The Chameleon

Way back in high school, I had an English teacher my senior year whom I really loved. She was an excellent teacher, a truly Southern woman, yet totally liberated. After I'd received my acceptance to college, and gotten accepted into a pre-med program, I told her all about it. Her response? "You should be an English teacher." I thanked her politely, but I told her I had my heart set on being a doctor.

One of my high school band directors also played trumpet with me in our church orchestra on Sundays. I told him about my plans to go to medical school after college; he told me "I can see you going to a small liberal arts college, majoring in music, and becoming a band director." It really was too bad that I didn't see myself that way at ALL. I thanked him politely, and told him I really didn't think I wanted to be a band director. Although, there are times when that option seems more appealing than it did then...

One of my surgery chiefs got all into the idea of my being a surgeon; she offered to help me find an adviser, and help me write and publish a case review. Both of my pediatrics attendings asked me if I was going into pediatrics, and were visibly disappointed when I politely (but firmly!) told them I had no interest in pediatrics.

Last night, on call for internal medicine, was one of the worst nights ever. I made several screw-ups that got me (nicely, and rightfully) chewed out by my upper-level resident. I misunderstood an errand I'd been asked to run, and instead of heading upstairs to fetch the cards, I drove to the med school and back (an hour round-trip in 5 pm traffic). As I got progressively sleepier and more brain-dead, only 3 Cokes and intense, unholy fear of my attending kept me moving. As I prepared my notes, I kept filling in blanks I'd left: a finger-stick glucose here, a TSH there. I finished and signed my notes, transferred data around until my scut sheets had all the values I'd need (hopefully), and felt the pressure in my chest get heavier and heavier. 6 am: go time. My respiratory rate sped up. The onslaught began with chest x-rays: "what do you see?", "why do we have this CT?" (the answer was almost always, "the ER ordered it") "what other abnormalities are there?" (after we'd discussed the only abnormalities I could see). One of my fellow students, a studious but nervous guy, had a visible tremor as he fumbled his papers looking for lab values (this same student has Gilbert's syndrome, and was a distinct shade of yellow this morning from the stress). It went on, and on, and on, for 6 hours and 20 patients. Constant calm criticisms flowed: "this is unacceptable", "you guys' physical exam skills suck", "that's not the question I asked you", "I'm asking you guys to use some common sense," etc. It was brutal. I managed to escape the worst of it, and after my first patient to present, the shaking stopped, and all I could think about was the fact that I hadn't peed in 6, 8, 10, 12 hours (nor did I really need to, which was more worrisome). Finally, the last quick staff note hit the last chart, and Dr. H said "Students, come with me."

We entered his lair, I mean office, and settled in for a quick chat. "I only yell because I care", "don't be overwhelmed", "medicine is tough--a lifelong process" were only a few of the quick phrases that were tossed around. As this was our last (and only) call with him, he asked if we had any problems or questions. When no one spoke for 2 seconds, he said "Great. I want to talk to you [pointing at me] for a second--the rest of you can go." The other three filed out, relieved at having gotten off so lightly, and looking at me with pity. I collapsed in a chair and waited while he made a phone call. What had I done wrong? Did I kill a patient? Did I forget yet another lab value? My notes went on the chart at the correct time, I had all my vitals, and I'd escaped the most furious of the tongue-lashings. Then I wondered, did he want to talk about my intern or resident? My intern was convinced she was failing, although I didn't think she was the most yelled-at of the interns. My resident was definitely the better of the two on the team. WHAT THE HELL DID I DO WRONG OH GOD I SWEAR I DIDN'T MEAN IT JUST GET IT OVER WITH AND KILL ME NOW! He hung up the phone, turned his chair around to face me, and said...

"You were made to be an internist."

I don't know how I kept my mouth from dropping open. My heart had definitely stopped.

He proceeded to tell me that I asked the right questions (I didn't recall asking any), that I had a good knowledge base, that I was not only made to be an internist but also a subspecialist, because I needed to know everything, to be an expert. He discussed an article I'd given him (at his request), and how I was obviously thinking in the right way. He said he wanted me to seriously consider internal medicine as a career, that he didn't know if I already had plans but he wanted me to keep medicine in mind. He then asked if I had any plans and I politely said "I'm keeping my options open now". I thanked him and told him I'd never felt as stupid as I had during the past week and a half. He reiterated the don't get overwhelmed speech, I said "thank you, sir", and we walked out.

I didn't know whether to laugh or cry or tell him how much I'd hated the previous evening, how many times I'd picked up my purse to see the next patient and thought "I could just leave now". I didn't tell him I'd never considered internal medicine, or that I liked surgery or OB. I just said "thank you, sir".

Even now, after a refreshing post-call nap, I still think I was hallucinating.