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Three surgeons operate

OR or OB? A medical student considers specialties

Stanford medical student Orly Farber ponders her response to the ubiquitous question: What will you choose for your specialty?

"What do you want to be when you grow up?"

It's a question I frequently hear from physicians on my clinical rotations. Phrased somewhat tongue-in-cheek, the wording allows me to answer either in jest or in earnest.

"An astronaut," I sometimes say, hoping for laughs and no follow-up. Other times, I try out different responses like Halloween costumes: a critical care specialist, an emergency physician, a surgeon. If I want the questioner's input, I'll open up: "I have some ideas, but I'm honestly not sure..."

I've heard that, in medicine, it's nearly impossible to know what each branch point will feel like until you're in the thick of it -- either in the middle of specialty training or in your first years as an attending. At that point, it's often too late to change course.

For students, no matter how much you love a particular specialty, medical school ends with a leap of faith. Unlike working at a tech company or even as a physician assistant, we can't try out our specialty for a few years -- we only get a few months at most before marrying ourselves to one type of medicine.

For those of us with focused interests, this decision would seem easy: my friend who loves neuroanatomy should, of course, become a neurosurgeon. But even if she loves studying the brain in a lab, and enjoyed the single month she spent rotating with one neurosurgery team, is that really enough evidence to commit to that time-intensive, emotionally-taxing career -- to that way of life?

For me and many others, our interests are less well-defined. I know that I want to connect with patients, comfort them and help them heal -- but I can do that in a variety of fields, with all kinds of patient populations. From here, I need to decide: where can I personally be most impactful? And equally important to me: where will I feel my happiest, my most intellectually curious and most compassionate?

Rotations are my opportunity to answer these questions and, in some moments, I've been blown away by the clarity I've found. I've been surprised by how easily I've decided no, I definitely don't want to do that. And I've been thrilled to discover new aspects of medicine that I enjoy -- unexpectedly -- as I've recently done on my surgery clerkship.

Doctors say that your first branch point as a student is medicine versus surgery: "Do you want to solve problems with your brain or with your hands?"

Having never been particularly handy -- I lose patience when assembling IKEA furniture and have trashed several crafting projects -- I assumed my answer would be "my brain." Plus, with surgery, I worried that most of the time spent with patients would occur while they're asleep.

But since starting my rotation, I've found that the hand-brain dichotomy is a vast oversimplification. I've also spent time with my patients after their operations, checking in with them each day to see how their recovery is progressing. And despite my IKEA mishaps, it turns out that I love fixing things with my hands. This week I helped remove a man's skin cancer and sew him back up. I left the operating room feeling satisfied, brimming with hope and enthusiasm; the patient left cancer-free.

I still don't know what I want to be when I "grow up," and I worry that I'll never be able to answer that with absolute confidence. I'll never see every specialty -- I have no rotations in ophthalmology, cardiothoracic surgery, or urology lined up -- and even with those that I do experience, a couple weeks on a service won't be enough to imagine a full life's work.

These gaps and guesses frighten me, but I'm settling into the discomfort of uncertainty. I'm treating my best and worst days on rotations like concrete pieces of evidence to affirm not this or yes, that. I'm paying attention to what parts of medicine bring me joy and where I derive energy. Maybe that's in the operating room. Or maybe in the emergency department. Or maybe somewhere in between.

Whatever I decide, I'm going to take a little leap of faith, just as I did when I committed to medical school in the first place. Luckily, that one turned out just fine.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Orly Farber is an undifferentiated third-year medical student from the East Coast. She loves reading and writing about medicine. Her written work has been featured online in STAT News and The Intima, as well as in print in The Boston Globe. In between hospital shifts, you can find Orly running The Dish or making a mess of dishes in her kitchen.

Photo by Rachel Baker

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