Liking the heart vs. liking cardiology

I wanted to be a cardiologist before I began medical school.  I like how the heart is an organ that is always moving, working tirelessly to perfuse the human body.

I like thinking about valves, the intrinsic pacemaker ability, and how the heart adapts to increase cardiac output.

I spent a clinical year in outpatient cardiology, and it eventually became "diuretic clinic" and "beta-blocker clinic."  I liked watching echos be performed, and thought stress tests broke up the monotony every now and then.

I saw heart attack survivors, patients with multiple stents, doing their best to regain their life and previous vivacity.  I saw people who wanted to live their life with as much energy and passion as before, but who were limited by a hurt, tired physical heart.

As I rotated in clinics, I saw people with ejection fractions close to 10% (normal EF ~ 55-70%).  I saw dozens of patients with congestive heart failure exacerbations, and still remember my first patient with new-onset heart failure and all their signs, symptoms and sounds.

I saw patients lying in their bed in a quiet, sad defeat, with diuretics and milrinone only doing so much as their only means for a good quality of life was a cardiac transplant they couldn't afford.

I saw doctors micro-managing doses of cardiac medicine, asking each other everyday when the projected end-point of their hospital was.

In my eyes, a failing heart is going to fail, no matter how good a cardiologist you are.  You need an LVAD or a heart transplant.  And you need money.

Many might see me as a cynical, miserable person.  But the reason I say what I do about various fields is that I can't bare to work everyday in a field where I see so much suffering while there is so little I can do.

My months of hematology/oncology crippled my spirit with sorrow, while everyday of my surgery rotation had more victories, cures, and hope.  I still remember the one patient on the surgery service who was extremely ill and passed away.  It weighs on me to this day. I still remember the first day I met them in the hospital.

Enter medicine not with bravado or a sense of heroism, but with a respect and understanding for the fragility of the human body.  While the human body is such an amazing machine, it is imperfect and has many limits.

Remember the figurative heart in all of your patients, those who are living, and those who passed.