Rank List Dilemmas

I thought that making my rank list would be about deciding what kind of program I want to go to- but it's turned into so much more than that.  It's about deciding what kind of person I want to be, what kind of life I want to have, what kind of surgeon I want to be....  none of which are questions that anyone else can answer for me.

There's one type of program- we'll call it Academic Central, that is great in a hard core, down and dirty surgery kind of way.  The residents are the coolest, slickest, most confident and cool-headed people I've ever met, and I want to be just like every single one of them.  They work really hard, but they save people's lives every day.  They come out of residency completely exhausted, but also as some of the best trained surgeons you'll ever meet. They publish lots papers and are taught by "famous" surgeons who have invented procedures and written textbooks. If I went there, I would have little/no life for 5 years- but afterward I would be on the track to becoming a world-renowned whatever-kind-of-surgeon I want.

The other type of program- we'll call in Community Galore, is much more laid back.  Smaller program with a heavy emphasis on bread-and-butter surgery cases (lots of gallbladders and appendixes).  They work less hours, and they see fewer super complex cases.  If I want to be a general surgeon, though, do I really need to see 14 Whipple's?  Probably not.  And as a 4th and 5th year, you operate fairly independently which makes you actually ready to operate alone in practice after graduating. Their average number of cases is higher than Academic Central's, and yet they work about 20 hours a week LESS (that's the magical thing about home call-  you stay at home at night and only come in if they need you) .  I would actually have a life for 5 years (the current residents have babies, run marathons, play poker 2x per week...) and I would graduate as a well prepared general surgeon, and I could go to fellowship if I want to (but no one will be beating down my door begging me to come to their program, like they would if I was from Academic Central).

I'm sure that half of you think its a slam dunk decision in each direction- but it's really REALLY not.  I don't think I'm ever going to be the world-renowned surgeon in anything, because that's not what I'm passionate about.  I don't care about being "famous" or "cutting edge", I care about having patients who I can take good care of and who I can help.  I'm going into surgery because I like operating and I like fixing people.  The more I do that, the happier I will be. 

I want to have a life outside of surgery too.  I've been told repeatedly that being in academics is general at the expense of any kind of family life.  I want to have friends, and see my family, and have my own family someday who I actually get to spend time with.   Call me crazy but don't get me wrong- I'm not lazy.  I don't have a single lazy bone in my body.  When most other medical students take a nap- I write a novel and run a marathon.   I'm not hoping for less time at work because I'm lazy; rather because I love all of my life so much that I want to have time for all of it. Balance.  I would love to start volunteering with Danny in my free time.  I'd love to become an adviser at my sorority for women interested in medicine. I want to write another novel.  I want to run half marathons.  I want to get married and raise good kids. I want to have a full and meaningful life, where I can point at five completely different areas of my life and say, "That satisfies me."  Surgery should be one of those areas- not all five.

And yet, there is a little voice in my head that says, "You HAVE to go to the most competitive program that you can.  You HAVE to always be reaching for the highest medical school, the highest program, the highest job. Otherwise, you're wasting all your hardwork and abilities."  My competitive nature tends to highly value adversity and difficulty; as though something being challenging innately makes it the most desired path.  True, I like challenges, but they need to have meaning.

So I'm stuck between this unrelenting drive that I have to succeed, do more, reach further; and the very real desire to be a well rounded person who is happy and balanced in every area of life. ADVICE WELCOME.