I met with Dr. W, my neurology program director, for my semi-annual review today. As Dr. F, the internal med director didn’t show up, and I’ve been in near constant contact with Dr. W over this “remediating” situation, it wasn’t quite as nerve-racking as usual. They’re still not planning on kicking me out, so I’ve got another 6 months to breath easily.

He did ask me, point blank, what my “end of residency plans were” and I admitted that I’ve been struggling with that very decision, trying to make up my mind. I feel like I’ve been wrestling with it since starting residency. Unfortunately, as applications for fellowships are due in just a few short months, I can’t afford to be indecisive for much longer.

Was I interested in multiple sclerosis? He probed.
No.
Dementia?
No.
Movement disorders?
Neuromuscular diseases and doing EMG and muscle/nerve biopsies?
Epilepsy and electroencephalograms?
Headaches?
No. No. No. So much no.
Having a continuity clinic and seeing general neurology or medical patients?
No!
And critical care?

Critical care? I love critical care. I love the patients. I love the systematic approach to complex medical decisions. I love the procedures. I love/hate that moment when the patient arrives sicksicksick and I’m terrified of how I’m going to mess this up…and then take the deep breath in and just listen to the lungs and heart while I figure out what to do. I love having the family meetings and helping people figure out what their loved ones would want, arriving at “good deaths” if necessary.

But. But. I can see myself as happy as a hospitalist or maybe working as a stroke attending. I can. And I could do that without any extra training.

My attending laughed at me by this point. Dude, he said (and yes he did say dude), You have to go into critical care and you know it. He basically parroted back everything that I had said… and he was completely right. I’ve been trying to convince myself to do critical care, (honestly since third year of medical school), but truly, I’ve been looking for excuses not to do it… and really haven’t come up with any. Except that I don’t want to go through the application process again (which, since I have to eventually apply for a job, is logically ridiculous) and that fact that I’m not nearly competitive enough. My CV (curriculum vitae or resumé) right now reads that I’m doing residency and not much else.

Dr. W. gave me some fabulous ideas of how to enrich my CV, including talking to some of my favorite attendings for letters of recommendation, and research ideas that I’m much more interested in, such as quality of life measurements and how we communicate with families. Exactly the type of stuff that I’m interested in.

So I have a plan. I’m emailing Dr. J and Dr. BFF for assistance and ideas on the research projects. I’m talking to Dr. N, Dr. L and Dr. H about letters of recommendation. I’m getting a list of good programs which to apply from my classmates.

And I’m applying for fellowship.