My Addled Mind

I've definitely been my own worst enemy this week.  I've been letting everything, big or small, stress me out to completely ridiculous levels, and it's made life temporarily quite unpleasant.  The worst part is that I've abandoned the things that would have made it better (studying, tackling my multiple upcoming research presentations, meeting friends for coffee) in the interest of things that just dig me deeper into my hole (eating candy, lying on the couch, obsessing over everything I've done wrong recently).  My brain has been a very inhospitable environment lately, and it's mostly my own doing.

Last night, after another stressful day at work in which I managed to lose both my pager (found) and my stethoscope (not found), I fortuitously was scheduled to go for dinner with some old friends from medical school.  I was a ball of anxiety and angst when I arrived at the sushi restaurant, but gradually relaxed with each bite of raw tuna or deep-fried tofu.  The visit was so good that we extended it to the restaurant next door for dessert, which we occupied until past closing, despite the frequent and unfriendly glances from our waitress*.

While talking with my friends, I realized that my main source of angst isn't what I thought it was (a new rotation, an insanely long to-do list before leaving for an away elective in nine days, feeling like an idiot at work), but rather uncertainty about the upcoming fellowship process.  I like to be settled, to know what the future holds, and I feel anything but settled about what I'm going to do with my life.  While I threw myself quite enthusiastically onto the oncology/palliative care bandwagon a few months ago, there's been a nagging voice in the back of my head questioning whether that's what I really want to do with my life.  The voice became very loud at the ACP conference last weekend, when I found myself dozing off during the Update in Oncology session.  While most of that was fatigue from late nights and early mornings, a small amount of it was from disinterest in what the speaker was talking about.  I realized while sitting there that, as much as I love the patient population in oncology, there's part of me that questions how much I'll enjoy the knowledge base of it long-term.  And I just don't know the answer to the question.

So while going about my work this week and preparing to leave for my rotation in medical oncology, I've been thinking and thinking and thinking about the future.  I've been trying on different careers in my mind, attempting to figure out which one fits the best and will fit well for the longest time.  I've been thinking about some of my areas of interest (palliation, community medicine, medical education) and trying to figure out which career I can best incorporate those interests into.  And after rejecting ideas like becoming a general internist (too much chronic sleep deprivation for me) and doing exclusively palliative care (not going to hold my interest for 25-30 years), the one idea that is sticking is hepatology.

I had pushed hepatology to the back of my mind because I haven't had enough exposure to it to commit to it, but it keeps coming to mind as a career with many appealing features.  I find the medicine very interesting, and I like the fact that there are patients who pose diagnostic challenges.  The lifestyle is good, and the call is generally very gentle.  It has a significant inpatient component, which is something I really enjoy and would miss if I practiced oncology locally, where almost all of oncology is outpatient.  And there are end-stage patients, so I could still incorporate my interest in palliative care into my career.  Many, many positive things.

Not to say that I've written oncology off, as it still has many appealing aspects, but I've definitely returned hepatology to the list of possibilities.  Which is exciting but terrifying at the same time, as I start the application process in just over two months.  And at the moment, I don't know which way to go.  But I do have a plan...in addition to two upcoming visiting electives in medical oncology, I've requested another rotation in hepatology for July.  I hope, hope, hope that I'll be able to get it, as I think a few more weeks exposure to hepatology could help bring me a bit of certainty.

Or maybe it'll just muddy the waters of my mind even further.  Sigh.

*  Before you think we were assholes to the wait staff, I'll point out that there were still three or four tables of people eating dinner when we left, and the staff were still in the process of cleaning the kitchen/dining room, so we weren't responsible for keeping them from leaving.  And we tipped generously.