Someday came so quickly…

I started blogging here just over eight years ago as I was preparing to start medical school, and started blogging for the medical school shortly thereafter. I named the blog for a nickname, Dre, after some good laughs that I would ultimately be Dr. Dre. I didn’t know at that point that I would ultimately be accepted into the MD/PhD program, and that someday I would be Dr. Dr. Dre, if that were really a title that anyone used. As of Friday, and for another ten days, however, I am writing to you as Dr. Dre! Someday is here! My PhD was conferred on 5/3, and the medical school graduation is not until the 17th. I think I’ll plan to keep the title of my blog until I’m as well-recognized as my namesake, Dr. Dre…

Ruti and I after the hooding ceremony! 

Some things…

from the interwebs…

I don’t usually just post links, but there were two things that I just couldn’t pass on sharing, and that seemed somewhat linked.

First, a lovely infographic from the lovelier Ania, a fellow MSTP, about the incredible Ann Arbor. While I’m excited to be heading out of town in a terrifyingly few short weeks, there are definitely things I’ll miss about being here.

Second, an article about deciding whether to go to graduate school. It’s written by a former humanities graduate student, but I think captures a lot of the feelings that I have when students ask me whether they should think about the MSTP or just go to med school or grad school like everyone else. Enjoy it here.

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.

The books of M4 year

Over the past eight years, I’ve frequently posted about “The books of…” various portions of my training. There were the books I read during my first summer of medical school in 2006, with the last few listed in a second post. Then there were all of the books I read while in South Africa just before starting graduate school in 2007, so voluminous that they couldn’t be captured in a single post. Then there were the books of the summer of 2008, which also required some wrapping up in an additional post, confirming my tendencies not only to read in binges, but also to post summaries of small portions of my life before they are actually finished. Continuing this trend, I’d like to post about the books I read for pleasure during M4 year, even though there are still some weeks left before graduation.

1. House of God by Samual Shem
I started reading this during 3rd  year, as I’d been strongly recommended to do by several faculty members, but was too overwhelmed by my internal medicine rotation to finish it at that point. I think I struggled through it for a variety of reasons, first and foremost being the volume of reading and studying I was doing for my rotations, but a close second being how disturbingly close it remained to my experiences as a medical student, even as so much about the hospital has changed in the intervening years.

2. Privatizing Poland: Big Business, and the Remaking of Labor by Elizabeth C. Dunn
My introduction to history and anthropology in Eastern Europe, I thoroughly enjoyed this. I was smugly pleased to note that when someone asked why I was reading this book, that I could casually mention knowing someone who is doing engaging and important work in that part of the world…

3. Lolita by Vladimir Nabokov
What can I really say about this that hasn’t already been said. It was disconcerting to enjoy so much a novel with such a troubling plot. I read this on flights while I was interviewing and creeped out many a neighboring traveler while passing the time. Mission accomplished.

4. Gold by Chris Cleave
This was no Little Bee or Incendiary, but I liked it nonetheless. As I have explained to several folks, I felt that his other two books took impressively extraordinary situations and made them feel intimate and quotidian, while Gold made a rather big deal out of situations that felt a bit like the daily grind. I suspect that some of this was my particular career choice, as the hospitals featured prominently in the book are a much larger part of my daily life than they are of many, but I also didn’t the writing was quite as skillful. Despite this, it was a good read, and motivated me to get on my bike.

5. The Tiger’s Wife by Tea Obreht
I’ve just started this, so I’ll need to write a second post both to maintain parallelism with my previous book posts, and to let you know how this goes. The first thirty pages have been great.

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.

On the twelfth day of Matchmas…

My ERAS gave to me,

a major scale serenading from Yale,

some hubbub about U Dub,

a hurrah for the Yellow and Blue,

a disco to lure me to San Francisco,

an evangelist for Los Angeles,

the pitter-patter of palpitations for Pittsburgh,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

Fantastic things about Yale:

• Some of the happiest residents I met on the interview trail
• Incredible School of Public Health
• New Haven! A surprisingly endearing town with fantastic pizza

On the eleventh day of Matchmas…

My ERAS gave to me,*

some hubbub about U Dub,

a hurrah for the Yellow and Blue,

a disco to lure me to San Francisco,

an evangelist for Los Angeles,

the pitter-patter of palpitations for Pittsburgh,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

The University of Washington was fantastic for the following reasons:

• The only OB/GYN residency in the state – that means all kinds of excitement
• Amazing research resources and residents who are excited about using them
• Seattle! So many friends, so much delicious food, and such a beautiful part of the country.

*Just a reminder that this list is alphabetical, and is in no way indicative of the order of my preferences. I said that at the beginning, but wanted to say it again. Alphabetical. All alphabetical by program name as I had them listed on my list (so basically random, since they were sorted by all kinds of odd abbreviations)…

On the tenth day of Matchmas…

My ERAS gave to me,

a hurrah for the Yellow and Blue,*

a disco to lure me to San Francisco,

an evangelist for Los Angeles,

the pitter-patter of palpitations for Pittsburgh,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

Awesomeness at Michigan:

• Fantastic residents that I know I adore
• An amazing chair who has mentored me for over a decade now
• Friends and family so nearby

*For those of you who do not already bleed maize and blue, this is a line from the alma mater, The Yellow and Blue.

On the ninth day of Matchmas…

My ERAS gave to me,

a frying pan-Rube Goldberg-plan to get to San Fran,

an evangelist for Los Angeles,

the pitter-patter of palpitations for Pittsburgh,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

UCSF has so many great things going for it:

• Awesome residents who are friendly and accomplish great stuff while doing all kinds of other things (like biking!)
• San Francisco! Family, friends, and all the queer culture a girl could want in an overall amazingly fantastic city.
• A great range of clinical experiences (including a PGY-3 rotation in Hawaii…)
• Faculty in my research area

We interrupt your regularly scheduled programming…

…to announce that I matched!

I find out where on Friday, but I got the official e-mail today letting me know that I’ve matched somewhere.

Let the Matchmas continue…

On the eighth day of Matchmas…

My ERAS gave to me,

an evangelist for Los Angeles,

the pitter-patter of palpitations for Pittsburgh,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

UCLA was an exciting surprise on the interview trail, as I’d never really visited LA before:

• Great mix of academic and county hospital experiences
• Phenomenal School of Public Health and research resources
• The beach – many of my other options are near the ocean, none offers a beach experience like LA
• LA! Great food, Hollywood, giant pits filled with tar, good friends, who could ask for anything more?

On the seventh day of Matchmas…

My ERAS gave to me,

some palpitations for Pittsburgh,

a passionate yen for Penn,

a paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

Offerings from the University of Pittsburgh:

• Big program filled with friendly residents
• Women’s Health Research Institute with amazing resources
• Pittsburgh! A surprisingly charming city that somehow straddles the East Coast and Midwest, retaining the best of both worlds, including a reasonable cost of living
• Every OB/GYN fellowship you could possibly imagine available

On the sixth day of Matchmas…

My ERAS gave to me,

a passionate yen for Penn,

the paragon in Oregon,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

Things Penn has to offer:

• Fantastic public health research resources
• Diverse patient population
• Nyia! One of my original med school classmates is an OB/GYN resident there
• Philly – a fun, new city with a super cute gay-borhood

On the fifth day of Matchmas…

My ERAS gave to me,

the paragon in Oregon

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.

OHSU (Oregon Health Sciences University) is truly an exciting OB/GYN residency programs:

• Closely-knit residents with interesting curricular and extracurricular interests (i.e., great research and bikes!)
• Unique research resources
• Portland! Friends, food, family nearby… Also bikes everywhere… AND affordable housing. I love Portland.
• Engaged and excited program director

On the fourth day of Matchmas…

My ERAS gave to me,

a turn toward Northwestern,

a hopscotch path to Hopkins,

a Partners program love telegram,

and the awesomeness of Beth Israel Deaconess.*

Amazing things about Northwestern:

• Chicago! Friends and family so near by! Countless academic institutions so near by! Delicious food so near by!
• Partnership with Storger (Cook County) Hospital for an exciting breadth of experiences
• Possible Physician Scientist Training Program for a fellowship when I’m done with residency (Please do not groan – it would be nice for someone to pay me to do my research…)
• Friendly residents who are excited about research

*I realized I had forgotten one of the key features of the Twelve Days of Christmas, which is that every new one is repeated every day following. Please forgive me…

On the third day of Matchmas…

My ERAS gave to me,

a hopelessly happy hopscotch path to Hopkins…

• So much history…
• Incredible connections to a great School of Public Health
• Beautiful new hospital
• Baltimore: It’s the Detroit of 2030 – an exciting and vibrant town with a troubled past that has lots of affordable housing
• So many friends living in or heading toward Baltimore, DC, and New York

On the second day of Matchmas…*

My ERAS gave to me,

a Partners program love telegram…

The combined Brigham and Women’s and Massachusetts General Hospital program, also known as the Partners program, has all kinds of great things going for it.

• Vast resources and connections to the rest of the Harvard system (i.e., School of Public Health)
• Boston! So many friends live in Boston!
• Residents dedicated to research and scholarship
• My PhD advisor’s PhD advisor is one of the chairs there, so it would complete some sort of crazy circle…

*We are going to need to double up for a few days, since I missed a few posts due to emergency medicine shifts and sleeping…

On the first day of Matchmas…*

My ERAS gave to me,

the awesomeness of Beth Israel Deaconess…**

• Small, friendly program
• Teaching oriented
• Boston! I love Boston!
• Easy to live near work
• Fantastic research support, including dedicated research staff who work closely with the residents

*Apologies for the terrible rhyming and alliteration that is about to ensue…

**We’re starting alphabetically, lest you think I’m giving away my rank list completely.

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.