Shadowing at OHSU
My mom works as an Interpreter for patients who can't speak English, and so she naturally interacts with physicians quite a bit in her profession. One of the physicians she met was Dr. Chaim Vanek, an Endocrinologist at Oregon Health Sciences University. Knowing that OHSU is my dream for medical school and being the incredibly unsubtle person that she is, she approached Dr. Vanek about me shadowing him in a conversation that probably went something like this:
Mom: YOU KNOW WHAT I HAVE A SON HE IS TRYING TO BECOME A DOCTOR AND HE WANTS TO GO TO THIS SCHOOL SO DO YOU THINK HE CAN SHADOW YOU?
Dr. Vanek: (Cowering in fear) Yes please, I'll do anything!
My mom is known to be pretty loud. But I wasn't complaining. She got me his contact info and I arranged a couple days that I could shadow him for. Unfortunately, I couldn't shadow him for an extended period of time like I would have preferred because of all the clearance and administrative mumbo jumbo that is required, but even the short time I had with him was pretty great.
As an Endocrinologist, Dr. Vanek's specialty is concerned with diseases and disorders of the endocrine system. Most of the time, this means managing diabetes and twiddling with insulin, but he also sees cases concerning the other major hormones as well. Dr. Vanek sees patients in an outpatient clinic where people are referred to by their primary care physicians, and also manages a team of residents who monitor inpatients.
What immediately struck me about endocrinology was how involved it was biochemically. Obviously medicine is all about biochemistry, but from the physicians that I had shadowed up until that point, the practice of medicine didn't seem to require such a constant awareness of the biochemistry. Dr. Vanek's specialty, however, is concerned almost exclusively on a cellular level rather than an organismal one. For example, he showed me how there are actually many different types of insulin that drug companies manufacture by changing an amino acid in the protein's sequence in order to alter how rapidly it functions (I was amazed that there even was more than just one type of insulin).
Mom: YOU KNOW WHAT I HAVE A SON HE IS TRYING TO BECOME A DOCTOR AND HE WANTS TO GO TO THIS SCHOOL SO DO YOU THINK HE CAN SHADOW YOU?
Dr. Vanek: (Cowering in fear) Yes please, I'll do anything!
My mom is known to be pretty loud. But I wasn't complaining. She got me his contact info and I arranged a couple days that I could shadow him for. Unfortunately, I couldn't shadow him for an extended period of time like I would have preferred because of all the clearance and administrative mumbo jumbo that is required, but even the short time I had with him was pretty great.
As an Endocrinologist, Dr. Vanek's specialty is concerned with diseases and disorders of the endocrine system. Most of the time, this means managing diabetes and twiddling with insulin, but he also sees cases concerning the other major hormones as well. Dr. Vanek sees patients in an outpatient clinic where people are referred to by their primary care physicians, and also manages a team of residents who monitor inpatients.
What immediately struck me about endocrinology was how involved it was biochemically. Obviously medicine is all about biochemistry, but from the physicians that I had shadowed up until that point, the practice of medicine didn't seem to require such a constant awareness of the biochemistry. Dr. Vanek's specialty, however, is concerned almost exclusively on a cellular level rather than an organismal one. For example, he showed me how there are actually many different types of insulin that drug companies manufacture by changing an amino acid in the protein's sequence in order to alter how rapidly it functions (I was amazed that there even was more than just one type of insulin).
And unlike most specialties in which such attention to cellular detail is restricted to one organ system, because the endocrine system has implications for the entire body, Dr. Vanek has to pay attention to all the minute details. He has to know how one hormone may have an effect on one body system, and how the effects on that body system might have an effect on another system. When it comes to diabetes, for example, because the body is not receiving an appropriate amount of glucose because it is either unable to produce insulin or has become insulin resistant, the liver starts producing a lot of ketone bodies which results in diabetic ketoacidosis (DKA). Another example that we talked a lot about was the relationship between parathyroid hormone (PTH) and calcitonin. PTH is responsible for bone degeneration by increasing the amount of calcium in the body, while calcitonin is responsible for bone growth by decreasing the amount of calcium in the body. We saw a patient who had a tumor in the parathyroid gland which was overproducing PTH. As a result, she had been suffering from fractures in her bones. Dr. Vanek was consulted to determine whether it was a hormonal problem, and he gave the all-clear for surgery. So the profession really requires a thorough understanding of biochemical pathways, and out of all the doctors I've seen so far, it's the one that seems most entrenched in science.
This perception was aided by the fact that there was a great deal of attention to labs and data. Again, because this branch of medicine takes place on the cellular level, there is no way to observe these processes tangibly. I know that all physicians look at labs, of course, but my understanding is that they look for certain key numbers. They look to see if a patient's health data is above, at, or below a certain threshold or standard number. In endocrinology, however, there is a continuous stream of data where trends are analyzed. For diabetes (like I said, it's a huge part of what he does), Dr. Vanek would measure the glucose and insulin levels of patients in the hospital over the course of their stays, monitoring spikes at meal times and gauging how much their medications needed to be adjusted. It's very technical, and there was more math involved than I thought there would be in medicine.
Is endocrinology a specialty that I would consider pursuing? At this point, I don't see why not. The biggest thing for me is that I get patient interaction. I want to be able to develop human connections. Since he's a specialist, Dr. Vanek doesn't see patients as much as a primary care physician would, but his line of work does put him in contact with people quite a bit, in the hospital and in his clinic. And what I noticed was that people were really taken with him. Even as he explained all these complex biochemical processes that were occurring in their bodies, it was clear that even though it was going over their heads, they still appreciated what Dr. Vanek was doing for them. This is definitely more of a reflection on the kind and caring person that he is than his profession, but I definitely like the fact that the specialty provides the opportunity for that kind of human interaction to occur.
I also really liked that the specialty was so oriented around technical details. It kind of seemed like detective work, which was pretty fun. Having all the residents throw around differential diagnoses based on the evidence in front of them felt a lot like House (and that impression was only furthered by the fact that Dr. Vanek always has a snarky comment up his sleeve). And even though the focus of the specialty is intangible in the sense that it occurs on a cellular level, it seemed to make more sense to me. I could look at the numbers and say "Ah, I can tie this symptom I observe in the patient to this exact molecular" or "This chain of events happened because of this biochemical pathway". There seemed to be clear cause and effects, even if those were part of a complicated web of events rather than a simple line.
The only downside that I observed in Dr. Vanek's profession was all the paperwork he had to do. I don't know that I would mind it, but he certainly seemed to. With a sigh and a heavy heart, he would plop himself down behind his desk and say "It's part of the job." I think this is true for all physicians, not just endocrinologists, so it doesn't deter me from pursuing the specialty. However, some random physician I met while following Dr. Vanek on his rounds told me that I straight up shouldn't become a doctor because it's not worth it. He told me that I would be much happier working at Costco, which had great hours, great benefits, and decent pay. Being a physician was not worth the effort because of all the debt and the insane amount of work and energy required. Honestly, I felt more sad for the guy than I felt scared. At this point, I know that I love the medical field and it's the only place I see myself dedicating my life to. Maybe he was warning me to avoid ending up like him, but it was wasted because I don't think I'll end up like him anyway. I don't think it's the profession so much as the person in the profession that leads to a life like that.
This fact became clear to me from my observation of the team of residents he was managing. They were all really cool and well adjusted. Unlike the horror stories you hear about how residents are zombies because of the insane amount of hours they work, these guys seemed fine. They were stressed to be sure, it was clear the amount of strain they were under, but getting through pre-med and medical school prepares you for a grueling life. Based on their personalities, which came with generous helpings of humor and humility, I think I'll make it just fine. One disconcerting thing they all mostly agreed upon was that residency was where they learned everything about medicine. Medical school was important, to be sure, but residency is where all the important pieces of information are brought to the forefront and practically applied. It was peculiar to be told that medical school - which I'm so desperately trying to enter - will be almost redundant by the time I'm a physician.
Looking back now, my only wish is that I'd had more time with Dr. Vanek and that I had shadowed him after taking Biochem 405 and 406. Almost everything we talked about showed up in class later, and I feel like if I'd had the great grounding in biochemistry that I do now, I would have understood the endocrinology a lot better and gotten more out of the experience. In any case, I'm just grateful to have gotten the opportunity at all. Dr. Vanek is one of the nicest, down to earth guys I've ever met. He's a younger guy, so I was able to relate to him pretty well. He was very interested in my path to medical school, even helping me out on some of my MCAT practice problems (when PTH and calcitonin showed up, he was visibly overjoyed). Even if I don't end up in endocrinology, I hope that I can be a physician like him. The respect he generates from his residents and his patients is all because of the kindness and genuineness he brings to his practice.
This perception was aided by the fact that there was a great deal of attention to labs and data. Again, because this branch of medicine takes place on the cellular level, there is no way to observe these processes tangibly. I know that all physicians look at labs, of course, but my understanding is that they look for certain key numbers. They look to see if a patient's health data is above, at, or below a certain threshold or standard number. In endocrinology, however, there is a continuous stream of data where trends are analyzed. For diabetes (like I said, it's a huge part of what he does), Dr. Vanek would measure the glucose and insulin levels of patients in the hospital over the course of their stays, monitoring spikes at meal times and gauging how much their medications needed to be adjusted. It's very technical, and there was more math involved than I thought there would be in medicine.
Is endocrinology a specialty that I would consider pursuing? At this point, I don't see why not. The biggest thing for me is that I get patient interaction. I want to be able to develop human connections. Since he's a specialist, Dr. Vanek doesn't see patients as much as a primary care physician would, but his line of work does put him in contact with people quite a bit, in the hospital and in his clinic. And what I noticed was that people were really taken with him. Even as he explained all these complex biochemical processes that were occurring in their bodies, it was clear that even though it was going over their heads, they still appreciated what Dr. Vanek was doing for them. This is definitely more of a reflection on the kind and caring person that he is than his profession, but I definitely like the fact that the specialty provides the opportunity for that kind of human interaction to occur.
I also really liked that the specialty was so oriented around technical details. It kind of seemed like detective work, which was pretty fun. Having all the residents throw around differential diagnoses based on the evidence in front of them felt a lot like House (and that impression was only furthered by the fact that Dr. Vanek always has a snarky comment up his sleeve). And even though the focus of the specialty is intangible in the sense that it occurs on a cellular level, it seemed to make more sense to me. I could look at the numbers and say "Ah, I can tie this symptom I observe in the patient to this exact molecular" or "This chain of events happened because of this biochemical pathway". There seemed to be clear cause and effects, even if those were part of a complicated web of events rather than a simple line.
The only downside that I observed in Dr. Vanek's profession was all the paperwork he had to do. I don't know that I would mind it, but he certainly seemed to. With a sigh and a heavy heart, he would plop himself down behind his desk and say "It's part of the job." I think this is true for all physicians, not just endocrinologists, so it doesn't deter me from pursuing the specialty. However, some random physician I met while following Dr. Vanek on his rounds told me that I straight up shouldn't become a doctor because it's not worth it. He told me that I would be much happier working at Costco, which had great hours, great benefits, and decent pay. Being a physician was not worth the effort because of all the debt and the insane amount of work and energy required. Honestly, I felt more sad for the guy than I felt scared. At this point, I know that I love the medical field and it's the only place I see myself dedicating my life to. Maybe he was warning me to avoid ending up like him, but it was wasted because I don't think I'll end up like him anyway. I don't think it's the profession so much as the person in the profession that leads to a life like that.
This fact became clear to me from my observation of the team of residents he was managing. They were all really cool and well adjusted. Unlike the horror stories you hear about how residents are zombies because of the insane amount of hours they work, these guys seemed fine. They were stressed to be sure, it was clear the amount of strain they were under, but getting through pre-med and medical school prepares you for a grueling life. Based on their personalities, which came with generous helpings of humor and humility, I think I'll make it just fine. One disconcerting thing they all mostly agreed upon was that residency was where they learned everything about medicine. Medical school was important, to be sure, but residency is where all the important pieces of information are brought to the forefront and practically applied. It was peculiar to be told that medical school - which I'm so desperately trying to enter - will be almost redundant by the time I'm a physician.
Looking back now, my only wish is that I'd had more time with Dr. Vanek and that I had shadowed him after taking Biochem 405 and 406. Almost everything we talked about showed up in class later, and I feel like if I'd had the great grounding in biochemistry that I do now, I would have understood the endocrinology a lot better and gotten more out of the experience. In any case, I'm just grateful to have gotten the opportunity at all. Dr. Vanek is one of the nicest, down to earth guys I've ever met. He's a younger guy, so I was able to relate to him pretty well. He was very interested in my path to medical school, even helping me out on some of my MCAT practice problems (when PTH and calcitonin showed up, he was visibly overjoyed). Even if I don't end up in endocrinology, I hope that I can be a physician like him. The respect he generates from his residents and his patients is all because of the kindness and genuineness he brings to his practice.