What to do for the rest of my life

At the end of each rotation, I like to look back, reflect, and ask myself "could I see myself doing this every single day?"

My first rotation was community health where I worked with adults and children with autism and other developmental conditions. I loved the exposure and opportunities I had during this month. I learned so much on how to interact with people who are different from you and I, but I never saw myself working in a school or senior center. There was never enough medicine for me to have this job forever.

My second rotation was psychiatry. This rotation will always have a special place in my heart because it was the first time I had to use medical knowledge that I had learned the year before and apply it to a patient in a clinical setting. Being on an acute inpatient psychiatric ward I saw really sick people. There were people talking to the window, others convinced they had the devil living inside of them, and patients who laid in their bed for days on end in a comatose state. Every moment of the day on the psychiatry ward was spent talking to patients trying to find the root of their depression or convince them to try a new anti-psychotic medication. While on this rotation I became very comfortable interview patients and asking them for their full medical history. I developed a lot of skills in establishing a strong patient relationship so that the patient felt comfortable opening up to me for me to help them. What I didn't like about this rotation was that I never once used my stethoscope or had the opportunity to do a physical exam. Psychiatry is medicine of the mind, there is no need for a physical exam. I came to realize that I need a job where I am able to both interact and talk with patients and perform physicals and procedures.

This is why I thought primary care would be a great rotation: equal amounts talking/ establishing relationships and doing physicals and procedures. I was very wrong. What I loved most about primary care was the lifestyle if could give you. The PA worked either 2-8PM or 8AM-2PM; 6 hours of work a day for 4 days a week was a blessing. I was able to have a social life and professional life and neither felt strained. What I didn't like about primary care is that 97% of the patients I saw either came in for blood pressure medication refills or a sinus infection. I found myself bored for most of the day because I never felt challenged. I'll admit that I got lazy during that rotation and when I heard someone describing their cough, runny nose, and headache for the past day I would listen to their heart and lungs quick, look in their nose, ears, and throat and either recommend or not recommend an antibiotic to the PA based on my findings. I never when above what was necessary for the patient. I constantly felt trapped in a routine that never felt like it was going to end. I desperately craved a challenge the entire month I was on this rotation. I think I can take primary care off my list of potential work areas.

Once surgery came, I finally found my challenge. Surgery was the perfect challenging combination of knowing complex anatomy for a surgical procedure, knowing how diseases processes develop and present for the surgical floor, and always being prepared for an unexpected medical case all while running on a minimal amount of sleep. There were so many nights I came home after a day in the operating room studying new anatomy and re-learning physiology and medicine so that I would be prepared for the next day.

I was also fortunate enough to be at a surgical center that had a Level I trauma bay.  I LOVED the trauma calls. The rush you felt when the intercom sounded "Trauma team Level I/II/III trauma to the emergency room" at any moment of the day is indrescrible. You have no idea what you are about to face. I saw old people after falling out of the shower with head bleeds and hip fractures, kids who fell out of their stroller and down the stairs, a prostitute stabbed multiple times in the middle of the night. You have to be prepared for anything and everything and knowing that you have to think fast and make critical life-saving decisions in seconds is an incredible rush of adrenaline.

I love the surgical world. The cool and silent air of the OR with the beep of the patient's monitors mixed with the quiet mumbles of the surgeons as they talk through the procedure. Seeing patients come in with extreme pain and following them through the course of their treatment until they are able to go home and feel better. What I don't love about the surgical world is the lifestyle. Unlike primary care, the hours are exhausting. Waking up at 4AM and not getting home until late, with no time to sit or eat during the day takes a toll on your body. Plus, if you have to work a 24 hour shift on a Saturday, there goes your Friday night and entire Sunday to have any time off. I'm still not sure if all the pros of loving my time while at work outweigh all the cons of the type of lifestyle you have to maintain while working on the surgical floor.

On this rotation I found myself back in the realm of primary care. While I was so happy to be in Belize for the month I was less excited to be refilling medications. Thankfully, I was pleasantly surprised to have had the opportunity to do a lot more hands on work during this primary care rotation than the one three months ago. Since the clinic serves children-geriatrics, including pregnant women, I was able to see newborns, toddlers, adolescents, pregnant women, adults, and elderly people. I also got to do so many hands on procedures in the clinic including every physical exam for every patient we saw, PAP smears, blood draws, listening to the fetal heart, wound care, injections, and more. While there were hundreds of patients who came in for their hypertension and diabetes medication refills and lots of people with viral colds, I found this rotation more challenging because I got to encounter so many different diagnosis based on the patients age/current health state.

I sit here at the end of my last day and ask myself if I have found exactly what I want to do for the rest of my life. I think it is important to take the time to reflect and assess what you like and do not like so that you do not forget later. I know I can say that I still have not found the exact field I want to work in, but I can use my experiences to create an ideal job. I want a job that keeps me busy, challenges me, allows me to interact and form relationships with patients while still being able to perform complex procedures. What this field is, I do not know, but only time and more rotations will help me choose a career I love.