No Regrets, Come What May by Dr Seshadhri Subramanian

What do you want to get out of doing medicine?

In the months preceding August 2012, if you’d asked me that question, I would’ve given an altruistic answer along the lines of serving the poor and the needy, laced with a touch of personal satisfaction and monetary gain – I am, after all, doing a job and deserve to get paid for it.

But from August 1st, 2012 – the day I got into my M.B,B.S. course at St. John’s Medical College – things have changed drastically and dramatically.

Okay. Maybe that’s exaggeration. Things did change – but neither were they that drastic nor that dramatic. But undeniable is the fact that they are different from what they used to be. My way of thinking and my outlook on what I want to achieve in the field of medicine has changed.

Let’s drift off topic a little bit here. Like almost every medical student and like a lot of non-medical people, I have watched the television show House, M.D. starring Hugh Laurie, Lisa Edelstein and Jesse Spencer among others. And I’m not going to lie, I liked what I saw. Who wouldn’t? This show was in some ways, what was attractive about clinical medicine – the thrill of getting a right diagnosis with somebody’s life on the line and other things of the sort. But what I didn’t realise at the time was that House, M.D. was about the rarities in clinical medicine. Cases like what you see on the show are the rarest of the rare, if not sometimes, downright near impossible to find.

Now let’s get back to me. I used to like clinical medicine during my early days in med school – say around second year. Every case was fascinating. Everything that I was exposed to – which was not a lot given how much I skived my classes – was a learning experience. Each opportunity was something that I could glean some understanding out of. In fact, I liked the idea of clinical practice (especially in the fields of Paediatrics and Internal Medicine) so much that I prepared and eventually gave my USMLE Step One – clearing it with ease and with a good score.

But even as I prepared for MLE, something started to change. Attendance issues in third year forced me to attend more and more of my clinical rotations – much to my chagrin. And during these postings, there was something that I began to notice. Clinical practice – from what I observed – started to become mundane. Everything seemed to be in rigidly set patterns which made me feel like all I was training to be was a robot who could listen to a patient, examine the relevant system, diagnose the problem and prescribe a medicine in a pre-set order and a pre-set fashion with no room for creative thinking.

This feeling only grew over the course of my final year of MBBS and during my period of internship. In fact, if ever there was a time to change my nearly well-formed opinion of clinical practice, it was during internship. The one-year period exposed me to the inner workings of the hospital system like no other. And rather than erase and rewrite my opinion of medical practice, it only served to cement it.

Somewhere slam dunk in the middle of my internship, during my medicine posting to be

specific, things came to a head – because it was less than half a year before I had to make a decision that would define the rest of my career in the medical profession – and I asked myself two questions.

One. In twenty years’ time, could I see myself waking up in the morning with enthusiasm for rounds that took care of yet another thirty to forty dengue patients with the same regimen of treatment? Or could I see myself enjoying doing an umpteenth caesarian or a hernia repair?

Two. Am I doing something that is different? Am I changing something significant in the

world? To break it down and put it in very simplistic terms, am I doing something new or am I just going to be an also-ran – one among a million other specialists in the world?

The answer, to both these questions, was an unequivocal no.

The final nail in the proverbial coffin was during my last posting, which happened to be

Emergency Medicine (or Casualty Medicine, if you prefer it that way). My decision was made well before this but E-med only served to reiterate that I had made the right call. Everybody I spoke to was excited about this rotation. They all spoke of it as being the one posting where “you get to be a real doctor – handle your own patients, give them your own treatment according to your medical judgement while only being supervised” and so on and so forth. I thought that if there was even a shred of doubt about my decision to enter into a career devoted to research, this would be the one posting that would expose that.

E-med started out quite well. I even liked the initial days. But as a wise man once said, a new broom always sweeps clean. Within the two-week span of my posting, I went from being enthusiastic to neutral to downright weary every time I had to go to work.

Now, I have always been a person who believed that it was always better to follow my passion. And by the end of internship, it became quite clear to me that clinical practice was not my cup of tea.

I don’t demean anybody who likes clinical practice. Most of us, myself included, became

doctors to cut through layers of skin and muscle with a scalpel or cure a patient with a plethora of symptoms and watch him/her walk home a new person. But the reality of the situation was, that for me, I could not take the monotony of it.

Now that I’ve dealt with one side of it, let’s get to the other. Why research? Why not something else like hospital administration?

Unlike my decision to not be in clinical practice, this one was far more straightforward. I’ve always been interested in discovering and inventing new things, even as a kid. And that feeling only grew with me as I found my way in the world. With research, I was making not only a difference but I was expanding the horizons of human knowledge. The first time I was exposed to real, scientific research was in eleventh grade – when as part of a team in IITMadras and SASTRA University, I investigated whether the use of nanogold would improve the efficacy, speed and the accuracy of Polymerase Chain Reactions. And I really liked it. I mean, really liked it. And my interest in research only increased when I did my second project – a study in the first year of my medical school whereby I, along with the Department of Pathology at St. John’s looked at the prevalence of ALK (Anaplastic Lymphoma Kinase) receptors in lung carcinomas.

Thus, on the one hand, I was becoming disillusioned with clinical practice and on the other, I found out that medical research was a viable career option for people like me. So I gave up my ambition of becoming a paediatrician in the States in order to pursue a career in medical research.

Today, I write this article, holding an offer letter for an MD degree in Oncology (Briefly put, it’s not a residency programme like the MDs in USA or India. In the UK, it is a research degree that follows the successful conduct of a research project, submission of a thesis and the passing of a viva) from the Northern Institute for Cancer Research at Newcastle University. I also know what my thesis project is going to be and what I would be investigating.

As I said before, most, if not all of us, joined medicine because we wanted to help people and heal lives. Fundamentally, the idea remains the same even now – with a career in research. You remain somebody who is working to improve our understanding of the human body and someone working to elucidate the solutions to many of the problems that plague human society. You just don’t like cutting through skin or inserting IV lines to do that. If you find yourself in such a situation, I just want you to know that there is nothing wrong with it, that you are not alone and that there is nothing unusual about a career in medical research following M.B,B.S., just as there is nothing unusual about a career in clinical medicine, hospital administration or any of the multitudes of fields associated with medicine today. Different people have different outlooks on life as a medical professional. At the end of the day, even if all five fingers on a hand are different, they work towards one goal.

So after the many months of pondering, indecision, taking the wrong turn (read as giving a fairly expensive USMLE Step One only to not go through with Step Two and Three), going through five years of med school, and finally finishing up by deciding to go and pursue research. I know one thing now for sure.

I took the right decision and I will have no regrets over it, come what may.

Looking for a life outside clinical medicine?

Home: Doctorness.com

How I quit clinical medicine – Rohan D’Souza

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