Today was good; I wasn’t supposed to be on the board, but the chief resident I was supposed to be in clinic with wasn’t there, so I tagged along with the third year resident. When there was an emergency Csection upstairs, at the same time that several complicated patients arrived in triage, she went up from the clinic to help, so I did too. At noon one of the attendings invited people to come along on a Csection for his private patient, so the intern and I went. He let the intern do all but the little bit of cutting and sewing that was most convenient from his side of the table. He also had to extricate the baby, as it was very large (mother had gestational diabetes), and its head had become very stuck in the pelvis during hours of unprogressive labor. The head was literally coneshaped, one and a half times as long as it was wide; a very astonishing sight. Even with a cap on it was still surprising.

Then the intern and I ran together to get lunch before going to a session to go over all the high risk charts in the practice, and we talked about ob/gyn residency. Among other things, I discovered that from first through third year, the residents barely get twelve consecutive hours off in a week. . . I remember one thing she said: “No matter how hard it is, I have to remind myself I chose to do this to myself.” And I’m asking myself, do I want to do this? I already have to say that about medical school; maybe I would be my own worst enemy, to chose OB. But what else would I do? I suppose I want to be a doctor; whatever I say, I don’t really want to be a midwife or a teacher; that’s not interesting.

So what kind of doctor? My father wants me to do ophthalmology. God knows I’ve waited for my grades to fall below competitiveness, but I guess that’s not going to happen; no easy solution there. Yes, ophthalmology has beautiful hours and very little call. But who wants to do repetitive micro-surgeries all day? To be honest, ob/gyn is repetitive too: vaginal deliveries, Csections, and hysterectomies; that’s pretty much it. No; if I have to be repetitive (and internal medicine and all its variants, family med and peds, are too repetitive to be considered) let’s have some action, and some blood, and above all let’s have a baby at the end of the repetition. I love hearing babies cry. It’s a miracle every time. Maybe some day I’ll get bored of seeing that huge head and body emerge out of that tiny hole, of seeing what has before been only an image on ultrasound, a heartbeat in the room, turn into a separate human being; but not any time soon.

Psychiatry is not even a consideration. Internal medicine and family medicine are just variations on each other, mostly geriatrics these days. In-hospital they’re almost interesting; but I don’t have the patience to concentrate on details like they do. And I simply will not go into a specialty which will turn into prescribing antibiotics for allergies and viruses, and soothing hypochondriacs all day long, and watching heart failure patients slide into death. Pediatrics is a little bit different, but not much. I don’t get along with teenagers; babies scream at me; I can’t connect with children; and it’s office practice again.

Which leaves ob/gyn and some kind of surgery. I already said opthalmology is too small, too detailed, and way too same. Surgery is an even longer residency, with even worse hours, so it’s not an improvement on OB. (Watch me not saying anything about their personalities.) I guess that brings us back to the beginning: OB/GYN is the best of all medical worlds.

There’s ER, too, but you can’t have any independence with that. You can’t take that overseas or into a very rural area. Besides, say what they will, the way most ER doctors practice, there’s not too much thought required: “CBC, BMP, chest xray, head CT, start an IV, give them oxygen, phenergan and vicodin.” There, I can do ER already. (Sorry, ER friends. . . but you know what you think of OB, so keep quiet.)

Thus, by means of being too lazy for details, and having a short attention span, I keep talking myself into one of the most demanding specialties. (How does that happen?!) Now I just need to think about residency programs. The one at this hospital is very good; the only thing I’m concerned about is the fact that they’re connected to a military base, which has its own hospital (not the same as the VA). All the residents I’ve talked to this year hate the base at least as much as they hate the VA. Although most of them are not very patriotic, which may contribute; but I don’t know if I want to set myself up to spend 4-6 months every year on the base. . .

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