The growing divide

Yesterday, I briefly spoke with a friend who is on his surgical ICU rotation. They have overnight, 30+ hour call every third day. On the other two days, he comes in around 3am and leaves around 7pm. He's supposed to have 1 day off per week, but his resident told him straight out that the only way he could really impress the attending would be to come into work on his only day off. My friend needs to do well on this rotation, as he plans to be a surgeon, but despite his love of the specialty, he is having second thoughts about a lifestyle based on such malignant masochism which will continue at least another 5-7 years unabated. I couldn't see living like him, completely isolated from friends, family, and the rest of the outside world.

When I think about doing ER, I get excited about being trained to react to most major medical emergencies. To be able to intubate in the field, to set a broken leg, to stabilize a critical patient. But when I go down to the ER to pick up my patients, I want to leave. It's crowded, smells of old urine mixed with feces and blood. The staff is rushed, cynical and emotionally closed off, or disturbingly entertained by the failed human tragedies that get wheeled in every minute. The pressure to move fast leaves dehydrated patients without IVs or mildly agitated patients snowed with benzos so much that we are unable to talk to them for days. It is not difficult to understand why ER has some of the highest burnout rates.

When I think about outpatient medicine, I feel torn. Good and bad relationships with patients, days spent looking at people's feet and prescribing antibiotics, on top of a constant pressure to stay vigilant and not miss the hidden cancer or reversible illness in a limited amount of time.

When I talk to my friends who want to do family practice, radiology, or even ER, they can't understand why I would want to be in the hospital long day after day, trying to tune up my exacerbated heart failure patient who will likely overdose on meth the minute we discharge him from the hospital. They don't like the "lack of a cure" nature of internal medicine, the sick and complicated population. Many hate the hospital. None understand why I would work such long hours.

...So after three years of doing everything together, my friends and classmates are beginning to part. We are following our hopes, riding out our motivations, looking across the halls at each other in mixed awe and relief that we are not in each other's shoes.