Death in the Family

While we were going to bed, my husband's phone rang. It was his uncle, calling to let us know that his grandmother had a stroke today and passed away. This news is somewhat shocking and unexpected, as we just saw her a month ago and she was in fairly good health. Also, his grandfather is in very poor health, so this wasn't quite the news we were expecting. If we may find any silver lining here, she passed away quickly and painlessly, after eighty-three years of good life. She had lots of family who loved her and who knew she loved them. MK, we will miss you.

This situation is very like what I faced last year, when my grandfather passed suddenly while my grandmother was battling cancer. Everyone, go hug your grandmother and grandfather. Our time with them is short.

Medical Student Lore

My ICU rotation ended with a bang on Wednesday. Patient rolled in from the floor, respiratory distress, status post intubation for same. She had a history of breast cancer and sigmoid colon cancer, and for months had been complaining of constipation. Now in the ICU on the vent, she still looked pretty ill.

Her chest x-ray was a thing of beauty. This thing will be published somewhere, I can almost guarantee it (in fact, I wish I could write it up). The diaphragms were grossly elevated, probably 4 inches higher than they should be. Below you see tons of air with some haustra. Basically, the diaphragms are elevated because of massive colon gas. On a plain abdominal film, all you see is colon gas and stool, distending the abdomen in every direction. On exam, she looked pregnant, and her abdomen was tense and hard.

Upon viewing her films, my attending turned to our group and said "This looks like a job for a medical student."

Yes, friends, she meant manual disimpaction.

I looked at my two fellow med students, then quickly looked away. I knew if I went in there, I would vomit--I am sensitive to smells like that. There was no way in hell I was volunteering for this job. Finally, the other two students, Derm Guy and Medicine Guy, volunteered to go in. I gave a huge sigh of relief and ran to help grab equipment.

They donned scrub gowns, double gloves, masks with face shields, and scrub hats. They went in, with the attending and the resident, and I sat outside, occasionally giggling and thanking my very lucky stars. Eventually they emerged from the room shaking their heads. Their efforts were only modestly successful, and the patient remained "FOS". Medicine Guy admitted to getting queasy at one point, even though Derm Guy had done the actual deed.

At lunch that day, we presented her chest x-ray to the rest of the teams. One attending joked about the "life-saving procedure" that the medical student had performed--"you saved her by relieving that impaction!"

After lunch, our team was called to the patient's bedside. Crash carts were brought, as her pressures had dropped and they feared a code was near. Another patient came to our team from the OR, so I left the scene to go handle the new patient. I figured there were enough people to handle the code (at least 20 people usually show up), and I wasn't really looking forward to performing chest compressions on my last day.

Half an hour later, I came back to check on the situation. My teammates were standing outside the room, and there didn't seem to be a code running. As I approached and started to ask, "What happened?", I inhaled too deeply and shut up fast. Easily 15 feet from the patient's door, I knew exactly what had happened. My teammate, Medicine Guy, elaborated.

"We were in there, and she was crashing, and the attending looked over and said, 'Guys, you've got to try again.' Her belly was hard as a rock--she said it was like compartment syndrome of the abdomen. So we went and gowned up, and I went a little bit slower, so Derm Guy went in there, and there it was, just hanging out, so he reached in and grabbed this huge thing, and yanked, and all hell broke loose--her belly just deflated with the world's longest fart. I kept thinking she was going to groan and say 'Thank God, that feels so much better.' And yes, I almost vomited AGAIN! It was amazing, though--she didn't code! Her blood pressure came back up and she started breathing better! Derm Guy saved her life with his finger!"

So many people complained about the smell on that unit that the nurses had to order orange oil from central supply and spray down the whole unit. The attending let Derm Guy go home early after his "life-saving procedure", number two. So to speak. For the rest of the day, every time Medicine Guy and I looked at each other we'd burst into giggles.

And thus ends my ICU rotation. On to internal medicine clinic!

Getting Busy

...with my fourth year to-do list. (I know what you were thinking! Naughty!) Here's what I have on my plate thus far:

1. Ambulatory Medicine rotation in November--location TBD
   
2. Step 2 CS on November 5
3. December: Interviews on the 3rd, 4th, 7th, 10th; Step 2 CK the 19th, interview in Colorado on the 21st, so we're spending Christmas up there with various family afterwards
4. Sub-internship in pediatrics in January--location TBD (could be county hospital, which will be asthma, or big hospital, which will be peak-RSV season with no patient caps and HELL)
5. Submitting rank list in January
   
6. Elective in February--currently Infectious Disease, but as my senioritis increases, I will probably switch to something like Diagnostic Radiology, where the hours are more like 9-noon.
   
7. March--Required senior stuff, Jurisprudence exam, MATCH DAY!!!, etc.
8. April--CHINA!
9. May--sitting on a beach drinking. Or possibly moving, if we have a house by then.

I may cancel some of those December interviews, especially if I hear from Top Choice Program. If somehow my letters don't make it in, or I don't get an interview with them anyway, then I'll keep most of those interviews. I had planned on picking from three potential local programs; I may have to choose from the two I've already heard from. This would not be the end of the world, and if I end up in a program where I'm really unhappy I can always try to transfer next year.

My hubby and I had "The Talk" the other day. I laid it out: should I rank programs outside our geographic region, and risk matching elsewhere, which would mean long-distance relationship and hubby finding new job? Or should I only rank programs in the geographic region and risk going unmatched, which means I'd have to scramble for a PGY-1 preliminary Medicine (or Surgery, shudder) year? After some consideration, he decided that it would be difficult for him to find a job elsewhere, and likely it would not be as good a job as he currently has. Neither of us wants to do long-distance again (2.5 years was enough!), so I think the verdict is that I will only rank programs in our region (and possibly Colorado).

When I expressed my slight discomfort at the idea of only ranking 2-4 programs, he laughed at me. What I see as a risk--going unmatched--he doesn't see. It's nice that he has such faith in me, but I can't turn off the anxiety that easily. Nor can I just assume that "well, of course I'll match within those programs! Who wouldn't want me?" Thank goodness psych isn't terribly competitive, so my chances are actually pretty good of matching; faced with the same decision in urology, I was sweating bullets from about January to July. It's not the reason I switched, but it's certainly a bonus.

It is nice to make the decision, and even nicer that we could make the decision together. Look out, world, in only 7 months it'll be TS, MD!

Super-Frustrated

I requested three letters of recommendation back in July and August of this year. One is from a psych attending at my school whom I've worked with twice; one from a psych attending on my away rotation; and one from a pedi attending I worked with last fall. I made sure they all had the ERAS cover letter (where I waive the right to read it, yada yada yada, and the address to my school is on it), my CV, and my personal statement.

By September 1, I still had no letters in ERAS, but I turned it in anyway. Interview offers started almost right away; I've now heard from 9 of the 10 programs I applied at, and all 9 offered me an interview. Several of my offers came in without any letters of recommendation.

By October 1, I started to panic a bit. After all, my first interview was October 19, and generally you are supposed to have all of your letters in before interviewing--I had none. My school sent out an email saying that several letter-writers had called to say that their letters had been returned, so to check with our letter-writers if letters hadn't arrived. I dutifully forwarded that letter to all three attendings.

One attending, the pediatrician, called me that very afternoon, confused. She'd prepared my letter in August, shortly after I asked her, and had confirmed with her secretary that it had been sent. Was I saying it hadn't arrived? Yes!, I said with great relief. I faxed her secretary a new ERAS cover letter, and she had someone walk it to the dean's office the next day. One down! TS 1: letters 0.

Emboldened by my success, I called the away rotation attending. I asked if she had any trouble sending my letter, as another one hadn't arrived properly. She hesitated, then said well, I hadn't gotten around to sending it yet, so sorry. Oh, uh, that's no problem, I stammered, fully feeling like an idiot. She promised to send it soon. TS 1: letters 1.

Two weeks later, still with only one letter in ERAS, I grew desperate and called the third attending; I left a message for her. She emailed me that night--I'm super busy, the letter is done, but I've misplaced the ERAS cover letter. I promptly faxed her another. That was a week ago. TS 1: letters 2.

This week, as I continue to check my email and ERAS obsessively (like, every 10 minutes when I can), I realized that I can't keep that up forever. Therefore, I decided to give them another couple of weeks, and try to contact the attendings mid-November, in order to get things moving before my December interviews.

The last program that I haven't heard from is my top choice program (pre-interview). While perusing their website and FREIDA tonight, I got startling news: their deadline for completed applications is November 1, 2007 (the date the dean's letter is released). Now, I'm in full-on panic mode, totally freaking out, chewing my fingers, etc. I just emailed the two attendings in question and laid it out for them. Look, I need my letter, do I need to come get it from you in a sealed envelope? Do you need another ERAS cover letter? WHAT IN THE NAME OF GOD DO YOU NEED I WILL DO ANYTHING BUT YOU ARE COSTING ME MY TOP CHOICE PROGRAM!!!!!!!!!!!!!!!

*is trying not to hyperventilate and seriously considering drinking wine tonight to calm down*

So, I have 6 days to get 2 letters scanned into ERAS or I'll never get an interview at this place. This effing sucks, people. For pete's sake, if someone asks you for a letter of recommendation, please do not take 3 months to get it turned in! If you can't do it, just say no!

*Author's Note: Please see the follow-up post here, where I apologize for being so whiny and continue to thank my letter writers for helping me out, despite my being a whiny, anxious little whiner.

The Mating Ritual

I sat there nervously, twirling my hair on my fingers surreptitiously. I was nervous, meeting someone new. I just knew he was going to ask me tough questions. How should I respond?

I'd dressed carefully, styling my hair, applying makeup, pulling on pantyhose and heels. Naturally, though, my hair had frizzed out, and I felt sweaty after walking in from my car. Our meal had been delicious Tex-Mex, but I could feel the beginnings of heartburn above my tight-waisted skirt. Was I shaking? Did I have a run in my hose? Were there any stray pet hairs on my outfit? Any lip gloss on my teeth?

He didn't really look nervous. He'd dressed up, too, but somehow it felt as though I were the one on the spot here, not him, even though I was here to interview him as much as he was me. I could see my photo on the table--ugh, what a terrible picture, why didn't I submit a better one? I wished he'd put it away.

We talked, asking each other careful questions, eyeing each other closely. What was he thinking? Could he tell I was so nervous? Was that the answer he was looking for? Am I asking intelligent questions?

Finally, it ended--only I knew I had 5 more people to see before I could leave. It was rather like speed-dating, residency interview style. Somehow I made it through all 6 interviews yesterday. Over all, the day went well. I believe I was able to convince all of them that I belong in psychiatry, even after we discussed the whole crazy "urology" thing. By the final interview, I felt like my brain had melted and run out my ears. Had I answered that question? What did she ask me? Could I possibly think of one more question to ask when pressed to do so? After the ending tour, I staggered to my car, found a fast food restaurant, changed clothes, ate dinner, and began the 5 hour drive home.

As of now, I have 5 interviews scheduled, one more to schedule and one I turned down. I have two programs yet to respond with an interview offer (or rejection); unfortunately, one of them is my top choice program. I still only have one letter in ERAS. I've mailed Thank You's, emailed, and called the two letter writers who are procrastinating, and I don't really know what else to do on that end. Pray, I guess.

Breaking News!

Dumbledore was gay.

Shout Out to All the First Year Med Students

Inspired by comments to this post at TruMed, I felt the need to drag out some advice to any first year med students who might need a little reassurance right about now:

Take some time out and BREATHE, now. Stat.

Hear me out: What you do in your first two years of medical school will not necessarily determine the rest of your life. Your job is to survive, and pass your exams. That's it.

But, TS, the speaker at the surgery interest group said I should make the best grades possible in order to be a surgeon! And my buddy is a super ultra gunner who told me that we'll never get into residency with any high pass grades! Help!

Seriously, breathe, and think logically.

1) If you are a med student in the US who plans to practice in the US, you are automatically ahead of the thousands of people who graduated from programs outside the US who are applying here. I'm not saying FMG's are stupid, or poorly educated, but the reality is that most US programs will accept a US grad over an FMG who is similarly qualified. Therefore, you already have an advantage.

2) If you are able to achieve passing grades in your classes, you are ahead of those people who don't. This sounds lame, but there are always people who fail classes for various reasons. Guess what? There are residency spots available for people who failed first year biochemistry, or for people who needed extra time for basic sciences.

3) The majority of med students have "average" grades. It's a simple bell curve, right? So the majority of the class falls somewhere in the middle. If there were no residency spots for people with average grades, then med school classes would be a hell of a lot smaller. In other words, most of your attendings made "average" grades, and now they're attendings. Conversely, the majority of your attendings did not make AOA, and they're still attendings.

4) Check out this article at Student Doctor Network. Residency directors care FAR more about your clinical rotation grades than about basic science grades (or USMLE scores). It's more important to show them you can think and act like a doctor than like a college student. This even applied to residency directors in ophthalmology, a highly competitive specialty.

5) Whether you know exactly what specialty you'd like to pursue, or have no idea, don't worry about it. Many people change their minds, even if they were sure at the beginning. So long as you are passing your basic science courses, you have a shot at most specialties.

6) There are ways to bolster a CV, even if your grades aren't as high as you'd like them. Want to do dermatology, but can't quite honor gross anatomy? Think about doing some research in the department. Kick ass on the Step 1. Can't handle standardized tests? Rock your clinical rotations. Do some volunteer work. It's not all about the grades, after all.

7) Lastly, whether you are a super ultra gunner type, and insist on making honors in everything, or a "P=MD" type, you should also insist on having a life. Sure, you're studying a LOT, and your apartment is filthy for a month before exams, but that doesn't mean you shouldn't take some time for yourself somewhere. Work out, or go out with your friends, or spend time with your significant other--whatever it is, take some time for yourself outside of medical school.

Remember, those two years will eventually be over, just like mine were (and I really didn't think they'd ever end), and you can get on with the rest of your life.

Thank goodness I'm not a first year anymore!