Guest post: No more second guesses

I walked in and out of his room repeatedly during my 30 hour shift, he was the one I was worried about.  It was the same room where, on my first ICU shift, my patient had died in an early morning code.  I feared that the same would happen to this patient, however I did not hope to avoid death of this patient, just delay it enough so that his family could arrive.   The patient was a young man dying of metastatic cancer.  I knew that I had to get him through to the early morning so that his family could be there by his side.  So armed with my lasix and morphine and one of the best nurses I have worked with, we both made it through the night.  I was as happy as I could be in the face of death, to see his family walk through the door.  We finished rounds,  I finished my notes,  and headed home.  I knew it wouldn’t be long.  I later found out that the patient died about half an hour after I left, with his mother and father holding his hands, just about the same time I was arriving home to eager hugs from my own two boys.

I hadn’t allowed myself to think about my kids all night, I had forced them out of my consciousness, so that I could do my job.  I did this to protect myself from imagining what I would do if it were one of my sons in that bed.   I drew the line between hospital and home, and I stuck to it, for better or worse.   At the start of internship I thought I would call home each night I was on call to tell my kids goodnight.  I never did this, in fact, most nights I didn’t have time to sit for dinner, aside from bites while writing notes into the wee hours of the morning.  What bothered me most, perhaps, was that I didn’t even think about doing it most nights.  I can’t count the number of bedtimes I missed or the number of daycare pickups my husband had to do this year.  It is acceptable to me to have to miss a soccer game or a play, it is not acceptable to me to miss most soccer games or most plays.  I can deal with missing a bedtime or a daycare pickup, but I do not want this to be the norm and I certainly never want to reach the point where I feel that it is acceptable. 

I wrote just over a year ago about my mixed emotions on my match and my future career in dermatology.  I felt logically, at the time, that this was the correct choice for me and my family, I just wasn’t sure emotionally.  Now, days from finishing my internship, I am thankful that I made the logical, not the emotional decision.  What a year it has been.  In my professional life, I have performed my first deliveries and pronounced my first deaths, I have treated infants and I have treated senior citizens, I have stayed awake for a 30 hour shift and returned home to stay awake with my children for several more hours, I have made tough decisions and I have made mistakes.   In my personal life, I have uprooted my family and exposed my husband to more call nights than I can count.  I have come to appreciate his patience and commitment to our family in a way I never knew that I could.  And, I have found clarity in my decision to pursue dermatology.  I think it truly hit me that dermatology, had in fact, been the right choice on my ER rotation this year.  I was never as happy as when I was able to fill my day with patients with chief complaints of rash and lac repair.  Or perhaps it was when I reported skin findings while on the cardiology service on a patient admitted for a STEMI.  Or when I noticed all I was teaching my medical students were skin findings and that I actually liked to look at the  NEJM photo quizzes of skin findings for amusement.  Perhaps some of my doubts from a year ago were unfounded.  I am now to the point where, had I to make the choice again today, I could do it with much less angst, knowing that I will enjoy my work and that I will have a tolerable lifestyle.

After this year, I know that I could have been successful in either ob/gyn or peds and I would have been satisfied with my work life.   In fact, in both of these rotations, attendings approached me about why I hadn’t gone into that field.  I give the one liner to these attendings and anyone else who asks, which goes a little something like this: “I love that in dermatology I will get to do both medicine and small surgeries, that I can follow patients across the lifespan, that I can cure cancer in 20 minutes, and that I can be home with my kids at night.”  But the longer answer is that I know myself enough to know that I do not do things half heartedly.  I am there when I need to be, until everything is finished and when I am at work, my mind is completely there. 

I need a career where I don’t have to feel guilty about how much I work or that I enjoy my work so much that I am not thinking about my kids and husband throughout most of the day.  And I need a career where I don’t go home and feel strange that I can be so emotionally distant from the things I have seen that day.  In dermatology I can have all of these things.  I love so many aspects of medicine and I feel privileged to have been a part of births and deaths and to have had patients share with me the most intimate details of their lives on a daily basis.  I will have patients who are as thankful to me for enabling them to control their acne or psoriasis as they would have been had I been there for the delivery of their children.  I will not have to tell another woman that she is miscarrying or tell another wife that her husband has died on my watch.   I am frightened as I move forward, for the sheer mass of information I will have to master, but relieved that I will be able to study at home at night, after putting the kids to sleep, where I cannot forget or ignore my life beyond the walls of the hospital.