Planning the Rest of Your Life

It happened when I was being active in the milieu, playing bananagrams with a handful of occupants admitted to the in-patient psych ward: two suicide attempts, one recurring major depressive disorder not responding to recent medication changes, and a non-psychotic manic depressive who in conversation appeared to be slightly more psychotic than the notes suggested. I was rather enjoying myself, realizing that I could spend hours talking to any one of these people. The etiology of mood disorders had always fascinated me, and now I was able to explore them by myself, at my leisure. 

And although these patients were very kind and open, they were growing frustrated with another patient--a schizoaffective--roaming the common area: she would not stop talking. It wasn't pressured speech--it was continuous speech. It was rambling, non-directed speech, spoken to the hospital at large, and it was spoken with an annoying twangy accent that could be described as an inner city uptown chicago accent--very short A's. 

The bananagram players began to mock her, not to her face, but they began to mimic her monologues as they spelled out intersecting words. Halfway through the game, one of my patients, a very irritable and consistently antagonizing schizophrenic, sat down at our table and tried to get on my nerves, insulting just about everything he could get his mind to focus on. The guise of bananagrams saved me because I appeared and actually was busy, trying to win a game. He left shortly and I felt relieved to once again be surrounded only by the moods. And I realized, painfully, that I could not go into psychiatry. I loved my mood disorder patients, but I couldn't tolerate the psychotic ones for more than a few minutes. And while I could eventually work solely outpatient and see only patients with predominantly mood disorders, psychiatry residency programs are four years long, so I'd be spending four years doing something I could kind of tolerate to do something I'd probably love for the rest of my life.

As a third year nearing the end of her clerkship rotations, I've been spending a disturbing amount of time freaking out--I suppose the correct term would be "having panic attacks"--about my future. But my debate between family medicine and psychiatry is far simpler than some of my friends considering even longer residency programs.

Take my good friend Annette. Everything about her screams surgeon: her steady, unshakable confidence, her ability to immediately befriend and then joke-around with just about anyone, her oversized-for-her-stature-hands. Surgeon! But if she was to become a surgeon, she would most likely want to go into something very specific: pediatric GI. Her internal debates, one would imagine, would go something like this: waste another five years of my life learning other types of surgeries to eventually get to begin doing fellowships in something I love. Five years. Five years of surgeries on adults. Five years where, yes, she would learn some very important things that would make her a better doctor, but also a lot of things that have no bearing on her future dreams.

I would consider anyone entering the medical field to be an expert at appreciating delayed gratification. But as my friends and I begin to plan out the rest of our lives, it sometimes seems like medicine is asking almost too much from us. 

Blasphemy, I know. I've already spent hundreds of hours preparing for tests that I promptly forgot all the answers to. I've delayed seeing my own physicians--sometimes for months--in order to never miss a day of clerkship. I've stopped exercising and my diet consists of, and I am not kidding, microwavable popcorn, cheese sticks, and diet coke. Medicine has already asked a lot of us.

For me, my choice is easy: I've always felt strongly about family medicine, and as it turns out, you see a lot of psych patients in primary care settings. Family medicine: where you see everything and the residency program is only three years. 

But for my friend Annette, her decision between surgery, pediatrics, and pediatric GI surgery has to take into account how much of her life she wants to live inside of a hospital.