When I started medical school I never expected to end up choosing Urology as my specialty. My medical school education was somewhat unusual in that I took a two year leave of absence to pursue research in oncology after the beginning of my third year internal medicine clerkship. After completing my leave, I returned to medical school to complete my studies where I had left off.
The intent of interposing my research into the midst of third year was to allow me to continue the remainder of my clinical training uninterrupted, specifically via participation in the care of patients with diseases relevant to those I was researching. In this way, I was able to partake in “bench-to-bedside” translational research at its best. A prototypical example of this involved a quantitative PCR test that I set up which was able to detect microscopic levels of malignant cells with great sensitivity. With this assay, we were able to discover very early if our patients had relapsed and then confirm whether they were indeed responding to their experimental therapies. It was an ideal arrangement which allowed my hard work in the lab to have swift payoff in regards to my patients. After enjoying two years in the midst of internists, I was convinced that a career in internal medicine was for me. It was not until I began my surgical clerkships that my feelings radically changed.
There were many aspects of surgery which held great appeal for me. I discovered that, to an extent much greater than that which I enjoyed in the lab, our hard work in surgery had immediate effects on the lives of our patients. Thus, by the end of the day I was able to begin to witness the fruits of our team’s labor: the cancer, stone, or bleed was already gone. In addition to this, I felt that the decisions of surgeons were of great consequence. In moments, our choices were literally saving “life and limb.” Finally, I saw that the actions of surgeons are definitive in nature. Once a problem is addressed in a surgical way, it is often solved. This meant that we were able to offer our patients cure of their problems instead of simply managing a fatalistic unavoidable end. Thus, the allure of the rapid, permanent, and magnificent rewards of surgery became quickly obvious to me. It took me a bit longer to realize that a surgeon’s mistakes could be equally rapid, permanent, and terrible. When things went badly, they went very badly. I saw that the rewards of surgery can only be realized with constant discipline and precision in both thought and action.
It is a balance that I am happy to accept. I am the type of person who flourishes when challenged. Because of this, Urology holds a special appeal for me amongst the fields of surgery. The diversity within Urology seems unrivaled to me. There I saw both males and females, children and adults, and acute surgery intermixed with long term outpatient follow-up. The interventions ranged from medical management to simple outpatient procedures to marathon RPLNDs. With such variety, Urology was the only field in medicine that could keep me consistently interested without effort. At the end of each day, I kept thinking to myself “that was so cool… I can’t wait to see more.” Now I wonder that if being a mere witness was that enjoyable, then what would it be like to actually hold the knife and BE the surgeon?
My pursuit of a career in urology is absolutely fitting for me. That it is so distinct from what I originally foresaw my path to be, makes me somewhat reluctant to prognosticate my future within urology. However, I believe my predilection towards diverse challenges will be maintained. Thus, I feel a career which includes teaching and research in addition to my primary clinical responsibilities will be most fitting for me. A mentor of mine once pointed out that choosing a specialty in medicine is akin to choosing a spouse. . With foresight, it can at best be a mere educated guess: you will never know with absolute certainty whether you have chosen correctly without the benefit of many years of hindsight. He advised me to follow my gut instincts. I can safely say that my guts are screaming Urology.