It's Only Kind of a Funny Story

First, I’d like to make a film recommendation: go rent It’s Kind of a Funny Story. It’s the story of a teenager who inadvertently ends up in the psych ward due to the trials and pressures of adolescence. It’s funny and it’s got heart. (It’s also got Zach Galifianakis, or Alan from The Hangover.)

But in reality, the psych ward isn’t all that funny. I spent four weeks there during my psychiatry rotation, and it saddened me far more than I had expected.

Yes, there are crazy people there, to put it crassly. But these are the sickest of the sick, people who are suicidal, homicidal, psychotic, or are so impaired that they are unable to care for themselves. So they don’t get better quickly, if at all. It is kind of exciting to see a textbook case of schizophrenia for the first time, complete with voices, paranoia, and bizarre behavior. But when the person is still hearing voices coming from the heating vents two weeks later and drinking mouthwash to make themselves throw up the medication because they believe the doctors are trying to poison them, it’s just heart-wrenching.

An episode of mania in a person with bipolar disorder can be amusing, too, for the first few minutes; my team treated several, and some believed that they were being stalked by millions of people, and that these people were also stealing all of their belongings. The patients jumped from idea to idea with no connection between them, leaving me with whiplash after each interview. Yes, they said some hilarious things, always with a completely straight face. But when I heard some version of the same stories day after day, despite increasing doses of medication, it became clear that these were people who likely would be unable to function on their own in society for long periods of time. They had their physical health, but their minds were seriously impaired.

Overall, I enjoyed the four weeks. I disliked not touching my patients and it was a little bit strange to need keys to let myself through the double doors onto the ward, but the hours (roughly 8AM-4PM) and autonomy (leading the team’s daily interview with my patients, taking full responsibility for calling patient’s families for further information and writing detailed daily chart notes) were great. I even had fun studying. But I quickly realized that, while I found it fascinating to read about the various diseases and symptoms that can affect one’s mind and personality, I could only feel frustrated and sad when I interacted with people actually dealing with them. It seems that pediatrics is still the field for me.

On Idols and Not-So-Idle Thoughts (Part II)

Gynecologic Oncology – it was what I had dreamed of doing for ten years. I had spent a summer working in that field, and lost a loved one to ovarian cancer, so this wasn’t idle fantasy. The very reason I had chosen to do my ob/gyn rotation at this distant hospital was because it was home to one of the leaders in the field, and I desperately wanted to work with her.

I did get that chance, and it went well. Embarrassingly, we have nearly the same build and haircut, so on the day that I worked her office, multiple staff members noted, loudly and repeatedly, that we looked like twins. Just what this renowned surgeon wants to hear, I cringed, that she looks like a lowly med student. It was especially awkward for me because I had previously stated to family and friends that I wanted to be this woman, and here it looked like I was imitating her. Of course, she had no way of known about my prior reverence for her, so she probably didn’t view me as a creepy stalker. Another student told me later that she had actually spoken highly of me. (Yay!)

I did like gyn onc. But I still wasn’t sure I liked it enough to endure four years of the ob/gyn residency necessary to get there. So maybe, as Tay gently suggested, the important part for me was the oncology, not the ob/gyn. I had loved peds onc; in fact, I had often caught myself fantasizing about my career in the field, only to reprimand myself: You can’t do that, you’re going to be a gynecologic oncologist, remember? What’s more, I felt sure that I would enjoy the years of the general pediatrics residency that would precede an oncology fellowship. I loved the kids. I loved the parents - dealing with them, calming them, explaining things to them. I loved that the medicine incorporated all of the body systems, rather that just one as was the case with ob/gyn. And the more time I spent in gynecologic surgeries, the more I recognized that my favorite part took even before the anesthesia was administered: talking to the patient, explaining the procedure, answering questions.

On the surface, then, it might look like a simple decision. But I spent nearly the entire rotation torturing myself with endless ruminations and unanswerable questions. If I wasn’t going to be a gynecologic oncologist, then who was I? How well did I know myself? What else had I been wrong about? (And having been wrong, in and of itself, wasn’t my favorite thing.) My soul ached. I felt like I was failing. I felt like I was losing my identity. I felt like I was letting people down.

It took many long talks with family and close friends, as well as a good hard cry one night as I drove back home for the weekend. Through the rain I picked out the sign for the cemetery where one of my favorite people in the world, the one whose life was claimed far too early by ovarian cancer, is buried. Through my tears, I realized, finally, that choosing a different field and abandoning my personal vendetta against the disease that stole her away, would not be letting her down. She would probably even be proud of me for wanting to help kids with cancer… and for figuring out what I really want and going after it.

One other factor eased my decision. Last summer when I attended a medical writing workshop, I met a physician-writer whom I came to greatly admire. She had written a book chronicling her experiences in med school (sound familiar?), and it was one of the things I read at night to try to distract myself from my daily worries.

I enjoyed her stories and related to many of them. Then I came upon the chapter describing her decision of whether or not to go into Ob/Gyn. What, now? I knew that this woman was a pediatrician; had she once been less than sure about her path?

In a word, yes. I read faster and faster in disbelief as she gave words to the turmoil that raged inside me. She, too, had imagined a career helping women. She, too, liked parts of her ob/gyn rotation (truthfully, I think she liked more than I did). And yet, she, too, yearned to have a career with slightly more flexibility in order to allow her to develop her blossoming writing career. And she, too, agonized over the decision, lamenting the confusion she felt about her very identity and even admitting to questioning whether she wished to practice medicine at all.

Today, this woman is a successful pediatrician, wife, and mother, and she is also one hell of writer. And from the bit of time I spent with her, she’s an incredible person. And a happy one.

So I have a new career path and a new idol to go with it. I also feel a new sense of in-tune-ness with myself and what is important to me in life. I finished my ob/gyn rotation successfully and set up my fourth-year schedule with lots of electives in pediatrics. And I haven’t felt that knot in my stomach since.

On Idols and Not-So-Idle Thoughts (Part I)

Obstetrics and gynecology was my carrot throughout the first few years of medical school. It dangled in front of me, the reward for those years of grinding, crushing study; for giving up so much of what I loved in life along the way. Third-year rotations in general served as a general type of carrot – after all, seeing patients had to be better than hours hunched over textbooks – but as the first few rotations proved less than inspiring, ob/gyn hung promising on the horizon. I had scheduled it for January and February; I would start out 2011 on the right foot.

But by the second week of the rotation, I could no longer remember how it felt to live without a knot in my stomach.

Tay asked again and again for clarification of just what I was feeling. From what he could see, I had loved pediatrics and was just having a hard time adjusting to ob/gyn, likely due to a combination of: 1) residents who seemed to hate their lives and barely notice the students like myself who frantically followed them everywhere, trying to make sense of roles that were never explained to us; 2) my general aversion to change that reared up predictably at the start of every rotation; and 3) the fact that I was living in the free student housing, an hour away from my home with him, in an apartment that I would have shunned even when I was fresh out of college and scrounging to find a place that my embarrassingly small paycheck could cover.

(The best part of that housing was the skinny mirror in my bedroom. That and the bright pink striped shower curtain that had cost $8.99 at Target. Another plus was that the hot water didn’t always emit a scree like the sound the smoke detector would have made had it not been dismantled and disemboweled of its battery; sometimes a full five minutes could be spent in blissfully quiet pre-sunrise steam.)

I had met so many people – residents, attendings – who reminisced bitterly, “I thought I wanted to do ob/gyn... until I did my rotation!” This sentiment had frustrated me, with its negativity and with these individuals’ apparently easy dissuade-ability. I wanted to prove them wrong, to prove that ob/gyn could be liked, could fulfill what one hoped it would, could be a path charted at the start of med school (or even before) and followed without deviation. I didn’t want to be just another of the stereotypical women who had been all about women’s health until they realized how demanding the hours were or how catty the residents and then went running to something like psychiatry... family Medicine... pediatrics. I had been sure that one day I would look down my nose at them and announce that I, in fact, loved ob/gyn and found it to be nothing like the stereotype. So there.

Except here I was, hating every minute of every day spent at the hospital, and using up every minute spent outside of the hospital dreading my return to the wards the next day. I stayed up later than I should, lamenting my unhappiness to Tay over the phone, reading a few chapters of a book for pleasure and then feeling guilty about the indulgence; half fighting through the din of the ugly, noisy town in search of sleep with the other half always keeping an eye on the alarm clock, terrified I would sleep through my 5:30 wake-up. As a result, I was exhausted and cranky in addition to being frustrated and confused.

What was so bad about it? The residents, for starters. The younger ones – the interns – were all very sweet, but personalities seemed to go downhill as one climbed the ranks. I spent idle moments trying to pinpoint at what stage in their training the kindness was beat out of them. Teaching was rare; the few questions they asked ranged from those requiring magical mind-reading abilities and ones so ridiculously simple they made you wonder what you were missing. I once scrubbed in on a C-section and received only two questions: What is this? (pointing to the uterus) and Very good, now what about this? (holding up the fallopian tube). They were the only words spoken to me throughout a procedure in what is supposed to be a teaching hospital.

The lack of organization, for another thing. The rotation was ostensibly well-organized, with each student spending one week on each of seven services: Gynecology, Labor & Delivery, Nights (which was basically more labor & delivery but with horrible hours and less action… in other words, an atrocious week), Urogynecology, Reproductive Endrocrinology & Infertility, Maternal-Fetal Medicine (high-risk obstetrics) and Gynecologic Oncology. The problem was that the organization ended there. No one had any clue about appropriate roles for students, so they didn’t really give us any; we chased the residents all day, with no warning about when we might be able to eat lunch or use the bathroom or when we had to attend a meeting in a building several streets away. Multiple times, I nearly followed residents into the bathroom because they hadn’t told me where they were going – hadn’t told me anything at all – so I judged it safer to follow along than risk losing them. At other times, the residents would be busy and decline my offers to do anything to help, so I would be left literally holding up the wall, torn between trying to look available eager to help out and trying to look busy, like I wasn’t just standing there counting the seconds.

And then there was the actual medicine of it. Truth be told, I just wasn’t feeling as excited as I’d anticipated. Yes, I got teary-eyed at each birth (especially if the dad cried – that really got me), but that didn’t make me want to do it all the time. And the surgeries were interesting the first time I saw them, but with each repetition my interest dwindled. Once upon a time, I had been excited by the uterus and its neighboring organs, by the infections that could plague them, the tumors that could grow, the changes that took place monthly and throughout the arc of a woman's lifespan. But now that I was faced with them each day, I wasn't all that thrilled. I missed the heart and the kidneys.

Of course, as everyone reminded me, I had planned to subspecialize in oncology, so maybe it was ok that I wasn’t so excited about the general stuff. They suggested I wait to see how I felt during my week on Gyn Onc. So I tried to control my freaking out until then.

Transition from Turkey

Well, we're home. We had a very smooth, nearly 11-hour, flight back to New York on Monday and after a few days we were able to kick the jetlag. Tay returned to work and I've had the past week off to finish some of the writing projects I've been working on during the past month of elective time (yes, even in Turkey) and to get organized for one final rotation of third year.

But before I jump ahead, though, I need to go back and play some serious catch-up. Prior to my Turkey posts, I hadn't posted any updates since the New Year. I recently spent some time writing those overdue posts, and I'll put them up over the next week or so.

For now, though, one evening of freedom remains before I start eight weeks of surgery. So forgive the short post; there is fun to be had. :)