Picking among disciplines
by Lorien E. Menhennett
“What do you want to be when you grow up?” It’s a common question throughout childhood. It comes from teachers and parents. It’s also a question we ask of ourselves. We dream into adulthood, trying on different career costumes, imagining what could be.
My own sense is that the question is in constant evolution. It can’t be definitively answered after high school, college, or even graduate school. Few people in this era complete a career with the same company. Each new promotion, each new employer, provide further clues into our professional identity.
When I decided to go to medical school after a career in journalism and publishing, I turned over a radically new leaf. I handed in my pen for a penlight, political sleuthing for a stethoscope.
Could I have imagined such a change in course when I first thought about my future? No.
As I approach the start of my fourth and final year of medical school, the original childhood question takes a far more specific turn: What kind of doctor do I want to be?
It’s pondered endlessly, ad nauseam, at times to the point of true nausea. As in childhood, my reply to the medical school version of the question has changed over time.
For as long as I can remember, I’ve made things with my hands, from beaded necklaces to stained glass windows to origami flower bouquets. So I initially pictured myself in a procedural specialty, something surgical, making the most of my manual dexterity. But I quickly realized that I much preferred waking patients to those under anesthesia. I also realized that the reporter in me craved stories, conversation.
In the context of my career history, filled with interviews and human contact, my chosen field — psychiatry — makes obvious sense. Admittedly it wasn’t the choice I’d imagined when I began medical school. In fact, it was among the fields I thought I wouldn’t choose.
But in a way, psychiatry chose me.
Before starting my psychiatry rotation, I’d rotated through obstetrics-gynecology and primary care (outpatient adult medicine). I’d loved aspects of each. In the ob-gyn segment, it was my two weeks on the labor and delivery service. Holding the hand of a mother-to-be, counting with her as she pushed out a new life. Talking, in between pushes, with her and whomever was there to support her (husband, partner, mother, sister, friend) about their hopes, dreams, and fears. During primary care, it was sensing the trust that patients put in their internist, who’d known many of them for years, knew their life stories and struggles as well as their medical diagnoses.
Not long into my psychiatry clerkship, I realized that in this one field, I could experience my favorite parts of my time in ob-gyn and primary care. I could talk about a patient’s hopes, dreams, and fears as well as develop ongoing relationships with them.
I could also use many of the skills I’d honed in my decade-long career before medical school. Psychiatry, like journalism, is about stories. It’s about developing quick rapport, asking the right questions, and being an active, empathetic listener. These skills are certainly not unique to psychiatry, but they are especially important in psychiatry, where a detail from the patient’s medical history, past hospitalizations, relationships, or living situation might be crucial to how you manage the person’s care. This background suddenly takes on immense importance because of the way past experiences shape mental health.
There is also an investigative aspect to psychiatry. One of the tasks frequently given to medical students on the psychiatry clerkship is to track down so-called “collateral” on a patient – to talk to a person’s medical doctor, therapist, psychiatrist, case worker, significant other, sibling, parent, or friend – to get a more complete picture of the person’s immediate situation. In psychiatry, as in journalism, you don’t rely on the story you get from one person. You approach information with healthy skepticism. And so you gather evidence from a number of sources and put the pieces together yourself.
Each field of medicine also has a vibe, a unique personality. Part of finding your place, I realized early on during my clerkship year, is finding your tribe. In psychiatry, I did. I found people whose personalities, interests, goals, sense of humor, wardrobe choices, and even favorite eyeliner color meshed with my own.
After completing my psychiatry clerkship, I was almost sure that I wanted to be a psychiatrist. After finishing other rotations, I’m entirely sure. Because the things I liked best about each of them also have a place in psychiatry. In neurology, my favorite patients were those whose illnesses blurred the lines between neurology and psychiatry. In surgery, I thrived under the tutelage of a particular trauma surgeon, one of the best educators I’ve ever met. He inspired me, on a daily basis, to learn and explore, to be curious. I’ve found mentors in psychiatry who do the same, and I find psychiatry’s subject matter inherently interesting in a way surgery concepts were not. In internal medicine, I liked the challenge of using artful communication skills to broach difficult subjects with patients and family members. I also felt at home in the role of being a comforter to those in distress.
While I’ve answered the next iteration in this serial question – “What do you want to be when you grow up?” – my future is by no means fully defined. First of all, where do I want to do my four-year psychiatry residency? And after that, do I want to do a fellowship for more advanced and focused training? Do I want to work with inpatients, outpatients, or a mix? What city do I want to practice in? I’ll find the answers to these questions and others, in time.
For now, I focus on what’s in front of me: finishing medical school, and finding the right place for me to become the best psychiatrist I can be.