Pulmonologist / Critical Care
His parents emigrated from the Caribbean and wanted him to “have a better life.” As a high school volunteer EMT, he had his first experience with patients needing critical care.
PARENTAL INFLUENCE?
CD was born the third of six children, raised in New York. His father was employed in property maintenance; his mother was an administrative assistant. Typical of many immigrant families, CD’s parents strongly suggested that to have a better life than theirs, their children should pursue a profession such as engineering, law or medicine. Not typically as the third child (usually it’s the first born who is most obedient to parental guidance), CD adopted his parents’ dream by choosing one of their preferred options: medicine.
EARLY CAREER VISION
Like many highly populated US cities, New York City supports high schools which offer career focused curriculums instead of the general, public high school courses. In accordance with his parents’ wishes and his own early interests, CD opted to attend a NYC high school which prepared students for careers within the health professions: e.g. physicians, nurses, emergency medical technicians, physician assistants, etc.
EARLY CAREER EXPERIENCE -ESSENTIALLY AN INTERNSHIP
During his high school days, CD volunteered to serve as an emergency medical technician (EMT), which provided his first exposure to people needing critical care. He became comfortable with assisting the care of patients in severe distress. Looking back, CD realizes that this emergency care experience was valuable during medical school to relate academic teaching more easily to “real life.”
COLLEGE PREPARATION AND CONFIRMATION OF CAREER PATH
College students’ plans for a career in medicine are often derailed by having to master courses in organic chemistry. CD’s favorite college courses dealt with organic chemistry, so he elected to take many related subjects. He also did well in advanced math courses but concluded such knowledge would not ultimately assist his medical career so he continued to focus on courses which would prepare him to be successful in medical school and in his career as a physician. CD was pleased that he had dealt so successfully with a requirement (organic chemistry) which for others was a trap door.
MEDICAL SCHOOL CHALLENGE
With college behind him, CD assumed that if he continued to devote himself to his studies in medical school, that he would be successful academically. With his college grades and aptitude test score, admission to medical school would not be a problem but his family could not afford to contribute to the tuition, so CD had to find a medical school with two attributes: an excellent reputation and affordability. He did.
Medical school requires two years of didactics (learning from teachers) and two more years of clinical training (learning from observation and participation in patient care). The first two years of coursework include anatomy and physiology, pathology, histology, microbiology and more. The following two years involve the opportunity to rotate through many medical and surgical specialties and subspecialty areas, such as general surgery, cardiology, obstetrics and gynecology, neurology, critical care, etc.
PHYSICIAN: KNOW THYSELF!
Having completed mandatory rotations through the major medical specialties, a soon to be practicing physician has by now self-assessed his or her interests and abilities. Is the future doctor comfortable dealing with crises within emergency rooms involving blood and often death, sometimes requiring decisions and action on little sleep? Alternatives include keeping “9-5” hours dealing with eyes (ophthalmology) or skin (dermatology). Or not dealing with patients at all while concentrating on medical research.
For CD, the choice was easy: based on his early EMT experience, he wanted to help patients through their potentially life-ending challenges. As CD considered medical practice options to match his interests, he broadly considered two paths: A. surgery / emergency room medicine or B. critical care. At this point, he realized that forcing himself to awaken in the middle of the night and to rush to an ER or perform surgery on little sleep would not be sustainable for him. Critical care could be managed on a more normal sleep pattern. This focus would require additional, formal education beyond his residency.
THE “MATCHING” PROCESS – UNIQUE TO MEDICINE
Completing college and medical school still does not earn the required state license to practice medicine. For would-be medical doctors, there is at least one and sometimes two, more step(s), both of which are initiated by the match process: the medical school graduate applies to several medical residency programs, is interviewed by each program, and then fills out a match form to rank each program. Concurrently, each interview program fills out a match form for each medical student it interviewed. This process proceeds annually across the entire US. All the match forms are submitted to a unified, computer-based system and the results are published – and eagerly awaited – on “Match Day” in March when medical school graduates learn where they will serve their medical residency.
MEDICAL RESIDENCY
CD limited his residency applications to the Northeastern US so that he could be reasonably close to his family. He was matched to a hospital in suburban Philadelphia, where he then served as a medical resident in Internal Medicine for three years.
MEDICAL FELLOWSHIP
For many of the medical specialties (e.g. internal medicine, pediatrics, and family medicine), completing a residency program is sufficient qualification to conclude formal medical education and proceed into licensed practice. However, some sub-specialties require continued medical education in a Fellowship program, admission to which mirrors the residency process: applications, interviews and ranked matching submissions concluding with an announced match for the medical resident to a medical fellowship program.
Since CD opted to specialize in critical care, he needed to complete a fellowship in pulmonary medicine and critical care. Of course he did, continuing to work hard for another three years of formal training, continuing to work with patients under the supervision of licensed physicians with certifications in pulmonary medicine and critical care.
FIRST JOB
Having completed specialty training (concluding with residency or fellowship), the newly licensed physician is now a “free agent” capable of seeking employment in any medical practice related to his or her specialty certification(s). Essentially, this amounts to choosing between employment by a large institution (e.g. hospital or government agency including military service) or a private practice with possible “hospital privilege” to care for patients within a specific hospital.
CD knew from his earliest days of pondering a future career that he wanted to be his own boss, not an employee. Accordingly, he never considered joining a hospital staff but instead, sought and found employment with a group of critical care specialists who had formed a partnership which would hire CD with the eventual opportunity to become a business partner.
CHALLENGE FOR EVERY PHYSICIAN
Regardless of a physician’s medical specialty, sooner or later, freqently or infrequently, patients will present with life threatening and fatal injuries or diseases. Significant analysis of available medical options must be considered, presented to the patient (where possible) and/or to the patient’s family. A basic rule for practicing medicine is the Hippocratic Oath, which commands that a physician “shall do no harm.” What care is required? What care is best under all the circumstances? Who should participate in these decisions? For some physicians, like CD, such issues are on their daily agenda.
CAREER SATISFACTION
CD admits to an early, sincere but naive belief that his medical abilities and determination could prevent loss of life in virtually every situation. He soon learned that despite his best efforts, patients would die. With more career experience, CD still dedicates his efforts to saving those that he can but when that doesn’t happen – or with consent of the patient or family who opt for final, compassionate care over extremely uncomfortable, heroic efforts to prolong life for a relatively brief time – CD is content to know that he has done his best, consulted as necessary and let the life process play itself out.
