Work in progress

As we come to the end of another academic year, I find myself two weeks away from my first chief call as a surgery resident. 40% prepared and 60% terrified, I am excited about the new level of responsibility but concerned about making the right decision for critically ill patients in the middle of the night. Of course, I won't be alone, but the decision to call for attending help will rest on my judgment.

Preparing for the transition, I recall our chief academic officer's introductory speech on my first day of residency as a fresh intern. "Welcome to residency!" he said. "It's gonna go by really fast, in a slow kind of way." So true--wasn't i just that fresh intern bumbling around? Another truth: "Don't expect to be comfortable. In fact, I hope you are never comfortable in residency." At the time, I didn't know exactly what he meant, but I have come to realize that despite the wretched feeling of inadequacy it brings, this is what I love about medicine in general, surgery in particular, and the vascular specialty specifically.

It has never been my personality to be cocky or arrogant. I am not bragging about my own humility--I have seen how far a little swagger can take you in life but I just don't have it. What brings me the most satisfaction is figuring out how to do something better than I'm currently doing it. This started with my junior tennis career, and a brilliant coach who would videotape each of my strokes and then painstakingly review the mechanics of my serve, forehand, and backhand to see how we could improve them. The lesson there was to keep perfecting my technique--not just to beat someone else (although that was the ultimate goal) but to be MY very best. It was a loftier goal than being #1 on the circuit, and something truly worth achieving. Of course, it can be painful and humiliating to learn your own shortcomings, and I learn them on a daily basis, but it is also most rewarding when you can tackle those shortcomings head on and come to a better place. That process is built into the career of surgery. Uncomfortable? Yes, but I never thought I was perfect anyway, and am far more content to see myself as a work in progress.

One of the greatest joys in my life is that I was able to continue this journey of perfecting my technique in the far more rewarding career (for me) of medicine. I wish I had a mentor like my tennis coach who cared enough about my technique on femoral exposures and vascular anastomoses to criticize every poor move. Isn't the whole point to be technically perfect? Of course, the onus is on me to learn my own best practices, but as a third year resident, I am still an apprentice. And the mechanics of a aortofemoral bypass anastomosis are surely far more important than the mechanics of my forehand, right?

Another turning point as third year comes to an end is the choice of a specialty. Vascular surgery has been my passion since I started residency, yet the acuity, lifestyle and lack of mentorship have made me question this choice. Until recently, I have strived to be on the academic fast track of publishing papers, presenting at meetings, and building my resume. But the realization of missing eight years of my family's life (it will be twelve once I'm done with fellowship) and a baby on the way have made me truly question my choice to become a vascular surgeon. What is the point of being a fancy surgeon when you haven't shared in the joys and trials of your family's life? When you cannot answer your sister's calls in the middle of the day, or help your mom plan her trip to Spain? Or even be emotionally present enough after work to enjoy an evening with your husband? And so many other things that fall by the wayside when you work 80-100 hours a week.

I have thought carefully about what I have given up, and what I will continue to give up in my life, for this career. While surgery will never surpass my faith and family in importance, it will, for a time, take up a lot of my time. But I figure I owe it to my patients to do what I truly love, what I can stay up all night reading about to help them, what I literally ache to do. Maybe there are people who can walk away from a career they truly love in order to be more available to their families--and maybe those people are just better people than me. But this is right for me. I need a career that challenges me, makes me uncomfortable, makes me look at myself twice and think about how to be my best and do my best for the patient in front of me. That career is vascular surgery. The list of priorities is the same, and I have faith that I will mold my career to reflect those priorities better than I am able to now.

I'm still a work in progress, for sure, but for the moment, it feels good to have this little bit figured out. And as the years pass, I'm getting ever so slightly comfortable with being uncomfortable.