update part 2...all about The Match

In the Fall of 2012, my girlfriend, who we'll call "N," and I began applying to residency programs. This meant that we needed at least 3 letters of recommendation (LOR) (some programs require 4). We get these on our clerkships in 4th year. The better we perform on these 4 week clerkships, the higher the likelihood that we would get great letters. I think in all, N and I were able to get pretty good letters. My letters were so good that my interviewers comment on them throughout the interview season (we don't get to read the letters ourselves so we don't know what's in them, it's a bit of a gamble). From what I heard from what's in my letters, I was able to learn how to properly embellish, it's an important skill, just in case I need to write letters in the future =)

In addition to letters, we need a personal statement. I think we were lucky here to have good people who read our PS and made great comments. I also had good comments from interviewers about my PS.

So far, the stars have aligned for our LOR and our PS!

Next we needed a curriculum vitae, or resume. This is a bit different than your non-academic resume, the CV highlights our academic or clinical medicine related achievements. Again I think we were pretty lucky here. My big thing on the CV were the long trend of working in underserved areas and the few projects I've done around them. Suffice it to say, I was able to make my CV look pretty impressive, even though yours truly may not be that impressive =). N on the other hand is a smart cookie in school she got elected into Alpha Omega Alpha, an honor society. The school elects the top 10% for AOA. It's something you can put on your CV and people would know how well you did in medical school. So that's pretty impressive. She also had a few other things to write about that made her CV as impressive as she is!

LOR, check, PS, check, CV, check!

Next to select programs. Here's the tricky part. Oh I forgot to mention, I'm applying for a residency spot in Family Medicine, yep primary care. And N is going for pediatrics (if you saw here you'd think peds too, not only for the fact that she's about the size of a small child, but her whole persona oozes kid love). Anyway, these aren't very competitive fields, the least competitive in fact. Then, how to choose which programs to apply to. People generally apply based on a couple strategies: location, reputation, shotgun the nation. We went with the last, although looking back on it now, we should have just applied more strategically.

As you can imagine, you apply, you get interviews (generally), you travel and go to these interviews and the costs add up. Plane tickets, rental cars, hotel in addition to the application fee! We went on about 20 interviews total. I didn't have the patience and wherewithal to go to anymore (we applied to about 30 and got offered about 30 interviews). We interviewed starting in October/November, then spent the whole month of December traveling, and January. It's always interesting to interview and talk about yourself for a day, but it's also exhausting. We probably spent about $5000-6000 between the two of us.

And there were other costly "glitches." In a laundromat in San Francisco, I forgot myself and left my nice new expensive laptop unattended for a moment and it was stolen! Did not get it back or have heard back from the cops yet and that was back in December. The second glitch was near Christmas, I was driving N to the airport early in the morning after a day of driving from San Fran to Southern California. We were talking about residencies and I wasn't paying attention, we were on a big 8 lane highway and it was empty and my speed got up there and I got a $500 speeding ticket! Yikes.

The tally so far:

• Stars aligning x3
• "Glitches" x2

Anyway, back to the topic. It's now March and we finished our rank list. Let me take a moment to explain this complex process. The Match works like this. You interview at your programs, lets say 4 programs each for me and N. If you were to do this individually, you would simply rank the programs you interviewed at in order of preference. The residency programs also have their own rank list. A ranking program then takes both list from every program and every applicant and tries to "match" everyone based on their highest preferences. So it would be to our advantage as applicants to rank the "dream" programs up high because it doesn't really hurt us. Another way of saying it is that we don't have to consider that we may not be good enough for a particular program, because the Match system takes that out of the equation and continually tries to put you, the applicant, in the highest position possible on your list. The guy who designed the algorithm won the Nobel for economics recently, he also designs the ranking system for school systems.

But N and I are couples matching, which means all of my choices are linked to her choices. Her number 1 is linked to my number 1 and so on. Both of us would have to "match" at each program to get our number 1 choice. It wouldn't make sense for me to link a Philly program and for her to link a New York program, we'd be 2 hours apart! This involves a lot of compromise as you can imaging, I won't go into that here.

What's our list like. N is from Chicago, her family is there, her adolescent siblings are there and we would love it to watch them grow up, it's a once in a lifetime thing that we won't ever get to experience again until we have our own kids. So 2 programs in Chicago, then we go to New York City. Our 4th and 5th choice is Philadelphia, we both have 2 programs here. And then the list goes on and on. But hopefully we don't have to go past Philadelphia. 

We submitted our rank list February 20th. We find out at noon EST on Monday, March 11th if we even matched. If we don't match, that means that we have to spend the week trying to find open positions in the country to get into. This may mean I may not be a family physician depending on what's available out there or that we could be far apart from each other. Obviously the competitive specialties aren't going to have open positions after the match. If we do match, then we sit back until around noon on Friday March 15th for the official envelope that contains our match location. That's it, you're all up to date! We're waiting as of this moment, nothing else to do but wait!

18 month update part 1

It's been sometime since my last update. Last time I wrote about finishing Step 1 (of 3). That was Summer of 2011. After that I went to France and Italy for 2 weeks before 3rd year, my clinical years, began. The clinical years are different from the first 2 years. Instead of being stuck in a classroom all day and learning about the foundations of medicine, medical students are thrusted into the high paced wards of hospitals, the freeze of operating rooms (temperature and temperaments), and many other environments where we have to deal with patients, nurses, and doctors.

This is where we transition from thinking like a student to thinking like a doctor, while striving for top grades in both standardized multiple choice exams and the subjective impressions of our attendings and residents. I had a tough time of it, although I was always a fast learner, there were many things to adjust to and I had trouble sorting it all out. Every rotation was different and new and something I'd never seen before. The learning curve was steep, but I eventually got over the hump.

At the end of the Spring of 2012, I went and took Step 2 of my board exam. I scored well. And I started my 4th year with much more confidence and with a renewed sense of purpose and enjoyment in finally getting the hang of medicine, at least at my level. There is still much to learn, in the words of my attending who said "after 35 years of practicing medicine, I feel like everything is finally clicking together."

I lost my father in the Spring of 2012, April 6th. He had another stroke, he bled into his brain. We withdrew his care, meaning he would only get medication for pain control. I slept and sat in his hospital room and watched him for a week. He was like in a coma, so we couldn't talk to him, though my family thought he could listen. It was hard to watch him for a week, it makes you doubt. I still think about it now. I felt empty after he passed. It's been a few months now, and I think I'm back to my normal happy self.

I also got a girlfriend in 2011. I successfully wooed a classmate, I don't think she knew what she was getting into =). We have been together now for almost 2 years. I love her very much and she says she loves me too. She helped me become well again after my father passed. It's too bad they have never met. We decided to couples match, meaning our residency ranking will be coupled so that we could stay together in the same city during residency, more later.

boards are DONE!

I took my USMLE Step 1 exam last saturday after 5 weeks of pure intense crazy studying that sometimes wasn't so intense, just crazy. I am very relieved I don't have to open my USMLE first aid anymore, hopefully. The key to the Step 1 is to not just pass, but also to pass with at least a decent score. If, for instance you get a barely passing score, you will have trouble getting residency spots because of the emphasis that residency sites place on Step 1, and to a lesser extent, Step 2 scores. Oh and if you pass, you cannot retake the exam for a higher score for 7 years! You're stuck with whatever passing score you get. This can be very traumatic to people's careers!

So what's a decent score?

The highlighted ones are the specialties I'm considering going into. You can see the average scores and the standard deviation of scores for each specialty. It would make my life easier to have a higher score because not all residency sites are created equal. Some are better than others. But I still believe it is what you make of it and for speaking for myself, I'm happy if I get an average score for those specialties I'm looking to go into.

So what was the test like? You go to a standardized testing site and sit down in a cubicle in front of a computer. You have to be checked in, finger printed, made sure that nothing is in your pockets or written on your skin somewhere every time you step away from your computer to take a break. No strip search though! You do hour long blocks of 46 questions each. You have to do 7 of these blocks and you're given 45 minutes of break time thru out the entire day and you manage it on your own.

I had enough energy to last me through the day and I didn't feel exhausted at the end. It was very nerve wracking at first to think how significant this day will be for my future. Once that passed, though, I got into the groove of working through the questions. I don't want to pretend to know how I did. I will find out in 4 weeks and for now, I'm blissfully ignorant!

What's next? I'm going to France and Italy for 2 weeks. I'll be visiting the French Riviera, Cinque Terre and Florence before heading north to Paris for a week. It's been a very strange and I guess rewarding 2 years. I think patience is the most important lesson I've learned these past 2 years. I learned how to be patient with life and with family and with myself. I learned the value of slowing down and stopping for a while just to enjoy the moment. I'm looking forward to more lessons to learn. Done with year 2. I've got 2 to go.

Gotta pack

Pictures coming!

Moved my photos....

...to flickr, see her: flickr

Months end update

My aunt may need surgery to close the PFO, she's been having chest pains and it sounds a little like unstable angina. But I don't really know her case. I'm praying for her.

My dad's endoscopy and colonoscopy is this Thursday, it's going to be a tough week of waiting.

I have an exam tomorrow so I'll keep it short. I miss my family, but I got some of them on Kik messenger so we can text chat across continents and oceans! Very happy about that!

month of months...

its been a month of months.

a couple of weeks ago, I received a call from the debt collectors. My dad has a $55000 credit card debt that went into default because the credit card company hadn't received any payments since June of last year. I can't really share any details about that since it's not resolved and the internet is like an open book. I'm dealing with debt collectors and they're really really good at making this difficult, I guess I'm not making it easy either. But I don't really know what the hell I'm doing. I just need to preserve what's left of our assets since that's what's keeping my dad in boarding care and day care.

Here's a little tutorial on how debt works. If you haven't paid your credit card bill in a while, it goes into default after which the credit card company will contract out a debt collection agency to call you and try to get as much money as they can from you. Typically, the client pays 10-30% of the total debt. If they can't get payment, the debt gets sold off to another collection agency, then another, and another. This supposedly goes on for a while. If they think they can't get money from you and also other factors I don't know of, they'll sell it to a law firm who specializes in getting money out of people. The law firm will then sue you for the debt. But, the burden of proving that you, the client actually racked up those charges is on the law firm. That means that they'll have to follow the paper trail of debt collectors back to the original bank and pull records and try to prove that every charge on there was made by you. This is a civil suit. If they win and there is a judgement against you, they can garnish your wages, confiscate your assets etc.

It's very scary. I'm still dealing with this right now, it's not over and it will take a while to resolve I think.

Additionally, my brother has an addiction problem. I've been trying to talk him into getting some help because he needs to, if not he can ruin his life and he won't be happy. I don't really know what I'm doing though. I'm talking to the school psychiatrist this week to ask for guidance. I want him to seek help and be able to stick with the program or therapy or whatever else it turns out to be.

Last week, my aunt collapsed. She has a patent foramen ovale, which means that there is a hole between her right and left hearts. Your heart is 2 pumps. The right side, pumps blood coming back from your body to be reoxygenated in your lungs. The left side, pumps blood coming back from your lungs to your body. When you're still in the womb, your lungs aren't fully developed and there is no oxygen to breathe anyway, you're bathed in amniotic fluid. So blood needs to bypass the lungs and there are two shunts; the first is within the heart itself, shunting blood from the right to the left; the second is a duct that connects the artery leading from the right heart to the lungs (pulmonary artery) and the left heart to the body (aorta). My aunt has a hole in the first shunt, the foramen ovale. This is supposed to close completely after birth, but in some cases it doesn't. People can live their entire lives without having symptoms, but I guess she was stressed enough that cardiac output decreased and she didn't get enough blood to her brain (this is my guess, I don't really know the exact details of her collapse).

She was worked up and the hole was small so the surgeons are not going to close it. The checked her out and everything seems good. A blessing in this month of months.

Last friday, my uncle died. He is the husband of my dad's sister. They live in Maryland. I don't know him very well, but I'm close with my aunt. He has diabetes, same as my dad. He suffered a stroke before same as my dad, he's the same age as my dad. The only difference is that he's in much worse health. It's been a tough weekend for me. I'm grieving much more than I expected. I'm also scared for my dad.

A few weeks ago, we found out that he had some blood in his stool, a positive fecal occult blood test. It means that there is bleeding somewhere in his GI tract, anywhere from the mouth to the anus. He was referred to the gastroenterologist for a colonoscopy. He ran some blood test to prepare for the colonoscopy. My dad has some anemia, there were abnormalities in his iron values. The doctor came up with a diagnosis of anemia of chronic disease. Chronic disease could mean a great many things. From kidney disease, colitis (inflammation of your colon), tumor, autoimmune stuff, anything that is chronic really. What happens is the chronic inflammatory process releases some molecules into your blood that makes your cells retain its iron stores so that your bone marrow can't use it to make new red blood cells. That's how you get anemia.

The anemia is an indication for an upper endoscopy, which is like sending a camera down your throat into your stomach, looking at structures along the way. The colonoscopy covers the other end. March 3rd is the big date. I don't know what to expect. I spent the day today learning about anemia of chronic disease. I still don't know what to expect. I just pray it's not bad news.

I felt like i had to document this here. I'm just not dealing with this very well. I was really feeling like I wouldn't be able to take anymore. I felt that after my aunt collapsed that there would be more to come and there was. I just don't want to make any prediction that will come true later. I'm a mess. Talking about it with friends helps, talking about it here helps more. I want to be able to remember this moment and come back here and know the details of what happened and see that this is a pretty bad time and my family and i got through it. Maybe it's a little messed up to want to remember the bad stuff, but i can't appreciate the good stuff without the bad.

Step 1 Board Exam scheduled...insert sense of impending doom

I just scheduled my step 1 date. It's going to be June 4th at 9AM. It lasts 8 hours, I'll be outta there by 5PM and asleep or drunk or comatose from food by 8PM.

I'll have exactly 5 weeks to study for it....I have no plan on how to do that yet.

Step 1 is probably the most important exam you'll ever take as a med student. For the most part, it determines the type of residency you'll get into, if you can get into something competitive like Dermatology or Radiation Oncology. Or it determines the location of your residency. It tests knowledge from the first 2 years of medical school. It's more memorization than it is thinking, or so I've heard.

So that's what's ahead of me right now