Everyone has his own specific vocation or mission in life; everyone must carry out a concrete assignment that demands fulfillment. Therein he cannot be replaced, nor can his life be repeated, thus, everyone’s task is unique as his specific opportunity to implement it.
-Viktor E. Frankl, Man’s Search for Meaning
This past Thursday I received my match assignment for residency, solidifying my future spot in UCLA’s psychiatry program and giving meaning to the past four years of toiling that went into earning my M.D. The process was brutal. The medical school experience is no doubt unique to the individual, and some students adjust better than others to the frustrating experience of having absolutely no control over your life or daily activities. For me, there was something about being constantly exhausted, hungry and demeaned by my superiors that turned a pretty enthusiastic incoming student into to a slightly more cynical and disheartened graduate. That being said, I am extremely grateful for a few things:
One, being two months shy of not being a medical student anymore (hallelujah!),
Two, matching at UCLA, my first choice program for residency and arguably the best program on the west coast, and
Three, having had the good fortune to discover my own vocation and mission in life within the field of psychiatry. Let me explain why it was difficult to arrive to this point.
Shortly after I decided I wanted to be a doctor (before the age of ten), I thought I wanted to become a surgeon. I distinctly remember doing a career report in seventh grade on neurosurgery. I don’t know what leads an eleven-year-old to pinpoint on neurosurgery with such laser-beam focus, but there I was, constructing pie charts and tables on the training process and neatly illustrating a scalpel pointed at a brain for the cover of my file folder (I got an A on the report, by the way).
In the process of preparing this report, I interviewed the chief resident of neurosurgery at Stanford and discovered she worked 18-hour days and saw her husband an average of twice a week. Not being a complete masochist, I dropped neurosurgery and began to consider plastic surgery as a future career. I actually spent most of my young adult life nearly certain I would go into plastic surgery. When I eventually changed gears, it was much to the disappointment of my future clients- friends, family, family friends, etc.- who had been lining up for years, patiently waiting for me to finish my training be able to do their nose jobs and tummy tucks.
By the time I entered medical school, I was fairly set on the field of urology. Despite what you may be thinking, urology is a phenomenal surgical specialty with many opportunities for women that I would highly recommend to any young surgeon wanna-be. I was inspired by my cousin, a private practice urologist in Los Angeles, who dazzled me with stories of relatively normal hours, ample time to spend with family, and meaningful service to patients.
The problem is, I spent so many years thinking surgery was such a great fit for me that when I was presented with evidence to the contrary I didn’t know how to process it. Within days of starting my third year surgery clerkship I knew I hated it. I loathed the early mornings and long days, the often arrogant and malignant personalities (at least in general surgery), and the algorithmic and predictable nature of the procedures. I could have cared less about reading the latest article on Lovenox dosing post-hip replacement surgery, or asking a patient with suspected small bowel obstruction if he had passed gas for the fifth time at 3am. I saw no imagination or creativity in surgery. The surgeons were no doubt bright and technically skilled, but to me they also seemed like glorified mechanics.
I was so focused on the idea of becoming a surgeon, though, and had spent so many years planning for this career, that it took me months after my disappointing surgery clerkship to even consider I didn’t have to continue on the same path. My feet were already too deeply rutted in.
For months I kept in the same direction. I scheduled my fourth year urology clerkships. I met with advisors to plan my application strategy. I researched programs. All the while, I had this underlying feeling of anxiety that something wasn’t right. Picturing my future in residency elicited a sense of dread. My pulse would quicken, my breath would become shallow, and my hand would immediately reach to nervously twirl my hair. The anxiety was palpable.
So where did psychiatry fit in? Well, I had always played with the idea of going into psychiatry. I was a psychology major in undergrad and my father is a psychiatrist. Nearly every book I read for fun relates to psychiatry or psychology. But the idea was almost an indulgence, like, “if I went into psychiatry I wouldn’t have to wake up at 4am” and “psychiatrists don’t throw scalpels at me in the O.R.” It was a nice thought, but I never believed I’d actually go through with it.
In retrospect, during those months that followed my surgery clerkship I externally clung to the idea of going into surgery while internally letting go. I was slowly and subconsciously processing the possibility that all my years of surgery-talk might have been for naught. It’s like the story where Ernest Hemingway describes how a man lost all his money “the usual way: slowly, and then all at once.” You could say the same of how I changed switched fields.
The all-at-once happened over lunch with one of my classmates. It was toward the end of my third year, and I was listening to him talk about why he had recently decided to switch from orthopedic surgery to family medicine. As I listened to his rationale- how family medicine physicians were the launch points to other specialties, and how this strategic position would allow him to pursue his business dream of building a multifaceted clinic-of-the-future- my own wheels started turning. I realized that the passion you have for your work is far more important than what someone tells you about the salary, lifestyle or prestige factor. There are no limits to what you can do within your field, only limits to your own creativity. Surgery would have just been my job, while psychiatry is now my vocation.
I love that so many aspects of psychiatry are undefined. I once heard a resident say, “In neurology you diagnose everything but treat nothing; in psychiatry you diagnose nothing but treat everything.” There is definitely some truth to the joke. The diagnoses, while useful categories, are artificial constructs. The mechanisms of the treatments are not fully understood. Because of this, psychiatry is not algorithmic, but imaginative. It is not confined, but boundless. And to me, it is far more interesting and meaningful to alleviate suffering though reconstructing the mind than through fixing the mechanics of the body.
The PsychoSphere is a place to theorize, create, invent and reflect about anything and everything related to psychiatry, psychology, mental health, mental illness, spirituality and self-help. Contact me with any topics you’d like to see covered, and feel free to comment if something interests you, confuses you, or pisses you off. Looking forward to it.
Ricardo Postemski says
This is an excellent post and may be one that you should followed up to see how things go
A mate e-mailed this link the other day and I am excitedly anticipating your next post. Keep on on the amazing work.
Elana Miller says
Thanks so much for the comment… I’ve been so busy with residency I haven’t had a chance to write much lately, but hopefully I’ll get a chance to put something good up soon!
Ettie Shurack says
Couldn’t help but laugh out loud when I read that as a 10 year old you wanted to become a neurosurgeon. That was ME at the same age. I wanted to be a doctor (and more specifically, a neurosurgeon of course) all the way through high school, and my first two years of undergrad I took biochem and all the premed courses. Long story short, I got married, evaluated what I wanted into life and how I thought I could make the most impact on the world given my strengths and talents, and went into social work, and am finishing my thesis hopefully in a couple months. I came to your website through a link my friend sent me about your recent article about being diagnosed with cancer. I just wanted to wish you all the best, a complete & speedy healing, as we say in Hebrew a refuah shelaima! Hugs!!!
I think you’ve got a great angle going on here… combining all the best stuff and leaving out all the flummery.
I sometimes get frustrated with people in healthcare, such as my general practitioner, my surgeon, etc.
General practitioners are generally the worst. Let’s say I visit him and I tell him I have a sneaking suspicion my headaches are caused by too much coffee…
He just flat out denies it right on the spot. Then I drop my coffee habit, and a week later my headaches have all but disappeared.
Why don’t these guys want to listen? And why do none of them ever recommend meditation rather than medication?
A gal’s gotta use her common sense this day and age. Too many health workers are stuck in a one dimensional tunnel of treatments, if you know what I mean.