Psychic Travels

So it turns out I'm not the first person to want to leave medicine!  Or even to write about it!  Wayyyyyyyyy back in 1988 (yes, that's sarcasm, although when I do the math, it's been 24 years and that makes me feel old), Michael Crichton (yes, him again) wrote a book called Travels. In it, he describes his extensive travels around the globe, mostly to lesser-trodden locales.  He details the self-insight and life lessons each journey teaches him, but he begins the book with a description of his four years in medical school. 

This book was recommended to me by my wonderful career-change coach, and at first I wasn't sure why.  Sure, I love to travel and MC has traveled to some amazing places.  He also describes his journeys on the spiritual plane - from psychic readings to astral projection to meditating in the desert, talking to a cactus for two weeks!  Initially, I wasn't really sure why he chose to begin his book with his med school days, since it doesn't really match up with the rest of the book, but he eventually spells it out - if he hadn't changed careers, if he had stayed in medicine, he might not have been forced into the sort of change that lays the track for all kinds of other life-changing experiences. 

MC started out as an English major, but found the English department at Harvard to be less than pleasant.  He switched to anthropology, and took some premed courses, "just in case".  He found the pre-med world to be quite different from the rest of Harvard, where people were less caught up in grades, and more eager for the learning experience in general.  In pre-med courses, he stepped "into a different world - nasty and competitive".  People would sabotage their classmates without a second thought - we called those people "gunners" by the time I went to med school.  No thought or consideration for anything but their own success.

He makes a couple comments that I found laugh-out-loud funny.  The first, regarding the gunners who gave out wrong answers to classmates who asked for help in his chemistry class and who sabotaged his lab experiments so he would start fires: "I was uncomfortable with the hostile and paranoid attitude this course demanded for success.  I thought that a humane profession like medicine ought to encourage other values in its candidates.  But nobody was asking my opinion."  How could I have found this LOL-funny?  Because it's true...  A quarter of a century later, medicine is still encouraging hostile, inhumane behaviour.  Not overtly, of course, and I do believe that things have improved.  My medical school had very few gunners, and overall was a pretty supportive place.  We were encouraged to explore our humanity, and we even had a humanities requirement in the curriculum (my favorite course - Red Flag #382 for my clinical career).  But I believe that the training, particularly by the time one gets to residency, beats most, if not all, of the humanity out of one. MC describes, "This... seemed more like hazing, like a professional initiation, than education."  I had to hunker down to get through it, and that hunkering down necessitated a complete absence of work on my inner self and created a version of myself that I really didn't like.

He continues, "I got through it as best I could.  I imagined medicine to be a caring profession, and a scientific one as well.  It was so fast-moving that its practitioners could not afford to be dogmatic; they would be flexible and open-minded."  Ha, ha.  Very funny, MC.  I am priveleged to know a lot of physicians who are wonderful people, caring as well as scientifically smart.  But I also know a lot of the other kind...  I will say that I believe that med schools today are trying to create more of the former, but unfortunately the profession does attract a fair number of the latter.  MC elaborates, "I learned that the best doctors found a middle position where they were neither overwhelmed by their feelings nor estranged from them.  That was the most difficult position of all, and the precise balance - neither too detached nor too caring - was something few learned...
 "It was certainly interesting work, and there was no doubt that you were doing something worthwhile with your life, helping sick people." This is true.  Medicine was, and is, an incredibly worthwhile profession, and it can be a very rewarding one as well. 

He goes on to tell some anecdotes about his pre-clinical and clinical training.  He explores the development of the gallows humor that anyone who deals with illness and death on a daily basis develops to some extent.  He describes the apalling behaviour of residents and attendings with whom he interacts, and his struggles with some patients.  He develops a theory of illness that requires that people take ownership of and responsibility for their mental and physical health.  He quits medicine.

MC tried four different times to quit medical school.  At the time, he was required to meet with a psychiatrist before he could quit.  The psychiatrist talked him into continuing every time, basically telling him he hadn't gotten yet to the part he wouldn't hate.  The psychiatrist did this each of the first three years of med school, then finally gave up the ghost, saying "I thought you would quit in the end".  MC finished out his four years, then quit medicine before ever becoming licensed or practicing.  Here's where my experience differed.  I actually enjoyed the classroom aspect of medical school, and I enjoyed many of my clinical rotations.  I still had (a little) time to devote to outside pursuits (reading, dancing).  The rotations I didn't enjoy were the ones that impinged the most on my outside life, or that were extremely stressful.  Red Flag #936. 

Now, MC had a backup.  He was already making money as an author during medical school.  He quit to become a writer, and he was already somewhat established by the time he gave up medicine.  He also had a tool with which to meet the naysayers when he publicized his decision to quit medicine.  "In quitting, I was following my instincts; I was doing what I really wanted to do.  But most people saw only that I was giving up a lot of prestige...They admired my determination, but they thought I was pretty unrealistic."  Hmmmm, sounds familiar.  MC, though, had written a little thing called The Andromeda Strain which was about to become a movie.  Once it was known he was a successful writer, people got off his back.  "All the doctors and residents who had shunned me became suddenly interested in me."

I have no Andromeda Strain in my back pocket.  I've got this blog, I'm working on a website, and I'm doing some medical editing and writing on a freelance basis.  My future best-seller of a book (think positive!) is still a mass of unorganized, unedited words on my computer.  But I do have one thing in common with Dr. Crichton:  I am following my instincts and walking away from an unhappy life, forward into the great unknown.  Cheers!

Sick of Being Sick

I've had an annoying, nagging cough for the last couple of weeks.  I never got really sick, but I'm sure taking my time getting better...  Before leaving medicine, I would have ignored it and plowed ahead with my busy life.  Now, I wonder what my body is trying to tell me...  Sometimes a cough is just a cough, but let's back up here to a little object lesson in psychosomatics...

I felt like I was sick all the time in residency.  I had been ill here and there in medical school – the worst was on my Pediatrics rotation.  All those little kids sucking on your stethoscope and coughing in your face will give you the flu like nobody’s business, I don’t care how many flu shots you get.  But in residency it got truly ridiculous.  Serotonin levels were down and cortisol was through the roof!  I was always getting the cold-of-the-moment, and when I wasn’t sick, I was feeling ill.  I often had stomach upset and general malaise.  Occasionally, more concrete abdominal pain.  Too bad I couldn’t see that it was probably psychic, not physical.  My body knew I was on the wrong path, even if my consciousness hadn't yet gotten the message.  But I didn’t pay attention, and continued on to graduation.  No surprise, it continued after I finished residency and began practicing out in the real world.  Yes, of course, when you see sick people for a living, you’re bound to get sick once in a while.  All the hand-washing in the world can’t save you from that cold or flu virus when it’s all over the hospital or your office.   But it’s not just that.  Working crazy hours compromises the immune system and raises cortisol levels.  The body is so stressed, it can’t muster the energy to fight off anything else, so you get sick.  But it's not just that, either. 

When you’ve stuffed down all of the emotions and inner voices that are crying out at you to make a change (you must suppress these in order to do what you do), they're going to come out physically. That's what psychosomatic means, although any good physician knows that only happens to other people, right?  I saw patients all the time who would come into the OB triage unit with vague complaints of dizziness or non-specific abdominal pain.  Often, there was something going on at home – either domestic violence or just being ignored on a Friday night.  They wanted a little attention, and a physical complaint was a "valid" way to get it.  I could recognize it in my patients, but couldn’t see my own “I don’t feel well” status as Red Flag #256.  Zero Insight Girl, that was me!

By the last year I was practicing, I was breaking out in angry, painful red welts under my arms each time I had a call shift.  I thought it must be the surgical scrubs, so I would take hospital scrubs home to launder them in my own detergent.  I saw my dermatologist who tested for allergies - all negative.  It took seven courses of antibiotics and a few rounds of topical steroids to calm  my skin before my wedding day.  I also took six weeks off work before the wedding, both allowing my skin to heal and because I felt I needed that time off to be a sane person on my wedding day (Red Flag #257, there you go!  If you need that much time off to feel and look like a normal person, something is wrong with your working situation).  Maybe it truly was a bacterial infection, but I think it had not a little to do with stress and something in me screaming out to be heard – if you won’t listen to me, I’ll give you physical symptoms so you have to pay attention! 

The thing is, that only works if you are tuned into it.  Otherwise it just leads to more denial, and an outward focus on the physical symptoms.  They at least detract your attention from the inner turmoil, and give you something upon which to blame your misery.  They will only heal, however, if you learn to dig out the real issues and deal with them.  Since this is both difficult and scary, most people choose never to go there.  I was not exactly raised to embrace my emotions, so allowing myself to feel them was terrifying, and it took a few years - this is certainly not something that happened overnight.  Once I started paying attention, however, there was no going back.  Luckily, by the time the outbreaks started, I already knew I was on my way out of medicine.  That didn't stop my body from trying to reinforce the message.  "What do you mean, you're giving six months notice?  Are you crazy?  You need to get out now!" 

And since I quit?  Clear skin and clear skies...  except for that stupid cough.

Coming Out

Today, I proudly present my first guest blogger, Rob Baginski MD.  I spotted this post on a website dedicated to physicians contemplating career change, and it really resonated with me.  I had struggled (and still do) with how and when to tell the people in my life that I am no longer a practicing doctor.  I hadn't thought about the comparisons to "coming out" until I read it here, and it's spot-on!  How will my parents react?  What will my friends think of me?  Read on, my friends, for Rob's words of wisdom, and feel free to pour a glass of wine whilst you peruse....
 

Telling Mom

So, I want to change careers. More specifically, I would like to change my career from that of a clinical, emergency department physician to that of… well, something non-clinical. I suppose the exact “what” has yet to be determined. I must say, the process is a daunting one, fraught with worries about what it is that I wish to do, what it is that I am qualified to do, how I can afford to leave clinical medicine, how to break into a new field, and many, many others. Nevertheless, a conversation with my mother the other day added yet one more concern, one more stressor to the list.

Now, as many of you who have or have had mothers in the past know, there is almost nothing in this universe that cannot be made more stressful by a conversation with her. There is something inherently anxiety-producing in getting helpful advice from the woman who bore and raised you. In this case, we were talking quite nicely about day-to-day things when I casually mentioned that I was speaking later that afternoon to my career counselor. There was a pause, and she asked, “Why, honey, are you speaking to a career counselor?”

I sighed, as we had discussed my desire to leave clinical medicine several times in the past.

“She is helping me figure out how to leave the ER, Mom. You know I’ve been wanting to get out of the ER for a while now.”

“Oh, sweetheart. You know you love the ER. You’re just confused right now. Give it time, and you will realize you want to stay there after all.”

And then she let drop the phrase that stunned me.

“You just haven’t found the right ER yet.”

It was then that I realized that I had to come out.

No, I am not talking about coming out as gay. I’m talking about telling the people around me, my family and friends, about my life choice to leave clinical medicine. I didn’t realize how my choice would affect them and how they see me. Like telling people about sexual orientation, revealing a dissatisfaction with “being a doctor” can be shocking to people who see you in a certain way. They now have to see you as a person who is unhappy at work, who has other dreams or aspirations other than medicine, and who is not fulfilled in a career that American society has somehow glorified and idolized. Therefore, I need to come out… again.

My mother’s words struck a chord that pulled me back 15 years ago. How many gay men and women have told their parents that they were homosexual only to be told, “You just haven’t found the right girl/boy yet.”

Well, it has been 10 years, and I still haven’t found the right ER. And, Mom, it isn’t that I haven’t tried. Believe me. I have dated around. I have tried small community ERs and large, city ones. I have flirted with urgent care centers. I have tried long-term relationships where I have stayed with one ER for years, and I have experimented with short-term, per diem trysts. None of them have satisfied me. As much as I want it to work out, whenever I am in the ER, I can’t help but fantasize about something else. Something more satisfying. I have to admit that I have desires that the ER cannot satisfy. I need something different, something more.

Now, I’m sure my mother doesn’t want to hear this. Coming out can be difficult not only for the person but also for his or her loved ones. For some reason, becoming a doctor has taken on a certain mystique, sort of like becoming a priest. Once you are a doctor, you are always a doctor, at least in many people’s eyes. Asking those around me, in particular my parents, to alter that perception of me is not easy. I understand that it will take time for my mother to adjust to this new reality. I also understand that this transition may be aided by her two close friends, Chardonnay and Pinot Grigio.

Coming out for a parent also affects how she interacts with people outside of our relationship. One of the time honored perqs of having a physician for a child is bragging about this to your friends who preferably have children who have failed out of beauty school or who have become roadies for the local Grateful Dead cover band. For my mother to confess to her book club that I have decided to leave medicine must be akin to telling them that I am leaving my beautiful, blonde, real-estate agent wife and 3 adorable children for a drag queen named Miss Kitty Litter. I can hear the conversation now:

“Mimi, how is that doctor son of yours doing?”

There is an awkward pause.

“Well,” Mom hesitantly begins. “He has decided to leave medicine.”

There is a shocked silence. But now that the confession has been uttered the dam has broken, and she tells all.

“He says he doesn’t feel happy as a doctor. He wants to quit and become… Oh, I don’t know, a… a…”

“A what?”

“A marine biologist!”

There are gasps of horror all around. Chardonnay is spilled on dog eared copies of “The Bridges of Madison County.” Finally, someone takes my mother’s hand and whispers..

“Don’t worry, Mimi. Don’t worry. I’m sure it is only a phase.”

And with that the coming out comparison is complete.

So, with my career transition in its beginning phases, I have come to understand that this decision doesn’t just affect me. It is something that touches my family, my friends, and my spouse. It is something that, while necessary, is a life-changing event for not only me, but for those who care about me. Nevertheless, I will forge on. I know that, no matter how difficult it may be, this change is for the good and that I, and those around me, will be the better for it. It is, therefore, with confidence and no small amount of pride that I proclaim:

“I’m here! I want to change my career! Get used to it!”



BIO: Rob Baginski is an emergency medicine physician in Massachusetts who is in the beginning stages of transitioning to a non-clinical career. He lives in Rhode Island with his husband and a spoiled dog who doesn’t care what he does with his life as long as there is enough time for belly rubs and an ample supply of Milkbones.