Making that Rank Order List

I’m currently on my second (and last) vacation of intern year, and it is also the week that 4th year medical students across the country must submit and certify their Rank Order Lists (ROLs), ranking all of the programs where they interviewed… basically, choosing which programs will be a the top of their lists and which they will *hopefully* Match into next month. In just a few weeks, we find out who will get to replace us as interns next year! (But really, how on earth am I almost a senior resident?!)

Making our ROL last year was much more nerve-wracking than I ever anticipated. It’s a big decision to put all of those programs into a list and then submit that list into an algorithm that has the power to put you (and in my case, a family in tow) anywhere in the country for (potentially) years of your life.

I interviewed at far too many places: I was offered 24 interviews, planned on attending 20 (one was cancelled due to weather and then the program rescheduled me on a date I had an interview somewhere else, so I declined the rescheduled date), actually attended 19, and ranked 14. (My school’s leadership has us all believe we needed a ton of options if we wanted to successfully Match, even in “non-competitive” pediatrics.) Going into interview season, I thought that there would be a few standout programs and the rest would just be “meh”, so it would be easy. Not so. I could have seen myself being happy at just about any of the ones where I interviewed. My approach to every program was: I need my first job as a resident so I can become a badass general pediatrician. That is my top priority. And I think that I could achieve that goal pretty much anywhere. But the next priority was: Where will I be HAPPY? Because that is a completely separate entity. There were a few programs that I honestly thought, “I would be miserable there…..” but with all of the advice I received to “rank every program!”, I was hesitant to discard any of the programs. That being said, it was still much harder to make this ROL than I originally anticipated, so I needed some help with sifting through all of these programs. I did use the NRMP’s PRISM app to submit an initial ranking immediately after each interview, which set me up with a good idea of where they all fit into a list based on many factors, but it still felt a bit off.

I needed something more tactile, more visual. I wrote down every program I interviewed with onto a Post-It. All 19 of them. I then met with my med school advisor/best friend at a bookstore coffeehouse along with The Handsome and The Ladybug. At a tiny table, I took all of those Post-Its and went through them one by one, moving some higher or lower on the list. My advisor/best friend would give her input on the individual programs where she knew people, knew my interests, and knew my family and how they would all fit together. Her input helped immensely! It was nice to step back from the stress of the process to see the big picture. When we left the coffeeshop (An hour later? Two hours later?) I had a rough list and felt a little more reassured. There were still some programs that I wasn’t sure were in the right place on my list, or if I wanted them on the list at all (at that point, I had not yet discarded any of them).

So then, using those same Post-Its, I played a little game. I folded them all up, and over the course of several days, I would randomly draw one and open it…. pretending that was my envelope on Match Day. If I was excited, it stayed at (or moved to) the top of the list. If it made my heart pound and I wanted to cry….. I threw it away. Once I had played this game and drew all of the program names….. I knew my ROL, and I knew it was right for me (and my family). I submitted, certified, and never looked back. Based on the AAMC’s data for pediatrics, I knew there was a >95% chance that I would Match at one of my top 5 programs on my ROL…. and when I opened those 5 Post-It’s, I was very excited. I knew we’d be ok no matter what my envelope  said on Match Day.

I’m glad I don’t have to go through that again… at least until the fellowship Match in two years. 😉

To all of the MS4’s out there stressing over the ROL deadline TOMORROW…. it will all be ok. I can’t wait to see where everyone is headed! (But if you’re going into Peds…. my program is the best and I hope to see you this June!) 🙂

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Intern Year so Far

My first rotation of intern year was inpatient pulmonology. My very first day was on “short call”, meaning that I was on call til 9pm accepting admissions (and could stay til 11pm finishing up notes). Plus it was a weekend, which meant I was cross-covering two other services until handing off to the night team. I was terrified. I started out the morning by introducing myself to the nurses: “Hi, I’m Dr. Allie, and I’m a brand-new intern. I have no idea what I’m doing. Where are the stairs? Where can I find this room number? Where do I put my used isolation gowns?”

Pulmonology was really interesting. It took awhile, but I became more comfortable with taking care of common illnesses like asthma, bronchiolitis, and Cystic Fibrosis as a doctor, instead of a med student, or someone on the sidelines.

I wanted so badly to make a good first impression that I think what I actually did was more self-sabotage than anything else. Double-checking everything because I didn’t want to make a mistake made me slow. But, by asking questions I started to learn how to do things, got acquainted with our EMR system, and quickly fell into a routine.

Without a doubt, though, the best part so far has been getting to know my co-interns, senior residents, and the attendings here. I’ve made so many more friends and it feels like I have known them all much longer than the few months I’ve been here.

This was also my first month teaching med students as a resident. When you spend your days feeling like an idiot every single minute, it starts to feel like you have nothing to offer. As I started out in residency that first month, I felt like I was barely keeping afloat. After a couple of weeks, I was much more comfortable in my role, and began dedicating more time to guiding the med students. These were med students on their first-ever clinical rotation, and it didn’t take long to feel like, “actually, there IS something I can teach you!”

School may be out, but that doesn’t mean the learning (or re-learning) ends. I’m the type that learns through reading, and my med student habits have stuck with me, so I try to always carry something to read. Many of my days look like this:


There’s still time for fun. One thing I love about my program is their dedication to wellness. Once each block or so, my program sponsors Riley Rounds, fun outings for residents (and their families!). The first one was to an Indians baseball game, and the second was at a restaurant that also hosted games. One day in the lawn between hospitals they set up an inflatable obstacle course just for residents (plus Sno Cones)! We work hard but we definitely play harder!

So far, I am really enjoying residency, even when I feel like I’ve been an inadequate idiot all day. I’m slowly learning that it is ok to stick to my gut, speak with more confidence, and say NO. One of my interviewers last year said that “putting on the doctor pants” is a difficult thing to do, but if I chose a program that supported me in ways that I needed, it wouldn’t be as difficult as it could be. I’m only a few months in so far, but I am so glad I chose this program (and that they chose me)!

To see more frequent posts and snippets about my days as a pediatric intern, follow me on Instagram @pagingdrallie

Long Time No See

The last time I posted, I had just found out that I matched into one of the programs on my Rank Order List for a residency in pediatrics, accomplishing a goal I’ve had since I was 14.


It has been such a long time since then, and I haven’t written about it. After Match Day, there was so much to do, and it felt like we had no time. It all went by so quickly.

We immediately went on the hunt for a house. On one Saturday, we toured 19 properties, put in an offer, and bought our first home.


My brother got married with my Ladybug as the flower girl:


I finished my final med school rotation in the NICU, which I absolutely loved.


We had to find a new daycare and it completely broke my heart to leave the one we’d used since the Ladybug was 8 weeks old.

I GRADUATED!


We took a family vacation to Key West, FL, Dry Tortugas National Park, and Savannah, GA.


We spent two weekends painting the house and moving in, with the help of the best family and friends.

Then the fun started. Mountains of paperwork and training and licensing and certifications before even starting orientation.

And now they call me Doctor. Paging Dr. Allie. It is real, and no longer a fantasy or far off in the future. It doesn’t feel like it at all. I’m currently on my second rotation, which means I have “survived” July of intern year, but not without rubbing one of the children’s hospital’s ladybugs for luck on my first day.

Match Day

So I haven’t posted in awhile. No worries! Match Week was absolutely crazy, and since Match Day, I’ve celebrated with endless family and friends; looked for, found, and bought a house; started my last rotation of medical school; and have just in general been enjoying life.


I don’t keep it a secret that I had to apply to medical school four times. It’s just a part of my story. However, I truly believe that by going through that process, my self-confidence has been irreparably damaged. I constantly doubt myself. I doubted that I would ever get in; I doubted that I would pass all of my classes; I doubted that I would pass my Step exams; I worried and fretted frequently about my ability to obtain a residency position, or if I did, that it would be in a place that I did not necessarily want, but that I should just feel lucky to have obtained a spot.

I never imagined that I would go from a third-time re-applicant to being actively recruited for my first job as a doctor. Not a single one of those bad, scary things that I lost sleep over ever happened.

I also never imagined that putting together my rank list would have been so hard. I absolutely loved my top 4 programs and was hopeful that I would Match at one of those four; but what if I Matched at the place at the very end of my list? Getting the “Congratulations” email from the NRMP on Monday lifted the fear of not Matching, but waiting four more days to hear where was nerve-wracking. Zillow was confused about why I was looking at houses in four different states.

On Match Day, we arrived at the Mellwood Arts Center early to take part in the festivities. Local organizations were sponsoring giveaways, provided food and drink, etc. The nervous energy that filled the room was intoxicating. My husband and I grabbed a table with several of my friends and their spouses as we anxiously awaited getting our letters at noon.

The last hour felt like it stretched on for ever and ever.

When it was finally time to go up and get our letters, I was a shaking mess. I held the thin white envelope in my hands and I was terrified. Would I Match at my #1? #2? #14?

When we got the go-head at noon, I ripped open the letter, took a deep breath, and looked for my program name.

“IND—

I dropped the letter, clasped my hands to my face and cried. David picked up the letter, read it, and cried too. Screams of triumph filled the room. Smiles were plentiful. Everyone at my table Matched at their #1 program!

 

We are moving back to Indianapolis! We could not be happier.

Frustration

My medical school is in a city at a boundary between two states. I live in the state opposite my school’s city. Because of this, there are lots of instances, especially in healthcare, where there are notable differences between the types of health services and execution of policies between the two states. I love my home state. I don’t agree with all of the laws and policies, but I love my home state. I don’t agree with all of the laws and policies of my school’s state either, but we have to function in a way that serves patients from both states well.

I am currently on child psychiatry and let me tell you… oh my goodness, the systemic problems are rampant. There isn’t a single child that we have had that hasn’t had at least one major problem/difficulty/delay in some form or another. These kids have some serious issues, and mostly not due to their own fault. It is so frustrating trying to get these kids the assistance they need when we repeatedly run into obstacle after obstacle. Psych is, by far, the singular specialty I have experienced that has this volume of barriers. It is unbelievably frustrating to have to hear each morning what new barriers we are waiting to overcome to give our patients the help they need.

To top things off, I overheard my attending this morning talking about the poor state of care patients from my state receive if they have the Medicaid my state offers. How my state is known for simply “not caring” about these people at all. That he is frustrated with his home state’s methodology for caring for patients, but that my home state is, despicably, even worse. It is enraging. I am so disappointed in my home state.

Disappointment isn’t enough. I want to do better for the people of my state, and every state, that has these sorts of issues. These issues are a systematic problem. There must be a way to fix these problems. That is not to say that the problems will be easy or fix, or that one particular group is responsible for the issues as a whole. As a medical student, I feel like not much that I do from day to day really matters, because at this point in my career my job is simply to learn so that I can be a great physician once I start practicing. I have a hard time accepting that I am not in a position that can make much change at this point. I have seen student-led groups reach amazing conclusions when they assemble for a common cause.

One person can’t do much alone. But if a group of passionate people with a cause work together to effect positive change…. THAT is what it is going to take to make these problems become less of a burden for the patients that depend upon the system to work for them. I want to start now. Not after I walk across the stage to get my diploma, not a decade later when I’m finally an attending, but now.

So, dear friends and readers…. how do we begin to tackle a systemic problem? How do we get those in power to care enough to be called to action? It is hard for me to see where all of the real obstacles are. These things, though, are immanently important.

HEART Article

I just have to share this article. It’s very well written, but totally heartbreaking. I can’t imagine being a parent and having to go through that with my child. It also shows that even if you’re a physician, when it’s your child, there are things you don’t know and need to turn to others for help.


http://www.nejm.org/doi/full/10.1056/NEJMp1312171

A Dream Realized

This is the beginning of a new adventure.

I was the kid who was excited to get home and check the mailbox to see if the latest issue of National Geographic had arrived.

The best week of the summer, for me, was Shark Week on the Discovery Channel.

I spent my summers chasing butterflies in the field behind our house, completely covered in chiggers, to put them in a bug box for observation while I looked up their Latin genus and species names.

I was the girl forever lost in a book.

Being the “smart kid” in a small town school is an occupational hazard. Classmates hate you when you are singled out as the “smart kid.” Teachers don’t seem to realize the damage they are doing when they praise some but not all. It makes me cringe when I see or hear it, because I know what the backlash is like as a kid.

Junior high and high school were no better. I’d say the fear of what my classmates would say or do to me was a major factor in my introverted personality that I still struggle with. Because, when an acquaintance in your class tells you to your face that he has always hated you because the teachers like you…. Well, I remember the smile that fell off my face, and I remember asking for independent study immediately after class, and spanned all four years. I withdrew within myself because I felt threatened. My senior year was the loneliest; I had one class, out of eight, with classmates.

High school was no place for me.

The teachers were wonderful, but they had to spend too much of their time babysitting certain kids to be any benefit to me. Independent study was a dream come true. I could work at my own pace to focus on my own goals. In my spare time, I edited copy for the yearbook and newsletter, as well as took on editorial positions with the literary magazine because writing was an escape for me. I would walk the hallways looking at the floor and making eye contact while talking to anyone was difficult if not painful. This is why I turned to writing; I can do it entirely on my own. I had been offered the opportunity to advance a year or two, but I declined for personal reasons. At the time, I thought that was the best decision.

Maybe I was wrong.

If I learned anything from these experiences, it was humility.

I am a very goal-oriented person. Once I made a goal chart out of colored construction paper– I would write out individual goals on paper squares and stick them to the board. Every time I achieved one, I’d take down the square and replace it with a new goal. Some were small (“understand calculus”), others a bit bigger (“graduate valedictorian”)… And some fairly lofty (“full ride to college”). Most if not all of these were achieved. I never told anyone about my goals, or my chart. I even hid the chart from my parents.

So what does that have to do with humility? When others–usually the adults, the teachers, at the time–would be happy and congratulate me, it made my life harder to live. (Of course, they never meant it that way.) When classmates and peers looked at me with glares intending for me to burst into flames, it’s impossible to be happy about my achievements. So instead, I’d keep my mouth shut. Silence seemed to be the better answer. I was known for being “quiet”, to a fault. To avoid the glares, I’d keep my nose in books.

College was such a huge relief.

Intelligence and achievement were celebrated. Talents were showcased. I was no longer an anomaly, an outlier. I could be happy in public. I could talk about the good things in my life.

But it is still hard to share my joys, even after all these years.

I know, for a fact, that there were people who giggled with joy when I didn’t get into med school the first time. I know that there are people who think I always have things “handed to me.” Because, of course, I haven’t earned anything through hard work or perseverance, right?

I am tired of hiding my joys because some people are either jealous or pessimistic, or whatever else.

Not much has changed, really. While I am not as introverted as I used to be, the people I connect with best at school are still the professors, even now. I have no idea how to explain that.

And, I am still keeping track of my goals.

For instance, today, a longtime dream came true.

My heart has been drawn to medical missions for as long as I can remember, but there has always been a barrier of some sort, either time or skills or money. Or all three.

One of the privileges of being a medical student is that you are encouraged to use your skills for the underserved. My school offers several opportunities for students to go abroad during the summer after MS1 to serve on medical missions. There was one in particular that I have had my eye on.

I’ve written before about Timmy Global Health. I love this organization and what it stands for–working with the Ministry of Health of the country to provide sustainable access to care for underserved populations. After dreaming for years to be a part of this organization, I was anxious for the opportunity to apply for one of the 20 spots to go to Ecuador next summer.

And then I heard how many of my classmates applied. For 20 spots, I heard rumors of 40, 50, or 60 applicants. So, I knew my dream may just remain a dream. But I applied anyway, prepped for the interview, and put it in God’s hands.

I cried tears of joy when I got the congratulatory email.

And of course, I wanted to share. I wanted to know who else in my class was going with me. I told my husband, my parents, and my closest friends. But at the same time, I was sad and didn’t want to share the news, because of how many people I knew were probably disappointed, and I didn’t want to rub my good fortune in their faces. Salt in the wound hurts all.

In this day and age, oversharing is the norm via Facebook, Twitter, whatever. We share what we ate for lunch (and where, with pictures, check-in’s, etc), vacations, how much work sucks… and my favorite (sarcasm), parents who share their children’s every bowel movement. It’s not just what we share, but how. The new term I overheard the other day was “the humblebrag”, bragging while trying and usually failing to sound humble. There have been so many articles and papers and blog posts about how these outlets for sharing hone our abilities to just post our “highlight reel” for the world to see, and so they are lies, mostly by omission. So, for instance, “I made this awesome dinner!” but leaving out the “I burnt it the first three times.” I’ve even read articles about how reading others’ highlight reels makes us feel depressed and inadequate. In my experience, it’s totally true! Someone else is having a great time doing X. I wish I was too. So I am immediately ungrateful for all the things in my life that are great, because I am falling into the trap of comparison. “Comparison is the thief of joy,” as the adage goes.

And so, I am sharing my good news anyway–I am so very excited that a dream is becoming reality, that a Bucket List item can be checked off next summer, that my head, hands, and heart can be used to help someone else. I hope that those not selected for this trip are selected for the other trips our school offers to Kenya, Brazil, or Thailand.

Ecuador. South America. The Amazon Basin. Galapagos. Straddling the Equator. Getting to use my Spanish skills. Actually using my newly-acquired clinical skills. New people to meet and communicate with. New problems to solve. So many new things to learn and experience on this adventure. I can’t wait!

But for now… back to studying the pelvis, the bane of my existence as a medical student.