Days of Daze

I only recently met with the man who will write my Dean's Letter¹.

I'm dazed. I'm tired. I'm fighting this fog of exhaustion, and I feel like I've lost my way. Having to think about applying for residency turns my stomach. It means writing personal statements, and exposing your blemishes for all to see. Perhaps it's my perception, but it's always my shortcomings that seem to stand out, muting whatever good things that may be in my portfolio. Instead of comments like "Wow, nice job with the research and publications and clinical performance" I get "Hmmm, well, couldn't you have honored this clerkship? You should schedule some external rotations next year. Are you really happy with that board score?"

I wonder how much of my angst is me just being tired of trying to climb the academic ladder. I've been at this large university medical institution for almost a decade and before that I was at NIH, an even larger medical institution, so I've have quite a level of comfort being at these places. At the same time, I'm kind of sick of the idea, and I'm thinking seriously of just going into primary care and waving goodbye to academia².

And what, pray tell, am I supposed to say when I start hitting the interview circuit? I spent five years in graduate school, and having to still sell the line about academia is such a tiresome thought. And that strategy about being yourself? I think that's true to an extent, but being too honest at this point can only hurt - can you imagine hearing the following from someone applying for a residency spot in your program?

"Nah, screw academics. I'm tired and burnt out - there's nothing worse than the thought of spending the rest of my life hanging around a place like this."

See? Refreshingly honest, but not exactly endearing.

There's also the possibility that my exhaustian is somehow a manifestation of me being quite lost at the moment. I haven't yet decided what I want to do with myself. I liked pretty much all of the third year clerkships, meaning I haven't chosen yet. Here are the rotations in the order of my third-year schedule:

1. Psychiatry - I enjoyed it, and as much as I enjoyed talking with patients, it just doesn't feel like practicing medicine. Yeah yeah, you can order a couple tests here and there, prescribe some drugs, but in general, I would find it relatively unfulfilling.
2. Medicine - aka "Mental Masturbation." Talking to the patient and getting the diagnosis is fun. Treating them can be gratifying, but it can also be infuriating, especially in this day and age of diabetes and heart failure where you're just managing the illness and slowing the progression of whatever disease they have. The endless morning rounds can be really painful, but Medicine offers quite a few options for career choices.
3. Family Medicine - Much like medicine, but a little less emphasis on hospital work, more outpatient medicine. Basically, you take care of patients 'From Birth 'til Death'. Not a bad option, although spending so much time in the office could potentially drive me crazy. But I'm weighing that against the fact that apparently I'm really allergic to hospitals.
4. Pediatrics - Medicine, except for little people. Loved it. Not certain I want to make a career of it. I's not like there's a shortage of pediatricians out there, and, like family practitioners, it's a tough living salary-wise.
5. Surgery - I enjoyed surgery, I could think like these guys. But the early start to the day (surgeons are slicing someone open when the rest of the world is brewing their morning coffee) combined with a diminished relationship with the patient is quite the deterrent for me. You have to love the procedures more than you do the patients.
6. OB/GYN - I actually haven't done my OB clerkship yet. I'm anticipating the worst.

So...I'm pretty where I was last week, last month, last year. I have no idea what I'm going to do next.

1 Fourth year of medical school is mainly about getting more clinical experience and applying to medical residency programs. The Dean's Letter is basically an advocacy letter written by a faculty member, who focuses on the student's strengths whether it be academic record, research experience, physique, hairstyle, or manner of dress.

2 For further thoughts on being in academia, see oh, any one of my previous postings on my experiences during graduate school.