Sunday, June 13, 2010

Tomorrow, I am going to walk into the largest and best children's hospital in America and pretend to be a doctor who works there.  Or at least, that's what it feels like.  It feels unreal.  In some ways, the last five years of my life have been a lot of learning how to play "the game" -- learning to put the best foot forward, make a good impression, meet the right people, get the good test scores & accumulate the symbols of ones status and knowledge.  Completing med school feels almost like a purely symbolic task, performed to sate my determination and showcase my ambition and intellect, but having nothing to do with actually becoming a doctor.
    By and large, I know that the ways in which the above are actually true are minimal compared to the other ways in which med school was important in my life -- what I've learned about really caring for other people (not just as a turn of phrase), how to perform myriad clinical tasks from procedures to telling someone that their loved one has died and learning massive amounts of biomedical science.  I know that I am the best I have ever been -- the smartest, most educated, most knowledgeable, but also the most compassionate, most understanding of ethics and least cynical I have ever been.  I know that I can be a resident and that I will be a good doctor.  I know, intellectually, at least, that I deserve to be a doctor at America's best children's hospital.  That doesn't stop me from feeling like an impostor, though.

    I think that part of the feeling of unreality is that the dream of being a resident at this particular hospital, or even a hospital like it, is less than a year old.  Just over one year ago, I decided that if I was serious about making a career of clinical genetics, I needed more training in it than what I had gained from my home hospital.  My home institution had a genetics department that I love and that treated me extremely well, but, by their own admission, was small and not equipped to prepare me to deal with a large, academic genetics department.  In search of the best place to have a genetics experience, I landed on the hospital that had trained my favorite teacher and mentor.  I never once considered that I would try training there for longer than one month -- the hospital was large, with a reputation for being snooty and, I felt, too prestigious to take me.  
    I changed my mind last August, after stepping foot in what will be my work home for the next five years.  There was something in that atmosphere -- it buzzed with scientific curiosity; little things, like the protocols for hand-washing, were clearly laid out and it was clear that from every level, there was an investment in improving the hospital even more.  But moreover, it was a giant place for kids and every single person I met from MAs to world-famous MD/PhDs cared about providing the best care for children anywhere.  I wanted to be a part of that.  I had never been exposed to such a large-scale, free-standing children's hospital before.  I had no idea that they even existed.  My home hospitals, largely out of necessity, shared the most specialized of sub-subspecialists between adult and pediatrics.  This hospital had the most arcane specialities just for kids.  Every day I came home even more impressed with the hospital.  I knew I wanted in.

    However, even for pediatricians, getting a residency spot is competitive.  I walked out my last day trying to commit details to memory, just in case it was the last time I ever set foot in the hospital.  And my application process was rocky: I was denied an interview.  It was overturned, but I knew that my dream was over.  I focused on the less "reach" programs.  When I came for my interview I repeated the ritual of committing the hospital to memory on my way out.  I knew it was goodbye.  

    For all of that, I wasn't shocked when I matched at The Hospital -- correspondence between interview day and Match Day was very encouraging -- but by that point, the journey had been so hard fought that it felt symbolic, rather than real.  Last week, when I entered The Hospital for only the second time since interviews was the first time it hit me: this is my home hospital know.  I work here.  I'm part of this.  Weird, right?