Can you send me a couple articles to help me make an informed decision about the vaccine for myself?

This is exactly the kind of question that I would like to answer for my friends. Unfortunately, it is also overwhelmingly complicated, and I hesitate for fear of making things worse. I think one on one conversations are a good place to tease out where a person is starting from, and what matters to them in their decision making. For the sake of this writing, I am planning to share 3 articles, and hopeful I can give fair context to help place them in the informational ecosystem from where they originate.

To begin, I’ll bring up a role model who as a public figure, and alternative health author, has taken to social media to defend and promote the vaccine for public health reasons. Lissa Rankin is concerned that criticisms of vaccines lead to hesitancy which is actively harmful for public health. She has published her take on the various issues, and in the writing invokes a frontline physician and a vaccine hesitant intellectual, here: https://lissarankin.com/a-front-line-covid-er-doctor-a-vaccine-hesitant-intellectual-answer-the-question-should-front-line-health-care-workers-get-vaccinated-now/

From my perspective, the information playing field is weighted with the interests of the pharmaceutical companies being protected. I believe that the television news (CNN, ABC, NBC) and written and audio broadcasts including the NYT, NPR and even the algorithms on social media (twitter, facebook) effectively filter content in a way that does not allow representation of  valid vaccine criticism. From Lissa’s perspective, this may be a good thing because vaccine criticisms tend to manipulate and mislead their audience in a way that is generally harmful. So I advise using plenty of critical thinking and skepticism when engaging with content from vaccine detractors, but differing from Lissa, I do encourage you to consider their perspective for yourself. 

In my opinion, RFK Jr is the most well-balanced voice among the vaccine critics, and because of that status, he is often strongly rebuked in the mainstream media. His niece, who is a physician, wrote an op-ed which was published in the NYT criticizing both his arguments and his character. He wrote a response, but it was not published on the NYT, and instead is only available on the website associated with his vaccine critical advocacy, the Children’s Health Defense. Here is that article: https://childrenshealthdefense.org/defender/new-york-times-kerry-meltzer-covid-vaccines/

Finally, as a 3rd option, here is a personal blog from a friend of a friend. I know little of the author, only that she is a scientist and vegan, and she is sharing her perspective much in the way I might try to do on this blog. Here’s that link: https://sarinafarb.medium.com/covid19-vaccination-one-size-does-not-fit-all-c5dbf55df688

This morning I was considering speaking on a conference call with clinic staff where I work, and where the vaccine is being heavily promoted. Our clinic administered the first 20 doses of the Moderna product to employees this morning. I have responded to a survey indicating that I am not willing to receive the vaccine at this time. I imagine sharing these thoughts in a video for social media. The time I think is coming for that kind of activism, and the response it generates will be worth navigating… I think. Here is a brief writing of what I might have said on that clinic meeting:

Hello, before I say anything, I just want to voice that I am open to further discussion about my position, and about your decision on whether or not to receive the vaccine. I am choosing to wait at this time for a couple reasons which I’d like to share. First, I hesitate with the terminology; since a “vaccine” as I understand it, should have the antigenic components to which our immune system generates antibodies. In this case, the injection contains the genetic coding sequence for the spike protein which is then generated in our own human cells. It’s an interesting idea, and it might work, but it is not a vaccine in the traditional sense of that word. Second, the studies that were done to get it approved were completed by the pharmaceutical industry that benefits financially from its approval for use and distribution. They know how to design studies that satisfy the lowest bar for approval, and there is not effective oversight for long-term safety. This product has not been fully evaluated and approved by the FDA, it was granted an emergency authorization for use due to circumstances of the pandemic, and so from my perspective, appropriate caution is warranted. I don’t yet know if the benefits are greater than the harms. I’m not in a position to advise against the vaccine, because there isn’t evidence now that it is more dangerous than beneficial, but I am here to simply voice my uncertainty in the setting of a medical industry that is rapidly promoting its use. It is not mandatory now, so you have the opportunity to decide for yourself. As do I, as a physician currently seeing patients. I am at low-risk for severe disease from COVID (and not zero risk), and I am choosing to delay on receiving the vaccine that is being distributed to my colleagues today.

I am a conscientious objector to the COVID vaccine. I am a millennial who graduated from medical school in 2016, which means my Facebook feed is filled with my peers who are bravely and proudly receiving the shot in a bid to promote public confidence, hopeful for a path out of this pandemic which has been so challenging for so many of us.

    Since the first days, we have heard from Bill Gates and others that the way out of this will be through the vaccine, which we initially thought would take years to develop. Operation Warp Speed was announced on the evening news at our house, with the plans to manufacture a supply of the vaccine while the testing was being completed to expedite the relief from the pandemic. At the time, I was a doctor out of work, living with my parents after taking time for a personal retreat. The clinic where I had recently worked, and clinics everywhere were seeing very few patients as people were too afraid of exposure to seek care.

    I went back to Minneapolis and to the clinic in July. I have been there on a part-time schedule, seeing mostly patients who were screened as non-infectious and had concerns that outweighed their virus concerns. Occasionally, I also worked in the COVID screening clinic with full PPE and did see a few patients who needed hospital care for their deteriorating condition. For the majority, it was simply a question of whether they needed to quarantine to prevent spread of the infection because they had had symptoms that were concerning for it.

    I have always been interested in holistic health. To me, that means paying attention to the food we eat, the way we move, as well as the quality of our relationships, and the way we manage stress. To be complete, it includes everything, including our finances, our emotions, our jobs and our spirituality. In the conventional system, it can be hard to address, or even identify the root causes for the problems that lead to the complaints that show up in the clinic.

    During my time off, I had more time to read, and given my personal and professional interest in holistic health, those are the topics I like to explore in my free time. In particular, I started to look into the perspectives from people associated in my mind, with the “anti-vax” movement. For the most part, they all seem to reject the label “anti-vax” for themselves, often claiming that they are supportive of safe and effective vaccines. In medical school, even in residency when I was the doctor ordering the shots at the well child checks, we learned to follow the CDC guidelines. That was the curriculum, and that was what we did. I learned that there is no maximum to the number of shots that can be given during 1 visit. If the patient is behind on their routine schedule, we can give 6 doses in one day to help get back on track.

    I am aware that most of my former classmates, and most of the current medical staff have little tolerance or interest in “anti-vax” perspectives. I recognize in myself, that it would be difficult to suspend my judgement long enough to understand their arguments and claims while I was also working in a clinic and routinely recommending the shots. So during my break, I had mental bandwidth to sit through and consider the perspectives presented in a 9 (!) part documentary series entitled ominously : “The Truth about Vaccines”. Ty and Charlene Bollinger co-hosted the dateline-esque series of interviews with a number of figures who pieced together, as best I could tell, the case against vaccines.

    I’m not able to boil it down to a damning sentence. Even this whole essay might not convince you. I wasn’t sold after watching the series, but I had a sense of who the figures in the community were. Paul Thomas and Robert Kennedy Jr. were two of the figures who appeared more credible, but in general I was intrigued that most of the speakers appeared sincere and with a story to tell, and not desperate or overly emotional, the way their arguments get reduced down in memes on social media.

    So here I am, working at a community clinic as a family physician during the pandemic, with the decision on whether I personally would like to take the vaccine when it is available to clinic staff. Initially, I was quite uncertain. I listen to my peers, I listen to the news, I listen to Dr. Fauci, I listen to updates from doctors at the hospital and I hear a promising message of a safe and effective vaccine. I understand that our clinic would like to build trust with our community so they too will be ready to get vaccinated, and they would be glad to have staff like me, demonstrate that we are willing to receive the shot.

    Also, I know where to find those alternative perspectives, the ones who never seem to end up on the evening news or in the conversations with medical professionals. My job now is to integrate the information, all the information that I can process, and come to a decision for myself. And given what I know, for now, my answer is that I am not ready to receive the vaccination.

    I will continue writing. I have a lot more to say. I am nervous about putting these thoughts out to the Facebook community, but I know that I eventually do want to address a wider audience. I am open to conversations, and I recommend you do plenty of research before making this decision for yourself. I wish I could say that your doctor or health provider is a good source of information, but in my view, I strongly suspect that they are likely not familiar or articulate in the case against the vaccine. I apologize if this feels like I’m leaving you hanging, but that’s all for now. Be well everyone!

    I am a physician, and I am not planning to receive the COVID-19 vaccination. I have more questions than I think will be answered by the time it is offered to me. I won’t rule out the possibility that I might change my mind as more information becomes available, but it feels both vulnerable and important to share my views. I think conversations on this topic are needed, and I hope that my writing contributes to healthy communications.

    My first question is whether the term “vaccine” is the right one for this injectable therapy. In my experience, when a vaccine is administered, it contains the antigenic component to which the immune system is sensitized. With this new mRNA technology, the antigen isn’t created until our own cells build the spike protein from the synthesized gene. I think a more accurate description than “vaccine” would be “gene therapy”.

    The metaphor that comes to mind, is that of Roundup-ready wheat. We have genetically modified those organisms with a gene that protects them from the poison glyphosate. Then, farmers can spray their fields with the roundup which kills all the plant life except for the genetically altered product which is grown as a commodity. I’m not saying the mRNA is inserted from the injection into our genome, just that it was synthesized and now involved in our cellular machinery. Still, I can hear the critics now, who believe that without our level of production of these commodities, that an opponent of Roundup must be against farmers and that the result of these dreams must surely worsen world hunger. Not so, I say. To bring the analogy back, I want patients to be defended from the Coronavirus with adequate vitamin D levels, with exercise and good sleep, stress management, and healthy relationships. I don’t want to ignore or minimize the growing death count from the Coronavirus. But I don’t think the new vaccine is the only option for defense.

    Back in the metaphorical territory, I believe, optimistically, in the opportunity of regenerative agriculture. There is a lot of hard work involved in raising crops in a way that nourishes both the land and our bodies, and the path forward I see involves a lot more of it done by a new generation who realizes that we need to get off the doomsday path we are on with fossil fuel use and environmental exploitation and degradation.

    There is more to say about the new “vaccine”. As a millennial doc, who finished medical school in 2016, I am plugged into the Facebook network, and I see proud selfies of so many of my former classmates and colleagues who are doing what they think is right to promote the public image of this product that is sold as “safe and effective.” I wonder how they know? Do they accept Pfizer’s and Moderna’s study results as presented? Do they simply trust Anthony Fauci or their professors and peers?

    When I look at the study, I see the heralded results of course. But I also notice that the study group was only monitored for 2 months. The tool they used to measure the difference in their treatment and placebo arms was the PCR test, which has its own limitations worth serious consideration. For now, I am just interested to know, what is the risk of autoimmune conditions down the road? Not 2 months down the road, but 2 years? Because remember, our immune system isn’t targeting the antigenic protein that is injected, it is targeting a protein that was created by our own cells. How does this protein get out of the cell? Does it not get tagged with any MHC “self” markers? Can we be sure that both the mRNA and the protein break down or are eliminated from the body after the injection? How long do those myocytes live with the active mRNA producing spike proteins?

    In another essay, I could talk about why so few physicians would speak out about the vaccine. I could talk about the ones who do and why they are so marginalized. For now, I’ll come back to the Roundup metaphor. Consuming those products won’t kill you. Some integrative doctors might talk about how glyphosate affects the gut lining and so on, but it’s not imminently dangerous to ingest their products. And, in my perspective, I don’t think it is a good idea. Which is where I land on the vaccine as well. I want to support the young people doing the hard work of biodynamic farming, or regenerative agriculture, aiming in the direction of a sustainable and thriving planet. I don’t think the Pfizer/Moderna product applied to 7.8 billion human bodies is a wise approach to the challenges we face.

Write something that takes a clear stand for something that you hold as sacred in the world that is getting threatened right now.

I’m going to decline the COVID vaccine when it is offered to me.

I am honoring my intuition, and not abandoning it to please others.

This is tied to a wound where in the past I wasn’t yet ready to make such a stand.

If this decision opens the door to my exit from conventional medicine, I welcome that opportunity.

My greatest hope, is that my courage reverberates to others, in a way that matters.

My greatest fear, is that I am not only wrong, but wrongheaded and making matters worse for everyone.

What’s true, is that I don’t have enough information to be certain. What’s also true, is that I am doing the best I can with the information I have.

I just had a very nice day. I toured applicants around the hospital this morning and that was no problem, and I was struck by 2 things. One, that one of the applicants asked about wellness and commented about how a lot of her classmates (not her, she was sure to say) were feeling burnt out even as they finished medical school and were anticipating residency. Well, okay. I guess I’m not surprised, but I’m also struck by the fact that these folks are headed for a lousy time in residency. And the 2^nd came from one of the 2^nd year residents, one who I had had a high opinion of. They had worked for an HIV clinic for years before starting down the medical route and I had heard them previously describe wanting a blend of inpatient and outpatient at a teaching hospital for a long career. Well, that seems to have changed, at least for today. Today, they were telling the applicants that they would not go back and do this route again. Not with what they know now. They’d be a barista at Caribou Coffee or whatever. Okay. These are like those cruel jokes that have so much truth that it’s just sad. Is it just complaining? I complain plenty.

But I really don’t complain all too much to my colleagues. At work, if anything I mostly buoy them up. I recognized that quite clearly this Monday morning when I was set to work with one of my favorite faculty and she came in with a “punky” mood. I apologized for her. I sympathized with her. I tried to be as easy to work with as I could. I’m not sure how much I helped, but what I took away is that even she, who has a very righteous purpose about practicing family medicine is feeling it too.

So that leads me to another story. One of being in routine clinic. And it was just a good day. I saw 6-7 patients, a very normal day, but I had such a good attitude about it. That, I’m not sure its cause (??) But the effect was tremendous. I went into each room with good intention and connected so easily with my patients. I focused in on the problem they came in with, that I either could or couldn’t solve and I communicated as best I could either with or without an interpreter as needed. I educated. I prescribed some, but other times not at all. I filled out forms. It was normal stuff, but I just had this unique feeling that “I can help a lot of people in this job.” And it feels like a commonplace thing to say, but it was an epiphany. Because I, at times, am stuck in such a negative, doubting place, that I really am not able to provide that. My patient’s show up and they expect a miracle pill for their problems and I don’t have it.

And so what’s really important about this insight is that there is a difference between doing a “good” job for my patients, and not doing it. It is not a difference that my employer can tell. It’s not a difference that the insurance payers can tell. For so many doctors, we get run down into the mode where we are just playing the game, filling out the paperwork, and it hardly matters. But it does matter to patients. And it feels good to do a good job. So if I am able to provide this kind of service, than I think this job could be sustainable. And for me, in order to feel good and feel like I can do a good job, I need to see way fewer patients.

I have determined a “dream schedule” for me. It would be: Monday afternoon, Tuesday am/pm, and Thursday afternoon. That’s it. It’s half time. 2 days a week that I do in 3. I start slow on Monday so it’s less intimidating. I have my big “full day” on Tuesday. And then I have Wednesday off to get all those charts done. And then I have another little peak of work and that’s it. The key is that I can do a good job for my patients when I am in, and I can do this for a very long time. A lot of family medicine doctors earn 180-220k. I might earn 80k. I don’t know. But that might be okay if I have such a nice lifestyle. I can work more if I someday have kids or something. But after residency, this kind of schedule makes sense to me.

A little more on “good work.” It’s about presence. It’s about waking up to what’s really going on and doing the best for our patients. Unfortunately, this is very hard to see for the majority of providers and they are stuck asleep. It is hard to wake up when your coping mechanisms, your salary depend on you being asleep. The financial drivers run the show and folks are chasing after those RVUs at the expense of quality patient care. Well, that’s the story that demonizes doctors anyways. It’s complicated.

Sigh. I’m not sure how to put here what I want to. But I’m sitting on something that feels heavy. I think part of the problem is that I expect this “art piece” to come out well formed to serve a purpose, when the purpose is simply to transmit honestly the experience as a process.

So last night I went to this event, sponsored by my hospital, that was a “Story Share” for physicians associated with residency programs in my metro area. It was at a brewery and it was kind of a swanky thing with hors d’oeuvres and craft beer, and I think it served its purpose well. They were at capacity and they had 20 readers. Self-care prizes included massage vouchers, coffee coupons, and a pre-paid cleaning service. We all do need a little help and those are sweet and thoughtful gifts. I didn’t read. I had thought about participating, but honestly it is a lot to share in general, and then the specific context of sharing with medical peers really changes things. I have a strong feeling towards speaking something truthful. And art has a purpose. In my case, I feel like my words speak in antagonism to the status quo, and so they generate discomfort for those invested in the system as it is. Which in this case, were the hosts of the event.

And I did speak with the Director of Academic Affairs (Dr. Rowan) from our hospital, who was involved in putting the event on. She knew, on some level, that I had something to say. She asked why I didn’t read. Well, I came to listen, I replied. But really I thought about it and it felt like too much to integrate my artistic purpose and my goal of completing residency. I don’t think that would have made any sense to her. But I do feel this kind of Venn diagram of my life. There is this physician role, which consumes my life, and that circle seems to be pulling away for the other. The artistic self. They can overlap more perhaps? I like to sit at the piano and sing with my guitar, but those activities get stripped thin when my energy is gone.

Some of the readings last night were heavy. An anxiety attack after day 2 on the MICU with some serious morbidity hovering around a completely fragile and humbling experience as a new doc. Dealing with a medical diagnosis of major depression as a medical student and how the time demands and the sleep sacrifice created bigger problems. One reader had collected vignettes of suicidal ideation from medical trainees at her institution where there had been 4 (FOUR!) suicides in her time as a student. 2 faculty members spoke, and their stories were personal, describing the damage they have taken on through their participation in this system. And now they have settled into positions that work for them it seems. But they were airing their grievances last night.

On one hand, what the fuck? I mean, I feel relatively “in the scoop” as far as physician depression/burnout/suicide go. But then, here we all are talking about it, and what does it amount to? This is a blow-off valve. Back to work we all go. We don’t know how to fix it. We don’t know how to address the systemic level problem that has made this profession so miserable. We do our jobs and we complain. Take the good and the bad. That’s where we are.

Perhaps my art can be more visionary. I could’ve read something about my plans. About my dreams. We need some dreams ya’ll. Signing a contract to eventually get out of debt ain’t it!

I called in sick to work today. It is a very hard thing to do as a resident. I was thinking about it last night and I was kind of gearing myself up for it. I woke up early today just to do it. I had to rehearse what I was going to say: “Hi Marge, I’m not feeling well today and I am going to use one of my sick days. I was scheduled for clinic in the am and pm. Thanks.” It is hard to say! I literally am afraid I will be somehow rejected and they will make me come in. That is not grounded, but I feel it.

So anyways, I call at 7:30 and it goes to voicemail, she is out of town and I am supposed to call her assistant. Ok. Repeat the rehearsal and then make another call. Same thing. Another voice mail with a message to contact the chiefs. Well fudge. I go to my computer to look up their schedules and send a text message to one of them, and then anxiously await the reply as minutes pass by. It’s creeping towards 7:50 and I’m thinking that my patients are literally getting checked in right now and nothing has happened. I call the front desk and of course am put on hold for a long bit before I talk to somebody who transfers me to someone else, who then wants to transfer me to Marge “hold on,” I call out. “I’ve already called Marge and she is out of town. I’ve called her assistant and she is out. I know you’re not the right person to contact, but don’t just transfer me to her voicemail.” So she says she will look into it and hangs up. I don’t even get her name. I decide to text the other chief. Now I am just anxious, and it’s getting to be 8:10 and I haven’t heard back from either of the chiefs. I looked at their schedules and one is supposed to be on study time at the clinic, the other is in our urgent care clinic.

So much for going back to bed. I am anxious and feeling guilty and not sure what to do with myself. I am physically laying in bed and letting the minutes click away. Finally, about 8:30 I hear back from the 2^nd chief that it’s okay, she’ll contact a 2^nd back-up admin staff person to let them know and take care of it. About 5 min later the other chief gets back to me with a similar message. Fine. Woo. I finally feel somewhat relieved. Now on to my morning.

I alternately feel guilty and validated. I have been dragging this week and I just am in a bad mood. I had clinic yesterday and I was frustrated with my MA, and I really felt overextended to be doing the basics of my job for patients. Today I was scheduled to see 16 more people. I thought about, and felt guilty about those people each either being rescheduled, or cancelled or whatever. But also, the clinic is responsible for making decisions about who needs to be seen urgently and who is appropriate to reschedule. And more importantly, if people are taking time to see the doctor, they deserve the attention of someone who is feeling better than I do. If I am fried, I am prone to taking shortcuts or not providing the best care. I want to provide the best care. Taking responsibility for 16 patient visits today when I am feeling fried is inappropriate. That’s what sick days are for. I am caring for myself.

In this (medical) world, you’ve got to take care of yourself. No one is doing it for you. They are just pushing, pushing, pushing. I am more sensitive in ways that do not get seen by this environment. I have to advocate for myself. And in the end, people deal with it. Others have called in before. When I am in clinic, and I know someone else has called in, I might have 2 thoughts about it, but then I get on with my day. That’s it.

And I am moving on. I am thinking about the beyond residency time. And I am thinking about medicine from this philosophical place. I lean towards outright rejecting the system as a whole. I think that is an emotional reaction and that the truth is not so black and white. There is a lot of good that happens through the system with the bad. Some are in better position than I am to be working with that good. But I think about this whole RVU game that the system is playing. Decisions are constantly made consciously, and subconsciously to play the RVU game. Patients deserve better than that. The RVU game serves the medical industry’s interests. I as a primary care doctor am stripped of any power, any agency when I am tied up in the RVU game. What kind of patient relationships can I have playing that game? They don’t feel like much to me.

I am reading this book by Henry Emmons “The Chemistry of Joy.” Part of what he is describing is an empowering model of delivering care that is based on education and not relying on pharmaceutical power. And I am reminded, that in the role that is set out for me, I am designated to prescribe a lot of medications. I am to “screen people for depression so they don’t miss out on the profound benefits of miracle drugs.” Well, it’s actually so much more complicated than that. When the SSRIs give people a little boost, so they have this story that “this is what normal feels like”, it’s actually a little trick to make them a bit elevated in the short term. It’s a fucking gimmick. They don’t work well in the long-term. And here we go, peddling them freely, often because we believe we are doing some good. And so my reaction, which is maybe also unhelpful, is so antagonistic in the other direction that it’s sometimes just like a grinding brake. I just want to stop everyone from taking medicines when actually in truth, some situations and some people benefit and they are used successfully and it’s not so black and white. It’s so hard to articulate why it is hard.

Last night I was on the phone with a friend (Raven) in Oregon with a natural health clinic and Adderall came up. She said she doesn’t use it, and that then people thank her. She made a comment about how it fucks you up and makes you less heart centered. I believe that. It puts us a little bit on overdrive. Ego. Confidence. SSRIs do that too (artificial calm). People get inflated chemically. Our world is so filled with exaggeration.

Our Department Chief gave a talk on coding and billing. RVUs. And also, as it turns out, contract and job information. Most jobs ask you to work 4.5 days/week and 44 weeks/year. Ok, so I saw 15.7 RVUs in one sample day, which would make 3108 RVUs for the year. Times 45 buckos, and that comes out to 139,887 for an “earned salary.” Hmmm. Well, primary care loses money I guess. You have to work very hard to make money. But salaries are more like 180K to 210K. He said the translation doesn’t exactly work out.

I had coffee with Dr. Williams. We stayed for like 3 hours. I felt like I was overstaying my time. But she didn’t complain. She thanked me. So, I guess it’s good. Our program has problems.

Welcome to the revolution. It starts with me and you taking care of ourselves. Woo. I’m feeling pretty good. I just got done a long clinic day and then I went to the Y and walked. I was cracking up coming up with good ideas. I plan to go on a medical/musical tour. I’m going to do the bit onstage about “I don’t have any merch, but I am a primary care doctor and I’m seeing patients tomorrow. $25. Bring your backaches, your earaches, your non-psychotic mood disorders, let solve some problems! I’ll have my tourmates do the typing on our medical typewriter. I don’t have to fill out of bunch of extra paperwork for any insurance companies. I just need to have some record if I get sued!

I was also thinking about how I am down most of the time, but people seem to think I’m doing a good job because that’s what I show outwardly. A lot of us are doing this. It’s nice that we are able to keep it up in some cases. And it’s okay that some people never are. We are all at different stages and that’s okay.

And I was thinking about my program. There were clear times as an intern where I felt that situations were unsafe for our patients. It is so inter-related to the culture of the program. It’s very hard to know if the problems that affect my program are really worse than they would be at another program. It can seem like it, but hardly anyone really has good perspective on that question. At one point when I was an intern I called an old friend from medical school who was a G3 at the time 2 states a way and was asking about some of the problem areas of my program. She sounded pretty surprised to hear I didn’t think I had enough supervision. I remember at the time wondering if I should think about switching programs in hopes of getting better training for my future career. I was worried that the foundations of my medical career had bad roots. That still may be true. But I don’t worry about it as much as I used to. There definitely is an effect of adjusting to your circumstances. And in the case of residency, we can normalize some pretty shitty conditions.

I know the new interns are going through some of the growing pains. I was talking with one about the difficulty of being an expert in such a broad array of fields, and how that is really counter-cultural in medicine. The mainstream gears towards specialization. Every medical problem has specific, sometimes technical answers. And if you are caring for the problem, the expectation is that you should be giving the best care. You can’t give the wrong antibiotic for a kid’s sore throat because you don’t see them very often. You shouldn’t undertreat a senior’s COPD because you aren’t up to date on the latest GOLD criteria guidelines. If your laboring mom meets pre-eclampsia criteria, you need to recognize it and induce her for delivery. If you know enough to get the consult, that’s all fine and good, but the danger zone is when you don’t recognize that you don’t know what you are doing. Anyways, primary care is a hard job. Even if some of our visits are easy. And the end of that conversation, she was pretty sure she needs to do a fellowship to narrow her scope so she can do a good job with it. That is a common sentiment in medical culture.

And so with our program’s culture, there are obvious problems. Some of them are BIG, some of them we are working on, and some of them WE ARE NOT. I recognized that I would be able to get through the training. I recognized that doing so would qualify me as a board certified family medicine doctor. I recognized that that doesn’t mean as much as I thought it did from the outset. The standard is sometimes lower than you might think (hope). People get through by sticking with it. That’s pretty much it. If you adapt to the system and keep going, you get there. I had had different expectations. The previous graduates of our program don’t meet those expectations. I don’t think I will meet those expectations when I graduate. I’m not getting the training I want.

Our program doesn’t do a lot of hand holding. I felt like there wasn’t a lot of hand holding in medical school. I have always wanted more explicit teaching. I have this golden image of what ideal teaching looks like. It involves expertise and attentiveness and patience, and creating the right level challenge for the learner so they are in their growth zone. Nu-uh. Not here. Here there are sick patients that you get to take care of. It’s high responsibility, low teaching. People should know that coming in. It’s not what I would have wanted. I don’t think it suits me. The intern process still intimidates me. Being a resident continues to be much the same. But actually, it does change. It’s weird, but I do get a sense of pride about it. It’s that odious “good old boy” thing. It’s this hard thing that feels good when you are done. I don’t know why it’s not considered hazing. Maybe it is. But it kind of feels good for me. From right here, right now when I’m close to done with it. I’m through the worst part for sure. And gosh darnit, I learned how to do it. I’m not completely done. But I’m through the hardest stage. And I’m going on to other hard stages. But it’s okay.

So after graduation, for a period I may go on a road trip. If I can charge 25$ a person to provide general medical care, that sounds like a dream. I’ll accept tips. And if I see 10 people, that’ll be a heck of a day. If I see 2, I can afford my meals and gas. It’s a hobo life. That what I want. I want to be a traveling doc. I don’t know how long it will last. I don’t know how long I’ll sit on my loans, with the interest festering. But fuck, this sounds fun.

And if I take a few urgent care gigs, that would be a real good skill set to get good at. That is close to what I will be doing. Urgent care, event medicine, travel medicine, lifestyle medicine. I can wear a lot of hats. I don’t want to do hospital work I don’t think. I can cover low acuity gaps. I can cover nights or something. I mean, I don’t want to run codes. But I could run codes. ??? I don’t know for sure. I can run a code. It’s a big deal, but I could do it.

I don’t want to be in an ER. But maybe I am fucking wrong? How do I know so little about myself? What the heck? Well… I have developed coping mechanisms that shut parts of myself down. One of those was a real stiffening in the ER. I was in survival mode and I was not thriving.

I have a lot to learn as a doctor. Residency is a phase. It sucks most of the time. It sucks more than most anyone can relate to or believe. But it is the route to a medical career. I have wondered along the way if I should just quit. It wasn’t wonder sometimes. It was just frank truth that I did not belong in medicine. I wasn’t interested in medicine. I didn’t care. But I kept going.

Holy shit. I went to this cookoff the other day and I cooked a pot of beans over an open fire. It took a long time. I gave up hope in the middle cause I didn’t think I had enough heat. The water wasn’t even boiling for the first 45 min. But eventually they were cooked. And at one point I had given up hope. But the beans didn’t care. It didn’t make one bit of difference to them what my attitude was. They were still on the fire, so they cooked. And they turned out. I missed the competition. They announced the awards while my beans were still cooking. I’m the beans!