KATE DOUGHTY - ORTHOPEDICS

I was seduced by orthopedics.

That is the best – the only – way I can describe it. I was happily courting a career in family practice when, late in my third year of medical school, I found myself inexplicably attracted to this undesirable thing called “surgery”. It was like meeting a cute guy from the wrong side of the tracks. I couldn’t understand the attraction. I mean, surgeons are bad people, right? They work too hard. They make med students cry. They don’t care about their patients. But I was drawn to the OR, to surgery, as if by a Siren’s song. I fought the temptation: I am going to be a primary care physician; I am NOT a surgeon! But I couldn’t deny the little first-date flutter that I felt every time I scrubbed for a case. I tried to resist – I am going to be a primary care physician – but I realized that I was actually smiling as I drove to work in the early morning darkness; I was voluntarily reading entire chapters of surgical textbooks. What was happening to me?! I want to take care of my patients and their children and their grandchildren and …

I was fortunate, I guess. I wasn’t irrevocably committed to primary care. You could say I was in an “open relationship”, and my surgical sites offered me a lot of freedom in which to explore this newfound interest. One day at the Faulkner, I dropped into a hand surgeon’s OR. Thought I’d check out a carpel tunnel or two so I could say I saw it. Have you ever gotten lost in your lover’s laugh, entirely oblivious to the world around you? That’s how I was in the OR that day – entirely taken in by the beauty of the anatomy, the precision of the surgeon. I went home grinning from ear to ear, giddy with the first blush of new love. But I am GOING to be a family doc, damn it!

The next week, I joined that same surgeon again. He invited me to scrub. He let me open. He invited me back the next week, and the next. He let me close. He listened to me pontificate on my desire to be a primary care doc. He explained his career path to me. He told me about orthopedics. He let me release the carpal tunnel. I admitted to him that I really liked surgery. By the end of my six weeks at Faulkner, he let me – me! – put the plates on a distal radial fracture. I used the drill and everything! We were using fluoroscopy to monitor our reduction, and when he printed a picture of the final result for the patient’s chart, I asked if I could have a copy, too. I showed that picture to my dad, to my friends, like I would show off a picture of a new boyfriend. That picture of my first hardware installation is still hanging on my refrigerator. I left the Faulkner with that doctor’s advice ringing in my ears: If you can see yourself doing anything other than surgery with your life, then do that.

Right. I’m going into primary care.

When I got to NEMC for the last six weeks of general surgery, I was almost embarrassed to admit how much I thought I liked orthopedics. I felt shy like a junior high schooler trying to talk to a first crush. In fact, I was pretty sure that this surgery thing was just a crush. I was sure I’d get over it. But I had to be sure. The 2 ortho electives were already filled, but by the grace of the ortho and general surgery departments, I was able to arrange some time on the ortho service. Those two weeks confirmed my fears: I really liked ortho. It was the perfect job for me. Like when the beleaguered heroine in a story finally meets Mr. Right, I felt at peace when I was with the orthopedists. Safe. Content. Home.

What I discovered in those 12 weeks of general surgery was that the myths aren’t true. Surgeons aren’t mean people. They work hard, but they love what they’re doing. They do care about their patients. Their personalities are different from those who go into primary care. Surgeons can be decisive, harried, brusque, even rude. And whether or not it’s a compliment, I fit in with them just fine.

Even into 4th year, I continued to court primary care, but my heart always returned to surgery. By Block 4, I had finally come to terms with this: I cannot imagine doing anything with my life other than orthopedics.

And oh, the ecstasy of surrendering to the love of my life!

MAX VERGO - INTERNAL MEDICINE

I thought I was going into Peds at the beginning of my 4th year. In the back of my head I was considering Med-Peds, so on a whim I took a medicine sub-I during block 1. I was blown away by how complex people's health became after the age of 35 years old. I also found that I really liked the relationships I could form with the patients. Through these relationships I had the privilege of trying to help patients change their lives for the better and make healthier choices. There is a huge component of teaching in medicine- to
patients, to peers, and to students- which is something I have a real passion for. Medicine is a double edged sword though because its complexity keeps me interested and learning constantly but sometimes its complexity frustrates the hell out of me. I guess I value the former over the latter. I flip-flopped probably every other day on whether to apply in medicine, peds, or med-peds until September. For some reason after struggling with the decision, it became clear to me that medicine was the best fit and I honestly have not turned back for a moment since then. Good luck in your searches for the perfect fit.

BRYAN BOUCHER - OBSTETRICS/GYNECOLOGY

I entered into my third year of medical school with an open mind as to which specialty I might eventually choose. The first time I delivered a baby and held it in my hands, I knew in that moment that my specialty should be obstetrics and gynecology. Being an integral part of such an amazing moment in a person’s life drew me to the field and I have enjoyed every aspect of it. I enjoy the dynamic mix that exists between performing surgery, caring for pregnant patients, and seeing patients in clinic. The fact that I will be able to follow a patient on a long-term basis, potentially diagnose a condition that requires surgery, and perform that surgery myself is very appealing to me. After my residency training, I plan on serving as an obstetrician/gynecologist in the Army. I would like to serve at a teaching institution so that I could continue my education by teaching medical students and residents. Eventually I would like to return to my home state of New Hampshire and join a group practice, so that I can have the continuity of care that I enjoy.

ARNEL ALMEDA - ANESTHESIOLOGY

Why did I decide on anesthesiology?

I felt that it provided the stimulation of what I found interesting in medicine: direct, immediate patient care in OR and ICU settings, opportunity to do some procedures (line placements, echocardiography, various blocks, subcutaneous pump placements), and clinical and research opportunities (especially in pain management). At the same time, it offers the likelihood that I will be able to do residency where I want to, have a competitive salary as an attending, and have work-hours that will let me spend time with family.

If anesthesia were simply about putting a patient to sleep, then I might not be as enthusiastic, but there is a lot of great medicine going on here. I take the philosophy that I am going to be a critical care physician in the OR and/or ICU, and a clinician in the pain clinic. An anesthesiologist can medically deal with any rapidly evolving crumping system and get the patient through a definitive surgical solution. Here is a general list of the tasks of anesthesia: blood pressure stability, use of pressors, line placements, securing an airway, vent-management, electrolyte management, fluid status assessment for renal function, assessment of hematologic problems, knowledge of proper musculoskeletal support during surgery, anesthetic and sedation management, and the know-how of the physiology to get through a disaster.

What is the down side? (a typical question during the interview trail was 'what don't you like about anesthesia?') Some friends felt that anesthesiologists act as subordinates to the surgeon. In what way? Well, surgeons sometimes yell at anesthesiologists, they tell them to raise and lower the table, and they also occasionally fume as anesthesia preparations take 'too long' and 'delay' surgery. I do not think that anesthesia is a direct subordinate of surgery, however I dislike that some people do not think of anesthesia as a respectable field. Anesthesia does its thing within the framework of OR medicine. Whatever it takes to monitor a patient during surgery to maintain stability, anesthesia does it. The know-how and the pace can be transferred to the ICU, and the technical skills can be transferred to the pain management clinic.

Anesthesia is not surgery. If you have to do more complex procedures and that is the only way you will be happy, then surgery is the way. In the end anesthesia provides the knowledge-base of medicine that I want, in a fast-pace environment, while granting me the time to have a life outside of medicine.

MEGHNA MISRA - GENERAL SURGERY
My first rotation of third year was general surgery, and within the first week, I knew it was what I wanted to pursue. I immediately found myself drawn to the work and people. I was most impressed by the work ethic of the surgeons – they spent hours in the operating room perfecting their surgeries, by paying meticulous attention to detail and using instruments with such dexterity and precision, to give their patients the best possible care. My respect for the surgeons - their mindset and practice – ultimately kindled my own desire to become a surgeon. Everything about surgery appeals to me - the pace, the energy, the procedures, the disease mechanisms, and the controlled environment of the OR. But it is the bond between the surgeon and the patient that I find to be so unique. The surgeon takes complete care and responsibility of his/her patients - from diagnosing their problem, to repairing their problem in the OR, to managing them post-operatively both short-term and long-term. And a further challenge is that from the time the patient walks into the surgeon's office, the surgeon has a limited 15-20 minute block in which they gain the patient's trust that will allow the surgeon to operate on them and establish this special relationship. It's hard to put into words all the aspects of surgery that make it such an exciting field - it is more a feeling and an instinct than anything else.

LOREN ROTH - PSYCHIATRY

I have always been more interested in what goes on in a person's thoughts than what goes on in their body. Even when I was doing medicine, the only other specialty I considered, I found myself more focused on a patient's anxiety disorder, reactive depression, or psychosocial stressors than their cardiomyopathy or fluctuating INR.

JESSICA MANDEVILLE - UROLOGY

Contrary to popular belief, urologists do not solely deal with one certain organ. I chose the field for multiple reasons including the wide variety of surgical procedures and the ability to treat patients with both medical and surgical problems. In addition, I really meshed with the residents and attendings that I worked with...it's definitely a different type of personality that chooses the field.

LOUIS TSAI - RADIOLOGY

I’ve always been interested in imaging. I did my research in undergrad and grad school in image processing, so radiology was a natural progression. I also enjoy the academic feel of the field. It is very problem/puzzle solving oriented and if you don’t know the answer, there’s plenty of time to look everything up. And lastly, the hours are great.

LAURA SNYDMAN - INTERNAL MEDICINE

I always thought I wanted to go into medicine, but I wasn’t sure until my 3rd year rotation. I was one of the lucky people who had the much-envied feeling of knowing “this is where I belong” when doing the rotation of my future career. In talking to many people in my class, I would say about 40% get this feeling. The 16-hour days flew by during medicine, whereas the 8-hour days in peds made me want to stick a fork in my eye (granted, my experience in pediatrics was especially bad for a variety of reasons). During medicine, I was actually happy to wake up at 5:30 am to get to the hospital to pre-round on Mrs. X who was post cardiac cath and pre-CABG, Mr. Y who was just diagnosed with pancreatic cancer, and Mrs. Z who was waiting for a dual kidney-liver transplant.

Medicine is exciting—every patient is different and there is so much to learn! I like taking care of “the whole person” and I feel that I can do that in medicine. I like the idea of psychiatry, but know I would miss the medical aspect. I feel that a good Internist can integrate psychiatry into his/her practice.

I did my surgery rotation first and thought: “This isn’t that bad. Sure the hours are horrible, and some of the personalities leave something to be desired, but I’m learning from real live people!” (N.B. Actually, most of the surgeons I met were wonderful and truly enjoyed teaching, but the few extreme personalities stick out in my mind). I realized that what I liked about surgery was seeing patients. Because you spend most of your day in the OR, I was worried that I would not like medicine because it would be “too much standing around, too much rounding, nothing hands-on.” In fact, I do not miss those days with a sore back and aching feet. If anything, my brain felt tired at the end of a day on the medical ward—I was learning so rapidly and everything was so interesting to me! You actually have time to think about your patients in medicine! I also love Morning Report. For those of you not yet familiar with MR, it is a daily conference in which a patient is discussed in a “figure out what’s going on” format. One friend told me, “if you love MR, then you are meant to go into medicine.”

ADRIENNE KASSIS - FAMILY MEDICINE

When I started my clinical training, I was fascinated by the talk on tachyarrhythmias from the cardiologists, Symes’ amputations from the orthopedists, ulcerative colitis from the gastroenterologists. But at the same time, I found that each field was limited in the scope of care they provided. The cardiologists for my pregnant patient with a myopathy treated her disease quite well, but they didn’t know, as I wanted to know, how many children she had, where she lived, where she worked, how she would feel once she got out of the hospital. While analyzing her EKG with the consult team, I would have to fight the urge to listen over her gravid belly for her baby’s heartbeat, or spend time talking with her children waiting outside the room. As much as I learned from and enjoyed the various medical subspecialties I have rotated through, I feel that I need continuity and breadth to be professionally fulfilled. I want to know my patients and their families better than anyone else. I want to understand the human body as a whole, not as a collection of parts.

KARYN ENTROP - FAMILY MEDICINE

So my specialty is Family Medicine. I chose this field because I want to practice in a field that requires a broad knowledge base and demands constant learning. Also, I loved pediatrics, medicine, and ob/gyn, and this specialty combines it all. I also like talking with different people, and family medicine allows you to form connections with entire families and communities.

JILL WARRINGTON - PATHOLOGY

I chose pathology for a variety of reasons. As an MD/PhD candidate, I was particularly excited by how well pathology blends research and clinical practice. I was also inspired by how intellectually curious pathologists are and have continued to be throughout their career. Also, with involvement in as diverse fields as surgical pathology, blood bank, molecular diagnostics, hematology, microbiology and chemistry (to name a few), pathologists dynamically interact with most of the disciplines of medicine. And, therefore, they are engaged in a wide range of medical questions.

MEGAN LAVOIE - PEDIATRICS

I truly loved nearly all of my clinical rotations, but I thought the attitude of pediatrics most fit my personality. In pediatrics, you work in an environment that is positive and laid-back. Even when kids are very sick, you always feel their energy and spirit and as a doctor you can feed off that and create a very energized and hopeful environment. Many people seem to think that those of us who go into pediatrics do so because "we love kids" and we like to be cute and play around. It is so much more than that-caring for a pediatric population is a whole different spectrum of diseases, equally complex as that of adults, and it involves a real need to always address social/familial aspects of illness. Finally, I like that pediatrics is a discipline where I will be able to intervene and change behavior patterns and health outcomes in a very preventative and pro-active way, as opposed to trying to change someone's ingrained life patterns.

KARIN COLE - GENERAL SURGERY

When I started med school almost four years ago, I thought I was training to be a medical oncologist. Cancer biology was really interesting to me in college, and I wanted to be able to help sick patients. During the first two years of medical school, however, I found that my favorite classes were physiology and pathophysiology, so that by the end of second year I thought maybe I would do internal medicine instead, or perhaps cardiology.

With this in mind, I put my surgery rotation first during third year, to "get it over with." What I found was that I kind of liked it. Four hours spent retracting fascia, sucking up blood, and developing varicose veins in the OR didn't seem so bad if I got to close up the wound at the end. I also found that I seemed to get along really well with most of the surgery residents and attendings. I liked the aspects of my personality (confidence, directness, twisted sense of humor) that seemed to emerge when I was among them.

I wasn't entirely sold on surgery until I did my internal medicine rotation. During that rotation, I found that I was asking myself every day "When are we going to the OR?" And every day I was dismayed to remind myself that we weren't. It wasn't just for my benefit that I wanted to go to the OR. I wanted to take my patients there, and remove their diabetes or congestive heart failure the same way I could remove their appendix. I found it very frustrating that this was not an option.

One last realization helped convince me that general surgery is perfect for me: it involves a lot of physiology. Patients can get really interesting physiological derangements in the post-operative period. As a surgeon, I'll be treating people with electrolyte disturbances, hemodynamic instability, renal failure, and a whole host of other complications. I'll be able to put to use what I invested so much time and energy learning during the first two years of med school, and I'll be doing it within the framework of a specialty I enjoy for so many other reasons. I can't see myself doing anything else.