copy and paste them here:
TL:DR Changing career pursuits, and I like sleeping in. Eat your damn fruits and veggies. But impossible burgers are also good on occasion.
Slushy start to the morning which I had off of clinic. Wanted to do some strides, but, where tf am I supposed to do those when the consistency of every hard surface is that of the frozen pop you get at movie theaters. Wait, do you adult age people still buy those? Am I the only one?
I took the morning off of clinic to meet with one my attending surgeons I had during my surgery rotation to go over career planning. How to get into surgery programs, doing research, all that stuff. And as I’m writing this – I’m coming to terms with the fact that it truly isn’t for me. Or at least, not enough of me to justify it. I think because I came into medical school thinking, hell KNOWING, this is what I wanted to do, I was able to find endless reasons for why surgery was better than medicine. And found countless reasons why, even though I absolutely loved medicine, and peds, and now loving primary care, that surgery was still the career I wanted. I blinded myself from the fact the residents I worked with during surgery were constantly tired, had some interest in teaching but were too busy with operations and consults to actually do it, consistently staying late, taking crazy call, and overall living a lifestyle that was just not compatible with longevity. Don’t get me wrong, all residencies are difficult. All of them require long hours. But operations are long, the length of cases range from unpredictable to down-right ridiculous, and the early mornings, are well, ungodly early. The nights are long. The sleep is nil. I saw it all first-hand and still, I was (unconsciously) desperately holding onto my preconceived notion of how sexy the career was.
It really isn’t.
Yes, absolutely, removing tumors, saving lives after trauma, it’s. awesome. Totally badass. And wonderfully exciting. And so far from the routine of any given day, that thinking I could justify a 7 year residency averaging 80 hours of work every week to do it is unconscionable to me now. After two weeks working in primary care, I can no longer really deny what really motivates me in medicine. It’s not taking lumps, bumps, and organs out of people. It’s utilizing learned medical knowledge, both from school and my own about nutrition, as well engaging in people and having active role in either saving and/or changing their life. It’s teaching. It’s finding meaning in my work and knowing I can advocate for things that are for the betterment of the health of my patients and the planet. I see every opportunity to do all of that in medicine, with less training, better work-life balance (I know it’s a cliche phrase but fuck it it’s true), better relationships with colleagues and students, and a deeper connection with patients and their families.
And every minute of my personal life, every curious fiber in my body, even all the interactions I’ve had with friend and classmates, lends itself to this realization that should have been obvious to me well before I started even medical school. I have talked more highly of the ICU than I ever have of the OR. I run and exercise, (a lot, duh) and know that lifestyle and nutrition are the components to actually getting people and their families healthy. I have listened to thousands of hours of podcasts on how diet can treat, prevent, and even reverse essentially every chronic disease across the world, while simultaneously making the planet healthier and saving sentient animals from rape and murder. I have had patients in both medicine and pediatrics that I’ll never forget due to the relationships I formed with them, yet I can’t remember even the name of a single one of my surgery patients.
And most of all, my personal story is wrought with reasons to pursue medicine. Overcoming binge-eating disorder, managing my stress and anxiety, changing my diet, these are all things that I did to (firstly, not kill myself, bye-bye binge eating) in order to achieve and pursue longevity in my life and career. The opportunity to help share in that experience of positive, scientifically based growth in people’s’ health and happiness is afforded by a career in medicine, not surgery.
Few things get me fired as much as talking about medicine. I’ve had quite a few conversations (including this morning thank you Mike Koski) where I’ve tirelessly monologued (this is not a real word but fuck it) about nutrition, medicine, and the horrid state of the american healthcare system. Why I hadn’t taken these countless conversations as signs of where my true passion lies is beget in my stubbornness and the all-too-human experience of believing whatever the fuck we already believe, even at the (almost!) expense of letting it dictate our entire career path. In the WRONG direction.
Perhaps I’m just fickle (this is absolutely true, I just hope not in this instance), or perhaps I just enjoy the work hours more (this is also absolutely true and is in no small part playing in this decision), and maybe I’ll regret this later on. But my highest potential as a provider will not come from being a surgeon (if I ever had the intellect or capacity to get into a program anyway, which is very doubtful). If I ever have power as a physician, it will come from my love of medicine, science, nutrition, and being a force for positive change in my patients’ lives.
This was very much a ‘stream of consciousness’ thread I wrote on Strava in January, writing on the fumes of endorphins following an undoubtedly wonderful (read: fucking freezing) Flapjack Friday run with my teammates whom I miss dearly. I spent much of my younger adult life planning on being a surgeon…so it’s unsettling (read: existentially terrifying) when those best-laid plans change seemingly overnight. The short of it is: I’m applying to internal medicine, and I really love the ICU. For the non-med folks, those are all your docs in the hospital treating the sickest COVID patients, among others. It’s a privileged place to be in medicine, at the intersection of life and death. Perhaps only second to the ED (I thought about that too) is that intersection so chaotic as it is in the ICU. Pulmonary/Critical Care is a 3-year fellowship after a 3-year residency. But if there’s anything I’ve learned in my 3 years of med school (hopefully more than just this), it’s that I LOVE the damn hospital and I love taking care of really really sick people.
I travelled more this year than I have any other year of my life. By plane no less. Not ideal during this time but when Uncle Sam pays for your school (and hotel and food and car) you do what you’re told. First made my way to San Antonio in June for 6 weeks of…training? Sitting on my ass and watching lectures in a hotel room? It’s a blur – and justifiably so. My brain was more or less non-functioning having taken my boards the day before I left for Texas. At least I was paid very well. Anyway, I came back in July, and began interviews for residency spots across the Army via zoom. I hate interviews. There’s nothing like trying to ‘sell yourself’ on a computer screen when you already hate the very essence of ‘selling yourself’ to begin with. I would be more comfortable selling my damn body. But they went fine (I think? Hope?). Intermixed with those interviews were school rotations, and two, one-month rotations at my top choices for residency. First in El Paso (I got choked up reading another horrific article about the situation there just yesterday) and then in Tacoma. I love the mountains, and I love the idea of a small program. 4 years of undergrad and 4 years of med school at the U, and I think I’m ready to not completely blend into another sea of bodies as a doctor. El Paso and Tacoma have both mountains and small programs. But the Pacific Northwest, and the west coast in general, is incredible. As I anticipated it would be. But somehow my time there beat even those expectations. I was hooked. In about 5 weeks, I’ll find out if I get to enjoy my residency in Washington. While having basically no time to see or explore any of what I enjoyed out there spending 80 hours a week in the hospital…I shoulda stayed in the restaurant biz…
I got back from Washington, and immediately I travelled for me. I was on vacation all last week – I went to California to see two of my closest friends in the world. Probably the least advisable thing one can do in the middle of a pandemic is to get on a plane for leisure…after spending most of the summer flying already. It’s hard to justify. And I think in different circumstances it would have been a no-brainer to stay home. But as competent as I am in my ability be alone, it’s exhausting as a non-voluntary exercise. And honestly a little precarious when you live alone with a history like mine. All that’s exponentiated when, between classes, board exams, prepping for interviews, rotations, and applications, I haven’t had an opportunity to give myself more than a weekend off in two years. Practicing isolation is not a lifestyle, and I wanted to change the weather on my terms for the first time in too. Damn. Long.
It was worth it. Of course it was. It would have been worth if it meant never seeing the beach or the mountains or the sunshine (I did all of those things), or just being present through my friends’ heartbreak or anxiety (I did those too). The company of friends far exceeds any visual aesthetic or adventurous journey I could conceive. I don’t know how or why I’m so lucky to have so many friends to lean on for insight, learning, and just plain fun. I’m spoiled rotten to have the friends I keep, and I can only hope that whatever constellation of factors that makes my friendship tolerable to them is maintained for as long as I can keep it. And wish I had more space (and brain energy – I’m such a slow writer and thinker) to include all the other wonderful people that I owe everything in my life to. 2020 can suck a fat one for a whole host of reasons, but I’m interminably grateful for my friends to help me enjoy so many bright spots in an otherwise god-awful shitty mess of a year.
