Since then, OB has ended, and I have begun [what I consider to be] the most important of all of my clerkships: internal medicine. So weighty is this among the other clerkships, that many simply refer to it as "medicine".
This is the second cycle in history of Ross' internal medicine rotations with Miami Beach Community Health Centers/ Mount Sinai Medical Center, but already it's far more organized than the other clerkships. I spent the first month of my three month clerkship conducting outpatient medicine at one of the Miami Beach Clinics with one fascinatingly intelligent internist. I've always thought that doctors who go either into internal medicine or pathology have the broadest and deepest fund of knowledge with which to approach the disease process, and I certainly hope I am one day able to think like this doctor. Fortunately the feeling was mutual; he wrote me a stellar evaluation - I'll certainly be requesting an LOR.
Every once in a while - twice a week, it's supposed to be - we have ER rotations. My first one was last month, scheduled from 3pm to 2am (my next shift was supposed to begin that same day at 6am, but we got that changed). Anyway, it wasn't terribly fascinating; so many of my colleagues want to go into ER medicine, but I believe that they either (1) don't know what they're talking about and just like what they see on t.v. or (2) do know what they're talking about and want ER medicine because of predictable shift work. However, after doing my second shift in the ER today, I've come to a conclusion - it's just too ADD for me. Every physician should know how to respond to emergencies - just as we should all know how to deliver babies, but, to me, emergency medicine is a faster-paced, slightly more exciting version of family practice. I say this because the Aventura ER is not a trauma center; in fact, Miami's only trauma center is Jackson Memorial (absurd, I think, that Miami's only got one...). Were I at a trauma center, it might be different. However, my comparison is based on this fact - both ER docs and family practitioners know a bit about a vast amount of disease presentations - enough, in fact, to know exactly when to refer, and to whom to refer.
Someone goes to their PCP (primary care physician) reporting that they get winded more easily, and get chest pain sometimes: referral to cardiologist. Someone goes to their ER complaining of crushing chest pain, nausea and vomitting: stabilization - and then referral to a cardiologist.
Someone goes to their PCP wondering if they may be pregnant: referral to an OB. Someone goes into their ER with severe lower left-sided abdominal pain after not having had a period for 4 months: stabilization, and then referral to an ER.
Someone goes to their PCP reporting a lump in their groin: referral to a surgeon (assuming it's an irreducible hernia). Someone goes to their ER reporting a terribly painful lump in their loin: stabilization, and then referral to a surgeon (assuming it's an incarcerated hernia).
Someone goes to their ER complaining of feeling down for months as well as feeling anxious: referral to a psychiatrist. Someone goes to their ER acutely psychotic, and must be Baker-acted (committed to care against their will because of the imminent likelihood that they will harm themselves or someone else): stabilization, then referral to a psychiatrist.
I'm mention these commonalities not to put down either of these very worthy professions, but rather merely to show that the reason that neither of them particularly appeal to me is what they share in common. It seems that, if I were to consider anything as far as the ER is concerned, it would deal with trauma surgery.
I hunger and thirst for depth and mastery. I do not desire to merely dabble, to but dip my fingertips in many different flavors - the excitement of variety is something that family practitioners and ER docs have both told me drew them to their respective fields. However...it doesn't do it for me. They all know more than I do, obviously....at this point. The internists, on the other hand, dig deep; they dredge the depths of the disease processes - perhaps I am drawn to disease as a mental puzzle. Do I, then, see myself as an internist? Only perhaps for three years.....or the amount of time it takes to complete a residency, and move on to a speciality - for internal medicine as an endpoint may be too general.
It is a thinking profession. And yet....the reason I fell out of love with psychiatry (aside from the oppressive shackles of their scope of practice) was that, in the anatomy lab, I learned that I loved working with my hands. In my head - in this....blissfully limited experience of mine - it all may come down to how much I end up loving my surgery rotation. Now there's a hard life...more than the three IM requires, surgery exacts 5 grueling years of sleep deprivation and....and what? I don't know. I have heard it's a difficult life. And at the end of 5 years, one has only attained the status of a general surgeon - fellowships require more years.
How many years are enough? I ask not from weariness of the path - merely curiosity.
Anyway. This next week, I'm supposed to be in the ICU - now that is going to be fun!
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