On existential crises and canine companions (or Neuro/Psych: a post-mortem)

Over this long weekend between rotations, we hosted two little dogs and one little brother. A rowdy female Pug, a nervous Pomeranian, and a combined masters/PhD student from the University of Virginia. The house felt full of love.

Spending time with my brother was lovely. He arrived on Thanksgiving morning and joined in our slow, post-exam pace of life. We video-called our parents before they left for their own early dinner with friends in the Jacksonville area. We feasted on roasted doe, homemade gravy, green bean casserole, stuffing, and of course some dumplings for good measure. The house fell asleep around 7p with a full belly.

Mackenzi and I both loved the weekend with the pooches. Returning to the house felt like a true homecoming every day, with their excited wiggles and enthusiastic kisses. Refreshing regular walks outside reminded me how you walk the dog and the dog walks you. Snuggling the sleepy pooches during an afternoon nap felt like a preview to co-sleeping with some baby nuggets.

Overall, the dog-sitting reminded me how much I love dogs. The question now: do we begin taking care of a dog? Could we reasonably care for a canine given our third-year obligations?

The idea rolled around when we first moved here. Back then, we decided against adopting a pooch. Now, not so sure. I love watching my partner talk to the pug. I love watching them play. I love cuddling with all of them in one big pile. I think we’ll wait until 2018, when we return from winter break.

Bringing a dog into our lives for a month, then leaving for a month during break, would be unfair to them. So, we’ll re-evaluate our feelings after a few weeks on our new rotations and with some distance to provide perspective on the decision.

The Neurology and Psychiatry rotation is behind me. The Shelf exam on Wednesday went as well as could be expected: I studied well and am confident that I passed. The only doubt that remains is whether or not I scored high enough to qualify for honors. An ideal outcome given my interest in a Psychiatry Residency. I must wait until 2018 to find out the results, probably halfway through Women’s Health and Pediatrics.

The night before the Shelf exam, I had a crisis of purpose. Existential evaluations rarely happen during quiet lulls. They seem to boil over when panic and doubt have softened you up. I wrote the following in one fell swoop as a study break, detailing some of my doubts about a future in psychiatry. Edited a bit for clarity.

Do I want to practice Psychiatry?

I think so. It is hard to give a definite yes. Getting to the point where I can practice psychedelic medicine is a long road.

Another year and a half of medical school, a quarter million dollars in loans, then four years of residency, and then I can finally attempt to start my true practice.

Is it worth it to jump through that many hoops? Do I want it that much? Will the Eugene that reaches the other side still want this?

I don’t know.

There are many unknowns that separate me from confidence in an answer. Where will I be? Will I have the work/life balance that I desire? Will I be financially stable for my family? Will I have patients that I want to see, day in and day out?

The next year and a half is simple to mentally project. Women’s Health and Pediatrics will be different and challenging. The surgical rotation will demand much from me. Fourth year will require lots of flexibility as I navigate Step Two, away rotations, and idle time. I’ll rack up debt and hours in clinic that will keep me stuck in the sunk cost fallacy.

Residency is a different unknown. Will I have mentors that can help me pursue my passion for a different model of psychiatry? Will I have like-minded colleagues? With whom I’ll want to spend long hours? Will I practice in a setting that I feel good about? Will the inpatient psych unit feel like a prison or will it seem like a therapeutic environment for healing? Will the nursing staff be stressed and take it out on the patients or will they support these people through their spiritual and emotional crises?

Will I support them?

Now, my concerns are less acute. My doubts are real and valid, but they serve as guiding principles going into the residency match process rather than a solid reason to leave the field of medicine. Much like the decision to adopt a dog, I have to create some distance before settling on a major life change.

I’ve attended a few transformational events, and the ones with the best facilitators told us to wait at least a week before initiating a major life change. During the course of the experience you may decide to quit your job, end a toxic relationship, or move to a different state, but you should make that decision soberly and with perspective.

That is why I am thankful for this long weekend. A chance to check in with family, to re-experience the unconditional love of a canine, and to gain clarity on the change that I’m undergoing. It’s been a long road to here and, in many ways, I’ve just begun.

As this year draws to a close, I must continue to evaluate my goals and desires. Everything is still on the table. If I feel stuck, that’s due to my perception of the situation. If I don’t feel joy, that’s because of a series of decisions.

Despite what the Pennsylvania winter shows me, I must remember that life is just beginning.

Long Form Sundays

On Death Podcast

6 thoughts on “On existential crises and canine companions (or Neuro/Psych: a post-mortem)

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