It was a rather unremarkable Tuesday in June. It wasn’t particularly hot, or sunny, or rainy. For anyone else, it was just a Tuesday. But I was so nervous I thought I was going to vomit. I was going to shadow a pediatric neurosurgeon in the operating room for the first time. I was positive I was going to step into the OR and faint.
It was a simple case, he’d told me. He was just doing a muscle and nerve biopsy on a child with a suspected metabolic disorder. He showed me how to scrub. I was painfully aware of where my hands were at all times, making sure I didn’t contaminate myself. I survived – and I was enthralled. I didn’t faint, I didn’t puke and I wanted to see more. Between cases, he walked me over to the adult OR to see some “real” neurosurgery – a microvascular decompression for trigeminal neuralgia.
It was love at first sight. My breath caught in my chest and my heart raced. I felt like I’d been kicked in the stomach. Seeing a brain on the screen, watching the neurosurgeon operate, swept me off my feet. At that moment, no other area of medicine existed. I couldn’t understand how anyone went into medicine and didn’t want to do this.
I held it together for the rest of the day, watched another minor procedure in the children’s OR and went home. I barely made it through the door before I began weeping. As someone who came into medical school thinking about a career in pediatrics, taking on a career as a neurosurgeon was a big change in direction.
I frantically Googled everything I could on the specialty. Longest residency program in Canada – six years. Like other surgical specialties, not the best job market. Likely would need to get my U.S. medical license for fellowship training. Not a single female neurosurgeon in the department at the University of Manitoba. Nationally and internationally a male-dominated specialty.
It was just a crush, I told myself. I just got caught up in the glamour of the OR. (Note from future self – people who don’t love surgery don’t find the OR glamorous). It wasn’t a big deal. I went back to the lab, working on my summer research project on medulloblastoma, and tried to keep neurosurgery out of my mind.
I went back the next Tuesday. It was a joint neurosurgery-plastic surgery craniofacial case. As this was substantially more interesting than the minor procedures I’d seen the previous week, there were a few residents present. Being at the bottom of the surgical food chain, I didn’t scrub. I told myself to play it cool, that I’d just made up the feeling I’d had in the OR last week. This was just going to be another day.
And then they took the skull cap off, exposing the dura of the nine-month-old patient. It happened all over again. I knew then and there it was more than just a crush. I was head over heels in love.
I spent the next year shadowing in pediatric neurosurgery as much as possible. Any time I didn’t have mandatory class, I’d go to the OR or clinic. There was literally nowhere I’d rather be.
When clerkship came around, I was determined to keep an open mind. Though I had a strong feeling neurosurgery was what I would apply to, I didn’t want to settle down too early. I started my clerkship on anesthesia – which was interesting but wasn’t neurosurgery. This would become an overwhelming theme of my clerkship experience. I liked a lot of things – could even see myself doing a lot of them, but none of them were neurosurgery.
And then it was time to pick fourth-year electives. I let go of all the fears of committing. Neurosurgery and I were going steady. I signed up for 10 weeks of neurosurgery electives in various cities. I immersed myself in everything neurosurgery. I took an obscene amount of calls. I ate, slept, breathed for neurosurgery. I wrote letters for my CaRMS applications detailing my love affair. I gushed about my love during my CaRMS interviews. I was ready to spend the rest of my life with neurosurgery. It was The One, capital T, capital O.
“No other area of medicine existed. I couldn’t understand how anyone went into medicine and didn’t want to do this.”
It wasn’t always smooth sailing. There were hard times – like the day I saw an athlete two years younger than me become quadriplegic. Or the time I saw a previously healthy father in his mid-40s come in after a single seizure, only to be diagnosed with a devastating brain tumour and be given months to live. But for every bad day, there were the good times that made my heart swell.
When it came time to rank, I was all in. I was ready to let neurosurgery put the ring on my finger. I couldn’t wait for match day so I could declare my love and joy to the world. I even had a witty hashtag for the Instagram post I’d make about my match results. I’d never been more sure of anything – I was going to do neurosurgery, and it was going to be what made me happy.
If only life were that simple, right?
Match week came and I was a mess. I know everyone is anxious during match week. I couldn’t shake this feeling in the pit of my stomach that things weren’t going to go my way. I was a nervous bride. I found myself thinking of all the hard times, all of the things I’d have to give up to be a neurosurgeon. I felt sick all the time. And not lovesick, just genuinely sick. It’s a defense mechanism, I told myself. No one wants to be rejected so I’m just setting myself up to deal with it on the off chance it happens. I tried to psych myself up, but I still felt sick.
Match day came. It’s one of the blurriest moments of my life. “We regret to inform you that you did not match”… Or something like that. My love had left me at the altar. I was ready to commit my life. They told me they loved me. They told me I’d be a great fit. And then they chose someone else. I was sick, and betrayed, and more than anything, devastated.
OK, so I wrote the part above in 2016. It’s now 2021, and so much more has happened.
A lot of what happened after match day is also a blur. I’m sure it seemed clear at the time but looking back now it’s hazy. I do remember there was a lot of talking – talking to my undergrad dean, talking to student affairs, talking to my friends, talking to my family. Perhaps the blurriest part of all is the second iteration of CaRMS – happening so quickly after such a profound rejection that I barely had any time to process the information. In many ways, it’s best that it happens so quickly. Somehow, both after an eternity and before I knew it, I was matched … to family medicine.
I was only “OK” for a while. Family medicine was not “The One” I wanted. It wasn’t even what I went to medical school wanting to do. I spent a lot of time at the beginning of my residency going through the motions, putting on a happy face. Little by little, my grief gave way to the routine of residency. A few months in I realized I was enjoying myself. Family medicine reminded me of all the reasons why I went to medical school in the first place – it certainly wasn’t about being a neurosurgeon at the start. I had incredible co-residents and mentors who helped me find joy that I worried I’d lost. I discovered an aptitude for low-risk obstetrical care. I began to wonder if maybe family medicine could be The One, capital T, capital O.
About a year into my family medicine residency, I rotated through pediatric emergency. I loved my rotation so much that I talked to the program directors about doing additional training in pediatrics. I felt like I’d found a niche in family low-risk obstetrics, and really wanted some extra pediatric training to make sure that I’d provide the best possible care for the babies I delivered. The more we talked, the more it became clear that the right path was a transfer to pediatrics.
The prospect of transferring terrified me. I had only just figured out how to be happy in family medicine, and genuinely felt like I loved it. But I knew that while family medicine had taught me so much, it wasn’t right for me.
Transferring to pediatrics felt like coming home, somehow. I have excelled and grown in the last four years of pediatrics residency in ways I didn’t know were possible.
I would be lying if I said I don’t miss neurosurgery. I do, reasonably often. I also miss family medicine – particularly the obstetrics parts. I feel a twinge in my heart when I realize my knowledge from those areas is fading away, being replaced with things more pertinent and important for me to know. I will always have gratitude for all the things I’ve learned along the way from my forays in both specialties, but in pediatrics I’ve become the best possible version of myself.
When I rotated through the Pediatric Intensive Care Unit, I knew within a few hours that I’d found my place. Unlike my first encounters with neurosurgery, it wasn’t an all-consuming, chaotic love at first sight. My first shift on PICU wasn’t extraordinary but it provoked a deep and quiet certainty in myself. It felt, and still feels, different than any way I’ve felt before. There have been challenging moments and I’ve had momentary doubts, but I’ve always quite promptly come back to being sure that PICU is the spot for me.
Last fall, I had the experience of applying to CaRMS again, for the pediatric subspecialty match. My past experiences left me anxious and very sure that history was going to repeat itself. However, my past experiences also let me be more myself and more raw than I’ve ever been in interviews. I decided that if history did repeat itself, I could live with that, but I couldn’t live with not putting myself out there. If my new metaphorical groom was going to leave me at the altar, it should know who it’s missing out on.
I’m happy to report that history did not repeat itself. “We are pleased to inform you that you have been matched to” … or something like that. I have secured a pediatric critical care fellowship spot at UBC next year. I can say with confidence that I cried more tears on PSM Match Day 2020 than I did on PGY1 Match Day 2016.
After all this time, I’m not sure that I truly believe that within medicine there needs to be “The One.” My experiences proved to me that I could have been happy in many places, and I likely could have excelled in many places. While this path was unconventional, I think I finally found “my one” and it’s worth every step I’ve taken along the way.
The comments section is closed.
Best wishes as you proceed into your paediatric career. I enjoyed reading your story. My daughter did a MSc in neuroscience and was interested in and exposed to neurosurgery at med school. In her case, by 4th year she had decided on paediatrics and was happily matched to an excellent residency program.
They style of writing is highly intellectual and made it very difficult for me to follow. I wish it had been written in a more simple form so most people could understand – it has a point – despite my “highly intelligent brain” I remain confused as to what the “point” really was.
It is wonderful that you have found a place for your skills and passion. However, your story is unsettling about the Canadian medical system. Too many medical students are taught that they should go for what excites them. It seems to be about their ego, with little consideration of what society needs. Canada only needs very few neurosurgeons, (and other “high glamour” specialties) but has many more applicants, in part because “the system” encourages students to focus on that, with research funds and electives. There is no concern for what happens to those rejected. They have to pick up the pieces themselves, as you describe. Too often they are told to apply to family medicine, as the default option.
Every year in second round CARMS, family medicine picks up new graduates who lied about their interest. Though poorly prepared, with a lopsided set of experiences, they may get places in the program, but many spend their first year in mourning for their unfulfilled hopes, as you describe. Some are so consumed that they go though the motions, not learning. A few get into a program that fulfils them, as you describe. Others may scrape through the program, then go into practice as “specialoids”, trying to recover their dreams, and providing unsatisfactory general care to their patients.
Medical education, selection into medical school, and the career pathway need to be more focused on promoting the needs of society, rather than the wants of individuals or the desires of specialist groups to generate crowds of “career junkies” from whom they can pick a few lucky ones while rejecting the rest with no care for their outcomes. Every medical student should get an education that gives them a wide range of experience, especially away from the central city teaching hospitals, so they can actively choose and learn to enjoy a career that is needed by the population, not just exciting for the student.
James, while you may have some valid points about potential flaws in medical education, the matching process etc. To equate medical students pursuing a speciality as ego-driven self satisfaction is a leap in logic. To be passionate is not de facto to be egotistical. To be drawn to a speciality and later practice in family medicine because of employment realities does not necessarily make you any less engaged in the practice of family medicine. Mourning the loss of an opportunity and an aptitude to learn and excel are not mutually exclusive. Your analysis is too simplistic and puts too much emphasis on the so called failure of the medical student’s societal responsibility.
Dear Albert,
You misread what I wrote. I do not blame the students, who are doing what they have been selected then taught to do. It is the system that is wrong. Of course, many make the transition to make the best of the family medicine role they find themselves in, but I know a proportion do not, and carry a grudge long term. That is really sad, when it need not be that way. The medical education system is largely focussed on producing research-oriented specialists for our cities, almost to the exclusion of general specialists and family physicians where they are most needed. Change is necessary.
You’re wrong. Doctors are not automatons. Personal career aspirations and the flexibility to pursue them are key to patients receiving top notch care. People can, and do, change their minds through training, and there is no way to accurately select for people who will go into family medicine or not change their minds. Shuttling disinterested people into fields ‘because the gubmint wants it’ does both patients and doctors a grave disservice.
The match should be abolished and a general rotating internship with general practice licensure should be reinstated.
Congratulations on believing in yourself & growing in the direction your experiences led you.
You are a gift to the medical community.