Part 5: The Match

     Welcome back!  Thanks for reading.  I'm going to finish up this series of "educational" posts about medical school....
     At this point I've covered pre-med, applying to med-school, and what goes on in years1-2 and 3-4 in med school... so now that you've successfully completed all of your required courses, rotations, and steps 1 and 2 of the board exams, you're almost a medical school graduate, and (gasp) a real live doctor.  But what has to happen to get yourself a job after graduation.... otherwise known as residency training.  Well, it's pretty complicated and stressful actually, and it all starts with what, for some people, can be an agonizing decision... what kind of doctor do you want to be?  At first glance it seems like this should be an easy decision... but let me say this: I'd say at least half of the people who enter medical school thinking they want to be one kind of doctor ultimately decide over the course of the four years, that they'd rather be a different kind.
     Case in point - I always wanted to be an OB/ GYN... in college I did a semester-long shadowing experience with a gynecologic oncologist (he dealt with cancer of the lady parts - ovarian, endometrial, etc), during the first two years of medical school I was vice-president and the president of the OB/GYN interest group... but then I got out on third year rotations, and once I was actually experiencing the day to day realities of being an OB/GYN, I realized it wasn't for me.  I loved OB - prenatal care and delivering babies is awesome - and I didn't mind office GYN (PAPs, pelvic exams, etc), but I hated (in fact despised is probably a better word) GYN surgeries.  I knew that if I had to spend a significant portion of the rest of my life (because let's face it, OB/ GYN is really a surgical specialty) doing vaginal hysterectomies I would lose. my. shit.  I would end up pulling out my own hair and being miserable.
     So here I was, having spent at least the last 5-10 years absolutely certain I knew what kind of doctor I wanted to be, and this was completely ruined for me inside of 6 weeks.  Now what?  I had to choose something else I wanted to do....surgery: nope - I like being able to sit, and pee, and eat when I want to; ER: not bad but I didn't want to miss out on continuity of care; internal medicine: interesting, and I really like inpatient medicine (ie taking care of patients in the hospital) but I'd miss out on working with kids; Pediatrics: I like the kiddos, their insane parents not always, and I love, love, love the elderly and I would miss out on working with them.... and then somewhere toward the end of 3rd year it dawned on me... hello, family medicine!  It combines pediatrics, adult medicine, geriatric medicine, OB/ GYN, inpatient medicine, outpatient medicine, continuity of care.... ta da!  Perfect combination!
     In some circles family medicine has the reputation of being the specialty people go into when they don't have good enough grades to get into any other specialty.  In my opinion family med is one of the most challenging fields of medicine - you have to know SO much about so many things and you're constantly switching "hats" as a provider - delivering a baby one minute, admitting a patient to the hospital the next, then back to the office to see a 70 year old with high blood pressure and chest pain, followed by a 3 year old well-child physical.  I was lucky enough that my grades and board scores were good enough that when it came time to apply to residencies, programs could see that I wasn't choosing family medicine as a "last resort," but that it was truly something I wanted to do.
    Anyway.... once you've decided on what specialty you'd like to go into, you next need to apply.  There is a lovely service that handles all the applications for all the medical students (and foreign graduates trying to obtain residency spots in the US) for all spots in all residency programs... whew!  Their website can be found here.  On this site you create your profile with all your demographic info - name, date of birth, medical school, address, phone number, email, anticipated graduation date, etc - and upload such things as letters of recommendation, and (here it is again) your personal statement,and where your school will submit such things as your dean's letter.  There is also an area for you to request that all of your scores from the various steps of the national board exam to be submitted to this application service.
     A word about letters of recommendation and your dean's letter.  You will be asked to either waive your right to read these things or not.  There are many schools of thought about what is the right thing to do, and ultimately the decision is yours.  For what it's worth, here are my 2 cents: waive them.  That way programs will know that you did not influence their content in any way.  That being said, there have been horror stories about schools submitting dean's letters with incorrect information, and if you waive your right to see it you will never know it's there and could potentially be sand-bagged by it.  In the end - do what you feel is real.
     For this round of the much reviled personal statement, they no longer want to know "why do you want to be a doctor," they want to know "why do you want to be this kind of doctor."  Again, originality will stand out, but you also don't want to be too outlandish...if you've never written a poem before now is not (I repeat NOT) the time to start!  Give consideration to what the specialty is all about, and why this appeals to you/ why you think you would make an excellent physician of this type.  Why is this field of medicine where your passion lies?  Also, think about the program itself, and why you want to go there/ why you would be a good fit there.  Please note it is OK for you to talk yourself up a little bit.... but don't over inflate yourself too much to the point where the person reading your personal statement is left thinking "bullshit," or "what a pompous ass."
     Osteopathic students have one additional step: you can choose to apply via the osteopathic match, the allopathic match, or both.  Some residency programs are osteopathic only, some are allopathic only, and others are dually accredited.  If you're only applying to one type of program, only apply via that match process.  If you're applying to both types, or to dually accredited programs, apply via both matches.  Keep in mind that the osteopathic match actually takes place about a month before the allopathic program, and that you may have a better chance applying to dually accredited programs via the osteopathic match (since they have separate slots reserved for DOs through the osteopathic match, and for MDs through the allopathic match, and if you apply through the allopathic match and all of the DO slots have been taken through the osteopathic match you will likely be SOL; also if you do match into a dually accredited program through the allopathic match, you won't get credit from the AOA - American Osteopathic Association - for your intern year unless you do a whole lot of ridiculously complicated paperwork, and even then it's no guarantee... all of this is very confusing, and if you want more specific information, feel free to comment below).
      Once everything is uploaded and ready to go, it's time to designate programs to receive this packet of information.  But how do you actually choose which program is right for you?  Well, there are several factors to consider.  As with real estate, one important factor is: location, location, location.  If there is a certain area you want to be in and that is more important than other factors, then apply only to programs in that area.
     Other things to consider are the size of the program - how many residents are there per year and overall?  Do you want a smaller program or a larger one?  Another consideration: do you want to be in an academic teaching hospital - typically larger, in a city, and with an emphasis on research - or in a smaller community hospital - typically more rural, not affiliated with any one particular school.  One other thing to think about is do you want a program that is unopposed - in other words, the only program at a hospital.  This is a particularly important aspect to think about when applying to family medicine programs.  If you do a family medicine residency at a hospital that also has residency programs in internal medicine, OB/GYN, and/ or pediatrics, you may (and I say may, because I know for a fact that this is not the case at all programs) end up being second in line for inpatient admissions (both adult and pediatric) or deliveries, etc.  Just something to think about.
     OK so your application is ready to go, and you've elected which programs you want to send it to.  Now comes the part where you pay a bunch of money to have the application sent out, and then you wait to hear back from programs.  You will either be invited to interview, or not.... or in some cases inconsiderate programs will just not get back to you all together (shame on them, what would their mothers say about their manners?).  Interviews typically involve dinner the evening before with some of the current residents - informal, but be on your best behavior because I'm sure that what goes on at these dinners gets reported back to the residency and factors into their decision about you at least a little bit.  This is a good chance to ask a few of those burning questions of the residents such as: are you happy here?  would you choose to come here again? etc.  That being said, don't grill them like it's the Spanish Inquisition - you will come off as overbearing and more than a little crazy.  Most residency programs will put you up at a hotel for the night, so after dinner that's where you'll head.  Use the time to do your homework - read up on the various aspects of the program you're about to interview at - get to know the things that make them unique, and find the obvious answers to the questions you have that, if asked the next day, will only serve to make you look unprepared (ie how many residents do you have here?).  Get a good night's sleep, and make sure that fancy suit is ready to go (kudos to you if you can still fit into the same suit you wore for medical school interviews!  No easy feat... and yes, it still counts if you have to pull on Spanx underneath to get that zipper to close).
     The actual interview day usually begins with a welcome/ introduction, sometimes includes attending morning report or sign-out, and almost always includes a tour.  You will undoubtedly hear from the program director, and maybe a resident or other faculty member.  Then you will get to the nerve wracking part - the interview(s) themselves.  Places that I interviewed at, for the  most part, had a series of low-key conversational interviews with a faculty member or two and a current resident or two.  Be prepared to discuss your personal statement, any research or extracurricular activities you participated in in medical school, and any less than stellar aspects of your record (disciplinary action, poor board scores/ board failures, extending your medical school program beyond 4 years, etc).

***INTERMISSION***

     Still with me?  This post is becoming something of a marathon!  Hang in there... it's important and confusing stuff for those of you getting ready to go through this process.... I'm trying to write about the stuff that I wish I had know before/ when I was going through all of this!

     And now back to our regularly scheduled programming.....
     So, you're done on the interview trail, and now you have to sit back and try not to bite your fingernails down to bloody nubs while awaiting match day.  Make sure you've registered for the match or matches you will be participating in.... more demographics, more money.  The website for the allopathic match is here, and the website for the osteopathic match is here.  Don't forget to create your "rank order list" (just like what it sounds - a list of the residency programs you hope to match into listed in order of preference), and to certify it by the deadline.
     You submit your list of programs, and programs submit their list (again in order of preference) of the applicants they're interested in... and some magical computer program somewhere does some sort of voodoo and matches the two together to come up with the most favorable combinations possible for the most number of applicants/ programs possible and compiles the all-important match list.
     If you've applied through the osteopathic match, you will find out both whether or not you've matched, and where all on the same day via the same email.  If you've applied through the allopathic match you will learn your fate roughly a month after the osteopathic match, and will learn whether or not you've matched a few days before you find out where (if you were lucky enough to match).  If you did not match, you can do what is known as "scramble," which is where you look at the list of programs that have unfilled spots, and submit your application to these programs again and often times do phone interviews, and then hope to match there.
     A few things to note: if you've applied via both the osteopathic and allopathic matches and you match into an osteopathic program during the osteopathic match which takes place (as I've said) about a month before the allopathic match, that match is binding, and you cannot then go through the allopathic match.  So choose how you rank your programs carefully and wisely.  I'll use myself as an example.  I registered with both matches, and ultimately decided that I wanted to rank 5 programs (note: you do not have to rank all the programs you interviewed at - if you went somewhere and thought "uh, thanks but no thanks," leave them off your list).  Of those 5 programs, three were dually accredited, and two were allopathic only.  My first choice was leagues above the rest in terms of my desire to go there, and it was dually accredited.  As I explained above, I had a better chance of matching there if I went through the osteopathic match.  My second and third choices were allopathic only, so I couldn't rank them through the osteopathic match.  My fourth and fifth choices were dually accredited as well, but much much lower on my list of choices than my second and third.
     What was I to do?  I didn't want to rank my 1st, 4th, and 5th choices in the osteopathic match in case I didn't match at my 1st choice and ended up stuck in my 4th or 5th choice without even having a chance at my 2nd or 3rd choice since the osteopathic match is earlier and binding, so I would have had to have withdrawn from the allopathic match.  In the end I took a bit of a gamble.  I ranked only my 1st choice in the osteopathic match, and ranked all the others in the allopathic match.  Luckily it worked out, and I matched into my 1st choice and didn't even have to worry about the others.
     While MD students have it somewhat easier in terms of ranking programs, osteopathic students have the advantage of essentially having 4 chances to match: the osteopathic match, the osteopathic scramble, the allopathic match, and the allopathic scramble.

     So here I sit, having completed medical school, matched, and graduated, and as of 3:30 this afternoon having completed my residency orientation.  I'm on the eve of my first shift as a real, live doctor.... or resident at least.  One of my attendings here was coaching us on what to say if patients ask if we're real doctors: "Yes, I am a doctor, and now I'm getting extra training in family medicine."  Very truthful, and very tactfully put.
     Tomorrow I start a month of what is known as "Night Float."  I will be working nights from 5PM until 7AM taking care of all the patients admitted under our services in the hospital, answering after-hours phone calls from patients, delivering babies, going to codes, and admitting patients who come into the ER and need to be hospitalized.  Thankfully I will have a second and third year resident alongside me at all times, but tomorrow night is still going to be a huge shock to the system... especially when I introduce myself as "Doctor" to that first patient.  Despite the fact that tomorrow is also my birthday and I will be 28, I still don't feel old enough to have earned that title....I'll let you know how it goes!

Part 4: Med-School Continues

  Wow, been a busy couple of days...more on that in a minute, but first.... where was I?
  Ah yes....so you've passed the vilified Step 1 Board exam, and are cleared to start third year - the year of core clinical rotations.  At my school this consisted of 8 six week blocks, one block each of: psychiatry, OB/GYN, Pediatrics, Family Medicine, and surgery, and two blocks of internal medicine.  One of the six week blocks was made up of four weeks of "community medicine" (basically family medicine in a rural area or working with an underserved/ underinsured population), and two weeks of elective time (I did mine in emergency medicine).
     Different schools do slightly different rotations, and some do them in four week blocks, but (as I've said before), I can't comment too much on that since there's only one of me, and therefore I could only attend one school (which, believe me, was plenty)!
     My school was not associated with one major teaching center, so we went through a "lottery" system to determine which one of the roughly 10 hospitals our school contracts with we would be going to for our third year.  I was lucky enough to end up at the site that is closest to my home town, which was also one of the sites where you could stay for the whole year and didn't have to move to another site to complete one (or more) rotations.  We were also the first group of medical students that this site had ever had, which was a bit of a gamble on our part since we didn't know how well the hospital would do in terms of teaching, but being "guinea pigs" really worked out in my opinion - they were really eager to have us there, and very interested in our feedback on what worked and what didn't.
    Third year is basically the time when medical students have that "oh, yeah, this is why I went to medical school!" moment that reminds them why they put up with the hellishness that is the first two years of medical school.  Essentially the third year experience is made up of a combination of shadowing attending doctors (as well as residents if the hospital you're rotating at is also a residency teaching hospital), and seeing patients and "precepting" them to the doctor you're working with.  For the uninitiated, precepting means that you go in and see a patient first - gather their history (ie what brought them into the office, and all the questions that go into figuring out what might be causing their complaint) and in most cases do a brief physical exam (obviously anything "sensitive" such as a PAP smear or rectal exam isn't done at this point in most cases during third year).  After you've done the history and physical (H&P), you go out and present the patient to the doctor you're working with ("Mrs. Smith is a 65 year old Caucasian female with a past medical history significant for hypertension, and diabetes, who presents to the office today with a complaint of a wound on her foot that isn't healing.....and so on).  Once you've told the doctor all about why the patient came in, and any information you gathered and what you found on your exam, the two of you go back into the room with the patient and see them together.  Sometimes this involves the physician asking all of the same questions and doing all of the physical exam over again (which as a third year, especially first off is a good thing, but towards the end of fourth year it's like really?  I just told you all of this, so it looks to the patient like either I wasn't paying attention when I was in here with them/ am really dumb, or you weren't listening to me when I told you about the patient.... either way, not good).
     Finally, the doctor figures out a treatment plan for (and hopefully with) the patient, or if they're feeling feisty  they'll put you on the spot and say something like "So, student doctor, what do you think is going on here/ what would you like to do?"  At which point you must fight your instinct to assume the fetal position/ turn beet red and stand there drooling on your shoes, and try to come up with something that sounds at least halfway intelligent/ correct, all the while (at least if you're me) thinking "Screw you Mister Doctor Man, hanging me out to dry like this!"  I don't mind being pimped (ie grilled on medical knowledge) when not in front of a patient,  but I don't feel like it serves much of a purpose when with patients (other than to make the med student look/ feel dumb), and I learn  assessments and plans much better when I see how an experienced physician handles them (ie I like to act like a sponge and soak it all in).  Any physicians out there want to shed some light on this in-room pimping?  Is there some hidden agenda behind it all that I'm missing here?
    You start out in third year fresh from taking Step 1 of the boards, so you are filled with all kinds of medical knowledge that, while good on paper, is for all intents and purposes useless in "real life" clinical medicine.  So much of third year is spent learning how to actually interact with patients and realizing that patients and their diseases did not read your text books, so disease A might not always present the way you learned, and disorder U might not always respond to drug J the way you were taught.  And just when you finally think you're getting the hang of things, third year is over, and it's time to take Step 2.  Ugh.
     Step 1 was heinous, and is still fresh in your memory (you may even still have night terrors in which Step 1 features heavily), but now you must study for and take Step 2.  Oh, but just wait!  The news gets even more torturous better!  There is not just one part to Step 2, but two!  One is an 8 hour computer based test just like Step 2 - in this case it covers more diagnosis/ treatment type information.  The other part is a practical exam in which you have to go to a testing center and see 12 patients in 8-10 hours (I blocked this one from my memory for self-preservation purposes as soon as I left the building, so I can't remember exactly how long it was)... it is approximately the longest. day. ever.  By the last few patients I was so brain-dead I'm surprised I could even remember my own name!  The point of this test is to basically make sure of 3 things: 1) you can speak English well enough to understand/ be understood by patients, and 2) you are not such a social pariah that you can actually interact with patients in a semi-human/ semi-caring way, and 3) that you are not such an ignoramus that you can formulate an idea of what is going on with the patients, how to treat them, and how to document it all.  And it gets even better - you get just 14 minutes to see each patient, and just 9 to write a note documenting the visit.  Not so bad in the real world, but bear in mind that third year medical students are given an absurd amount of time to see patients on any given clinic day, so trying to speed up to get everything done in just 14 minutes seems impossible.
    Once you've survived Step 2 (and again waited weeks upon weeks for your scores), you can sail on through to graduation. Well, almost, there's still fourth year and the match to get through.
    Fourth year consists of more rotations - 4 weeks in this case (which fly by after doing 6 week rotations for all of 3rd year).  And, at least at my school, you get to choose what rotations you want to do, and where you want to do them.  We had only a few required rotations: surgery (I did ophthalmology), ER, OMM, and internal medicine or pediatrics (I did pediatric intensive care).  Beyond that you were on your own as long as you got to a total of 82 weeks of rotations (between 3rd and 4th year) prior to graduation.  Other rotations I chose were: family medicine, radiology, and palliative care.  The downside to all of this freedom is that you end up moving every four weeks, which is exhausting.
     Since fourth year is the time when students are making final decisions on what specialty they want to go into, and where they'd like to do their residency, they typically do rotations in specialties and at hospitals that they would like to do their residency.  Some call these "showcase" or "audition" rotations since you're basically trying to convince programs that you're a rockstar and should be selected to do your residency there.  Just remember that in addition to working your butt off to make a good impression, you should also be assessing whether or not you'd be happy in that program/ hospital/ location for the next 3, 4, 5, or however many years the residency program is that you're interested in.
    I was going to try to cover the match process in this post too, but it's already long enough, and the match is pretty complicated, so I'll spare you for now.  Instead I'll fill you in on what I've been up to the last couple of days!

     Yesterday, mercifully, we had no orientation activities, so I was able to tie up some loose ends and get some errands done.  I finally got my Pennsylvania license plates, and I have to say (no offense PA), the NH license plates are nicer looking.  I feel like the front of my car looks naked, since PA only requires a rear license plate.  In the afternoon I baked a fruit pizza, and took it to a cookout at one of my fellow intern's house:

     Soooooo delicious!  Find the recipe here.  I didn't do the glaze part with the jelly on top, because that just seemed weird to me, but there were no complaints from my fellow interns or their significant others, so I think it's OK to omit that part.  Also at the cookout were hot buffalo wing Snyder's pretzels, which are pretty much fantasticness in a bag, and something I should never be allowed to purchase and bring into my house, because I'm fairly certain I'd eat an entire bag in one sitting and blow my calorie allotment for an entire week.

     After dinner I went to trivia at a local restaurant - every week there is a group representing the residency made up of attendings, residents from all years, medical students, and significant others.  This week there were a record number of us there and we actually had to form 4 teams, one of which came in first place.

    It was a late night, so it made getting up this morning a little rough, but it was worth it since I won't be able to go to trivia for the next four weeks since I'll be working nights.... I think they'll survive without me though (actually, they'll probably be better off!).

    Today we had our last EMR training session!  Then an afternoon of learning all about how the OMM program works here, and a quick tutorial using plastic pelvises and babies on how to place your hands when delivering a baby so that the mom doesn't tear and the baby makes it out safely.... good to refresh my memory on that, it's been almost 2 years since I've been in on a delivery, and there's a very real chance I'll have to be in on one on Friday night!

     After the orientation activities were over for the day I hit the gym, came home and ate leftover cabbage and ramen noodle salad for dinner, and then transferred my seedlings into larger pots.  I'm growing tomatoes, scallions, green peppers, strawberries, and a sunflower (the damn birds ate all but one sunflower seed out of my pot).  Once they get a but more impressive looking I'll post some pics.

    And now you're all up to date (not to mention edumacated about 3rd and 4th year of medical school), and I'm off to bed before my final day of orientation tomorrow!

Part 3: Med-School Begins

     Hey friends, family, and others.  Winding down another fun-filled orientation day here in delightful PA with yet another informational blog for you all to (hopefully) enjoy.   So, without further ado...
     Alright, so you've successfully managed to convince some admissions guru that you're worthy of admission to their institution of higher medical learning, now what?   Well, year one kicks off with the time-honored hazing of - you guessed it - anatomy.  Nothing like diving into a dead body on day one to really make you feel like a medical student!  Most schools still use actual cadavers, though several places use prosections (pre-dissected bodies cut in various ways to show the relevant structures) and more and more schools are doing virtual anatomy with 3-D computer reconstructions of human anatomy.  In many places this is due to a shortage of (for lack of a better term) "bodies," but where I went to school we were fortunate enough to have a robust body donor program, and were able to work 4-students to a body.  Yes, it does smell particularly bad - though after a while you do get used to smelling like that...you can definitely pick out the first-years in the hall because that smell clings to everything.  And it is certainly humbling to know that some other human being had the generosity and forethought to donate their body to medical learning upon their death so that future doctors can learn about anatomy - the most disconcerting/ unnerving part is dissecting the head, and (oddly enough) the hands... those parts were the donors' identities, and just think of all the things that they did with those hands - the work they did, the meals they made, the new babies they held - it can be overwhelming.  But, at the same time there is no better way to really understand how all of the various structures are related, how tough or fragile the various organs are, to build a three-dimensional picture of how it all goes together.  In my mind, a computer model just wouldn't cut it (no pun intended!).
     One of my fellow interns here mentioned the other day that every class she took in medical school had to be attended in full "preceptor dress" - ie clothes you would wear if you were seeing patients.  No scrubs and sweats for her class!  Disgustingly enough this also included anatomy lab.... I can't even imagine guys wearing ties, and girls wearing skirts in there.... ick!  The stuff you wear in lab ends up so greasy and foul-smelling that every year my school hosts a bonfire where we burn all that junk!
     Along with the vast amount of information required to master the anatomy course, the first year medical student also takes such classes as: embryology, histology, pathology, biochemistry, and (in the case of osteopathic schools) osteopathic principles and practices where we learn the tenets of osteopathy, as well as how to treat people using osteopathic manipulative medicine (OMM, alternatively called osteopathic manipulative therapy - OMT).  There is also a course that ostensibly teaches us to be doctors, where we learn such things as how to use an ophthalmoscope (the thing a doctor uses to look in your eyes), an otoscope (same device but with a different "head," used to look in the ears), a sphygmomanometer (BP cuff). We learn things such as ethics, medical jurisprudence (legal what-not that has to do with medicine), and pharmacology (my nemesis).  I once heard that during the first year of medical school the average student learns 13,000 new words.  If that's not enough to make your head explode, I don't know what is.... clearly you are a glutton for punishment!  I know (and my parents can attest to this) that there were MANY times during my first year when I thought "what the hell am I doing here?" or "I want to quit, but I'm already in too much debt," or "they must've made some mistake when they let me in!"
    But somehow I survived - to be honest some days I'm really not sure how - but I passed all my classes and the powers that be let me come back for round 2!
     Year 2 - at least at my school - was more reasonable than the first year, with the exception of one course: neuroanatomy.  Brutal!  It was a course so intense that the entire first month or more of second year was dedicated to neuroanatomy, and neuroanatomy alone.   So much to learn, so many structures, functions, and tracts to memorize, and diseases/ conditions to study.  Once that was over we moved through various systems throughout the rest of the year: cardio, gastrointestinal, reproductive, endocrinology, pulmonary, pediatrics, geriatrics, musculoskeletal, derm, hematology/ oncology, and so on.  Mixed in with these were the second year of OMM and our "doctoring" course, as well as nutrition, and various other courses.  Other schools, I'm sure, have different set ups, but since I only went to one medical school (thank God!  that was all I could handle!), I can only comment on how we did things.
     While second year was slightly less of a pressure-cooker than first year in terms of the newness/ overwhelming sensation of things, there was constantly one nasty black cloud looming in the horizon...Step 1 of the national board exams.   Enough to strike fear into the hearts of medical students country-wide, and still sends a shudder through me to this day.  It is an 8 hour computer exam designed to test every little detail learned in the first two years of medical school - from the most obscure tendon in the forearm, to the pathology test for a particular subset of a particular kind of hematologic malignancy (see what I mean about those 13,000 words?), to the mechanism of action of an anti-retroviral medication.  8 hours of this.... or, I suppose, until your eyeballs begin bleeding and you start having a seizure because you've been staring at a computer screen for that long and your brain is completely fried.  When I was done, I didn't know whether to laugh or cry.  And then....... you wait.....and wait.....and wait..... for 6 looooooooooong weeks.... until they release your scores and tell you whether or not you've absorbed (and regurgitated) enough information to pass the exam and be allowed to move on to the last two years of medical school.
    And, God forbid, you are not a good standardized test taker, and you fail the exam....lucky you, you get to take it again!  And a 3rd time should you be so very fortunate enough as to fail it the second time.  But after that they stop torturing you - at least at my school - it's 3 strikes on step 1 and you're out.
   Thankfully I passed the beast on my first try, and was allowed to progress on to my third year of medical school - the first clinical year....but that's a story for a different day.

     Today was the first day of my last week of residency orientation.... 4 long hours of computer training (again), followed by being reminded all about how to tell if someone is in labor, and whether or not her membranes have ruptured, and what to look for on her fetal heart rate tracing, and what to do in an emergency, who to call.... and they capped the day off with risk management (AKA how not to land in hot water, piss patients off, or get yourself sued).  Since I'd spent all day sitting on my butt with my brain oozing out my ears I headed directly to the gym, and then had a super delicious sushi dinner with one of my fellow interns.... just what the doctor ordered (in this case the doctor being me.... hey, you just read what I went through for the first two years of medical school, if I order sushi for myself it counts!).
     Now as my DVR records Weeds for me (seriously, this DVR thing is awesome!  Probably my fourth favorite appliance after my computer, dishwasher, and kitchen aid stand mixer), I'm going to ignore the pile of ironing that is still waiting for me (the iron being my least favorite appliance) and call it an early night.
    No orientation activities for me tomorrow, so I'm going to use my last free day (sadly we do have orientation on Wednesday and Thursday) before residency officially starts on Friday to take care of some business such as registering my car, picking up a white coat, and paying some bills before meeting the rest of my intern class for dinner (hopefully), and then more members of the residency for trivia at night.  Should be a productive, and enjoyable day!

Part 2: Med-school Application Process

     Another all-too-short weekend is drawing to a close, and before I crawl into bed to get ready for my final week of orientation, I thought I'd whip up a quick post for y'all.  So here it goes....

     Once you've taken all of the courses deemed necessary by the med-school admission gods (and of course done well in all of them, right?  Even organic chemistry, right?  That's what I thought), it's time to take the MCATs....a lovely little tool of the devil standardized test designed to give you premature grey hairs and raise your blood pressure a solid 20 points.  It has 3 parts: physical sciences, biological sciences, and (because writing a personal statement for medical school isn't proof enough of your English-proficiency) an essay-style writing section.  These days the test is "only" a 4 hour computer exam, but "back in my day" it was a 4 hour written exam.... fun times.  Schools won't say they have score cut offs for admission criteria, but most do, so it's important to do well.  If, like me, you're not a great standardized test taker, have no fear... you are "allowed" to take the beast more than once should you so choose.

     Ahhhh.... once the test is over, and you are more or less reasonably satisfied with your score, you can breathe a sigh of relief.  But wait, the fun has only just begun!  Now you can work on your applications, and that other tool of the devil - the personal statement.  I think Dante missed a level of hell, because in my mind there is a whole special level awaiting me where I must sit and write personal statements of various sorts while a little red goat-man pokes me with a pitchfork for all of eternity....but I digress.  In a nutshell medical schools want to know the answer to a question that you will, from this point forward, be asked approximately 6000 times: why do you want to be a doctor?  Or, the ever-popular variation: what made you want to go into medicine?  And your answer better not be generic..."because I want to help people,"...."my father was a doctor, his father was a doctor, my great, great, grandfatzzzzzzzzzz"... sorry, fell asleep there, but you get the idea.  Much like college personal statements the idea is to be memorable and unique, without being so unique that the admissions people are left thinking "what the hell??"  Be genuine and honest and let the passion that has sustained you through all those grueling years of pre-med courses help you to write a convincing argument for why you want to be a physician.  If there was some magic formula I'd give it to you, but there isn't, except to say (and I can't stress this enough): write it yourself!!  Hiring a service to do it for you, or buying a personal statement off the internet is such a bad idea that I won't even waste the space on here to tell you all the reasons why you shouldn't do these things.... if you don't believe me, go ahead and give it a try, you shouldn't be in medical school anyway, so just see how it works out for you!

    OK, so, to recap.... MCAT = check, Application (complete with an all original personal statement) = check, all that's left.... interviews!  Here's the part of the process where you get to bust out your fancy suit, shine up your shoes, and convince the admissions folks face-to-face not only why you want to become a doctor, but why they should teach you to do so at their school.  Be prepared to discuss any research you've done in detail, and to explain any gaps or deficiencies in your record.  A med-school admissions favorite: tell us your strengths, and weaknesses...ugh, I hate that one!  Men - get a haircut; Ladies - while a black or grey suit is not mandatory, may I suggest that you not wear anything too revealing?

    That's all for this round of advice/ education on the process of becoming a doctor.  Tune in next time for some highlights of the first couple years of medical school and the next round of soul crushing standardized testing: Step 1 of board exams, yippee!

       And now for something completely different - a brief look at how I spent my last weekend of freedom!

Saturday I went to the farmer's market and had a fantastic pear and smoked Gouda crepe....so good!  Afterwards I hit the gym, grabbed some Starbucks (I swear they lace those double chocolaty chip cremes with crack), did some grocery shopping and made a delicious dinner of cabbage and ramen noodle salad.  It sounds gross, and I don't really care for any of the things that are in it individually, but throw them all together (and cover it in a salad dressing that contains no less than 2 tablespoons of sugar) and I'm sold.  After dinner I went to a friend's house and played a complicated game called Ticket To Ride (note: has nothing to do with the Beatles, and a lot to do with geography and trains), which was quite fun, though I'm still not sure I fully understand how to play....

     Today I took my bike out for a spin (on a trail, with a helmet Mom, don't worry) and realized I really could use a road bike instead of the heavy mountain bike that I currently have and don't need on the paved trail.  Afterwards I went and saw Bad Teacher.... pretty funny, though maybe not worth the $7 I paid to see it in the theater.  I capped off my evening with a trip to grab some ice cream with one of my fellow interns (and classmate from medical school... and she also happens to be my upstairs neighbor), which was delish!  As I type my faithful DVR is recording the season premier of True Blood, and knowing I have it waiting for me to watch is what is going to get me through 8 hours of orientation tomorrow...4 of which will be on the electronic medical records system..... again....

    Nothing too exciting, but that's fine with me.  Hope you all had a great weekend as well!

Time to Drop Some Knowledge (AKA How Did I Get Here?) - Part One: Pre-Med

     It's my last weekend of "freedom" before residency officially starts next Friday, July 1 (which just so happens to be my birthday... "Happy Birthday, here's a whole boatload of responsibility"), so I'm trying to make the most of it by visiting the farmer's market, doing some cooking, maybe taking in a movie, and hitting the gym.... and, oh yeah, sleeping!  I also figured it'd be as good a time as any to fill you all in on what it takes/ what the process is to get to the terrifying exciting position I'm in now.  The soundtrack for this post is currently being provided by my musically not-so-gifted neighbor as (s)he practices the drums.... neighbor ain't got no rhythm.... just to set the scene for you.
     Before applying to medical school, there's this little, 4-year, process known as college.  Many people - high school guidance counselors, parents, friends, doctors, etc - will tell you that in order to get into medical school, you have to major in something like biology or chemistry.  So, I did....and turns out, it's a lie.  Yes, you need to do the pre-med requirements which vary from college-to-college, but typically include things like chemistry, organic chemistry, calculus, english, and various biology courses.  But, you can do these things via a concentration in pre-med, or by taking them on your own outside of a structured program if your college doesn't have one(just peruse through the "admission requirements" section of a few medical schools, and you'll get an idea of the courses that most of them require).
     Trust me when I say that if you don't LOVE biology or chemistry and you choose one of these as your major in college on the misguided information that you have to do so in order to get into medical school, it will be a loooooong four years.  I majored in biology because, I liked it well-enough, and I thought that that's what all future-docs major in.  Well, looking back, I think I would've enjoyed majoring in sociology/ anthropology a whole lot more, and would've probably enjoyed my priceless 4 years of college more.  Obviously I still would have had to suffer through organic chemistry, but I would have had the balance of a non-science major I was more interested in to help me keep my sanity.
     The upside to majoring in something other than biology, chemistry, etc when it comes to interviewing for medical school is that you are able to talk passionately about your major and medical schools are able to see that you are a well-rounded individual.  Now, I'm sure there are plenty of medical schools out there that love, love, love to see students who did nothing but eat, sleep, and breathe science during their undergraduate days, so I can't speak for them or the students who are crazy enough to want to go to a school like that, so take my advice with a grain of salt.  Any other medical students, residents, doctors out there echo my sentiments or have anything to add?
     But what if you're sitting there thinking "When I went to college I had no idea I wanted to be a doctor, and I never took any of these pre-med classes?"  Don't despair.  There are these convenient little programs called post-bacs, and they were designed just for you!  They are often a year or two long (depending on if you go full-time, or half-time, etc) and include all of the pre-requisite courses for entrance into medical school.  They are also good for people applying to medical school as a mid-life crisis career change after being out of school for a while.
     A lot of medical schools like to see that you have interests outside of school, so just like when you were applying to college, they appreciate things such as volunteering, mission trips, research, jobs that you may have had, and so on.  So keep these things in mind as you go through your four years of college.  That being said, don't just do these things to pad your resume, it's more important that you do things that you are interested in - if volunteering at a soup kitchen isn't for you, don't do it, medical school admissions folks will be able to see right through you, choose something else to do.  If the thing you do includes leadership, all the better.  For example: I was an RA in college - I loved it, and it showed leadership and an ability to balance work and school, as well as training in how to resolve conflicts, and enforce school policies.
  All right, that's enough information for one post.  If you have specific questions, feel free to leave them in the comments and I'll do my best to answer them - remember, I'm old, college was a while ago for me, and information may have changed since "back in the day," and my memory may be a bit rusty.
     Some good websites for more information are: https://www.aamc.org/about/medicalschools/, http://www.aacom.org/Pages/default.aspx and http://www.studentdoctor.net/.
     Take the Student Doctor Network (SDN) website with a grain of salt - there is a lot of good information on there, but a number of people who post on there do so to brag about grades, test scores, and the like and to make people who aren't the valedictorian at Harvard or Yale or Princeton feel bad about themselves.
     I included the links for both allopathic (MD) and osteopathic (DO) schools, so you can read about both and be better informed.  I went to an osteopathic school, and am very glad I did - it fit my philosophy of why I wanted to practice medicine, and what kind of doctor I wanted to be, and I think I got an excellent education.  I suppose at some point I should probably do a post about what osteopathy is, and how it's similar to/ different from allopathic medicine, but for now just know that there is more than one set of schools out there.

These are a few of my favorite (and not so favorite) things...

     Obviously family and friends are at the top of that list!  But aside from that, I figured I should let you know a bit more about me since it might provide some insight into some of the posts I write in the future.
So, without further ado, these are a few of my favorite things...
1) Food - I like to cook, I love to bake, and I LOVE to eat!  I may be a pescetarian (ie I don't eat meat, but I do eat fish/ seafood), but aside from that there are very few things I won't eat or at least try...unfortunately for my waistline!  Specifically I love chocolate, carbohydrates, sushi, and everything in between.  The only downside I've found so far in the city I just moved to (aside from it being so far from my family) is that there's no Indian restaurant anywhere nearby, and while my homemade chana masala is good, it's just not the same!  When I moved in, I stocked my freezer with single-servings of some homemade faves so I don't have to worry about cooking all the time - the aforementioned chana masala, vegetarian chili, truffled mac n cheese, and several others!  Yum!  I'm sure that there will be more posts about food since I spend a large amount of time and energy thinking about food.
2) Sleep - not much to say about this, other than I apparently went into the wrong field, huh?
3) Travel - can't get enough of it.  I recently returned from a 5-city tour of Europe with the little brother - Dublin, Paris, Barcelona, Florence and Rome.  It was amazing and I can't wait to go back, and to see other parts of the world.  Someday I'd love to go live in Paris for 4 weeks and take an intensive language course.
4) TV, Music, and Movies - how original, eh?  There's too much to list here though, so I'll spare you.
5) Crafts - I love to make homemade cards, and to cross-stitch.  I don't care if that makes me seem like a 50 year old woman.
6) Recycling/ being green - don't let my crossover vehicle fool you.  I recycle every possible thing, and do my best to convince others to do so too.
7) Animals - makes sense for a pescetarian, right?  I especially love cats, dogs, and most farm animals.  I really want to have goats, chickens, sheep, and pigs someday... and maybe a cow or two.  But definitely no horses, they freak me out - disproportionately large heads.  But don't worry, I'll never be a crazy cat lady, or like this girl.  Just saying.
     And some of my least favorite things:
1) Cleaning - my Martha Stewart-like domesticity ends with the cooking/ baking, and crafts.  I'm a neat-freak, so I'm super organized, but man do I hate cleaning... specifically vacuuming, doing the dishes, and above all... ironing!!  Sigh, someday I'll be able to afford a housekeeper.... right??
2) People who drive like morons - unless your car was made in 1940 I'm reasonably sure it comes with directionals, and no... I don't have ESP and therefore can't predict that you're going to turn left in front of me. Also, if the speed limit is 30, I don't care if you go exactly 30 miles an hour, or a little over, but I swear if you go 27 mph in front of me, there will be steam coming out my ears in roughly 3.5 seconds.  Cutting me off = seriously irritating.  Before my BP increases to unhealthy levels I'll move on...woosah, woosah.  (Name that movie!)
3) People who waste my time - spit it out, get your shit together, and for God's sake don't stand around in the middle of an aisle in a store with your cart blocking everything and be completely oblivious to the fact that people around you are getting annoyed.  Presentations/ lectures that contain only 10 minutes of information but for some absurd reason take an hour to deliver?  I've got better things to do, so get on with it!
....noticing a pattern?  I'm a little impatient!  Basically I value my time, and don't want it squandered!
4) Waking up to an alarm - see #2 under things I like

  None of this is earth shattering news... most people probably feel the same way about all of these things.  I'm sure more shades of my personality and likes/ dislikes with come out naturally in my postings, so I'll spare you... for now!  Especially since this is starting to read like a personal ad.
   ACLS is finally over now, and I passed both the written and practical portions, which means that someone apparently thinks I'm competent to save someone in an emergency...yikes.  To add to the pressure, I got my first monogrammed, long white coat today...oh crap, that makes this whole doctor thing real.  Thankfully we still have another week of orientation, but after that it will be a whole lot of trying not to kill people or let them die, and trying not to drop babies as they come squirting out of the womb (I know, I know, I've obviously never had a baby or I'd know there's definitely no "squirting" involved... but they're pretty slippery, and I really don't want to drop one!  That'd be a definite "party foul," and somehow I don't think me mumbling "my bad," or brushing it of as a "man down" joke would go over all that well with the delivery room crowd!).
Off to enjoy a few of my favorite things - TV, then reading, then sleep - and ignore the ironing that I put on my to-do list, oh, 4 days ago.
     I leave you with one more fave - a picture I took on my recent European vacation of my favorite building of all time - the Notre Dame Cathedral:

OK, just one more.... this homeless guy and his dog in Paris were just too sweet to resist taking a picture.  Don't worry, I dropped some money in his cup too!

One Month Out (...or "what I did on my summer vacation")

     Today officially marks one month since I graduated from medical school.  It seems like it was just last week that I was up in Maine with all of my classmates, unable to believe that we had made it that far, survived the four years, and that someone was going to give us our diploma and unleash us on our unsuspecting victims (um...patients).

    Kind of made me think...where did the last month go?!  Well, since I owned next to no furniture (read: a rug, a small dresser, and a trunk/ ottoman), I had to decide on and buy an entire living room set, and bedroom furniture.  Thanks to a loan from the good old "bank of mom and dad" I was able to find some stuff at a discount furniture store to at least take care of the essentials.  Note - a dining room table was not considered an essential right off (especially since the one I want from Crate and Barrel costs about $900), so if you come to my house for dinner we can eat on folding chairs on my front porch, or picnic-style on a towel on my living room floor like I've been doing (I definitely don't trust myself to eat on my nice new light beige sofa!).  It's fancy around here, what can I say?

   I was lucky enough to find a nice apartment close to the hospital down here and to have two fellow residents (both of whom graduated from my school as well - one with me, and one last year) as my upstairs neighbors.  I really felt like I needed to live on my own, but it's nice to know that if I need anything, they're right upstairs.

  The apartment is in an older home, and definitely needs/ needed some work.  Some things I won't be tackling since I'm only going to be here for 3 years and I don't own the place - ie refinishing hardwood floors, upgrading from oil heat, replacing kitchen appliances with the stainless ones I really want; But other things clearly HAD to go - ie the mustard/ lemon yellow kitchen.  And I don't mean just some unfortunate wall paint, whoever lived here before apparently didn't do anything halfway... the walls, cabinets, trim, door, window casings, and counters were all the same disgusting shade.  See for yourself:

      Hurt my retinas!  There's my awesome dad helping me out with the sanding, and taping, and removing cabinet doors.  Thankfully he was able to take a few days off to drive down with me and help get me started on the kitchen transformation.  Unfortunately everything takes longer than you think it will, and one weekend was just not enough time to get it all done, so I had to tackle the final coat(s) on the cabinets, as well as painting the walls and counter tops (praise whoever it was at Rustoleum that invented counter top paint) by myself.  But I think all the hours (days) of hard work and inhaling paint fumes (that counter top paint is awesome, but it definitely kills a few brain cells... I just hope they weren't the ones holding on to the last traces of my medical knowledge!)  were definitely worth it.  You be the judge:

Ta Da!!  The picture doesn't really do the color scheme justice, but even so I think you can tell it's better than yellow!  The counter top paint isn't the most durable thing in the world, so I definitely have to be careful not to let water sit on it, etc.  I kind of gave it a bit of a tattoo already - set a bag of shredded cheese on it, which then condensated (is that a word...?) and the expiration date transferred to the counter top.... whoops!  Oh well, live and learn, I'll probably have to touch up the counter paint sometime in the 3 years I'm living here anyway.
     After the painting there was a LOT of cleaning (seriously, the people who lived here before lived like filthy little pigs, and had evidently never heard of  cleaning supplies)... there was gum on my bedroom floor that was attracting ants... gross!  And after the cleaning there was unpacking.
  At this point, my living room is mostly done, as is my bedroom, and the kitchen is complete... my dining room is about as un-complete as it can get, and my office also needs a lot of work.  All in due time (by which I mean paychecks).
    Last Monday we started orientation - which so far has involved meeting a whole lot of people whose names I've already forgotten (sorry!) and doing a whole bunch of paperwork/ administrative things.  Also, listening to presentations on all sorts of super exciting topics such as EMR (electronic medical records) training, OSHA, HIPPA, safety and security, blah blah blah.  For the last two days we've been taking an ACLS course (advanced cardiac life support.... AKA how to try to not let people die who are really really trying to die).  Side note: there are a lot of acronyms in medicine, eh?  Tomorrow will be day 3 of the ACLS course, and will involve a written and practical skills test - both of which I should be studying for instead of writing this, but my brain is too fried at this point!
  So, this post wasn't a whole lot more exciting than the last one, sorry.  Things will get more interesting once I'm actually up and running doing doctor-y things.  Instead of boring you all to death (assuming anyone actually reads this thing) with the monotonous details of residency orientation I think I'll devote the next couple of posts to telling you a little more about me, and what I do outside of medicine, as well as talk about the process of actually getting to the point of being able to be called "doctor."  The process can be confusing, and I've found that a lot of people really don't understand what it's really all about.  Case in point - I recently printed some graduation photos out at a local RiteAid and when the cashier looked thru them she asked what I graduated from...
Me: Medical school.
Her: Oh, cool, so you're a nurse!
Me: No, a doctor.
See?  To a lot of people no matter what type of school you go to it's automatically assumed that girl = nurse, boy = doctor... not that there's anything wrong with being a nurse, they save our butts many times over and often know what's going on with our patients more so than we do... not to mention that it's hard work and they get little credit for doing it much of the time, but... I went to medical school, not nursing school, so... I'm a doctor, not a nurse.  (Definitely no power trip intended here, I don't mean for it to sound that way, I just want a little recognition of the extra four years of hell I went through, and the deeper financial hole I'm in as a result!).
    Anyway, I'll dedicate a few posts to (attempting to) reveal some of the mysteries of the process, so if you're a family member, a wannabe doc, or someone in the general public with a specific question you want answered, leave it in the comments and I'll do my best!  Until then I'm off to dream sweet dreams of ACLS algorithms...."Annie, Annie, are you ok!?"

Introductions

     AKA the who, what, why, where and how.  OK, maybe not so much the how part, but you get the idea.
I'm a newly-minted doctor (egad, hide your children!), fresh out of medical school and about to start residency in family medicine in a small-ish (approx. 30,000 people) city in Pennsylvania.
     I've never lived outside of New England, and when I got my Pennsylvania driver's license, it marked the first time since I was 3 weeks old that I was legally a resident of a state other than New Hampshire.  All of my family is in the New England area (with very little exception), and since I am not going to have the luxury of getting back there as often as I'd like... and (let's be honest) since I'm notoriously bad at keeping in touch with family and friends... I thought this blog would be a good substitute for one-on-one communication.
     I tend to use a lot - a LOT - of "..." and parenthetical statements, but I was a biology major, not an English major (I left that one to the little brother... hey little brother!),  so if you're going to read/ follow this blog I apologize if my grammatical habits drive you insane.  Also, by way of warning, I am incredibly sarcastic so while I don't intend to offend anyone, I can't promise that I won't!  And lastly, this blog will likely NOT be PG (seriously, did you hide the kids yet?), so if you don't like it, stop reading - or call my mom for the PG translation, she'll filter me like nobody's business.
   Since I am going to be working in a hospital and blogging about real-life experiences, I will say up front that this blog will also be 100% HIPPA compliant - for those of you who don't know what that means, it's basically equivalent to the "names have been changed to protect the innocent" statements you see on TV/in magazines, except it takes it one step further.  I won't be using any names, or any other identifying details of patients. Those of you who know me, know where I'm doing my residency,  those of you who don't won't, sorry.  So if you're reading this trying to scope out some baby mama drama-type gossip or other small-city going's on, you'd best keep looking!
    All right, enough of the legalese/ disclaimers, even I'm bored now.  I'll try to keep things more upbeat and interesting from here on out.
   Feel free to post any comments/ questions/ panic attacks in the comments!