Delayed Gratification...Delivered

Medicine is about a lot of things: service to humanity, life-long learning, ... and delayed gratification. Academia too. How many life experiences or projects have been put off "until I finish the dissertation," "once I land a permanent job," or "after I achieve tenure"? I've been blogging here for about a decade (actually 11 or 12 years, depending on whether you count the place-holding post I put up once I had decided on the name for my blog-to-be). I feel that I know a thing or three about delayed gratification. This is the story of gratification delivered.

Dear Husband designed this "Dr. Kristen Ehrenberger, PhD" nameplate
when I was still an intern. He presented this vision of the future to me as
a pick-me-up during a particularly grueling rotation. Hot/cold tumbler
from my mother; hand-drawn mug from my older niece and nephew.

Premedical college students study subjects that are not-quite-medicine: biology, genetics, general and organic chemistry, physics (!). Maybe the geneticists, pathologists, and radiologists can more directly apply what they learned in those classes to their final careers, but for most aspiring physicians, those are the lists we have to joust in order to pass the MCAT, in order to go medical school, in order to land a good residency, in order to get a fellowship, in order to become >>duhn-duhn<< AN ATTENDING PHYSICIAN.

In medical school it starts over again with anatomy and physiology, microbiology and immunology, histology and epidemiology, pathology and pharmacology. At the time, these basic science courses seemed so far from the clinic that motivation to hang on to what we were learning was hard to come by. Each exam seemed like just another hoop to jump through in order to get to the promised land of "clinical rotations." 

Like many medical schools, mine tried to get us excited for patient contact during the first two years by having us shadow practicing physicians. We didn't really know much in the way of useful knowledge or skills yet, however. While we sat in the corner, observing, it was difficult to look ahead to realize what use anatomical landmarks would be for the musculoskeletal physical exam, or that a significant portion of general medical practice involves diagnosing and treating infectious diseases. (I wish I had studied harder in microbio, and immunology really only made sense after we had finished the class.)

I of course chose a path less traveled that simultaneously made this problem of delayed gratification harder and easier. Pursuing an MD-PhD added 8 years to my medical training. It became harder to wear the label "student" the further into my 30s I got. (Don't get me started on the short white med student jacket.) However, the other discipline(s) I was learning--academic history, body scholarship, interdisciplinary science studies, medical humanities--also allowed me do the thing I was studying. I've been a practicing historian since I delivered my first conference paper in my second semester grad school, just over 15 years ago. Not only did I co-author a monograph at MIT Press while still in graduate school, but I am now being asked to organize groups and to edit publications as an early-to-mid-career academic.

By contrast, I have only been practicing medicine since I started internship, 5 years ago. And even then, a lot of what I did as a resident was still observing, or "pretending" to be a specialist on various rotations (ID, cardiology, pulmonology, neurology, etc.). Because internal medicine residency produces general internists (and pediatrics residency yields general pediatricians) who have a little bit of knowledge in a lot of different things, I had to wait until my first attending position to actually do full time the thing for which I had been studying: practicing primary care medicine for adults with and without disabilities. Well, part-time, since my faculty position gives me promotional credit for my medical humanities scholarship but not the protected time in which to do it. I grew tired of squeezing my scholarship into nights, weekends, and vacations, so I took a pay cut to get to do it all of those times and also one day during the work week.

The waiting "to arrive" wasn't over with graduation from residency a year ago today, because we still had 3 weeks of service left before the end of our contracts. And I waited 2 months to start my job because I wanted a break from 20 years of continuous higher education to relax and travel (::sigh:: pandemic). And even when I did start at the beginning of September, I still felt like a resident, because my attending credentials had not been entered in the computer system, so I couldn't do my own billing and had to sign my notes over to a colleague for 2 weeks. And for 2 months I was still studying (for the second of 2 board exams).

After I passed my boards, I finally felt like I might have arrived. Except that no one had made provisions for me to have an office, or even a desk in a shared space, so I squatted in empty conference rooms or used one of the fellows' shared desks. (When I pointed this out rather piquedly to the senior attending who had taken over the computer I was using while I was in clinic because his was farther down the hallway, he retorted, "Do you have a job? Have you been receiving a paycheck all this time?" Yes and yes, on the very last day of the month, thank you for reminding me how precarious it was to go 3 months without income last summer.)

Other milestones have been delayed. Dear Husband and I have been trying to try to buy a house almost since we moved to Pittsburgh. We had planned to find a home equidistant between our places of employment between the first and second year of residency, but it took him all that time to find a job. Then we promised ourselves we would buy after five years of renting, but the housing market was too hot for us this spring. And I've been dreaming of a Greek second honeymoon to celebrate 15 years of marriage for at least 2 years (::sigh:: pandemic).

Nevertheless, things are looking up. I am no longer studying in all of my free time, now using it to work on a variety of projects (including TeachingRounds, the ultimate study project). With some promotions and retirements, I finally have my own desk (in a shared space). My name is even on the door! The backboard is a green-brown bulletin board, so I splurged on designer pushpins from Etsy: one set of woodland creatures, and another set of beach glass from Maine. A goal that will hopefully be reached is getting my residency research project published soon (that had to wait until facultyhood, because residents don't have access to the kind of statistical help I needed.) And even though we don't quite have the room for a full-sized LaZBoy, I decided I didn't want to wait for us to move to have a more comfortable armchair than the wooden, second-hand, twice-recovered rocking chair I have been using for the last 13 years.

This is what gratification looks like. It was delivered on Thursday. Now Rosamunda, DH, and I don't have to jockey for dibs on his comfy chair, and I can kick back with my feet up to "attend" lectures, review charts, and write. Ahhhhh...it feels so good.