Third Year and Dog Poop.

It's well established in Medical Lore that the third year of medical school is the most taxing of the four. Over the past 4 months, I found myself doubting that assertion. Sure, the hours of third year are substantially longer and the clinical years require a more concerted effort to "bring it" every day, but I found myself having so much fun and time was passing so quickly that the days did not necessarily feel more "difficult."

Then I hit The Wall.

It hits your subtly. The fatigue from the chronic sleep deprivation becomes more pervasive. Your physiologic response to that third cup of coffee becomes less marked. The days drag on longer than you're used to. I was walking downtown the other morning, and unknowingly stepped in a pile of dog poop. I went the majority of my day ignorant to the fact that it was stuck to the bottom of my shoe until later in the day when I caught a firm whiff of it while charting at my station. Burn out is a lot like dog poop. It gets stuck to your shoe, lingers with you the whole day, and before your know it its stinking up your living room. When you finally smell it, its quite unpleasant.

So the days feel a lot more "difficult" lately. I know I'm burnt out, and just like the smell of dog poop, the sensation is quite unpleasant. Feeling tired all the time, feeling like you are just trying to survive your days, finding yourself feigning interest - it is not the ideal way one hopes to spend their days. And unlike the preclinical years, you are not afforded the luxury of being able to take a couple days or a weekend off to recharge your batteries. The alarm is going to go off at 5 AM tomorrow, rounds are going to start at 6:30, your first patient is going to show up in clinic at 8, your notes need to get done, you need to read up on your patients, you need to take that call night, whether you like it or not. That's the true challenge of third year and clinical medicine in general. Your patient's illnesses do not know nor care whether you are having a good day, a bad day; whether you're tired, or sick; whether you're rearing for a new day, or working for the weekend. Your responsibilities do not change with the color of your mood ring. Fatigue breeds complacency and apathy, both of which can be very dangerous, and the real difficulty in third year is learning how to suck it up and be at your best, even if you may not feel at your best.

Luckily, I have 2 1/2 weeks left on this rotation, then a week in the classroom and a 4 week block of research. The halfway point of third year. And a good time to wash off some dog poop.

Why ENT? Choosing a specialty and what drew me to ENT

When you first enter medical school and begin to ruminate on your future specialty choices, there are two distinct camps which stand out.  The first are the captains of the sinking ship… the physicians who for whatever reason have become dissatisfied with their practice, and their pessimism can be contagious.  The second are the victims of luck… individuals who have stumbled into a field which seems to complete some deficit in their life and who love their job with every resonating electron shell in their body.  Both camps can provide an impassioned argument, and it’s not uncommon to find yourself alternating between empty despair and emboldened determination your first few years of medical school.  But I would argue that the gross majority of us are neither pessimists (we entered this field for the right reasons) nor lucky (it takes a little work to get what you truly want in life).  Some of the best advice I’ve received in regards to choosing a specialty lies somewhere in the middle.  One resident I interacted with for a brief period of time passed along a great anecdote which I think offers a great deal of insight.  She bought one of those massive white boards from Office Depot at the beginning of her medical school experience and created a list of the 18 different medical residencies, along with a “Strengths” column and a “Weaknesses” column.  She filled out each column for each field as she learned more about each specialty.  She also kept a log of the different aspects she wanted to have in her future practice, and different aspects she wanted to avoid.  For example, she wanted longevity of care with her patient base.  She enjoyed simple procedures but didn’t particularly yearn for anything beyond that.  As she proceeded in her years of study, she would reach a point where she could definitively say she did not want to go into a particular field, and it would get crossed off her list.  With her progression through medical school, she developed a good sense of the future physician she would become as her list became steadily pruned. 

I hold no stock in Office Depot, and am not saying everyone should go out and buy white boards.  But I think the process is a good one to practice, in whichever way is comfortable for you.  We all go through the same steps subconsciously in our own right, but it’s often helpful to have the proverbial “writing on the wall.”  For example, I found myself enjoying clinical medicine much more in medical school than I anticipated.  But I don’t think I could go into a field where I would never step in an OR.  For the longest time, these facts simply existed in me as feelings.  Feelings of unease at the hectic and sometimes superficial pace of general surgery clinic.  Feelings of boredom or futility that sometimes hit me as I saw patients in family medicine.  It wasn’t until I sat down and began to verbalize why I was having those feelings that I began to develop a sense of the sort of things I desire in my own future practice, and was able to develop those into criteria I could apply towards choosing a specialty.  Introspection takes time and work and can be difficult, especially in the hectic pace of medical school where it can often seem a lower priority then studying for your next exam or getting enough sleep before tomorrow’s rounds.  But it is an invaluable asset towards the decision making process. 

  

So what ended up drawing me to wanting to become a “snot doc”?  That is a difficult question to give proper lip service, but it’s a question I’ll be endlessly answering on the interview trail, so I’ll try to elucidate some of the factors that led me down this crazy path.  There’s a lot of reasons to consider ENT, these just happen to be a few of my own and my own experiences coming to those conclusions.  The first three reasons are what I consider the Pillars of ENT (must be said in dramatic movie trailer voice): 

(1) Is it medicine? Is it surgery? 

The divide between medicine and surgery goes back into the annals of time.  As a medical student, it’s easy to become indoctrinated into the school of thought that the two are mutually exclusive.  But with the explosion of outpatient and minimally invasive procedures and more specialists taking over procedures related to their respective practice, the line is more blurred than ever and a wide variety of fields offer the ability to both practice medicine and do procedures to varying degrees.  However, for some people (like myself) there is nothing that can compare to being in the OR.  From the ritual of the scrub and gown to the feeling of observing living, breathing anatomy spread open in front of you, the experience of the operating room can intense and immensely rewarding, almost spiritual.  And there’s often a (misguided, in my opinion) sense that to commit to the OR means to forsake the clinic.  ENT offers a truly unique niche where just as many, if not more, patients are managed as an outpatient as those that are treated with the knife. For me, it means having my cake... and eating it too. 

(2) Variety of procedures & practice 

When I say “ENT,” you say “tonsils.”  True, ENT may not be as sexy as, say, neurosurgery, but in the public eye it remains a largely hidden specialty.  As I learned more about otolaryngology as a specialty, I kept finding myself saying “they can do that?”  That’s the beautiful thing about ENT.  It’s a little bit minimally invasive surgery.  A little bit non-invasive procedures.  A little bit of plastics.  A little bit of orthopaedics.  A little bit of neurosurgery.  And a little bit of good old open dissection. A little bit of immunology, rhinology, family practice, pediatrics, infectious disease, oncology.  The advantage of having a specialty that is specialized on a specific anatomical region is the ability to treat the myriad of disorders associated with that region, regardless of the specific "discipline" of medicine it may fall into. 
  

(3) The anatomy 

This is a funny one to me, because I absolutely loathed head & neck when I slogged through anatomy as a fledgling first year medical student.  In the beginning of your training, it’s easy to feel overwhelmed by the learning process simply adjusting to the sheer volume of information.  And with my first interactions with head & neck anatomy, I was sufficiently overwhelmed with vein, artery, nerve that the region felt damn near impossible.  But hindsight is a funny thing.  As you build on your foundation of medical knowledge and master basic concepts, the nuances of the brilliance of the human body begin to reveal themselves.  By the time I rotated through general surgery as a third year, the anatomy of the abdomen had progressed from frustrating to boring.  Head & neck went from overwhelming to elegant.  The intricacy of our upper anatomy is both awesome and inspiring, especially when you consider how important the function of the region (from facial expression to voice to hearing) is to the basic human experience

In the not too recent history, I had breakfast with a faculty member in the ENT department at my medical school.  Of course, he posited the classic “why ENT?” question and I spent a few minutes discussing the above 3 reasons and how they shaped my interest in the field.  At the end, he smiled and said “Good.  Those are good reasons. *pause* You do realize that’s what everyone else is going to say on the interview trail too, right?”  We laughed, but the point is valid.  Interest in the scope of practice, types of procedures, and anatomy involved in ENT are so essential to what it means to practice in the field that that are somewhat proverbial prerequisites to have any sort of substantial interest in the field.  But what else about the field is unique or interesting?  Here’s three others that I’ve found that really get me going: 

(4) The toys
The first time I saw a surgery performed with a CO2 laser, I was geeked out beyond belief. Granted, a lot of that is likely rooted in my Star Wars Nerd childhood, but my love of technology and inner geek are two things I have tenderly fostered over the years (granted, more quietly at certain times than others – namely, high school).  One of the advantages of working with structures in the body which are accessible from one of its orifices is it provides such a unique access to pathology.  ENT is a field which has warmly embraced the cutting edge of technology.  The strides it has made in recent years are sometimes awesome to observe, and there’s no indication that the field has any intention of slowing down.  If you like gadgets, there’s plenty of things to keep your hands busy in ENT.  Plus, there’s something sexier about a flexible laryngoscope when compared to its colorectal brethren. 

(5) Surgeons that don’t want to operate? 

I am hesitant to paint entire areas of medicine with broad strokes of generalities, so I preface this section by stating: this is based on my own experiences and is part of my own story of what drew me to ENT.  While I was on my general surgery rotation, I was somewhat disconcerted with the flippant way in which some attendings would approach the decision to take their patient to the OR.  Clinic felt more like a screening process to determine if the patient was fit for surgery, rather than an assessment of if the patient truly needed the surgery.  I've seen enough complications from simple surgical procedures to have developed a healthy respect for the degree of stress that general anesthesia can place on the body.  At the first ENT rounds I ever attended, one of the attendings discussed a case where a patient suffered a permanent complication from a relatively straightforward and simple surgical procedure.  His take home point: "Surgery is still surgery.  Never be complacent when placing someone under the knife."  It's an attitude I've found to be consistent within the field.  One of the advantages to ENT, with a myriad of therapeutic and diagnostic procedures that can be done on an outpatient basis, is that there is there is a lot than can be done to treat patient's conditions which keeps them out of the OR.  One surgeon is particular I have worked with really enjoys the challenge of engineering new ways to effectively treat patients as outpatients.  Its a refreshing attitude within the surgical subculture, and one which I would hope to maintain in my own future practice.

(6) The personalities 

The stereotype of the gruff, domineering surgeon has been around for generations.  While it is dangerous to think solely in stereotype, and there are plenty of examples of exceptions to the rule, there is often a certain amount of truth hidden within stereotype.  Stories of surgeons throwing instruments in the OR often inspire terror in young medical students facing their first experience in the OR.  I personally had an experience on call where I watched a trauma chief publicly berate an ED attending in the middle of the emergency department, ending her tirade with "I'm the CHIEF of trauma surgery! That is beneath me!" I was told once by a cardiothoracic surgeon I preceptored under (a very gentle man who was very un-like the stereotypical surgeon) that "Surgery is full of ego.  Just because it is, doesn't mean you have to be egotistical.  But you have to be able to interact with colleagues who are to still enjoy your work."  The stereotype of ENT, from my interactions with docs in various areas of medicine, is that of the "nice surgeon," and like many stereotypes, I've found quite a bit of truth in that assessment.  The field tends to attract a kinder personality, and job satisfaction is very high comparative to other fields.  If people have told you that you are a nice person, and you enjoy working with other nice people in turn, you would not find yourself adrift in the field of otolaryngology.

These are just a few of my own personal reasons I've fell into ENT.  The website has also outlined several others in their "Why Otolaryngology?" page which I thought were very insightful.  In conclusion, there's three key things when it comes to choosing your specialty which I have learned are invaluable to ensuring you end up in a field which will bring you satisfaction in your professional life.  (a.) Be proactive.  Don't write off a field just because on first glance it doesn't like you would be interested in it.  Shadowing doesn't stop when you get into medical school.  Use the flexibility of your schedule the first two years of medical to get exposure to a wide variety of disciplines.  Don't depend on only your core clinical rotations to get you the exposure you need to determine your future.  There's a lot more out there than your medical school exposes you to.  (b.) Know your strengths and weaknesses, your wants and do-not-wants.  It's easy to fall into the trap of liking a field because you had a good rapport with one specific physician.  If you find yourself liking a specific clinical experience, ask yourself why.  And write it down; put it into words.  Same if you find yourself loathing one.  After enough time, you'll have a good sense of what aspects of practice are important to your future satisfaction and happiness.  (c.) Ultimately, you're in charge.  Be aware of other field's opinions of the fields you are interested in.  There is some truth to them.  But don't let other people tell you what you do and do not want to do.  When push comes to shove, you are the sole authority on yourself.  Don't let people tell you a field is too competitive to match into.  Don't let people tell you that you won't be happy in a specific field.  I'm a big believer in personal initiative and determination, and if you have your sights set on something, trust that with hard work and perseverance will get you where you need to go.

Best of luck, and until next time.

Monkey See, Monkey... Don't Do

One of the unofficial purposes of the clinical rotations of medical school is to expose students to a wide variety of "styles" of doctoring by rotating beneath a wide breadth of physicians. At its core, medicine is a service industry, and there is much to be learned on how to navigate the landscape of illness besides basic science and "standard of care." One of the benefits of working with a variety of clinicians is the opportunity to steal small techniques or tricks to incorporate into your own future practice. I learned how to use the otoscope on children by pretending there's a bird in their ear, then asking to see the other ear because it flew across. I saw a brilliant and humbling example of how to break bad news when I had a patient die from a PE and sat it on the conference with the patient's parents. From discussing end of life care, to learning how to sternly (and compassionately) say to patients "sorry, I will not prescribe you vicodin," to motivational interviewing, to diagramming medical conditions in an understandable way on a piece of paper, I've been fortunate to have hoarded a small arsenal of personal experiences up to this point which aid in my clinical acumen.

Along the same lines, ever so often you come across an experience where the way a physician handles the situation makes you grimace on the inside. These are also valuable pieces of information to incorporate into your own clinical style, as who you are as a person is just as much who you aren't, as who you are (courtesy of the Department of Redundancy Department). I recently had such an experience today. So, without further ado, I will now impart upon you the latest addition of Things MedZag Will Not Do As A Doctor:

If you are interviewing a patient and are faced the opposite direction to update their active medications list on your EMR, and the patient begins to talk of their recently deceased spouse of 40 years and breaks downs in tears, PLEASE do not continue to chart with your back to the patient while they sob in your general direction. For the love of God, turn around and face the patient.

The medication list can wait. That is all.

Hula Hoops

Jumping through hoops is a familiar feeling for any medical student. After all, it's something we have been doing at every level of our education. High school had its own set of hoops, filling college applications with National Honor Society merits, projects, AP classes, and the ilk. When time came to apply to medical school, there was a whole new set of hoops to tackle. Dean's lists, president's lists, scholarships, shadowing experience, personal statements, activities lists. Many experience a sense of relief on the arrival of that medical school acceptance letter. A feeling that you're finally reached the upper echelon of your training and the jumping of hoops is finished.

But alas, medical school brings its own new set of hoops. Anatomy, physiology, pathology. Step 1 and Step 2. Networking, schmoozing, research, clerkship grades. Once again, I will be pounding my head against a keyboard attempting to coherently produce a personal statement within the coming months. With my decision buck up and shoot for an ENT residency, the theme of the past month has most definitely been one of hoop jumping. I've been (somewhat) frantically trying to throw things together for a research elective coming up in November/December. Working on trying to network and get some clinical and OR experience in the process. Basically filling up my free time afforded to me by psych with numerous small projects all to play the game. Who wants to be bored anyways?

I tell myself this is the last time, but know that's just a personal delusion. But hey, I hear hula hooping is a great core workout.

No intro required... MedZag has added an extension to his already popular blog

Hey all.  This being my first post here at Headmirror, I wanted to take an opportunity to introduce myself and talk a bit about what I hope to accomplish with this column here on the site.  So without further ado, *ahem*....

My name is Robert Morrison and I'm an MS3 at Oregon Health & Science University, tucked away in the upper left corner of our nation in eccentric Portland, Oregon.  I was raised in the area, and as such have adopted many of the common practices of Oregonians.  I never carry an umbrella, despite the fact it rains 180 days a year.  I recycle.  I use paper bags at the grocery store.  My nalgene bottle is BPA free, and my wardrobe would make a good magazine spread for REI.  But I do shower daily, I promise.  I was not an "otolaryngologist from birth" to say the least.  Frankly, my extent of knowledge of the specialty coming into medical school consisted of something along the lines of "aren't those the guys who take out tonsils?"  I entered my training convinced I was en route to a general surgery residency, and my interest in the field of otolaryngology blossomed somewhat late in the game (as late in the game third year could be considered, anyways).  There's a couple of things I'm hoping this column can contribute as I progress through the various aspects of discovering, rotating through, applying, interviewing, and *crossing fingers* matching into ENT.

(1) Give a sense of the journey

The 4 years of medical school are intensely productive, and when looking at everything you must accomplish in between your first cut into the cadaver in anatomy lab and opening that envelope on match day, the journey can seem exhausting and overwhelming.  Easy to become lost in the forest from the trees, to borrow an oft-used cliche.  I hope that providing a chronicling of the journey as I progress through each step can help lend some insight into each hurdle in the obstacle course and provide some reassurance that getting everything done that you need to is most definitely possible.

(2) Dispel common misconceptions

Yes, ENT is quite a competitive field to match into.  To downplay that fact would be a disservice to the realities it takes to match into the field.  However, with the blessings of the internet and all the information it affords us, there is the same amount of misinformation out there.  I hope to provide a good sense of what the baselines requirements are to make it into ENT and hope to dispel some of the notions that it is impossible to match into a competitive specialty like ENT.  I can assure you, there is nothing particularly incredible about myself (despite what my mother will tell you); I'm just like the majority of the 17,000 other medical students out there trying to do my best to succeed within the rigors of medical school.

(3) Provide good resources

Along the lines of information and misinformation, one of the most difficult things in medical school is finding the right places to learn the sort of things you need to know in terms of choosing a medical specialty.  Unfortunately, such things are not handed to you on a silver platter, with a note stating "You are going to be an otolaryngologist.” My "exposure" to ENT my first two years of medical school consisted of a one hour lunch talk and the luck of having an ENT surgeon lead one of my physical exam small groups in my clinical medicine class.  There is often a dearth of good information about learning a realistic overview of a given specialty, and opinions from docs in other fields can often be skewed by personal opinion and misconception.  Along the way, I hope to give some good resources you can reference to better frame your expectations and desires for how you want to practice medicine as a career.  

(4) Crack some jokes

Yes, medicine can be a stressful and demanding field.  But as our friend Freud so excellently described: humor is one of the mature psychological coping mechanisms.  It’s good to have a little fun along the way.

So, I hope you stick around for the journey.  Grab your popcorn, or favorite multi-grain bar of choice, and stay tuned.  I hope I can shed some light on what it’s like... becoming an ENT surgeon (dramatic dimming on lights).

The Mind Is A Beautiful Thing To Waste

So I am in the midst of my 3rd week on psychiatry, and I would be remiss if I didn't at least talk about it a bit. My duties are relegated to the locked ward in the VAMC of my city (or the "Vah" as its affectionately referred to here), which means more substance abuse, PTSD, and homelessness than you can shake a stick at. I can confidently say that I could never be a psychiatrist. I have a great deal of respect for those that enter the field, and find many of the conditions patients carry very interesting (I was a philosophy major in undergrad, what can I say?) but the pace of the field is maddening to say the least. I'm the type of person who likes to have my work and get it done in an expedient manner, but often find my days filled with dawdling waiting for x to happen. "In 15 minutes" can mean up to an hour and a half later. Especially coming off of general surgery, the adjustment has been... interesting to say the least.

Alas, I do not have any amusing psych stories yet. Just a lot of sad ones. Between the limited resources social work has to deal with, the intractable condition of many of the patient's disorders, and the high relapse rate on substance abuse, there just aren't many warm fuzzies to come about. I've been experiencing a pretty good amount of countertransference while on service, and many of the days can feel emotionally exhausting. Plus the nature of the physician-patient relationship carries a very different flavor. Sure, the hours are nice, but I just do not feel the same get-up-and-go in the morning I've felt on other services.

Unfortunately, that's about all I can say about the matter. Such is the life of the third year med student. You do some things because you like to, and you do a lot of things because you have to. 2 1/2 more weeks until I'm on family medicine, and definitely looking forward to getting back in clinic and interacting with patients on a normal playing field again.

MedZag Picks A Specialty

There are few decisions more consternating to a medical student that choosing their eventual field. Sure, there's a few students born to be pediatricians or neurosurgeons or ED docs out there who know it, but the gross majority of us go through a great deal of waffling and procrastinating when it comes to deciding what more we want to be when we grow up besides the esoteric "I wanna be a doctor! Cause its cool!" Even those who were convinced they were going to go into x when they entered med school often do a complete 180 once they rotate through the clinical aspects and their face is to the table saw as they hover over the "submit" button on their ERAS residency application.

There's a certain progression to the process:

(1) Panic: The Lifestyle Specialties
When you first come into medical school, you have these idealistic views of what being a physician entails. Then you actually get into medical school, and a disenfranchised attending comes along, convinced the entire field of medicine now sucks, and blows that idealism into tiny, sparkly little pieces. You begin to become convinced that the only way you could possibly be happy is if you find your way into one of the highly-touted ROAD specialties: Radiology, Ophthalmology, Anesthesiology, or Dermatology. You begin to become convinced you could be happy staring at a computer screen all day, or rashes for that matter. After a while, you realize that all rashes look the same to you anyways, and you move on to...
 

(2) Resolve: Screw What Everyone Thinks
You encounter a doc who absolutely flippin' loves what they do. They tell you that it doesn't matter what area of medicine you go into, as long as you love what you do. You begin to convince yourself the same. You tell yourself that the disenfranchised attending from step 1 can go to hell, and you're going to go work for Doctors Without Borders as a surgically trained general practitioner. As medical school and the ongoing debate about healthcare reform progresses, you begin to notice that little "Total:" line on your student loans climbing at a otherworldly pace. You then move on to...
 

(3) Hopelessness: It All Sucks Anyways
Why does it matter anyways? In a few years, you're either going to be a government employee, and make peanuts, or privately employed, and make peanuts. Either way, you'll be working your glueteals off the rest of your life. You'll never pay off your loans. You're going to be driving that 1995 sentra for another 20 years. Your daughter is going to grow up with daddy issues because you'll never be home. You procrastinate thinking about what you want to do, because its no longer fun to think about it. Some stay in this stage perpetually, and become the attending referenced in Stage 1. If you're lucky you get to move on to...

(4) Chance: Your Specialty Picks You
The residents and attendings I've talked to who really enjoy what they do, and are pleasant people in turn, almost universally give the same advice about picking a specialty: get rid of your preconceptions, analyze your strengths and weaknesses, the things about practice which are important and unimportant to you, prune your list, then go out there and experience as many areas as you can. When you come across your specialty... you'll know. It'll be the one where you don't want to go home at the end of the day. Where you'll look and read about things not because you have to, but because you want to.

I came into medical school convinced I was going to be a surgeon. My friends told me as much, I told everyone as much, my ESTJ Meyers-Briggs personality evaluation told me as much. Now granted, my concept of "being a surgeon" wasn't all candycanes and lollipops - I had shadowed enough in undergrad to have a general idea - but I will be first to admit I had a very naive and limited view on the scope of medical practice and the proverbial "potpourri" of options afforded to me early in medical school. I found out in a hurry that telling people in the Real World™ that you want to go into surgery evokes an entirely different response to telling people in the medical field that you want to go into surgery. Namely, that instead of eliciting the token "Ooooo! Like Gray's Anatomy!" response, they instead try to scare you the hell out of considering the field. And granted, much of that behavior is grounded in either reality or stereotype of the field. And so began my progression of through the steps.

First was "what have I gotten myself into? I don't want to work 120 hour weeks for the rest of my life!" Followed "I'm going to do it anyways! It'll be fine!" I eventually just resigned to telling myself "you'll know when you rotate through surgery if its for you." But alas, my surgery rotation came and went, and by the end I was still just as on the fence about the whole surgery conundrum as before. So I began to break it down. I knew that there was nothing like being in the OR for me. That time flew when I was in it, and I missed it when I was out of it. But surgical clinic also left a bad taste in my mouth. I found myself enjoying the clinical aspect of medicine more than I anticipated, and I found clinic in general surgery too fixated on "to operate or not to operate?" Yet after leaving surgery and venturing into the realm of psychiatry, I found myself missing the faster paced lifestyle of the specialty.

ENT was a specialty that first caught my eye during second year. I had a small group doc who specialized in laryngeal surgery and speech therapy, and he really tried pushing us to take a look at the field. But at the time, I was too hung up on the "to surgery or to medicine?" that I never stopped and said to myself "self? how about both?" It was a field I kept on my list but never really investigated... namely, because I had no idea what in the hell an "otolaryngologist" was or did. With no frame of reference, I wasn't in a position to realistically examine the field. But the seed was there, and as third year started and I began to have more interaction with various specialties, I began to notice that I was really digging this ENT stuff. The more I read about the field, the more it seemed to jive with my expectations and desires for how I wanted to practice medicine. There was a monday morning report I went to that was presented by the ENT department... and instead of sleeping through it I found myself taking notes. I scrubbed on a pharyngolaryngectomy with a free jejunal transplant and even though I was on the colorectal service and was parked by the abdomen, supposed to be focused on the jejunal resection, I found myself fixated instead on the bilateral neck dissection. It was the small things that slowly roped me in, and after extensive email conversations and a few tall coffees with a couple members of the faculty, I've finally come to a decision. I said to myself: "Self, you're going to match into otolaryngology."

Along those lines, I'm going to be guest-posting about my experiences in discovering ENT, rotating through ENT, applying, and such over at headmirror.com (see the new side banner). If you're considering ENT, I suggest you check it out - there's a lot of great info on the site. All I can say is that its incredibly exciting to find that niche of medicine which really vibes with your persona. When I decided to commit myself to the field and really get after it, all I felt was this overwhelming sense of relief. I think that was really telling.

Till next time.

Surgery... Is Exciting.

So I took my surgery shelf exam yesterday. It's hard to believe that the rotation is already over and done with. I guess the true gauge of how much you're really interested in the field is how much you miss it when you move on, and - well - I already miss it. Yes, the hours can be exhausting, but the human body has an amazing ability to adapt to even the most extreme conditions and once you get used to the lack of sleep, you begin to enjoy what happens when you're awake a lot more. And boy, does a lot happen when you're awake. Nearly every day something would happen which would make me stop, if only for a second, and think "I can't believe we're allowed to DO this." And then I'd grin a little bit.

The great thing about surgery is that its a field ripe with ingredients for stories, and I have plenty from the past 5 weeks. The unfortunate thing is you often don't have the time to digest and tell those stories. So that's my project for the next few weeks, just bear with me.

Starting on psych on Tuesday - which is about as black and white a field from surgery as you an get. I think I'm going to be bored, but I'm trying to not carry any preconceived notions into the rotation.