Noun; A term of endearment, a nickname.
Trying to figure out who I am as a future physician versus 4th year medical student versus ED scribe has been more difficult than it seems to play out. I was lucky enough to score my old job back to earn some cash while still in medical school (yeah, I'm crazy). But there are only so many books I can read, hours I can sleep, friends to see, and workouts until I get on a whole other level of crazy. Plus I'm broke. Like $400,000+ broke. Let's not talk about it.
Scribing is dealing with large volumes, multi-tasking, and getting out of my comfort zone. Because to be honest, it's a little uncomfortable trying to "only" be a scribe - but don't get me wrong, scribing gave me an entire skill set that made me a better medical student. But when you've worked so hard to get to where you are - 4 years of medical school and matched into surgery residency - the mentality and the way you carry yourself is different. It has to be; there are lives on the line. But despite me trying to keep a scribe mentality, lots of people are curious and ask, so I keep responding. It is becoming more real every single time I say it. Surgery. Denver. Me. Sometimes, I'm still like - who, me? Nah. That's crazy. But God knows I worked for it.
Emergency medicine was actually my first love. I worked as an EMT-B on an ambulance for 1.5 years before I transitioned to an ED scribe for another 1.5 years prior to medical school. It was all I knew, and I thought I knew it was for me. These were the seeds I was growing and roots that were taking hold. It was my first clinical introduction to medicine in a provider role or mindset. I think there are still a lot of redeeming qualities I like - the fast pace, the idea that you never know what might come in the door, the check list mindset (that also doubles as a negative), the shift work, no clinic, procedures, and the awesome personalities you find working in the ED.
You also get to meet interesting people as patients, young and old and everything in between. I recently met someone who was diagnosed with ITP and had a platelet count of 8,000 (crazy low). It's a diagnosis of exclusion but basically your immune system attacks the platelets in your blood, and eats them up so that they don't work as well. This means you don't clot as well and you could have bleeding and bruises as symptoms.
I met a man who has Men 1 syndrome, which involves multiple neoplasia located in the pancreas, parathyroid glands, and pituitary gland. Then someone was being given 2g Metronidazole and I correctly guessed they had Trichomonas (and there was going to be an interesting conversation between her and her husband). Reading about these conditions in medical school made them seem so distant and removed, seeing them in real life in the multi-faceted aspects of humans, was another thing altogether.
Before I go further - choosing a specialty is a very personal process, and this is mine. It says nothing about how great EM can be because it just wasn't for me. The switch was gradual and unbeknownst to me at first. In the beginning of second year, I realized I wanted more definitive care, and I didn't want to feel like a slave to the endless revolving door of "not real emergencies." It felt like primary care to me, but you only had <10 min with them and you knew nothing about them. I felt like I would be providing sub-par quality care and I felt burnt out before I even started. I wanted to understand and provide tangible results - but in EM, you rarely get to the bottom of what is happening - they are either admitted under the hospitalists' care, or they go home with outpatient follow up.
Then I had my general surgery rotation, and it just seemed to click. It had all the aspects I enjoyed in emergency medicine but with everything else I didn't know how to articulate I wanted. I love the dynamic, fast paced, challenging, yet incredibly rewarding environment of surgery. I love that it constantly challenges me. I enjoy learning about the pathophysiology of surgical conditions and how to treat them, and also ended up really enjoying surgical critical care/trauma medicine. It's tons of medicine, yes, but in the context of surgery and how we manage surgical patients (cue nerdy hemodynamics and homeostasis stuff). I love the intimate relationship that surgery allows - the intimacy of working in someone's body - combining physiology, anatomy, and hands on skill all in one. It's an orchestrated step-by-step methodical process, but also challenges one to constantly adapt to bleeders or anatomical differences. That, and my personality fit well with it - I'm highly observant, read others and anticipate well, and I'm calm in the storm, but I also realized I wasn't some neurotic overachiever (okay maybe I kind of am). But that these were my people. Always on it, always striving for better, hard workers, on a crazy insane level. I want that. I want greatness.
What helped me was being aware of what I liked, disliked, and valued. It was a process, but I became involved in things I enjoyed and it led me down a path to what really fit. Leaving you with the words of Lara Casey: keep intention living, cultivating (what matters), and goal setting. Peonies grow through the dirt, and so do we - know your roots. Then write me about it, because I'd love to hear your story.