A fond farewell

Cross-posed on Dose of Reality

I’m writing this now from San Francisco, sitting on an air mattress in my new apartment, with the dog curled in a packing blanket that I also used as a comforter last night. We’ve spent the past four days traveling across the country to arrive in our new home. Some highlights from our trip:

• Our route took us through Michigan, Indiana, Illinois, Iowa, Nebraska, Wyoming, Utah, Nevada, and California. This totaled 2,358 miles over 35 hours of driving time.
• The cats were supposed to be constrained by a pet barrier to the back few feet of the minivan we rented to make this journey. They figured out how to climb over it within minutes, and spent the remainder of the trip free-ranging throughout the van, in particular enjoying cuddling in Walter’s bed. You can see the barrier standing uselessly in the background of the photo...

• We stopped in Des Moines, IA on the first night to see my grandmother (and accept her generous hospitality, having invited me, Mike, Lynn, the cats, and the dog to stay with her). I hadn’t seen her in years, and it was wonderful to catch up.
• There are Whole Foods stores approximately every 9 hours along I-80. Lynn did a pretty incredible job finding places for us to eat along the way that would accommodate our various needs for tasty vegetarian and gluten-free food.
• We had one pretty remarkable Google snafu that led us to an interesting off-roading experience in the minivan. We ultimately found the relaxing State Recreation Area we’d been looking for (about 12 miles up the highway), but only after about 40 minutes of harrowing round-trip craziness and then an easy jaunt down the interstate. We actually passed several ATVs, who looked at us with a level of incredulity I had not previously experienced.

The beautiful two-track road...

The van after our adventure...

For those of you who have been following me on the Dose of Reality site, thank you for your lovely support throughout the past eight years. I hope you’ll consider adding this link to your favorites, and continue to follow me through residency. For the rest of you, stay tuned for the further adventures of one Dr. Andrea in SF…

And then we came to the end…

Cross-posted on Dose of Reality

Believe it or not, my last real day of medical school was Friday. I finished all of my exams for OB/GYN Boot Camp (which was the most fabulous last rotation I could have imagined), and now I just have a month of vacation before I graduate. The phrase “and then we came to the end,” which I used to title this post, is the title of a book by Joshua Ferris that I read a number of years ago, courtesy of the free book room at Borders, if I’m remembering correctly, which chronicles the end of a company as employees are laid off, and moral falls. I keep thinking of it, in relation to medical school, because a few of the characters get a little crazy with the stress of the uncertainty of their fates. I suspect it’s clear why this seems to relevant to my life right now. Despite having checked a number of things off of my list over the past few days (i.e., finish exams, give conference presentation, buy chips and salsa so that Lynn does not go into withdrawal when she comes home today), everything still feels pretty up in the air. As annoying as I find the “Keep Calm & Carry On” memes, that is, in fact, the mantra I keep repeating to myself. Here is a paragraph I posted in 2007, as I was finishing my second year of medical school:

Remember riding on the merry-go-round at the playground when you were little. And you’d hold on so tightly as your parents or friends spun it as fast as they could run, terrified that you’d lose your grip and fly off into the hard ground. Remember how you smiled as you screamed, loving every minute of the terror. And then, remember how gentle it seemed as the merry-go-round slowed to a delicate spin, how calm you felt as your heart slowed, your eyes adjusted to the gently revolving world, no longer a blur. Finally, remember how unsteady your legs felt as you climbed back onto steady ground. Now imagine that the merry-go-round spun until you felt sick - that it wouldn’t stop even when you started crying instead of laughing.

It’s amazing how little has changed, how frequently over the past eight years I’ve felt like I was hanging on for dear life, just hoping it would all slow down soon. Despite the impressively high amplitude of fluctuations between the ebbs and the flows, I’ve loved it, and will certainly be a bit nostalgic as I walk across the stage in another month. For the next few weeks, however, I’ve got a lot of things to catch up on, so, much to my chagrin, I’ll keep calm, and carry on.

Matched… and then…

Cross-posted on Dose of Reality

As some of you have heard, Match Day is over and I’ll be heading out to San Francisco to start my OB/GYN residency at UCSF in June. It’s hard to believe that the day is past, and no one really said what we could all anticipate after Match Day itself. Some had hinted that it was somewhat anticlimactic, but I didn’t find it to be that. Finding out where I would be living in just a few short months was nothing short of exhilarating, to say nothing of sharing it with so many important people in my life. Confirming that I’d be leaving the University of Michigan after 12 years here was monumental. What have been odd are the days that have followed. All at once I have nothing to do and so much to do. It’s too early to find an apartment, but too anxiety provoking not to peruse the SF Craigslistings; I don’t have any of the paperwork I need to sign yet, but I know that it’s coming and will need a quick turnaround; I don’t have the energy to really focus intensively on academic work, but there are so many things I’d like to get done before I graduate. I know it’s only been a few days, and it is all starting to settle into place, but I’m getting the sense that this is only a beginning.

Sometimes it’s hard

Cross-posted on Dose of Reality

I’m in the midst of my emergency medicine rotation right now - my last real clinical rotation of medical school. I didn’t save it until the end intentionally, and I was a little worried about how burned out I’d be during a rotation that included night shifts and an unpredictable schedule. This turns out to have been justified. Now that I’m safely on the other side of a cluster of 3PM-midnight and 11PM-7AM shifts, I am feeling better, but the last few weeks have been really rough. The biggest challenge, however, has not been the schedule. The disaster that is my sleep schedule pales in comparison, as the most difficult aspect of this rotation has been the intimate partner violence. Little has made me feel more powerless than the women* who have been bruised and beaten by their partners. They come in to the emergency room because of pain that won’t go away, because of unborn babies that have them worried, and because of risks for disease they can’t ignore. They leave with medical assessment, reassurance, and treatment for these things, but to be honest, I’m not sure whether they really get what they need. I say I’m not sure, because I’m embarrassed that I’ve not taken the time to find out whether a social worker sees them, or whether they are given references for shelters or other resources. I’ve been too overwhelmed by assessments of the pain, ultrasounds of the babies, screening for disease risks, and, most of all, the management of my own emotions, to get much past the emergency care they ask for explicitly.

We talk about intimate partner violence during the pre-clinical years. We talk about the statistics, how many people are harmed by those closest to them in a given year, and we talk about the shelters and resources available locally. I seem to remember a panel discussion featuring survivors of intimate partner violence, and maybe a few healthcare providers who were some sort of experts in this area. We learn that we should ask every patient whether they feel safe at home. And I think most of us do it. I know I tried to include that as a part of the social histories I took during M3 year. And I don’t think a single patient told me “no” in response to that question all year. I’m certain some of them were lying, definitely to me, and maybe to themselves, but I nonetheless really didn’t confront this kind of violence directly. I do recall patients I saw in clinic who discussed their past or present violent situations either with me or with a previous provider who had documented it, but it was hard to connect the women I was seeing in clinic with what I knew to be going on at home.

The ER is different, and so much of what we see there has just happened and is written all over the faces of the patients who present there. I get the sense that for people who love emergency medicine, this is a big part of why. There is a rawness to the undifferentiated nature of many of the complaints in the ER that can be exciting; there is an adrenaline rush that goes with being the systematic hero, even when the heroic measures aren’t enough. But what do you do when the raw edges were supposed to be soft? And when there are no heroic measures? I’m not sure, and I’m still reeling a bit from having something revealed about the world that I’d really rather not know. What do you do when sometimes it’s hard?


*I know that men can also be victims of intimate partner violence, but the patients I’ve seen have all been women.

Waiting

Cross-posted on Dose of Reality

Today is the deadline for certifying rank lists. This blog is no stranger to talk of rank lists and matching, and I’m about ready for it to end. I talked about my list starting to emerge here, and if you need a refresher on how the whole match process works, check here. If you care to, you can also take a look back at my post about when my original med school class matched and graduated, not-so-optimistically titled “Moving on when everyone else is moving out.” I certified my rank list a couple of weeks ago, sitting with a coffee shop with Michelle, another fabulous MSTP, who helped me proof my list to make sure I wasn't accidentally ranking a program where I didn't interview, etc. A few of the highlights of this waiting game:

• I reviewed my list again today to make sure it was right. The application program (ERAS) and the ranking program (NRMP) don’t use the same program codes – that would be too easy – so I double checked and cross-referenced the codes when I made my list, and checked them for a third time today. I live in fear that I've accidentally left my favorite program off the list.
• Somehow this deadline is only the beginning of the waiting. Even though I feel like I've been waiting since December 14, when I finished my interviews, it will take the matching algorithm almost another month to grind through my list, and those of all of the other wishful applicants, and assign me a spot. March 15 feels so far away.
• I’m fairly certain that no matter where on my list of twelve I match, I will be happy and get great training. I think I’ll be taking the advice of one sage AMSA friend, and in the twelve days leading up to Match Day I’ll go in alphabetical order through my programs and share with you all of the things I love about each of them. We’ll call it the Twelve Days of Matchmas. I haven’t decided whether I want a partridge or not.

Burn out

Cross-posted on Dose of Reality:

Between October 4 and December 14 I did fourteen residency interviews, although most of them were concentrated between October 27 and December 14, so all told I did an average of two interviews a week for seven weeks. I was home for 17 days during that period, spread out over the interview season.

Things that were wonderful about the interview trail:

• Catching up with friends in distant cities
• Enjoying cuisines that aren’t available in Ann Arbor
• Meeting so many delightful future colleagues/potential co-residents

Things that were terrible about the interview trail:

• Sleeping on floors, air mattresses, couches, and guest beds; thank you to everyone who hosted me, but the cumulative effect was rough
• Air travel
• Leaving Walter with every friend and relative I have in the greater Ann Arbor/Detroit area

I’m glad I did it, but I’m really glad I’m done. Now the excitement of making a rank list and holding my breath until March 15 when I find out where I’ll be heading for the next four years. Stay tuned!

Emergence of a rank list?

Cross-posted on Dose of Reality

At the beginning of the interview process, I had some sense of which programs would be at the top of my rank list*. I also had some ideas about which would be at the bottom. I'd set up a list for myself of programs likely to be in the top 5-6, and programs likely to be in the bottom 5-6, but the middle of the list was a bit of a mystery. Now that I'm through nine of my fifteen interviews, I'm getting a better sense of what I'm looking for in a program, although it's still difficult to make concrete pre-interview predictions. Some things I have learned:

• As promised by all of the residents and faculty I've talked to, interacting with current residents is really important. Not only do they have a completely unique, insider perspective on the programs, but their personalities and preferences seem to be the best indicators available of what kinds of applicants match at particular programs, and what sorts of people do well there.
• I'm really glad I'm not couples matching. Applicants who have a significant other (or anyone they want to match with, really, as there is no requirement that you be in any particular kind of relationship) who is also applying to residency this year can choose to link their match lists with that person's. The match algorithm then processes the two lists together so that if Applicant A only wanted to be at Program X if Applicant B were at Program Y, and Program Y isn't an option for that applicant, then the algorithm moves on and looks for a better match. This means that although OB/GYN isn't the most competitive specialty, those applicants who are couples matching with someone in a crazily competitive specialty have to apply and interview to many more programs. The travel is already wearing on me, and I can't imagine having to do more than I already am.
• The fit and feel of a program are much more obvious after an interview day than I'd expected. I know it sounds dubious, but you really can get a good sense of a program after an informal mixer/dinner with the residents and then an interview day. There are, I'm sure, lots of things that can't come out in that amount of time, or that are intentionally hidden away during interview days, but the personality of a program really does come out quite clearly in that brief interaction. 

I've definitely not finalized my list at this point, as there are still lots of interviews to come, but it's exciting to feel like I'm getting closer.



*For those of you confused about what a "rank list" is, I refer you to a post from May that describes a bit of the match process.

"I have always depended on the kindness of strangers"

Cross-posted on Dose of Reality

While I'm optimistic that the end of my interview trail will not parallel the end of Blanche from Streetcar Named Desire, I nonetheless feel that, at least right now, I am wholly dependent on the kindness of friends, family, and even some strangers. I'm writing this post from dearest Ruti's living room, having stayed with my sister last night and a gracious UM alum the night before*. In Boston I stayed with a med school classmate, and an old friend in Seattle. I've got friends lined up for many of the rest of my interviews as well, and I feel incredibly grateful at their willingness to pull out their air mattresses, unfold their couches, and make up their guest rooms for me. I'll be working to balance my karmic withdrawals by hosting some applicants interviewing at UM back in Ann Arbor. I can't say thank-you enough to all of these folks who have made the first half of the interview trail that much more hospitable. Don't hesitate to call if you find yourselves in Ann Arbor. Thanks!

*The Office of Alumni Relations runs an impressive hosting program that connects interviewing fourth years with UMMS alumni across the country. I've only used it once so far, but was thrilled with it. Yay for having a gigantic alumni network!

And the interview season marches on…

Cross-posted on Dose of Reality

I’d had a bit of a break since my first residency interview, but this weekend I was on the road again for interview number two. This really marks the beginning of the craziness that will be my interview season. Looking at my calendar for November, there are a total of about 10 days (including the week of Thanksgiving) when I’m not traveling somewhere. Here is how Walter feels about the prospect of my being away so much:

I'll note that these photos were taken on two different occasions. The dog has taken to smooshing his face into small spaces that look ridiculous. And adorable.

Despite having similar feelings about so many flights, rental cars, trains, and hotels, I’m pretty excited. [For the record, I’m not sharing here the full list of places I’ll be interviewing, out of courtesy for the match process and my friends and colleagues, so if you know them, please don't share!]

The following are some highlights from my trip this weekend:

• I ended up in the airport Friday waiting for a rebooked flight for about four hours after my original flight was delayed enough to miss my connection and thus cause me to miss my interview dinner. [Insert diatribe about what air travel has become.] But I was calm.
• I ate the following (delicious?) airport food while waiting: a hummus and pretzel cup, a California roll, a Snickers bar. Only the last item really helped my mood, although it’s possible that it was really a cumulative effect.
• I made it to the last 20 minutes of the dinner/mixer on Friday night, and everyone was delightfully welcoming and wonderful.
• My interview was great, and I ended up being more impressed with the program than I anticipated.

Here’s a photo of me in my interview suit, seeing a bit of the campus.

Rolling, rolling, rolling…

Cross-posted on Dose of Reality

The residency application is definitely moving along. The official opening date for application submission was September 15, and everyone has been doing their best to get their materials in as early as possible. My application has been in for a bit, and the stress of watching my e-mail has increased so much! Here is a snap-shot of my thought process over an average afternoon during the past few weeks:

Hmmm, I should look at my phone and see if I have any new e-mail. I wouldn’t want to miss an interview invitation. Everyone keeps talking about how quickly the dates fill up after they are offered. Oh my goodness, look, an interview request that was sent 45 minutes ago already! Ahhhh! Let me open up my Google calendar where I have all of the potential interview dates entered and figure out what other programs are in the same region and need to have interviews that are near the same date. And also there are national holidays in November that I’d rather not miss. And also I would rather not fly to the West coast 12 different times. And also I need to make a decision on this half an hour ago. Ahhhh! Okay, it looks like this date should work. Take a breath, Andrea, so that your e-mail doesn’t read like some crazed and desperate applicant. Try for “Thank you so much for offering me an interview” rather than “I am so glad that someone will take me as a resident some day.” Okay, breathe. The tone is okay and the address is correct, so hit send.
Done.

There is a small amount of adrenaline that goes with each of these exchanges. Maybe a large amount. I’ll be glad when they are all scheduled and I can just deal with the anxiety of interviewing!

Warm Blankets

Cross-posted on Dose of Reality

Inside every operating room, or at least very nearby, is an appliance that looks like a refrigerator. It does not, however, keep things cold. Instead, it is devoted entirely to keeping things warm; specifically, it keeps blankets warm so that when patients first come back to the OR, or when they are just waking up, they can be wrapped in a warm blanket (or two, or three) so that they are comfortable in the subarctic temperatures that sometimes occur. Today, I got the opportunity to experience the warm blankets for myself. I was watching a laparoscopic operation (read: a procedure performed with instruments on the ends of sticks inserted into an abdomen blown up like a balloon, so that there is no need to really open up a giant incision). One advantage to these is that, during most of the procedure, there is not much for the medical student to do since it is all inside the abdomen and it is all shown on huge TV screens around the OR. There is then no need for the student to scrub, wear a sterile gown and several pairs of gloves, and focus vigorously on contaminating neither her/himself nor the operating field. Instead, the student can stand or sit and watch the TV. In the cold. The cold that is usually mitigated by said gown and gloves, as well as by the lights and the pressure of working not to contaminate anything. I was cold, and while I was lamenting not having grabbed a scrub jacket from the locker room, I saw that one of the nurses had a blanket wrapped around her shoulders. I snuck into the hallway, grabbed a warm blanket, and wrapped it around myself. It was amazing.

It turns out I am not the only one who loves warm blankets. In addition to at least one notable person in my life who extols the virtues of heated mattress pads and heated throws, look who else loves warm blankets. He snuck into the basket while I was turned away to fold a sheet:

As the weather turns toward the chillier, but it’s not quite okay to turn on the furnace, consider joining me in front of the blanket warmer, or if you aren’t quite ready to invest in one at home yet, in front of the dryer. It’s warm.

Urology!

Cross-posted on Dose of Reality

Somehow it’s already been two weeks of my urology rotation, and I haven’t shared with you all how awesome it is. I have been busy with other things (like ERAS – the online residency application – which I will tell you more about later), so here are a few highlights:

• My first week included “the Nesbit,” which, as far as I could gather, is a symposium organized each year to feature interesting research from urologists at UMMS and other important people in the field. This hear it was specifically about Health Services Research, which was a fantastic coincidence. Everyone was very gung-ho public health (with the possible exception of one speaker, but he was there primary to remind us of how much we need to continue to work on communicating our work with colleagues who do not have lots of statistical background), and it was fascinating. Topics ranged from specific descriptions of interesting studies and funding mechanisms to frontiers in urology (both methodologically and geographically).
• I’ve gotten to spend some time with the Neuromuscular and Pelvic Reconstruction (NPR) service, who are the urologists that spend the most time with female patients. They do joint cases sometimes with the urogynecologists (with whom I thoroughly enjoyed a rotation last November), and provide a slightly different perspective on things going wrong in the pelvis. I’ve seen some crazy reconstructions, some procedures for incontinence and some interventions for painful bladders.
• I’ve also gotten to see other things that I’ll likely never do again, like the construction of a new bladder from a piece of stomach combined with a piece of small intestine, for a child who was effectively born without one. So cool!

I would highly recommend a urology rotation for anyone. Here are just a few of the the specific (and I’m sure widely applicable) skills I have learned or refined so far: foley catheter placement, suturing and knot-tying, cystoscopy, penis jokes, and smiling and nodding at gynecologist jokes.

Tub Birth!

Cross-posted on Dose of Reality

For the past month I’ve been rotating with the midwives, as I outlined here. One of the things I was most looking forward to this month was getting to attend a tub birth. Delivering in the tubs, which are fairly spacious and definitely still located inside the hospital room, seems to make most of the physicians delivering babies nervous. As a result, I’d never seen one, and was very curious. It didn’t seem that this wish would be made reality until the last day of my rotation. Due to some quirks of the healthcare system that I won’t enumerate due to HIPPA requirements, this particular mother decided to labor in the tub. The whole process went very quickly and easily, and she and I caught the baby together. So exciting!

This whole rotation has made me think a lot about how I’d like to do antepartum, intrapartum, and post-partum care in my own future practice. While lots of things, like having 30 minute rather than 10 minute prenatal visits to allow for questions and teaching, have helped me to understand why so many women so strongly prefer the midwifery model to the physician model of care during pregnancy, few things seem to emphasize this as starkly as the tub birth. In the world of low risk, low intervention pregnancies and births, there’s no reason not to get in the tub and deliver there if that’s what the woman wants. It’s warm, is really helpful for pain during labor, and is a great way to get skin-to-skin with your baby right after birth. In the world of high risk, high intervention pregnancies and births, it seems that behind even the most benign of deliveries lies a strong concern about something possibly going wrong, and the need to do everything possible to prevent that.

This preoccupation with potential problems is what physicians are trained to do. We see the possibility of a critical airway with every cough, spinal cord compression with every twinge of back muscles, and hidden malignancy with every fever. While we are continually told in school to think “horses, not zebras” when we hear hoof beats, the rare and the bizarre are emphasized in lectures, exams, and the questions we’re asked on rounds. How then, is the well-intentioned medical student to take a step back and recognize a truly uncomplicated and normal process as it takes place, rather than waiting and finally conceding after the fact that nothing went wrong? After working with the midwives for a month, I confess that I haven’t shaken the niggling doubts I have each time someone mentions a mother pushing for seven hours before her baby is born. I think that most of the midwives have some doubts too. But they’ve helped to remind me that most women know how they want to birth their babies, and that most of the time, they’re right.

Whoa...

Cross-posted on Dose of Reality:

Somehow a few weeks have flown by since I last posted. This may be related to how much I'm loving what I'm doing right now... No, I'm not thrilled to be studying for boards, which I am also doing, nor to be preparing my resident application. Neither am I incredibly pleased that the dog required another small procedure to get rid of some infection at his old surgical site. The primary thing I'm doing this month, however, is working with the midwives, and it is fantastic. I'm actually posting from the callroom, so I will be brief. Here are the things I've loved so far:

• Prenatal visits in English and Spanish and with patients across the demographic spectrum that Ann Arbor and Ypsilanti have to offer
• Natural deliveries and the proud and happy mothers and babies that result
• Hands-on learning; I've helped with a couple of deliveries, a few repairs of perineal tears, and lots of physical exams, prenatal teaching, and post-partum follow-up!

These last few weeks have been a flash-back to the best weeks of medical school, my OB/GYN rotation, but with an extra emphasis on the collaborative relationship between pregnant women, their families, and their healthcare providers. So wonderful!

33-40%

Cross-posted on Dose of Reality

I don’t often think about my life in terms of percentages, particularly as a way of judging success, but there are times when it is hard to avoid. For example, as sub-interns (the fancy word for fourth year medical students on more intensive rotations, such as in the ICU), we are expected to have off one day in every seven, or a total of four for the rotation. If a normal workweek, one in which the weekend is free, is 5/7, or 71.4%, then my workweek is 6/7, or 85.7%. This leaves only 14.3% of my time as free, which is small. Smaller even than the proportion of arterial lines that I have successfully placed, which is what prompted the writing of this post. An arterial line, or art line, or a-line as you may hear, dear readers, is a special IV that goes into an artery, most often the radial artery in the wrist. It allows for the easy drawing of arterial blood for labs, for continuous blood pressure monitoring, and for the humiliation of every medical student who ever did an ICU rotation. I have attempted the placement of five arterial lines, six if you count the one that I missed the first time but then got later after the one my resident placed failed, and that I subsequently got, as two separate lines. I have successfully placed two. That’s right, two. That gives me a resounding 33% or 40% success rate, depending on the counting I mentioned above. This is not reassuring. It is, however, profoundly humbling, which is probably not a bad thing. Maybe humility is what the ICU teaches most effectively of all?

Medical decision-making

Cross posted at Dose of Reality

I know the title sounds approximately as riveting as not at all, but I’ve been thinking a lot about it since I’ve started my ICU month. While I’ve been reflecting on the medical decisions I’m making, in the time I take to process everything I’ve seen, I’ve been focused more on those we expect the patients and families we care for to make. We call on them during their most dire hours and ask them to consider options they don’t necessarily understand, to weigh risks and benefits that are hard to put into context, and to make calls that no one ever wants to have to make. And they do it. Not always with the calm and rational process that would be easiest for the physicians working for them, but more often than not with an incredible degree of grace and reflection mixed into the grief and frustration.

The conversations are almost always accompanied by a great deal of sighing, sobbing, and shouting, which can be disconcerting to those of us working to provide medical care. I think what made me most frustrated back when President Obama’s plans to encourage the discussion of advanced directives turned into a death panel debacle, was the callousness of it with regard to the families of critically ill patients. How many of the individuals who were most loudly heard during that national discussion had been in the position of trying to determine the appropriate goals of care for a loved one at the end of life? I’d hazard a guess that there were very few. Anyone who has had to weigh these questions, particularly without the benefit of a signed document crafted by the patient him/herself charging the course ahead, would think twice about protesting a more considered approach.

With or without a mandate from the government, however, I increasingly believe that physicians and other healthcare providers have a serious obligation to discuss end of life care with all of their patients. A few questions about code status when a person is hospitalized (i.e., whether or not an individual would want chest compressions, shocks to the heart, or other measures to bring back a patient whose heart has stopped while in the hospital) are simply not enough. Although I have been impressed with the way many of my teachers and mentors have navigated these challenging situations with hospitalized patients and their loved ones, I can’t help but wish that as a nation we could pause, reflect on what we want from our last weeks, days, and hours, and take a moment to write it down.

Looking for more resources on Advanced Directives and Living Wills? Check here for the UMHS Publication.

Bikes, books, and bakeries

Cross-posted on Dose of Reality

As has been discussed here previously, I’m training for a large bike ride that is coming up in less than a month. As usual, I’ve been tracking not only my mileage and speed, but also my ranking on BikeJournal. I like to think of it as my keeping-up-with-the-crazy-cycling-Jones-o-meter. If I’m rising in the ranks, then I’m biking more than the average member, and if I’m falling, I’m not keeping up. Granted, in order to stay even one really only needs to bike about 2 miles per day, but it’s still an interesting metric, and plotting it over time makes it even more interesting.

Look how much awesomer I am than last year! So far my predictions about dermatology and research rotations as good for biking are bearing out. Check back in another month or so to see what kind of curve the ICU month generates...

My training schedule marches ever onward, and I’ve been looking for longer rides to fit into my training schedule. Luckily, I received a copy of Cycling Michigan: 30 of the Best Bike Routes in East Michigan by Karen Gentry for either my birthday or Christmas over the winter, and stuck it on my shelf for summer reference. I pulled it out a few weeks ago and was pleasantly surprised! It features lots of rides, as the title suggests, in the eastern part of our lovely state, and includes quite a few that start in or near Ann Arbor. Because Michigan has so many beautiful places to ride, it can be hard to find a book with more than one ride in any given place, but Ms. Gentry does not disappoint.

 The first ride from the book took us through some beautiful countryside out to Manchester and back. Here is my bike posing for the picture.

My one complaint about the book is that each ride is described in copious detail without a succinct cue sheet or list of turns, and the maps are not detailed enough to use alone. On the first ride I did from the book, I simply copied the pages describing the ride and stuffed them into my jersey pocket. I had to stop frequently to read through the text to figure out where I should turn next. Two weeks later, much the wiser, I went through the book before the ride, typing up a cue sheet and copying the map onto the lower half. It was much easier to just follow the turns and glance at the map for reassurance. I love the routes in the book, but would recommend a little prep work to make for a better ride!

 The second ride went through Dexter, Pinckney, Brighton, and yes, Hell, MI. 

Another thing that makes for a better ride: doughnuts! I could not write a post about my recent bike rides without mentioning the Dexter Bakery. They make by far the finest apple fritter I have ever consumed, as well as wonderful soft pretzles and regular doughnuts as well; I would highly recommend it as a cycling stop. It’s conveniently located about 11 miles from downtown Ann Arbor, making it an imminently reasonable cycling destination. Yum!

Welcome to M4 year, the best year since kindergarten

Cross-posted at Dose of Reality

I learned a lot last year, and one of the oft repeated nuggets of wisdom shared by residents and more advanced students alike was the joy of the year to come. They promised a less intense grading environment, electives chosen for purposes other than fulfilling core requirements, and more free nights and weekends. So far this is mostly true. I’m in the midst of a dermatology rotation at Henry Ford, a community teaching hospital in Detroit that is connected most closely to Wayne state, but at which UM students have the opportunity to do a few M4 year rotations. In spite of the fact that everyone seems slightly horrified that I’m not planning to go into dermatology, I’ve gotten to see a wide variety of dermatologic complaints while working with delightful residents and attending physicians.

Lessons I’ve already been applying from M3 year:

• You will never know exactly where you should be or what you should do, so don’t be afraid to ask questions.
• Smile a lot. People are less likely to think you are dumb if you also appear friendly and they like you.
• Fake it. Listen closely to what your resident asks of patients so that when you have to see a patient by yourself, you know what questions they will think are important to ask and report back. Eventually you will make it and understand why they have asked those questions.
• Wear gloves. Especially when someone has a rash on the palms of their hands, as it could be secondary syphilis and that is contagious through the rash.

New lessons I’m already learning about M4 year:

• The word elective not only means something you chose, but also something that is not required of everyone. This means that the rest of your medical school training is unlikely to have covered this material and you will need to read a lot.
• When someone tells you that something will be the best “X” since kindergarten, they do not necessarily mean that the entire thing will be filled with naps and snacks. They might mean that you can pick your poisons and that your schedule will be more predictable than previously.
• Smile more. Especially when someone gives you the stink eye after you delicately explain that you are leaning strongly toward (read: have already chosen) another specialty and are just there to learn about their specialty, not to audition for their residency program.

The sorting hat

Or, thinking about the residency application process

(Cross-posted on Dose of Reality)

Right before I finished my last rotation of M3 year, I had the opportunity to attend a dinner hosted by the Department of Obstetrics and Gynecology for prospective residency applicants. It was a great chance to say hello again to the residents and faculty I worked with on my rotation and to learn a bit more about the application process. These sorts of events are often overwhelming and sometimes cryptic, but I was particularly struck by the reassurances from many of the faculty.

“Come talk to us, we will help you make a list that will work for you.”

“People who come and talk to us are happy with their matches. We can help you identify the right programs.”

“No, there isn’t another way to find good programs. Come talk to us.”

I left feeling like there was a sorting hat that would sit on my head, discern my clinical grades and Step 1 score, geographical and program-type preferences, and spit out a list of 15-20 programs to which I should apply. While this seems a little fantastic, it is closer to true than you might imagine. Having met now with three faculty members to talk about this process, I’ve come away with three fairly comprehensive lists of programs to consider.

For those of you not already familiar with this process (and those of you who are can skip to the next paragraph), the residency selection process is a match. Students submit applications through a central application system, and much like many other application processes, schools that are interested in particular candidates can offer them interviews. The similarity with most systems stops there, however. After the interviews, each applicant makes a rank list of programs and each program makes a rank list of applicants. These lists are fed to a computer algorithm that matches applicants and programs. The result it spits out is legally binding for one year. Because of this process, the list of program list an applicants starts with is important – there is only one application/interview cycle so there is no (easy*) way to go back and apply if one’s rank list seems a little thin or the match doesn’t go well.

As I’m looking over all of my lists, I’m wishing that there really were a sorting hat that could spit out a definitive set of options, but there aren’t, and honestly, I feel pretty lucky just to have a good sense of what specialty I’m entering and what I’m looking for in a program. I’ve created a spreadsheet (cue either scary or optimistic music, depending on your perspective), and am looking forward to doing a little sorting of my own. 

*I should note that if an applicant doesn’t match, then there is a second small match that used to be referred to as the Scramble, where applicants re-apply for program spots that have been left unfilled. This doesn’t happen often at Michigan, and certainly isn’t the best way to get the match of your dreams as the most desirable spots are already taken, but can yield an acceptable outcome for all involved.

One more week

Also posted on Dose of Reality:

I have one remaining week of M3 year. It's hard to believe, and I have enough studying to do that now is not really the best time to reflect on lessons learned or experiences gained. Suffice it to say for now that I'm looking forward to being done, and when I take brief study breaks, I imagine what my two weeks of summer vacation are going to look like before M4 year is off and running. It's an awful lot like this:

 

Walter enjoying the newly remodeled Huron River canoe route just past Argo Canoe Livery.

 

Things I am planning to do starting 4/28:

• Ride my bike: I've got to get in shape for that ride coming up in July!
• Walk the dog: He deserves it after a year of craziness. 
• Reading for fun: The list of books I need to read at this point is endless, but I might as well try!
• Things that are as yet unscheduled, because I will not need to be scheduled within an inch of my life...