June 23rd, 2023

My intention was to write quite a lot more last evening, but my shift became rather busy as patients required more attention (namely one, who‘s EVD [external ventricular drain] stopped draining and she soon after had increased drainage from her nose that, by golly, looked clear. She‘s unfortunately still draining CSF from said nose, but unclear if she‘ll need further operations vs. a wait-and-maybe-self-heal approach.

Interactions with my patients are what really drive me to continue with this work/training. Turns out I seem to enjoy talking to people more than my brain, that claims to be a militant introvert, would have me believe. It ends up taking up quite a lot of my time, but I‘ll spend quite a lot of my encounters chatting patients up, not only to tease out the relevant information for my exam, but just to get to know them, too. I‘ve met likely thousands of people across all the patients I‘ve either directly or indirectly treated (not to mention their family and friends) at this point and I‘m still quite early in my career. That time, so it seems, is otherwise well spent because people seem to appreciate it. I take it as my duty and in a sense passion to care for people, and I think part of that caring is simply listening to the patient - they do a pretty good job most of the time telling you what‘s going on, if you really listen. It probably doesn‘t hurt that I can apparently run my mouth about anything, so give me a chance to talk an it‘s off to the races.

My whole diatribe last evening was intended in part to be a prelude to discussing some of the other events (transitions?) that have happened since I last laid down these walls of text. For me, the most impactful is a fairly dramatic shift in education and careers. Namely, beginning in less than two weeks, I‘ll have officially joined the brotherhood of anesthesiologists. At least in training.

At least these last two years, but I‘d wager extending as far back as my Dad‘s death (if not further yet?), I‘ve seriously explored the idea of a change in trajectory. It‘s such a nuanced discussion on which I‘ll obviously elaborate, but my desire to continue the pursuit of Oral and Maxillofacial Surgery had eventually come to a halt. My thoughts lingered on suicide often - not unique to this situation, though, just a problem I‘ve struggled with most of my adult life. I no longer felt any passion for the practice and felt I‘d descended into a true hatred of everything around me, wanting nothing more than to escape but instead being cemented in place.

There were other things I considered, some more seriously than others: Completing my residency then quitting medicine all together. Leaving the country and not returning. Quitting the residency and practicing as a dentist. Quitting the residency and doing who knows what else, but not residency. What I didn‘t initially consider, as it was only a „What if?“ thought that crossed my mind on a few of my medical school rotations, was pursuing a different field in medicine.

My Emergency Medicine rotation was the first, early on in my clerkships, where the thought of being an EM doc weaseled its way into my thoughts. I explicitly remember saying it to a few people because the experience was that interesting. It never went far beyond that, I completed the clerkship and moved on. That experience happened several times across the clerkship year - not always for an entire field, but maybe for a given type of interaction or procedure or schedule even (there‘s so much to be said about a regular schedule with reasonable hours for one‘s mental and physical health). Pediatric Medicine, oddly enough, was another one of these instances. Later in the year was my short-lived rotation on Anesthesia where I was instantly enamored with, though constantly scared shitless of the practice. I’ll never forget the first time I intubated a patient, which I’m lucky to say was smooth as hell, too. Like all the clerkships though, I moved on to the next, eventually to complete them and then in the Spring of 2022, graduated with my MD.

By late spring 2022, I finally made a stolid decision to pursue actual treatment for depression again, as opposed to bringing the problem up to my physician then doing nothing to help myself. I started an antidepressant for the first time since I was a teenager and continue on it to this day. At this point it‘s become rather routine to take it, but I struggled significantly with the idea of restarting one of those medications again as my first several years with them were enough to turn me off ever wanting to take them again. Thankfully, I‘ve not experienced noteworthy side effects. I can‘t, though, say that the improvements I‘ve had in my overall mental health (or maybe a better metric is the overall reduction in time my mind spends thinking about suicide) are exclusively because of the med.

My therapy, it turned out, was putting people to sleep. My first major rotation in my PGY-4 year was Anesthesiology. As part of the training requirements for Oral and Maxillofacial Surgery, residents must complete a minimum number of intubations on both adults and children, in addition to administration of deep or general anesthesia. My training program then coordinates a five month adult and one month pediatric Anesthesiology rotation where we function at the level of a CA-1 resident (Clinical Anesthesia). I can‘t accurately express the mix of emotions involved in starting the rotation. An amalgamation of profound interest and crippling fear were at least a part of it; the latter with the understanding that this was the first in all my rotations as a resident that the responsibility of another human being‘s life what immediately and acutely in my hands. From the very first, that experience changed me deeply.

The next several months were spent doing the most enjoyable learning and practicing of medicine I‘d ever experienced. I don‘t say that lightly either, because I‘ve seen and done some pretty cool shit in my years as a teacher, then dentist, now physician. Within the first couple days of the rotation, I couldn‘t shut up about how great my experience was going and not even a couple weeks in before I was very seriously considering this as the alternative path I‘d sought for so long. Could I, as a 4th year OMFS resident (5th if you count that pesky intern year), really just leave all behind and become an anesthesiologist? Spoiler alert: I can.