and the winner is...

So I'm 99% sure. Enough to have asked one of my favorite attendings to be my mentor. Enough to be declaring it here on this very page. No, I'm not going into surgery... That thought was considered seriously, but with far too much trepidation. Too many sacrifices would have to have been made, and frankly, I'm not sure I like the operating room. I just had a blast on trauma, and I sure admired the efficiency of a surgeon's mind.

No, I'm pretty sure that it is going to be Internal Medicine. After one month on IM wards, I have to say that there is nothing about it that has discouraged me so far. Yes, all my patients are really sick, and yes I've sent more people home on hospice in the last week then I have known to be on hospice in my entire life, but it's surprisingly not that depressing. Life is life; full of sickness and death, and in medicine, by confronting that every day, I'm finding that this reality is not shaking me at my fundemental core, as I was worried it would. It is still sad, it can still be overwhelming, but it is not consuming.

There are several things I like about medicine. For one, it reminds me of the Agatha Christie novels I used to read. There are always clues to look for and mysteries to solve. At the same time, it is not that subjective: there are fundemental, physical rules to follow -- almost like a complex mathematic equation. If you get to the end and the result doesn't make sense, you can usually retrace your steps and find the calculation error. I like how internal medicine makes my head feel at the end of the day: a bit swollen, but well exercised.

And then there are the patients. They come from all walks of life. Occasionally, I'll have a previously healthy patient pass through and exit quickly, like yesterday's thirty year old school teacher with a benign abdominal mass, but mostly, my patients are all very ill. Many are old, with stories to tell; others are young and unlucky. So far, I have been able to connect with all but one of them (he was dying and I could not bring myself to bother him every morning), and the connections have been wonderful.

For instance, I've had a grouchy old patient for the last few nights who was admitted for his third exacerbation of heart failure in two months. He refuses to take his heart medication because a pharmacist once mentioned that they were "strong" drugs. He knows his heart is weak and he is now convinced his drugs are too strong. I talk with him every day, trying to change his mind, pointing out that in fact, every time he is hospitalized he is being given those drugs and they help not hurt his heart. But he is a stubborn old man and he answers me with "You are not listening to me. It's the drugs I tell you; it's the drugs. My heart is too weak for them; you have to give me less." Whenever I come and visit him, he greets me with "Where's my food?" as if we'd been starving him for days, when in fact, he has likely just eaten...but he always smiles and says "Thank you dear for talking to me" when I leave. And though he can barely walk, last night he was found sitting at the nurse's station, reading his roomate's medical chart. He is quite a character, one who's mind I won't be able to change, and I'm OK with that. We'll make him better for a while, and that's not a bad thing.

One of my most memorable patients was one who I saw twice on my service. Once, during my first week on the wards, he was admitted for worsening leg and abdominal swelling secondary to his end stage liver disease. We were trying to get him on the transplant list, but there were complications that were postponing the process. We treated him for his symptoms, and sent him home. A week later he was back, for the same problems and the same treatment. During that time, we found out that the cancer he had been treated for years ago had metastasized to his belly, which meant that he could no longer be a candidate for transplant. I had to break the news to his family myself, and to him several times later again, as it took awhile for it to register. He talked about his feelings more than most men do, but he also somatosized a lot, and I knew he was having a hard day on those mornings when I would visit him and he would keep asking me to adjust his bed because he was uncomfortable. I got to see him go home on hospice on my last call night, and we had a good talk. I felt like I had made this brief period in his life better for him, and he helped me grow as a future doctor.

So internal medicine it's going to be. Don't ask what type, please! I'm done with stressing about that kind of stuff for a while.