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9th June 2005

Decisions, decisions – a look back

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PS – You should be proud of the job you did in the MICU. You were
outstanding! Feel free to ask me any career questions you may have. We
would love to see you stay in Internal Medicine, either general or a

From an email I received from one of the residents I worked with this past month. I got excellent evaluations from my residents–the best I’ve received all year long. Now, you know me, I’m not saying that to boast. Oh no, Julia’s never satisfied with a compliment.

Since around October, I’ve been planning on doing Neurology as a residency. Of course, I always prefaced it, even in my head, that “I’m keeping an open mind so another specialty might sway me,” but I didn’t think that anything would. I mean, if you had asked me when I was starting medical school what I wanted to do, I would have told you pediatrics (genetics) or family practice. I certainly never thought that I’d want to do something with the complex, “way too many blood vessels and did they have to name every bony bump a different name?” brain. But the neurological science block second year fascinated me, and I absolutely loved every minute that we spent studying about Parkinson’s disease and multiple sclerosis and how to do a neuro exam–and better yet, be able to locate where in the brain the injury occurred. I spent hours studying, because I loved it. And in the rest of second year, while there were classes that were interesting, there was never that all-encompassing passion for them. And nothing clicked in the same way, nothing made as much intuitive sense like Neurology did.

So then I started my third year, frightened, confused. Within a few days, I discovered that I liked talking to patients and that medicine was really for me. OB was a blast–but Gyn wasn’t, so that took that specialty off the list.

Next, my first six weeks of Internal medicine. I had a fabulous time. My residents were great. My attending was hot. My patients were interesting… but my favorites were those who had the neurological issues. But I felt really comfortable in the rotation. The evaluation from OB, my resident said I had “confidence issues”–when I told the chief in IM, he stared at me in disbelief. So IM stayed on the list of possibilities.

First day of Radiology I knew that there was no way I could ever go into that specialty. I’ve never gotten so much sleep and been so tired. I missed the patients, finding out their stories. It was pretty cool being able to mark something off the list with such a bold stroke. Neurosurgery… well, you all remember my experience. My aching feet and back would not be able to tolerate the long hours–and the thought of not seeing the sun for seven years was not appealing–no matter how interesting the cases were.

Neurology was next, the rotation I managed to worm my way into. It was a great experience. I liked my patients and I love discovering new neuro exam techniques that I had never even heard of before… But I also felt a little… lost then. It was a new hospital–it took me days to figure out where they put the nurses charts and what all of the little abbreviations meant. I felt intimidated–these were the people that I really had to impress, the ones whose opinion really mattered. And in the end, it’s the rotation that I’ve done the poorest in (well, psych might be competition, but I don’t know yet). My attending, the woman that I need desperately to get a letter of recommendation from (because she’s president of all of these societies and is very well known), wrote in the evaluation comments: “great enthusiasm. Worked on weekends. Interested in the field.” That’s it.

Hence the reason I haven’t exactly been knocking down her door asking for that letter.

Family medicine taught me that my primary love was in the hospital. I love taking care of the acute problems and not spending a morning fitting in 16 patients who are all in because of a cold.

Pediatrics–I had a lovely time here, besides working with Kyle, who end in the end actually started nodding in my direction when he passed me, a definite improvement. The kids were cute and it was inpatient medicine again. It was at this time when I was submitting my schedule for next year and my advisor suggested that I consider child neurology. I went and talked to the head director of pediatrics, who happened to be a child neurologist and was really excited–they see so much and have such an impact in their patients’ lives. So then my dilemma became–adult neurology or child neurology.

Psychiatry was definitely not for me. It wasn’t as bad as I had heard, but I never got the drugs down, much less the differences between Schizoaffective Disorder and Depression with Psychosis. And I missed my stethoscope.

And that brings us to the second internal medicine rotation. Three weeks in the Medical ICU. I can’t even begin to describe what an incredible time I had there. Well, if you read my entries, you know. I felt like an integral part of the team–it was so difficult but it was exhilarating. I didn’t even mind the every third night call (q3 in medicalese).

And now for the first time in months, I’m conflicted and confused. Neurology versus Internal Medicine. A combination program? There’s about 6 in the whole country. Adult Neurology? Child neurology?

We’re supposed to be making up our minds right now–getting the letters together (ugh, ugh, ugh, ugh), confirming what you need to do with your advisor. I was planning on writing and getting application information from various residencies, and now I feel like I’m back at step one. *sigh*

No, I haven’t written my resident back, thanking him graciously and taking him up on his offer for advice. I’m supposed to write a paper for him, one that will get published with my name on it!, and yeah, I’ve been bad, and haven’t done much on it. Oops.

My huge practical exam went okay on Monday. Fifteen minutes with each patient. I thought I’d be hard pressed to finish in time–uh, yeah, I usually finished five minutes early. Not good, because it meant that I was rushed. Of course, as I’ve thought about it, the more huge mistakes I’ve remembered. Like not washing my hands before the exam. Or forgetting to ask about drug allergies. My physical exams were sloppy in general–I’m usually not that bad. My thyroid exam was terrible–I think I might have gotten a point for knowing where the thyroid was, but not much else. I didn’t percuss out the lungs on a guy who was coming in because of shortness of breath. And I didn’t ask the depressed patient if she was suicidal. We’ll see if I passed.

This entry was posted on Thursday, June 9th, 2005 at 1:14 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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