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 21st century people, it’s time for medicine to catch up.

@livingwhilelearning

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Hoping for a better sense of self? Maybe applying to residency will help

Time is crazy in the sense that moments can pass in the blink of an eye, or seem to last a lifetime (ie. waiting for your apple update to load, Dovetale training, getting stuck behind slow moving people and cars).

While applying to the Canadian Resident Matching Service (CaRMS) – what’s known as the NRMP in the US – felt like an intensely slow, arduous process, I simultaneously felt like I was stuck in a pressurized boiler. Maybe it’s because I went through almost daily quarter-life crises, but these introspective weeks left a strong impression. They forced me to think about who I am, what’s important to me, what skills I have, what skills I wish I had, and all the things that are critical for me to stay sane.

In these weeks, I particularly realized the importance of friends, of family, of running, of stress-relieving hobbies such as knitting and of doing things other than obsessing about applications. Just ruminating about myself and on how to turn my weaknesses into strengths probably would have driven me crazy. You can only read through your application a certain number of times before the words all blur together.

Applying to residency is like applying to medical school all over again, but this time, with the added pressure of determining who you’ll be and where you’ll end up in the not-so-distant future. Applying to residency is like applying to be an adult – you’re finally taking that step into the real world, where your line of credit is no longer an excuse to YOLO. Before medical school, you have a lot of choice. You may be accepted to one, to four, to twenty schools across the country or across continents. You can choose to be by the beach, suffer through bitter cold winters, or decide that your true calling is actually in business or fashion and skip medical school altogether. Regardless of your background in university, you have a crazy amount of choice throughout these formative years that can leave you dazed and confused, but also optimistic and determined.

When I applied to medical school, I knew that my seven-year-old dreams could withstand the test of time. I indulged in my other passions – business, healthcare technology, travel, research – but becoming a doctor was always the ultimate goal. Once you’re in medical school your interests become more focused. Where previously you engaged in global health as a primary interest, now you think about these skills and how you can apply them to your future practice. Where previously you did hobbies for fun, now you do them because they keep you grounded after long shifts at the hospital. Where before, you could take classes like philosophy, ocean sciences and negotiations because they sounded interesting, now you take courses on evidence-based medicine, medical education and pharmacology because you believe they will make you a better, more well-rounded provider. What I love about medical school is your ability to take all the passions you’ve accumulated over the years, and turn them into something productive for society. With this MD degree, you have the ability to leave a legacy – but what that legacy is is up to you.

While I love reading travel blogs like this one: I am Aileen, and occasionally wish I could run off for a life on the road, I’m pretty sure my school, the Canadian government, the bank and my parents would hunt me down pretty quickly. But through your experiences in medical school, you realize that being a medical student, and soon to be physician do not preclude you from also being yourself. Applying to residency, and all the steps leading up to application submission on November 21st, helped me learn more about myself, my achievements, my failures, and the challenges that have shaped my personality and my ambitions.

They say that you should know your CV intimately for interviews, but more importantly, your CV can help you understand what’s important to you. What electives did you do over the course of medical school, who were your most influential mentors, what extracurricular activities did you participate in, what hobbies did you keep despite time and resource limitations. Writing my personal statements was even more so a challenge in distilling everything I’ve done in my life, understanding the story I’ve woven, and highlighting the things that stand out. A question that has repeatedly popped up while going through this process is why? Why did I apply to the specialties I did, why do my experiences make me a good fit, and why do I think I’m qualified to be in these fields?

At the age of twenty-four, I’ve watched my friends go into a variety of fields – into consulting, investment banking, research, and marketing, as well as pursue MBAs, Masters and PhDs. If you ask most millenials where they’ll be in 10 years, the answer is usually uncertain. There’s usually a goal in mind but the journey there is far from set in stone. They have all of these choices, whether they want to make partner at their firm in 10 years, whether they want to make a lateral move into another field, or whether they want to move to Africa and work for a NGO.

While medicine is by no means a locked box, on match day, when that final decision comes out, you’re effectively committed to whatever is written in that email. Whether that is your top choice program, your tenth choice program or no match at all. For the first time in my life, I feel as if I’m taking a plunge into the deep end. The plunge into adulthood, where I will be responsible not only for myself, but for the lives of others. The decisions I make can and will impact the patients I serve, and my mistakes could, for the first time, be life threatening.

The idea of starting residency is like the open water scuba diving course I finished this weekend. They teach you all of these skills in the pool – how to put your gear together, how to share air and rescue other divers, how to fix problems that come up and how to be safe but have fun at the same time. After the weekend-long course, it was time to go into open water for four deep water dives (felt pretty blessed that these could be done anywhere in the world ie. Mexico and Panama, as opposed to the freezing waters of eastern Canada), to review all the skills we learned under the supervision of a trained instructor. I recently finished two of four dives in Mexico, but it won’t be until I finish the last two dives that I’ll be fully certified and deemed ready for deeper open water dives. In the ocean, everything is a lot bigger, mistakes are more dramatic, and things can truly go wrong. If you’re not prepared in the pool, you certainly will not be prepared in the ocean. Much like the path to becoming a doctor, where you first get eased in as a medical student, practice and hone your skills as a resident, and finally, prepare for independent practice as a staff physician, it’s important to learn the basics in a low-stakes environment before facing the reality of responsibility.

Two-and-a-half years in medical school, I still can’t believe I will carry a “Dr.” before my name from May onwards (hopefully). It’s a huge privilege but also a humbling responsibility. There will be people trusting my advice, and patients for whom I can make difference. I’m excited, I’m terrified, and I feel as if time has rushed by, constantly yelling back at me to catch up. I feel like just yesterday I was a first year medical student, who had yet to do my first history and physical exam, and had not experienced the thrill of the OR or the reward of seeing patients improve over time. Although CaRMS is far from over, and we have interviews coming up way too soon, this application process has been an incredible growing process, and has demanded introspection into everything that makes me, me.I mean what is medicine but a commitment to lifelong learning?

Of course, all of this being said and done, it’s important to stay sane while going through this process, take those holidays in Mexico, do that half-marathon, share a bottle of wine with friends.

Now that Part I is over, I guess I’m a little more ready to tackle Part II: the interviews. There will definitely be more ramblings to come.