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

Year in Review: 2014

Following the sappy trend of reflecting upon the wonderful year that was 2014, below are my responses to 50 questions about the last year and looking ahead to the next:

YOUR 2014

1. What one event, big or small, are you going to tell your grandchildren about?

This was the year we welcomed our firstborn. This is the year we will never forget.

2. If you had to describe your 2014 in 3 words, what would they be?

Studying, sleepless, blessed.

3. What new things did you discover about yourself?

That I am capable of much more than I imagined, but also that I need to scale back some things…. sure, I can kill myself through working too hard, or I can relax a bit and be much happier and much more fulfilled. I’ve discovered that I rather like the latter these days.

4. What single achievement are you most proud of?

I am really excited that my writing is seeming to take off. I’m excited to see where that trail leads. That was always a huge dream of mine, and to have an outlet like in-Training to share my work, and even have an article picked up by Student Doctor Network was a huge accomplishment.

5. What was the best news you received?

That Ladybug is healthy. 100%, perfectly healthy. Having to go through both Medical Embryology and Biochemistry/Genetics while pregnant is not the best idea… you learn absolutely every tiny thing that can possibly go wrong. It turns out that hearing about such awful things like holoprosencephaly and the mucopolysaccharidoses makes you think that it’s inevitable that your growing baby will likely have one of those horrid things.

6.What was your favourite place that you visited in 2014?

When we went on our road trip to Galveston in April so I could present my research at the UTMB conference, we side-tracked on our way home to visit, for the first time, our long-lost friends who live in Louisiana. That has to be at the top of my favorites list, since we didn’t get to travel as much as we’d hoped, and this was a bonus state and bonus layover with great friends (who selflessly gave this 8-month pregnant lady a warm, comfortable bed for a great night’s sleep).

7.Which of your personal qualities turned out to be the most helpful this year?

Hands down… perseverance.

8.Who was your number one go-to person that you could always rely on?

David is my hero when I need one, my comedian on occasion, my travel buddy, my partner in crime, my co-daydreamer… my other half.

9.Which new skills did you learn?

I learned how to really use my stethoscope, and I’ve been practicing with heart sounds. I know this sounds extremely nerdy and not very useful in the long run, but since the sounds are difficult for me to hear correctly, to me, it’s a big accomplishment to gain this skill.

I am also much, much better about keeping my mouth shut these days. It’s really hard to do around friends who are anti-vaxxers or when friends and family members ask me questions about their health, but I’m learning discretion in my remarks. I have a feeling that this will be a very valuable skill.

10.What, or who, are you most thankful for?

I can’t just say one person and do justice to anyone who has helped me through the past year. David was my hero every day of my pregnancy, and my parents help us out so much now so that I can continue to pursue my dream. Dr. H, Dr. F, Dr. B-C, Dr. T, G, A, and Dr. C were all instrumental in helping me finish my first year strong. I couldn’t have done it without all of these lovely people.

11.If someone wrote a book about your life in 2014, what kind of genre would it be? A comedy, love story, drama, film noir or something else?

It would have to be a comedy. Me, waddling everywhere for half the year. Me, sleep deprived ^1000th degree. All of my mishaps in first year and the first few weeks of Ladybug’s life. Yep, a comedy.

12.What was the most important lesson you learnt in 2014?

How much I value calm, relaxed days at home. I used to be such a busy-body. Now I value my time to relax, regroup, focus, and rejuvenate so much more. I realize that I have to make time for myself, and it’s ok to ask for help–even if I just need a morning to sleep in and have one of the “aunts” come over to babysit. Calmness, the need for less “stuff” and more memories, is something that I have appreciated even more this year, and I’m ready to start downsizing and enjoying life more than stuff and clutter and tasks. Downsizing will be good for the long run as well… looking ahead to moving for residency.

13.Which mental block(s) did you overcome?

There were several times where I thought that I couldn’t do this…. “this” being, being pregnant and a student. When I got to the point where I got overwhelmed when I was slow to get ready in the morning, couldn’t tie my own shoes, and had trouble with getting winded just walking to class, I wanted to give up. That was really tough. I’m so glad that phase is over.

14.What 5 people did you most enjoy spending time with?

Aunt Sherry and Uncle Mike; David; Ladybug; and the other Aunt Sherry. All people I either take for granted, don’t get to see often, or enjoy down-time with.

15.What was your biggest break-through moment career-wise?

When I realized that I really was made for this. Every time I get to see a patient that really sticks with me, I am so glad that I chose this path, and this path seemed to also choose me. I am always amazed by how many things there are to do with a medical degree, and I am encouraged that all the things I want to do, eventually, I will be able to with all of these skills.

16. How did your relationship to your family evolve?

It became much stronger. I am ever so amazed by the intense love my parents feel for my child, and we have grown much closer with her arrival.

17. What book or movie affected your life in a profound way?

I grew up watching the 1980’s cartoon version of The Hobbit. When I was a bit older, I read the Tolkien books. And now, the cinematic adaptations have come to an end. While they’re not dead set on the book plot, I love all of them, all 6. But seeing the last Hobbit movie, The Hobbit: Battle of the Five Armies, was harder on me than I had predicted. Now that they are over and there are no more to look forward to seeing, it feels like a bit of my childhood has died, and this makes me immensely sad.

18. What was your favourite compliment that you received this year?

That my daughter is a great baby. I know this sounds totally cliche, but it’s true. The whole time I was pregnant, I was hoping she would be a happy and healthy baby. The first 8 weeks were the hardest part about being a mom, because I’m learning how she likes things, and she’s learning to cope with being on the outside. It was really, really rough for what seemed to be a long time. But in all honesty, she’s a great baby. She hardly ever cries; she gets fussy when she’s hungry, or sleepy, or needs changed. That’s it. We’ve gone out to dinner with family and friends, and no one can believe she is already as well-behaved as she is. I prayed so hard during my pregnancy that she wouldn’t have colic and that she’d be a calm, happy baby.

19. What little things did you most enjoy during your day-to-day life?

Once Ladybug goes to bed and I can have some quiet time with David. Everything is always so busy… and I’m of the frame of mind to “quit glorifying busy-ness”. It’s nice at the end of the day to relax and remember who we are as a couple, not as parents or employees or students, but as “just us.”

20. What cool things did you create this year?

I am working on a project for Ladybug’s room: a travel map of everywhere she’s been. It’s not done yet, but I love this little project and I hope we instill a love of traveling and adventure in her as she grows up.

21. What was your most common mental state this year (e.g. excited, curious, stressed)?

Worried. Ever so worried. Worried about how I’d survive the semester pregnant… worried that what if I had to repeat the year, or needed to take a leave of absence… worried that maybe she wouldn’t be healthy…. worried about how my relationship with my husband would change… worried about how I would juggle school with being a mom… worried that I’d made the wrong decision and should have taken the year off… worried that I wouldn’t be a good wife/mom/student. Always so worried, with no need to be!

22.Was there anything you did for the very first time in your life this year?

Of all the things I could choose, I’m going with this one: observing an autopsy. Hats off to the pathologists who have a stomach for this endeavor. While I was fine with the physical work that was involved, as I learned more about the case from the coroner, the more I did NOT want to know… and I think the “knowing” about these cases, and having to testify for cases as part of my job, would wear down my soul. I firmly believe that forensic pathology is out of the question for me. I cried on the way home that day–the case was just too overwhelming.

23. What was your favourite moment spent with your friends?

Taking Ladybug to see one of my best friends for the first time. This friend likes her dogs more than she likes kids, but she took right to Ladybug and I’m pretty sure the love was mutual.

24. What major goal did you lay the foundations for?

For a long time, I’ve wanted to be a runner. Even when I was in the best shape of my life in high school running track, I was mostly a thrower–discus and shot put–and running has always been a challenge for me. I do not have the hips of a runner… but I’ve wanted to overcome that and start to actually enjoy running. While we lived in Indianapolis, I convinced (conned?) David into running a 5k with me (The Color Run), which was tons of fun, but my goal was to run a mini marathon. My dad started running several years ago, and has run 7 mini’s. If he could do it, I could too. So we trained, and we finished! That medal is something that I’m extremely proud of. But it’s not enough. Not long after, I started school, got pregnant, and couldn’t run the second mini I had already signed up for. (Dad couldn’t run it that year. So I wanted to finish it, 7 months pregnant, with a shirt I made that said “For my Dad… (and my grandpa!)” and present him with the medal. But this was not to be. At 7 months pregnant, I could barely waddle from the parking garage to campus, less than a mile.) So my goal is to run the Derby City Mini Marathon in April of 2015, with hopes to keep running after that. I’ve recently found out about the St. Jude Children’s Research Hospital mini marathon, and a series of races in the national parks that I really want to participate in, in the future.

25. Which worries turned out to be completely unnecessary?

Worries are always, always, always unnecessary.

26. What experience would you love to do all over again?

The holidays with Ladybug for the first time. Sure, she won’t remember it, but since she means so much to all of her family members, their reaction to her was my favorite thing about the holidays so far, and I’ve really relished it.

27. What was the best gift you received?

I don’t want everything to tie into having a baby, but she is definitely the greatest gift… I am also so thankful for our health, insurance, family and friends…. but if I have to pick just one gift that someone gave to me this year, I would have to say that the luggage tag that David made for me, custom with one of his photos from our roadtrip vacation to Glacier National Park, is probably my favorite.

28. How did your overall outlook on life evolve?

I have discovered what I want my long-term life to look like. It seems like so much of my life has been working toward just getting to the “next step”… high school, college, med school…. or just making it from exam to exam. Now, though, I’m learning what I want my life to look like when I am–finally–working. (I miss working.) I don’t want my child to feel neglected. I don’t want to keep my focus on the “next step” of climbing rungs on a ladder. I’m the type that is a badass at her job, uses all of my vacation days to their fullest, and strives to be happy. I don’t think I would do well in hospital administration or any type of work where climbing the ladder is expected.

29. What was the biggest problem you solved?

The biggest problem that I needed help with, especially once the semester began, was how to manage my time most effectively so I could save time, be less stressed, and make as much time as possible to spend with family. It was a learning process, and took awhile with trial and error to get down to a science… Now that we have our routine, I can study effectively when I need to focus, and once I come home I can relax and not worry.

30. What was the funniest moment of your year, one that still makes it hard not to burst out laughing when you think about it?

David made the mistake of telling me that his mind is a colander, and this has definitely came back to bite him on several occasions. This has made me burst out laughing many times, but I guess the story is only funny if you were there at the time.

31. What idea turned out to be the best decision ever?

Using my “last summer ever” as my maternity leave. I was uncertain about what this would mean for my career, but I’m glad I had that time at home to recover and focus on myself and my family instead of worrying about how a few weeks would affect my entire, decades-long career.

32. What one thing would you do differently and why?

I would not listen to the hospital staff about breastfeeding. The best advice I got came from another OB in the group practice that came to see me when mine had the day off–and he was male! I stressed out so much over breastfeeding in the beginning, something that is supposed to be natural. In the long run though, I think it’ll make me a better doctor because I know what it’s like to be in a tough situation as a brand-spanking-new mom with a brand-spanking new baby who are both learning how to fill those new roles. And, note to self: if I’m ever in a private practice pediatrician’s office, hire a full-time lactation consultant, and don’t rely on nurses for such services.

33. What do you deserve a pat on the back for?

Continuing with M2 without taking time off. I’ve wondered if I made the right decision many times, but pursuing this so I can graduate on time and move on with life has been a great decision for us, even though it has been much, much more difficult than I had imagined.

34. What activities made you lose track of time?

Showing Ladybug the world… reading to her, watching her learn and play. She’s such a smart baby already, and curious about everything. The days of breaks go by so quickly now that we have her.

35. What did you think about more than anything else?

Vacations and trips. I have had intense travel fever for about a year. When I was working full time, I could go about three months before I needed a trip somewhere to clear my head–even if it was only an extended weekend. I tend to feel better about myself and am able to focus better if I have had a trip somewhere new.

36. What topics did you most enjoy learning about?

Over the past several years, I’ve started following blogs written by medical students all over the world: Canada, South Africa, the UK, Australia, the Philippines, etc. I love learning about all styles of healthcare and medical education. What I find to be endearing is that even though the countries are different, the systems are different and the curricula vary dramatically, is that we are all going through a lot of the same things as we grow as physicians-in-training. It’s nice to see other students’ lives and how we manage all of the stress, the unknowns, and life outside of medicine.

37.What new habits did you cultivate?

I am not an optimist by nature. I tend to always think about worse-case-scenario first… and my lifelong motto has been “always be prepared.” So this year I have made a conscious effort to be an encourager. This academic year is stressful by nature, with the constant reminder that Step 1 is just around the corner. I don’t like seeing people so overly stressed when we are already pushed to our limits. Simple things, such as a smile or a hello or a complement, can really turn someone’s day around. I try to do that for everyone, every day. It’s made a difference in me as well; I’m not nearly as pessimistic as I have been in the past.

38.What advice would you give your early-2014 self if you could)?

I would tell myself not to worry so much. Lord knows I worried way too much about how things would turn out with having the baby and then going back to school. It all has worked out far better than we imagined.

39. Did any parts of your self or your life do a complete 180 this year?

The things that I worry about, and even worrying itself. There are some things that I used to care a lot about that now, I simply don’t have the time for, and letting them go has made me a lot more stress-free.

40. What or who had the biggest positive impact on your life this year?

Dr. T has played a huge role in my school life, and she’s been a key player in formulating what I want my future career to look like. She also has a family, so she is a great mentor.  I hope I can adopt her outlook on life. I have never, ever seen anything but a smile on her face. Her husband is actually in the first year class this year, so she understands a lot about what is going on in the lives of students.

YOUR 2015

41.What do you want the overarching theme for your 2015 to be?

Learning/Leading/Random Acts of Kindness

42.What do you want to see, discover, explore?

I am dying to get back to the mountains. Being in nature and not thinking about school or work does a wonder for my mind. I can’t wait to go back.

43.Who do you want to spend more time with in 2015?

My baby girl. I love her so much. She is growing so quickly and let me tell you, this kiddo is already so smart. I cannot wait to take her to the Smoky Mountains for her first birthday, to teach her all about hiking and exploring. I can’t wait to see how much she continues to grow and learn from now til then.

44.What skills do you want to learn, improve or master?

I still want to learn medical Spanish so I can optimize my time with patients. I’d still like to get better with suturing. I really, really hope that I can work my way up to being an avid runner. I want to be a great mom. I hope I grow in Christ, and love my husband well. I want to get back into yoga again, and improve my own health overall. I hope to start reading more for fun instead of just studying or avoiding fun reading. Improving my SOAP notes and clinical knowledge and experience are always high on my list.

45.Which personal quality do you want to develop or strengthen?

I want to continue to strengthen my generosity. Since moving home, I’ve had less opportunity to serve the homeless in my community like I did in Indianapolis.

46.What do you want your everyday life to be like?

Happier. Sure we’re more stressed because Step 1 is approaching, but there is no reason we shouldn’t still be having fun while in the preclinical portion of our medical education, the very last year that we’ll ever be in a classroom.

47.Which habits do you want to change, cultivate or get rid of?

My laziness. I’ve been so lazy this year. The habits that I cultivated while pregnant (take it easy!) have persisted and I’m working on getting back to the before-pregnancy mindset and being more active.

48.What do you want to achieve career-wise?

1. Get a great score on the USMLE Step 1 so that when it comes time to Match, I don’t go without a job, and hopefully we wind up somewhere that all 3 of us love.
2. Solidify my global health research project.
3. Spend more time in the NICU–I really miss those tiny babies. I have much to learn from them.

49. How do you want to remember the year 2015 when you look back on it 10/20/50 years from now?

It is my hope that 2015 will be the year I gain more confidence in my clinical skills, and sets me up well for my first job, residency after graduation.

50.What is your number one goal for 2015?

KILL STEP 1. This “silly summer quiz” has taken over so much of my life and my friends’ lives, and it has such a huge influence on what we can do for our careers and where we can train, that I cannot wait to get it over with… and hopefully have a score that reflects competence, hard work, and dedication.

Summer Plans

Friday was Match Day 2014, where MS4’s find out where they will do their intern year/residency for training after medical school as newly-minted physicians. This was the first year in the past three where I haven’t spent it with MS4s and shared in on the excitement; I really missed being able to share that with my upperclassmen, but we had two graded in-class assignments that day… *sigh* It never ends.

I cannot wait for my own Match Day in 3 years. It’s blowing my mind that we have only 8 more weeks of this academic year before my last summer free. This year, although has seemed long, is wrapping up very quickly.

And now, for the good news. A summer program that I applied for finally emailed me back with an answer I was hoping for: I’ve been accepted, AND I “matched” into my first choice! After everything I’ve been through lately, I think I’ve finally made up my mind about what I want to do with my summer with all of the acceptances I’ve received. My school runs a summer program that is fairly unique, called a Pediatric Externship that is conducted by the Department of Pediatrics. We had to fill out an application (with essays) and rank 11 different departments. The selected students spend 4 weeks acting as a part of the medical team with patients, learning how to present on rounds, practice taking H&Ps and writing SOAP notes with attendings’ inputs. There was a lot more interest in this program for this summer than in years past, so it wasn’t a given that those who applied would even get a spot, let alone one of their top choices. I ranked Neonatology, Heme/Onc, and Infectious Disease as my top three. It now looks like I’ll be spending the first month of my summer with the babies in the NICU! I am so excited! This way, I can have some fun and do something that I want to do (while doing something useful for my CV), and still have plenty of time to relax on summer break before the baby arrives.

There are so many days where I feel overwhelmed, stressed, and like I’m barely staying afloat… and then there’s the days where I feel like I’m competent and things just might work out the way I hoped they would. Sometimes it’s hard to keep the bigger picture in focus. Now that I have some clinical experience to look forward to, that is directly aligned with my career and research goals, I get a second wind and am reminded why I signed up for this in the first place.

Win Some, Lose Some

Highs and lows, highs and lows. Things come, things go. It happens. Roll with the punches, celebrate the highs, etc etc.

I’ve been saying it a lot lately… A LOT… but, cast your net wide, and you just might catch a fish or two.

A fish or two. Not all. I wouldn’t know what to do if I caught ALL of them.

But there’s still a sense of disappointment that comes with not catching them all, even if I already know that that is not the goal.

Lately, it’s been a toss-up; some things that I thought had my name written all over them wound up not coming to fruition, which is just fine, though the disappointment persists. And yet, there has been some good sprinkled in, too.

It’s been a very packed week, given that it’s Spring Break and supposedly a calmer week than usual. I’ve been accepted into one summer program, placed at the top of the alternate list for another, and rejected from three, all while two more applications are currently pulled up on my laptop screen and I’m still waiting to hear back from almost 20 more programs.

Or maybe, just maybe, I’m overreacting to the email we got from one of my advisors about how tough it is to get a residency spot these days, in all specialties (even the “uncompetitive” ones). Maybe, just maybe, that one little email has elevated my anxiety for no good reason. Either way, it’s still toying with my confidence, and I am not a fan of that.

Baby Steps

To me, the perfect job would be:

Seeing patients on a daily basis (hopefully, as a neonatologist); sitting on a bioethics committee; teaching fellows, residents, interns, and med students; giving talks on my areas of expertise; conducting basic science and ethics research; working on public health and policy projects; working in global health; and writing/publishing articles and books about my work.

Yes, that’s a lot. But, I’ve always been the Queen of “And.” One of my mentors told me, eons ago, that “You CAN do it all… Just not all at once.”

But, I’ve got to start somewhere.

Recently, I’ve had an awesome opportunity fall into my lap.

Although I’ve mentioned before that SDN can be a lot of hassle if you just read the premed forums, the articles that they post have been very informative and helpful. I’ve saved and printed several of them for future reference. While I’d love to be able to write helpful articles like that, I never thought I’d get the chance to do so, not even knowing how to get started to search out an opportunity like that. Until now.

I’ve accepted a position to serve, on a volunteer basis, as a member of the Student Doctor Network Editorial Board.

As such, I’ll be reviewing and editing articles for content and relevance for publishing on the site, as well as writing articles myself.

I’ve got to start somewhere. =)