Rotation Series Part 2: Gastroenterology + Taking Time for Myself

 
Attempting to hide my donut consumption.

Attempting to hide my donut consumption.

 

Has anybody ever met a mean gastroenterologist?

You haven’t, had you? I’m not sure they exist. A mean gastroenterologist is like Bigfoot: mythical and existing only in our collective imagination.

As my third year marches on, I am almost done with my GI rotation. It is these exceptionally pleasant personalities that have defined the rotation so far. Perhaps something about the GI specialty attracts personalities that are kind, patient, and understanding (more on this later). Perhaps the intensity of my last rotation—surgery—skewed my perception of what rotations will feel like. Perhaps the gastroenterologists where I rotate are exceptions, and this pattern isn’t even “a thing.”

Some examples:

The first day on the rotation, my preceptor was intensely curious about me as a person. What are my hobbies? What is my story? What are my interests? He recommended a book about writing; he listened to my answers and followed up on them throughout the next few days. He acts this way towards patients, too—asking open-ended questions like, “So, what should we talk about?” and “What else haven’t I addressed for you?”

He’s thorough. He takes his time. He listens. When he’ll briefly leave me in a room with a patient, they’ll turn to me and say, “He’s the best, isn’t he?”

While on call with a different gastroenterologist, she asked what I know about hyponatremia. My answer left quite a bit to be desired, so she smiled and told me (in a playful way) that hyponatremia is my “assignment” as she writes up a few notes.

I found what I could about it. When she was done, I showed her the chart I made. She grabbed a pen and pulled a chair up next to me, letting me talk through it line by line, gently adding or editing my presentation. We worked like that for what seemed like too long—I wanted to let her know that if she had more important places to be, we could come back to the hyponatremia topic later. But she took her time with me. I still have that hyponatremia paper and keep it in my bag.

Yet another GI preceptor is possibly the friendliest person I’ve met in a while. He loves asking questions and teaches in a way where no answer is the wrong answer. It makes it fun. If I answer a question right, he’ll exclaim, “Correct!” Then elaborate on the details of the topic. If I answer it wrong, he’ll fault is own question-asking. He’ll say, “Hmm – let me word this another way…” It keeps me in the game. If I answer a question close-but-not-exactly, he’ll state: “That’s fair!” And help me to understand why my answer might make sense, but why it might not be the absolute best answer.

These are the gastroenterologists I know in a clinical setting: three out of three are kind, patient, understanding humans. The gastroenterologists I know as friends of the family are also kindhearted. And the gastroenterologists who I’ve connected with on social media are thoughtful and compassionate in so many ways.

The analytical side of me wants to know if there is any truth to this. My working theory is as follows, and suggests two reasons for the specialty-to-personality pattern I’ve witnessed.

 First, gastroenterology visits so frequently bring up sensitive subjects. Many patients preface their concerns with, “I know this sounds gross, but…” or “I’m sorry you have to hear this…” They often feel embarrassed with their symptoms. It’s harder to talk about accidental defecation than it is to discuss, say, a sinus infection or knee pain. Gastroenterology is intimate. It takes reassurance on the physician’s part that there is no judgement and that it isn’t “gross.”  

Whether reassuring personalities tend to be drawn to this field, or if this field creates reassuring personalities, comforting and understanding behaviors are requisite for this line of work.

My second theory is the subject matter of gastroenterology itself. The gut-brain connection is bidirectional and linked in innumerable interconnected ways. I’m curious whether gastroenterologists—who presumably have superior gut health than the average population—are able to better take care of their gut health which, in turn, provides improved general wellbeing. Improved general wellbeing might help explain the kindness and understanding I’ve been experiencing with these physicians.

I’m not sure. I’m absolutely making this up. I’d love to hear more anecdotes on this topic.  

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Despite these generous personalities, I needed a break this rotation. This is a rare situation. My personality is one that is stimulated and energized by work, where I often hear—and roll my eyes at—requests to “take a break.” I enjoy staying busy and I feel the need to be challenged.

But I was becoming lethargic and moody. The amount of work required of me was not the culprit. I finally realized: it was an overwhelming feeling of isolation.

My previous rotation, surgery, was hands-on and team oriented:

I had a classmate on the service with me, which I don’t have now on a GI elective.

Tasks were required and graded because surgery is a “core” rotation—so I was tested on my knowledge (unlike electives).

There were more opportunities to participate (retracting, suturing, holding the laparoscopic camera), whereas many GI procedures are designed to be done by one person.

On top of this, the classmates who I lived with in preclinical years are absent because we went separate ways on rotations. My family is several states away. I live alone.

I felt isolated and disconnected from the world. Less contribution during the workday and no connection with friends or loved ones once I went home.

I knew I wanted to ask for time off to see my family, but I was terrified how it would be perceived. What would my preceptor think of me? How could I explain this concept of isolation I’m feeling?

It took some nudging by my mom to make it happen. She texted me:

“Maybe a courageous conversation with the GI doc? Don’t know if you’d have anything to lose. Probably a great skill to just ask for what you want … med school and college sports are oppressive patriarchal guilt-inducing machines … it’s time to break the cycle!”

The next day was booked for 14 procedures. I figured I had plenty of time to discuss taking two days off, but I couldn’t do it. Break after break came and went and I didn’t say a word about it. Finally, at the end of the long day, when my preceptor told me I can leave whenever, I stayed sitting next to him. I told him I had something I wanted to ask, but I was scared about doing it. He stopped typing. I said it would mean a lot to me to see my family this upcoming weekend, and I was wondering if he’d grant me two days off to allow me to do that. I was terrified of his response.

When it finally came, I heard: “Sure, Jamie!”

I was a little stunned. It was that easy. I tried to continue pleading my case, as I had planned it to go in my head, but he was already smiling at me with an understanding expression. He pulled his phone out and helped me schedule the best time to take flights.

I got to go home and see my family that weekend.

 And I’ll forever be grateful for the generous, patient, and understanding personality of a gastroenterologist.

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