Like a number of my peers, I am a career changer. Having started in social work, I shifted course four years ago this month, returning to school to complete the dreaded pre-medical sciences. Social work is an amorphous field, one that both the public and practitioners sometimes struggle to define. After all, it seems like they do everything, from individual therapy to foster care case management to public health education. More and more, physicians are also being tasked with “doing everything.” A growing body of research, for example, has linked adverse childhood experiences and other social determinants of health to poor outcomes over the lifetime. Interdisciplinary practice is clearly the linchpin of addressing these intersections, but the field continues to struggle to understand how.
Piloting a sexual health curriculum in rural Rajasthan, India as a social work student.
As a social worker, I thought a lot about how to create change and how to empower others to be thoughtful, value-informed actors in their communities. The sudden transition to studying the basic sciences was, thus, jarring. Whereas in social work I often worked in the liminal space between the rational and irrational (what makes us act the way we act and think the things we think?), the sciences were somehow both rigidly delineated and also impossibly abstract (see Schrödinger’s cat). To my great surprise, however, I began to think like a scientist over time, applying rigid rules to natural phenomenon. Nobody cared about how the molecules felt, only how its electors were distributed. But then medical school happened. Medicine exists somewhere in between these two, which is why it is often described as both a science and an art. While this maxim was originally used to describe how to treat illness when we only had a partial understanding of its mechanism, it is evermore becoming a way to understand the relationship between the physiologic and the social. For example, physicians today are working to understand both the underlying mechanisms of COPD and why people don’t stop smoking. As physicians, we are taught to understand the body rationally: X process leads to Y disease. But the waters become muddied when we factor in human behavior: Why would someone smoke when they know the harms to be so great?
In my previous career I often struggled to describe what I knew how to do. As I’ve embarked on a new process of professional acculturation, however, I’ve begun to realize that my previous training gave me a way of thinking systemically, evaluating how individual experiences relate to the larger sociopolitical processes that shape everyday experiences. This, for instance, can help us understand how an individual opiate addition relates to prescribing patterns, the legal system, economic markets, and public health infrastructure. With my growing knowledge of medicine, however, I’ve been better able to understand the biophysiological processes that underlie both pain and addiction, creating a much richer understanding.
As the interaction between society and health becomes even more clear, medicine and medical education is changing. For example, our Doctoring course helps us to both learn how to listen to the heart and to counsel patients on exercise, and the Paths of Excellence give us an outlet to explore fields such as public policy and the humanities. It was in this spirit that I initiated two projects this summer to help us be better advocates for health. In one, I am working with the Center for Experiential Learning and Assessment to develop a self-reflection module paired to clinical simulation. Physicians are given the tremendous privilege of working with patients on some of the most stressful, emotional and personal aspects of their lives. How we process these situations, and learn from them, is an important professional skill if we are to gain comfort navigating these complex situations. In the other project, I am preparing a study to examine sexual violence amongst gay and bisexual men. Given that life experiences can impact the health of our patients in myriad ways, better understanding their context can lead to tools to identify and address these factors.
As summer draws to a close, I am struck by the tremendous intellectual diversity that defines medicine. From basic scientists to clinical investigators to public health researchers to health care economists, all collaborate to give an understanding of what makes us healthy and what makes us sick. No one discipline can do it alone, but also our collaboration is only as effective as our insight into what we bring to the table.
In the last two months, I have been to six surgeries. I have felt warm, viscous, blood course over my gloved hand as I held a retractor during a Cesarean section. I have seen the inside of a man’s abdominal cavity as I held a laparoscopic camera. I have watched as boogers were pulled out of a man’s sinus by a tiny vacuum cleaner. And I don’t even want to be a surgeon.
As a social worker, I often encouraged the teens I worked with to step outside their comfort zone in order to learn more about themselves (and I practiced what I preached, like zip lining!). Medical school shouldn’t be any different.
My journey to medicine began in social work school in Chicago. There, I focused on health disparities and working with teenagers, thinking I would spend my career as a community organizer and health educator. And thus, I was shocked when my advisor connected me with a watchdog group conducting citizen oversight of the Illinois prison system for my social work field placement (a residency, of sorts, conducted in your final year of school). “You should try new things,” she said as I left her office that day, deeply disappointed. She was, of course, correct. My time working on prison reform gave me tremendous exposure. Not only did I collaborate with an interdisciplinary team of lawyers, I also learned that I could connect with people very much unlike myself by being open and honest. I learned that changes in bureaucracy happens both at a policy level but also in hundreds of individual decisions by the hundreds of employees carrying it out. I learned to elicit information not from asking questions but by staying silent, and I learned how to cope with moral ambiguity. But in the end, after graduating, I did not go into prison advocacy, or health education for that matter. Because truly, that wasn’t the point. Instead, I took a job running youth leadership training programs at a synagogue. Go figure.
Which brings me to my first time in the operating room. It was by a chance invitation that I found myself standing there at 7:00 a.m. one morning, the patient confirming his identity one last time before being put under anesthesia. I looked around, at the sterile instruments laid out on the table expectantly, at the phalanx of monitors beeping indecipherably, at the resident typing furiously, at the nurses conducting a stream of seemingly endless tasks. I wasn’t just out of my comfort zone, I was out of my league.
As an older student, and a career changer, I feel that I have some sense of my skills and interests. I like building partnerships for change, synthesizing information and prioritizing goals, working with children and teenagers – all of which have been pushing me towards medical, not surgical, disciplines. “Why am I even here,” I asked myself, intimidated by the charge nurse who kept eyeballing me as I tried to blend in with the tiled walls. And yet, slowly at first, but then all of a sudden, I started to become comfortable and fall into the choreography of the surgery.
With the arrival of the attending, I was invited into the small community of health professionals who would, over the course of the next three hours, become a self-contained universe focused on the removal of a tumor growing in the patient’s sinus. I marveled at the surgeons’ knowledge of anatomy, at the technology employed, at the teamwork exhibited, and at the fact that I didn’t contaminate the sterile field. Near the end of the surgery, peering deep down into the patient’s sinus through a pencil sized hole through his gums, I didn’t know what to make of it all. It had been a tremendously exciting morning, not at all what I had expected, but I also didn’t feel like it was my calling.
Again, by chance, five other surgeries followed in two different ORs. While I didn’t seek out these opportunities, I also didn’t say no to them when they appeared. There is something magical and disquieting about being inside of a body, seeing an artery pulsate or a uterus be pulled outside the abdomen. I still do not think I am interested in surgery, too technical and goal oriented, but I am grateful for the chance to be able to have decided this through experience not bias.
Like my time working in prisons, I have learned a tremendous amount from being in an unexpected environment. I learned that hierarchy is not the same as devaluing other’s contributions. That trust is shared not just between surgeon and patient, but also between surgeon and nurse and tech. That honesty about one’s capabilities is respected by the right kind of leader. And that there is such a thing as a very tiny booger vacuum cleaner.