I've reached something of a watershed in my career. And like all crossroads in this life, making the choice is the toughest part.
The choice before me is this: Remain a general anesthesiologist, or concentrate in one particular field. My favorite field is trauma, however this particular hospital treats very little major trauma. One of the reasons that I like this field is that I'm an adrenaline junky. The emergency, the stress, the mess, rolling up my sleeves and getting dirty. I love it. I admit it, I'm addicted to the adrenaline. We can't always save trauma victims, but when we do, there's no better feeling. I admit it. The ego trip of pulling someone who is literally down the tubes back to life is exhilarating.
The reason to stay a generalist is that I like variation. I like the idea that I can anesthetize any patient from 750 grams up to 200 kg. I can handle anything this profession can throw my way, and I like that. If I concentrate on one field, I'll become rusty in the others. I won't forget any of it, but I won't be as sharp. On the other hand, there is the down side to being a jack of all trades and master of none. A very few gifted people can maintain the highest standard in all fields. The rest of us, mere mortals, must do the best we can. Eventually, to ascend the ladder of this occupation, one must specialize. It is expected and encouraged.
If I specialize, I'm most interested in obstetric anesthesia. It is a dynamic field, and has just the right dose of adrenaline for my habit. After all, what could be more stressogenic than an emergency C-Section when both mother and child are at risk? On the other hand, I like my peace and quiet. What better way to achieve that than by providing an epidural to a screaming parturient?