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)

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