Thursday, January 30, 2014

Nowhere Else But Here

In recent months, I've been preparing for residency interviews, thinking about questions I'd likely be asked and those I should ask of programs. One question sure to come up is, Why do you want to be a psychiatrist rather than some other kind of doctor? I've thought a lot about this, especially in light of third and fourth year rotations, the medical school version of a Baskin-Robbins ice cream shop (or any other, since I've discovered we don't have B-R in Maine) where you get to sample the flavors before deciding to buy.

Prior to rotations, my heart was set on psychiatry. I'd worked and trained in the field, coauthored a book related to a psychiatric sub-field, and truly loved every minute of it. My background set the stage to do well in residency; why do anything else? 

The trouble was, it was like being raised on chocolate ice cream (not a bad thing, by the way) and considering it my favorite. Never having tried any other flavor, how could I be so sure? Maybe it was just familiarity. Medical students often find their plans for residency change after third and fourth year rotations for that very reason. 

In order to deal with the matter fairly, I decided to approach rotations with the intent of evaluating them on their individual merits. If I still loved psychiatry best, by keeping an open mind I'd learn more and be better able to make an informed choice, come Match time. 

The outcome was surprising. I liked surgery, as do many psychiatrists, and I encountered nearly as many surgeons who'd seriously considered entering psychiatry. Why this was true and whether there's a connection between surgery and psychiatry, is unclear. Maybe that would be a good topic for a psychiatric residency research project? 

So, that was surgery. Being involved in delivering babies was wonderful and pediatrics was every bit as enjoyable as I expected it to be. Rural family practice was a warm, nurturing experience and emergency medicine was hard work and a ton of fun. A fourth year sub-internship in internal medicine showed me how much I had yet to learn and at the same time, gave me a boost of confidence about beginning residency. They were all great in their own ways, but eventually you have to make a decision. You can only sample so many flavors before the person behind the counter gets impatient.

What do you want to spend the rest of your life doing? I asked myself. This is not a casual question. No one knows how long "the rest of your life" is going to last. Could and hopefully will be a long, long, long, long time, but none of us is born with a warranty. For me, the various considerations boiled down to a second, more important question, Where have you been the happiest?

Coming up with an answer wasn't as easy as you might think. Never having had children, obstetrics and pediatrics teetered close to the front burner. But obstetrics entailed short-term relationships with patients and my interest in pediatrics was mainly directed toward child/adolescent psychiatry. Reflecting on my experiences, there was only one rotation where it was impossible to contain my enthusiasm about getting to the hospital every morning. It was the same one that made it ridiculously easy to ignore the clock at the end of my shift and the only one I had no reservations building a life around. Turns out, "chocolate" really was my favorite flavor, after all.

A few years ago, after a long day at the hospital in Denver, I took the dogs out and looked up at the stars. It was a chilly fall evening and after finishing their business, I'm sure they were both wondering why we didn't rush back inside to get warm. It had been a good day and at the moment I was caught up in the sudden awareness I was better at psychiatry than I'd ever been at anything else. What I mean is, I worked harder, felt like a better person, was more fulfilled, and more effective. More than anything, I was happy, truly and deeply happy, from the top of my head all the way down to the holes in the heals of my socks. That feeling has never gone away, it's just gotten stronger.

There are a lot of reasons to love something and I don't fault anyone for not loving psychiatry, though I freely admit when someone says they don't like chocolate ice cream, that does give me pause. Continuing to love it, after third and fourth year rotations, probably makes me a hopeless case, which is okay because I'm a happy one. And for me, happy like this is found nowhere else but here.  

 (Creative Commons image "Happy" by Rickydavid via Flickr)

Enhanced by Zemanta

Wednesday, January 29, 2014

More Than Just a Piece of Paper

That's what we say, sometimes, when we're tired, when burning the candle at both ends seems to have done little to bring the end of a long academic journey into view. "___ more months, ___ more rotations," we say, "I'm going to get my piece of paper and I -- am -- gone."

I've said it. After slamming into another obstacle that meant I'd graduate another year later than my entering classmates, I've said it. On good days, I tried to act a reasonable approximation of my age and call such things "character-building." On bad days, they were miserable. The truth is, the good ones really did outnumber the bad by several factors of ten, no whitewash -- except on bad days and then they seemed to multiply as fast as zits on a teenager's face.

Medical education is a group effort and a personal one. We begin in community, like runners in the Boston Marathon, and we string out along the way. I lived off Beacon Street in Boston for a while and stood within inches of the Marathon as it passed by. First came elite runners, like the Kenyans I got to know in Boulder while walking my dogs, some in training for Boston. Long after they were out of sight, came local runners, wheelchair athletes, and those for whom a personal best was the point.

Every year there are runners who, for reasons of their own, cross the line at Boylston Street, where the bombing occurred, way late, maybe after midnight. A father, pushing his wheelchair-bound son, someone else who was injured and refused to quit. It could be anyone. There have been times in this process, when I felt like that, hell-bent on crossing the line whether anyone was there or not, and not really expecting anyone to be, certainly not at that late hour. The virtual presence of more than a hundred cheering friends on Facebook showed me how wrong a guy can be and how amazingly good it feels to discover them waiting for you.

But that's how things can go. All the potential in the world can't ensure the medical education master plan is carried out without a hitch. Something happens, then another, and before you know it, you've had to stop and regroup. Most students make it by the clock (four years), some say they made it by the grace of God and maybe they did. Maybe that's how all of us make it, even when it seems like sheer, dumb luck.

Anyway, yes, I called it a "piece of paper," especially when circumstances and/or my own frailty conspired to raise the bar -- and right when I was starting to get good at reaching it! One of my favorite Robert Browning lines goes, "A man's (person's) reach should exceed his (their) grasp." Well, gee, thanks, Bob, bet you never went to medical school, huh?!

Eons ago, when I was a kid watching classic movies about doctors and psychiatrists on our black and white TV, medical school was something other people did. To me it was as far away as growing up. Eventually, however, I did grow up or at least got taller, and found my way to medical school. When my diploma finally came in yesterday's mail, I can tell you, it was much more than just a piece of paper.

A friend, on his graduation day in 2010, waved his diploma in its protective cardboard mailer and shouted to me, "Don't forget, Beggar, there's one of these with your name on it!" I thought about him as I walked back to the house, carrying mine the same way he had. I thought about him again, opening the package and seeing my name. He was right; there was no mistake.

How does it feel, having finally crossed the elusive finishing line with my diploma in hand to prove it?  It feels empowering. Better than all those other times the bar was raised and I cursed and swore and stretched and strained and reached with all my heart and realized I could reach higher and farther still. It feels right. Residency is fast approaching (Please, God, let it be psychiatry) and it feels like I'm in the starting grid at Indy, waiting for that cute little country singer to finish the National Anthem so I can hear the words I've waited a lifetime to hear: "Ladies and Gentlemen, Start Your Engines!"


(Photo copyright 2013 by the author)

Sunday, January 5, 2014

Contraception and the New Fisherman

What's going on in Rome, lately? Is there a new voice crying in the wilderness? Pope Francis declaring the Church has become obsessed with birth control, abortion, and gay marriage? Shades of Anthony Quinn.

Who's Anthony Quinn? He was an actor probably best known for his roles in Zorba the Greek (1964) and The Guns of Navarone (1961). He was also cast as the first Russian pope in the film, The Shoes of the Fisherman (1968). What brings him to mind was his character's willingness to drain the Vatican of its wealth and holdings in order to feed a starving Chinese nation and stave off World War III. For him, charity took precedence over tradition. I wonder if that may be true for Pope Francis as well.

Whether it is or it isn't, he's certainly not afraid of going out on a limb. In an interview published in September, 2013, he stated: "A person once asked me, in a provocative manner, if I approved of homosexuality. I replied with another question: 'Tell me: when God looks at a gay person, does he endorse the existence of this person with love, or reject and condemn this person?' We must always consider the person."* This is fairly radical, it seems to me, bending Church doctrine around the needs of people rather than the other way around. 

Such a pope might prove to be a powerful ally at a time when faith-based groups are arguing for exemption from the stipulations of the Affordable Care Act regarding coverage for contraception. Bearing in mind their legitimate concerns about conscience, it helps to bear in mind another, equally legitimate concern, namely, of the four million births in the United States in 2011, 393,772 were to mothers ages 15-19. What is that, about 10%? The picture is complicated by the fact that teen pregnancies are associated with greater risks for low birth weight, preterm birth, and death in infancy.

How many of these births could have been avoided had their mothers had access to contraception? All of them, potentially. What if one was your daughter or mine? Which would we prefer, to discover she was having unprotected sex whether we approved of it or not, exposing herself to sexually-transmitted disease and unwanted pregnancy? Or to be assured that even if she was having sex, her future (and ours, by the way) was far less likely to be altered, negatively, by an unwanted pregnancy? 

I don't think there's a parent on the planet who welcomes the thought of their daughters or sons being sexually active teenagers, but it happens. It happens to the best of families in the best of communities. It happens to families of faith as well as families with no faith. It happens to Democrats and Republicans, Whites, African-Americans, Hispanics, and everyone else. It just happens.

Effective parenting is not ideal parenting because there are no ideal parents. There's only us and we try to do rightly by our children and sometimes that's not enough. An ounce of prevention is worth a pound of cure. Admitting the truth is hard, but the consequences of denial are much harder. Preparing our children for adulthood entails protecting them from the impact of their own impulses. I can't be with my children 24 hours a day and expect them to grow into independent, functional adults. I've got to give them a measure of freedom and that means taking a few risks. Of all the ones I must take, an unwanted pregnancy is not one of them. I hope it turns out, the New Fisherman agrees with me.

*Citation from The New York Times, 9/20/2013.

(Creative Commons image by twm1340 via Flickr)
Related Posts Plugin for WordPress, Blogger...