Wednesday, July 22, 2009

Life is like riding a bicycle. You have to keep moving in order to stay balanced.

Almost a week ago, I discovered what specialty I want to pursue. This has been a overwhelming relief since I have spent most of my first year in medicine wondering if I had made the right choice. At last, I feel as though I can find my own footing and start really digging into things with enthusiasm instead of feeling lost and frustrated.

I'd like to be a surgeon. A general surgeon, who specialized in trauma.

Surprised? I thought not. Frankly, I was. Having barely survived a year of med school, I was a little shocked that I could look upon a 7 year residency with enthusiasm rather than utter horror. But, I'm getting ahead of myself... here's the back story:

I've spent the last 3 weeks doing a rotation in general surgery with the chief surgeon, whom we shall call Dr. M*A*S*H. The hours were long - 7am to 6pm every day and then home to read for 3-4hrs every night. But, my doc had a great sense of humor and the cases were interesting and exciting. I took to it like a duck to water and my learning curve was steep and profound.

Most of our surgeries were laparoscopic cholesysectomies and segmental resections of breast (cancer). We also did a few very bloody bowel resections including an APR, which is about the worst thing I think a human being has to go through - or at least, the worst thing I've seen medicine do to "help" someone so far.

I came home most nights tired but happy. I liked the work, I liked my preceptor, and surgery is just plain cool. For the most part, though, I didn't give surgery much more thought than "hey, this is pretty fun". And then we spent an afternoon repairing hernias...

We had 3 inguinal hernia surgeries in a row one Monday afternoon. The first one was completely overwhelming. While I'd read up on the anatomy the night before, everything down in the pelvis is so 3D and layered that it's pretty much impossible to picture it without having a body (or a living, breathing body) right in front of you. The second surgery went much better, I'd figured out that Hasselbach Triangle and the difference between direct and indirect hernias. After the third surgery, I walked out of the OR thinking to myself: "This is it. I want to be a surgeon." I could easily see myself being 55 and repairing my 400th hernia and still loving it.

I called Penguin as I walked out to my car to drive home that night and told him the exciting news. I could feel him smiling on the other side of the phone but we were both cautious: 7 years of residency is a big commitment and what about adventuring?

Over the next 1.5 weeks, Dr. M*A*S*H did everything he could to deter me from surgery, in the nicest way possible. He pointed out that surgery is still very much a Boys Club - you gotta be able to smoke cigars, drink whiskey, and drive stick. (I have 2 out of 3 there, at least!). He also pointed out that you have a responsibility to your patients, colleagues, and the hospital to do call and be around for follow up. You can't just slice off someone's breast, diagnose her with cancer, and then leave town for 6 months to go climbing thereby leaving all the follow up to someone else. In fact, as a surgeon, you spend 70% of your time at work. Everything else: family, food, sleep, play has to fit into that other 30%. Your work is your life.

I listened. I thought about it all. And on my last day, Dr. M*A*S*H and I got some coffee and sat down to talk. I said I was still interested. He said that he might have some ideas on how to solve my obstacles...

1) I'm about as much of a boy as a girl can get when it comes to playing rough and acting tough.
2) Wherever you go in medicine, you have to absolutely love it. It's too much of an investment to settle on a speciality that doesn't really float your boat just because you want a certain lifestyle. If I loved surgery, I should go for it. Nothing is impossible - difficult, yes, but not impossible.
3) If I want to go adventuring (and/or have a family), I don't have to take a staff job right away after graduation. Instead, I can do locums (which lets me travel in itself) and the contract work would give me the flexibility to take time off on my own schedule to jump on an expedition or pop out a bambino (yick!). Even if I were to take a staff job, it's still possible to go adventuring (Kenneth Kamler does it, afterall!), I just have to find the right colleagues and understanding hospital admin to let me.
4) With surgery comes specialization, something that I've been worried about avoiding. Dr. M*A*S*H specializes in breast cancer... but the plus side of Gen Surg is that you get to see everyone: 2 y/o, 97 y/o, and everything in between. Over coffee, we talked about what kind of Fellowship I might pursue after residency and he pointed out that I could do traumatology. I looked it up on CaRMS and only 3 universities in Canada offer this option: UBC, Toronto, and uOttawa. Clearly, this works out perfectly for me!
5) 70% of your time is a huge portion of your day to devout to work. After 3 weeks of surgery, I was hungry, tired, and excited. I thought about spending the rest of my career in this mixture of exhilaration and exhaustion and that's when I thought about Einstein's quotation: "Life is like riding a bicycle. You have to keep moving to stay balanced". I've always been a happier person when I'm stupidly busy (sorry Mom and Dad, but you know it's true!). And I was certainly the happiest that I've been all year while I was doing this rotation.

The best thing about surgery is that it's hands on: there's a problem, you fix it. You're always the last option: you only cut when medicine and time can't make things better. And if you can't fix it, then there's nothing else that can be done. It's that simple. It's this kind of perspective that totally feels right to me. Hopefully, I'm right for it.

Saturday, July 11, 2009

On Ovarian Cancer: Go Suck a Different Egg, Cancer!

Summer Reads:  

Voltaire's Bastards - John Ralston Saul
The Sickness unto Death - Soren Kierkegaard
Human Happiness - Blaise Pascal
On the Suffering of the World - Arthur Schopenhauer
Thus Spoke Zarathustra - Friedrich Nietzsche
The Human Condition - Hannah Arendt
Your Inner Fish - Neil Shubin (this one is mostly just for fun) 

I know what you're thinking: Saroja, how on earth are you going to read all these books in just 2 months while still doing school full time? My answer: I don't have a freaking clue but I'm really determined. If I'm going to enter that contest, I need to start writing pronto. Alas, before writing comes research.

If anyone has any suggestions for good reads that relate to my thesis, please send them my way! My goal is to start putting pen to paper by Sept. 5... deadline for contest entries are Jan 15.
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