Interview Season in Pictures

The best year of medical school is the year you are accepted. The second best year is 4th year. Or so I was told four years ago. =)

Somehow it is already Christmas Break of my 4th year of medical school and in less than 5 months people will start calling me “Doctor” and I’m actually going to know how to do stuff and know things. It’s pretty unbelievable that after so many years of wanting to go to medical school and going through the process of applying to medical school four times and thinking it would never happen for me…. I am actually almost done. It doesn’t quite feel real.

I am very happy to report that the nightmares I was having back over the summer, before the ERAS residency application opened, were completely unfounded. I have more interviews than I know what to do with and the odds are in my favor that I will actually Match in March and will have my first job as a physician come next June/July. It’s been an incredible experience, if not time-consuming, alienating, and exhausting, but a necessary evil in the long run. I have met so many incredible people in the field of Pediatrics, and I feel so lucky to be going into the best specialty! (I may be a bit biased 😉 and I’m sure all of my colleagues in other fields feel the same way about their specialty.) I can’t wait to get started on my career but at the same time, I wish this year would slow down.

Over the past several months, my Instagram feed (@PagingDrAllie) has been flooded with snapshots of the interview trail. Because what else am I supposed to do when I’m going to new states, new cities, new places all by myself for nearly three months?

I purposefully do not share where I am interviewing. Not only for anonymity (which really, in having this blog, I’m probably not doing a very good job about that anyway), but I feel that sharing and bragging about those sorts of things is just in bad taste. A program that I am not thrilled with may be a friend’s top choice and they may not have received an interview invitation…. and I’m not the type of person who relishes in others’ despair. Below I’ve gathered some of my Instagram shots from my travels, with captions. I hope you enjoy a small taste of my life living out of a rental car!

One of the unexpected bonuses of traveling so much in November/December: all of the hotels and hospitals are wonderfully decorated for Christmas (and Hanakkuh, and others), which delights my soul in a particularly special way. There’s just something about twinkle lights that makes me deliciously happy.

 

This has been my view for so long that anything else almost seems foreign. After awhile, all of the hotels just blur together. There have been a couple that have really wow’d me in terms of the bedding. As a mom of a two-year-old, having a full night’s sleep, alone, without interruptions (or being kicked in the face) is a luxury beyond belief. Even so….. I do miss my own bed at home. Once I’m actually working, maybe we can investigate investing in a bigger bed that is as comfortable as this one was!

 

The bad thing about racing home, while driving alone, is that when you’re driving into a beautiful sunset, there is no one to share the experience with. Which means you pull over onto a safe pullout/shoulder and snap a few quick shots before getting back behind the wheel and trying to make up for those minutes.

I spent a week and a half in a new state to interview at several programs, thinking that would be best for my rental car and time. What I didn’t anticipate when I scheduled those interviews was how much I’d already be missing home and my kiddo, even that early in the interview season. So the Handsome came up with a brilliant scheme: instead of coming all the way home, I’d meet him and the Ladybug at the halfway point between home and the next interview to spend a weekend doing things she’d love like swimming in a heated pool and an excursion to the Children’s Museum there. So after my last interview of the week on a Friday, I raced to our rendezvous as quickly as I could to surprise the little one and when I came into the room….. she was already asleep. Figures.

Again, racing home (or to the next interview city) and I was alone with a great sunset.

This one, though, was on my way home for a weekend. This shot doesn’t do it justice, because it was seriously one of the most gorgeous displays I’ve ever seen.

This year, I’m taking a course that explores the marriage of Art with Medicine and Wellness. One of the stipulations of the course is that we make time to visit museums, aquariums, etc to help boost our wellness. The Georgia Aquarium is one of the very, very few aquariums to house Whale Sharks, and I couldn’t pass up the opportunity to visit when I was in Atlanta. I really wish I would have had more time there!

One morning right before I left home for the majority of three weeks straight. Foggy yet golden, I couldn’t help but snap a shot to remind me of home.

Thank you notes are the bane of my existence. I was raised to express gratitude where it is due, so I’ve always been a fan of handwritten notes. I had no idea that I would be writing 4, 5, or 6 or more per program, though. Mentors have pressed upon me that for Pediatrics, thank you notes are pretty important, so I should make sure each one is personalized because all of them may wind up in my file, and if they are verbatim alike, it could be a mark against me so….. I spend a lot of time writing these things.

In one city, I came into town a bit early to catch up with an old friend from college at a local coffee shop before dinner with the residents. I wanted the chance to walk the city to get a good feel for it, and as I made my way to the coffee shot, I happened to notice the sky. This shot doesn’t really capture the cotton-candy sky, but I still liked the way it turned out anyway.

I left one program just in time to sit at a coffee shop in a different city for an hour or two before meeting the residents of another program for dinner, so I took that time to compose more thank you notes.

Niagara Falls at dusk! 🙂

Probably one of my favorite shots. It doesn’t quite look real, and this is #nofilter.

There was one interview that was really, really far away. Luckily, the Handsome could go with me and we made the executive decision to take the Ladybug with us and stop over at the halfway point, Niagara Falls. She LOVED it, and I am so glad that we weren’t deterred from bringing her with us. The first thing she said was “Whoa!” which was quickly followed by, “Mommy! BIG WATER!” All three of us marked off a couple new states and this little one got to add a new country to her passport as well!

I never knew the northeast was so pretty, even in late autumn! One thing I didn’t get to take a photo of: while driving through the mountains I saw where a semi took out the biggest black bear I’ve ever seen. So sad!

On the very first morning where I was supposed to be traveling to an interview, I went out to our deck for some meditation before beginning the long drive. It was so peaceful until the small flock of geese came by to interrupt me. Not a bad way to start out an interview season, I think.

I am almost done with my interview season. Some of the advice I got from last year’s graduating class were to wrap up the interview season before Christmas break, but that didn’t work out for me. I’ve been on a ton already, but I still have 5 more in January, and I am really excited for those programs. I’ve been keeping a running “rank list” and my top 5 are very clear in my mind already, programs that I loved to pieces. I’m hoping a few of my last interviews also make it into that category.

Rotation: Inpatient Neurology

Name/Location of Clinical Rotation

Inpatient stroke at our local stroke center/Inpatient General Neurology

What did I like most about this specialty?

It was pretty relaxed. I got to spend a lot of time with my patients, and there was a lot of time to think and research things for my patients.

What did I like least about this specialty?

There were some really sad stories, and what I didn’t like about Neuro was that a lot of the time, the patients never got better; at best, we might halt or slow a disease process, but we didn’t really fix anything.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I was on inpatient stroke/neuro consult and had my ED experience, which gave me a lot of unique experiences. I enjoyed that part, and I feel like I got a view of a large scope of that sort of practice.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I liked that I got so much time with my patients, but it isn’t the right specialty for me. It did not click at all.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There’s inpatient, outpatient, and subspecialties in stroke and lots of things that I didn’t know about prior to this rotation! I feel like I got a good view of them, but I don’t see myself pursuing neurology. Right now my list is: IM>Neuro>Surgery, but I’m only on my third rotation!

What info do I still need?

None–I feel like I saw enough and got a good enough feel of it to know that I am interested in looking elsewhere for my specialty selection.

Has my perception of this specialty changed? If yes, how?

I learned a lot on this service. I really sucked at localizing lesions in the beginning, and with the neuro exam encompassing so many steps, I was always nervous performing a total neuro exam in front of my attending and residents. I felt like I had a good relationship with many of my patients. I still wonder about some of them, how they are doing. I do have a much higher respect for the specialty now.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

Now that I’ve gotten a chance to really see what working in neurology is like, I do not think I will be selecting it, but it has been a positive experience.

Right now, how interested am I in this specialty?

IM>Neuro>Surgery at this point.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Some of these patients were so sad. I tried to give my patients plenty of time to complete the MMSE exam, but it was frustrating to them as well as me when they tried so hard on this silly set of tests and sometimes could just not do them no matter how hard they tried.

Psych so far

My last rotation of 3rd year is Child Psych, and let me tell you, it is so much different than everything else I’ve done this year, in good ways and  not so good ways.

The unit is a locked unit, with multiple doors and multiple keys. All trash bags in the unit are paper bags, not plastic. Most rooms with showers don’t have shower curtains. Since most of the kids are school-aged, there are school sessions throughout the day so that they aren’t counted as truant. There is art and music therapy. There is a schedule that is followed every day so the kids have to get up at a certain time, have showered by a certain time, etc.

We start out the day with table rounds at 8am (no pre-rounding). We then go see the kids before art/music/school/drama/the daily activity and go to any family sessions that are scheduled. I think write my notes and we’re usually done by noon or so. Lectures/Grand Rounds/Journal Club is in early afternoon, sometimes from 11-3, depending on the day. In the afternoons, three times a week, we have a clinic. We are either in the child clinic, the suboxone clinic, or the bipolar clinic. Those days can stretch out for a really long time.

During this rotation, we also have three “on call” days in EPS, Emergency Psych Services, and I’ve done all three of my calls. It is so much different than what I’m used to seeing in the day.

There are now only two weeks of third year left. Just two. I don’t feel like I know enough to be a 4th year medical student, but it is coming soon regardless.

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.

Sometimes, There are Just No Words

There has been radio silence on this blog lately. I’ve tried writing this post several times and just can’t seem to do it.

Surgery was a very rough rotation for my family. It wasn’t just the change in schedules because a normal day was 5am to 5pm for me, with call days being 5am on call day through at least 8am the following morning. When I was home, I was exhausted. Part of the required assignments was completion of online video modules; on more than one occasion, I literally fell asleep on top of my laptop doing the modules. That is just the nature of this particular rotation–it was exhausting, but the majority of the time I was still having fun, even if I didn’t see myself going into surgery.

There are just some things that you can’t prepare for. My strategy for the surgery rotation was to keep my head down, work hard, be helpful, and move on. I didn’t think I wanted to go into surgery, but I was looking forward to the experience and learning a lot.

On the night of Memorial Day, David got a phone call. From his mom. Which wasn’t exactly unheard of, but this time things were different. My father-in-law was diagnosed with small cell lung cancer in July, and he was going downhill fast. After a couple of hours of panic at the sudden change in status, the ventilator was withdrawn. With the diagnosis, we knew there wouldn’t be much time, but we were not prepared for this so soon. This happened after midnight and I was due to get up at 4am to be in the hospital before 5am to see my patients. I still went into work that day, because 1) short notice 2) there was nothing I could do for my family as we were all in shock and 3) I deal with grief better when I am busy. That was the first time I have ever thought that I really didn’t want to spend time in the hospital on a particular day, so it was quite unlike me.  I did let my clerkship leadership know, and they did let me take off a day to comfort my family and help with the arrangements. The funeral was on my post-call day, so I didn’t need any extra time off for that. I am not the type that likes to ask for help, or likes to have special arrangements made, but this was one time that it was nice to have supervisors that were understanding. The situation put me into a mental funk that I still don’t think I have recovered from, on top of still having some guilt for missing a day of work–I totally felt like a slacker even after I made up the time and assignments.

The most difficult part, though, was being home. My father-in-law was a good man, and I loved him, but I’ve only known him for 6 years. It was much harder for David, and I didn’t feel like I was doing a good job of comforting him when I spent so much time away. This is why I feel medicine is a tough profession for families–the perception is that time away is weakness (especially in surgery). Many people have asked me how I balance being a mom, wife, and med student. Most of the time, it’s not too bad, because I get to do so many of the things that I love on a daily basis. However, there are plenty of instances where I feel like I have stretched myself too thin. This was one situation where I definitely felt like there just wasn’t enough of me, or enough time, to go around.

There were a few other things that happened during my surgery rotation that were beyond my control, and that are beyond the scope of this post, but I have learned from them and moved on. This particular rotation was Murphy’s Law for me… everything bad that could have happened, did happen, and happened at the worst possible time. I haven’t really felt much like writing/blogging since, especially about this topic. After several weeks, I am just now getting back to feeling like I know what I’m doing again, and with that, comes the need to write.

Rotation: Internal Medicine Wards

Name/Location of Clinical Rotation

IM wards (4 weeks) at our local University hospital.

What did I like most about this specialty?

Establishing a relationship with adult patients. Several of my patients gave me nicknames and would at least be happy to see me in the mornings. That, to me, was a great compliment. I also really enjoyed the hospital environment and even having call days where we’d rush down to the ED–it was so exciting! I also liked that we could do procedures. At the end of a call day, right before we were all getting ready to leave, we got a call from the ED about a patient that needed a paracentesis. The intern on my team passed on the opportunity, so my upper level asked me if I would like to do it…. and of course I said yes! So I got to do the full work-up: H&P, informed consent, and the procedure. That day, I really felt fulfilled. I know that in my future career, I do want the opportunity to perform procedures.

Plus, my team rocked. It always helps when your teammates encourage you and are enthusiastic about teaching. I think that’s another reason why I loved my month on inpatient wards.

What did I like least about this specialty?

In Kentucky, we see so much obesity, diabetes, and heavy smoking… and the consequences… that it can be draining to give the bad news about a person’s health. Giving the bad news is not fun. At times, patients were even upset with me and/or the hospital because of the bad news. Learning to apologize and learning to communicate with people despite bad news was a learning opportunity in and of itself.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I really think that it does, apart from not really seeing what adult outpatient medicine is like.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I feel like they do–lots of work one-on-one with patients, and I felt like I got enough time with them that I wasn’t rushed. In the long-term, though, I’m not sure if the IM I’ve been exposed to has enough community involvement and advocacy/outreach that I’m wanting in my future career. That would take more investigation.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There are so many opportunities in IM that it’s no wonder that most students apply to IM residencies. General outpatient, hospitalist, subspecialist… there are so many options and so many fields! I don’t think that two weeks on subspecialty was enough for me to make a decision about what type of medicine I’d want to practice long-term, but it was nice to get to see those things as well.

What info do I still need?

None. I feel like I got a well-rounded experience and that I understand the work and workload of what it would take to be a successful IM resident.

Has my perception of this specialty changed? If yes, how?

Yes! I was honestly dreading working with adults, but I loved getting to spend time with my patients. I didn’t really think IM was on my radar but now it at least has a chance.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I found that I really enjoyed working with adults more than I thought I would. I felt like I had great rapport with most of my patients, and I never once thought that I didn’t want to go to work that day.

Right now, how interested am I in this specialty?

Being my first rotation, I didn’t really have anything to compare it to, other than the two two-week subspecialty rotations I’d had. However, I am keeping IM on my list of choices; I definitely think I could be happy working as an internist.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Our rotation gave us a lot of exposure to this field, and I have to say, I loved it. Also, working in more than one hospital gave me exposure to working with more than one EMR/EHR which I thought was a valuable experience.

Things I did not expect: We encountered a LOT more heavy drug users/OD’s and inmates as patients than I anticipated. And I was surprised by how at ease I was with working with them–even if a patient came in in an orange jump suit, giving them the best care I could muster was the same as I would give to any of my patients. I was also pleasantly surprised by how my assumptions were challenged by some of our patients.

Resources I used to study for the shelf: Step Up to Medicine and Case Files: Internal Medicine. This was a LOT of reading and a LOT of work to do during my first rotation while I’m still trying to figure out exactly what my role is as a third year medical student. I really wish I would have front-loaded my study time, as I didn’t get to read all of Case Files or Step Up. I didn’t even finish all of the UWorld questions in Internal Med (which has the most questions on the Step 2 Qbank). So I performed ok on the shelf, but I was disappointed in myself. Lesson learned.

One Week to Go!

I take Step 1 in one week. In all honesty, I will be so thankful to have it over with. Seven weeks in study isolation with my falling-apart copy of First Aid (minus my time spent on DIT videos… that’s social interaction, right?) have nearly driven me mad. Especially when we have had some gorgeous weather (so I’ve been told…) and I haven’t left my study area in that timeframe. When I do get a quick chance to run to the store, I feel like I don’t know how to interact with society….

I did take one day to get all of my paperwork done for the VA (I was hoping that my old VA paperwork would transfer from Indianapolis to Louisville, but I was out of luck there and had to redo all of it), even though I didn’t know if I would even be spending any time there on rotations, not having our schedules yet…. which turned out to be a good thing, because this week I got a very short list of my schedule for my first rotation! I will be starting my Internal Medicine rotation at the VA, two weeks on Cardiology and two weeks Infectious Disease! Those were my top choices for the elective month of my Internal Medicine rotation, so I’m pretty excited. The second month of my IM rotation is at University Hospital where I’ll be on wards (I’m not even 100% sure what that means). My first rotation starts one month from today! I’m really hoping for great experiences on this first rotation as a third year medical student, as I figure out how medicine works in a real setting, all day every day. How is it possible that my first two years went by so quickly?!

So that is a quick update from me. One week til Step 1, one week and two days until we celebrate a special girl’s first birthday, and less than 3 weeks until we take our longest family vacation ever. I cannot even tell you how excited I am that this is almost over and I get to spend some time with my family in the mountains again.

Back to studying. #CrunchTime #FinalPush #JustKeepSwimming