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.

Shifting Back into Gear

And so the final chapter begins.

Late last year, a convergence of circumstances jarred me out of the complacency i'd been lulled into since graduating from residency.  Life was good - and would probably continue to be so for the foreseeable future - but it was time to move on.  So i decided to try my hand at getting into a Pulmonary Critical Care Medicine (PCCM) fellowship.

My friends know that i haven't always wanted to do PCCM.  For most of my medical career, i wanted to do Hematology.  But after some soul-searching and re-examination of priorities/aptitudes/interests/skillsets, i realized that what i truly want to do is down-in-the-trenches, hands-on hyperacute internal medicine founded on a solid, procedurally-inclined subspecialty base.  PCCM FTW!

(This is not without precedent, as i had spent most of my medical school wanting to do Trauma Surgery, which i ultimately decided wasn't all that i thought it would be.)

The beginning of the process was laced with hubris.  I thought i was prime beef, the shiznit.  But as the months dragged on and the response rate to my application turned out to be considerably less than overwhelming, i began to fill with quiet despair.  At some point i decided to keep my intentions under wraps, mainly to avoid embarrassment if i didn't get in anywhere.  Not that my self-esteem is extremely fragile, but i didn't want to have to explain/speculate why i didn't match over and over and over.

So June 15 came and went, and i found out that all my worry was for naught.  I matched to a great program in a great city - Pittsburgh! - and now my anxiety has been replaced by its more pleasant cousin: excitement.  Our family's Grand Rapids sojourn ends next June, and over the next three years we can finish writing what is hopefully the final chapter in this Dugyot's adventures in the USA.

Yup, from where i'm standing, the future looks bright.

Bright, indeed.  (Picture taken in Batanes, not Pittsburgh)

P.S. Thanks to all the well-wishers and supporters! 

Life is Good

So this has been a good week so far.  Except for the fact that Miami lost... but depending on when your week starts (i.e. Sunday vs. Monday), that might still be considered part of last week. 

I just finished nights, which is always good. 

I'm running four-milers again on a consistent basis with little or no pain, and am slated to rack up twenty miles by the end of this week. 

I've been spending quality time (well, watching movies - to each his own) with Gianina.  Two superhero movies down so far (X-Men and Thor).  

My new Android phone is working better than expected (more on this later).  

And oh yeah... I matched.