I finally know what I want to do with my life...

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And it was the hardest decision that I've ever made.

I started medical school with the clear idea that I wanted to be an ER doctor. Having worked almost two years as an ER nurse and spent extensive time volunteering in Haiti with ER docs, I felt confident in my decision. But the farther along that I got in medical school, the less certain I was...I liked continuity with my patients, with is not really present in emergency medicine, and I found myself with a different personality than many of my classmates planning to pursue emergency medicine. Then enter OB/GYN...

Delivering a baby is unlike anything else in medicine or life. There's something about the raw joy of that moment and the privilege of being a part of it...nothing really compares. I also liked the prenatal care, the postpartum care, and supporting women with fertility issues. There were a couple of problems though. I knew that I would be a natural family planning OB, which mean that I wouldn't do tubal ligations or prescribe contraceptives, placing me in a very small minority of OBs. This would have implications on where our family would live, based on me finding a hospital and group that would support me practicing this way. I also knew of the implications on family life in traditionally one of the worst residencies in terms of hour requirements, and even after residency as an attending since babies are never born at predictable hours.

In August I spent a month in St. Louis, at an OB/GYN residency that was strong, high-volume, and NFP-friendly (about one-third of the residents are NFP-only). It was one of the best months of my medical school career. I participated in many, many deliveries and did some of my own. I got to know the residents, a smart, kind, and supportive group. I reaffirmed my love for OB and discovered that it was possible and needed to be an NFP-only OB/GYN (possible, but not always easy). I prayed that God would show me what I was supposed to do.

I guess I should add that when I prayed, I told God (always risky in a way) that it would help me make my decision if Stephen and I became pregnant. We had tried for a couple months, knowing that there was only a brief window between residency interviews and the start of intern year, and hadn't been successful yet. I knew that it would impact my decision if I were expecting, because of doing one of the hardest residencies with a newborn. We found out that we were pregnant the month after St. Louis (yes, God listens).

I still interviewed for OB, but I also interviewed in emergency medicine. EM was my 'first love' in a way, and residency and life after were light years different (probably one of the best residencies with a family, and certainly a great lifestyle afterward for having children). However, there was a nagging feeling inside that I didn't want to give up OB. It took me months to make my decision (which I solidified pretty much right before our rank lists were do). I reflected on life, my priorities, why I went into medicine in the first place. As I got closer to decision day, I realized a few things. One was that I didn't like the operating room: as much as I wanted to like surgery and did like the idea of it, it wasn't for me and probably never would be. Surgery is a huge part of OB, and this helped make the decision easier. I also realized that I would miss a lot of the medicine that I'd learned by pursuing OB. It's a very specialized field, and the broad spectrum of knowledge that I'd always hoped to have as an emergency physician wouldn't be a part of it. Knowing both of this things helped me to be at peace in the end, because I didn't want to make the decision based only on family life or the fact that being an NFP-only OB would be difficult.

And so I made my decision of emergency medicine. There's a part of me that still has a hard time letting go of the idea of delivering babies (not that I won't ever in the ER, ha) but I know in my heart that it was the right decision for both our family and for me. It was reaffirmed last month when I was working in the ICU: ER doctors can pursue a fellowship in critical care and become an intensivist, and I realized that the ICU encompasses so many of the reasons that I went into medicine: caring for patients at their most vulnerable, and practicing in a field that requires me to use all of the pathophysiology that I've learned on a daily basis.

That brings me to today, Match Day. If deciding between emergency medicine and OB was the hardest decision that I've ever made, then ranking programs was a close second. I was so torn between the programs closer to family and a few programs at some of the top hospitals in the nation. Ultimately, I ended up ranking the two programs that I felt were the combination of most family friendly with the best education at the top...one is close to family, where we'll have a lot of support, the other is at a world-renowned facility. The Match leaves a certain element to fate (and God) since we rank our top programs and the programs do the same, but then it all goes into one big computer system to give us our assignment. It's 5:30 a.m. now, and in only a few hours we'll know...the countdown continues...