This is a picture taken 4 months ago while we were traveling to Bwindi Impenetrable National Park in Uganda on an adventurous weekend when we decided to go track gorillas. In the distance you see the 3 peaks of Virunga volcanic mountains that define the borders of Rwanda, Democratic Republic of Congo, and Uganda. It is actually a range of 8 peaks with the tallest being 5000 meters.
Uganda feels so far away as I finish the 3rd month of my pulmonary and critical care fellowship in Indiana, USA. When I look at all my pictures, I can almost hear the faint decibels of those memories drowned into the background of the composed, yet chaotic, symphony of fellowship.
Fellowship so far as been not without challenges and obstacles but also fast-paced and fun-filled. When I think of how much enthusiasm and love I had for the medicine part of the internal medicine residency, I now realize that’s what fellowship is amplified exponentially. I have always loved procedures in the ICU and thoughtful decision making for the critically ill, so I knew I would enjoy this fellowship, but I am surprised how much I love learning pulmonary. Pulmonary is a challenge, and I basically know nothing about it. But from learning to read PFT’s to doing the bronchoscopies, I realize that I am completely intrigued by many aspects this field. Not only do I get to be a critical care physician who is trained to consider the whole patient each and every day, but I get to be a specialist in pulmonary medicine. The best part, though, is still being able to be there for patient and their families, and being woven into the narrative of their lives.
This week, I met a patient who had presented with shortness of breath and was found to have a large malignant pleural effusion that needed a thoracentesis to drain in order for him to have relief and be able to breathe. He had not been able to sleep for days and was found to have an adenocarcinoma of unknown primary on a prior thoracentesis. He and his wife and I got acquainted for the 30 minutes as I used the ultrasound and performed the procedure. When I was done, I had learned of how they met, how long they had been married, who their kids were, what their dog’s name was, and their lives’ details. Many days later, they found out that this was a metastatic pancreatic cancer and he had months to live. I met them again to place in a more semi-permanent catheter for them to drain the pleural fluid at home on their own for symptomatic relief as part of palliative therapy. He told me he was just thankful to have relief. I don’t know if any part of this story is particularly special or extraordinary. In fact, it’s a pretty common scenario in our daily lives as pulmonary physicians. But it is one of many stories with a face imprinted upon me so far in fellowship.
In residency, I chose PCCM because of the admiration and awe I had for the unflappable attendings who taught me to love the field. Nothing seem to rattle them or make them uneasy. There was thoughtful and skillful decision making, action, and compassionate care for each and every patient. I feel blessed that I get to learn and work with these same people each and every day. They not only fully support me but are patient and diligent in teaching me the skills and knowledge I need to become competent and successful.
Fellowship is hard, but I am surrounded by amazing attendings, fellow fellows, nursing staff, RT’s, and ancillary staff. I try to iterate to my medical students (and now residents) that the success of every procedure depends on the tools and setup with which you have to accomplish them. I think that success in fellowship must be the same way. In my case, my set up and tools afford for me the hope that, I too, will learn to be a pulmonary critical care doctor like the ones I admire.