Special Treatment, Not Specialty

by Samia Nawaz

“Most college interviews are fairly predictable,” my high school guidance counselor told me. “Just remember to answer thoughtfully and honestly.” Nodding studiously, I took her advice, which worked well for all but one interview. It was for a combined BA /MD program, and I don’t remember many of the questions I was asked. However, one is too interesting to forget. As we sat in what resembled a broom closet at the university medical school’s Eye Institute, my interviewer asked me what specialties of medicine I was interested in. Earnestly, I responded that I had always wanted to do plastic surgery, but I was also interested in cardiology. His eyes narrowed as soon as I mentioned the former—I doubt that he even registered the latter. “Plastic surgery, huh? So you don’t want to be a real doctor.”

I had never stopped to think that there might be a hierarchy in medicine. True, some specialties required longer residencies or were more competitive than others, but in the end, every doctor tried to make his/her patients’ lives easier in some way, whether that was through treating acne with salicylic acid or cancer with chemotherapy, right? At that time, I knew only that plastic surgery was one of the most competitive residencies. Some found the field shallow, but there was no question that it was extremely lucrative and offered a great lifestyle (the combination of the two was almost too much to ask for in medicine—most specialties offered a trade-off between money and downtime). While the mean salary of a general practitioner was reported to be $177,330 (U.S. Department of Labor, 2011), plastic surgeons reported a mean salary of $350,000 (Association of American Medical Colleges, 2012). Additionally, if the plastic surgeon dealt with the cosmetic spectrum of the specialty, cases usually ended successfully and being on call was rare. These benefits made plastic surgery a field that was hard to break into, one that attracted many students but chose only the top-scoring, most ambitious ones. My cousin, a recent medical school graduate, told me that people chose plastic surgery for different reasons, some wanting to help burn victims, but most wanting to deal strictly with cosmetics. My most pressing goal as an aspiring doctor was to care for my patients, and if one specialty could accomplish that more so than another, I was curious as to which one. When I entered college the next fall, I began shadowing doctors of different specialties to get a feel for clinical medicine. Still, the question posed to me in the broom closet haunted me—did I want to be a “real doctor”? What exactly was a “real doctor”?

Plastic surgery was the first specialty I shadowed, and admittedly, I was extremely nervous about it. I remembered Heidi Montag’s drastic makeover that combined ten surgeries in one day, making her look like a Barbie doll instead of a human being, and a line from the teaser I had seen for Emily Owens, M.D., the week before echoed in my mind: “Plastic surgery attracts the mean girls of high school.” I imagined the quintessential plastic surgeons: women with glossy, blonde hair driving bright red convertibles down the palm-lined streets of Beverly Hills and tall, athletic men enjoying antioxidant-packed green tea and tennis at the country club after work.  I wondered if my interviewer had a point about the impact that plastic surgeons made on the world in general. True, shows such as Nip/Tuck and the media sometimes focused on reconstructive plastic surgery for burn victims or more famously, the heroism of the plastic surgeon that created a face for the woman who was attacked by her friend’s chimpanzee. But these seemed to be standout cases; portrayals of fictional plastic surgeons certainly suggested that most of their daily lives consisted of performing breast augmentations or rhinoplasties for patients who wanted to relive their youth or more closely resemble Kim Kardashian.

My initial notion seemed to be reaffirmed when I called my friend, a receptionist for a rather well-known plastic surgeon in my city; she told me that I would be observing a facelift case from start to finish. What good will this do, I thought as I put my scrubs on the next morning. I don’t see how giving a patient a facelift really changes her life. It may even capitalize on her other insecurities. What if she wants to change her nose after this? Don’t our faults actually build our characters?

I met the doctor, a kindly woman who instantly made me feel at ease. She took a few minutes to tell me about the mechanics of a facelift, making sure I understood the physiological aspects of it. We proceeded to pre-op to meet the patient, a middle-aged blond woman. She had lived abroad for many years and had accumulated a lot of sun damage on her face. Areas of her face were tender and burned, and no sunscreen completely alleviated the pain she experienced when exposed to bright light. I understood her situation well because many of my family members had similar problems, having spent much of their lives in the tropical climate of India.

I watched as the doctor deftly removed the patient’s top layer of skin on her face with a laser, exposing a new layer. It was easy to tell that she loved her job. “I don’t ever get bored,” she noted during surgery. “I can do surgery some days and clinic other days, and I genuinely like all of my patients.” I noticed all of the different procedures her clinic offered, from laser hair removal to CoolSculpting (a new, noninvasive form of fat removal) to rhinoplasty. I realized how versatile a plastic surgeon had to be, working with many different parts of the body. It would explain why the residency was so difficult to attain; students had to prove competence in many different areas.

Two weeks later, I returned to the clinic for the patient’s follow-up appointment. I almost didn’t recognize her as she walked into the room. Her skin glowed and she looked happy. The procedure had gone extremely well and she was thrilled with the results. “My sunscreen actually works now,” she told me happily. “I feel like I’ve taken years off my age and everyone is telling me how healthy I look. I feel healthier too!” This was my first glimpse of what a difference plastic surgery could make in a patient’s life. Of course, not all cases would be for purely health-related reasons, but this patient’s improved self-image showed that plastic surgeons were making just as much of an impact on their patients’ lives as doctors of other specialties were.

The next week, I experienced a day in the oncology unit of a local hospital. I mainly observed the infusion room, where patients received chemotherapy or blood transfusions. Needless to say, it was a very different atmosphere from the plastic surgeon’s clinic. The patients were all terminally ill rather than undergoing elective procedures, and it was reflected in their demeanors. The room was still and quiet, not upbeat and optimistic, and the doctors and nurses spoke in soft voices, careful not to disturb the patients. Sometimes the infusion process lasted for hours, but the doctors and nurses did everything possible to maximize the patients’ comfort, bringing them and their families food, blankets, and reading materials. I also saw that there would be no dramatic result at the end; cancer was a difficult disease to treat and obviously had a very high mortality rate. Many patients would never be cured, and most of the people I observed looked exhausted. One patient, an elderly man from Minnesota, told me about his experience with cancer: “I’ve already been here eight times and don’t know what difference it’s making. I guess the only consolation is that the doctors here really care about what happens to me. But it is exhausting and sometimes doesn’t feel worthwhile.” As sad as this was to hear, I did agree with him about the kindness of the doctors and nurses. The oncology unit was simply different from the plastic surgery clinic because it was an entirely different field of medicine and dealt with different situations.

At the end of my shadowing experiences, I knew that my experience with the plastic surgeon had been the more enjoyable one. Objectively, this was not surprising. I was able to physically see the impact of her work on a patient’s life in a positive, relatively lighthearted atmosphere. I didn’t have to compartmentalize my feelings or experience any sadness when I got home; the facelift was performed for the patient’s health, but it was not a life-or-death procedure. Most plastic surgeries were elective; in fact, 92% of them were, according to a 2010 press release from the American Society for Aesthetic Plastic Surgery. Contrarily, no one went to an oncologist unless they absolutely had to. Cancer is a life-or-death disease, and treatment is nonelective and often unsuccessful. The mood of the oncology room was entirely different than the plastic surgeon’s office because many people’s fates would be determined there. So was my interviewer right? Were plastic surgeons and their specialties less important than doctors dealing with noncosmetic, non-elective procedures?

From my perspective, the answer is no. The world needs many different kinds of doctors, as each specialty is different and abundantly necessary. People have medical needs that need to be fulfilled, and they need professionals to administer treatment. Each specialty of medicine attends to a different medical need, and all medical needs must be attended to. However, across both specialties, I did find one similarity. The type of medicine, atmosphere of the clinics, and had nothing in common, but the doctors did. They emphasized patients’ well-being above all else and tried to make their patients’ lives easier, whether it was through treating cancer and alleviating their pain or by improving their personal appearances. My interviewer made it seem like there was a divide in medical specialties between “real” medicine and lesser specialties, but I found this to be untrue. Treatment is treatment. I don’t think suffering can be qualitatively or quantitatively measured; I think doctors aim to fix whatever problem they are presented with. Choosing a branch of medicine also is defined by what the aspiring doctor wants his/her day to contain. Some doctors are skilled at dealing with illnesses such as cancer, whereas others are more suited to operating on the brain, delivering babies, or administering facelifts. It all depends on what the doctor desires to see every day. Each doctor wants to perform optimally for his/her patients, so loving his/her profession every day is of the utmost importance.

If I become a doctor in the future, my main priorities will be treating my patients in the most compassionate, expedient manner possible, and loving what I do. A good doctor is characterized by many things: ability, trust, passion, and compassion, and I aim to fulfill these qualities in whatever field that I choose or that chooses me.