From the air

Today I’m writing from a plane. I tend to get a lot of good thinking done on flights. This one is from Chicago where I spent the weekend at an advanced endoscopy training. I spent much of yesterday placing endoscopes into pig stomachs and practicing on tools that deliver staples, sutures, rubber bands, and other goodies to bleeding vessels, or polyps, or tumors. We doctors need to practice- and trust me, better on a pig than on you. Still, most of what we do for the first time is with real patients. Many people still believe that one should avoid the hospital altogether in July since those of us practicing are so new. But this has been disproven in the literature which is summed up in this article: http://www.newsweek.com/id/144227/page/1. In some ways, I found in residency that July may be the safest time of year to come in since the amount of supervision is high. I assumed nothing in July during my Junior and Senior years- I double checked all of the interns’ work. Every resident does this- and in that way, July patients get very careful workups, lab checks, etc. that they should be getting all year round, but may not in later months, when assumptions are made, for better or for worse, about the level of knowledge gained by an intern by, say, February. The intersection of earning independence and others taking for granted that you don’t know everything yet is the toughest one to cross in residency- and most of my friends and I struggled with that as we bridged from intern year to managing the team as Juniors.

It is at these moments of quiet, abord this plane admiring my view of the clouds and the remains of hurricaine Ike (which has unfortunately destroyed the homes and uprooted the lives of many Texans this week), that I reflect on my life from the 30,000 foot view. Everyone needs moments like that- where you simply stop the madness of the busy days, and tasks, and stress- and ponder. I don’t think we do enough of that. When patients and I discuss difficult things- the death of a family member, a new illness, a lost job- sometimes my urge is to fill the void of those moments with encouragement, with words. But I am learning, as I get slightly further along in my career, that silence is the most powerful tool at times. It doesn’t always take a plane ride to find that moment. Luckily for me- I have found one now and I find myself thinking of how I got here and I will share a bit of that.

My career in medicine probably began before I knew it. At five, my favorite book was an old set of Encyclopedia Britannicas my parents kept in the living room. Chapters on how to make soap sculptures were fun for Sunday afternoons- but even better were the diagrams of anatomy. I remember well tracing the brain over and over with tracing paper- and somehow feeling proud that I could copy it so that it looked real. In elementary school I loved my science classes. I begged my parents for just about every pet I could have and I spent days with my fish tank, measuring the pH of the water. I guess I was pretty nerdy in my private time- but outwardly I played soccer and hung out with friends and was very much an active boy.

In high school I started to see that my appreciation for science could one day lead to a career. I didn’t really work that hard and I certainly should have gotten an earlier jump then- since now, in my 30s, I wish desperately every day that I could be done training and actually making money and making decisions for myself. But I credit my high school biology teacher, Mr. Howard, for his constant enthusiasm. It was in him that I started to see that science wasn’t just a fun hobby- it was a way of thinking- and in many ways I thought scientifically. Still, musical interests, sports, girlfriends- all sort of distracted me from diving in head-first and I was not the quintessential pre-med student in college. For one, I majored in English. This was a terrific decision. Young doctors-to-be, you will spend the rest of your studying medicine- take a few years in college to branch out a bit. I wrote poetry and short stories in college, and a thesis on Raymond Carver’s (who permanently changed how I see the world). And I had fun. Maybe too much fun- as I realized that I was not the top of my class, and that medical school would be a challenge to get into. I didn’t apply when I graduated from Cornell in 1995. I waited for life experience- for the right moment.

What I did not know is that the moment wouldn’t be for six more years. Looking back I partially blame this on my own insecurities in my ability. Partly, though, I think circumstances- my parent’s divorce at 23, an accident that year that left me completely dependent on others for 3 months, jobs in research that excited me- all delayed the inevitable. But after 5 years of waiting, I took my entrance exam for medical school in 2000 and applied that year. I remember the day I interviewed at Thomas Jefferson Medical School, In Philadelphia- with a woman my uncle (a gynecologist) had worked with for years. She is an incredible doctor- a neurologist named Dr. Madhu Khalia who became my good friend a few years prior when she on sabbatical in Boston where I lived. It was she whose encouragement at that time motivated me to go for it- and she who I still credit for understanding that sometimes, those of us who chose this long path, need some help to find it.

I’ll save medical school and residency for other entries- as I know, throughout this blogging experience, I’ll cover the whole story. What I can say now, with authority, as we approach our destination, fasten seatbelts, follow the relentless rules of the less and less friendly skies- (which happen to cost more and more)- is that I am happy to be a doctor, and that all of this hard work is worth it: even a weekend far away, one of my only weekends off in a while spent not with my wife and daughter, but with pig stomachs. Oh, and before I stop writing this, I do wish to share that time with my family is the most important thing to me, by far, and that which I get to enjoy the least. That is the single biggest sacrifice of being a doctor so far- time. More on this tomorrow.