I recently found in my archives a handwritten endocrinology notebook from my third year in medical school at Jordan University in the early 1980s. At the time, my lecture notes, as well as those of a few other students (with readable, if not neat, handwriting), were popular common study materials and were shared across the medical school, especially during exam seasons. But this notebook was not traditional lecture notes. This was more like a book, the only one I wrote, for some reason, page by page and volume by volume, throughout the course of that year. The book was neatly written using references in pathology, physiology, pharmacology, and so on. It came to five volumes, with chapters and sections, with drawings and cartoons as illustrations, and with humor! The cover page was an imitation of an anatomy book. Now, I have no memory of why I chose endocrinology in particular for this work while a medical student. At the time, I had no plan to choose endocrinology as a career. In fact, I used to hate the specialty in medical school and post-graduate training — until November 1993, while I was a senior PGY-3 at Hurley Medical Center, in Flint, Michigan. That fall, in my senior year of internal medicine residency, I woke up one day with the decision to switch from my declared specialty of rheumatology to endocrinology. The specialty switch was swift, and while unexplainable to myself, it was shocking to Dr. Barbara McIntosh, our IM program director and a rheumatologist! My interest in rheumatology had developed during my fourth (senior) year of IM residency (Arab Board Training) at Hamad Hospital, Doha, in 1991 to 1992. At the time, the division of rheumatology had a vacancy for a senior resident or registrar (postgraduate junior specialist). The chief resident selected me to join rheumatology to fill that position. I had learned the subspecialty and fell in love with it. In addition to improving my knowledge, I greatly improved my procedural skills in the specialty. While working with the chief of rheumatology, Dr. Mohammad Hammoudeh, I was also inspired and touched by the career and personal story of Professor Muhammad Asim Khan, a senior rheumatologist at Case Western University in Cleveland, who was a mentor of Dr. Hammoudeh himself when he was a fellow there. Dr. Khan visited Doha a few times, and Dr. Hammoudeh would host him and invite us. Years later, I also met Dr. Khan in Amman, during the 2002 Pan-Arab Internal Medicine Convention, where we both spoke. A world expert on ankylosing spondylitis (AS), Dr. Khan himself has AS, and that is the inspiring part. He wrote a beautiful article several years ago (Ann Intern Med. 2000;doi:10.7326/0003-4819-133-3-200008010-00018), in the humanities section “On Being a Patient,” in which he told his personal and career story since immigrating to the United States in the late 1960s, having finished medical school in his homeland at a record young age. To this day, I always share Dr. Khan's story with my students and trainees, the most recent occasion being the musculoskeletal problem-based learning class for MSU second-year medical students. Coincidentally, when I began residency in Hurley in July, 1992, I was on call and admitted an elderly women with an acute illness. The next morning the nurses noted sudden swelling of one knee. I knew what it was. My attending asked me to call Dr. McKintosh (yes, the program director), who did not know me yet. Dr. McKintosh came and asked me, the intern, to present the case. “So, what do you think?” she asked. “Pseudogout,” I answered. Impressive, right? “So, what is the next step?” she asked. “Aspiration and polarized microscopy,” I answered. Dr. McKintosh asked the nurse to prepare the arthrocentesis tray and began to wash her hands. Then with a humble voice, I asked, “Can I do it?” “What?” she asked. “Do you know how?” I nodded “yes,” and I did it and it was like a breeze. Another impressive deed, right? So, at Hurley, it was known from Day 1 that I was going into rheumatology. Dr. McIntosh was in full support of my expected rheumatology fellowship application to any program of my choosing! But — That November, in the fall of 1993, the usual time in which senior residents apply for post-residency fellowships, I knocked on Dr. McIntosh’s door. “I have bad news, and it will disappoint you,” I announced shyly, almost whispering. She was quite concerned, “If not rheumatology, what then, and why?” “Endocrinology, and I don’t really know why,” I said. Today at MSU, I regularly interview senior residents from around the U.S. for our endocrine fellowship program, and I always read their personal statements on their online ERAS application, word for word. I realize some statements are generic, but some are genuine and passionate. Candidates describe how they’ve sought to be endocrinologists since childhood, some feeling they were born to be endocrinologists. They had been inspired by family members who were physicians or who had Grave’s disease or diabetes. But in my case I had never planned to be an endocrinologist. In fact, I wish to confess that I had always wanted to be an engineer, not a doctor, but that is another story. My switch from rheumatology to endocrinology remains a mystery even to myself. In retrospect, perhaps that makeshift endocrine book was a clue. Will I do it again? Without blinking, over and over again! Source
