Officially an MD!! Now What?

Last Thursday: Was hooded by my faculty adviser.  Apparently these academic hoods were useful back in the day (not so much as hoods, but as a means to keep the neck and shoulders warm, and a place to put one's wallet, lol).

Last Friday:  Graduated!!  Now officially an MD, woohoo!!

Last Saturday:  Pack pack pack.  Friend's wedding.  Pack.

Sunday:  Pack pack pack.  Last brunch with friends in town.  Then drive 6-7 hours back to my parents' place.

Today:  Happy Birthday to me!  Well, my birthdays tend to almost always be lackluster, so whatever.  It was pretty chill.  Watched the new Star Trek movie with my brother, that was good.  :-)

The Next Stage

Wow.  Graduation is in less than a week.  In less than a week I'll have my MD.  And in a month from yesterday I'll start orientation for residency in a state across the country (at least it's not as far away as Alaska or Hawaii? lol).

The last 3 months have flown by.  It's like I blinked and I'm here.  Doesn't help that it's still a bit cold outside even now in May, haha.  I'm not sure I'm mentally ready for this next stage - for financial independence, for having a real job, for being responsible for the life (and death) of patients.  It's only in retrospect that I can appreciate how far I've come, but I've still got a ways to go in so many respects.

I was never one of those people who hurried to grow up.  In fact, just the opposite.  I did NOT want to grow up.  Childhood is so short, adulthood is so long and fraught with issues that no one else can solve but you.  Maybe this is part of the reason why I'm doing pediatrics, who knows.

At these critical junctions I find myself reflecting in nostalgia - what would and could have been if my life had taken a different path.  What if I decided to take a year off and complete my MPH?  What if I decided not to pursue medicine?  What if, instead of being paralyzed in fear and confusion, I had decided to date her in undergrad?  What if I had decided to come out to my parents?

I have little regret in the things I have done.  I only regret the things I haven't done or haven't been able to do.  They say that medicine is one of the ultimate delayed gratifications.  You spend the majority of your 20s studying your ass off, working long hours, often putting life and health on hold.  This continues (or perhaps worsens) in residency, and in the blink of an eye, you're in your 30s.

It's okay though.  There's still some of my 20s left.  Sure I may not have much time off each year, but that just makes each day off that much more precious.  With my salary, with my own money, I will have the ability to do many of the things I want without having to consider the debt looming over my head (which will get paid off in time).  And with the new duty hour limits of 80 hours/week, I may even have time to develop a social life if I'm efficient.

So it's alright, I can't stop the flow of time just as much as I can't reverse it.  I have just begun creating a bucket list and I'll be damned if I'm unable to do every one of those items!  This wasn't the post I originally meant to write, but here you have it.  Sorry for the scattered thoughts.

I Matched!!

Wow.  What a day.  The Ides of March.  Match Day.

It's been a crazy ride.  I'm SO glad that my med school doesn't make students read where they matched out loud to the entire class.  So many people would've completely broke down crying (in joy or sadness).  Instead, my med school puts all the match envelops in a bin and chooses out names at random.

As each of my friends go up to get their results, I see their faces downcast as they matched their 6th or 8th place.  Finally one of my friends matched her #1 and I was called shortly after.  I was SO nervous - like nauseated and heart palpitations.  Imagine my (shock and) surprise when I matched at my NUMBER TWO rank!!  :-D

It's not my #1, but it's (obviously) the next best.  I had psyched myself up for my #1 so much in my head that really almost all of my other ranks paled in comparison, which is unfair.  It's unreal.  Even now I can't quite believe it.

Actually I'm starting to have irrational doubts now.  Will I be okay with the culture shock of moving so far away?  Did I make the right choice in the order of ranking my programs?  Did I lower myself as a candidate for not ranking more "prestigious" programs higher?  Will I have the time and energy to have a social life outside the hospital?

Like I said, irrational.  In retrospect, this may be the perfect match for me, even though it's #2.  It's a smaller (but not "small") program without fellows, and so more attention can be paid towards teaching me and mentoring me.  It still has all the sub-specialties represented and is a free-standing children's hospital - so my training is automatically solid.  And it's still in the state I want to be in (albeit not quite in the area of the state I'd prefer to be in, but that's okay).

It was a tough match this year.  Lots of disappointed people who applied to a surgical programs, or even medicine programs.  The number of American med school graduates keep growing, but the residency slots are static (some programs may even have shrunk a little as a consequence of the crap going on at the federal government level).  It's only going to get tougher but at the end of the day, most people match, which means most of us will become the clinical doctors that we went to med school to be.

In about 2 months, I will have an MD and have a spot as a pediatric resident.  :-)

Lonely Thoughts

First of all, thanks to those who read my last post.  Alas, said guy in that post has been accepted to a 4-year university in another state (one I didn't apply to for residency) and has a crush on another guy for a while now.  The chances of something physical between us are vanishingly small.  But I'm okay with that, I seriously wish him all the best - I'd rather have him as "just" a friend than not at all.

I'm glad that I'm done with surgery - forever.  It's almost surreal.  It's been such a privilege to be a part of surgery.  I think that's the main reason why I don't hate the OR (operating room).  At no other time can you say you've been hands deep in another person's abdomen, or held a person's bowels out of the way, or cut off a person's leg.  It is a privilege - as is all of medicine - to help someone in such an intimate way.  But whereas I willingly relinquish my privilege to ever do surgery, I acquire the privilege of being the first doctor a child sees in life and helping kids and families through good times and bad.  And that's exactly what I signed up for.
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So the real purpose of this post is to vent my annoyance.  Over the past year, most of my friends have paired up and a number have/will be getting engaged.  And much of our conversations involve them talking (either positively or venting) about their significant others.  And it irritates me.

I know they don't mean to, but I can't bring it up.  I can't ask them to not be with their other half especially when I'm friends with all of them too.  I've apparently been described by some friends as a "bitch" lately for being annoyed and snapping heads off at particular things.  Maybe I have but I'm not going to apologize for it.  I know I'm treated (unconsciously) as a secondary friend by now.  People will bend over for their significant others but make excuses to not hang out when I ask.  I expect no less.

I'm at such a stagnant time-point in my life.  It's frustrating.  I hesitate to act until I know where I'll end up for residency (Match is next Friday! oh my!!).  But here everyone is on the way to getting married and I'm not much further than I was since I started this blog . . .

Maybe I should just focus on me, my career, and accept that I'll be alone forever.

Happy Chinese New Year!

Take Care little Sister 2012 leaves 2013 by =ShadowSaber on deviantART

新年快乐!  恭喜发财!  身体健康!!

Happy Chinese New Years everyone.  The Year of the Dragon now gives way to the Year of the Snake.

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Apologies for the lack of posts of late.  Transitioning from interviewing and vacation back to rotations is tough, and to a surgical sub-internship no less!  My hatred for surgery is nowhere near as intense as it was last year, though my . . . displeasure for surgery is 90% in the hours (specifically how early I have to wake up).

That said, this surgery site is pretty chill all things considered.  I love taking the surgeries that don't have a resident in them because I get to be first assist and do more (and see more).  The attending surgeons here let me do a fair bit more than I was allowed to as an M3 last year.  I can see how one would love doing surgery; however, I still hate waking up before 5am and standing for hours on end putting strain on my lower back.  I should start doing some yoga . . .

More posts coming up soon (hopefully).  I have an unfinished one drafted.

To Be Wanted . . .

It's such a weird feeling (for me) to be wanted.

What I'm most caught off-guard by during these residency interviews is just how much the program wants me (I suppose that makes sense, otherwise they wouldn't invite me for an interview).  Still, I'm left awkwardly speechless when an interviewer enumerates the various things I've done in med school and react amazed when I describe them.  It's almost embarrassing.

Up until now I've received little recognition outside my circle of friends and faculty advisors for the things I've done.  Everything I've done felt like it was being quietly conducted in the shadows outside the glowing praise of my institution at large.  I never received an award or anything of that sort, and I doubt I ever will - I simply don't have the overwhelming popularity to bring visibility to the things I champion.

But at almost every interview I've been asked to describe (in some detail) the community advocacy work I've done for the Asian and LGBT communities.  Some interviewers are more keen on hearing about the health literacy project I did in the Asian-American community, others are eager to hear about the cultural competency training I forwarded in LGBT health education, and still some want to hear about my involvement on a state policy level.

At one of my recent interviews, my interviewer asked me, "How are you able to do all this?"  And I began to reply that I was lucky and these opportunities fell into my lap in such a way that I couldn't turn them down.  He cut me off and corrected me that I instead "seized the opportunities."  I never thought of it that way, but I suppose he's right.

As these interviews wind to a close, I'm more and more certain of what I bring to a residency program.  This wasn't crystal clear at the beginning, but now I know.  Programs didn't choose me because of my grades or Step 1 score (verily, I'm positive that many programs rejected me based on those criteria), but rather the extensive community outreach and advocacy work I've done.  I'm glad that the 11 places that chose to interview me saw beyond the numbers to something more important that I can bring.

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P.S. For anyone applying to residency programs, everything you write in your ERAS application is fair game for interviewers to ask you about - and they will ask you about them, so know your application stone cold.

Interview Trail - Part 1: First Impressions

H DeVos Children's Hospital 2 by ~dharvell on deviantART

I hope everyone's had a happy holiday so far and looking forward to the New Year!  Almost as soon as 2013 starts, I hit the interview trail again.  But before that, some first impressions on Part 1.  There are things I've come to realize that are personally important to me when choosing a residency program, as I'll be stuck where I match for at least the next 3 years.  So in no particular order:

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1. Location

Location, location, location.  This is huge.  More so than I initially thought.  You want to be in a city and an area of the country you can see yourself living in for the next 3+ years.  Weather and geography are major filters for many people.  Some people really want to live on the west coast, or the east coast, or NYC in particular (not entirely sure why . . . no one can survive there on a resident's salary).  Others, like me, cast a wide net over huge swathes of the country to see what might fit best.

2. Hospital

The hospital you'll be working in is very important.  Is it old?  Recently renovated?  New?  Does it have readily accessible computers?  Does it use an EMR (electronic medical record)?  Are there good ancillary staff (nurses, pharmacists, etc)?  What is the patient demographic?  One of my filters is that I only chose free-standing children's hospitals because I felt that I'd get the best pediatric training at those tertiary referral centers.  Also, children's hospitals are all so colorful and friendly!  Adult hospitals are dull and depressing in comparison (particularly the VA).

3. Residents

You'll be working up to 80 hours/week with your co-residents.  You'll interact with them more than you do your friends or family.  They will become your family.  What kind of residents are at the program?  Do you mesh and fit in with them?  What kind of person are you?  While everyone in pediatrics is universally nice, I can definitely see myself fitting in with the residents at some programs more than others.

4. Curriculum

The ACGME dictates the fundamental curriculum for all residents.  The money is in the details.  Some programs are well designed, with a ward structure that residents are happy with, and a ton of flexibility to explore interests.  Other programs are rigid or else in so much flux it makes one anxious.  I've definitely come across some interesting and innovative ward structures.  Also the size of the program can be important.  There are small (1-9 residents) programs, medium (10-19 residents) programs, large (20-29 residents) program, and ginormous (30+ residents) programs.  In what environment might you thrive?  Does it matter to you at all?

5. Benefits

A residency is a job, and it behooves the applicant to have some inkling of the benefits.  How much do they pay their residents?  Does the hospital cover medical/dental insurance, or do the residents pay a portion out of pocket?  Amount of vacation/sick leave?  Is there free parking?  IS THERE FREE FOOD?!  I didn't realize how important the latter was to me until I encountered a program that did not feed its residents.  All the applicants looked at each other and were like, "What is this? An adult program?"

6. Gestalt

At the end of the day, trust your gut instinct about a program after you've visited it.  Some of my friends have created Excel spreadsheets to "objectively" score programs to determine their rank order list.  But the gestalt of a place trumps all that.  I've walked away from programs feeling very good about them - they treated the applicants well, I enjoyed my interactions with residents and faculty, they gave a nice tour of the hospital, they answered all our questions and more - whatever it might be, it's definitely a good sign when you walk away from a program feeling really good.  I've also walked away from programs where I'm like "Hmm . . . not sure what to think about this place" or "I really can't seem myself working here."

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I'm only in the middle of mine.  I've heard from many other applicants that after about the 4th one they're just like, "Okay, I'm tired of this now.  Everything's blurring together."  But here I am after my 6th one and I'm still excited to go on my remaining 5 interviews and each hospital stands out fresh in my mind (we'll see if that changes later, lol).

I think the reason why is because I listened to my advisor's advice (that's what they're for, right?).  And he said that I'll get competent training anywhere because the ACGME demands it, so it's more about how I feel about the place.  Thus I try to explore the city a bit the day before the interview and really feel out the residents and see what makes them tick and whether I "belong."

Residency interviews are so much better (and more fun) than med school interviews (at least for pediatrics/internal medicine - not as much for surgery I've heard).  You are selected for an interview because they want you there.  The interviews are mostly a get-to-know-you and to convince you to go there.  To be honest, it's weird to be complimented and feel wanted, that what you've done outside the classroom and outside rotations mattered.  I can't even count how many times I've been told that the whole process favors the applicant (as long as the applicant isn't a dick).

P.S. The hospital in the picture above is very nice on the inside.  And the people are amazing.

Let The Journey Begin

And so it soon begins, the traveling across the country to visit and interview at residency programs.  And then to create a rank list from my most preferred to least preferred programs.  And finally, letting the Match dictate where I'll end up for the next 3 years of my life.

One interview down, nine more to go.  First to southern California, then to Michigan, then to Philadelphia, then Delaware, and then Chicago.  I didn't get interview invites at several programs I really wanted to have the opportunity to interview at (i.e. Kaiser North in Oakland, CA, UCSF, U of MI, UW-Madison, DC programs), but no matter; 10 interviews is plenty to match.  According to NRMP statistics, I only "need" to rank about 8 programs to virtually guarantee myself matching somewhere.

You may wonder what "matching" means.  Basically, I get interview invitations from residency programs that I send my application to.  Of the programs I interview, I create a rank list of which programs I most to least want to end up at.  Meanwhile, the programs create a similar rank list of which med students they want as residents from most to least desirable.  Then each party submits their list to NRMP and through some computer alchemy, it matches applicant and program.  This is a binding contract, so wherever the match dictates, the applicant must go for residency.  I've heard that the process favors the applicants, insofar as most applicants get one of their top 3 choices or so.

Still, it's a daunting thing.  I've come to accept that I'm almost a second-tier applicant and hence am out of the running for many of the more competitive residency programs.  And that's unfortunate but whatever.  I'm hoping to fall in love with a few programs, as people keep saying will happen.  We shall see.

Let the journey begin!  But first to finish packing . . .

Check & Check

Step 2 CK: check. (Did 20 points better than on Step 1, woot!)

Step 2 CS: check.

Letters of recommendation: check.

ERAS application: check.

Schedule my first few residency interviews: check.

Haven't actually gotten a residency interview invitation in a while now, and it's making me nervous.  I applied to 29 programs, which most people have told me is overkill for pediatrics (on average, people applying to pediatrics apply to about 15-20 programs).  I really need to hear from more programs NOW.

I'm on pediatric anesthesia right now.  For the past month I've been on my vacation month (for another post), so coming back to starting at 6:30am is a bit of a shift.  It's been a good experience so far.  I like getting the opportunity and practice of putting IV's in babies and kids, as well as manage the airway.  I like being able to see a diversity of pediatric surgeries because I can migrate from OR to OR each day and see something totally different than if I were just on one surgical service.  Everyone I've interacted with has been very nice and (usually) patient with me.

But I have to say, some people have got to stop trying to make me question why I want to do pediatrics.  Yes, I will be making about 1/4 to 1/3 of your salary.  No, it's definitely not for the money, that's abundantly clear.  I'm well aware that I'll be making among the bottom salaries as far as physicians go.  That said, I will make more money than both my parents' salaries combined.  And I see absolutely no need to "upgrade" my lifestyle.  Yes, I will come out with far more debt than both my parents, but I don't doubt that I'll have the ability to pay it off (annoying rough as that may potentially be).

Anyway, there were some cases I've seen that have definitely reaffirmed some of the reasons why I choose to pursue pediatrics (for another post).  And who knows, if I get bored or burnt out, pediatric anesthesiology might be an option, as it seems almost 1/3 to 1/2 of the staff peds anesthesiologists here apparently started off as pediatricians.  Hmm . . . I must pick their brains on this.

Another Step Taken

Another step by ~F1rstcl4ssn00b on deviantART

Step 1: check.

Step 2 CK: check.

Check off each step taken towards my medical license.  Hopefully I passed Step 2 CK, but I won't definitively know for almost a month.  Blah.  I shudder to think about retaking that 9-hour long test (not to mention how much it costs!).  With some luck, I did markedly better on Step 2 CK than on Step 1 last year.

Steps left to go: Step 2 CS and Step 3.  After that, it's just the re-certification exams every 10 years to be board certified.  Yay.  Endless testing.  -_-

But for the moment, I have a short window of freedom (and a short vacation coming up!).  So I'm going to enjoy this while it lasts.  Alas I also have to work on ERAS applications for residency programs.

Oddly Chaotic

M4 year has been oddly chaotic.  Where to even begin?

1.  I finished my peds sub-I last month.  The last week and a half were awesome and really renewed my desire to pursue peds.  While on night float it was just me, a senior resident, the nurses, and the attending physician that I rarely saw or talked to.  I liked the smaller team structure and I enjoyed interacting more closely with the nurses and got the opportunity to know all the patients on the service a bit better.  I also became really efficient literally overnight and that efficiency carried over when I returned to the day shift.  Unfortunately I'm still worried that my comparatively poor performance the first 3 weeks caused irreparable damage to my grade and comments, which could pose an issue later when I interview for residency programs.

2.  I'm taking USMLE Step 2 CK at the end of this month.  I'm so not ready!!  I keep hearing that most people do better on Step 2 CK than on Step 1, and I desperately hope that's true because I didn't do nearly as well on Step 1 as I had expected.  :-/  Must study study study!!!

3.  I'm working on my ERAS application to pediatric residency programs.  I'm partway through but I honestly expected to be mostly done by now.  I just haven't had the energy to dedicate sufficient time towards it.  There's so many little things to do and complete!  And I have to really do some introspection into what kinds of programs are a good fit for me.  Ugh.

4.  I have to touch base with all my writers for letters of recommendation.  In addition I need a letter from the Chair of Pediatrics.  Fortunately, in an oddly deus ex machina fashion, that bit worked out far better than I could've dreamed.  So now I'm just waiting for one letter writer to get back to me as to when he can meet with me to finalize things.

5.  I went out on a date with this guy a couple weeks back (he considered it a date, I thought we were just hanging out having brunch - clearly I suck at such things).  He's about my age, is a good conversationalist, is witty.  We've been flirting a little bit back and forth via the app we first chatted on (he has limited texts, so I avoid texting him too much).  Hopefully there may be more?

6.  Last month I visited a friend in a city about an hour west of me.  It was a lot of fun.  I also ended up (unintentionally?) jacking him off . . . while his boyfriend was out of town.  Oops.

So yeah.  Oddly chaotic beginning to what's supposed to be the best year of medical school.  But these first few months are death.

Hardest Month . . .

Precocious Patient by ~ThirstyEye on deviantART

M3 year has flown by.  Sometimes I still can't believe I an M4 now and on my pediatrics sub-internship.  This is by far my most difficult month of med school yet, more so than even surgery.  I literally act as a functional intern on one of the pediatrics ward teams, except all my orders have to be verified by my senior resident.

There are rewarding moments.  There are moments and areas that I feel I shine at.  But all that is overshadowed by this constant anxious feeling that I'm not doing enough, or not doing things the right way, or not thinking fast enough.  It's terrifying.  Being the one responsible for a child's care in the hospital is daunting.  It's not that I don't basically know what to do, it's that I'm unable to instantly anticipate all possible (worst) outcomes and prepare for it.

I'm able to prioritize tasks fairly easily, to do what needs to be done, but I can't prioritize my thoughts as quickly when someone asks me a question or I'm asked to present a patient.  The information is there, but it's not organized the way I (later) type it up and it's unfiltered because I just ramble all the information - pertinent and non-pertinent.  I don't know why I'm getting flustered and blanking.

I'm now 2 weeks in to the rotation, about half-way done.  And I feel like I haven't significantly improved despite working my ass off.  Today was the worst day.  I showed up and was instantly handed 5 patients I didn't know, didn't have sufficient time to read through their chart, and on top of that I was the one admitting a new patient and had to do her whole work-up.  I was a mess and constantly second-guessing everything I said the whole day after that.  It took me way longer to catch up than it should.

Words can't express how defeated I feel right now.  How stupid I feel.  How slow I feel.  How not cut out for this I feel.  Maybe I should consider switching fields.  This was not how I expected to start M4 year, and definitely not how I expected this month to go.

Ending with the Crazies

Ya know, I could say how I've been busy and whatnot.  But that'd be a lie this time.  I've just been lazy.  The year has been winding down for some time and I just couldn't be bothered, lol.  And as it is, I end the year with the crazies (aka, psychiatry).

It actually wasn't a bad rotation.  Spent 2 weeks on child/adolescent psych, 1 week on eating disorders, and 1 week on adult psych.  As the director of the place told us several times, "Most of these patients ain't dumb, they ain't crazy, they just have had crazy things happen in their lives and couldn't handle it, and that's why they're here."  On about day 3 I realized how true his words rang.

The vast majority of psychiatric patients I saw aren't crazy.  Most of them aren't schizophrenic, they don't hear voices other people don't hear, they don't see things other people don't see, they aren't foaming at the mouth or anything (that said, the couple of schizophrenics who weren't taking their medications really were sometimes kinda scary crazy).  Most of the people I saw actually had mood disorders - anxiety, depression, irritability, etc.

The best way I can describe most patients' situations is that crazy things happen in their lives - a kid is witness to domestic violence or is abused (verbally, physically, emotionally, and/or sexually), a teen feels out of control when her parents divorce and start restricting her eating, an adult couldn't handle the pain from multiple surgeries and turns to drugs - and their minds just can't take it.  Something inside breaks and they snap.  These people try to resolve things and find an outlet for the trauma of their minds and find themselves repeatedly bashing their heads against a proverbial wall.

And when they're at their lowest, when there's not much further down to go, they come to us at an inpatient psychiatric hospital.  Here we control the environment, take the responsibility out of their hands for a time, talk to them, counsel them, prescribe medications.  And these medications often work (it may take some fiddling around to find the right drug and dose for the right person, but it works out more often than not).  They kind of reset the imbalance in the brain and allow people to think clearer, calmer, and more rationally.  They smooth out the edges of emotions so one doesn't soar as high or dip as low.

Mental health.  It's a real thing.  Sometimes all one needs is some counseling, and sometimes it requires medication.  In that regard, it's not really any different than diabetes or hypertension.

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Oh yeah, I'm 3/4 of an MD now!  :-D  Unfortunately the other aspects of my life have been less interesting than the things I witness when I'm in the hospital.  Still a few things here and there worth blogging about in posts to come.

Oh yeah, PPACA (aka, Obamacare) survived the Supreme Court ruling.  Thoughts?  Also for another post, lol.

The Past Few Months

It's been a while since I last blogged.  I could easily claim that I've been busy (which I have), but it's just as much my fault for being lazy.  Blogger has changed in this interval time (I kinda like the old version better, lol).  I've seen and learned a lot these past few months in the various rotations I've circulated through.  Each month presented a different slice of medicine.

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Family Medicine

Truthfully, this was easily one of my favorite rotations.  I worked in a clinic with a preceptor, no residents on site, and I got to do a lot.  It was almost like a continuation from outpatient pediatrics the month prior and I loved it.

Family medicine is the "jack of all trades, master of none" field insofar as it sees the full spectrum of ages and patients, and can do a little bit of everything but is unable to narrow down into most sub-specialties (e.g. cardiology, pulmonology, etc).  But you see the bread-and-butter of everyday illnesses and do things like lance boils, freeze warts, do a little physical therapy, and things like that.

But the one thing I most took away from family medicine was my preceptor's outlook on life.  He spent his career nurturing his perfect work-life balance, and it was something he reiterated to me over and over again.  He didn't mind earning a little less money than the other physicians in the practice because the flip side was that he got to spend more time with his family and kids.  It all comes down to priorities.

One life philosophy that was parroted by his son one day is, "Have a good day, or not.  The choice is yours."  And he told that to more patients than I could count that month.
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Pediatric Infectious Diseases

Peds ID was something I was almost certain I would do coming into med school.  My background almost perfectly set me up for it - a year of public health, focus in genetics and molecular biology, interest in HIV/AIDS, etc.

But then something curious happened.  I loved outpatient pediatrics.  I loved family medicine.  I loved pediatric rheumatology.  I could no longer choose or peg myself down for something so narrow as pediatric infectious diseases with a focus in HIV/AIDS.  I found myself wanted to become more general.

That said, I still enjoyed the month.  I got to know my patients in the hospital (they didn't always know me, several of them being babies or else mentally handicapped).  I got to understand the work-up for an infectious etiology.  And every Wednesday at the weekly conference where all the staff physicians in peds ID got together to discuss the treatment plans for all the patients on service, they would all go at each other.  It was one of the most entertaining, and intellectually stimulating, things to sit through.  I was entertained, anyway.

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Perioperative Medicine

Aka, anesthesiology (with bits of trauma and emergency medicine tossed in).  I knew I'd like this rotation.  I liked doing things with my hands and doing small procedures (not surgeries though).  I didn't expect to love it but I did.

In anesthesiology, you put patients to sleep in the OR (operating room), keep them alive throughout the surgery, monitor pain, and wake them up.  Your job is one of the most important jobs because you are directly responsible for someone's life.  You control every aspect of their physiology - their breathing, their heart rate, their muscles (via paralysis), and their consciousness.  My resident asked me, "Who is in the best position to kill the patient?  The surgeon?  No, it's us, the anesthesiologist.  Without us the patient can't breathe.  And if we make a mistake with a medication, the patient may never wake up."

There was a sense of immediate gratification and power in anesthesiology.  I got to put in several peripheral IVs (didn't miss a single one I'm proud to say).  I really liked putting in IVs . . . I got to monitor and chart the patient's course in the OR.  I got to breathe for patients.  I attempted to intubate a few (intubation is quite difficult for me, grrr).  I got to help prep and push drugs that slowed a person's heart rate down when it got too high, or boost a person's blood pressure when it dipped too low, or reinforce paralysis when a person began to twitch in the middle of surgery (always under the direct watchful eye of a physician, of course).

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Obstetrics/Gynecology

I . . . didn't really like ob/gyn. I mean, it was okay.  Not as brutal as surgery.  I just don't think I could stand women and pregnant women all day.  The vast majority of the residents are women as well!  That said, I did like participating in vaginal deliveries.  Got to catch a couple babies too!  They're just as slippery as you'd imagine.

The one thing I REALLY disliked about ob/gyn is that you spend almost zero time with the baby once it's out of the womb.  You hand the baby off to the nurse or the neonatologist and don't bat an eye at it again.  I found myself lingering more at the baby's side than the mom's.  Yeah . . . it's a sign.  Babies are so cute (even right after they're born and are all slimy and malformed-looking)!!

One other thing - you don't truly appreciate blood loss until this rotation.  In surgery you think you've seen someone bleed during surgery.  Just wait until a birth or better yet, a C-section.  A woman is expected to lose one liter of blood during that procedure - one liter!  The vast majority of women do just fine afterwards though, because their bodies have spent the better part of up to 9 months prepping for that loss.  Still though . . .

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Neurology/Psychiatry

Well I just finished neurology and will be starting psychiatry tomorrow.  Neurology was okay.  I was on an awesome team with great residents and good attendings who taught quite a bit.  But I saw a very small slice of neurology as I was on the neurovascular (aka, stroke) team.

We saw many patients with strokes or suspected strokes.  The neurological deficits are interesting to see when they're there.  What's nice to know is that most people recover and do just fine after a relatively small stroke.  It's the large ones that really take out half your body that're devastating.  There were a few devastating strokes on our service in our short time there.

So public service announcement: exercise some, eat healthy, take your blood pressure/high cholesterol medication if you need them, do not smoke.  A stroke is a scary thing to have happen to you, especially when you're young (less than 65 years old).  There are a lot of things we can do to reduce that risk.

Return from Unexpected Hiatus

Wow, hard to believe it's been a month since I last posted anything here! Also kind of hard to believe that I haven't been blogging about all the things I've seen and done the last 3 months (and there's oh so much to tell). Didn't mean to not post . . . oops.

Days have become long again, now that I'm on ob/gyn. It's an abomination to wake up and be at the hospital before dawn. Thankfully, the break of dawn is slowly creeping earlier and earlier in the day such that by the time I get to the hospital, the cracks of daylight begin to alight the horizon.

But before I get back into my day to day, week to week, month to month recount, there are 2 things I came across on Facebook recently.

On Being Gay in Medicine: A Leading Harvard Pediatrician's Story
This is an amazingly written (albeit long) article. The author recalls how when he was in med school, you had to stay closeted otherwise your career can be ruined at a whim. It's almost weird reading about that and about how much things have changed. Things are getting better, but there's always some room for improvement. I think this article resonated with many people, gay/bi/straight/otherwise.

It Gets Better at Brigham Young University

This is a really touching YouTube vid I saw posted. Very well done (albeit long-ish) and very moving. It's not secret that BYU is among the least LGBT-friendly campuses in the nation, but it's reassuring to know that even there things are changing for the better. Definitely worth watching the whole thing.

Chosen Path

This post is actually 2 weeks later than when I made my decision, but it has to be written nonetheless.

I've decided that I will not return and finish my MPH.

It's not like I'm necessarily giving up on getting an MPH (eventually), it's just not what I'm looking for in my career at this time. I may end up getting an MPH as a part of a preventive medicine or ID fellowship, if/when that time comes. I may end up coming full circle and return to some lab work, but not now and not in the near future.

And I've decided this for the reasons I wrote in my previous post. The words that clarified my decision came from my M4 advisor, who told me:

"I'm going to tell you what I tell residents who're deciding whether to do a fellowship or not. A fellowship, like your MPH, requires you to give it your all and your total dedication. If you're going back and forth now, ask yourself: is this really what you want? Or is your doubt telling you something?"

Those words shone in my mind like a sun burning up morning fog. I've made my decision. And I'm at peace with it.

Uncertain Crossroads

Crossroads by ~Nadja18 on deviantART

Last week my application for re-admission to complete my MPH (Master's in Public Health) was approved. Initially I was ecstatic because I had been talking about this moment for over a year, about how I loved/valued the program, etc. Now for the past week or so, I'm not so sure - I've been getting some cold feet and doubting whether I will actually go back and finish what I started. The conviction which I had held for the past 1-2 years is gone. And it all hinges on "uncertainty."

I am uncertain that:
1. I will get funding to finish my MPH (I do NOT want to tack on any more to my growing student loan debt).
2. I really need to finish my MPH to do what I want to do.
3. I still want to do what I had originally set out to do when I began med school.

Here's how those primary uncertainties are being addressed at the moment. 1.) I stand a fairly decent chance of getting funding via teaching undergrad courses as a grad student. It was reassuring that the professor I taught for was very willing to write me a letter of recommendation and remembers me so well. 2.) I do not need to finish my MPH to do what I want to do. Would it be useful? Perhaps, but it depends on what I end up doing. Which brings me to, 3.) Without even realizing, I've changed. I had set out to be the so-called "triple threat," that is the doctor who sees patients, does research, and teaches students. Now I'm not so keen on the research bit, haha. Also I had set out to do ID (infectious diseases), and while that's still on my career list, I've begun to shift away towards primary care or another specialty like rheumatology.

My MPH degree is very specific towards a particularly ID-oriented skill set. With my degree I would be better equipped to understand infectious diseases, conduct laboratory "bench" research, and create surveillance programs relating to infectious diseases and the agents to treat them. And prior to med school, that was one aspect I had wanted out of my career. Now I don't know.

Now a few things are certain and have remained certain (if not strengthened) over the past several years: 1.) I want my career to be clinically focused on treating patients. 2.) I want my career to have a public health/community engagement component. 3.) I want to teach students (doesn't have to be med students). 4.) I want a good work-life balance. None of those require an MPH - or more specifically, my focused MPH program.

So I'm in a bind. Will I regret later down the road for not having finished my MPH? If I get my MPH and never end up going into an ID field, will I feel like I "wasted" a year? I can see myself going either way, and neither road is superior to the other (not really, anyway). I can convince myself to go either way and I've been changing my mind on almost a daily basis for the past week. Ugh.

Talking to one attending physician who basically does what my MPH would prep me to do, he asked me, "What do you want to do?" And I said either peds or something within peds, like peds ID. And he emphatically said that I did not need an MPH to do peds or peds ID, and it wouldn't necessarily help me that much. What matters most is not how many letters I had after my name (so long as I had letters at all); what matters most is talent, hard work, and good networking. That said, if there's something I wanted to do within medicine that requires an MPH (or practically requires it), then I should definitely get it.

Anyway, what do you all think? I've talked to so many friends and several faculty, and I keep ping-ponging between the two options. I can't delay my commitment too much longer, have to make a final decision soon!

The Importance of Caring

Several days ago I came across this article, The foundation of medicine is care. Like many words in healthcare, "care" has become overused (right up there with "professionalism"). What does it even mean anymore?

We adhere to standards of care - the set of questions, actions, labs, imaging, etc that we do to diagnose a patient's problems and provide adequate treatment. We provide care to patients, to help them when they request it of us. None of this necessitates that we care about our patients. As the article argues (and I agree), this last kind of care is the most important.

Today, a distraught parent explained her daughter's "history of present illness" to the physician I am working with this week. In trying to get an accurate picture of her daughter's current illness, he asked the mom question after question to make sure he had the story right. The mom got frustrated because she's had to explain the whole thing for who knows how many times and she felt like he wasn't listening - such is the perils of an academic teaching hospital, you must tell the same story at least 3 times (and often more). The mom became so frustrated that she broke down. She was the first person I met who said how horrible this hospital was, how no one seemed to care enough to get the story right or talk to each other so that everyone's on the same page. She's not entirely wrong. Our hospital system is set up in a rather fragmented way. We provide the same standard of care (if not better) than most other hospitals, we provide good care for our patients. But we, as a system, didn't care about the patient.

Inpatient medicine is very different from outpatient medicine. In the outpatient setting, I felt that every physician actually cared for his/her patients on a personal level. I had a . . . heated discussion with my roommate about a month back. He asked me why I cared so much, why I get so worked up over a patient encounter. Really, I couldn't help it. By actually caring about my patients, not just for them, I feel like I am able to do more and am willing to try harder for them.

He didn't share my same views. For him, once he met the standard of care, he need not go further. If he couldn't get a patient to comply, then he is perfectly satisfied to give up and walk away from the situation. While in some scenarios this is indeed the correct course of action, I felt that it would be a disservice to our patients if we gave up every time they gave us even the slightest hint of grief.

Anyway, just some thoughts.

Privilege & Entitlement

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."

I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:

"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."

In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!

Mediocrity

mediocrity by ~seven20 on deviantART

In grade school (K-12), I was always at the top of my class. I was pretty good at everything (except gym) and the world was full of endless possibilities. In undergrad, I understood that few people are truly Renaissance men. I learned where my strengths were and I knew where my limits were, in some cases hitting that unmovable wall. In grad school, the world - while more limited - was still full of potential. I learned what I loved and I learned what I could excel at.

In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.

Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!

I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.

I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.

As I talked to my friend, he said the following to me:

"Don't feel defeated, you passed and you are a bad ass med school person. You're like, proving yourself beyond 99.9999% of all people in the world. Can't get too upset about that last 0.00001%."

I always loved him for his perspective on things.