What do you want to be?

Dr Christine O’Malley recounts the difficult experience of deciding upon a medical specialty and when she knew geriatrics was for her

It’s odd that people are so prescriptive about the “right” personality for doctors. Medicine is a broad church;there’s room for everyone.

I left school in the Dark Ages, before the CAO. I was offered places in engineering and in medicine. What do you want to be? I was 17 and I didn’t know. I went ahead with medicine, but to be honest, I wasn’t sure. Through the hard slog of studying and exams, that feeling lingered – that I hadn’t quite made the choice.

I got through it.Then after graduation and intern year, the question came round again: What do you want to be – what sort of doctor?

Not surgery. I think surgeons are born, not made.

A few years ago, I was stayingwith friends on an island in Lough Ree. The party included two students: An engineer and a medical student who was thinking of doing surgery. My little dogs had a very exciting holiday, chasing smells and jumping through the long grass. Unfortunately, mostly they caught ticks. I couldn’t bear to touch them.

It was the engineer who got out the tweezers and tackled the patient. The ‘surgeon’ hung back, commenting on the specimens. No, I said, I don’t think you’re a surgeon. Maybe try pathology.

Post-internship, I narrowed my choices down to the medical specialties. In the Dark Ages there wasn’t much structured training. I worked in different hospitals and started studying again. Finally, I had my MRCPI.

The very next day, someone asked: What do you want to be – which branch of medicine? Oh no! The world of medical specialties was there and once again I didn’t know how to choose.

I took some wrong turns, but they can sometimes help in the end.

Because I was considering clinical pharmacology, I did six months in geriatric medicine. I really enjoyed that job and wondered if I should continue. But some time before that, my elderly grandmother had moved into our family home, with all her medical issues; I found it very difficult. If I can’t be kind about my grandmother’s problems, I thought, how could I possibly be a geriatrician?

Since then, I’ve learnt that family is different. It’s much easier to love other people’s difficult grandparents, especially when they are our patients.

I settled on immunology and worked in a science research lab in London. It was very fascinating intellectually, but so different to my world of patients and hospitals. People were friendly, but I really missed being part of a team. As for the endless debates about the possible structure of the T-cell receptor, I wasn’t that interested. Let me know when you have the answer.

Science sits at the edge of the known world, looking into the unknown. Medicine, in contrast, has to work with known and unknown at the same time, in the same patient. Vague symptoms, unclear tests, diagnosis not confirmed? Get on with it – treat your patient, doctor.

Medicine has scientists too.

In my registrar days, I was enthusing to an intern about a fascinating case when he said: “I can’t wait to get out of clinical medicine.” I was shocked. But he had done a science degree and was now enduring medicine in order to get into a career in clinical microbiology.

Years later, I was having a careers discussion with a bright SHO, who was struggling with postgrad exams. Finally, he confessed: “I can’t stand clinical medicine.” I was surprised because he was very popular with patients and staff. But at home in Sudan, Dad left medical school because of family illness, so this young man was fulfilling the dream. He was stuck, no way out. We worked out that immunology was a possible escape route for him.

I dropped out of the London lab and a PhD and was very embarrassed at my failure. I went to Australia to recover, including working in Katherine, in the Northern Territory.

Then back to London.So now, really, what do you want to do?

I took locums to try different specialties. Gastroenterology bored me. I hated oncology – all those chemotherapy protocols. But on my first day in geriatrics, it was like coming home.For the first time, I knew medicine was right for me.

I loved the patients and their families, the teamwork, the complexity of it all. There is no protocol for a strong-willed 85-year-old with multiple problems who refuses medication. It’s just me and the patient.

Every day, a courteous gentleman, with failing memory, tells me I bring “colour and femininity” into his life. A daughter hugs me and says it’s like Christmas to have her mother recover from a long illness.

Yes, I found my tribe.