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My Journey to Medicine: Charmian’s Story

I’m not going to lie, I experienced palpitations when I was asked to write about my medical career journey. 

My history with personal narratives is abysmal. I was given the assignment twice in college and both times the professors returned my paper to me ungraded. They noted that the work was not characteristic of my usual quality and lacked focus. I was instructed to try again.

In hindsight these results were inevitable—the personal narratives lacked focus because I completely lacked self-awareness.

Why I Became a Doctor

My parents were born in Alabama and Georgia during the Jim Crow era. When I was growing up, no one in my family, except one relative who was a teacher, had graduated from college. I was brought up to believe I would go to college and could be anything I wanted to be. 

When I was 9, my family moved to a small town in conservative, southern Oregon. My parents both worked at the Air National Guard base. The other main industry in the city was lumber. 

There were scant role models—especially those that looked like me—to show what other opportunities existed. However, what I did have, like other kids in my generation, was “The Cosby Show” and I faithfully tuned in every Thursday night. 

I excelled in all subjects in school so naturally, I wanted to be a doctor or a lawyer. I started to lean toward becoming a doctor after freshman biology and solidified the choice in my junior year of high school when I took human anatomy. 

But I wouldn’t become just any doctor; I would become an OB/GYN like Dr. Healthcliff Huxtable.

My Dedication to Women’s Health

I entered Stanford University as a premed. Most Stanford premedical students major in Biology or Human Biology. The latter is a multidisciplinary major that includes sociology, psychology, and biology. The core curriculum in human biology was two lectures at 9 a.m. and 10 a.m. while biology was a single lecture at 10 a.m. My plan was to sample them both and decide on my major afterward. 

I will never forget that first lecture in human biology on the evolution of lactose tolerance. I was riveted by the interplay of changes in human migration, disease, and physiology. I never made it to the 10 a.m. biology class. I stayed in human biology because I had to know how the story ended. 

The human biology major allows you to tailor your coursework to your particular area of interest. I was going to be an OB/GYN so I focused on social determinants in women’s health. In my junior year, I attended Stanford in Washington and interned at the Department of Health and Human Services’ Office on Women’s Health. I helped draft educational materials informing patients of the recent trial showing zidovudine decreased the risk of perinatal transmission of HIV and reviewed grant submissions for the Women’s Health Initiative. (If I didn’t date myself with “The Cosby Show,” I certainly did now.) 

I loved my major. Studying and interning in Washington D.C. was a highlight of my undergraduate experience. Two of my defining characteristics are my curiosity and empathy. Women’s health and the relatively new focus on studying disease processes in female patients allowed me to utilize and strengthen those traits. In my mind, it also reinforced that OB/GYN was the perfect specialty for me. 

My Medical School Journey

I entered medical school having selected my specialty years prior and I made it known that I was going into OB/GYN. 

I was assigned a patient with a müllerian anomaly during my pediatrics clerkship and a patient with postpartum psychosis during psychiatry. All the attendings were supportive until I came to OB/GYN. 

A few attendings frankly asked, “Why do you want to go into OB/GYN? You should do something else.” My response was inevitable: “I’ve always wanted to go into OB/GYN.” 

I had a few seeds of doubt but I wouldn’t let anyone nourish them. Either they heard the decisiveness in my voice or were too exhausted to pursue it further because the conversations ended there. 

I’ve already discussed my love of women’s health and have tremendous respect for OB/GYNs, as well as other clinicians who all deal with chronic sleep deprivation, chronic stress, and personal sacrifices to care for their patients.

However, if I had been honest with a trusted friend, adult, or even myself, I might have realized I had been struggling for a while. I held myself together by relentlessly focusing on my academic and career goals. Things began to unravel as I neared the “finish line.”

Training and Practicing in OB/GYN

Most everyone has heard of the “freshman 15”. Well, I experienced a significant weight gain during my intern year. My stress and anxiety levels were high and comfort food, generously provided by patients and their families, was in abundance in labor and delivery. 

Stress and anxiety levels skyrocketed when I became an attending. In my mind, I was now solely responsible for every outcome, good or bad. The significant weight fluctuations were an obvious sign I was having challenges in my life but no one genuinely asked if I was struggling. My patient satisfaction scores were high, my colleagues respected me, and the executives awarded me healthy bonuses. 

But I was burning out quickly. 

There is a lot of discourse and conversation about burnout now but it wasn’t a focus back then. We weren’t educated on signs of burnout. But I knew something was seriously wrong when I saw a patient in the clinic one day who responded “yes” when asked if there was any change in fetal movement. We performed a biophysical profile in the office and she scored a perfect 10/10. 

Yet, I woke in the middle of the night overcome with anxiety that her fetus would die. I briefly considered whether or not I could recommend an elective induction of labor. 

Indication? Term pregnancy; obstetrician anxiety. 

Becoming Self-Aware

Cognitive behavioral therapy was a component of my dealing with my struggles. I learned I have multiple cognitive distortions, chief among them is internal control fallacy (e.g. I must control everything and everything is my responsibility) and polarized thinking (e.g., everything is black or white or all or nothing). This type of thinking played a role in my high achievement but did not serve me well in some aspects of life, including practicing OB/GYN. 

As my self-awareness grew, I thought about what specialty I would have chosen if I had stopped to consider my options instead of relentlessly pursuing OB/GYN. It was pretty evident—pathology. I loved the subject! Pathophysiology is what kept me glued to my seat in human biology back in undergrad. 

In my first year in medical school, I would return to the pathology lab with my colored pencils and draw the histology slides in a notebook my friends and I used to study. Pathology presentations were also my favorite aspect of multidisciplinary gynecologic oncology rounds. 

I was hopeful for the first time in a long time. I reached out to the Dean of Medicine and was told that it used to be possible to do a second residency but the federal government no longer funds it, making obtaining a spot extremely difficult. 

Next Steps

Transitioning to pathology was not an option. So, I began to examine what other experiences in my career I enjoyed. 

I had some experience with public health, a strong belief in the value of multidisciplinary care, and an interest in technology. I had been the resident and attending OB/GYN champion during two EHR implementations at my medical centers. 

Meaningful use had just come into effect and it seemed like an exciting opportunity to have a positive impact on the health care system. I was hired by an EHR vendor and for years, I loved the work. I created problem-based order sets, logic for clinical decision support, workflows for quality measures, and designed new features for a prenatal care documentation product—the latter of which was my favorite role. 

Unfortunately, the realities of EHR had yet to fulfill its promise. If you’re unaware of how hated it is by some clinicians, let me provide you with an example. 

I was invited to Thanksgiving dinner by a friend who is a family practitioner and her husband who is an orthopedic surgeon. Most of the attendees were in healthcare. I met an emergentologist who asked me my specialty. I informed him I was an OB/GYN but had transitioned to clinical informatics and now worked for an EHR vendor. His demeanor immediately changed and he replied, “I hope the vendor is not XYZ. If so, we have a problem and one of us is going to have to leave.” Fortunately, I didn’t work for that vendor and we enjoyed the festivities. 

I was neither surprised nor offended by his response. I too was becoming disillusioned with EHR work. That same friend who hosted Thanksgiving had recently started doing sex assault forensic exams which are exclusively performed by physicians on the island of O’ahu. I decided to join and found it to be incredibly rewarding. Around the same time, I started writing medical content. I missed working with residents and found it an amazing way to be creative, stay abreast of the latest evidence, and mentor physicians early in their careers. 

Today, I am extremely satisfied with my work for the first time in a long time. It is rewarding and challenging and allows me to lead a balanced lifestyle. 

Advice To Premed and Medical Students

I’ve shared this painful story of professional struggle because I learned that I could have avoided some of the pain if I had been more honest and transparent early in life. 

My advice to medical students is to learn from my mistakes. Do not prematurely choose a specialty. Instead, go into your clerkships with an open mind. Generate at least a top three list of specialties you’re interested in and discuss the options with your friends, family, colleagues, and mentors so you gain different perspectives. Before making a final decision, carefully consider how the specialty aligns with your dreams for the future, both personally and professionally. 

And if you’re struggling or feeling uncertain, show yourself some compassion and be curious about those feelings. Explore them internally and with a trusted friend or advisor. 

Would I have followed this advice? I honestly don’t know. 

My hope is that if I had read a similar blog, those seeds of doubt would have sprouted sooner. Lastly, matching at the residency of your choice and board certification is not the final goal—this is how I considered them, and once achieved, I was left adrift. 

The goal is a long, healthy career. So, please check in with yourself regularly and prioritize self-care because your health is as important as your patient’s.

Charmian Lewis, MD, FACOG, ABPM Clinical Informatics is a Forensic Medical Examiner at the Kapi’olani Medical Center for Women & Children and an author/content champion in Obstetrics & Gynecology at Rosh Review.

Everyone’s journey to becoming a doctor looks different, but they all start with the MCAT and applying to medical school. Blueprint MCAT can help you at every stage of your journey with free MCAT resources, MCAT courses, and medical school admissions consulting.

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