But(t) Why Gastroenterology?

Ever since that glorious and emotional Fellowship Match day back in December, the title of this blog post has been one of my most frequently asked questions. It's funny because to me, it doesn't even seem like a question (doesn't everyone want to do GI?) but when I take a step back and really think about what this specialty entails I start to laugh because I get it.  For the rest of my life, I will be in contact with patients' anuses on a daily basis.  I will be asking the most in-depth questions regarding my patients' bowel movements-- "When you say "dark" do you mean dark brown, or was it BLACK?" "Did you see any blood clots in your stool or just red blood mixed in?" "When you say diarrhea, have your stools been soft, or fully liquid?" I understand why this may not be appealing, but to me-- the GI tract is the most fascinating system in the body.

Gastroenterology is the specialty of treating diseases that affect anything along the alimentary tract (the passage way from mouth to anus) and the organs that interact with it (pancreas, liver, gallbladder.) My good friend Michelle in medical school first pointed out why GI was so cool; she'd always say "everything is just so, CONNECTED and things go in and get processed and well, eventually comes out." Yesss Michelle, it's SO COOL. I have always ascribed to the belief that we are capable of improving our health simply by changing what we eat and absorb from our environment. While the heart and brain are fundamental for sustaining life, the gut determines if that life will be maintained in wellness or illness.  This basic idea had me hooked on gastroenterology-- realizing we really are what we eat, and how simple imbalances in our GI tract affect every. other. system.  Don't get me started on the gut-brain axis-- I literally get giddy when talking about how we eat directly affects our mental health too, and vice versa-- how stress and emotional wellbeing directly influences the gut.  IT'S FASCINATING OK?

Very early on in medical school, I was dead set on doing internal medicine and willing to explore the subspecialties from there.  When I really thought about how I wanted to be trained as a resident, I romanticized internal medicine because it was all about knowledge consumption and synthesizing information to help diagnose/treat patients.  Internal medicine training is so incredibly broad, and I craved that kind of knowledge base.  Some people are of the opinion that having to do internal medicine prior to procedure-heavy subspecialties is a waste of time, but I truly disagree. Medicine residency prepares you so well for critical thinking and differential diagnoses; having a strong foundation makes a big difference in the approach to a patient.

That being said, I can't deny the major reason I'm so excited to start GI is for the procedures. Really, my hands are ready to scope! To develop a technical skill is so satisfying, and sometimes I'm just sitting here thinking about holding a scope, how to maneuver, performing therapies, etc; I know the learning curve will be challenging, but I'm really so eager for this part.  I think of endoscopy skills as an incredible extension of a physical exam-- how amazing to have a very strong clinical suspicion of a certain diagnosis based on your history & physical, and then be able to see it for yourself.  Over the years of medical school and residency, I've done a TON of elective rotations in GI and have sat back and observed the trained/training gastroenterologists performing these procedures, and I am just so excited (also very nervous) to step up and learn these skills too.  On that note-- a big part of my desire to do this specialty has also been the incredible mentorship from all the fellows and attendings who have trained me. To see them genuinely happy, engaged, and fascinated with their work every day makes it so much easier to feel confident in a career decision.

When trying to talk myself out of GI in the past (because, it's competitive, it's more years of training blah blah blah) I then started visualizing myself at the age of fifty, ~20 years into my career.  Where did I see myself? As a hospitalist? Meh, that sounded fun and satisfying in the short term, but I couldn't do that forever. Infectious disease specialist? It's a field I find very fascinating too, but the clinical work is not something I could imagine doing long term. But Gastroenterology--  I clearly saw myself 20 years from now still engaged and excited, with a work week mixed with inpatient consultations, *procedures*, and office visits with patients for whom I've established a rapport.  If you're ever stuck on what is the best field for you, I seriously recommend this mental exercise; you may be surprised at the clarity it provides you.

My only hope is that I can stay true to my idealistic dreams of how I wish to practice in this field.   When it comes down to it, I love evidence based medicine; nothing brings me joy quite like knowing and following guidelines.   I struggle with being a perfectionist in this way, wanting to practice exactly by the books, while at the same time being frustrated that components of nutritional medicine and the concept of medical therapy individualization hasn't quite caught up in the literature. I respect and live by the high standards of western medicine but also understand the pitfalls and sometimes want to throw my hands up in the air and be a little "woo-woo" in how I care for patients.  Every day will be a learning process of finding my middle ground-- honoring the books, but also high-fiving patients when we finally figure out a gut health solution nowhere to be found in a randomized controlled trial published in the most esteemed journal.  I do, however, find true happiness in reading the recent explosion of medical literature on the gut microbiome. It makes me feel like I'm entering this field at such a pinnacle time, as if we're just starting to unravel all the answers to health and wellbeing (and it just so happens to revolve around my specialty of choice.)

Without a doubt, I feel incredibly lucky and humbled to soon be a part of this specialty- every time I was on a GI elective I felt "in my element" and it's so thrilling to remember I now get to do it forever! So, cheers to 4 & 1/2 months of medicine residency remaining, and let the non-stop poop talk begin (or perhaps, continue) on July 1st-- and,   *cue thrilling excitement/elation/anxiety/fear <3


Shanny DO