Shepherding Our Minds by Lindsay Veit

As medical students, we are repeatedly warned directly and indirectly that our position on the medical hierarchy puts us somewhere equivalent to the part of a totem pole that is below ground. I recently began to reflect on the personal and academic ramifications of this mindset and I am beginning to see that the mixture of fear and admiration with which we approach attending physicians can become damaging if unchecked. As the medical school culture elevates our teachers to the place of unapproachable divinity, we can miss out on the real teaching.

At UNC School of Medicine we are fortunate to have countless professors who understand that teaching is more than relaying a set of facts. They desire to shepherd our hearts and minds to be both compassionate physicians and inquisitive scientists. With only the rare exception, I have learned that most attending physicians deeply desire to help us succeed in whatever path we choose. They have wisdom to share if only we would get over our insecurities and approach them with our questions and doubts.

One of these attendings, who has been instrumental in both my personal and career development, is the wonderfully sarcastic Dr. Laurence Dahners. Unlike the nearly divine physicians we imagine our attendings to be as MS1s (who know every answer, decided on their specialty in preschool, and miraculously have time for friends, family, research, teaching, and seeing patients every day of the year), Dahners is honest and real. I hope you will find his story and advice as refreshing and encouraging as I have.

Dr. Dahners describes himself as an inquisitive person by nature, who admits finding great joy when his research can overturn the status quo. In fact, when asked which of his many research projects most excited him, he responded by describing a project he worked on with Alex Berger (a current MS2) last summer, which measured the dimensions of the pelvis in adults of both genders aged 25 to 80. This study showed that the pelvis continues to widen after skeletal maturity has been reached.

At this point in the interview I had to interject that (as a woman) such a discovery didn’t surprise me. We had a good laugh. Then he continued, “it should [surprise you] because all the doctor books say your bones don’t grow. Doctor books can be wrong.” Yes, so much of what I learned first year is already obsolete. What will it be like in five years?

Dahners continued to explain that the established view explained widening bones as the body’s response to osteoporosis. This view, he explained, holds that as bones become weaker they make themselves mechanically sounder by becoming larger. But, he added, “I honestly think that part of the reason their bones look less dense is because they have gotten bigger and distributed their calcium more peripherally. . . But anyhow, I just think this is fascinating.  Those people who say ‘our bones are just big, we aren’t really fat’ might be right . . . when you get to about 80, because your bones really are getting big. And I just think this is so cool; anytime you overturn the current wisdom that is pretty cool. Although I’m not sure what clinical relevance [this finding] has.”

That inquisitive, scientific form of rebellion against established protocol is one of the personality traits that drew Dr. Dahners to Orthopedic Surgery, which not only allows but demands constant innovation. The same personality trait pushes him forward in his extensive research. It is also the quality to which I can best relate.

Dr. Dahners’ journey into the operating room is a refreshing break from the typical “Mary Poppins type” specialty stories we hear at pizza catered lunches during MS1/MS2 years. He explains the journey like this:

“I had watched some surgery and thought that any monkey could do that. But I had only seen two surgeries, and they were ones where they just opened up someone’s abdomen, took out an organ, threw it away, and sewed them back shut. It really looked pretty ‘low brow’ to me. So I decided that I was going to be an internist. But then [in 3rd year] when I did my internal medicine rotation, I was horrified to find out that I really didn’t like what they did. This was after I had already decided that I didn’t like pediatrics because there was too much screaming, psychiatry, or OB-GYN.” This last sentence ended with a subtle knowing look exchanged between us that implied no further explanation was needed as to why he didn’t like the latter two.

“So I had already done all the big [rotations]. And now Internal Medicine I found I didn’t like! A lot of people feel like they enjoy most of their rotations, but I didn’t like any of them. Surgery was the only one left, so I was pretty depressed. Then I did surgery and realized that ‘oh, they actually do think some, and they actually do more than just whack people open and throw things away.’ Then I did Orthopedics; I was so naïve that I thought all they did was put casts on people with broken bones. I learned that they actually did surgery . . . and that it was the kind of stuff I like to do. I did wood-working and things like that, screwing things together . . .” Then there was a brief but dramatic pause, and “then I was in love.”

But after falling in love, it wasn’t simply “happily ever after.” Residency was long and hard. So hard in fact, that Dahners quit his program and moved to a shorter, lighter specialty. When he grew bored, he remembered his love and decided it was worth the temporary sacrifice. Isn’t this the story of all great romances?

Dahners often shares this story with students considering a surgical specialty to remind them that yes, it really is hard but it also is worth the sacrifice to do something you love. He concluded our interview with these words of admonishment for medical students still struggling with a specialty choice:

“You are going to be doing [your chosen specialty] at least eight hours a day for the rest of your life. I wouldn’t make a decision like that based on how hard the residency is. After you finishe, then you can decide if you want to work hard or not. And doing something you love is way more important than having an easy residency.” I couldn’t agree more.