How is the Fellowship Going?

Going into fellowship has been one of the most humbling things i've experienced in my life.  It stripped all the facades i had built up over the last five years bare and exposed my glorious ignorance for all to see.

In all honesty, i thought i was a good hospitalist.  And maybe i was, which was the problem.  In five short years, i had mastered the ability to expedite a hospital stay (maximizing DRGs) and had memorized enough time-tested spiels to guarantee patient satisfaction.  I could come in at 8am, round on 16 patients, discharge 3 before lunch and admit 2 after, and still be at the gym to do a few miles on the treadmill by 5pm.  Unfortunately, in the pursuit of efficiency, i had allowed much of my deep medical knowledge and critical thinking skills to atrophy.

The first few weeks were an eye-opener.  As i pored through the books and papers that comprised my chosen specialty, i realized that a lot of what i had known in residency (and even medical school) i had already forgotten, and whatever had come out in the past few years, i had not kept abreast of.  It was basic stuff, but i had stopped paying attention because i had learned to distill it down to "what is the most important thing i have to know to improve my throughput?"  My mediocrity was laid bare; everything i had consulted a pulmonologist and intensivist for in the past, i was being consulted for myself... with me having only a rudimentary idea of what i needed to do.  My biggest shame was that i didn't even know how to read a chest x-ray anymore; for the past five years, my chosen method of "reading" an x-ray was to pick up the phone and ask the radiologist on-call what he saw.  I felt like an idiot, like an impostor pretending to know medicine when all i was good for was asking others for help.  The only point in my career when i felt lower was when i had just started out as an intern.  I considered quitting and going back to my old "cushy" job more than a few times because i wasn't good enough for a subspecialty.  But i slogged and putzed my way through.

Things are a little bit better now that i have a whole year under my belt.  I've read more journal articles and book chapters in the past twelve months that i have in the past eight years (yes, including residency).  I can now interpret chest imaging without talking to a radiologist.  I can translate PFTs into their appropriate clinical correlations.  I can discuss most lung diseases from physiology to the latest treatment options.  I can (almost) put lines in with my eyes closed and do a decent diagnostic bronchoscopy without getting huffed at for poor technique.  While i still feel moronic most days, "most days" has come down from 90% to around 60%.  Of course i still make mistakes, and i'm deathly afraid that my errors will cost (or have already cost) someone their life.  So i work hard to fill in the gaps in my knowledge and correct my bad behaviors.

Most importantly, my fellowship is not all about hardship and self-loathing anymore.  Ultimately, despite all of my perceived difficulty, i am on the whole enjoying myself.  I love learning about things, be it "old news" (such as the Fletcher-Peto curve from 1977) or "hot-off-the-press" stuff like edoxaban for PE.  I am tired and chronically sleep-deprived almost all the time from all the hard work and studying, but when my brain and my body are running on all cylinders, that's when i feel like i'm truly applying myself, like i'm doing what i was built to do.  And i am loving it.

So, how is the fellowship going?

In a word: good.

Love and Whatnot, Part 5

I have never been able to make any sense of these two statements:

1. "Live your own life, make your own money, and travel," and

2. "Collect before you select." 

The first is a mantra that older women pass on to their younger counterparts when they start having significant others.  The point (i presume) being - that the girl should stay single and not allow herself to be tied down so she can do her own thing and be happy.  Whether or not "travel" implicitly includes having naughty relations with various men from other countries (oooh, those sensuous Frenchmen) is beyond me. 

The second declaration is much like the first, although applicable to both boys and girls; that is, that you should "shop around" and date people of different shapes, sizes, and dispositions so that you're exposed to the whole spectrum of relationships before you decide what's best for you.  After all, it's impossible to know that you're "meant for" somebody if you haven't even tried the competition yet. 

Well -

Half my lifetime ago, when my girlfriend and i first got together, naysayers left and right tried to blast the idea to bits.  Different permutations of the above statements were thrown around and psychological warfare was declared.  Essentially, we were told (and compelled in not-so-subtle ways) to cease and desist.  The underpinning philosophy was that fourteen-year-old kids are not expected to understand their budding emotions, that it was easy to mistake a crush for True Love, etc. - essentially, that we were doing THE WRONG THING. 

Of course, being the antipatiko that i am, i brushed them off my shoulder (not enough room for both them and that big chip there) and did things my own way.  Making the long story short: although it was not a straight shot from there to here, my girlfriend and i stayed together through thick and thin, went against the "wisdom" of our elders, and never got it on with other people. 

The end result?  Now we're happily married.  

Before we got together, we seldom used to go out (no interest, no money).  Then we became an item and the whole world just came ALIVE; we started going out at night, discovered strange food in out-of-the-way restaurants (including turo-turo), watched plays and movies (we're not much for clubbing) and just overall had a grand old time. 

When we were single, we never used to travel for pleasure (too much work, not enough inclination).  Now we plan vacations together and explore every nook and cranny of this strange and wonderful world hand-in-hand. 

Back when i was much, much younger, i mused about the future with a sense of impending doom, wondering what the days ahead would bring.  Now i look forward to living and loving every single day with my wife and One True Love, flying off and disappearing into the wild blue yonder. 

There is no solitary way to live a life; no simple declaration that can teach you how to conduct relationships, no single piece of all-encompassing advice that can guarantee happiness.  No one should be able to force-feed a cliche down your throat and tell you that this is the way it should be!  We've spent half our lives proving that.  Still, there will be cynics out there who will look at my marriage with disdain and say that i settled too early, that i should have looked around more, that i don't know what i'm missing because i boxed myself in.   

But somehow, lying beside my wife at night, watching her sleep and feeling a little firecracker of love go off in my heart whenever i think of our lives together and all the days, weeks, and years we have left to spend with each other - i know i was right.