Two childhood dreams come true

It's not everyday that I get to fulfill two childhood dreams. But March 21, 2014 was that day. I got my first choice program! My Match letter is on my refrigerator door. It's Sunday now and I still can't stop smiling when I think about it or open my refrigerator door.

I'm going to be a doctor and I'm going to be a New Yorker.

I have wanted to live in New York ever since I was a child. First it was because I loved the touristy places that I saw when I was little. But I got older I loved New York because of the diversity of people and experiences there. I have no illusions about my upcoming life in New York. I'm not going to be living in a nice apartment and probably not even in Manhattan. But I'm going to live and work in New York.

I have wanted to be a doctor ever since I was a child. Everyone who applied to medical school wrote that (and that they "want to help people"). But that doesn't make it less true for me. My grandfather was an ENT specialist and my grandmother was a Chinese medicine doctor. When I was about five or six years old I remember their former patients came to their apartment in China to thank them, or visit with them, or something. I don't really remember the details but I do remember that the patient were very grateful. I also remember accompanying them to the hospitals where they worked before retiring. We'd run into younger doctors who told me that my grandparents had trained them. My grandparents modeled for me the compassionate physician and educator that I want to be. They are always on my mind throughout medical school and particularly now as I am about to be a doctor. I know that they would be very proud of me and the path I have chosen.

Everest Base Camp: End of one trek and the start of another

I've started a travel blog called "Farthest Away from Home" about my upcoming trip to Nepal, including a trek to Everest Base Camp at 18,000 feet. This piece is x-posted there but I thought it relevant for medical school here on the eve of Match Day. I will be updating my travel blog now before I leave and along the way. 

The most important reason that I am going on this Everest Base Camp trek is because I believe I can do it. Finishing medical school has given me a kind of confidence in myself that I've never had before because I know that I have made it through a very challenging four years.

What have the past four years been like? Medical school was without a doubt the most demanding thing I have ever done. Maybe other people have been through more trying situations but relative to my experiences, medical school has the most challenging thing I have ever done. I had to learn more information that I ever had to before. I had to give up things that were important to me. I had much less free time to explore my hobbies and interest and to relax than I really wanted to. Many times I was really jealous of my peers who had money AND free time.

What have I learned now at the end of four years? I feel empowered. I feel like I can endure hardships for a greater reward because that's what I did every evening I spent in a basement study carrel. The trek to EBC will be physically demanding, I'm sure. But I know I can get to 18,000 feet because I feel like medical school was a mental challenge at least equivalent to that height.

I am less than 12 hours away from finding out the results of my residency match, where I will training for the next three years. It feels like the end of a long trek. As this trek finishes, it has prepared me to begin another.

Next time I will share with you some of the physical preparation for the trek...

Monday of Match Week

This is Match Week, which culminates on Friday, when I find out which residency program I will be in for the next three years.

Today at noon EST I found out that I matched into a residency program!

Last night I woke up three or four times because I was worried about the match. I didn't think it was likely that I didn't match. Rather I had some vague anxiety about if there was some computer glitch and my rank list got lost. Luckily that didn't happen!

But the Match system doesn't reveal which residency program I have match into.

That will happen on Friday at noon EST.

The end of the trail

I'm done with residency interviews and second looks! I finished last Friday.

Here's a summary of my travels:
44 days on the road from the end of October until mid January in
10 states for
14 interviews and
2 second looks

My first interview was New York City in the fall. 

My last interview was San Francisco, beautiful, sunny, and 70 degrees.

In between, I was in a grey Portland...

...and a frigid Chicago

... rainy New England

13,430 miles flown, including my first time traveling on Alaska Airlines, though not to Alaska (Unfortunately they were not all on the same airline so I haven't accumulated any free flights.)
633 miles by train (1 train cancelled due to snowstorm.)
511 miles by car and bus (1 megabus cancelled due to snowstorm.)

Bonuses:
1 celebrity hand shake (Mayor Rahm Emanuel)
1 Broadway play seen starring

Sirs Ian and Patrick in "No Man's Land"

2 knights (Ian McKellen and Patrick Stewart)
10 day vacation between interviews to Turkey!

Cappadocia, Turkey

Hagia Sophia at sunset

The best part:
Many, many nights with my wonderful friends and couchsurfing hosts.

I am so grateful for my friends who hosted me while I was traveling. Not only did they give me a place to stay but they showed me around their town. This goes for long-time friends and the couchsurfing hosts I had never met in person before. Their hospitality and openness makes me hopeful that wherever I end up for residency, I will have a network of friends to support me. Thank you all so much.

It's the end of the interview trail but only the beginning of residency decision time!

At the Trailhead

I had so much fun last weekend Asheville. I visited a friend of mine from medical school. We hiked to Looking Glass Rock and took these photos. 

It felt like fall: leaves changing colors, cooler air, shorter days. It also signaled that my summer of away rotations was coming to an end. 

Monday I start on a different trailhead: the residency interview trail. I'll be flying out for my first interview of the season, literally a quick 30 hour stop. I'll be back in Atlanta to finish my last week at the CDC, then drive back across the country. The interview trail will begin in earnest then because I have several consecutive interviews.

Thank you for reading this blog.  I've had some kind of internet writing up since Xanga when I was in middle school. It's nice to have an audience!  

Is Downton Abbey making a case for primary care? (or is it just me)

Downton Abbey

It's no secret on this blog that I will be a family physician, as I have said in previous blog entries here. It's not secret that I believe in primary care, as I have said here.

But now I'm bringing in my non-medical life to this blog: I wholeheartedly love Downton Abbey. I have shamelessly watched every episode at least once. Downton Abbey is about a British aristocratic family of a husband, wife, and their three daughters, and their servants set in the 1910s-1920s. They have a huge mansion in the British country side. 

I tell you this because this is relevant to my medical life! Downton Abbey shows that family doctors are important. Dr. Clarkson is the GP in the village where they live. There aren't other specialists in the village because, well, it's a village. 

I won't give away any plot points from season 3 but I will say that Dr. Clarkson's relationship with the family members was important to the care he provided. In one episode, a specialist was called in by the family to assess Sybil, another daughter. But this specialist hadn't known Sybil before whereas Dr. Clarkson had known the three daughters since they were girls. Because of this Dr. Clarkson picked up on a mental status change in Sybil, another daughter, when the specialist missed it. This missed sign led to a serious deterioration in Sybil's health. 

In the most recent episode of Downton Abbey last night, Dr. Clarkson mentioned that he was proposing to the hospital board to opening an out clinic. Don't worry, this is a minor plot point so I haven't given much away. 

Dr. Clarkson: I'm just on my way to convince the board of the merits of an out clinic so people can come early for treatment. 

I think "out clinic" meant an outpatient clinic for less-acute problems. Later Robert, the patriarch of the family, dismissed at the idea of the out clinic saying that it would make people go to the doctor more often than is necessary. Basically Robert's character is old-fashioned so it doesn't surprise me that he disagrees. 

Robert: Aren't we encouraging a nation of hypochondriacs if people rush to the doctor at every twinge? 

Isobel: On the contrary I think it encourages people to look after themselves, and not become a burden. 

There, I'm quite pleased to find common ground between primary care medicine and Downton Abbey! 

Dr. Clarkson

Greetings from Atlanta

The non-essential staff at the CDC, including me, are at home because of the government shutdown. I'm supposed to be working in the Division of HIV/AIDS Prevention on a perinatal HIV transmission policies. It's really exciting stuff, though I've only been on the job for a week. So I've had a couple days off to be contemplative, or bored perhaps.

These past few months on away rotations I felt similar to when I studied abroad during my last year of college. The similarities is the constant stimulation of new experiences. There is always some new to do, a new restaurant to try, new people to meet. I'm in a new part of the country I had never been to before. I'm planning to go to a Korean Southern restaurant.

Today really felt like studying abroad because I had a Google Hangout with some classmates in Flint.When I was studying abroad I Skyped frequently with friends in the U.S. Today was actually for a med school committee I sit on, so it was for business. I've met other medical student doing this elective but it was nice to see some familiar faces of my classmates today.

Just like when I was in Denmark, I had so many new and exciting experiences but I also missed the familiarities of home. It's a bit wearing to always be navigating an unfamiliar city, always answering the same questions from new acquaintances. I never thought I'd say this but I kind of miss the Michigan fall. I find the climate here in Georgia strange.  It's literally 80-85 degrees here. It's October! I do a doubletake when I see Halloween merchandise in stores because it feels to me like summer.

I'm on my third and last away rotation of my fourth year. But I don't think I will feel like I'm home for some time. When my elective ends at the end of October, I will continue to travel. I'm planning to interview in November and December so I expect a lot of traveling, staying in hotels, and living out of suitcases yet. And still yet after that I will be living in a sublet apartment in Flint.

It had been and will be a nomadic year. Next summer I will have a place of my own, at an as-of-yet unknown city for residency. Maybe then I will feel like I am home.

I know the kind of doctor I want to be

When I think about all that I've done in the past few months I feel giddy like I'm in love. I'm currently in Chicago on an elective rotation. Before that I was in New York City for another elective. They were in family medicine and reproductive health.

It's wonderful because I'm learning all the things I want to know. During the last couple months I think I've better than the average 4th year student at placing a speculum and finding the cervix. I probably get it 9 times out of 10! Too bad I can't write "pretty good at finding the cervix" on my CV. I'd really like to. I'm proud of it.

It's wonderful because I feel I'm going to provide a really necessary service as a doctor. I had a patient thank me even though I really didn't do anything. I told her my name and, "I'm a student doctor working with Dr. So and So." Then I basically stood behind the doctor. But I feel very touched by this, more so than a lot of my other achievements because I think she really meant it.

It's wonderful because I'm meeting people like the kind I want to be, attendings, residents, and people who share and support my passions. They understand reproductive health and reproductive justice. They get it. They're really smart and down-to-earth.

Surprisingly, I've been treated better on my electives. Being treated like a person is something I believe all people deserve, even medical students. I hope it's because I know more medicine now because I do. I hope it's because I have better articulated what I want to do as a doctor because I have. I also hope it's because I've found "my tribe" because I have.

I will be applying to family medicine residencies that include training in family planning and a strong academic component. In the long run I'm hopeful that I will do all the things I care about: be a good full-spectrum primary care doctor for my patients and a proponent of this work via research or public health or advocacy.

80 hours

I was going to write about how the following week will be nightmarish for me because I have three calls in seven days. I thought to myself, that is SO MANY HOURS so I will add up the hours in quantify my misery and self-pity. 

(Call is when you get to the hospital at the regular time and stay at the hospital longer than than usual. For me the calls are until midnight.)

So I added up the hours I will be working. 

Monday       7a-12a 17 hours

Tuesday      7a-5p   10 hours

Wednesday 7a-5p   10 hours

Thursday     7a-12a 17 hours 

Friday         7a-4a     9 hours

Saturday     OFF!! 

Sunday       7a-12a  17 hours

It's 80 hours. 

I'm free* Friday at 4pm all the till Sunday 7am! That's 39 hours! 

*I'm going to sleep and study for an exam I have the following Tuesday. 

I thought to myself only 80? I thought it would be more hours. 

Then I realized that medicine has so messed with my mind because I think 80 hours shouldn't be that bad. Residents work 80 hours/week ALL THE TIME. There have probably been only a few others week in my third year that I have been at this hospital this much. So basically I felt like I shouldn't complain now because it's going to get worse when I'm working 80 hours/week for many months. 

two things

Yesterday my housemate told me that I looked like I was really tired and stressed, to which I replied, "It's because I really am tired and stressed." It's been a really difficult past couple weeks in part due to my rotation schedule and figuring out what specialty I want to do. 

But there are two things that make me happy:

1. I'm going to be a doctor. What kind of doctor, I don't know, but a doctor with MD after my name. 

It's very like that I will finish medical school and get a residency position somewhere barring any disasters in the next 11 months. Of course there are programs that I think will better fit my goals and those are competitive. But so far I'm pretty sure I'm going to match somewhere. I feel that I have (almost) survived the brutality of third year because I have only 4 weeks left, even though it's going to be a miserable 4 weeks because I have q3 call for the next two weeks, then the shelf exam, and then moving out of Flint. 

2. I have friends and friends of friends who don't even know me at all who have offered me housing during my away rotations. This has been a huge source of stress removed. Thank you. 

Advice for recent college grads and me

I usually don't read advice letters to recent college grads because I'm not a recent college grad but mostly because I find them insipid drivel. But this from Jezebel spoke to me because I have been thinking a lot about what specialty of medicine to put down on my residency applications this September. 

I don't want to turn you into a misanthrope at such a tender age, but listen: most people do not have your best interests at heart. I now see that most of the idiots who told me I'd surely fail were projecting their own insecurities onto me.

I knew that all the people who told me that I should choose one of the ROAD* specialties weren't giving me good advice. Nobody has said that I would fail if I did any other specialty, but they have given me this look of pity, like I'm going to be miserable and disillusioned in a couple years time. (Radiology, Ophthalmology, Anesthesiology, Dermatology. These are very high paying specialties with comfortable work hours.)

When I think about the next few months: moving out of Flint and going to an away elective IN ONE WEEKEND, endless traveling for electives and residency interviews, graduating from med school, interviewing for residency, starting residency, having real responsibilities to keep people alive, I'm so overwhelmed! Then I felt better when I read this:

I've slowly gotten better at dealing with overwhelming responsibilities and terrifying experiences because I've been through similar overwhelming responsibilities and terrifying experiences before and I know I'll pull through. 

When I think back on the past few years, I have already so much that was overwhelming and terrifying, like pass Step 1, move to Flint, work with doctors, talk to real patients, navigate a hospital. That was all SO terrifying but I've made it to today. And that is a little bit reassuring. 

I don't want to wear a white coat.

When I was a second year medical student, I volunteered at a primary care clinic called Care Free. On my first day, I brought along my white coat and stethoscope like I did for every situations where I expected to see patients. I was working with an older medical student there who told me, "White coats are actively discouraged here," and had me set it down in the office for the rest of the afternoon I was there. I was a little confused at first but none of the other doctors, residents, or medical students there had white coats and I didn't want to look like an anomaly.

I think the non-medical public associate closely white coats and doctors. Even before my third year of medical school, I thought I would like wearing a white coat. 

Now that I am more familiar with the medical field, I hate white coats. I want to disassociate them from medicine. For me, the white coat represents an attitude to patients. It means that I'm really smart and important and you must talk to me. I'm more comfortable talking to patients when I'm not wearing my coat. 

This was actually one of the reasons I disliked my Internal Medicine rotation. Everyone wore white coats all the time. When we were rounding, I felt the residents, attendings, and students were ghosts huddled together and whispering. 

When I am I doctor, I will get some more freedom to decide the kind of practice I want. I'm sure that don't want to wear a white coat. 

To specialize

When I introduce myself as a student to patients, the more pleasant patients respond by asking what kind of doctor I plan to be. (There are much less pleasant ones too.) I say that I haven't decided yet.

One patient's family member told me, "Don't specialize."

I was so confused by this. I explained that the purpose of this year of medical school is to experience different specialties. He then explained that he thought I should do "general practice". I explained to him that family medicine is a specialty, so when I said that hadn't decided what to specialize in, I meant that family medicine was still on the table.

I was irritated because it was another example of the fact that family medicine is misunderstood. This was evident because this person didn't consider it a specialty. I see how people think that family docs are less "specialized" because they are see pediatric to geriatric patients. Most specialities are based on either patient population (e.g. pediatrics, OB/GYN, general internal medicine) or organ system (e.g. every field ending in -ology.)

Family physicians are specialists. They specialize in care for  all people with an emphasis understanding the patient's family and community. It saddens me that people don't think it's a skill to understand patients, to be engaged in the patient's community, to advise patients on lifestyle changes, to keep people healthy in the first place.

I also don't like it when people who don't know me at all think they should tell me what to do. I understand that probably they are trying to be nice since they're engaging me in conversation at all. This is better than complaining that they don't want to be seen by a student. But I don't think it's necessary for people to pinpoint what specialty I should do. I hate "advice" like that.

The best thing they could say to me also seems to be the most rare: 

I hope you find what makes you happy and good luck.

Future OB/GYN?

Before I started this rotation I thought that by the end of it I would have decided that I didn't want to specialize in OB/GYN. On the contrary, I haven't rule out this specialty. This fact really surprises me.

OB/GYN rotation ended almost two weeks ago. At that time, I jotted down some things I liked and disliked about the rotation.

Relevant medspeak:
obstetrics: branch of medicine that deals with pregnant women during pregnancy, delivery, and the postpartum period. 
gynecology: the branch of medicine that deals with diseases of the female reproductive organs. 

Likes:

• I'd be okay if I only saw female patients for the rest of my career. 
• I like asking people about their gynecologic history. Yup, this includes all the awkward questions we had to practice asking in pre-clinical years. 
• I like gynecologic surgeries. Some common ones I saw were ovarian cystectomy, dilation and curettage, salpingoophorectomy, hysterectomy, different types of tubal ligation, endometrial ablation, diagnostic laparascopy, salpingectomy for ectopic pregnancy. I think it's the coolest thing that I get to see the inside of someone's body. 
• I like doing a speculum exam and finding the cervix. 
• I like palpating uteruses.
• I like checking cervical dilation even though 80% of the time I can't find the internal os of the cervix. 
• OB/GYN residents are nice. But so far I haven't worked with any other residents so I'm not sure how they compare.
• Getting dirty in blood and amniotic fluid. 
• It's the medical application of my longstanding interest in reproductive health and reproductive rights. I've learned a lot more about reproductive medicine, which is someone I always wanted to learn about. I feel like I'm being true to my values and beliefs. I guess I'm still telling people to use birth control, just in a different setting. 

Dislikes:

• Ridiculous work schedule in residency and as an attending. What other physicians or working person would feel fortunate to have to work every fourth weekend and every fourth weeknight? Really, this is considered a cushy schedule for a full time OB/GYN.
• So... I kind of don't like obstetrics. I know this is half of OB/GYN... If I could do a residency that only consisted of gynecology, I would be ready to commit to that now. Unfortunately, it doesn't work like that. I could do a fellowship after an OB/GYN residency in an gynecologic field so that I'd pretty much only see gynecologic cases. But I'm not sure I'll have the energy to do a fellowship by the time I'm through one of the most difficult residencies so I can't make that decision right now. 

The typical patient on L&D

I have finished my clinical duties on OB/GYN rotation. This week we have exams and presentations. So I think this is a perfect time to procrastinate by blogging.

In preclinical years there were rare instances where we saw real patients in hospitals, not hired actors playing the part of patients. One time we were seeing patients on the pediatrics unit. A classmate of mine said something when addressing the parents of an infant that implied the parents were married. But they weren't married and the student felt really awkward.

Now that I've been at this hospital for about two months, the image I have of a typical parent is completely different. The typical obstetric patient at this urban safety-net hospital:
-Teenager or early 20s African American girl.
-The standard age to have a baby is in your late teens or early twenties. I'd say that most of the pregnant patients we see are between 16-22. This means that they're younger than I am. I'm a little bit taken back when I see a date of birth on the chart that's in the mid nineties. I remember the mid nineties! But now I'm not that surprised.
-The baby daddy (terminology is per patient) is minimally involved, if at all. At her delivery are usually her mother, her aunt. A few times I saw the baby daddy cry when the child was born and I was touched by that. But this is pretty rare.
A few days ago I saw a 28 year old patient who was pregnant for the first time. Reflexively I thought that she was old.

Then I saw a pregnant patient in her late thirties so by definition was AMA. Advanced maternal age: 35 years or older at the due date. I thought she was really old. She was starting to have grey hair.

First rotation!

An attending I worked with yesterday asked what specialty I wanted to do. I was honest and said that I wasn't sure. I probably won't decide until the end of my third year, which is as late as possible. He suggested that I write down notes from my rotations so that I can look back on them when making a decision on choosing a specialty.

That is a very good idea, I thought.

Also a couple friends inquired about my blog recently even though it had been on hiatus for months.

So I'm blogging again!

Quick recap:
I'm a third year student now. My first and current rotation is OB/GYN.
Passed USMLE Step 1!
My score was pretty good and I'm pretty happy with it. (Though I really wanted five more points. That's how it always is, isn't.) Good or bad, that uncertainty is over.

A doctor explained Bartholin's gland to a patient this way:
When you are about to eat delicious food, the glands in your cheek produce saliva to lubricate your mouth. Bartholin's glands have a similar function. When you have foreplay, these two gland on each side of the vagina that secrete fluid to lubricate.

I thought that that was a fitting analogy but I think about it every time my mouth waters.

One of the many ways med school irritates me

Medical schools really want to humanize the patients to their students. One method my school has adopted is including a photo of the patient to go with each case we get in PBL.

(PBL is problem-based learning. Each session we get a new patient case where the information is presented to us as if the patient came to see the doctor. I'm sure I'll rant talk about PBL a lot this year so you should remember this.)

I generally like the photos when they fit the description of the patient because they help me remember the patient's symptoms and their diagnosis. But many photos do not fit the description of the patient. One common problem is that the photo does not fit the description of the patient. For example, the woman in this case is 5'3" and weighs 157 lbs.

This is the photo:

http://www.flickr.com/photos/sharon_love/4154466098/

This woman does not weigh 157 lbs! Even if you're a smartass and tell me that people with large muscle mass weight more, blah blah blah, this woman does not look like a bodybuilder. She probably weighs 110 lbs.

It annoys me so much that this is such a simple thing but the school can't get it right! I'm pretty sure it's not that hard to find on flickr a photo of a woman who is 5'3" weighs closer to 157 lbs. Whoever is finding these photos is doing a terrible job of making these patient cases more realistic. This defeats the purpose of including photos!

8-year-old African American...

IT'S SICKLE CELL!

http://www.flickr.com/photos/snapeverything/4158509106/

A fellow classmate would blurt this out every time an clinical vignette featured an African-American patient. It become a joke that if there was a sick African-American man, woman, or child, that person had sickle cell disease before we even got to his or her symptoms. Every time we learn about diseases with an ethnic predisposition, sickle cell disease is always the prime example. While it is a fact that sickle cell trait and disease is more prevalent in people of African descent, it's troubling that sickle cell disease and thalassemia seem to be the only two diseases that people of African descent according to clinical vignettes we get in medical school. Caucasian patients are the default in most other clinical scenarios.

Oh every Jewish baby has Tay-Sachs.

3/3 of the depressing future: Attendings tell us about their lives

(attending: a physician who has finished all training. So actually a doctor.) 

So we've learned about how terrible Step 1 is, how terrible clerkships are, and how we've learned how terrible it is even after we're actually doctors.*

There was a panel of docs, one of whom was a doctor in his last year of orthopedics residency. They told us the following things:

"If you stand still, you will get passed over." - 5th year orthopedic surgery resident

"When I was a resident (in internal medicine) at one point all the attendings I worked with had been divorced. I'm now divorced." - pulmonologist

"I have four kids and just went through a divorce." - urogynecological surgeon

"I get home around 10pm every day and get up around 5am." - either the urogynecological surgeon or the orthopedic surgery resident, I can't remember which

"I leave work at 5:30 every day." - a radiologist. At this point all the students decided they want to be radiologists.

At the end of the panel, the career services coordinator sensed the mood of the event and had to beg the panel for encouraging closing thoughts.

*unless you're a radiologist and leave work at 5:30pm every day.

Part 2 of 3: Ethical Issues during clerkships

One of our classes this semester is ethics. The first day of ethics class was a panel that all students were required to attend. There were a few third and fourth year students who shared with us some "ethical dilemmas" they faced during their clerkships. (Clerkships are rotations. You follow around a resident (usually), wake up at ridiculous hours, and get asked questions to which you don't know the answer.)

Basically three of the four stories had this moral:
Don't say anything if you think you're resident or attending is wrong or is just acting like a jerk. 

(The last one wasn't about the attending or resident being wrong or a jerk. It was about a teenage patient who feigned pain in order to be admitted and then her boyfriend tried to sneak onto the floor during the night or something. It was weird.)