The A-Ha Moment

By Alyssa Brown

It started snowing this weekend, and it is the first snow of the year. I was staring out the window dreading the next six months of winter. I was also trying to think of something to write this piece on. I’ve covered patients’ deaths, prosciutto, and watching match day. Usually, I have something smoldering in the back of my mind that I want to write, but this time, I had nothing. It finally hit me as I was watching the snow falling. As I watched the snow tumble and swirl past my desk, I flashed back to a time during third year when I was standing outside at 5am watching the snow fall. I am sitting 647 miles and almost two years from that time and place now. It was a moment that shouldn’t have been that important in the grand scheme of things, but it was the day that clarified my path.

Third year of medical school is what I dreamed about during first and second year. I couldn’t wait to see patients and “practice medicine.” In reality, third year is a lot harder than I thought it would be.  There are sweet patients, whose names, faces, and stories I still remember, countless hours writing notes, chart checking, and gathering records from outside hospitals, sore feet before I learned about compression socks, miraculous surgeries, and miracles that never came. In short, I grew up during third year. I had done my surgery rotation in the fall, and I loved it. I came off that rotation though feeling beat up. The attending on my rural rotation had been incredibly demanding, and it made me question if I was good enough to pursue surgery. No matter what I did, it never seemed right or good enough in his eyes. It may have just been him being tough on me, but honestly, it wore me down. I loved being in the operating room and the patients were the cherry on top, but he made me waiver in my belief in myself. I lost my confidence. To be fair, we had an incredibly tough eight weeks, whatever could go wrong with patients did, and we had a long hard streak of “bad” call nights and tough cases. He operated like a graceful amazing machine, but often, nothing would have been enough to save them. It was neither of our faults, but I was physically, emotionally, and mentally worn out by the end of this rotation.

At the start of third year, I thought it would come down to a decision between surgery or obstetrics and gynecology. My friends had all put their money on obstetrics and gynecology. I started my obstetrics and gynecology on benign gynecological surgery on New Year’s Day. I had a team that worked like clockwork. They integrated me very quickly in the OR. By the end of the first day, I was getting to hold the camera during laparoscopic hysterectomies and suture closed the laparoscope holes. It was an incredibly busy service, but I enjoyed it. I loved the opportunity to learn in what felt like a safe environment. They encouraged me to ask questions and to do and learn. After two weeks on benign gynecology, I was sold. I loved working in  women’s health, and I loved the team I was working with for those two weeks. Following that, I had a fairly uneventful weeks of obstetrics and gynecology clinic, which I have to admit, was a little boring. The patients were great, but I didn’t get to do much more besides finding fetal heart beats. My last two weeks were spent on the Labor and Delivery Floor. I liked labor and delivery, but I missed being in surgical cases. I found caesarean sections much more fun than vaginal deliveries. Looking back, it should have been clear which direction I would eventually go, but I was enjoying my time. It finally crystalized was the final night of my Labor and Delivery Rotation.

 It was the night of the 2018 Super Bowl. I had been on night shift for a week, and I had made it to the last night. I only had to make it through until 7am, and I would be done with labor and delivery. As an aside, I loved working at night. It was weirdly calming to me. I focused better, and I felt more productive working all night and sleeping all day. To break my sleeping during the day habit, I decided to shadow my surgical mentor in pediatric surgery in the daytime after I was released from Labor and Delivery at 7am. Was this a faulty plan? Probably, but my sleep deprived brain thought it would be a fantastic way to reset my internal clock. That night shift was fun, and one of my favorite clinic patients came in for a vaginal delivery. She started pushing at kick-off of the Super Bowl, and she delivered a healthy boy right before the halftime show started; she really wanted to see Justin Timberlake perform. The rest of the night passed with patients coming in from the Emergency Department, but nothing major occurred. I had become very comfortable with the obstetrics and gynecology teams, residents, and patients, so I was sad to change rotations. I changed out of my scrubs and bid the labor and delivery floor goodbye.

The sun was still not up when I slid through the doors to the main hospital to walk the four short blocks to the children’s hospital. I had not seen the outside world since the previous afternoon, so I did not notice it had started snowing that night, which is a rarity in the south. That early in the morning, even around the hospital, it is eerily quiet. There are not many cars heading to park, people milling around, or patients and family members smoking cigarettes outside the doors. It was just me on the sidewalk. I didn’t see anyone else on my walk to the Children’s Hospital. It was peaceful and beautiful. The streetlights caught the falling snow. The entire world looked like a snow globe, as the snow danced and spun in the yellow light of the street lamp. A strange calm hugged me and held me tight, as I stood transfixed watching the snow. It was pure magic. I thought of a song lyric from a long time ago that I loved, “The smell of hospitals in winter/ And the feeling that it’s all a lot of oysters, but no pearls” from Long December by Counting Crows. It is a sad song, if you know it. I always liked that line though because I understood the feeling of constantly going through things looking for the pearl but never finding it. For a split second under those street lights, the world stopped spinning, and everything felt right. I am rarely calm, but in that moment, I just knew that it was okay if I didn’t find the pearl. I was waiting for a big a-ha moment that would never come, and I finally knew it was okay that it wouldn’t.

I had been waiting all of third year for the big a-ha moment that would come sweep me off my feet and tell me what I wanted to do for the rest of my life. I had seen it for others. I had seen people have torrid love affairs with specialties, the surprise love of something they never considered, or the slow burn of the thing they always knew they loved. I hated when people would say that “when you know you know.” I felt happy working with patients. I felt happy with good mentors and teachers. I knew there were rotations that I didn’t love, but it was hard to feel that decisiveness that I was going to pick something to love for the rest of my life. I had shadowed hundreds of hours during my first and second year of medical school and hundreds before medical school to try to make sure I didn’t miss some hidden specialty that I would regret not exploring. At the end of one day, and the beginning of another, in that still dark, quiet morning, I knew that was the day I would decide.

I think shear exhaustion brings a beautiful focused clarity to some decisions in life. I had been to the eighth floor of the children’s’ hospital countless times. I could find my mentor with my eyes closed. She always sat in the PACU. I found her easily and quickly fell into step behind her. I knew my day was going to start with a curt catch-up of our lives, but we would easily fall into talk of surgery and patients. She didn’t know that I had been on labor and delivery the night before with no sleep. I fell into the all too easy rhythm of scrubbing in with her and watching her incredibly deft and elegant movements in the operating room. I would be lying if I said I remembered the cases that day. All I remember is that the decision had never been clearer to me. I had felt comfortable on my OB/Gyn rotation, and I am sure I would love being part of an OB/Gyn residency. What I loved most about that rotation though was the surgery. At the end of that day, after 24 hours of being awake, I knew what I wanted, I knew where I belonged. I belonged in the OR with my mentor. I belonged in surgery. I know the path will not be easy, and I don’t expect it to be. I suspect that some days will be miserable, and it will drive me to the brink. At the core of things though, I don’t think I would be happy not doing surgery. I don’t always believe in miracles, but I do believe that sometimes, the path becomes clear, and you finally catch a glimpse of what you knew all along. For some, it will be a big wondrous a-ha, a big pearl, while for many of you, like me, it will be the knowledge that you knew all along, many oysters. It is okay to take your time. It is okay to not know. Deep down, I think I always knew I wanted to be a surgeon, it just took a cold, snowy morning to solidify that in my mind.