Choosing my Medical Specialty

Whoa, this post has been a long time coming -- since January, I've finished my third-year med school rotations in internal medicine and general surgery. Both of these rotations have been quite enjoyable, and it's been crazy to actually be able to (competently) do stuff like cut open an abscess with a scalpel, suture skin, and read an electrocardiogram. However, this story isn't going to be about these past rotations -- it's going to be about *finally* figuring out what I want to do after I graduate from medical school.

Back when I started UIUC's MD/PhD program, I didn't really know what I wanted to go into -- I knew I liked clinical research, and I thought everything by Michael Crichton was interesting, but that was basically the sum total of my medical aspirations. This lack of definite purpose was always somewhat unsettling, so I'd sometimes go to school-sponsored 'big-brother / big-sister' roundtable discussions, and ask an old and wise 4th-year med student how they decided what field to go into. Every time I asked, they would always respond on the lines of ". . . you'll know it as soon as you do it." or ". . . um, it's like falling in love" or some other non-specific and unfulfilling response. Looking back, I remember being frustrated by the vague answers and wanting some quantitative backing -- is it median income? the length of residency training? the prestige index? I never quite understood how to choose a field until last week, when I finally decided to go into anesthesiology.

It's hard to describe what it feels like to fall in love with a profession. I guess the closest thing that compares came during my second year in the MD/PhD program, when I was writing programming code in Perl and SAS to conduct epidemiological analysis on my dissertation project -- back then, I remember spending countless hours overnight in the lab, eagerly reading textbooks on nonlinear mathematical models, grooming my database for outliers and anomalies, and writing elegant macros to analyze the data. And after months of hard work, when the programs finally compiled and the computer spit out odds ratios with significant p-values, geez, it was the best feeling in the world -- just absolutely nothing like it.

After moving from graduate school to medical school, it was hard to capture that feeling again, just because there was so much volume to learn, some of it interesting, some of it not. In the first two years of med school, I enjoyed physiology and pharmacology, partly because I liked seeing how things worked, but mostly because I liked reading Harry Potter and was curious if one could really do the whole 'Stupefy' or 'Petrificus Totalus' spells in real life. Soon after my second year of med school, I decided to do a FAER summer research fellowship in anesthesiology at Northwestern University -- I'd heard from my aunt (an anesthesiologist) that most anesthesiologists were pretty mellow, the fellowship research centered on pharmacology / physiology, and hey, free food and a stipend are always nice. I had a great time at Northwestern Anesthesiology, and had a lot of fun doing research and making friends with departmental attendings. However, the best part of the fellowship came after the close of my research experience, when I was selected, invited, and sponsored to deliver an oral presentation on my summer research at the 2008 American Society of Anesthesiology national conference. The conference was really an eye-opener in that it showed (1) that a ton of really smart and cool people around the world are interested in anesthesiology, and (2) they have crazy awesome ideas about the field (one feedback comment I received was "Your project might get better data if you temporarily stopped the heart at point X. Adenosine is a good drug").

After getting good vibes from the national anesthesiology conference, I returned back to start my third year clinical rotations, and started getting a feel for what parts of clinical medicine I liked and did not like. After several months of rotating on the floors & wards, I came to several conclusions about my preferences -- I liked working with my hands, liked seeing a variety of problems, liked to be intellectually challenged, did *not* like outpatient clinic, liked fast-paced action, liked starting the work-day early, and liked wearing hospital scrubs (mmm, crisp and fresh scrubs in the morning!). Moving through the rotations, I tried without success to find a solid fit with my preferences in psychiatry, pediatrics, internal medicine, or surgery. However, when I started my first clinical rotation in anesthesiology last week, everything just clicked.

It's weird, but when I'm typing this post now, I'm remembering that irksome piece of advice "You'll know it as soon as you do it", which is exactly what happened of the first day I spent on anesthesiology. There is a remarkable rush of fulfillment that occurs every time you successfully slide an IV into a vein and see that bright red flash of blood in the catheter . . . or do an oral intubation with the whole OR team watching and see the endotracheal tube pass through the gleaming white vocal chords and just *know* that you nailed the procedure perfectly. Similarly, it's intellectually fulfilling to keep a patient balanced on the optimal peak of their physiological curve, all the while submerging the patient in the murky twilight between life and death. Lastly, (and I'm doing a very poor job of describing this), there's this immense sense of *trust* that is central to being an anesthesiologist -- the patient has an implicit trust that you'll keep them without pain during their surgery, the surgeon has an implicit trust that you'll keep the patient safe while they are focusing on their surgical procedure, and the operating room staff has an implicit trust that you'll keep the patient stable while the patient is in the OR, no matter how much blood exsanguinates or what perioperative trauma occurs. I know this sounds absurd, but there's a solid feeling that one gets by being the last layer of defense during an operation -- if something goes wrong, I'll fix it, I'll take care of it (GARR! BEAT CHEST!)

Anyway, that's my story about choosing my medical specialty. Like all true stories, this one isn't finished -- I'll be doing five more weeks of anesthesiology at the University of Illinois, and then will be going to Stanford University to do an away elective in cardiac anesthesiology. I'm excited that I've found a field that I love, excited that I have the skills to do research in the field, excited that I only have a year left of med school. In a few days, I'll be an old and wise fourth-year medical student, slated to give advice to young students who don't know what medical specialty they want to go into.

My advice? You'll know it as soon as you do it.