Wednesday, March 15, 2017

I think I'm dying . . . not really, but it surely seems to be the case

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Medical school is, for once, going extremely well for me. I'm in a pediatric neurology portion of my neurology rotation, and I'm enjoying it to the extent that it is causing me to rethink my eventual area of focus in medicine. I cannot consider going into this precise specialty because it would require me to study straight neurology for three years of my residency, then to study the pediatric form of it. I'm scared shitless of regular neurology. Alzheimer's freaks me out. Lou Gehrig's Disease gives me the willies. Parkinson's scares the socks off of me. I  could probably to some degree deal with traumatic brain injury, seizure disorders, and multiple sclerosis, but I wouldn't actually like doing it.

This segment of my rotation is focusing essentially upon pediatric neuro-psychology, though the attending physician's board certification is in pediatric neurology. There's quite a bit of cross-over between the specialties. Though he has patients on his caseload whose chief complaints are related to seizure disorders, this physician's practice is fairly heavily into psychoeducational implications of his students' conditions The doctor deals to some degree with his patients' schools and educational programs. He is in contact with special education personnel. He does consultations and sometimes even attends IEP meetings. 

Because of  having a mother who has been a teacher, a school psychologist, and a director of two different  school districts' special education programs while I was growing up and because of my mother's tendency to figuratively and literally bring work home with her, I am well-versed in matters relating to special education. (My brother is less well-versed in the same subject matter than I am because he was always much better than I at tuning our parents out when they spoke of work-related matters.) My knowledge certainly has its gaps for the simple reason that I've never completed any course of study related to educating students with special needs, but I know far more of the qualifying conditions for special education, of Public Law 94-142 and of the other laws and regulations pertaining to special education, and of the procedures and methodologies utilized in educating students with special needs, including but not limited to students with learning disabilities and with speech disorders, than does the average medical school student. It never occurred to me that material stuck forever in my brain simply because I had no way of getting it out would ever be so useful to me in the study of medicine.

The attending physician is arranging for me to take the exam for the complete neurology rotation (which I'm less than halfway through) on Friday. If I can score well on it, he says, he can arrange for me to spend the rest of my neurology rotation right here in this psychoeducational-focus pediatric neurology practice. That means no Alzheimer's evaluations for me, no amyotrophic lateral sclerosis, no multiple sclerosis, no demyelinating disease, Bachmann-Strauss dystonia (or any other form of dystonia) , no Parkinson's, no Huntington's Chorea, no progressive supranuclear palsy (or any other form of palsy), no spinal-cerebellar ataxia, no hundreds of conditions I'd rather not even read about, much less encounter in the flesh. Instead I will be allowed to sit in on and occasionally offer opinions concerning ADD/ADHD, varying degrees of autism spectrum disorders, tic disorders, speech and language disorders, and other neurologically based conditions. 

I eventually told the attending physician here that even though I've tried hard to feign enthusiasm for the specialty of neurology, I have a degree of distaste for much of what it entails. I like what this attending physician does, but I probably could not do what he has done to be in the position he is in today. He suggested that there are different paths to essentially the same place. He mentioned that he would like to add a child and adolescent psychiatrist and pediatrician to his practice to more fully cover  the spectrum of patients he sees. He told me of five-year programs from which a resident physician emerges fully trained and, once board exams are passed, fully board-certified in pediatrics, adult psychiatry, and child and adolescent psychiatry. This may be something that is feasible for me. Though I don't want to work in any primary-care field, I enjoyed my pediatrics rotation. Psychiatry is my next clerkship rotation. If I find that it is an area of specialty that I enjoy, I can look seriously at what the attending physician suggested and can tailor my visits and interviews for residency programs at those institutions which offer the 5-year trifecta plan. 

This is the first week all year that I have been neither sick nor tired.  We finish working at a civilized hour every each evening, as in around six o'clock, and we are allowed to go home. The attending physician does not leave interns or medical students working after he has gone home. He doesn't want us in the office before his nursing staff arrives, either.  This doctor is on call at the hospital for general neurology only one weekend every two months. He said that if I return to his practice or a similar one at this facility, I, too, will be on call at the hospital for general psychiatry only one weekend out of every two months after I have completed my residency. 

While I genuinely like pediatrics, in the grand scheme of things, I do not wish for my ultimate job description to be that of a primary care physician for patients of any age. Pediatrics in particular involves too many hours for not enough pay, and the level of prestige associated with it is too low for me. Some people would say I'm a bad person for admitting that the level of prestige and rate of pay associated with a particular domain of medicine will impact my selection of a specialty, but I'm being honest.  I may eventually need to work substantially fewer than forty hours per week for several years if I have children and my spouse is not in a position to work part-time.  I need to be prepared to support myself and any children I may have while working essentially half-time, as I will not bring children into the world so that their de facto guardian can be a daycare provider or a nanny. I will likely need to rely upon on the services of a daycare provider or nanny, but I wish for my future children spend more time in the care of their parents than in the care of hired help. If my spouse is not in a position to spend substantial time each day caring for these potential children, I will need to do so. I can't do that easily on a pediatrician's salary. We will not have to live as the rich and famous do, but I will need to earn enough that I can support my family with or without the help of a spouse as necessary.

In terms of the prestige, I don't wish to say a great deal because it's almost impossible to say much about it without coming across as a snob. It may not seem as such to a person who has never worked in the health care system and operates under the assumption that all doctors are on the receiving end of esteem and respect, but such is not always the case. If it were my dream to work as a primary care pediatrician, I suppose I would do so anyway and would accept the baggage of being considered second class or lower among physicians, but since it's not my dream,  it's one thing with which I do not have to contend. After all these years, even being female causes a medical doctor to be given less than her due respect in the workplace. I choose not to place myself at further disadvantage. 

When everything is going well, something has to be just a little bit wrong. That's the way life is. My current problem -- really my only current problem -- is that I'm having difficulty swallowing. I can swallow food and drinks perfectly well. It's the physical act of swallowing saliva that is plaguing me. I'm fairly certain that it's an anxiety issue. I'm fine as long as I'm busy and have no time to think about the problem, but once I'm finished being busy and need to relax or to sleep, I cannot because of issues with swallowing. I'm not wishing the problem on anyone else, but if you want to know what I'm experiencing, try really thinking about the process of swallowing as you're doing it. If you over-think the act of swallowing, I suspect it becomes a difficult process for anyone. Then, even if you try not to think about it, once nothing else occupies your mind, thoughts about swallowing will invade your consciousness and will make the act of swallowing far more complicated than it needs to be. Try to fall asleep when your muscles are not cooperating in the act of swallowing. It's extremely difficult.

The problem, I'm reasonably certain, is that difficulty in swallowing is a symptom of many neurological conditions that I read about every night when I study for my neurology exam. It's a classic case of hypochondria.  In the morning I'll run it by the attending physician under whom I'm working. Attending physicians supervising medical students are accustomed to the students imagining they are experiencing the symptoms they read about. I probably just need to take a benzo when it's time to relax, but I don't like to take benzodiazepenes unless I am directed to do so by a physician.


  1. I'm back! Glad you are doing well in med school. I am no longer working as a journalist. I have gone into research and am earning 25% more money. I should have made the switch years ago!

    1. Wow, Matt! That is awesome! What area of research are you in?

  2. You said "Medical school is, for once, going extremely well for me." I am very glad to hear that. It makes my day. As far as swallowing, it reminds me of floaters. "Eye floaters can be clumpy or stringy; light or dark. They are caused by clumps or specks of undissolved vitreous gel material floating in the dissolved gel-like fluid (vitreous) in the back of the eye, which cast shadows on the retina when light enters the eye."

    A friend asked me about them. I only see them if I look for them. Most of the time I do not think about them and do not see them.

  3. Replies
    1. Yes, and it's such a bummer. Many things I can control, but I can't control some of the outrageous hours and the necessity of dealing with life or death issues.

  4. Xerostomia is a nasty problem. However, an antihistamine may cause you to need to swallow less. Or a bib. Drooling also requires less swallowing!

    1. The doctor under whom I'm studying prescribed an antihistamine in addition to the antibiotic for my sinus infection.I'm not quite ready to give up on the problem and wear a bib yet. maybe when I'm 90 if it's still an issue for me I'll view that as a viable solution. LOL Thanks.