My closest friends always admonish me that I think way too much, which is most certainly true. If I had the knack for shutting off my brain at least partially, I would probably enjoy life a whole hell of a lot more. Unfortunately, when I give it a try, it seems like my brain shuts off completely, and a lot of untoward and sometimes disastrous things tend to happen.

But I was just driving down the freeway, and I realized that, yes, I am happy right now. I’m sure that it’s probably just because I am on vacation (as of 2 p.m. this afternoon) Not that work has been all that demanding these past few weeks, but the fact that I don’t have to be anywhere at all tomorrow is pretty exciting. And then it struck me. Why is it that I have to analyze everything to death? Why can’t I just be?

On another note, I think I’ve discovered (or re-discovered) what it is I want to do with my life, career-wise. I did write way back when in my personal statement that what interested me was the care of chronically ill patients, and that I was interested in the problem of Transition™, which is the short buzzword for the process of signing out pediatric patients to internal medicine physicians. Some of the more prominent patient populations where this is important is with children with chronic lung disease, including asthma, but even more impressive with cystic fibrosis patients. There are also the type I diabetics, inflammatory bowel disease, connective tissue disorders, the transplant patients, and, almost fantastically, the children born with congenital heart defects who have been surgically-repaired. In previous eras, a lot of these patients would never even come close to adulthood, but they are now knocking on internal medicine doctor’s doors, with issues that aren’t typically covered in traditional internal medicine training programs.

This is the patient population that for some reason I have been drawn to. And today one of my attendings brought up the fact that she is looking closely at this, and was wondering if I would be interested in being involved in a study.

So my first conception is to become a med-peds primary care physician who follows kids through Transition, trying to maintain some semblance of continuity of care. Because of the way that our insurance reimbursement system is structured, you get arbitrarily cut off from your pediatric specialist at age 21, and you’re forced to transition to an adult specialist, which frankly makes no sense whatsoever. (Here’s another argument for universal health care.)

So we’ll see, I guess, is all I can say. Two weeks of no responsibility, and then I’m turning thirty in a month, and I’ve got less than two years of residency left. Things will be changing fast, whether I want them to or not. It’s kind of exciting, actually. I hope I can hang on to this optimistic feeling for at least a little while. I’ve unfortunately been conditioned to hope for the best but to expect the worst. But if you expect the worst all the time, sometimes it seems like that’s all that you ever get.