Wednesday, May 25, 2011

Specialty Thoughts

A lot of people have asked me what kind of doctor I want to be. Most often, it's the first question out of someone's mouth after they discover that I am working toward applying to medical school. I don't know how it is for everyone else, but at this point in my journey to becoming a doctor, I am pretty clueless about where I'm going to end up. Unfortunately, that's not for lack of consideration...

I have shadowed a number of different physicians in different specialties. I've spent four hours each shadowing a cardiologist, a general surgeon and a sleep specialist. I haven't yet had a chance to shadow anyone in family / internal medicine, and I'd like to, so if you know anyone... ;-) I've also spent almost 30 hours shadowing an emergency room physician. All of them were very enlightening experiences, but the imbalance leaves me with a bit of a problem. You see, I find myself identifying with the ER experience the most, but I don't know if that's because it's truly where I should end up, or if it's simply because that's where I've spent the most time so far. I've also spent about 150 hours in the emergency department as a volunteer.

I enjoyed the other experiences as well. I could see myself enjoying a wide variety of physician specialties. The heart is an amazing organ, and it astounded me how much the cardiologist I shadowed was able to understand from a simple ECG printout. Plus, the heart catheterization that I attended bedside was just awesome; watching him run a line up through someone's femoral artery into their heart to release a contrast dye that gave a high resolution, real-time, instantly-viewable video of how their blood was flowing through their heart was one of the coolest things I've ever seen. He said he usually does 1-2 heart catheterizations each day. I'm sure it becomes old-hat eventually, but it was very cool to see.

The surgeries that I watched with the general surgeons were also very enlightening. I learned that I don't get sick easily. I was surprised by two of my senses during the procedures- sight and smells. You never really think about the wide range of color you see inside someone's chest cavity, especially how vivid yellow adipose (fat) tissue can be. The other is the smell, specifically of burning flesh. What most people don't know is that there is a lot of burning that goes on in a lot of surgery because the surgeon has to cauterize different areas as they cut so as to minimize the patient's loss of blood. I had a blast talking with the surgeon, asking questions occasionally while she worked. It was really interesting, but again, I can see how it could become routine to be a general surgeon. There's a lot of adrenaline involved, knowing you're INSIDE someone's chest, but I don't know how I would feel about doing something like that long-term.

I think what attracts me to emergency medicine the most at this point is the variation in the work. Most of your time, at least in a small-town emergency department like Holland Hospital, is spent on smaller things like fevers, stomachaches, concussions, broken noses, cuts, broken bones and that sort of thing. However, every once in a while, you'll have a trauma situation come in, and then everything gets crazy. A controlled crazy, an intense, interesting crazy, but very definitely crazy. It's time to perform. That person's life depends on whether or not you as the attending physician know your stuff. You have to know how everything is connected, how one drug interacts with another, how the patient's previous medical history (or whatever you happen to have access to) plays into the current situation, and a dozen dozen other details. And the thing is, once you get everything under control, it's not the end of your day; you still have to go back to the rest of your patients. You can go right from an intense, critical-condition situation right into a room with someone who has a frustratingly persistent cough. I found that polarized dynamic to be fairly intriguing.

I think what probably attracts me the most about emergency medicine is the mixture of hands-on procedures and diagnosis that the emergency physician needs to do. While they might not be actually setting the bones (they call in a bone specialist to do that and apply the cast), they might go from resuscitating someone who is having a heart attack or helping stabilize a car accident victim to trying to figure out why some other guy has intermittent pulses of level 10 pain in his abdomen. Clinical procedures are regularly mixed in with problem-solving and diagnosis. I like the idea of doing both, and while this mixture might be present in the daily work of other physician specialties, I'm not aware of it at the moment. So, at this point, emergency medicine retains a tentative hold on first place in my list of potential specialties. It will be really interesting (however many years from now I actually make a decision) to see what I end up picking, then look back on my thought process at this point and see how much has changed or stayed the same.

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