the underwear drawer

the switch

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My last neuro call was gloriously frontloaded, with a moderate amount of action during the day but a quiet night. Got called a couple of times for kid seizing, but since they were in the hospital for EEG monitoring of their seizure activity, we didn't really do anything about it. Seize away, little children. Just make sure that you stop after a few minutes.

Since I was able to get some sleep overnight, I set my pager to wake me up the following morning at 6:15, even though attending rounds didn't start until 8:00. After a brief peek in on my kids first thing, I went downstairs, walked through the building from the Children's Hospital to the main hospital administrative building, and went upstairs to the offices of the Anesthesia Department. There was a 6:25am lecture on airway management for the new Anesthesiology residents, and I didn't want to miss it. Now what the hell was I doing sitting in on an Anesthesiology lecture at 6:30 in the morning?

Here's where it gets crazy. Don't get too excited, but I have something important to tell you.

I'm switching residencies.

Starting this Spring, I'll be a first-year Anesthesia resident at [University Hospital]. Starting April 1st, to be exact. This is not something totally out of the clear blue sky, I'd been considering it for a few months now, but I have to admit, once I made the final decision to switch and spoke with the necessary administrators, it all happened very, very fast.

And now, becuase I'm a mindreader, here are the answers to some FAQ about my switch:

Why are you switching? What, you hate kids now?
Not at all. I still want to work with kids, and I still want to be involved with Pediatrics. I just came to the realization that I didn't exactly want to be a Pediatrician. Let me emphasize this one more time in case it isn't clear: I'm not switching because I had a bad intern year, or because I don't like Peds. My decision has nothing to do with my life in its immediacy, I'm not that short sighted that I extrapolate that all life in Pediatrics is as grueling as intern life. However, after my intern year, I realized several things. The first thing I realized is that my interests tended towards acute care. I like the ICU setting, I like critical care. I also realized that I wanted to do something moderately procedure based, not necessarily cath or endoscopy (read: cards or GI fellowships), but a field where I could be a little more hands on than a generalist. I wanted something with a good amount of flexibility, meaning that I wouldn't have to be pigeonholed into too specific of a field (NICU, for example). I wanted a career where I could have time to reasonably accomodate a family life, where the job prospects were good, and where I could have a comfortable lifestyle while still managing to keep my fingers in academic medicine. I was really struggling to find a fellowship or career path within Pediatrics that could accomodate all these things I was looking for, and having a really hard time with it. Then I realized that things weren't as rigid as they seemed. The field of medicine is dynamic, and so is the development of a medical career. I realized that switching fields was possible, and, after wrestling with my decision for a good long time, I decided to go for it.

What, so you can just leave your residency? Weren't they pissed?
Not really. I mean, I think they were surprised, certainly, but once I told them what I was planning to do and why I was doing it, they were actually great about it. My fellow residents were nothing but supportive, and my program director was invaluable in helping me call the Anesthesia program and set everything up. The late switch date is out of deference to Pediatrics, since I wanted to pitch in and help them out with their call staffing (I feel guilty, all right?) but the Peds Department really went to bat for me, and I don't think my cross-over could have been accomplished as quickly or as smoothly without them.

So, now what?
So for now, I'm a Pediatrics resident, same as ever. I'll keep on working, on Neurology, in the ER, in the NICU, PICU and wards for the next few months. I'll take call, I'll pitch in where I can, and come April, I'll switch over to Anesthesia, and be a clueless first-year all over again. Anesthesia is a four-year residency, of which one year is a preliminary year, usually Internal Medicine, but sometimes Peds or even Surgery. I already completed what amounts to my prelim year, and I'll be doing a little more on top of that before I begin (the nine Peds PGY-2 months that I'll be doing before the switch), so basically, I'm looking at at least 4 more years of training from this point in time. Which sounds like a long time, five years of residency training total, but even if I decide to chase my Anesthesia residency with a one-year fellowship, I'd be finishing at the same point in time as if I decided to complete three years of Peds followed by a Peds fellowship, which invariably runs an additional three years.

How long have you been thinking about this? Didn't this all happen really fast?
Yes, it does feel like it happened really fast, once the machinery was in motion. But I'd been contemplating the switch for a couple of months now, at least since this past winter. And whereas I dismissed a lot of those early thoughts as the winter blues, or the halfway-through-intern-year-disenchantment, the fact still remained that I knew what I liked and I knew what I didn't like, and that I was struggling to carve out a career path for myself that could accomodate all the things I envisioned for my future, both professionally and personally. Am I 100% sure that this move is the absolute answer for me, and that I can guarantee perfect Nirvana-like happiness forever and ever into infinity because of my decision? Well, I don't think you can say that about any decision you ever make, unless you're delusional. But do I feel with confidence and faith that this is a good choice for me, a well-thought out mature move, both for my life now and for the long-term? Yes, absolutely. I'm glad I'm doing this, and I'm grateful that I was given this chance.

Wait, hold on here. Your name is Dr. Ow and you're going into anesthesia? Don't you think that's funny?
Oh, don't think that didn't occur to me. Wait until I do a fellowship in Pain Management, then I'll really have you rolling in the aisles.


Currently reading: "Basics of Anesthesia, 4th Ed." I'm not switching for months yet, but I might as well start doing some reading now.

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