An Open Letter to the Second Year Medical Students I Spoke to Today

Dear second year medical students,

Two years of training down and the biggest adventure is still ahead. Are you scared? Excited? Just relieved to be done with step 1?

Probably all of the above.

I don't know why they picked me to be here today, sitting on this panel talking to you. But I have something I think I should tell you.

My mother loves cleaning.

Stay with me now,

My mother loves cleaning, it gives her some sort of release, sense of control. I labor through it because I enjoy having a clean house but the moments in the middle of actually scrubbing things -- I loathe.

My fiance loves fixing broken cabinets or replacing drain pipes. I don't gain the satisfaction from picking out just the right size drill bit -- it's something I struggle through because whatever it is that needs to be fixed is too expensive to replace.

My father loves gardening. I can't keep a plant alive for more than a week. I achieve no satisfaction from picking homegrown tomatoes (I love eating them, though) or turning soil. The meditative intensity my father can bring to this, I did not inherit.

So cleaning, fixing, and gardening are mind numbing affairs for me, but I love to watch people who are excited by little things, love to hear them talk about their ability to change the oil in their car or spend hours carefully carving wood.

Why am I telling you this?

Because today, I I got to hear a lot of other fourth year medical students who will be starting radically different residencies talk about what it was that made them pick their path.

Strangely, each of them often identified something about their chosen specialty they loved that had put it firmly on my NO list. A soon to be ER resident talked about how he loved the excitement that came from not seeing the same patient twice and never knowing what you would get when you walked into the room. The guy going into psych discussed how he could spend hours talking about someone's deeper motivations for each action. A newly accepted peds resident told us how she loved seeing healthy children at outpatient clinics.

ER fell off my list because I couldn't stand not knowing the final piece of a puzzle -- I was the kid who read books all the way through to the end even if I didn't like them because I had to know what happened.

Psych was a no because I didn't have the patience to listen and listen and listen and really hear those little underlying pieces that drove someone's motivation.

Pediatricians spent too much time in outpatient clinics for me -- so many doctors love seeing healthy people to refresh them in the middle of their days full of the sick -- I find it tedious.

I realized that each and every thing I love about surgery makes someone else crazy.

I love the meticulousness of suturing together friable bowel or carefully dissecting away a tumor from blood vessels. For other people, this immensely slow work must make them want to pull their hair out.

I love the whole picture work in surgery moving from diagnosis to treatment to follow up but focused on a single problem. For others this is neuroticism or micro-focus ignoring the whole picture.

I love that in the OR the whole world goes away and there's nothing else but hands inside bellies or chests and your mind goes click, click, click solving problems and remembering the next step. But I know that for so many, this detachment is sickening or the procedural aspect of surgery is boring.

There are things innate in each of us in medicine that will draw us one way or another. Our mechanical inclinations or our endurance, our quietness or our scientific curiosity will pull us to a specialty that fits us.

I'm sitting here in front of 100 of you and there are some of  you who are probably very sure they know what they want to be. Some of you are probably still very confused about it.

Whether you think you know or all the possibilities are scattering out before you in terrifyingly different life paths, I want you to know that one day it will be there. It will feel like it always was. You'll realize you are a internist or a radiologist or maybe a surgeon. Maybe that moment will happen quickly in the rush of a trauma bay resuscitation or slowly in the breath of holding someone's hand as they cry. But it will happen.

The pieces of this idea are still coming together for me. They're nebulous and as you can probably tell from this letter they slip away from me as I try to tack them down with words.

I suppose I could tell you all that it goes like this:

Along with my obsession of watching other people do the things they love and being completely confused by their pleasure, I devour books about the nature of excellence and success in fields vastly different from mine. I love books about the training of Navy Seals or the discipline of ultra-marathon runners. The biographies of physicists who covered their walls in equations or musicians who played until their fingers bled fascinate me.

What I've realized is that we can train skill. No one is born a great pianist or a marathon runner or a Navy Seal.

Skill can be trained. 

Temperament cannot. 

I loved a great deal of the rotations I went through third year, I learned a lot from each one and you will too. But I didn't think like a neurologist, I could learn the pathways and find the lesion, but my brain didn't bend the right way. I didn't have the excitement at variety possessed by family practice docs even though I could learn about sports injuries and diabetes management or the right way to council someone about smoking cessation.

This was much how I felt as a child in dance, I could learn the steps. I could memorize the position of my feet and hands. I could dance. I just never had the temperament to be a great dancer.

And so time and time again when doctors said to me "you think like a surgeon", I listened.

I will not walk into residency day one and be a good surgeon -- I won't walk in and even be an okay surgeon. It still takes me too long to suture, the details of an Ivor Lewis procedure escape me, the dose of most antibiotics is something I have to google. But I honestly believe that I've picked the right path.

So, second year medical students, do not be afraid.

Because you'll walk into an OR one day and you'll have no idea what's happening between the surgeon's hands, but something will feel right. Or you'll be sitting in a clinic or staring down at slides in a pathology room and the quiet voice in your head will whisper to you: "yeah, this feels pretty damn good".

Take the pieces of yourself that are strange, that stick out at awkward angles, and find a place where those pieces make you feel perfectly at home.

Clinical years are hard. Not all days will be good days. Not all doctors or residents will be nice to you or even care you're in the room. Not all specialties will be your piece of cake (or pie).

But you will find that thing you love -- even if it's a thing someone else hates doing.

I'm going to end this letter, so I can go cook dinner now, (something my fiance hates doing because he never sees the satisfaction in perfectly salting a sauce, or the glee that comes from gaining the perfect sear on a piece of chicken -- but something I love).

Do not be afraid to take those steps toward something you love, no matter how little skill you have at it at first. If you feel at home there, chase after it.

Second year medical students, I hope that you will wake up one morning two years from now and know that you could never have done anything else.

With love,
Katharine