Friday, October 05, 2007

Medical Bottle Rocket Training


I'm old enough to have spent entire summers goofing off with my friends, running around the neighborhood on our bikes, laying waste to our parents' homes, and setting off fireworks with complete abandon --- all without having adults constantly warning us about one danger or another. A favorite sport was spending hours setting up a field of army men, and then wiping them out with a combination of Black Cats and rubber bands. Marty, my next door neighbor, and I destroyed enough plastic soldiers that a poorly written scrawl of "army men" in red crayon was often placed on my mother's grocery list. Of course, the battle would not be complete without firing up at least a few bottle rockets.

OK, I know I shouldn't romanticize playing with fireworks; heck, where would I be today if I didn't have all my fingers? Probably I'd be an orthopedist, but that's another story. But I often think back to my bottle rocket days when a high school or college student asks about the process of becoming a physician. Why compare medical training with bottle rockets? Why not choose the classic "hard work, followed by harder work" theme? Let me try to explain.

Step 1: Light the match. Traditionally, the vast majority of students who choose the pre-med route in college need to take a single-track-mind approach. There are fairly strict class requirements, with even stricter grade demands, in order to even start the medical school application process. Of course, just like some dud matches that won't strike, some kids wash out due to lack of interest or lack of adequate grades.

Step 2: Light the fuse. Acceptance to and then attending medical school is just about the most exciting thing that can happen to a young mind. The excitement burns bright and hot, just like the bottle rocket fuse.....and it needs to, in order to propel a student through long hours of study for two years followed by longer hours on hospital wards in the last two years of medical school. Of course, the fuse is really only a precursor to the big blastoff, but it can be so much fun that we lose sight of what is to come.

Step 3: Blastoff into residency. If someone told me I could take a ride in the nose capsule of the greatest bottle rocket ever made, I would think I had died and gone to heaven. Just like a conventional bottle rocket, it expends a tremendous amount of fuel to get going and lift off; a lot of that is wasted energy --- think "intern year." Then and then the action and learning is accelerated, coming fast and furious from every direction. And once again, this was at least for me so much fun that I had a hard time focusing on what would come once it was all over. Don't get me wrong, it was also pretty friggin' hard, especially on SWIMBO.

Step 4: BOOM! The bottle rocket tops out and explodes; pieces tumble everywhere. Residency is over and real life starts --- find a job, start a practice, buy malpractice insurance, take out loans, move, sometimes marry and start a family ("my biological clock is ticking!"), experience complications that are your very own, and try to remember to breathe.

Step 5: There is no step 5. The incredible joy of the bottle rocket ride is a one-time event. The rocket topped out and blew itself into a thousand unreconstructible pieces, blown away by the wind so quickly that all that is left to remember it by is the acrid aroma of gunpowder. And that fades rather quickly as well.

If that sounds bittersweet, well, that's because it is. Once the rocket ride is over, what is left is a lifetime of medical practice --- sort of a gradual drifting through space. There are no grades to study for, no accolades to garner, no "best resident" awards to hope for. Unlike our brothers and sisters and friends who are not in medicine, there is no corporate ladder with promotions to climb, no executive VP position to covet and achieve, no corner office to angle after. For some doctors, accustomed to a life of achieving one goal or another, that's not enough. Those are the physicians driven to start their own clinics, insurance products, new techniques and instruments, and the like. The rest of us --- myself included --- have to radically change our mindset and learn to get our jollies in a different way.

It took me several years to figure this out. Slow learner, sorry. While the rapid fire excitement of medical school and training is far behind me, I have learned to enjoy the simple pleasures of talking to new patients and listening to their symptoms, of putting the pieces together to make a diagnosis and a plan, of then carrying out that plan in the operating room. There are no teachers that praise one for this, no pats on the back, no grade reports; only the satisfaction that when the skin is closed, I know that my best work is hidden where it can't be seen. And that's OK, because then every day can be its own little "bottle rocket" for me.