Dearly Beloved You Guys:
I am struggling to keep up this blog. Clearly. In the past, I have declined to post because I have nothing to report, because I’m chugging away at a manuscript deadline or cramming for an exam, because my personal thoughts are quotidian. However for the past three months, the opposite has been true: so much has changed and in such remarkable ways that I never had the time to write it out.
For two months, I was on an in-patient internal medicine service: long and demanding days, very sick patients, many triumphs, a few heartbreaks both professionally and personally. I struggle to write clearly about it because I struggle to think clearly about it. Talk to a hundred doctors about their training and you likely will get a hundred different stories. Maybe more. The only thing physicians might agree upon regarding training is that it changes those who undergo it.
To me it feels as if medical training is changing me almost faster than my ability to perceive. Most notably, I have become largely unperturbed by suffering and death. It’s something of a surprise, and not entirely unwelcome. The father of modern internal medicine, Sir William Osler spoke at length about the young physician’s need to develop the quality of ‘aequanimitas,’ of being able to keep one’s self mentally and emotionally steady in the face of semi-chaotic situations and highly charged emotions. It is this quality I suppose (and hope) is beginning to affect how I see the world. This isn’t to say that I have achieved any great deal of aequanimitas; though having cared for patients with very poor prognoses before, over the past months, I for the first time witnessed death as it happens. For the first time, I made and delivered a terminal diagnosis. So long as I was wearing the white coat, so long I was in front of patients or physicians, I betrayed no sign of strain. But in the bottom of empty hospital stairwells, during 2am car rides home, in personal relationships, the cracks showed. Things fell apart. And yet…those most important were put back together. The service we provided in the hospital felt more important than the transitory distresses. These were the two most challenging months I have yet faced in medical school, but also the most rewarding.
The holidays were a welcome break, a chance to look back at 2011—the year my second novel came out, the year I began to truly develop a sense of what it means to be a clinician. Looking forward to 2012, I anticipate it being a pivotal year. Only surgery and OB-GYN remain of my required rotations. Thereafter, I’ll complete a few months of electives, select my future profession, and after a month of being a “sub-intern,” will very suddenly be done with medical school. In the time before I start residency, I will have to finish up the third and last novel on my current publishing contract. After turning in that manuscript will come the difficult decision of what I am to write next. Another fantasy? Something about disability? About medicine? All three?
In short, this year I will have to define myself as a physician and redefine myself as an author. But thankfully, things won’t be all work and tough decisions. In fact, I’m excited to announce that I’ll making three authorial appearances across the country in the coming months. (See the events blog post shortly after this one.) So while San Francisco is more likely to see snow in the coming months than I am likely to blog turning my surgery rotation, I will hope to see you in the spring.