Scalpel? DSM IV-TR?

I think sometimes people think I say it just to see the look on a person's face when I respond to the inevitable, q twice daily question of, "so, do you have any idea what you might want to specialize it?"

"yeah... I initially came to medical school wanting to be a neurosurgeon, but I've actually become quite interested in Psychiatry lately, so I'm not sure... I guess I'll have to wait and see."

Sometimes I get the polite nod of, "yeah, sounds like an intelligent two options you've got there... I hear [bipolar] med students say that all the time."

Sometimes, I get the blatant, "wow, um, those are two VERY different fields you've got there... ::nervous laughter::... [you must be one very confused person.]"

It's okay. You can say it. I get it. I got into medical school didn't I?

Seriously, what is one to do? I know, I know... wait for the rotation (which are BOTH scheduled for next semester, although I did sign up for a surgery elective starting October 5th). Part of me LOVES the hands-on, digging inside, immediate (okay, within 24-hours for most surgeries) gratification (vs. writing 30 Rx's for Lipitor daily and waiting and seeing and waiting and seeing). I remember back to Block II of anatomy when we moved on from the muscles and ligaments (thank GAWD) onto the interior anatomy of all the organ systems. We kinda stood around waiting for our professor to show up, until the only guy at my anatomy table and I, while flipping through our manual, realized we wouldn't be dissecting the uterus and freaked (he wanted to do OB/GYN. i just wanted to dissect anything and everything because i was simply fascinated by the systematic way our bodies worked on the inside)

Lo and behold, we spent the next hour (during which our professor still didn't show up) lifting bowels out of the way, the gallbladder aside ("OMG! it's GREEN! guys, did you see this!? the GALLBLADDER is actually GREEN! just like in the atlas!" - yeah, the simple things excited us back then) searching in vain for the uterus which ended up being about a foot from where we were desperately searching for it (note: this was month two of medical school. we're better now. sort of.)

Our gloves were covered in nonspecific brown goo, we were trying to decipher why there was a "fat pad" in the middle of the abdomen (later turned out to be the Pancreas), and we almost gave each other a splashy, icky high-five when we "found the left kidney!" (turned out to be the spleen).

The point of this isn't to turn anyone off from donating their body because med students obviously have no clue what they're doing (we do. by the end of anatomy. which is exactly why it's so important.) I just always look back on anatomy as the most amazing learning experience of my life... I went in not even KNOWING what side of the body the liver was on (yes, I'm serious), and to be quite honest, I didn't really care. I started off like everyone else: anatomy sucks. get through it alive.

I ended up with a near perfect score on both Block II and Block III (head and neck) exams after pretty much flunking the first one. Not because I was in the lab studying to get a good score, but because I couldn't let go of my awe at the ability to touch and explore the insides of a human body... my body. To hold someone's heart in my hand, to hear the crack of arteries under my fingers when i squeezed thanks to atherosclerotic plaques (i ate reallllly well during anatomy, I will admit), and the best part: to hold the human brain in both hands and feel its weight, connect it to the nerves going into the various foramina and fissues... and just let it sink in exactly what i was doing!

The 3-D nature of head and neck anatomy fascinated me... the routes of nerves and arteries, the variability of it all, and the implications of even the tiniest slip (to go from our dissection skills in Block I, where I think one of us cut the trapezius in half by accident, to Block III, when we actually found, without killing, the ansa cervicalis - totally gets you automatic baller status- was nothing short of miraculous.) were beyond intriguing.

Then, of course, I re-discovered my love of all that psychiatry encompasses (in theory anyway). With my psychology background from college (this is why I had no clue what side of the body the liver was on), I started to see patterns of behaviors that played a huge part in the health of my patients in the family medicine clinic I rotated through during my first two years. Sure, they had diabetes, HTN, the whole schebang, but I liked sitting there taking my "history" and letting my patient with the uncontrolled HTN let her long day's worth of frustration and agony with her job, her family, and her feeling of being "trapped into this life" out... as an MSI, you're not allowed to do much but take a history anyway, so what harm was there in letting her talk it out? What harm was there in a teeennnyyy weeeeeeny bit of some cognitive behavior smidgeons thrown in about why she felt trapped and was she really trapped? What brought that thought on? "Well, okay, I'm not really trapped - I keep feeling that way, but I'm not. I guess that just gets me down even more." Hmmm... let's work on that, shall we?

Obviously it was just pulling stuff out of my ass and more from my own experiences than medical school, but seriously... I saw those patients again and again throughout my two years, and it always warmed my heart to get a hug from them on their way out, or get excited when they saw me walk into the room. And then of course there was the 55yo man I convinced to stop smoking (even after my preceptor had told me it was a lost cause - turns out he was just frustrated about not "getting any" from his wife and didn't wanna approach it with her, so he smoked instead. now he "gets some" and breathes easier too :)) and he REMAINED that way!!

There was the little boy with a buttload of paperwork for speech therapy, OT, psychiatric care, and a grandma who said she had no idea where the patient's mother/her daughter was... who I talked to for about 15 minutes, asking about mom and the pregnancy, only to go up to my preceptor and say, "I think this kid's got fetal alcohol syndrome." And lo and behold, righto I was!

My heart valves tugged on their chordae tendinae when older patients were brought in by their children, not just for the patient, but for the children... and given that as a medical student I had the luxury of time that most PCP's don't, I always turned to the caretaker and asked them how THEY were doing... it wasn't my job, I didn't get brownie points, I just FELT the innate need to do so. What followed never failed to amaze me. These poor, hardworking, guilt-ridden children, wives, nieces/nephews were simply overwhelmed and in desperate need of someone to understand the hardships they faced daily in the care of their older parent or loved one. I cannot begin to count the number of times I've had someone simply burst into tears the minute I asked that question... often sobbing it out because they haven't had a chance to till now. There were times I got extra crucial pieces of history by asking that question, but mostly, I got a LOT of "thank you. thank you SO much for asking. it meant a lot. no one has ever asked before."

Cheesy? Yeah. I know. But true. I was much happier sitting and yapping and listening to my patients than answering pimp-like questions about the significance of the MCHC or RDW on the labs (which I quickly learned was ENTIRELY attending-dependent - some attendings scrutinze each and every lab value much to the horror or the poor medical student working under them, and others couldn't care less about the rest of the lab report as long as certain "golden" values were satisfactory.) I loved procedures, I loved writing scripts (and spelling Omeprazole wrong, so that the attending had to rip up the script and write a new one anyway... I shudder even thinking about it... "Amiprizoll" i think it was... hey, I've come a long way!)

None of the above experiences reflect the true nature of either of the two specialties in question. I realize this. Loving the touchy-feely-awe-inspiring feeling of anatomy is NOT comparable to being in the OR at 4am scrubbed in and unable to scratch your nose on your own (these things matter to me when making life-long career choices, yes). Listening to a genuinely distraught middle-aged woman in an outpatient FM clinic and perhaps being able to prescribe her something to help her cope or help her change her behavior pattern, etc. is not the same as day-in, day-out med management for outpatient Psychiatry and the non-continuity-of-care, often tedious and trial-and-error management of inpatient.

It was also easier to entertain the idea of giving up my stethoscope first year of medical school when I couldn't hear much out of it anyway (other than the static-y rustle of hair on my then-bf's chest as I pretended to check for murmurs and heart sounds - he might as well have had a grade VI mid-diastolic rumble with an opening-snap loud enough to deafen the little robin perched outside the window. I would have written normal S1S2, RRR).

Now that I can hear murmurs in infants, it's a bit harder. Oh, and I've graduated to Grade II's ;)

I think I mostly wrote this out to document my own naivety to chuckle at later when I'm chief of Physiatry in Alaska or something. Life rarely goes and I intend it to, and I've learned that I'm pretty awful at predicting where I'll end up and what I'll be doing at any given time.

One thing's for sure now though (I've discussed it with the parentals and I'm all clear!!): I am saying good-bye to my beloved NYC and headed to SoCal...

There comes a time when you need to shed out of your comfy cozy scrubs-you-wear-everywhere, aka skin, and just go for it.

Right now I'm going to go for some brunch. Sitting by the water typing away makes me hungry.

(That was meant to instigate some slight feelings of jealousy. Someone please feel jealous. Just a little bit. Especially given that the closest I've come to wireless by the water in the past few years is typing up a last-minute, due-in-twenty-minutes patient write-up first year while sitting on the john in my bathroom by the tub. That's probably mega TMI, but sunshine makes people say funny things.. especially when they normally don't get much of THAT either year-round ;o))