"So are you going to subspecialize?"
At each stage of your medical career, you're asked what your next step is going to be. For all of med school, you're asked to pin down a specialty - and as soon as you make it to said career path, people want to know if you're going to subspecialize, especially in a field as broad as internal medicine.
My answer remained the same for most of intern year "That's an excellent question, ask me again tomorrow."
It's no secret that I love the ICU. I like sedated patients, septic shock, acid-base status, central lines and vasopressors. I love our intensive care nurses, and am in awe of the intensivists we have on staff. To me, there is a certain zen in knowing that you have the sickest patients in the hospital, but it's ok - you have A Plan, and incredible staff to help you carry it out, and what will be - will be.
You save the ones you can, and learn from the ones you can't.
A decade ago, I was convinced I was going to be an ER doc. I wanted the adrenaline rush, the variety - the be a cowgirl and jump into the thick of a trauma and save the day.
And then I learned that the experience described above describes MAYBE 5% of a typical shift in the emergency room. Also that the other 95% was like pulling teeth for me. I hate abdominal pain, have little to no interest in syncope triage and dealing with headaches gives me one.
So I was left with the rest. Peds? No. Surgery? Oh HELL no. Ob-gyn? Maybe... but do I have to do all the gyn stuff too? Yes? No. But then I found medicine and thought "This could work, this is fun."
And then I hit ICU in november of my 4th year - and not just any intensive care unit. This was Henry Ford, birthplace of the Rivers Protocol - my attending was a legend in the field, and my upper level was a 5th year ER/IM resident whose favourite phrase was "C'mon Kat, I have another procedure for you."
So I trekked across the south for interviews, saying "I like medicine, but I really love critical care. Can I see your ICU?" Ultimately I found Memorial's - an enormous, sunlit loop that comprised our 40 bed Neuro/Cardiovascular/Medical/Trauma intensive care unit. It felt like home.
I worried that my expectations were unrealistic, though - after all, medical students were shielded from the worst duty hours, and were rarely given the truly sick patients to manage. But I hit the ICU as an intern with a pair of 6.5 sterile gloves in my pocket and the phrase "I'm here to learn" on my lips. I loved it. I loved the variety of the patients, the in-depth understanding of physiology and the procedures.
But then I found myself at the end of intern year, and the put-up-or-shut-up moment. To get into a critical care fellowship, I was going to have to shine up my CV with some really impressive pulmonary research, start gunning for chief resident and start looking at uprooting from Savannah in two years. Oh, and commit to an additional 3 years of resident pay and lifestyle.
I definitely was not without guidance - I talked to the ICU docs, the female attendings, our critical care-bound chief resident, my Mom. All the factors were brought up, rehashed, reconsidered again and again. I'm young, I've got time. But I want kids, and not when I'm 30. It's only 3 more years, but the closest program is in Augusta. But you're good at it! But do I want it enough? It's harder to go back later! But I have loans NOW.
And so I decided. No. No, I don't want it enough - enough to uproot Nick and myself (again), try and sell the house and match again. Not enough to commit to the lifestyle and missed time with my family.
I realized I'm going to happy "just" being an internal medicine doc. I'm still going to see seriously sick patients, do my own procedures and know that I can call in calvary when they need more acute management than what I can provide.
Besides. I really, really hate sputum.