Why did I want to be a doctor?

My friend went through a lot of grief before settling on psychiatry for a profession. Third year of medical school is tough that way. You play around in all these various fields of medicine and while everything should be appealling and fun, it's all sucky and tiring and you wish you could just be a doorman. That's third year of medical school. And without fail, any good medical student finds himself questioning what ever possessed him to enroll in medical school, and now the $100k of debt means that the only two ways out of this sticky wicket are to die or to become a doctor.

And the true value of this exercise in self-deprication is to ask yourself the question: So, why did I want to do this? When you can answer that question, you're home free. You can look someone in the eye and say with a straight face that you really want to be a doctor.

For me, it's working with patients, educating them. I am their user's guide to the human body. I get to work with people and help them to understand themselves. I'm the guy that says you're going to be fine or you have 6 months to live. I'm the guy that people come to and ask if it's normal to have burning chest pain after eating pasta with 3 cups of coffee. People have switched from their long time family doctor to me because I answer their questions and I want to know who they are. It interests me that she's a molecular biologist or he's a janitor or that she loves meatloaf or that he runs 3 miles a day. That's what gets me up in the morning.

The problem is that the decisions we make about what we want to do with our lives, other people read shit into that. And no field is more fraught with this than psychiatry. Psychiatry is very cart before the horse. This lady is depressed, and she's depressed because she's a widow and she just retired from her job which was her only connection to other people. Now she spends all day at home with her needlepoint, waiting to die. She is fucking depressed. I say she needs a life. The psychiatrist says she has a chemical imbalance.

It's one thing to say someone has a blocked coronary artery and needs angioplasty. It's another thing to say that a person's grip on reality is all fucked up by a couple chemicals and proteins that are not doing what they're supposed to. But are the chemicals causing the depression or is the depression causing the chemicals to be all nuts?

Granted, people with psychosis need treatment, and a lot of it. But it's quite a big thing to say that I need to alter someone's perception of reality. That's why psychiatry is frowned upon. No other field of medicine questions reality, and supplies such a shitty answer as an imbalance of neurotransmitters.

But here's the deal. In any field of medicine, there are people who are in it to pay the bills, people looking to pay off their 6 digit educational debt, and there are people that honest to God love what they're doing. You'll meet them. You'll meet a radiologist that spends 30 minutes talking about Houndsfield units on CT. You'll find the internist that sits you down for an hour and is in love with hypertension. You'll stumble across the hematologist that is sad that you don't care about factor VII nearly as much as he does.

And happiness in medicine is as simple as realizing that something completely geeks you out, and for example, the idea of spending an hour talking about immunosuppresants for HIV sounds like something fun. When you find something like that in medicine, screw what other people think. You've answered your big question.

Nirvana

I've been listening to Nirvana lately. The advantage of a 6 disc in dash CD player is that you can put in all sorts of tunes. And while I was driving home from another nightmare day, I was rocking out to "Smells Like Teen Spirit." That song, such a breakthrough, and propelled Nirvana and the whole grunge movement, it's old. It was released in 1991. Holy crap. That was 14 years ago. I remember how it turned the music world on its head and made everyone take notice. Now, it's old.

The nurses around me, a lot of them are young, like real young. Some of the clinic nurses are 20. And I think about them, and all those 20 year olds, and they didn't have a Nirvana. They were all of 6 when it came out. They were watching Sesame Street (or maybe Barney). It makes me realize that I'm not young anymore. I'm old.

Sometimes, I wish I was young again. I wish that I could do it over, not to fix anything or to correct the injustices of my life. I just want to live like that again. I want to feel life. I want to grasp life in my fists again. I don't feel that anymore. I can't feel life. Where did it all go? And sometimes, in my car, driving to work to play doctor, I'll turn up Teen Spirit real loud and try to remember what it was like to be so young and so alive.

Springtime is for lovers

Once the weather warms up, suddenly it's short skirts and t-shirts and couples everywhere. It's wonderful to walk around and enjoy the Spring after a long and sucky winter, but Spring is not without its own troubles.

It's tough not to feel kind of alone. I'm not one typically prone to such whimsy, but I have to say, I'm pretty lonely these days. It's kind of empty, my life. I just come home and eat dinner and then go back to work. That's about it. I wish there was more to it, but there just isn't.

Maybe that's my own fault, really. I mean, I'm just not a social person anymore. I don't have the time or patience to cultivate those kinds of relationships, meeting people out of the blue. Part of meeting people is knowing people, and I just do not know anyone except the people that I meet in the hospital. I lead a pretty sheltered existence, and that's okay for just getting by, but it seems like I should be doing more with my life.

I miss women. I miss the touch, the smell. It's not something that I really expected. It just kind of snuck up on me. And without the cloudiness of jealousy and self-pity and desperation, it's strange to feel lonely and have little control over rectifying this. And so, I am left with *shudder* online dating. To be fair, it's treated me rather well, but that's not really fair; I haven't asked much of it.

I guess I'm not sure what I want out of life right now. It seems like my desires and my options aren't really matching up. I guess it'd be nice if everything fell into place, but in my life, that's not something I've ever counted on.

The finer things

There's nothing wrong with appreciating the finer things in life. Lately, with my new found wealth, I've been enjoying the niceties of existence, such as my new digital camera, my new Swiss made watch, and other joys like writing my notes in the hospital with my Waterman pen. It's a nice $40 Waterman rollerball that I got as a graduation present. It's been sitting in the back of my closet for years, and I finally thought that damn, it's about time I broke it out and started using it.

I used to feel a little guilty about all this capitalistic excess, but not so much anymore, because there's something about the finer things in life. There's something enjoyable to refining one's tastes. I drink Johnny Walker Gold and Highland Park. I buy Darjeeling tea. I enjoy nice things because I've bothered to develop a taste for them.

I wonder if maybe I'm throwing my money away, but it doesn't take long for me to remember that while it's admirable to save for a rainy day, my life is flying by, and after the life I've led to this point, I deserve to enjoy the ride from here on out.

Oh yea!

Today, I was reminded why I went into medicine, and it wasn't anything that I got out of a book. I was talking with a patient and said something about ruling out MI and checking this out and that and how I thought the patient's symptoms were noncardiac. He looked at me and said, "That's easy for you to say."

My reply: "It is easy to say. Would you like me to say it again?" We both broke out into laughter. That's medicine for me, being with people when they've got problems and not offering cures but offering help, whether it's medication or just talking to someone. It's talking about the football game with a guy who has terminal pancreatic cancer. It's joking with a patient about serious medical conditions.

I've often been told that I have excellent rapport with patients, and it's an easy skill to possess. Step one: remember that you're treating patients and not diseases. done.