Friday, October 15, 2010

Crazy and Happy

Heme/Onc (blood and cancer) fellowships are competitive. As far as medicine subspecialities go, they are one of the harder programs to get into. I still remember how relieved I was the day I "matched" into Heme/Onc in Little Rock. I thought it was exactly what I wanted. And, that was the last time I can remember being excited about my career choice. I've never loved this fellowship. But, medical training is not meant to be fun so I have just trudged along feeling like it's probably the training and not the content that I don't like. From the start, I have talked about leaving but I was scared to walk away from such valuable training. Before I got sick I was just starting to get into a little groove and feeling like maybe it wasn't so bad...this Heme/Onc thing...I could do it and it would be fine.

But, then I got sick. I'm learning that such a life changing experience is, well, life changing. Fine is not how I want to describe my work life. I'm not the same person and I'm definately not the same doctor. I thought that after the fear of thinking I might not ever get the priviledge of being a doctor, I would relish coming back to fellowship. I mean, this time last year I was PRAYING to be able to complete my training. At one point while I was out there was a question that I might have to completely redo my fellowship because I had missed so many months in a row. I had decided that I would quit if that was the case. When my program director called to tell me that I wouldn't have to start over and could pick up where I left gut reaction was disappointment. I guess that should have been enough, but I just kept thinking I would start to like it more.

Since coming back to work...I have been miserable. At first I was just so exhausted that getting through the day was my only focus. But even as I get better and stronger, I'm still not enjoying my work. I have been unsure of my career choice from the start and the deeper I go, the more unsure I get. But, I kept on....I mean, people don't walk away from Heme/Onc would have to be crazy. I even started looking for jobs and I found that a career in Heme/Onc is pretty tough. You either hang out at the V.A and have a great quality of life but make not a lot of money (I could make more as a primary care doc) or you go into private practice, work like a dog, and make lots of money. The more I researched and interviewed and talked to practicing docs...the more I realized the reality of my options. I was nearing the end of the tunnel and I couldn't see a light. And, I was not loving my job (not really even liking it). So, what to do?

Then, my program director called me into his office. He said lots of things...some true, some not. Bottom line...he wanted to know if I was committed to this program. He said things like, "when your on, your on but you aren't on as much anymore." The conversation was long and when I walked out of his office I really started to consider my choices. It is one thing to have an internal struggle but obviously my struggle was not so internal anymore. For the 1st time I REALLY thought about leaving. And so the inner turmoil began. Of course, we were already scheduled to leave for Boston for my board review course (in Heme/Onc) so we went. I tried to forget about everything and just focus on the course. I did talk to a few people about hospitalist and primary care options, as well as, private Heme/Onc options. But, mostly I focused on having fun, learning, and trying to relax. I prayed about it and really tried to let it go..which I was only moderately successful at.

I could finish out the remaining 12-15 months of my fellowship or jump ship. My logic in staying was that I only have a little over a year left and I didn't have to practice Heme/Onc when I was done but I would have to option if I wanted it. But, it is not an easy year. I missed a LOT last year so this would be a year of back to back service (read = hard) months with plenty of call. Basically, it would be the hardest year of my fellowship yet. Not to mention the reading and studying I would need to do to get caught up and ready for full fledged practice. A challenge I could 100% take on....but did I want to? For what? I job I don't really like that much? More money?

At some point in time I just became really obvious that I need to leave. I may regret it later but I can't live my life worrying about regret. I have to do what makes me happy today (and in the near future). I was talking to a friend about it and she said, "what do you really want to do?" and I said (without any thought at all and almost instantly), "I want to take care of dying people." That also got me thinking about palliative care (end of life care/hospice) and why I ever chose Heme/Onc in the first place. Really, end of life care is why I gravitated towards Heme/Onc and it has always been where I excel. There is something so satisfying about helping a patient and their family at the end of life. I know it sounds grim, but it really is so amazing to be a part of the dying process and help make it a peaceful experience.

So...I resigned this week. I took a job working as a Hospitalist (taking care of pts in the hospital) and as a palliative care physician at a local hospital. The work is satisfying (I hope), the hours are good, and the pay is nice. What more could I ask for? Now I just have to make it out of here.......

When I resigned my program director cried. He tried really hard to talk me out of it and in the end made me an offer I couldn't refuse. He offered to relieve me of Heme/Onc duties and let me go do 2 months of palliative care with our palliative care attendings/team. The job I was offered was more than happy to let me wait until Jan before starting, so I accepted the offer to stay for 2 more months. I felt like it was really generous of him to make me such a deal. Of course, today I found out why he made me the offer. He is hoping I will change my mind and stay. He is hoping that in the next 2 months he (or someone else)can convince me to stay. I also found out that he approached a few people and specifically asked them to talk me out of leaving. Which explains the constant onslaught of questions, being told I'm crazy, and me repeating myself over and over and over.....

We will see what the next 2 months holds. I'm done worrying about it. I'm just going to do what fits for me, whatever that might me crazy (and happy).


Sarai and Dani said...

Good luck!!! You're spot on; do what you love and you'll never work a day in your life.

K J and the kids said...

You've just managed to make one of the toughest decisions in your life and you did it. WAY TO GO! In my book you already won.
I don't think you are grim....I think you are loving and have the special ability and chance to help others pass along comfortably.
I hope the next 2 months are a relaxing comfort and not more torment.

Sonya said...

YAY for Happy!!!

Jamie said...

See? I need to add your blog to my reader which is why I did not know before you told me about it at the party. I finally explained it so that Sheila could understand. You go, girl!!!

amy said...

good for you!! it certainly speaks to your value that he got creative to find a way to keep you. my best friend is a hospitalist and it's perfect for her. her husband is also a doc and they have 3 kids so the hours and bene's were perfect for them to have some balance and quality with the kids. good luck, no matter the path you wind up on, sounds like lots of good awaits!!

Heather said...

OMG Jess, I am in this SAME SPOT. Well, not exactly like you, but I am really really struggling. I am in the MPH program now on top of everything else, which was a horrible idea I think, and I'm just completely overwhelmed. All I want to do is just get out! I commend you for your perpetual honesty with yourself and your courage to be true to yourself and your life. I hope that this opens doors for you and you'll find the happiness that you've been missing out on! Congratulations on a huge moment in your life-- bigger than most people understand. Miss you friend!!