Inadequate –> minimally competent?

Driving is such a spiritual experience. I’m realising this is a pattern for me, that it’s not just once in a while when I notice how much I love driving in summer, it’s pretty much every time I get in the car. It says a lot that at least once or twice a week, I will drive around the block around my house, buying myself an extra 5 or 10 minutes that starts off with “Oh let met just keep driving until this song is over.”

I reflect a lot on my drives home, and I appreciate the sky and the sun and the breeze, and it just ends up being a time of pure meditation if I ever had one. I think about things that stick out from that day–particular patients, their strength, their resilience, their psychosis.

Tomorrow is my last day of third year. Somehow, I made it. Somehow I made it through the toughest year of medical school with zero mental breakdowns, a minimal amount of tears (very few related to school, anyway), zero failed exams, zero failed rotations, and still a wonderful group of supportive friends and family around me. I know that sounds like it’s setting the bar pretty low, but maybe that’s what the first year of clerkship should be about. Maybe it should be about pats on the back for passing instead of the 80s or 90s you’re used to, and smiling about the days you came home and didn’t get yelled at by someone. Because that’s honestly what the first year of clinical experience feels like: feeling grossly inadequate, underprepared, and feeling like the punching back most days. You take the hit from the nurses, the residents, the attendings, and the patients. You always don’t know the answers–and as soon as you start to learn them, you switch to a new rotation and go back to knowing nothing. You just get used to a feeling of general “I suck”ness. And none of it is healthy and none of it is pro-physician-wellness or all the things they talk about nowadays, but it’s the way it is and probably the way it will be for a while.

So that’s why I guess I’ve set the standards pretty low for myself in third year, and I got out in one piece. And trust me, it didn’t start out this way, because it does always seem like other people do so much better (because no one in medicine puts up a mask, right?) and come out of clerkship looking like superstars but… here we are, and I’m happy with where I am.

I have a long, long way to go before calling myself a competent physician. I assure you it definitely won’t happen by July 1, 2016. But I’m starting to find my groove in what I consider good medicine, and what I don’t. I can look at different attending physicians and know which traits I want to pick up and which I’d rather leave behind that probably should have died in the 18th century. I can look at different ways to practice and know what calls out to me. I know, with nearly sound certainty, that I want to become a psychiatrist–one that maintains their medical skills. And I know that, generally speaking, practicing psychiatrists have expressed that they can see me as such and have welcomed me into their profession.

Whether or not I got everything out of my internal medicine rotation that I should have, whether or not I continue to get just average evaluations, whether or not I have outshone my peers… I think that feeling “home” in a specialty is the biggest achievement I could have expected out of third year. I always could have done better, shown up earlier, acted more interested. And I’ll try to keep working on all those things. But in terms of what I got out of this, I a) survived, and b) found my calling. What else could I ask for at this point?


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