#418

I love my job. On Monday I returned to clinic, this time in Dermatology. After a 2 month hiatus, I finally figured out how to iron clothes and pack a lunch the night before, and get up with enough time to make it to morning report. I've also figured out how to study at least 2 hours a night. Amazing what 2 months of consistent sleep will do for you. And did I mention I'm studying again? How I missed reading and learning all of those little details you should know, like use a number 15 scalpel blade and a 30 gauge needle. And the difference between an ointment and a cream.

I'm not a fan of specialties for many reasons. I've found difficult personalities like to focus their attentions intensely, so difficult people like specialty medicine. I've also found that most patients have been so abused (and disabused) by the time they actually see a specialist that they do not make happy patients, and the time spent suffering and waiting often magnifies the issue. (Witness the knee replacement patient who after years, literally years, spent with pain and limited mobility spends an entire office visit complaining about the size of their surgical scar. But I digress, and I don't sound compassionate.)

To my delight, I have found that I enjoy dermatologists. Really and truly. I suppose that happens when there are only 7 residents, scant call, holidays off, and an 8-6 work day. I'd be content too. There are few dermatologic emergencies as well, so stress level is nice and even. And you do procedures all day, a nice way to split your brain.

When I started medical school, I thought there were only two questions you had to answer: Heal with steel (i.e. surgery or medicine)? Like kids (i.e. pediatrics or medicine)? I wish I had understood that the "heal with steel" question was really OR vs office procedure? Because the OR sucks (sorry, Mom to use that word, but it does), while office procedures rock. And you get paid a lot of money for them.

The other fun things about dermatology is the patient mix. Mostly adults (of all ages) and you get to see men without cardiac issues (truly rare), but a fair mix of bubbly 3 year-olds, too. I've spent the last 3 days wistful about the fact that I will never treat an adult patient again (because, c'mon, most 23 year-olds don't qualify as adults). I like hanging with adults - the stories they tell, jokes - because they remind me of my family. Isolated in snowy Upstate New York, I can still see my grandfather peering out of that patient's eyes, or this patient with the same name as my Dad. And then I remember adult bodies and the problems that come with them, and I am thankful I can forget about whole portions of the physical exam (which I'm not good at anyway). Kids are so simple (mostly) and their anatomy is in the right place (mostly).

I'll spare you the gross pictures.