Jen-n-NYC: At last, my love has come along...

It's happened at last. I followed the yellow brick load laden with endless research, uncomfortable visting rotations, a river of tears, and the constant insecurity that comes with being one small person among a sea of many competing for the same impossible dream. Along the way, I think I might have found my brain, my heart, and my courage. And Toto, I am not in Internal Medicine anymore. I have reached the wonderful placed called Dermland. Sigh. If there is anyone out there reading who isn't sure what this Dermland is to which I am referring. Let me take minute to explain.

There is an endless chain of decisions that one has to make once the initial decision of medicine is made. For a lot of people, you figure out during college what you want to be when you grow up. You want to be an engineer? You get your engineering degree and poof!, you're an engineer. Not so much in medicine. Deciding you want to be a doctor is merely the beginning. Once you have decided that, then you have to decide a specialty. Do you want to be pediatrician slaving away the days in a tiring but rewarding career? Do you want to be surgeon and go through the multi-yeared torture of a surgery residency? Do you want to be a psychiatrist with an awesome schedule but day after day of depression, psychosis, and suicide? You also have to consider where you qualify because not all specialties are created equal in this respect. Do you have the grades to go into something more competitive? Where does your personality fit? Do you have the "moxie" to be treated like an ridiculous pile of uselessness at times? Etc, etc, etc. And then it's still not over. Do you want to endure another few years of fellowship in order to subspecialize? Do you want to be a pediatric hematology/oncologist? Do you want to be an orthopedic surgeon? Do you want to be a rheumatologist? Do you, do you, do you? Blah, blah, blah.

When I came out at the end of my third year of med school I had no idea what I wanted to be. It took a few anxiogenic conversations with the career counselor before I eventually decided on dermatology. I loved that I could work with both kids and adults. I loved that I could do surgery and clinic. I loved that it encompassed some aspects of my other interests including plastic surgery and psychiatry. So why not? Well, I will tell you why not. Almost 50% of applicants who go for derm do not match into the specialty first time around. You are told that if you are not perfect then you are not sufficient. You have to have the grades. You have to have research. You have to be savvy in impressing people. You have to seem interested but not too interested. You have to be perfectly agreeable, keep your nose free of any mucus, and your hair free of split ends. Bascially, you are told that it's impossible. And after spending endless time and nearly $8000 on applications, away rotations, and interviews, failing to match can be a disheartening experience. An experience, unfortunately, that I can call my own...

After the gutwrenching disappointment of rejection by 10 different derm programs (despite a load of positive feedback), I went ahead with my required year of general medicine and in the meantime applied again for dermatology at the cost of another $3000 or so. This application would be for a spot beginning 2011. That meant I would have to put my career training on hold for yet another year, somehow find a job for that year, and likely move another 2 more times. But suddenly in December, Hallelujah, I received notice that I had an interview with a small program in NYC for a position that would begin 2010 (merely 7 months following the interview). No waiting, no putting my career on hold, and I could be moving to NYC!

Given that this blog exists, you should already know that I made it, and today, my friends, was my very first day as an official citizen in Dermland.

Since I have been an internal medicine intern for the past year, it took me some time to get used to the empty feeling on my hip where my pager should have been. (Not that I was too hurt by this - being paged every hour of the night/day takes a toll on your sanity after a while). I only smiled to myself as I heard a Code Blue being called overhead and realized that some other poor soul would be sprinting up the stairs in a cold sweat in order to manage another stressful, terrifying life-or-death experience. And at 3:30 PM, when I was walking out the door of the hospital to go home before my last day of work before beginning a long weekend, I had to pinch myself at the thought of even getting a weekend off, much less one that lasts more than 2 days. Though it was intimidating to be starting all over as the newbie yet again, it began coming back to me how much I like what it is that we dermatologists (yes, WE dermatologists!) do. I don't have to click my heels and state "there's no place like home" anymore because, ladies and gents, I AM home.

And the view from where I am standing is pretty sweet.