So it's official. I matched. Despite all signs to the contrary (the lack of communication by program directors, the very few interviews), I got an Emergency Medicine Residency. Half of me wonders if that's because of how I ranked my list.
When the program director called me, he spent time phrasing things like "We hope its a happy day" and "we know we're not everyone's first choice" which made me scared more than anything. I had second thoughts like, wow, was this really a not-so-good program afterall?
Being that I want to continue this blog as residency begins, I will not be revealing where I matched to. To keep HIPPA rules private and all of that.
____THE UNMATCHED____
I was also really shocked, because I had prepared to not match, had even written a second personal statement, had done everything I needed to scramble (or participate in SOAP they call it). I had friends who scrambled and it was kinda a shit-show. I had no idea it was that unorganized. Plenty of good candidates didn't get spots, got phone calls from directors in the scramble promising spots or saying things like "we really like you" and then no offers during the first rounds of SOAP. It was very disheartening. Only half of my friends who did not match, got a scramble spot. And those transitional years that were everyone's backup--- filled up fast. And family wasn't as easy to get as everyone said it was.
6 of the 13 friends I know who didn't match were Peds!! This baffles my mind. Peds is supposed to be easy to get into. I guess in the end it made more sense tho because those specialties who were likely to not match: surgery, ortho, etc -- had anticipated that and actually interviewed for transitional years. The rest of the friends who didn't match were things like: OB/GYN, EM, gen surg, and even one family.
That said, I was still really gung-ho family because I spent the last two months convincing myself that family was what I really wanted. Especially after that Rural Family Med/Free Clinic rotation. I was really all ready. So now I'm faced with some disappointment.
Despite the fact that I spoke to several family docs, who despite liking their jobs also hate them-- every piece of paperwork, every argument with insurance, and every patient who does nothing to help themselves with health.
In the end, I dunno if my planning mattered or not because the Almighty Match has spoken. And i am legally bound to go to my residency spot for one year even if I didn't want to. Which means for you med students out there.... rank only the programs you actually COULD go to. And during the whole process you keep say "i just want to go anywhere as long as they take me" and that is a big fat lie. There are obviously places you dont want to go. So be real and honest with yourself.
_____AN ASIDE FOR THE MATCHED____
Getting yoru temporary medical license is something you have to apply for almost immediately after you get matched because it takes so dang long (12 weeks or more). Every state is different and requires different paperwork. Its a crazy pain in the butt and everything has to be notarized including your copies of birth certificates and whatnot. So make sure you get that paperwork in on time, because you can't start your new job without it!
On top of all that stuff, you also have to get your 98th TB test (Come on people!! Why are you torturing me?) and another health check, another drug test, a really intense FBI background check where they take your mom into a dark room (not really) but it seems like that. They call everyone you've ever known or passed on the street.
____BEYOND THAT____
In the meantime, I have soooo much to do. Getting things ready for graduation has completely trumped the celebration I might have held for the fact that my last med school rotation is April 12th!?!?! WOOOO!! I had no idea graudating was this much paperwork, invites, and preparation.
A word of advice for all med students who are in the process of graduating. It is very exciting and it seems like all you want to do is go find a new place to live (which you should do). But also, do 1 thing that has absolutely nothing to do with school. Take a VACATION. Because from what i hear you don't get any vacations in residency. And it is harder than med school ever was because you're actually responsible for your patients.
Frankly, I'm secretly terrified I'm going to be a horrible resident and an even worse doctor because i don't really know anything...... I think my board scores prove that. ((Does that mean I can get off the hook?)) But I am taking a big vacation ( a whole week and a half) and I'm also gunna get a puppy. I'm pretty sure.
Wednesday, March 20, 2013
Friday, February 22, 2013
Guatemala: summary stuffs!
So this is the honest truth. Preparing for this trip was a nightmare. It is supposed to be a rotation. But the faculty sit back and want the students to lead, which is fine and good, but they gave the student leaders no guidance or instruction as to what needs to be done until its already due. And a peer leader, especially of some 30 odd 4th year medical students who are burnt out and just want to chat to their friends, is not going to make them do their work. Those peer leaders have no authority because there are no consequences for not listening. So it was frustrating just sitting around for hours trying to figure out what drug assortment needed to be in what trunk with what supplies in what order. Not to mention figuring out how each drug needed to be sorted and counted. It was kinda a nightmare of communication. And the faculty sorta treated it like a vacation. And who could blame them.
Guatemala was GORGEOUS! Its just like the pictures. Warm, but not tropical and unusual plants, flower, weather, animals, and culture everywhere. There is a difference between the Mayans and Guatemalans, not just in language but also in stature. Our schedule was pretty decent. We were gone 2.5 weeks and had 8 days of clinic. Each day of clinic was at a different village and usually lasted from 9am until dusk. We traveled on colorfully painted school buses (called chicken buses) for several hours to get to the villages on unpaved roads in moderately poor condition. Some of the villages are poorer than others, and I couldn't help but notice that we didn't really seem to stop at the poorest or the Mayan villages. I guess its a political thing being the Guatemalan govt decides where we go. But we did have very LONG lines of people waiting when we got there and always had to turn more away when we left. I do have to say that I thought 12 hour clinic days were exhausting but add to that treating people in families as fast (and as efficiently) as possible and speaking only in broken Spanish with very limited resources often in school kid chairs or church pews and exhausted doesn't even cover it. I spent most of the rides home feeling like a puddle. I was so glad we got a 3 days weekend between the clinic days or I might have forgotten my own name. 
But our days 'off' weren't really off. We spent them doing excursions-- I don't regret them, but I sure didn't get much sleep. So we hiked the Volcano Pacaya which is an active volcano pictured above. Although it looks like clouds are always perfectly positioned above that mountain it was legit steam. The freakin thing erupted while we were there, which was mostly uneventful but we did get to roast marshmallows over the lava- which was EPIC. Best marshmallow I've ever had. But it was a very strenuous climb. We also spent some time on a black sand beach, boy was that sand hot. The water had the strongest rip tide and under toe that I've ever experienced, but I got to spend a day in a hammock reading a novel.... I have a hard life :)
I also go to zip line over a coffee plantation and then tour the plantation afterward. Did you know coffee comes from a red fruit that resembles a large grape and that 1 lb of beans = 1 plant? And that the lighter the brew of coffee the more caffeine? I guess the brewing process takes out caffeine rather than allowing more through. Oh the things I never knew! I loved the coffee there. Coffee in Guatemala doesn't have a bitter aftertaste. it was awesome. 
We also go to go see Mayan Ruins from the post-classic age, called Mixco Viejo with multiple temples. We had a Mayan Xamen accompany us and participated in a Mayan Ritual that blessed humanity. It was very... informative. I have to say that the Mayan people have earned my respect in many ways. I mean they were doing brain surgery while my people still believed the earth was flat. Granted the Mayans also believed that if a man cut his penis and bled into a fire a substantial amount he could breathe in the smoke and see the future, also maybe would pass out and be sterile for life but hey, why not? They also believed that jade was from heaven and shell was from the underworld and in order to wear jade you had to wear shell somewhere on your body. I never knew that there were different shades of jade and not all were green. I guess there is also black and lilac jade that are exclusive to guatemala. Google it, its really cool.
Other time off or spare moments we spent wandering Antigua, trying to look at the market and buying things. It was fun because their currency is called the Quetzal and you are expected to bargain... in Spanish. It was kinda fun to get good at it. Also to realize that 900 Quetzals in about $100 US Dollars. Everything they sold was very bright colored with pretty cool designs.
Overall, I loved the coffee, patients, and getting SO MUCH BETTER at Spanish the most. I got the most annoyed with being unable to flush toilet paper, the cold showers, and the excessive drinking that most of my fellow med students participated in during the trip. But it was so worth it. And to get a tiny taste of this trip, here are a few pictures...
Wednesday, February 20, 2013
My Rank List
Rank lists were due today! So... about rank lists and matches. As I've already explained, the Match is a computer algorithm that will assign every medical student int he country their residency program based on a list we call the 'rank list' -- a numbered list of the student's preferences for residency in order. You can only list the programs that have interviewed you---- and the 'rank list' submitted by the programs of the students they have interviewed listed in numbered order. The computer uses the lists to 'match' the student to the program.
Since this is 2013, the D.O. match and the M.D. match are seperate still--- this is going to merge into one big match in 2015 (those LUCKY DUCKS!). Since we don't have that we have to chose between the matches because the D.O. match happens in feb and the M.D. match happens in march.
Long complicated story short... after much deliberation I chose to drop out of the D.O. match. Ultimately, I applied to 60 ER programs got a total of 10 interviews. 5 DO and 5 MD. (ironic no?) When I looked at my list, my #1 & #2 are MD and after 4 years of med school i couldn't give up on a chance of getting them. They were just so much more my style than any other programs I saw, I made the decision to ditch the DO. Maybe this was a good decision maybe it wasn't. But I couldn't help but notice that in ER at least, the quality of the programs was just night and day. DO programs were just not as organized or polished and seemed to have less trauma. Obviously there are some exceptions. Anyhow, its what I did. For those wondering how I chose this list, its all about 'fit' and honestly I thought where would i be happiest? Where did the people seem like I would be friends with easiest? And maybe some about location, but mostly just where I fit best. So here is My Rank list....
If i am unmatched, which is unfortuntely likely, since I really needed to rank 10 places to be assured of a match (ER is very competitive this year), I must enter the scramble (also called SOAP). This involves me logging in to access the list of programs with spots after the match. I then re apply using ERAS to 30 programs. These programs I chose from will be in a variety of specialties and most likely will not be ER spots. Usually the unfilled spots is one of four: family med, internal med, psychiatry, and transitional year. I chose not to enter transitional year because of funding cuts to Medicare (they pay residents salaries) they make it less likely for programs to want to pick up residents who already have been paid 1 year -- this will increase the chance that the hospital or program will have to pay the last year of the residents salary. Anyhow, this was a really hard and crappy decision to make. This boils down to meaning I may not end up being an ER doc like I wanted, but I am making this move so I can have some kind of paying job next year without having to go through this HELL another year.
So here's to my uncertain future and to March 11th, when I find out what kind of doctor i will end up being.....
(Edit: Before I forget I know 10 people personally who did not match in the DO match this year who ranked more than 8 places. Not looking good! Their specialities were: ER, Ob/GYN, Surgery. The NRMP reports that 10,000 med students won't match this year in the MD match. I'm getting freakin nervous!)
Since this is 2013, the D.O. match and the M.D. match are seperate still--- this is going to merge into one big match in 2015 (those LUCKY DUCKS!). Since we don't have that we have to chose between the matches because the D.O. match happens in feb and the M.D. match happens in march.
Long complicated story short... after much deliberation I chose to drop out of the D.O. match. Ultimately, I applied to 60 ER programs got a total of 10 interviews. 5 DO and 5 MD. (ironic no?) When I looked at my list, my #1 & #2 are MD and after 4 years of med school i couldn't give up on a chance of getting them. They were just so much more my style than any other programs I saw, I made the decision to ditch the DO. Maybe this was a good decision maybe it wasn't. But I couldn't help but notice that in ER at least, the quality of the programs was just night and day. DO programs were just not as organized or polished and seemed to have less trauma. Obviously there are some exceptions. Anyhow, its what I did. For those wondering how I chose this list, its all about 'fit' and honestly I thought where would i be happiest? Where did the people seem like I would be friends with easiest? And maybe some about location, but mostly just where I fit best. So here is My Rank list....
- University of Mississippi in Jackson, MS
- John Peter Smith in Fort Worth, Tx
- University of Nebraska in Omaha, NE
- St. Francis in Peoria, IL
- St. Vincent in Toledo, OH
- Lehigh Valley in Allentown, PA (this is dual program)
If i am unmatched, which is unfortuntely likely, since I really needed to rank 10 places to be assured of a match (ER is very competitive this year), I must enter the scramble (also called SOAP). This involves me logging in to access the list of programs with spots after the match. I then re apply using ERAS to 30 programs. These programs I chose from will be in a variety of specialties and most likely will not be ER spots. Usually the unfilled spots is one of four: family med, internal med, psychiatry, and transitional year. I chose not to enter transitional year because of funding cuts to Medicare (they pay residents salaries) they make it less likely for programs to want to pick up residents who already have been paid 1 year -- this will increase the chance that the hospital or program will have to pay the last year of the residents salary. Anyhow, this was a really hard and crappy decision to make. This boils down to meaning I may not end up being an ER doc like I wanted, but I am making this move so I can have some kind of paying job next year without having to go through this HELL another year.
So here's to my uncertain future and to March 11th, when I find out what kind of doctor i will end up being.....
(Edit: Before I forget I know 10 people personally who did not match in the DO match this year who ranked more than 8 places. Not looking good! Their specialities were: ER, Ob/GYN, Surgery. The NRMP reports that 10,000 med students won't match this year in the MD match. I'm getting freakin nervous!)
Wednesday, February 6, 2013
Friday, January 25, 2013
Underserved: Free Clinic & Homeless shelter
So this is a required rotation and honestly, I signed up for the site I did was because I wanted to be close to home. I also wanted to blow it off because I was so burnt out of working in places where I have to try to prove to someone every second of every moment that I belong there.... I just wanted to something chill. So I picked somethin close to home. And my school strong armed me into this place 45 minutes away from my parents. Its a free clinic right next to the homeless shelter, where I slept during the week--- partially.
And it was so much better than I ever could have asked! This rotation is stressful because well, any rotation during January is because that is when all medical students have our Rank List is due. (more on that in a different post). Anyway, suffice it to say I have to sum up all the choices I have for residency.
But this place functions only on volunteers. Which means that we only had docs, what 4 days I was there. The rest of the time we had other students and the one nurse practitioner who ran the place and signed our scripts if needed. So it was ALL me. Nobody checked behind me. I was the doctor.
It was intimidating but it also was the single best learning experience I've ever had. It forced me to go remember what I learned and remember mistakes on the job. And the clinic was special. We didn't deal with insurance. So it means that I now know almost every medication on the $4 list by heart and where to get what medication for cheaper. I also now know the dosages for most of the antibiotics as well. For example did you know, Albuterol inhalers without insurance costs $45.
Beyond no insurance, we also don't have nurses. So we did our own procedures. Preg tests, Urine Analysis, Blood Sugar, Vaccinations, and all the paper work that goes with it all. Its actually super helpful to know.
My favorite part was working with so many students. Nurse practitioners and PAs and med students. And we could all sorta be each other's brain trust and bounce ideas off each other and it was the kind of environment I wanted to work in!
This whole thing ended up being pretty cool, because my patients would call in and ask me questions or specially request me. I had refills and it made me feel very official.
So i decided that if i don't get into ER this year.... I will be applying for family med. And maybe I won't be so unhappy with that....
And it was so much better than I ever could have asked! This rotation is stressful because well, any rotation during January is because that is when all medical students have our Rank List is due. (more on that in a different post). Anyway, suffice it to say I have to sum up all the choices I have for residency.
But this place functions only on volunteers. Which means that we only had docs, what 4 days I was there. The rest of the time we had other students and the one nurse practitioner who ran the place and signed our scripts if needed. So it was ALL me. Nobody checked behind me. I was the doctor.
It was intimidating but it also was the single best learning experience I've ever had. It forced me to go remember what I learned and remember mistakes on the job. And the clinic was special. We didn't deal with insurance. So it means that I now know almost every medication on the $4 list by heart and where to get what medication for cheaper. I also now know the dosages for most of the antibiotics as well. For example did you know, Albuterol inhalers without insurance costs $45.
Beyond no insurance, we also don't have nurses. So we did our own procedures. Preg tests, Urine Analysis, Blood Sugar, Vaccinations, and all the paper work that goes with it all. Its actually super helpful to know.
My favorite part was working with so many students. Nurse practitioners and PAs and med students. And we could all sorta be each other's brain trust and bounce ideas off each other and it was the kind of environment I wanted to work in!
This whole thing ended up being pretty cool, because my patients would call in and ask me questions or specially request me. I had refills and it made me feel very official.
So i decided that if i don't get into ER this year.... I will be applying for family med. And maybe I won't be so unhappy with that....
Thursday, December 13, 2012
ER: last stand
Another hospital and my very last ER rotation. This one is a big deal. A much bigger hospital system with many different hospitals. And allegedly my biggest chance to shine since I've had lots of previous experience before, but something was up with this place. The people were fun, other students who were rotating, but the residents and the attending docs I dunno they were just blah. They didn't really want to be there, nobody was super pumped to be there. And the whole time I just couldn't put my finger on it. But I knew I didn't really want to go there, even tho they looked awesome on paper. This hospital system saw crazy amounts of pathology tho.
One of my best cases was 29 year old was dropped off at the ER all burned over his thighs, legs, arms and belly. He stated he "woke up and was on fire." So we are in the ambulance with him in the back. He has already been intubated, as we must do with all burns over 40% of your body to prevent lung collapse (this is a long explaination just trust me on that) so he is unconscious. When we get to the big hospital, they route us to the wash out bay. Apparently, since the fire is of unknown origin and obviously suspicious they are going with meth lab explosion. Since that kind of a burn would involve various caustic chemicals that could burn hospital staff it means we must go through decontamination protocol and wash him off with a certain amount of water before they will bring him in the building. Unfortunately, this guy has been crashing in the ambulance, with irregular heart beats and the heart monitor is not something that works well when sprayed with water.
Despite our attempts to fix it, they took off his monitor for 3 minutes to wash him down. Luckily, nothing unseemly happened and the doc got in to see him right away. It was quickly determined these burns were not from a meth lab explosion but rather from electricity. The muscle in man's leg was rock hard under those horrible burns. It was something I've never seen in real life until today, but something med school always warns us about: Compartment Syndrome. The muscles and skin in his body were so inflamed from having electric bolts running through them, that they were expanding and filling his thighs to the point where they choked off his arteries and nerves. He can lose body parts and eventually have his heart give out because of this. The doctor took out a big knife and cut a long, deep cut down to the muscle from pelvis to knee on both sides, his pink muscles squeezed out of the cuts like toothpaste. Then he did his arms, lucky this guy wasn't awake. Apparently, he had been stealing copper wire from a live set of wires on a power line. And of course got burned. He ended up having several of his fingers amputated because the flesh and muscle were so burned they would never be functional again. This is a picture of his hand. I didn't get the best shot, which was his palm because the docs didn't want me to take pictures because of his critical condition.
Beyond that case, I did get to participate in a Code Grey or a Mass Casualty. We had a huge 10+ car pile up including a bus full of kids. So we called in all our docs and had people being checked over in hallways, closets, and 3 people per room. We had crazy parents running all over the place and causing a rukus, which didn't help anything and in the meantime we had several seriously injured adult patients from the same crash. It was amazingly chaotic, just the way I like it!
We also had a inner hospital tradgedy. A 28yo internal med resident who went down to the ER on her shift and checked in as a patient because she had such a huge headache. And 6 hours later, she was dead. Meningitis. It was intense. Everyone around the hospital that day was crying and calling in to see if they could get antibiotic prophylaxis. Then her parents came and everything in the hospital stopped because everyone wanted to talk to them, docs, nurses, even some patients for whom she had made a difference. It was just so close to home, I think it really made a lot of people think hard about their choices.
The final crazy story I have from this rotation was a 15yo boy who came in after playing paintball. He had taken off his helmet to wipe the fog from the visor, when a paintball nailed him in the eye. When I saw it was swollen to the point where it couldn't open even when i tried to pry it open. THe poor kid was in shock I think, because he didn't really know what was happening. We got a CT scan to see what was going on and we noticed that the normal bulge of the eye wasn't there. And sure enough, the eyeball had ruptured, we call it a globe rupture. There is very little likelihood that he will ever be able to see out if it again. They took him to surgery to see if they could save it. This case was especially memorable for me, because I had to tell the parents what happened and that their son would most likely not have 2 eyes. Last I heard, the surgeons were discussing glass eyes with the parents.
One of my best cases was 29 year old was dropped off at the ER all burned over his thighs, legs, arms and belly. He stated he "woke up and was on fire." So we are in the ambulance with him in the back. He has already been intubated, as we must do with all burns over 40% of your body to prevent lung collapse (this is a long explaination just trust me on that) so he is unconscious. When we get to the big hospital, they route us to the wash out bay. Apparently, since the fire is of unknown origin and obviously suspicious they are going with meth lab explosion. Since that kind of a burn would involve various caustic chemicals that could burn hospital staff it means we must go through decontamination protocol and wash him off with a certain amount of water before they will bring him in the building. Unfortunately, this guy has been crashing in the ambulance, with irregular heart beats and the heart monitor is not something that works well when sprayed with water.
Despite our attempts to fix it, they took off his monitor for 3 minutes to wash him down. Luckily, nothing unseemly happened and the doc got in to see him right away. It was quickly determined these burns were not from a meth lab explosion but rather from electricity. The muscle in man's leg was rock hard under those horrible burns. It was something I've never seen in real life until today, but something med school always warns us about: Compartment Syndrome. The muscles and skin in his body were so inflamed from having electric bolts running through them, that they were expanding and filling his thighs to the point where they choked off his arteries and nerves. He can lose body parts and eventually have his heart give out because of this. The doctor took out a big knife and cut a long, deep cut down to the muscle from pelvis to knee on both sides, his pink muscles squeezed out of the cuts like toothpaste. Then he did his arms, lucky this guy wasn't awake. Apparently, he had been stealing copper wire from a live set of wires on a power line. And of course got burned. He ended up having several of his fingers amputated because the flesh and muscle were so burned they would never be functional again. This is a picture of his hand. I didn't get the best shot, which was his palm because the docs didn't want me to take pictures because of his critical condition.
Beyond that case, I did get to participate in a Code Grey or a Mass Casualty. We had a huge 10+ car pile up including a bus full of kids. So we called in all our docs and had people being checked over in hallways, closets, and 3 people per room. We had crazy parents running all over the place and causing a rukus, which didn't help anything and in the meantime we had several seriously injured adult patients from the same crash. It was amazingly chaotic, just the way I like it!
We also had a inner hospital tradgedy. A 28yo internal med resident who went down to the ER on her shift and checked in as a patient because she had such a huge headache. And 6 hours later, she was dead. Meningitis. It was intense. Everyone around the hospital that day was crying and calling in to see if they could get antibiotic prophylaxis. Then her parents came and everything in the hospital stopped because everyone wanted to talk to them, docs, nurses, even some patients for whom she had made a difference. It was just so close to home, I think it really made a lot of people think hard about their choices.
Monday, November 12, 2012
Allergy: frustrating
So allergy rotation is 2 weeker. And to be honest, its hard to focus on it. The doctor doesn't even see his own patients- he has his nurse practioner do it. Which is totally fine, she is very competant and has been working with him for 15+ years. She knows what to do and what he would do. But it makes it so boring for me. I don't even see patients by myself I just shadow silently. It bores me to tears I actually bring my LAPTOP to work and in between patients have begun reading kindle books. If you are a preceptor who is somehow reading this, let the students at least THINK they are helping or doing something. It is so hard to have gone over a year doing things, at least training to form opinions or learn things, to go back to being silent in the corner. I'm no longer satisfied with just being there, I want to engage.
Anyhow, sorry no pictures unless you want endless rashes.... which i don't care enough to even take pictures. I suppose it also doesn't help that i have serious romantic troubles and also maybe if i learn something rather than staring at walls, i will post more.
Anyhow, sorry no pictures unless you want endless rashes.... which i don't care enough to even take pictures. I suppose it also doesn't help that i have serious romantic troubles and also maybe if i learn something rather than staring at walls, i will post more.
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