The choices we make

For a long time, I wanted to be a surgeon. I’m good with my hands, love the intricacies of the human body, and enjoy figuring out where each puzzle piece belongs. In a recent group chat, my  best friends from high school (jokingly?) summed up my personality, “I’d just go for the one that’s most competitive, tbh.”

Whereas for some children having a parent in medicine is a huge deterrent, that was never the case for the Gu’s. We were, and still are, a family that finds satisfaction in our societal roles, and are passionate about our work. My dad is a family doctor, my mom is a Traditional Chinese Medicine practitioner. While I was never overtly pressured into becoming a lawyer/doctor/engineer, I always knew it would bring my parents immense satisfaction to have Dr. Gu “Junior” carry on the family tradition. But like, I already speak Chinese, played a million years of piano, and have a lightning tea pouring reflex – it also just made sense that I’d go into medicine (note: your girl is not good at math).

College was a somewhat grueling experience for me. I spent a lot of time exhausted, mentally and physically. I subsisted on 3-4 hours of sleep most nights, because I needed the other 20 hours to study, go to class, do research, be involved in my school, join a sorority, have a social life, be a good friend, take on internships in SF, maybe eat. Many of us pulled long hours in the libraries, putting every ounce of dedication into being in the top 10% (of hundreds of “premed” students) and getting that elusive “A.” I could only look on in awe of the lucky ones who were naturally brilliant. Most days, I hoped my 10 or 20 hours to their 1-hour of studying would be enough to get the grades I needed to get into medical school. Of course, it wasn’t just about academic success. To get into medical school, it was engrained in us that you also need leadership, volunteer hours, research, experience in the hospital, a “unique” activity, all while being “well-rounded” in a non-extracurricular way. Managing life was tough, and we all joked that “you could only choose 1 out of 3 things” – those 3 things being sleep, social life and academic success. Of course, being the (mostly internally) intense, type A person I am, I also needed to have a social life. So rather than sleep, I would go out on the weekends, come home at 2 or 3am, and continue studying for calculus, or whatever academic purgatory it was that night. What I learned from my first 2 years of university is that if you deal with your stress and anxiety by ignoring it, eventually you will break down. And so, it became a bit of a ritual, I would continue on like this for a few months, and then for a whole weekend, I would just PTFO and ignore everyone and everything for 48 hours. 2 days later, I would emerge into our living room, like a butterfly out of its cocoon, ready to take on another few months of that #berkeleylife.

Obviously things became easier as I progressed in university. I learned that sometimes it’s ok to say no, that I don’t have to go to every single event I’m invited to, and of course, I started taking upper division and graduate level classes that didn’t have the same ridiculous “only <10% get any kind of A”  curve. Those glorious classes of 20 people, sometimes spent outside on the glade in the spring, were a vast change from our packed 800-student lower-division chemistry courses. And of course, in senior year, once I got that first medical school acceptance in fall of 2014 (hallelujah), it was time to really live my life.

This is all to say, while maybe my experiences don’t shine a light to the 120 hours a junior surgical resident works in a week, and certainly the responsibility of getting an A in organic chemistry is nowhere near the responsibility of saving someone’s life, for a few years of my life, I experienced the toll of little sleep and a lot of stress. The stress however was well worth it for my original ultimate goal, to be a plastic surgeon.

So obviously that dream died a very early death in medical school. I realized early on it wasn’t the specialty for me, and went specialty shopping in my first couple years of medical school. From plastic surgery to ophthalmology to a brief dalliance with pediatric neurosurgery, to urology – you can probably spot the trend here. No matter what specialty it was, it always seemed to circle back to surgery.

I know I’m a very goal-oriented individual. I like having my schedule packed to the brim with activity, I like being involved in every extracurricular activity available, I like being good at what I’m doing (and being acknowledged for my work). What I liked about surgery wasn’t just the technical aspect, but the glory? of having to work 80+ hour weeks and still be a functional human. I liked the idea of being in an intense program where I wouldn’t necessarily have to sacrifice, but would learn to spend my free time “more wisely.” I loved the idea of “fixing people,” where someone could walk in with a problem and walk out with a solution.

In clerkship, something that’s hard to fathom is just how difficult residency truly is. Having done several surgical electives, I can attest to the fact that even though I always volunteered to stay late, even though I stayed overnight so I could do that closing suture, even though I came back in the middle of the night so I could be present for those moderately interesting cases and still worked a full clinic day the day after, I would never really know how challenging being in a surgical residency truly was. Because, at the end of the day, my stint was only a few months and I could look forward to easier rotations and a long vacation. Sure, I sacrificed some dinners, some birthdays and some family events, but the sacrifices you make in clerkship are temporary. You’ll always move on to an easier, 9am – 5pm kind of rotation, when you can catch up with friends and life.

I didn’t really question this life I was leading, or the path I was going down until I started my family medicine core rotation. What was this feeling? I had my weekends off? My day ended at 3 or 4pm? I had an hour off for lunch everyday? I think that feeling was…relief. I was rarely pimped, I worked with an interprofessional team, and I had an amazing work-life balance. I loved chatting with my patients, getting to know them over the 6-week period, and doing small procedures in the office. It was during this rotation that I questioned my intense fascination with surgery, and wondered if I really loved it as much as I thought I did. It’s so easy in medical school to get caught up in the vortex of “I should do this because I’ve done x hours of research, published x papers, done x electives, schmoozed with x faculty and everyone knows I want to match to this specialty so people will judge me if I don’t.” I’m not a fan of this aspect of my personality, the part where I care a lot about what others think of me. I care deeply about the image and persona I portray – maybe to the detriment of my own happiness.

Even with these questions, going into CaRMS – the Canadian residency matching process – I still wanted to match to “a very competitive specialty” because who was I if not the person who “goes for the most competitive option, tbh.”

Obviously today, I’m in family medicine, the field that for a long time, was outside of my radar. Today, I am so, so grateful for this alternative path. Almost 7-months into residency, I can honestly barely remember why I ever wanted a surgical specialty. I love the whole-person approach to medicine, I love getting to know my patients, I love the variety in my days in patient population, procedures and organ systems, and I love that I have time to take on leadership, medical education, research and volunteer roles, in addition to spending time with friends and family and having time for self-care. There are dozens of sub-specialization options, from obstetrics to emergency medicine to anesthesia to palliative care, so really, there’s something for almost everyone if general practice isn’t for you. Of course, it’s not all this peachy, and there are definitely things that leave me feeling disgruntled and unsettled, but for the most part I feel pretty free to voice my concerns, to advocate for my rights and to be a human being. Sure there are weeks I’ve worked 70-80 hours, days where I’ve worked 30+ hours, but at least for me, that’s not an everyday reality.

I’m down to work hard. I see the value in reading up on cases, in staying late to tidy up a patient’s work-up and admission, in teaching medical students, in following up on interesting cases, in putting off dinner plans to help a colleague. I don’t mind 12-hour work days and occasional 100-hour work weeks, as long as I have a sense of ownership and responsibility, I feel respected by my program, and I have the support of my staff. I have the fortune of working in a dynamic clinic with an amazing and kind preceptor, with a patient population that demands a lot, but provides significant personal and professional satisfaction. Being totally honest, this isn’t quite where I thought I would be halfway into my first year of residency, but everything happens for a reason. It’s all about perspective, and sometimes it seems like fate knows you better than you know yourself.

95% of the time, I’m happy to go work, and I wake up pretty content with my life. I feel supported by my staff and clinic, and I feel connected to the people who matter in my life. I truly believe that this is the way residency should be. It’s important to learn and grow, but it’s also important to sleep a certain amount of hours a night, and not live in fear of being scolded at 3am in the morning.

I recently read an article by @mindbodymiko, “the ugly side of becoming a surgeon,” where she talks about her experience as a surgical resident. It’s not fair that there are residents who work these completely crazy hours, are expected to work a full clinic day after being on 24-hour call, and feel like they cannot advocate for their physical and mental well being. And can I just say, hospital food is TERRIBLE. The cafeterias are loaded with unhealthy options (the pizza just calls out to you at 2am in the morning), and there are always baked goods and chocolate laying around. I admire the people who can say no to a delicious chocolate chip cookie on call – personally I have little to 0 will power after 24 hours without sleep.

Physicians are notoriously known to be “bad patients” but just like we explore why our patients don’t adhere to recommendations, perhaps we should explore why this is the case for doctors (who see firsthand the implications of non-compliance). It’s not fun to be exhausted, it’s not safe for patients to have wearied physicians operating on them and general exhaustion certainly does not decrease the number of preventable errors.

All this is to say, being in medicine isn’t always easy. It’s something we dedicate a large part of our lives to, it’s a degree that becomes a part of who we are, and a profession that gives us daily purpose. Medicine is a field where the perfect balance of compassion and disengagement leads to professional success. It’s not just a job, it’s a lifestyle, but this lifestyle leaves many residents feeling emotionally exhausted and burnt out. There are higher rates of depression, suicide and divorce among medical professionals, and it’s no mystery as to why this is. So yes, I love medicine, but maybe it’s time to re-evaluate medical culture and find more ways to support resident health. It’s easy for programs to say “let’s increase wellness activities” but much harder to engage residents in these initiatives.

We’re in the 21^st century people, it’s time for medicine to catch up.

@livingwhilelearning