Choosing your specialty: a poorly developed metaphor

Friends, your 3rd year clerkships are a whirlwind. The year seems daunting at the start, and as soon as you blink it’s already almost time for board exams again. Or, maybe it only feels that way in hindsight. My knees and back seem to recall the long, grueling days on general surgery.

I told myself from my first year that I want to do primary care. Maybe internal medicine, maybe family medicine. I really like the kids, so I’d rather family medicine than internal. But internal medicine has much more interesting and intense medicine. Family medicine can be so blah. Perhaps my preceptor was the one who ruined it for me, making me stand quietly in the corner, not make eye contact with the patients, definitely not touch the patients, and most certainly don’t look at the patient’s charts. Oh and it was rainy and foggy for 10 days straight right in the middle. Either way, I was pretty turned off from the specialty.

Internal medicine it is then, eh? I did not love my IM rotation either. The administration at the hospital was bad. They did not let students rotate alone. There were four students to one resident. It was a small hospital that sent all the interesting cases into the city. I could think of 100 more reasons that I did not like the rotation. So, let me think about the patients. Sweet old ladies with heart failure, alcoholic men with pneumonia, thirty-something-year-old cholos with alcoholic liver failure and/or a necrotic foot secondary to unchecked diabetes. These are the cool cases in IM. Getting a history from these people was fun, diagnosing and choosing a treatment was stressful, but the good kind of stressful… right? RiGHT?

Then along came my pediatrics rotation. There is nothing more exciting than a well-baby exam. Otitis media is otitis media is otitis media. ADHD has three treatments: bim, bam, boom. Easy. Peasy. Lemon. Squeezy. I get to talk about kids (my favorite subject) to their parents (whose favorite subject is also their own kids) all day??? I realized on my pediatrics rotation that I actually LIKED the patients. In IM and FM, I liked my patients for the same reason that I like to drink dark roast coffee: I just don’t know any better.

My brother-in-law swears that dark roast isn’t good. Lighter roasts let you taste the real flavor of the bean, the soil in which it was grown. A dark roast just lets you taste, well, the roasted part. Burnt bean water. I’m so sorry, but adult medicine is like a dark roast coffee. It does not matter too much where the bean was grown, the type of soil it grew in, or if mom and dad wanted to vaccinate it. In adult medicine, every patient is just a big old cup of burnt bean water, and at best you can decipher if it needs some cream, sugar, maybe a splash of water to dilute it a bit, or it might be are really hopeless cup of joe that you can’t save with a little sugar so you refer to surgery for triple-bypass and then BEG that cup of joe to take less cream and maybe try walking a mile every now and then.

Kids on the other hand: light roast, or maybe freshly picked from the farm. Not processed yet. Not burnt yet. Not stale and sitting in a diner’s ancient coffee machine with a bright orange handle indicating “decaffeinated”. The essence of the soil is still there. Perhaps the bean is still just being roasted, and as a pediatrician I get to decide the temperature so that when the bean becomes a cup of hot coffee someday, it won’t even need triple-bypass surgery. I get to look into the perfect little ears, and tiny eyes, and itty-bitty mouths of the young coffee beans and figure out how to put them on the trajectory to become the world’s best cup of coffee. No cream and sugar needed if I do my job right. And that’s what I love about it.

I didn’t realize this post would become one about coffee. I really meant to just say that pediatrics snuck up on me as my chosen specialty, and it happened a little later in the game than I wish it had. But here I am, coffee metaphor and all.

Go find your spot in the life cycle of a coffee bean. You’ll eventually find the coffee you love best, and the cream, sugar, whipped cream, almond milk, and double pumps of syrup that you love putting in it best.

Disclaimer: I have only tried a light roast ONE time in my life and it was sour and disgusting. I’ll need to do a little more experimenting to find out if I even like light roasts done right. Either way, I think my metaphor stands up.