Sunday, March 28, 2010

Time To Go

The year progressed. My schedule was pretty diverse so I got to sample several different areas in pathology. Early in the winter I met with a really supportive faculty member in my department who gave me an open ear and some advice about my struggle with missing patient care. We got my schedule rearranged a bit so that I could sample the areas of pathology that were more clinically-oriented. I also started reaching out to advisers from medical school to see what my options were if I decided to switch. They were all very supportive and helpful. In the end it seemed like my best bet was to keep exploring pathology. Since I had invested so much to get to this point, and had really enjoyed what I had seen of the field as a medical student, I was not convinced that I had explored the field enough to make a decision to walk away from it. And from a logistical point it was already pretty late to re-enter the match for that year. Because pathologists do not do a standard intern year, I would need to start over as a PGY1 in a new field.

There was not really one moment that I can point to as the turning point for when I made the decision to leave. I knew that I wanted to give the field enough time to get a good sense of all of the options available to me in it. Since I was missing patient contact I figured I either needed to find a niche where I felt that need was fulfilled, or I needed to find something that intellectually excited me enough to give me fulfillment in another manner.

So I did a month on the FNA service where I got to see patients. I liked the interactions but was not drawn to the morphology of cytology. Blood banking was a pretty clinically-driven rotation. I had a list of patients getting special products that I followed, did a lot of consults, and even saw some patients; however, I was not drawn to the lab side of things at all. Hemepath was similar--I loved the consults and even some of the initial morphology. But I was not passionate about the molecular side of things, which would not bode well for a future in that area.

Then there was anatomic pathology, which had drawn me to the field as a medical student. I had not enjoyed autopsy as a medical student, so was not surprised when I hated my autopsy rotation. But surgical pathology was a surprise. As a medical student I had really loved it--the excitement of frozens, following a specimen from grossing to looking at the abnormalities under the scope, the satisfaction of making the diagnosis. It just wasn't what I had thought it would be when I did it as a resident. I hated going into the ORs and the stress of frozens. Grossing was gruesome and tedious. And I just did not feel that excited or intellectually stimulated by the work at the scope. That excitement I had felt in the course during 2nd year of medical school and on my rotations 4th year just was not there. Given that the majority of private practice and many academic jobs have surgicals as a large portion of the daily work, not feeling the love for surgicals was a big problem.

As I was feeling of these things, I saw that my colleagues were thriving. Where I saw a complicated, tedious specimen that I dreaded grossing and doing a multiple stain IPOX work-up on, they saw a challenging, interesting diagnostic puzzle to solve. It became clear that the field was just a bad fit for me. While the prospect of having to enter the unknown and go through the match again was really scary and unsettling, I really could not see myself doing pathology for the next 3+ decades of my life. That was the final driving factor in needing to make a change.

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