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.

Why I Chose Radiology

One night, months or years ago, my husband looked up from a collection of short stories he was reading, and said, “This one is interesting. The protagonist is a radiologist.”

To this, I laughed out loud. “Why would the protagonist be a radiologist?”

Judging by the lukewarm reactions I’ve received this year when I’ve told people that I was going into Radiology, I suppose most people feel the same way I did: that there is nothing interesting about a radiologist.

Don’t get me wrong, I absolutely adore Radiology and honestly feel that I’ve made the best possible career choice. But, given that my interest in Radiology did sneak up on me at the last minute after I’d already changed my mind half a dozen times between other specialties, perhaps I owe everyone an explanation.

In the beginning, as I’ve mentioned, my intention was to be a neurosurgeon. I never felt like it would give me the life I envisioned, but the work sounded challenging and heroic, and that was what brought me to medical school. I quickly realized that being away from my family for 120 hours a week was even less tolerable than I imagined. The neurosurgeons I met on my Surgery rotation, though very nice, made it clear to me that working one-third time (a normal 40-hour workweek) was not acceptable, even for a woman. In fact, I got the impression that having ovaries was entirely incongruent with Neurosurgery—people simply didn’t make time for babies and lives in that field. A Surgery resident gave me this valuable piece of advice: “Is there anything else that you like besides Surgery? Because you should do that instead.”

Then I thought for sure I would be a psychiatrist. I loved brains. Surgery was invasive, but Psychiatry was also invasive. Coming from a Psychology undergrad, analyzing people was second nature to me. The patients were interesting beyond belief, and I found plenty to write about, so I knew it would make an entertaining career. In particular, I felt at home with the idea of being a child psychiatrist—I had a knack for working with children, and I was inspired by their ability to heal and overcome. But I did not know just how difficult it would be. Halfway into my Child Psychiatry rotation, I was exhibiting symptoms of PTSD. I begrudgingly admitted that I did not have the mental resources to cope with the side effects of being a child psychiatrist.

Next on my list of “brainy specialties” was Neurology. I considered it only briefly. It wasn’t part of the curriculum, so I didn’t get a fair chance to explore it beyond my dealings with stroke and seizure patients. From what I gathered, the diagnostic aspect of Neurology was highly complex and elegant. But the treatment aspect was almost non-existent—for all the time spent figuring out exactly which part of the brain was damaged, there was usually nothing to be done about it.

From there, Pediatrics was a no-brainer (you guessed it—pun intended.) Cute sick kids, stuffed-animal stethoscope covers, doctors acting goofy in exchange for a peaceful listen to the heart and lungs. The idea of being happy all the time won me over almost instantly. Plus, this opened a new slew of possibilities for subspecialties: Pediatric Cardiology, Pediatric Endocrinology, Pediatric Whatever-ology. Since each of these would entail an additional three-year fellowship after residency, I was secretly buying myself more time to really decide what I wanted to be. (What? I like to dilly-dally over life-changing decisions!) It was a great plan, and I felt confident enough to start telling everybody about my decision. This was mid-January of my third year, and many of my classmates were jealous that I’d made up my mind so early. I went forward with it, collecting recommendation letters and setting up visiting internships, until August.

Because I kept telling myself that I loved children and hated adults, as pediatricians tend to do, I thought I was destined to hate my Internal Medicine rotation. As it turned out, I loved Internal Medicine because it was the first rotation in all of my medical training where I felt like I was personally and legitimately a doctor. Much of that feeling came from being introduced to the systematic approach to reading a chest X-ray. We were taught by a pulmonologist whose hobbies happened to include Radiology and Physics. He opened his first lecture with a discussion of radiographic density. I believe “density” was the word that changed my destiny—it activated my inner Physics geek and thereby illuminated what had previously been a black box.

Radiology is glossed over in medical school. This is a mistake, because Radiology is ubiquitous and crucial to the practice of medicine—rarely is a diagnosis made without some kind of imaging. I may not have considered radiologists to be real doctors at the time, but I wasn’t about to call myself a full-fledged doctor if I didn’t have a proper understanding of Radiology. So I scheduled two full months of it right in the beginning of my fourth year.

Those two months were tumultuous. I started out with a lukewarm feeling: The work was engaging to varying degrees depending on who was teaching me, and sitting in a dark room all day was marginally tolerable. I often felt like I was watching other people play a video game that I didn’t understand. That is, until one of the radiologists handed me a textbook to leaf through when times were slow. It was the best book I’d ever read in medical school, and I was raving about it to my husband when he asked for the millionth time if I was going into Radiology already. (My husband is himself a huge fan of Radiology.) I retorted that I did not come to medical school just to sit in an office and be nobody’s doctor. But as I became more and more intrigued by what I was learning, I found myself in a dilemma. I started to question my commitment to Pediatrics, and indeed my whole paradigm of doctoring.

It was at this time that I re-read some of my old blog posts to start compiling this book, and I came across a piece I’d written about how to choose a specialty, called “How To Make Lifelong Decisions: Don’t Compare Apples to Oranges. Just Make the Lemonade.” I had forgotten all about this, and it took me completely by surprise. Apparently, I had figured out at some point that choosing a specialty wasn’t about the nature of the work so much as about the kind of person I wanted to be—and I knew, undeniably, that radiologists were exactly the kind of people I wanted to emulate. Besides being the smartest of the smart, radiologists were sensible, sociable, happy, and generally wonderful to work with. And they all loved their families very much.

So then my gears were churning frantically. I only had a couple weeks left to submit my residency applications, and I had everything set up for Pediatrics. Radiology is a much more competitive specialty, and I frankly wasn’t sure if I would be able to get in, especially with such little preparation. I finally came to the Dean of Student Affairs, Dr. Dupey, whom I consider the “Sorting Hat” of my medical school and to whom I give full credit for ensuring that we all match into residency. She looked at my credentials and gave me the thumbs up! I still wasn’t 100% ready to burn the bridge on Pediatrics, so she challenged me to write a personal statement for both (which I’ve included in the following pages.) I found it extremely easy to say why I wanted to go into Pediatrics; that essay took me about an hour. The Radiology one took me an entire weekend. I thought really hard, I got frustrated that my writing was inadequate to express my feelings, and I cried a lot. But when I emerged from this process, I was convinced that, one way or another, I would be a radiologist.

Seven grueling months later, I opened an envelope that fulfilled all my hopes and made all the trials worthwhile: I am going to Dartmouth to become a radiologist!