Level Up

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On my first day of Radiology residency, I was assigned a pager and a white coat with my name embroidered on it. I chuckled along with my fellow first-year radiology residents. “What are we supposed to do with these? Does anybody ever page a radiologist? What, will they want us to carry stethoscopes too?”

Now two months later, I find myself clinging dearly to any remnant or semblance of my former doctorhood!

It’s an abrupt and humbling change of pace, becoming a radiologist. Of all the medical specialties, this one is hands-down the hardest because it really is like nothing I’ve ever done in medical school, and I’m starting from scratch with minimal foundation from my previous education. I remember the daunting, sinking feeling I had while being told during orientation, “Don’t give up. You will see your senior residents nonchalantly spewing out diagnoses that you have never even heard of. Just keep studying.” After being at this so intensely for 5 years, how could there still be anything in medicine that I’ve never heard of?!

Only a couple weeks prior to this, as an Internal Medicine intern, I was running the hospital, making big decisions, receiving thanks left and right for saving patients’ lives, and frequently being reminded by my attendings how I was wasting my talent by going over to “the dark side.” Then all of a sudden, I was stripped of all my glory and confined to a dark room all day, doing something I sucked at and being told again that I was entitled to stupidity. To make matters worse, my first rotation was Fluoroscopy, which is not even like the rest of Radiology. The work involves acrobatic photography and heavy machinery; learning it is like learning to ride a bike in Boston during rush hour. Everyone was kind in helping me, but I couldn’t help anyone. My only dignity rested in micromanaging the lives of the Internal Medicine interns calling me for consultations; it was a pittance of consolation.

Since the beginning of July, I’ve been aching to be a good doctor again. All the studying is helping, but there is something more to be gained by experience—and in that regard, the years can’t pass quickly enough for my taste.

Thankfully, the learning curve is insanely steep, which means that I am constantly reaching new summits as I clamber my way up. It seems that every couple days I can look back and say I am drastically better than I was before. I owe a lot of this to the help of my senior residents; I am so impressed by them, and I’ve improved so much while trying to emulate them. The long list of things I’ve come to terms with over the last few weeks includes: abdominal radiographs, operating fluoroscopes, dictating reports when other people can hear, shouting out answers in large conferences, and talking to surgeons.

And lumbar punctures! Four weeks ago, I asked my neuroradiology fellow if I could observe him doing a lumbar puncture. An hour later, he insisted that I get right to performing my first lumbar puncture. I struggled through the next few, usually trumped by attendings who had the nasty habit of jumping in to complete the procedure. One attending asked in front of an already-nervous patient, “Does she even know how to use the fluoroscope?” I filed away these notable memories and kept asking for more. I just wanted to be good at something, even if it was something everyone else considered simple. In the second week, my goal was to do one without any physical help, and then without verbal help. In the third week, I started teaching my medical student to do the procedure. In the fourth week, I got to teach an attending who was out of practice. I went so far as to cut my own umbilical cord, telling my neuro fellow that I didn’t need him anymore (which I only hoped was true, knowing he wouldn’t let me live it down if it wasn’t). On my last day of the rotation, I did the whole thing alone within ten minutes, surprising an attending who had walked away expecting to see me still struggling when he got back.

Back when I first chose Radiology, I was attracted to “the intellectual challenge of having familiar concepts swept out from under my feet,” and now I get exactly what I wished for. Fluoroscopy is over. On Monday, I’ll be starting out as an idiot again; new rotation, new learning curve. I expect the stupidity cycle will continue for about six months before I get to revisit something I already know. At this rate, I guess I am starting to see how, in four years, I could totally be nonchalantly spewing out unheard-of diagnoses too.

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Radiology Personal Statement

Two years ago, I embarked on the exhausting and exhilarating journey known as the 4th year of medical school, where residency programs and applicants court one another for a season and dreams are made or broken. As the newest generation of 4th year medical students (including a few of my own “doclings”) now bravely set forth on this path, I thought it would be appropriate to stand with them by doing something brave, too—publicly posting my personal statement. After all, it was through writing this personal statement that I became convinced I needed to apply for Radiology. I hope my words will prove helpful to at least a few people who feel, like I did, doubtful and overwhelmed at the start of a long year.

 

I am so happy to be choosing Radiology as the path to becoming the kind of doctor I’ve always envisioned: smart, cooperative, and compassionate.

I love that Radiology is “brainy,” requiring great mental power and flexibility. Radiologists are central to the practice of medicine, as diagnoses and treatments so often pivot on the proper understanding of imaging. Of course, as a proper Physics geek, I am intrigued by the technology that continually increases our ability to know more and diagnose more. But what I love most about being on the cutting edge is the intellectual challenge of having familiar concepts swept out from under my feet. It’s not enough to memorize the pathognomonic patterns—those may change along with advances in imaging modalities. For radiologists, there is a real advantage to reasoning by principles and not by rules; the difference being that a rule may forbid stepping off the roof, but the principle of gravity also extends to not jumping off a cliff.

I want to be a good colleague, one who uplifts and brings out the best in others. I’ve seen how a good radiologist can turn others into better doctors. During my Internal Medicine rotation, a very patient Radiology lecturer introduced me to the Physics principles of imaging and systematic approach to reading films, which opened my eyes to a new level of reasoning and sparked my interest in becoming a radiologist. In learning how shadows translate from densities, and densities from pathology, I finally began to illuminate what I previously saw as a mystery in medicine. I realized that there is an order and logic behind the shadows, revealing the answers to those who understand. I am excited not only to gain the diverse knowledge and skills that radiologists employ when consulted by physicians of all specialties, but also to continue working as part of a diverse team.

I want to be a good person, one who respects other people regardless of where they stand in the hierarchy. I love that Radiology, far from being an antisocial desk job, requires clinical skills and bedside manner. I was impressed that of all my mentors, it was a radiologist who stressed the importance of cleaning up my own sharps and treating nurses with respect, and who, in answer to a 90-year-old lady asking if he would recommend the thoracentesis, considered his own wife. Even though it may be easy to dehumanize the dozens of scans that populate the computer screen each day, I will not abandon my philosophy of what it means to be a doctor: to heal and affect positive change through personal relationships. I’m happy to know that a dark cubicle does not preclude this, but rather makes it even more important.

As I reviewed my experiences to choose my future, I realized that the answer lay much deeper than, “Do I like thinking or cutting? Do I want to treat diabetes or gallbladders?” What it took for me to love all my rotations was a good attitude, a strong work ethic, and a commitment to being happy. I know these qualities will serve me well in the difficulties that I will undoubtedly encounter in my career. Ultimately, my decision is based on the kind of person I want to be, and I look forward to residency as the next step in shaping that person. In this regard, I am seeking a program that will expand my boundaries, where I will grow intellectually, work as a productive member of a supportive team, and provide excellent patient care.