Mar 31, 2011

Capitalism marches on...

After some end of school celebration (and what may be a case of pink eye), I decided one of my first acts as a doctor should be to attach something mercenary to my blog with the sole interest of getting money in the bank. If anyone wants me after this, I'll be overcharging Medicaid for unnecessary tests and double billing the whole thing. Bwa ha ha ha!!!!!

But for now, I'm keeping it to the google ads, which incidentally, if you click on them, I get money. If you do not click on them, the money is given to a fund dedicated to sucker-punching blinded war orphans. I know, I thought it was extreme too.

So that's my little plea to you fine people. Feel free to ignore it as readily as I ignore the little punks at Atlantic terminal that want 20 bucks from me for their "team uniforms".

In other news, I'm... working, speaking of capitalism. Friday, I'll be hanging, and Saturday, I'll be helping with and attending my very first baby shower. And no, it isn't for me. Any suggestions from you seasoned partyplanners? I'm told these things don't usually involve three crates of homebrewed beer and male strippers, so my hands are just completely tied here.

Mar 29, 2011

Shouldn't I be done with rejection?

Back when I was unsuccessfully applying to American medical schools, paper still ruled and the fact that I got an email from my home program rejecting me 6 months after I sent them my application (from the same city) was a source of puffed up ire for me.

Now, the fact that ERAS (and I imagine, AMCAS) has gotten everything into a neat package to be emailed around at whim is extremely convenient, and I do not miss paper in the slightest. That being said, the ease with which emails are sent leads to things like the the following:

-Rejection a week before the rank list was due.
-Predated invitation to a highly desirable and unlikely to interview me program sent the day after the rank list was due.
-Apology for fake emailed predated invitation.

Now...
-Interview rejection more than a week after Match Day! Slow clap, Colorado. Stay classy.

Mar 25, 2011

Tomorrow!

Last day of school EVER.

I mean, all right, residency is an endless learning process and there's still tests and such, but this is the last time, unless I invest in some adult education classes down the road, that I have to pay for work. With the exception of a few lulls, I've been in school since preschool. And since I was about 13, I've wanted to end up, well... here.

If all the paperwork goes through on time, I should be a doctor-fo-life as of April 8th.

I keep thinking a truck's going to hit me or something. It can't all be over with so little... whatever after literally decades of going at it. I mean, tomorrow, I'm probably going to go in, watch my attending round, have her forget about me for an hour, so I'll watch the rest of Wall-E on my iPhone, and then I'll follow her around a bit more, ask her to fill out my form, run the last paperwork up to my clinical coordinator, take my short white coat off, stuff it back into my Urban Outfitters bag (I threw up in my Trader Joe's bag; more on that in a second) stick my headphones in my ears, and take the train home. Same as any other day. Except I never have to do it again, and then I'll move to South Carolina where the weather is warm, the rents are cheap, and the palmetto bugs are terrifying.

To hinder my celebratory airs a bit, I got quite suddenly attacked by what seems to be a rollicking case of either norovirus or adenovirus. I was out at Other-Job, which is WAY the heck down on Long Island. Great job; long commute.

Suddenly, intense nausea, like run for it nausea, and I end up the one with my face against the tiles in the bathroom, because that seems to be the best medical treatment for vomiting - bathroom tiles to the face and a friend outside the door going "you okay?".

The problem? I'm an hour an half from home. There is NO easy way to get there. It takes over an hour by car when the weather has not been yet again set to "Apocalypse", so I'm forced to make a last minute run for the only train for the next hour.

It required four years of college and four years of medical school to bring me to this conclusion but:

Running + Extreme nausea = Bad

The doors close on the train with the characteristic Boooomp Boomp! Which is precisely how much time I have before freeing the beast into my grocery bag onto my white coat.

Sigh.

I had just been planning on burning the thing, but I suppose covering it in bile and partially digested peanut butter crackers works toward the same goal.

I collapse into the big bench seats with my feet up (not allowed) and I'm starting to get a good fever on by this point, so I'm lying there shaking and periodically vomiting and just REALLY hoping that the conductor will just take my ticket and not kick me off the train into the thunder-snow-hail because he thinks I'm drunk.

The train wasn't that crowded (thank goodness) but I became truly appreciative of the polite indifference of everyone in this city... The conductor took my ticket like normal, without comment, but didn't make me sit up, pull my feet off the seat, or... stop throwing up on his train. Other passengers left me alone pretty much entirely. Benevolence by indifference. I'm for it.

It still may have been about the worst 90 minutes of my life though. I've seen commercials for reality shows that seem designed to embarrass fat people into not being fat, and there's always a clip of a 300 pounder collapsing after her 10th sit up, and a personal trainer is yelling at her, and she's just going "I can't.... I can't" and crying?

I now have more sympathy for those people because when you're still retching uncontrollably LONG after all fluids have left your body, that's how it feels. Your abs are contracting against your will and you're weeping and going "I can't!!! I can't!!! No more involuntary sit-ups!"

So that was fun. But I did manage to get home and now I'm trying to brush it off in time for my partying to begin tomorrow night. Let's see how it goes.

One more day!

Mar 17, 2011

First choice!!!!!!!!

Pathology in Charleston, SC. Mega ecstasy bliss!!!!!!!

Partying now!!!!!

Brief synopsis...

The timeline of all this stuff comes out through this blog if you read from the beginning, of course, but who on earth wants to do that? Thinking back on everything, and with prospective students I talk to, the entire process of becoming a doctor is frigging confusing.

In other news, after over a year of my mother's pleading, I have a new profile picture. Kagome is dead. I'm probably going to give her about a month of peace before I switch to Ed from Cowboy Bebop, because that's how I roll.

The cliff notes of what I've been doing:
-finish bachelor's of sciences in US while taking MCAT (difficult but moderately priced test)
-2 years of basic sciences in the Caribbean. A more clever blogger than I referred to this as the Bob Marley School of Medicine.
-USMLE Step 1 (giant expensive test)
-1 year of core rotations (internal medicine, pediatrics, surgery, psych, OB/Gyn, etc) at a hospital in Brooklyn;
-USMLE Step 2 CS/Step 2 CK (two giant expensive tests)
-1 year of elective rotations at varying hospitals (okay, still in BK; I'm lazy)
-Graduate with Medical Degree
-Obtain ECFMG certificate (that's a bonus for us foreign kids)

FWI, you're still paying for all of this at this stage. For the last two years, you work in a hospital, but you are a paying student.

During this time, you must secure a residency for when you are out of medical school or you can be a doctor all you want, but you can't practice. A residency is additional training, for which you are paid, and this is what trains you to your specialty. Anyone graduating medical school is a doctor, but only people completing a pediatric residency are pediatricians. The process of securing a residency (since everyone's applying for them at the same time) is called the Match.

The Match:
-September through February of last academic year, choose a medicine specialty you want to practice and apply through a paid central database to programs you select.
-During this time, those programs that want to interview you grant you dates for them. You attend as many as you are able
-Mid February: submit a rank list. This is your favorite programs in order from top to bottom of your preference. How you rank stuff is up to you... location, training, prestige, hotness of fellow residents, etc. The programs are simultaneously ranking you.
-February to March: The central computers match up (get it?) applicants to programs. Programs with unfilled residency spots lose thousands of dollars for having those spots vacant. Applicants with no programs are jobless for a year while their loans go into repayment. Stakes are high. The computer uses an algorithm that tries to match the highest ranking applicant to the highest ranking program. If Pediatrics at Tulane loves Lucy and Lucy loves Tulane, and neither Tulane nor Lucy love anyone more. Match. This takes a while.
-Third Monday in March: Black Monday. The computers release whether students have successfully matched. Location is not disclosed.
-Tuesday-Thursday: Scramble: A list of the programs with unfilled positions is released to the unmatched applicants and a predictable clusterf-- of frantic emailing, faxing, and calling ensues. Applicants may have to switch specialties and explore other geographic regions to ensure a job.
-Thursday: Match Day. At noon EDT, the names of the programs are released to the people that matched there. Most American medical schools have a large ceremony to commemorate this. Some friends and I are making our own.

The name and specialty that is released on Thursday is where you are contractually obligated to go on July 1st of that year to begin residency training. The first year of residency (which used to be more of a transitional year, though now there are still transitional years and preliminary years) is what most people think of when they refer to "interns".

Usually, after your first year of residency, you take USMLE Step 3 (giant expensive test).
Near the end of your residency, you take the board exams (massive excruciatingly expensive tests) for that specialty. You also start a version of the Match all over again around then if you're applying for a fellowship, which is yet another 1-2 years of training for subspecialty fields (like pediatric cardiology).

So there we go... a probably largely unnecessary "Becoming a Doctor for Dummies" guide. Now back to being excited for the big reveal in ten hours.

Mar 16, 2011

Much love

to you guys in the trenches that are having to deal with this scramble nonsense this year with the server crashes. I can't even imagine what that must feel like, but my thoughts and hopes are with you. Good luck!!!!!!!!!

Mar 14, 2011

America! F- yeah!!

I MATCHED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

WOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOT

After March 25th, I am done with school forever, and I have a big-girl doctor job waiting for me in July. On Thursday, I find out where I'm going, but I did it!!!!!!

Mar 6, 2011

Everyone's leaving :(

Since I'm January class, people are finishing their clinicals at vastly different times since you can do anything from back to back everything and finish by December 31st or stretch the pain out until the beginning of June if you want scads of time off.

Everyone's also running really low on cash since all that extra time gives us loan check-less windows, so people are gradually dispersing back to their respective homes, which is sad. I know I'll see them again at graduation, but still. It's Grenada all over again; I get busy for a few days and then three people have left and I'm like "Wait... you're... gone? For reals? Oh..."

As of March 25th, I'm done with school. Forever. That is extremely frigging weird.

Less than two weeks until Match Day now. There's just really not much to say.

So what have I been up to then... I got to make and bottle my own beer for the first time, so now I'm the proud owner of 20 22oz bottles of dark beer, an amsterdam style and a wheat beer. I was part-creator of the wheat beer.

I'm doing radiation oncology, which is hitting me in the face with a whole new realm of medicine I knew absolutely nothing about, barring the words "prostate cancer". Usually I can BS along when being pimped, but this week's question was "Do you know what a linear accelerator is?" In what was probably the most intelligent answer, I've *ever* given, I cleanly stated "No." Not even going to try, homeboy.

I've gotten to be in the room where they actually give the radiation (not *while* they give it. In contrast to most of the giant intimidating machines in radiology, this one not only says "Danger" on the door, but "GRAVE Danger". Yikes). In fairness, the patients come out of it with little to few symptoms. In set up, it looks like a room where someone would try to kill James Bond.

This rotation has its own physicist... like PhD only, locked in a dark room surrounded by books with more diagrams than words and computers physicist.

I think this also may be the one field of medicine I genuinely couldn't do. While pathology is my life's love, I feel like with appropriate training, I *could* be a proficient surgeon, internist, dermatologist, hell, even pediatrician, but if you stick me in a room with the hard sciences and ask me to run quality control on a computer that is calculating frequencies and wavelengths on gamma rays that are being aimed at genitals, I am absolutely one hundred percent going to kill someone. I can't even divide a bar tab.

On a related note, anyone know anything awesome going on in NYC for Mardi Gras that's cheap? And no, $40 isn't cheap.

Feb 24, 2011

Official ROL Due Date

Medical school is full of all sorts of little pseudo holidays, particularly at this time of year, since short of Valentine's Day and Presidents Day (ew and snore, respectively) we're lacking on real holidays.

As of February 23rd, at 9 PM EST, our rank order lists were due, as are the rank lists of the programs. This means that everything is now in the hands of a computer algorithm and there's nothing anyone can do about it.

Spooky, but also removes the stress of reordering your list every ten minutes because you had a beignet craving at 11 PM and thought "Maybe that New Orleans program wasn't so bad", and then you panicked and changed it back.

March 14: find out if you have a job day
March 15 and 16th: Scramble days. This is a holiday the way a Christmas Eve where your wife leaves with your best friend, taking the kids and the dog with her is a holiday.
March 17: Match Day. Find out WHERE you have a job day. Incidentally, St. Patrick's Day. Incidentally, probably going to be "Stomach pumped" day.

Good luck everyone!!!!

Feb 16, 2011

Rejections...

Dear Program Directors,

While it's always good to send out your rejections early, as well as keeping some 'rejections on hold' because you never know when someone's going to cancel an interview and you're forced to send out an invite to your back up island-students, sending out rejection letters mid February is something of a... well, let me put this professionally, a "dick move", if you will.

If you haven't contacted me by January 31st, way before that actually, even if you have not *formally* rejected me, I have long since accepted that you're probably not going to interview me past the date that some programs are sending in their rank lists. I'm cool with that. While having a formal "hell no" email, or in UCSF's case a written "OH hell no" letter is always nice, a void on the other end of my computer is already a good indication that you do not wish to be graced with my dengue-soaked presence. Noooo problemo.

But why send out the noreply email via ERAS? They don't even have a subject line at this point.

Let me point out the converse side... there are some interviews I didn't take because I got a good initial response and the programs were too far away.

Now these guys may have sent an invite back in early December... now picture a student NOW emailing them going "Dear ________, gee whiz, I got so many interviews that I can't interview with your program, but I wish you the best of luck finding good students on Match Day."

Douchey, right?

Feb 13, 2011

Apologies to the MTA

Only for the stuff I was saying about them today. That whole part where they jacked up the unlimited pass price by twenty dollars while continuing to cut service? Drastically uncool.

So here's a thing... I was going out to Jersey today to meet some friends to brew beer, because the interview season was so frigging exhausting that I have to start making my own hooch (I'm not adding centipedes to it like the moonshine in Grenada)... We're supposed to catch a train out of Penn Station at 10:11.

900: Home station closed because f- you, that's why.
900 - 915: Walk to next station
920: Board 2 train.
930: Why aren't we moving?
935: No seriously, why the f- aren't we moving?
936: Attention passengers. This train is being held due to a police investigation at Times Square. Atlantic Avenue is the last stop on this train. All passengers leave the train.
936-937: WTF? What police investigation? If this is someone leaving a GD Macy's bag under a GD bench and that sets off a GD bomb scare, I'm ballisticizing on someone. Why is stuff at Times Square sufficient to shut down service in Brooklyn?
938: Let's take the Q train!
939: Q train closes door in face; takes off.
939: *&(*&(*&#)&(*&!!!!!!!!!!!!!!!!!!!!!
950: Q train arrives. Maybe we can still make it.
952: Q train running local. Profanity ensues.
1010: Let's get off at WTC and take the PATH train.
1015: Due to track work, the PATH train is running on a 20 minute schedule. Please plan extra travel time.

We made it, thanks to the willingness of one of our benevolent Jersey-side drivers to be willing to book it to Newark to pick us up, but naturally the 2 hours it took to make what would have normally been a 45 minute trip led to my attempting to think of any service that regularly ticked me off more than the public transit. Possibly whoever was responsible for clearing the roads after the Boxing Day blizzard.

While we were on the way out to the brewery, we were googling any possible justification for shutting off access to some of the busiest train stations in the world, and came across the early breaking version of this:


Suspect in Brooklyn Stabbing Spree Is Captured


So apparently, we couldn't take the train going uptown because while we were sitting on our train, they were taking down a guy that was, among many many many *many* other things, stabbing train patrons.

Okay, MTA. Good call.

Feb 1, 2011

No more interviews for me!!!

As of setting foot off the R from the N from the M60 from Laguardia, I am officially DONEZO with interviews. I can actually unpack the carry on bag (f- you, airlines, and your 25 dollar check bag fees for something you're gonna lose anyway) that's been always at a state of ready in the center of my room. I've made it through countless hotels still bedbug free. I have told literally dozens of people what I want to be when I grow up, why I want their specific programs, whether I'm an only child (???), and what my five year plan is.

Weirdly, I've seen more dead bodies than I have in years. What do you do on your job interviews?

I have bounced enough climates to be perpetually congested. I've given the Alamo in Union Square more money than an actual car payment would have cost. I have walked through more hospitals than the casts of ER, House, Grey's Anatomy, and Scrubs combined. I have consumed 50 thousand calories worth of free lunches. I've shaken more hands than a politician. I have rocked my black suit and used it to get my way at cheap hotels because it gives me a fake businesswoman street-cred. I have changed in the public restrooms of said hotels into beaten up jeans and strutted on the way out.

Since I'm a procrastinatey McProcrasterton, I finally submitted my final four week schedule, which will complete my 80 weeks of rotations, which finalizes my schedule and means that so long as I don't kill anyone in the next eight weeks, I'm solid gold.

Hell yeah.

Jan 21, 2011

Unusual plug

Okay, I don't usually just flat out post links, but all the subways are wonky in my neck of the woods (including a shutdown of one station which fortunately isn't mine), and this post was too funny for me to pass up. I wish I'd written it:

FIPS dislikes the new standard

Yes, that's the name of the actual blog. Know it, love it.

Jan 19, 2011

Ow ow ow ow...

So I just did my first time ever ten mile run in a triple loop around Prospect Park, an adventure that seemed like a grand idea until the moment I stopped and went "Wow! That was great; I don't even feel particularly OH MY GOD AAAAHHHHHHHHH", as every muscle in my body took that moment to celebrate the lactic acid build up they'd been accruing for the better part of two hours.

In other news, my attending seems peculiarly proud of me for going into my chosen field, which is a warm breath of fresh air. "You have no interest in my profession? Good for you!!!" He's also a Radiohead devotee, which makes surgery *so* much nicer. And everyone he's done brain/neck/back surgery on so far has been able to move all appendages halfway through anesthesia wake-up and no one's died, so I'm thinking that's a plus. It's less messy than all the abdominal stuff, but gets that bone/bovie/dentist office smell pretty far back in my sinuses, which kind of makes me nostalgic for my bone assembling days.

I also managed to at last secure a thyroid shield during surgery today. This is something that's irked me for a while. There are several types of surgery that require repeated x-rays during the procedure to make sure you don't wedge a tube through someone's kidney or stick a screw into their spinal cord. It also means you can see what you're doing in such spaces without needing to create a huge, infection prone, aesthetically unpleasant hole to do so.

Despite shooting anywhere from two to three dozen images, for the patient, this still doesn't amount to a huge dose of radiation. When you're scrubbed in and are leaning into thirty x-rays day after day, this starts to become a little much. As such, everyone in the room wears heavy-ass lead aprons. And they're good about enforcing that. I actually had to de-scrub and re-scrub one time because I forgot to put mine on after I'd gowned up. The circulating nurse was friendlier than most and made do with only one exclamation about where my brain was.

Problem being, at every hospital, there seems to be a dearth of thyroid shields for the med students, and when I went into urology to try to find one (because I knew they were there because I've seen their stash), was actively told they didn't have *any* back there while the nurse locked the door where four were visible (so I couldn't jack one, which honestly, I would have, though I would have put it back). The I one I found elsewhere, apparently *also* belonged to urology, but I was scrubbed in with it on by the the time someone told me, so ha ha, finders keepers.

The idea of aprons is great, but I have no plan to use my ovaries in the near future. Know what I am using? My thyroid!

This is also contributing to my continued blackheartedness against urology. When I did my mandatory rotation in it during surgery, I got assigned to a complete bastard of an attending that not only went to the Dr. Cox school of teaching but compounded it with sexist crap "Oh, going into pediatrics? Ob Gyn? You want to do Pathology? Oh, so you have time to have a family?" Seriously, guy? Just because you're around dicks all day doesn't mean you have to be one. It's not like being a werewolf.

Annnnnyway, my current attending is a lot nicer. Only two interviews left to go, weather permitting, and I'm officially registered for the 2011 match. Gotta start arranging my match list, which is kind of a tall order. Almost all the places where I've interviewed have had really great people there and they pull in different things. One place will have a ton of compensated offsite electives so you can audition for fellowships; one place has computer software that allows you to view some of your cases from home; one place sends home microscopes with residents; one place has ins with the coroner's so they're never wanting for autopsy numbers; one place has a tight association with a major cancer center, so you get crazy cases, etc etc. Most have warm fuzzy program directors and a pleasant group of residents.

Decisions decisions... a lot of it may just come down to where I want to live, which is also something I'm not sure about since I'm really evenly ripped between wanting to be in a lot of nature and being so spoiled by living in NYC that I wonder if I can get by anywhere smaller than... I dunno, Boston.

And a lot of it will be determined by the way the match operates. Path is a fairly small field, so instead of having 15-20 openings in a moderate sized program, like you'd see with IM or peds, you may have 2-4. Even if they like you, that doesn't leave a lot of room.

Jan 14, 2011

Drinking and brain surgery...

It has been recently brought to my attention that I have increasing time between blog posts, to which I responded something like "I'm not doing anything interesting right now... just drinking and brain surgery... er, not in that order". I'm also losing sight of what constitutes interesting. When I was on the island, at least if people reading this are anything like I was reading other people's blog, I was hanging on every word of people's daily activities because you're in another country. Where I ate, where I shopped, where I did laundry, that is all relevant information.

Now, I live in Brooklyn. Finding awesome things is as easy as throwing a rock in any direction, having the person you hit with the rock flip you off and scream stuff before rooster tailing you with snow, and then look at the business their car was in front of, and boom. Awesomeness.

I'm also not sure how relevant my interview shennanigans are. I ate oysters in New Hampshire, walked around in the Chicago blizzard, walked around in the NYC blizzard, and took a vacation from all this blizzard nonsense to interview a couple of times in New Orleans. The first time, I slept at a hostel in the Garden District, opened my toe in the shower and tracked blood all over the place. The second time, I went with two of my closest friends and stayed at an extremely opulent hotel while drinking hurricanes in a rooftop hot tub, because damn, medical school can be awesome sometimes.

But is that like medical schoolish? Is it Caribbean MDish? Is it travel blogish? I've always kind of wanted Samantha Brown's job.

My father had the whole heart attack thing, and that sucked, to put it in medical terms. I added a trip out to North Carolina for that in the middle of the Snowmagedopocalype of the Century and holy crap why did no one plow? It's frigging LaGuardia for chrissake. And there's the news worthyness of simply being in yet another Brooklyn insane weather moment. There was over a foot of snow on top of my *air conditioner*. There were taxi cabs stranded everywhere and it looked like the Day After Tomorrow. I tried to take a stroll through Rockefeller Plaza to see the tree and possibly take a skate because when the weather alerts on my phone say things like "GET OUT!!! SAVE YOURSELVES!! LEAVE THE CHILDREN!!" I think "Nah... they don't mean me."

Now I'm back in rotations and the interview trail is stammering to a close with a couple more out of state trips and then the blissful rest until March. I think it's going well. I'm doing neurosurgery so I got to touch someone's brain, so that's pretty awesome. No one in NS seems to begrudge my chosen field, which is particularly awesome, since I had one guy in family actually say the phrase "What can I do to keep you from going into pathology?" "Uhhh.... Give me Samantha Brown's job?" I'm also not cut out to wear lead vests. That crap is heavy. For the next surgery, I may just let the x-rays fry my eggs. I don't know how cops and rads techs do it. And lead vests while scrubbed? Good god, they should do that to prisoners. No wonder neurosurgeons and urologists make so much frigging money.

In other news, my doctor is more concerned with my thyroid than I am because apparently it was throwing off some abnormal levels in July, and being a responsible medical student, I ignored it until I needed a prescription renewed. Then my doctor was like "Oh, you need to come see me" which meant "I'm going to recheck your thyroid levels if I have to drag you into this office myself and no more baby-ex for you until you do.". I'm not sure why it's important because so long as it's not flashing in the danger zone, it's not like I'm going to do anything about it. He also seemed really surprised by my reaction to having my blood drawn because first he said "Don't look", and I'm like "Uhhh... no?" And then he said "You weren't scared at all!" "I'm 30. And a medical student. Now give me my Dora the Explorer sticker."

Next month I'm doing anesthesiology because... uh... yeah. Then a couple two week electives, some paperwork, and wow. Lincoln Center. My mom's already planning to cry at the ceremony. I'm just hoping they have a steel drum band. Grenada repreSENT!