Monday, April 19, 2010

Delayed gratification

I have never thought of myself as being indecisive, ambiguous, or confused. Well, definitely not about major decisions in my life. (That the trivial mundane simple daily chores pose a Herculean task to me, is, well a story for another day). Taking up studies in medicine and then pursuing a seemingly-misdirected attempt at a degree in epidemiology have been well-thought, well-planned, and well-weighed agendas that have over time proved worthy in my service. Yes, of course, there are those momentary lapses of 'what if(s)', but these transgressions of resolute are permissible and well within limits.

Then,what am I talking about now? I have always wanted to define my work in the field of health. That is something I have been absolutely sure of. I worked my way into a place in medical school that I earned for sheer hard work and dedication in preparation, topped with a little luck - what is popularly known as the 'merit seat'. I mention luck too, as I am sure there were many peers who similarly worked hard and lost out to factors intangible and inexplicable. Medical school brought me face to face with people - and it was this aspect of medicine that I loved. The feeling of bringing health to the ill, of saying a comforting word and lending a helping hand was honestly the reason I took to medicine.

Yet, behind this humane face, there is so much competition and the pressures of doing well, examining and reaching a decent diagnosis and treating the ill can indeed be overwhelming. I was surely overcome by fear of not being up to the mark. And in my growing disenchantment with my own capabilities as a doctor, I found solace in a field where 'we save million lives at a time' - epidemiology and biostatistics.

The daughter of an engineer and a mathematician that I was, I was always encouraged to love the rule of numbers and figures. Sometimes, I surmise, my act of entering a non-mathematical field was an act of rebelliousness against my parents. Little did I know how mathematics would continue to haunt me years later. I still marvel at how population genetics and genetic variation are fundamentally explained by the one equation from my 7th Std algebra class by Mrs Sati Purushottaman - a^2 + 2ab + b^2. How diagnosing a case is an individualized method of hypothesis generation, and how exploratory data analysis helps us identify patterns of characteristics in groups of people and how tweaking numbers and equations helps us define associations and causation such as smoking and lung cancer, identify and radically institute treatment measures such as that seen in the SARS epidemic or more recently the influenza pandemic in 2009. I also learnt how numbers can be manipulated in clinical trials and how vigilance can force reversal and recall of drugs after they were marketed. It was because of rigorous experiments on a large scale that gave impetus to local governments to create policies banning smoking in public places and especially in closed environments. But there is so much that goes on in the background of 'research', that my earlier dismissive notion of epidemiology has largely been corrected and I am humbled. Health policy, treatment, prevention, health promotion, natural history of disease, causes - I saw it all happening during my sojourn in epidemiology.

Then why now the thought of going back to clinical individual medicine? I am not frustrated, nor do I find the lack of a challenge. Logistically, I do feel my experience as a clinician will bring more to the table than just as a medical student - only because I do not have hard core statistical background, and especially because I regret neglecting calculus in high school. (Yes amma - you were right!). But now, I truly miss talking to patients, I miss learning from them. I have learnt that it is okay to make mistakes, and that all doctors kill people before they start saving lives. Yes, even in clinical medicine, we are allowed a few mistakes - as long as we recover from them, learn from then and make sincere attempts to never repeat them. As scary as it sounds, this is probably why our careers are renamed our 'practice'.

I am oft asked about the reason for my digression. These are manifold, some of them I do not understand too well myself. And then in times like these, I close my eyes and go back in time to three well-etched memories. One in my 3rd of medical school, talking to two of my dearest friends and confidants while strolling around our campus; an earlier memory that occurred a year earlier of me talking to one of those two friends in my room; and the oldest one, of an unsent letter to my parents and sister, that was discovered by my dear grandpa. And the common thread connecting these incidents was the desire to study populations to make inferences about clinical medicine, to be involved in disseminating the technology involved in this process, and to devote some of my time in the service of those ill and to make their illness disappear, improve or at the very least bearable.

I always knew I wanted to marry mathematics to biology, and in this I was fairly inspired by a close cousin who uses mathematics to model how drugs affect cells in the body. At the school of public health, I went through a phase of low morale that kept me from believing in myself. My plan was to get into a residency program next year and start running at full steam. Somewhere, I started to doubt my own abilities as a doctor, as a healer. I reached a nadir, and then when there was no lower to go, I started climbing up. With so much support from those closely associated with me, I have begun to realize that I was consumed with fear of uncertainty and with time and experience, my skills as a doctor will hone and fine tune themselves. I have finally begun to believe in myself, and I want to give myself a second chance with this attempt at my residency.

i do not want to rush into it, and then be overwhelmed by the whole process. I would rather take slow but sure steps. When I think about the big picture, I realize how there are some loose ends that I need to tie up, before I plunge three years of my life into the oblivion of residency. One more year, I sigh. And then think, one year, where I can firmly carve out the next five years of my life. (And work on enlisting the support of friends, confidants, family, and some special people in planning and espousing my dream).

I see myself coming back to me. I have begun to feel happier with the person I am. One year for a life long dream. A gift to myself with the promise of delayed gratification. I think, it is worth it.

1 comment:

Rao said...

think its worth it too. :)