So, I promised an update on an earlier post about the surprising turn of events in my medical career.  As many of you know, I thought I was going to do ophthalmology given my prior experience as an ophtho tech.  I did research in ophtho during medical school, I was part of the ophtho student interest group, and I did the ophtho rotation.  So what changed my mind??

It all started with my trauma surgery rotation in October of 2015.  I was taking care of a really tragic TBI patient who was in a car accident that killed his young daughter.  He was still in a coma, so every morning I would check on him–get his GCS, check his lines and tubes, talk to his family, etc.  Towards the end of the rotation he regained consciousness and he was able to communicate through grunts and motions with his hands.  His family told him the devastating news that his daughter did not survive the accident.  I don’t know how anyone could live after hearing that, but he did.  Over the next few days, he started to regain his strength.  We eventually transferred him off to inpatient rehab.

I was surprised we were discharging this patient given how sick he still was.  Also, this was the first time I heard about inpatient rehab–what kind of a place was that?  I also wanted to know what kind of outcome this patient would have, if he would fully recover–and if not, what his life would be like.  My curiosity made me look into what inpatient rehab was and opened up the secret world of PM&R.

Ok, it’s not really a secret, but PM&R doesn’t get the publicity that it should.  I didn’t really know much about it until the middle of my 3rd year!  Anyway, I shadowed some physiatrists during spring break to learn more about the field.  The doctors I shadowed were all super nice and answered my naive questions (I was still clueless about the field) and encouraged me to take the PM&R elective.

The PM&R elective was by far my favorite clinical rotation.  What I loved most about it was the inpatient rotation.  I was surprised because many of the patients we saw were extremely sick, almost all of them with multiple comorbidities and complex medical issues.  One patient in particular, Mr. C, was memorable and was one of the reasons why I decided to go into this field.

He suffered from childhood polio with residual RLE weakness, had a renal transplant and subsequent squamous cell carcinoma from immunosuppression, L eye enucleation from his cancer, jaw osteonecrosis from radiation treatment, who was hospitalized, believe it or not, because of diarrhea.  However, he also had a complaint of intermittent weakness in his lower extremities that neurology couldn’t quite figure out, so they discharged him to inpatient rehab.  Despite his extensive medical history, he was a very amicable and upbeat person, and I enjoyed all of our conversations.  I watched him go through some of his physical therapy and occupational therapy.  I watched him as he put on his orthosis and as he practiced walking down the hall.

Watching him reminded me of an uncle I had growing up who was very sick, and because of his conditions and treatments, ended up losing all of his hair and developed a waddling, or trendelenburg, gait.  My uncle was someone I really looked up to, he bore his illness with grace, he continued to work hard to support and love his family, he spread kindness and put others before himself until his dying breath.  He was really one of the reasons why I decided to go into medicine.  I think the way Mr. C appeared, with his bald head, his weakness, his complex medical issues, just reminded me of my uncle, and I knew that I wanted to help Mr. C to regain function so that he could live a fulfilling life like my uncle had.

I felt like I had remembered why I decided to go into medicine in the first place–to help people like my uncle.  I found myself happy and excited each day of the rotation, because I loved learning about rehab and seeing the patients progress in their therapy.  I also really liked the guiding principles of PM&R, which focuses on treating the patient as a whole and treating their impairments or disability with the goal of improving function and independence at home and in society.

The outpatient experience during the rotation was great too.  At the VA, I got to work with amputees and see the great resources the VA offers to its veterans.  I got to see spinal procedures, botox injections, EMGs, joint injections, and spinal cord injuries.  The field is surprisingly broad, so most physiatrists actually find a niche that they enjoy doing the most and build their practice around that area without even needing to do a fellowship in most cases.  For me right now, I’m thinking of doing inpatient rehab, but of course, that might change as I progress in my training if I find that I like something more.

When it came down to deciding between PM&R and ophthalmology, I just felt like I fit in better with the attendings, the residents, and patients in PM&R than I did in ophthalmology.  It was a tough decision, especially since it was so close to residency application season, but I felt good about it and haven’t looked back since.

Anyway, this was a long post, but I thought I should talk about it since it was one of the biggest decisions I’ve made in my entire life.  If you guys have questions about PM&R, feel free to comment in the comments section below!

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