How quickly everything changes

In one day, everything in my life became different. I left the classroom and entered the hospital, finally... after 19 years of formal schooling. I moved out of Brooklyn and into Manhattan. Okay so that's about all the change that happened. But it's bigger than it sounds. I started rotating at an off-site hospital where I am the only medical student on my team, so other than my lovely roommate I don't see any of my classmates or friends on a regular basis like I used to. I now live in a place where it's not only appropriate, but much more enjoyable to walk around the city and carry out my errands and just enjoy the atmosphere. It's almost like I'm at an entirely different institution. Pretty consistent with my trend of moving somewhere and changing my life every year or two. I guess the difference between this and that is that I am still at the same school and I am still working on the same degree... and I also didn't move cross-country this time. Thus far the change has been good and I am really happy with it.

I spent this summer studying for my boards, and I just got my score a couple of days ago. I'll be honest, it was a bit lower than what I anticipated. The part that really sucks though is that it's lower not because of inadequate preparation or a deficit in my knowledge, it's more because of my own mental blocks. When I first started medical school in New York, I noticed very quickly that my learning style was different from this school's teaching methods, so it took me a long time to figure out what I needed to do to do well... and I'm not sure that I ever got that down. In that process, in addition to this growing anxiety over exams that I knew I studied for but never anticipated a successful result, I've also had this feeling brewing inside me that my being here isn't honest. Like somehow I never deserved to be in medical school but managed to fly under the radar and land here. Everyone I talk to tells me otherwise. That I am smart enough, bright enough, compassionate enough, that my instincts are on target, and that I have the makings for a great doctor. But I still don't believe it. I'm just waiting for someone to look through my records and say, "Which idiot let you in? Why are you even here? And most importantly, what makes you think that you deserve to go any further?"

I don't know what to make of that. How come I can convince everyone around me of my potential, but not myself? Perhaps I don't want to be here. After all, I did ultimately decide to pursue medicine "for nothing better to do" and I'm just waiting to be kicked out because I don't have the balls to leave on my own. Entering that uncertainty and reopening the question of what I want to do with my life is pretty scary. I really don't know what to do with this. So many people work so hard to get to where I am... and if I were to throw it away now, there is absolutely no coming back. If I leave, my future in medicine is definitely out the window, and my future in anything else is entirely uncertain. If I stay, then what? Hopefully I learn to love it? My biggest problem with med school is that I haven't seen the kind of reward that I want from my efforts. One could make the argument that I'm just not trying hard enough... But I think I'm doing what I can without driving myself crazy. Then again I feel crazy now too. My ego has consistently taken beatings from all these exams, but it's unclear whether I've learned anything useful from that experience. In short, I don't know what I'm doing or why. I'm frustrated that whatever effort I've put forth so far just hasn't been enough, and even more frustrated that in addition to that, this phobia I've developed of just thinking of exams has become even more of a roadblock to seeing the success I want and feel I deserve. Maybe I have some unjustified sense of entitlement since I've gotten everything I wanted out of life so far being the way that I am, so I don't see why it shouldn't continue to be that way. I don't know what I'm supposed to learn from all this but I don't like this lesson at all.

That said, living in New York City is tons of fun. Even if I'm not wandering around, just looking out the window is a better time than it was when I lived close to school. I also really like being in the hospital. I don't feel capable of helping anyone yet in any meaningful way, but the opportunity to just talk to people on a regular basis makes my life feel so much more substantial. Now that I type that it sounds sad. But whatever, it's a nice change from the two months I spent in my room studying by myself.

I just might start a new blog to talk about my patients (anonymously, of course). That's why I'm thinking to start a new blog, entirely unlinked to this one so if you are interested you will find it on your own. In that I would change all kinds of identifying information - the school I attend, the hospitals I go to, patients I see, attendings and residents I work with, etc. just so that I can document my experiences without getting myself into trouble with any confidentiality violations.

I also might change the name of this blog back to My Crazy: uncensored. I feel more like a lunatic and less like a champ these days anyway, so it seems appropriate.

Penile lesions

So those of you among my loyal readers might recall a post from a few years ago where I wrote about how I chose medicine "for nothing better to do." One of the cool things about choosing a career almost at random (and without really looking into it) is its ability to keep surprising you as time goes on. I've already addressed how pursuing medicine made me live in places I never anticipated. But it doesn't end there. Last week I was evaluated on giving a physical exam to one of my classmates, and she was evaluated for doing the same to me. So the format was the following: same-sex students in pairs to examine each other, evaluated by a same-sex physician in a somewhat private setting. At the end of the physical we had to do a review of systems, where we ask questions on each body system (GI tract, cardiovascular, etc.). Now because this would take forever, the docs just had us pick a card labeled with a system at random, and we had to ask five questions related to that system. My card said breast, so I asked five questions on breast health. My partner's card was male genitourinary, however, and rules are rules. So we spent the next few minutes talking about lesions on my penis, pain during urination, erectile dysfunction, penile discharge, and blood in my urine. I didn't see that coming, but I am very happy to report that I don't have issues with any of those. Ever.

I have been considering pulmonology for my career for awhile now. So in my head, it's always been med school, internal medicine residency, two years pulmonary fellowship, and done. I talked to a pulmonologist today. Turns out I was way off. That's another consequence for being totally uninformed about your career choices: making plans doesn't really work. So I will do three years internal medicine, two years pulmonary fellowship, two years ICU, and one year sleep medicine. I'll be done in 2020 haha. The shock of hearing that all at once almost made me poop in my pants. My gut reaction was to say forget it... but I'm okay with it now. If I like the work then I'll do what it takes.

When I got to Downstate, they told us that a majority of doctors look back on their med school days as the worst time of their lives. No doubt it has its challenges and I get frustrated here and there, but overall I'm having the time of my life and all I can hope is that it stays this way. Here's to a great decade ahead, and the surprises that await.