Thread by @TheRealDoctorT

It’s a strange feeling, to realize that everything you ever wanted and worked for was a dead end.

I am a third year medical student and I have no idea what to do with myself.

My whole life I’ve worked for this, and now... nothing. 1/

I thought I wanted to be a trauma surgeon. Some friends convinced me that only a scalpel can make a meaningful difference to a patient.

Trauma surgery seemed like the kind of high intensity field I might thrive in.

Only one problem, now that I’m trying it.

I can’t stand it. 2/

My mentor is a trauma surgeon. He is a kind man, soft-spoken with a wry sense of humor. Kind of the opposite of how I imagined surgeons being.

I respect him, immensely.

We check in from time to time. I lie and tell him I love surgery. He seems pleased. 3/

The truth is I don’t have the passion for surgery that will sustain a career, nor the manual dexterity, nor the mindset.

So what do I do? My fellow students seem relatively certain of their career choices.

But I am lost. 4/

Finally I come clean. I tell my mentor that surgery isn’t for me. I expect him to be crestfallen, but he surprises me by laughing.

Apparently he sensed my heart wasn’t in it all along and was wondering how long I would keep up the charade.

He has some advice for me. 5/

He tells me to work backwards. Figure out what I definitely DON’T want to do, and then choose from whatever is left over.

Hmm. Surgery? No. OB/Gyn? It’s sort of surgical, so no. Psychiatry? No, I’m no good at it. Family medicine? Maybe. Internal medicine? Maybe. 6/

Pediatrics? This is a tough one.

I really love kids. One of the great regrets of my life to date is I haven’t become a father. The way I envisioned my life, I would have been a dad long ago.

But pediatrics involves sick children, and scared parents.

I’m not strong enough. 7/

So family medicine and internal medicine it is.

Family medicine includes pediatrics in its scope, as well as some OB/Gyn overlap, and that concerns me, so that leaves just internal medicine.

Ok. I have a direction now.

I shall pursue internal medicine. /8

I hate nephrology.

Ever since renal physiology in the first year of med school, I can’t stand the complex nature of the kidneys. They’re a black box that I can’t wrap my brain around.

Oh, and there’s math. And chemistry.

And yuck. Just yuck. Can’t do it. /9

But, like most things in life, it’s our mentors and role models who influence us.

The greatest clinician I will ever meet is an Irish nephrologist.

When I am first assigned to his service for a med student rotation, my heart sinks.

Anything but nephrology! /10

I don’t know it yet, but it is the rotation that will change my life and put me firmly on the trajectory I still follow to this day.

I’ll call the nephrologist Dr. G.

Dr. G has that rarest combination of gifts. The ability, and the patience, to explain something clearly. /11

Very quickly I realize that my “understanding” of the kidneys has been based on memorization, with little grasp of concepts and principles.

Dr. G deconstructs my framework, and rebuilds it slowly and carefully.

I start to see with clear eyes, the kidneys in their context. /12

There are few things in life as gratifying as finally understanding something that you thought was beyond your reach.

When I start to see past the math and the chemistry, I begin to see the precision, the intricacy, the magic, the incredible beauty of it...

I am hooked. /13

Dr. G is everything I want to be. He is kind, humble, and sharp as a hawk. He misses nothing, his clinical skills are superb.

I witness him diagnose a sub-segmental pulmonary embolism by auscultation and his instincts.

The CTA confirms his diagnosis, and the location. /14

At the end of the rotation he has me see a consult all by myself. When I am done, I am to formulate my own plan and present to the resident on the medicine team, Alice.

Alice is the chief resident, and a brilliant teacher.

Later on she will play a major role in my life... /15

I finish the consult, and apply the principles that Dr. G has been teaching me. It is like a Rubik’s Cube I am decoding, working the different permutations until I realize what makes sense.

Alice is impressed. By me.

A lowly student.

It is the happiest I’ve been in years. /16

I decide that I will pursue a career in nephrology once I am done with my internal medicine training.

I thank Dr. G profusely, but he is his usual self-deprecating self.

Many years later he will retire to play tennis with his friends and live in a lovely cottage in Ireland. /17

I’ve now been practicing nephrology for over a decade. As part of what I do, I teach medical and nurse practitioner students almost every day.

I see myself in them so often. The same uncertainty. The same hopes and fears.

I tell them something Dr. G told me many years ago. /18

Medicine, like life itself, is an exercise in managing uncertainty.

It’s okay to be unsure. It’s okay not to have all the answers. And it’s okay to figure things out as you go.

Cultivate resilience, and patience.

You’re not alone.

You’ll be fine.