I thought back when I started this that third year would be a time ripe for the picking of fabulous tales of patients--the hilarious, the heartwarming, the heartbreaking, the annoyingly clueless, etc. Instead, I've been on Internal medicine for almost 3 months and have almost nothing to show for it, in terms of stories that have actually been jotted down on (virtual) paper. It's hard, you see, when you've been at work since 6am and aren't home til 7-8pm, and still have reading to do about your individual patients and about general exam material before you collapse into bed at the woefully "respectable" hour of 9-10pm because it's all going to happen again the next day, to find energy (or just time, for that matter) to reflect upon the happenings of the day. Toss that in with a healthy(?) mix of stressing over the fact that we're halfway through the year and I'm only more confused than ever about what to do with the rest of my life and a desire to spend some kind of time with my husband and my family, and well, writing just goes by the wayside for a while.
Whatever, I hear you saying out there in Internetland, Quit making excuses and just write something already, I've already been here 10 minutes and haven't heard any good stories about insanity or blood and guts. And so, SCENE.
Seriously though, one of the hardest things for me so far about internal medicine is the push-pull over the decision of whether or not I like adults enough to pursue med-peds vs. categorical peds for residency and my eventual career. I enjoyed (for the most part) my time on wards, and was told by my residents that I was very good at it, which got me thinking about the possibilities. On the one hand, adult medicine tends to be more complicated and would require a lot more involved thinking and problem solving on a daily basis, which might be a nice change to just looking in ears and doing physicals all day. Plus, the idea of the kind of continuity an outpatient med-peds doctor could have with their patients--seeing a person from birth to late adult life, for example--is an extremely appealing idea. I got even more into the idea on some of the days I was on an Infectious Disease service recently, as I enjoyed the continuity and complexity involved in working with the many HIV patients we saw throughout those three weeks. On the other hand, this week I've been on an endocrinology service, and I just honestly don't know if I could handle dealing with multiple diabetics who don't take their meds, don't understand their meds and aren't willing to learn, won't quit smoking, etc. day in and day out for the next 30+ years of my life.
I've been going back and forth, sometimes daily, on this debate for the past 6-8 weeks. I have tried very hard (and, I think, at least somewhat succeeded) to be open-minded when it comes to the possibility of medicine, and some days I find myself coming home very excited by it and some days absolutely disgusted. At this point, nearing the end of the clerkship, I feel I'm really no closer to a decision than I was at the beginning. If anything, I'm more confused and, with holiday season burnout setting in in a big way, it's getting harder to tell if the dislike I feel for what I'm doing right now has as much to do with the specialty as it does with my general need for a break. Some days I feel like I just have no empathy at all for my patients, that I just want to escape and go home and have some time to play video games or take a nap or just do NOTHING for a while, and I'm not sure if this is a sign that medicine is not for me or just a sign that Christmas is coming and I'm tired and beaten down by a grueling schedule.
Luckily, I have one more week of endocrine, and then I'm done with adults for a while. After that, I'm doing a week long "career exploration" elective in the NICU, then a week off to study for the medicine shelf exam, followed by two weeks of Christmas break and then Peds in January (for which I'm so excited I could pee myself). Maybe that in and of itself is a sign, who knows? For now I just have to get through the next week.
