By Barbara Gunka
It only took several months into my first year of medical school to realize I wanted to pursue internal medicine as a future career. As a scholar committed to understanding the history and facts, I was always interested in etymology. The underpinnings of internal medicine are rooted in 19th-century Germany, when it was referred to as Innere Medizin. During this era, groups of physicians demonstrating ingenuity and commitment to scientific knowledge adopted an approach that moved beyond empirical observation to understanding pathologic causes of disease. Sir William Osler, the quintessential internist, stated, “It helps a man immensely to be a bit of a hero-worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies.” What this quote means to me is that we find our role models in medicine, those who not only motivate us but whose lessons move beyond traditional teaching.
On reflection, my predilection for complex disease management first started to flourish during my career as a registered nurse in the intensive care unit. At the extremes of disease, the comprehensive approach with reliance on the multidisciplinary team motivated me. Correspondingly, I pursued a path in medicine that would allow me to function as a physician in a problem-solving, detective role. I revelled in the critical thinking process and in endeavoring to understand the disease. I knew that I wanted a career where my persistence, creativity, and intellectual curiosity would lead me to answer complex diagnostic and therapeutic questions.
Inspiring my interest further was a community hematologist and eventual mentor and role model. After I started an observership early in my first year of medical school, it did not take long for me to admire her professionalism, unwavering advocacy, and compassion. She often campaigned for changes that would improve her patients' experiences. Even after years of practice, she appreciated the magnificence of her specialty of practice, describing the act of blood hemostasis as a beautiful symphony. She also recognized her patients for who they were, making sure to explain things in a patient-centered approach. I was most recently in awe of her strategy for defining the severity of the disease, which can vary in specific hematologic maladies. She used the analogy of disease ranging from acting as a candle (that is, not currently harmful or needing any intervention) to a forest fire (that is, likely very active and needing therapy to extinguish it). Over the years, our relationship moved beyond discussing only hematology to also talking about life outside of medicine—from conversations about work–life balance to choosing a location to work. She promoted well-roundedness, and I would often leave her office with a piece of literature ranging from Principles of Neurology to Being Mortal. She stimulated my ambition and sparked my interest in internal medicine.
With her advice and connections, I pursued early electives in different subspecialties and visited larger academic centers. I left myself open to the idea of other specialties; however, before entering third year, I was committed to the pursuit of internal medicine. Knowing my interest, she continued to engage me in educational opportunities through journal clubs and seminars detailing practice updates.
Now, 16 weeks of visiting internal medicine electives across Canada have left me even more puzzled about where I would and should want to go for residency. With only 2 weeks to explore each program and city, this would all be boiled down to making a decision that would account for the next 5 years of my life. As daunting as this task seems, I know that I have someone in my corner who will guide me in making this decision.
My advice to any medical student both starting out and already making their way through would be to find their “master of medicine.” In a field in which there are many paths one can take but there is also the pressure to feel like you should know the one meant for you, a mentor can be both supportive and directional. I just happened to stumble upon a physician who taught me not only clinical medicine but also the humility and compassion that cannot be achieved within the classroom.
Northern Ontario School of Medicine, Thunder Bay
Graduating Class of 2020