as an extrovert without good answers

Though I am loath to admit it, I am, by nature, an introvert. And despite the recent torrent of articles espousing the benefits of being an introvert (also see here, here, and here with funny retort here), it's the part of my personality I like the least. I wish I was better at small talk, better at making friends, more relaxed in a crowd, not so ready to leave a party, and not so frequently told to "smile".

Medicine made me into an extrovert. Or maybe an introvert who can affect the persona of an extrovert with an enthusiasm that actually is genuine. I do smile, a lot actually, and frequently when I don't feel like it. In my white coat I am animated and chatty and quick to introduce myself. Perhaps not surprisingly, I like myself as the extrovert - it's like pretending to be the cool kid I never was. And, again painful to admit, I think patients also prefer Extrovert Me.

On a less frivolous note, I was very much looking forward to this Topic Week, and so am now surprised by how difficult I've found writing on the subject matter. It's hard to collect all the ways medicine, with its messy contacts and daily pressures, changes its practitioners, then analyze and distill that change into a theme confinable to a blog post. I think, after many hours staring at my computer screen, that I can't be complete in the assessment. I will have to focus my thoughts more than I'd planned. 

Please excuse the generalization, but I think oncology, perhaps more than primary care and medicine subspecialties, treats patients whose disease cannot be clearly linked to poor lifestyle choices. Yes there are associations between obesity and breast cancer, smoking and (amongst others) cancers of the head and neck, lung, and bladder, and the various HPV-associated malignancies, but the majority of patients had no reason to think they were at risk for cancer. In plain terms, they never saw it coming. These patients, and particularly the young ones, will spend a significant portion of our initial visit asking and re-asking the question "how did this happen?", for which an abbreviated synopsis of cancer genomics is often emotionally unsatisfactory and scientifically insufficient.

I am just beginning to understand how frequently life lacks good answers to some very good questions. Terrible things happen to people undeserving of an early death or a near lifetime without their spouse. We do not all get what's coming to us. 

I used the fumble the question "Do you like what you do?" because, although the answer is yes, there are times when it's truly horrible.  I can't cure a substantial number of people who walk through the door and my job can involve making people understand something they don't want to understand. But there is meaning to what I do, there is meaning to palliation and prolongation of life, even when the situation itself seems meaningless. Medicine has taught me to find meaning where it isn't apparent and, in doing so, helped me to enjoy this short life that happens to us all.