I don't know the answer, but I do have some thoughts

There is a certain question that's been haunting me for a while. It's taken many forms: What do you want to be when you grow up? What are you going to major in? What are you going to do when you graduate? What are your goals in the business world? What kind of doctor are you going to be? My answer hasn't really changed...I don't know. The older I get, the weightier the question becomes. As the clock ticks down and I need to make a decision, here are some of my thoughts/options:

• Orthopedics. As I look back on all of the rotations I've completed so far, I've probably enjoyed this rotation this most. I enjoyed the people, I enjoyed the work itself. It fits in naturally with my love of sports. It is the most lucrative of all the specialties I am considering. It also carries some challenges with it. It is the most competitive of all the specialties I am considering, which means I have little to no control over where I would end up for the 5 year residency. I will be so much busier during residency than I've been thus far in medical school. I don't think it's even going to be close. Is it fair to ask Courtney to be move again, and continue to be away from family and friends during such a difficult time? I also think about Kyle and Brynn aging another 5 years without being able to see friends and family more. The bottom line is, we would love to be back in Dallas and that would not be possible with Orthopedics. Another factor is that while I enjoy the work, the lifestyle of a surgeon is the most demanding. I would spend more time at the hospital, be one call more, and miss more t-ball and weekends than for anything else I'm considering
• Internal Medicine. This was the hardest rotation I've taken, but it was challenging in a good way. The internists I worked with matched my notion of what a physician should be: they are supremely knowledgeable, value the physical exam, and excel at communicating with their patients. The residency is 3 years, and there are plenty of opportunities to specialize if I chose to do so. It less competitive, and I have more of an opportunity to control where I take a residency. With my scores, etc; I have at least a decent chance of ending up in Dallas. On the other hand, I am not sure to what extent I was able to picture myself in this field and be excited. I certainly found it interesting, but I'm not sure that I truly enjoyed it. It's difficult to say, though, if I was able to truly gauge the field with my brief look as a medical student
• MBA/MD. UTMB is partnering with a Houston school to offer a MBA/MD program. This would add an additional year to my studies, and I would increase my flexibility. It would certainly be an asset if I chose to open my own practice at any time. It would allow me to go into hospital administration if I became interested in that, and I'd also have the opportunity to be some type of consultant if I chose to do that. I do find that I miss some aspects of business, and this would be a unique opportunity to combine both of my interests. It would also give me another year to sift through my goals in medicine. On the other hand, I do not have any specific goals in mind in pursuing this, and it is difficult to justify dedicating another year, money, etc to something when I'm not sure how I would use it.
• Lifestyle specialties. One of my current fears about Medicine is about being able to strike the appropriate balance with my family life and career life. Most specialties are not forgiving with the amount of time required. Certain specialities offer a very good balance, and very good work hours. Anesthesia and Psychiatry fall into this category. Of the two, I'd say I'm more interested in Psychiatry; but I'm not sure to what extent....

The decision is both overwhelming, and exciting. I'm not sure I'll ever know exactly what I want to be when I grow up, and honestly, I'm not sure I'd want to. I never want to feel like I have all of the answers. I never want to feel like there isn't something else out there. I never want to feel 100% comfortable. For better or worse, I'm trying to do my best. Thanks for your support. Please know that I could never be at my best without you!

5/17 - quick notes

• Today was orientation for Ob-Gyn. I start tomorrow at 5:30am seeing the new moms who just had their babies (post-partum). After that I'll spend a week seeing the moms who are pregnant and are having hospitalized with medical problems prior to their due date (ante-partum). Then I'll have 2 weeks at a gyn clinic, followed by 2 weeks delivering babies (or trying to help).
• Brynn is growing up so fast! She's now eating baby food for dinner every night, and is able to sit up by herself. For a split-second tonight, I mistook her for Kyle because she's so much bigger than she used to be, and she reminded me of him when he was yonger.
• Kyle's is going through another language growth-spurt. He's really starting to put some sentences together. Of course, he also loves to repeat everything he hears...this part is getting really interesting (i.e. choosing our words carefully is becoming more and more important).
• We've started with potty training Kyle. He's doing pretty well: he's really good about a) going when we take him to the bathroom, and b) reporting when he's dirtied his diaper. We'll be excited when he starts to report the need to go!
• Brynn and Kyle will have a new cousin tomorrow....Ellie Chrietzberg is going to make her debut!

4/27 - thoughts, updates

• I wonder how many of the blogs that have been created on blogspot have a post that was created in the past month? 20%? 10%? It's a difficult thing to get in the habit of doing, though I'm still shooting for twice a month.
• My goal of running a marathon may need to be put on hold...my right knee started hurting about a week and a half ago and has not improved with rest.
• We get our initial schedule for 4th year this week. More to come...
• I'm halfway through my psychiatry rotation, and it's going well. I'll be working in a hospital in Houston for the next 3 weeks seeing inpatients (patients who voluntarily sought help with a problem like depression/bipolar disorder or were hospitalized against there will as they were deemed to be a danger to themselves, or others).
• I hope the Mavs can push this playoff series to game 7.
• Hearing "HI DADDY!" from Kyle never gets old, especially when the enthusiasm in his eyes exceeds the enthusiasm in his voice.
• Courtney is a great mom, and I couldn't do it without her: Love you, Courtney!
• Many of the sick patients I see share a number of characteristics: obesity, smoking, hypertension, low socioeconomic status, and chaotic families / home life. Family seems to be particularly important in the development of many of the problems I am seeing in psychiatry. What a blessing to have such a great family! What a shame that there are so many without.

family time

We're enjoying the great weather here in Houston -- it's been in the 70's - 80's for the past few days. Both kids love being outside. Kyle absolutely loves playing in our cars, going for walks, and playing with his jumbo dump truck. Brynn loves being carried by Courtney, and watching Kyle get into trouble. We also gave Kyle his first home haircut. Five minutes in the tub with my hair clippers, lots of tears, and a popsicle later and Kyle emerged a new man!

before 30

A few personal goals I have written down to accomplish before I celebrate the big 30:

-Run a half marathon. I'm deciding between a marathon on 5/15 vs one 5/30, giving me about 6 - 8 weeks to train. I've run 7 miles so far this week, and need to run 6 this weekend to stay on track.

-Drop 10lbs from my weight on Jan 1st. I'm only 2 pounds away thanks to Courtney and her Weight Watchers cooking.

-Finish out my 3rd year of medical school

-Last, but not least I need to have a specialty picked out.

on residency

Thought I'd take a shot at answering some questions you may have about residency.

What is a residency?

• Residency is required after medical school in order to become a licensed physician who can practice medicine independently. It represents a training period in which recently graduating doctors can practice under the supervision of licensed physicians.

What is an intern?

• 1st year residents are referred to as interns

How long is residency?

• It depends on the specialty, but ranges from 2 - 6 years. (6 years for some surgical specialties).

What are the work hours during residency?

• The maximum allowed is 80/week. My experience from observing our residents is that many do work this many hours, especially during the 1st year.

What is the application process like?

• It is very similar to the process of applying to medical school. You submit an application consisting of a mission statement/essay, your medical school academic record with standardized test scores. After an initial screening process, they invite you for an interview process. Afterwards, there is a "match" process whereby schools and applicants alike rate their applicant and school preferences. This information is used to assign applicants to existing residency slots. Each year around 15,000 US students apply for around 16,000 residency slots.

school progress

I am more than halfway through my third year of medical school. I've completed the following clinical rotations this year:

-Pediatrics

-Surgery

-Anesthesiology elective

-Internal Medicine

Here are the rotations remaining during this year:

-Psychiatry

-Ob/Gyn

-Family Medicine

Things on the horizon beyond this year:

• Year 4 scheduling. I will need to take the following courses: Senior surgery, Emergency medicine, neurology, 5 electives of my choosing, and what is referred to as an "acting internship". I have submitted my preferences, schedules will be revealed at the end of this month.
• I will need to take my USMLE step 2 exam (united states medical licensing exam). This is a standardized test that all medical students must take before residency. It is a 370 question that will take a full day to take. There is also a "practical" component" where we will encounter actors, or "standardized patients" portraying various clinical scenarios; we will be videotaped and evaluated on our clinical competency. Target date: July
• Putting together my application for residency. The two main features here will be a mission statement, and a "CV" which details my medical education and experience to date. 1st draft target date: Mid June. Applications accepted beginning in November.
• Residency interviews. November '10 - January '11
• Choosing a specialty. I would like to decide this by June. I promise to discuss this more in the future

getting started

If I were to ask you how much essay writing were involved in medical school, what would be your guess? If you'd asked me that question before I started school, I would have guessed just one...the essay on my entrance application. The truth is, I've written 10 or so during my 1st three years (mostly relating to medical ethics). Each time an essay is assigned I have the following reactions:

1) Surprise. Are we really being asked to write an essay in medical school?

2) Denial/Procrastination. I immediately pass all aspects associated with the assignment out of my mind, except for a general idea about when I need to start worrying about it again.

3) Concern. I'm in a crunch, I've waited until the end of the class/rotation, and now need to prepare for an exam and write a paper.

4) Surprise.

5) Brainstorming without writing. This usually takes about two days. I try to collect my thoughts and determine the general idea of what I am going to try to say.

6) Writing and frustration. This takes at least 3 hours longer than I anticipate; and at least 60% of that time is spent typing and deleting a series of horrible introductory statements.

7) Excitement. Done!

Getting started is the hardest part of any project, and I suppose it should be no different with starting a blog. I'm starting this in an effort to better communicate with family and friends, particularly as it relates to me and medical school. I've never enjoyed talking about myself, but I'm going to give it a shot here. My goal is to post something twice a month, but it is entirely possible that will not happen every month (please forgive me if it does not). I'm looking forward to getting started and seeing where this goes.

(I started typing this post at 7:30, and it is now 9:20. See 6 above)