Problem list starting Internship:
1- The newness
2- Being alone
3- Having to interact with patients in a context they understand
4- Being hard on yourself, and overwhelming-ness
5- Not knowing what to do
6- Failed expectations
(PS: this is an outline that will guide through a two-piece article).
I have always, as always as my adult-self started forming, thought of myself as a scientist working in a lab, being on the frontier of advancing medical sciences and technology. I was never really intrigued in being one of the everyday soldiers of the medical practice, the tediousness of clinical medicine with all its protocols and politics had a bureaucracy in it that I always thought of as a definite death for passion. Alongside the human factor that comes with a lot of emotional investment and occasional misery, that I never had the interest of throwing myself into.
If anything, the way I thought of my future career was philosophical in nature, the next step of human evolution was not happening on a biological level anymore but we were evolving into our technology. I was such an advocate for Transhumanism* that I based my entire prospect of future career on a track that enables me to outlive the morals I held in this regard.
I was always so fascinated with stem cells, ever since I was a 5 yo being told about the birth of Dolly the sheep the first mammal to ever be cloned*. I finished my bachelor’s in biology carrying the same fascination in stem cells, molecular biology, and evolutionary biology. As I was stumbling through medical school I was never really quite sure about what I liked best, I loved the science of medicine and was taken by almost every specialty I encountered in a way.
Around my 5th year at the beginning of my clinical rotations I met a very inspiring man, Dr. Bassem Albeiruti, it was a course about the advances in immunotherapy and stem cells research and as he stood there all passionate and dedicated speaking about what I believed to be the salvation of humanity from disease I thought that this man is a sign guiding me to everything I wanted to become one day.
A couple of conversations with him afterwards, a bit of reading around and numerous reflections with my best friends and I was totally convicted that the entire purpose of my life was to go for Internal Medicine -which would give me the broad knowledge in medicine as a science- then go for a fellowship in Regenerative Medicine and Stem Cell Research. And this became the dream that was encompassing for all my previous ventures in life, the dream that gave me goosebumps every time I dreamed it.
The amusing thing about life is how extremely very surprising it is. Because I made the decision of going into clinical research, and not being a clinician almost 10 years ago and every step down my path ever since went along with that, but here I am about to start my residency training program in Emergency Medicine, the most clinical aspect of the entire practice of medicine as a whole. And despite how excited I feel, I am still awed at how the hell did I so unexpectedly end up here?
So, let me try to explain to you what happened in a year’s time to shift my entire perspective into a different frame, by walking you through the thinking process that led me here. We were asked to set our internship schedule 6 months in advance and of course, I arranged it according to what will be the most convenient for the matching timetable, it was set to be this way:
With all these months before February (the time to submit our application to SCFHS for the match) being invested in Internal Medicine you can see how deeply convicted I was about how much I wanted to go into IM. During my first month doing Emergency Medicine I did not even consider it, sure I enjoyed the exposure and the people and how the work was so quick and neat but I thought I already knew what I wanted. Especially that my overwhelming-ness with the general situation (refer to my previous blog for further details) kind of dulled out any pleasantness in the rest of my experience. To my disappointment, a week into my General Internal Medicine rotation, and I knew with no doubt that this isn’t what I wanted. You see, studying internal medicine means learning about every single pathology inflicted on the human body, and how physiology overreacts, respond or basically fails to respond. You learn so much, but when it comes to real practice you will mostly be seeing one subset of patients -elderly diabetic hypertensive with poor compliance to medications admitted for urosepsis (or any other sepsis)- and due to age and multiple comorbidities there is nothing much for a physician to do but give them antibiotics and support them until they’re well enough to go home. Same patients. Same rounds. Same practice, almost every day. Arguably, I only needed to survive that for 4 years before I go into a subspecialty that would give me a better variety within the focus of that subspecialty. I realized that I did not like that. I did not work so hard for all these years to only know everything about a single organ and have the rest of my knowledge fade away with time. It felt too confining and honestly boring. It works for a lot of people, brilliant people, but just not me.
It was extremely difficult to walk away from my dreams, and in a way the identity I built for myself based on it over the years. So, I figured that maybe I could reach the same end result by dealing with younger patients and going into pediatrics. I learned that if I wanted to eventually get to work in Regenerative Medicine I’d need a fellowship in pediatric hematology/oncology. I decided to give that a try so I decide whether or not I still want to follow this career route. I changed my electives into the following:
And from here comes the most important lesson out of this entire article; make sure you try out as many specialties AS AN INTERN as possible before the match because you’d be so surprised to what you will find out. The month of November in General Pediatrics was the happiest time I had up until that point in my internship. The patients were ADORABLE, super easy to deal with and most importantly each one was a different age group and a totally different disease. And there was something about how concerned most of the caregivers were, how lively the ward was, and how during visitation hours the ward fills up with people and more colors that made it super lovely to be around. Pediatricians were so meticulous in caring for their patients and I wanted that to be a value I train under. And knowledge-wise, as a science pediatrics contained the added aspect of genetic diseases, immunology and inborn errors of metabolism that were way more understood than in adult medicine. And the complexity of such science added a fascinating aspect to the practice of pediatrics. Added to that the fact that most pediatric patients go in really sick and in a couple of days they were discharged back to their normal lives really well and healthy, that made the atmosphere so hopeful and pleasant, I was almost sold! However, as soon as I started my Pediatric Oncology rotation a total shift in my perspective towards clinical medicine happened.
During my years as an undergrad student, studying biology and getting exposed to a lot of cancer research that works on treatment from the basic sciences point view, a drug that worked with a tolerable side effects profile and an adequate efficacy and specificity was considered revolutionary. You would read a paper and feel exhilarated with the results for how far science has taken us, but none of these papers mentioned the faces of these children after the treatment, the tears of their mothers as they watched their children wither away, and most importantly the complications that at times seem way worse than the primary disease. For example; a child getting a Bone Marrow Transplant to fix his really bad poorly managed Sickle Cell Anemia would need around 3 years mostly spent in the hospital to complete the process. The Entire bone marrow producing blood cells need to be ablated (yes leaving the child open to all sorts of infections) then reseeded with a donor’s blood cells then waiting to see if it’d take without attacking the body. Read about graft vs. host disease and Scleroderma in transplanted patient and you would definitely understand my horror. I guess my new moral was life is not worth going through all of that pain to live. Especially, if you are just a child with no choice but to follow that of your guardians’, without even having the mental capacity to understand what’s happening to you. It is necessary to have people working so hard to cure little children from cancer or transplanting them new cells to cure their morbidities that will eventually kill them in ugly ways but I cannot be one of those people. Childhood is only beautiful in health and hope far away from hospital hallways and little frail bodies with some freckled hairs.
So, a change in my long-term life goals had to happen. And since fulfilling a dream was not my propeller anymore I had to come up with a better scheme to navigate through the situation. I was blessed to have many friends that helped me in this regard, many many conversations with so many many many people in and outside of the hospital really helped me put things in perspective. Which takes us to my second piece of advice TALK TO PEOPLE. Your family and friends because your choices will eventually affect them. Your seniors especially in your field of interest, hear their feedback and assess their satisfaction with their work and their quality of life. And remember to consider all possible factors while choosing a specialty, even if it didn’t seem important right now. Mostly because passion is not static it changes as you grow so does your life situation. Organize your priorities and see which matters most to you, and which specialty can provide for them.
A small list of things that matter in life and you should arrange according to priority:
– Social life/ lifestyle
– Social status
I am a person who cares the most about loving the people I love, practicing my hobbies and talents outside of medicine, and most importantly living a life of passion. Money and job security were also essential for my thrive to be a “strong independent woman”. And this last point really kind of pushed towards going to a specialty that is not as oversaturated as pediatrics. I also could not keep myself from thinking of how dealing with children day in and day out would eventually get me soft, instead of the strength and empowerment I sensed every time I worked with a female emergency physician. I wanted to be that woman. I wanted to go into the specialty that the majority in my misogynistic society would think I am not tough enough for. I wanted to challenge the sexist assumptions about my limited capacity as a woman.
When I started my second Emergency Medicine rotation I felt electric. That everything I am and want to be is made to exist there. How dynamic and practical the shifts were. How encompassing of all the science of medicine the science of EM is. And most importantly how exciting it is to think of all the variable cases I’d have seen in 20 years from now. The practice of emergency medicine is undermined by people who fail to understand that emergency physicians don’t just stabilize and refer, they diagnose, thwy manage and they need to know the what, the why and the how. I wouldn’t just need observation and crude intelligence alone but I’d need to be extremely skillful and creative. And most importantly I’d need to always work on my social skills to communicate better with my patients and the different hospital departments. My decision was naturally made the moment I went back to try emergency medicine with the eyes -and heart- of someone who’s considering it.
The months that followed were filled of so much anxiety waiting for the match results which somehow became the center of all my attention and conversations. I got what I wanted at the end. And my internship year was all and all full of life-changing lessons, that I will carry with me forever. Most importantly was the need to always keep an open mind, and the skill to make a decision and stick to it.
Today, I am starting my residency in Emergency Medicine, and I am beyond excited for everything I will learn and the person/woman I will be at the end of the road. So far, it has been such a blessed journey and I cannot wait to see how the next four years of training would shape me and the lovely new friends I made that I will be witnessing their growth first-hand.
I do realize that it won’t be easy, but we don’t become anyone sitting easily in our comfort zones.
As for you please, give yourself a chance to explore all possible options, trust the calling of your heart and believe that God has a place for each one of us. And with the right intentions, our paths would lead us to that place eventually.
I would love to hear about your journey so do share it here, with me on twitter or via email.
EMRTP-WR PGY1, Welcoming Ceremony
*Transhumanism; he belief or theory that the human race can evolve beyond its current physical and mental limitations, especially by means of science and technology.
* Dolly the sheep was the first mammal to be cloned born on July 1996