Second Year = Life & Death

My second year of medical school was filled with drama (as if my 1st year wasn't dramatic enough). I had spent the summer between 1st and 2nd year doing research with Dr. Linda May and meeting with a local reproductive endocrinologist to assess the physical damage that had been done to my reproductive system during the ruptured ectopic pregnancy and resultant open surgery (where they removed one of my fallopian tubes, a procedure called a salpingectomy). While the break from classwork was fairly drama free; it wasn't exactly a vacation. I saw the REI doctor at least once a week and worked between 20-40 hours with Dr. May on the research project. Even though I was quite busy, I still found plenty of time to relax and enjoy my time away from books and exams.

Dr. May and I studied the effects of maternal exercise on fetal nervous system development using a special machine called a biomagnetometer. The biomagnetometer is a special machine used to record the electromagnetic waves that are produced by fetal movement. It is very similar to the special cortical cap that is used to record brain waves when doing an EEG (electroencephalogram). The results from our study suggested that maternal exercise was quite beneficial to a developing fetus. I was later asked to present our study findings at a conference at KCUMB and at a convention in New Orleans (this is a link to an article about the convention). Dr. May was featured in Fit Pregnancy and our manuscript was selected for publication a few months ago! So, I guess that my summer work paid off; I can now say that I have a publication!

Dr. May and I working on our research project!

As for my reproductive evaluation; the summer evaluation did not turn out quite as we would have liked it to. We found out that it would be nearly impossible for Brian and I to conceive on our own. We were also informed that if we were interested in having children we should consider doing so sooner rather than later. ...Well, that gave me something to ponder while starting off my second year of medical school.

Year 2 = Life & Death

Second year is similar to the first year in the fact that it is learning the basic sciences before we are allowed to go into hands on training during years 3 and 4. Our school teaches medicine by the "genesis" system, where we learn the body in systems. So we study the musculoskeletal system as a whole and all of the conditions and medications that are related to that system, and then proceed through the rest of the body in a similar fashion (GI, reproductive, cardiopulmonary......). The 1st nine weeks of 2nd year are spent focusing on the nervous system. This section is known to be the most difficult section of all of medical school. The brain and nervous system are incredibly detailed and very hard to learn about. So, we are told that we must devote all of our time and energy into this section and then we can relax a bit while finishing off the rest of the body and studying for boards. That is exactly what I intended to do. I had survived year one, and I was going to do all that I could to devote all of my energy into making it through year two. No more issues, or drama in my life until medical school was over.......

That was my plan anyway, but things rarely go as planned. Instead of being able to devote all of my attention to this incredibly difficult section, my beloved Grandmother got very ill and was diagnosed with end stage lung cancer during my 3rd week of neuro. So much for no more drama. I was very close to my grandmother, so watching her go through the last 2 weeks of her life in horrible pain was a nightmare. The only thing that made it worse was the fact that while I was sitting by her side I was trying as hard as I could to memorize all of the intricate pathways in the brain. My Grandma's last wish was to die in the comfort of her own home. We did everything that we could to get hospice to step in and get her there before her final hours. We were able to succeed and she passed away a few days after returning to her house. At the time of her death she was surrounded by her family, and it was a very peaceful experience. We were all sitting by her bed holding her hands and talking about happy times that we had all shared when she took her final breath. 

 She was an amazing lady and I loved her very much. I wish that she were still here today; I know that she would get a big kick out of my having twins and becoming a doctor. She was very proud of the fact that she was able to get a degree and participate in science fairs. She always said that "back in her day, women didn't do things like that." She often told people that I was going to school to be a nurse. It didn't bother me and I usually didn't correct her. I don't know if she didn't know I was going to be a doctor or if she didn't understand that females were able to become doctors now. I guess I will never know. I wish that I had a picture saved on my laptop to add to this post, but I haven't uploaded any of my older photos yet... 

Grandma was 93 years old and had been living on her own and doing very well until a few weeks prior to her passing. Her quick decline in health was quite a shock. It made Brian and I think about how short life really is and how we have no certainty about the future. At that point we decided to consider working with the REI to have a baby. One of my closest friends, who was in my medical school class was getting ready to have her 1st baby, so we decided that this year was as good a time as any. We didn't want to wait until we were ready and miss our opportunity and regret it later, so we made an appointment with the doctor to discuss IVF.

So, about a week before the neuro final, I started giving myself injections in the abdomen to start the process of creating a new Million. IVF is very expensive, but Brian's insurance covered it. That was actually the deciding factor as to when we would attempt to procedure. Since his insurance was going to pay for it and the job market was a bit insecure, we decided to do it while we didn't have to fork over 15-20K out of pocket. I remember going through the final exam and having hot flashes and chills from the medication. Looking back, I have NO IDEA how I passed that exam. 

The IVF process takes 4-6 weeks and it isn't the most pleasant thing a couple can go through. You have to REALLY want to have children in order to give yourself daily hormone injections, and undergo 2 lovely surgical procedures. We really wanted kids, so we suffered through. I will never forget toting my little lunch cooler around with syringes everywhere that I went so that i wouldn't miss a scheduled injection. I even allowed Brian to inject me a couple of times and two of my best friends gave me shots just so that they could say that they helped get me pregnant. After all of the drugs and injections egg retrieval was a welcome event, because it meant that I was done with the shots and hormonal shifts. 

Retrieval went really well. They put you in a twilight state and use an ultrasound guided catheter to suck the eggs out of your enlarged ovaries. We got 21 eggs. As soon as they remove the eggs the embryologist surrounds each egg with sperm and leaves them to do their magic. The eggs are fertilized while the mom is waking up and the dad is hanging out in the waiting room. The next day we got a phone call saying that 19 of the eggs had fertilized, which meant that the ones that had not were probably not mature enough when collected. On day 2 we were informed that 15 of them were thriving embryos and that we would be undergoing a day 5 blast transfer instead of a day 3. It was a Sunday when we went in to "get pregnant." We were excited and nervous all at the same time, but we felt comfort in the fact that we had so many embryos.

Unfortunately when we arrived at the hospital we found out that only 2 of the 15 embryos had survived to the blastocyst form. We were crushed, and so was the doctor. So, instead of putting one embryo back in as we had planned, we put in 2. It didn't seem very likely that they would survive, so we were already planning on changes to make in our next IVF cycle. Well, that was the case until we got a call on Wednesday that informed us that 2 of the embryos that had not made it to blast stage on Sunday had started dividing again and were in excellent shape. They wanted to know if we would like to have them frozen for future use.....We froze; if those 2 had survived, what about the 2 that they put back in me???????????????

The next 12 days were perhaps the LONGEST days of my life. We had to wait until day 14 to have a blood pregnancy test to see if the IVF worked. Thank goodness that I had so much studying to do for school, because I think I would have gone crazy if I didn't have something else to focus on. 

On day 13 we had decided that we couldn't handle it anymore and went out and got some pregnancy tests. I drank a bunch of water and used the test as directed. We waited in anticipation for 3 minutes until the bright pink line appeared in the test box and then nothing showed up in the control area. Hmmmmm, what does that mean? It must be a defective test kit; how can you screw up a urine pregnancy test!!!! So, we tried again & this time within seconds both lines were BRIGHT pink! The waiting game was finally over. We were pregnant!!!!

The next day I got my blood test done and later found out that my hCG levels were so high that they thought I may be having triplets. At that time I think I might have had a mild heart attack! So, it was time to wait again. We had to wait another few weeks for the ultrasound to confirm a fetal heartbeat and to tell us how many. During this entire process I was still able to go to school full time and focus on my medical education. I aced the reproductive section; I think that I only missed a handful of questions on that final exam!

The very 1st picture of Molly (left) and Benjamin (right). The sight of this left Brian speechless for a day or two...

Benjamin

Molly.....the fact that she is upside down & kicking Benjamin,
is proof that personality develops before birth....

By Christmas we had gone through enough ultrasounds to feel comfortable to announce to the public that we were going to have twins and that we were due in late July. However, it was not until a few months ago that we decided that it was okay for the world to know that Ben and Molly are "test tube babies." So, I must apologize to anyone who is involved in our life, who is just finding out that the twins were made in a lab and who are shocked by the revelation. We did not keep this a secret from anyone on purpose; we just weren't sure how many people we wanted to share it with and we didn't know if we wanted the twins to know how they came to be. We have decided that it is a good thing for the twins to know and we want them to know while they are young so that they don't find out when they are older and go through some strange phase of hating us for not telling them everything or resenting us for not letting them know. We even found a few children's books about IVF babies and got them for the twins. They don't quite get it yet, but they do understand that we loved them long before they were born and that they are very special. Besides, now that I will actually be practicing medicine, I want to be able to share my story with patients who might be going through the same thing that we went through. So, enough about IVF....

The rest of year 2 went by really fast. We started studying for Step 1, which is our first of many medical board exams, and we whizzed through the rest of the body sections at warp speed. Nothing too exciting happened, except for my trip to New Orleans with my mother, Dr. May, and Dr. Yagoda. That was fun, except for the fact that I was VERY big and pregnant at the time. New Orlean's has some amazing food! I ate my way through the entire city! When we got back from they conference we started putting together the nursery when I wasn't too busy studying or going to class (so, we might have spent 3-4 hours a week on it). And then, at about 27 weeks I started having contractions that forced us to go to the hospital and be monitored in labor and delivery for a few hours. I was given IV fluids and some medication and the contractions stopped so I was sent home and told to return to the hospital 2 times a week for fetal non-stress tests so that the babies could be monitored more closely. It was not fun to try to schedule three hours a week at the hospital on monitors around board studying and class work!

I LOVED these adorable cupcakes from one of my showers!!!

A few weeks later, I was put on strict bed rest, because I was going into pre-term labor and the babies were too immature to be out in the world yet. The school allowed me to watch lectures over the internet, and I was told to postpone Step 1 until after the kids were born. A few of my classmates (& best friends in the world) would come over in the afternoon to study with me and to set up the nursery while I laid on my left side in misery. They would bring me treats and try to make my imprisonment seem more tolerable. I was addicted to frozen custard with cheesecake in it; no wonder I gained 72 pounds! 

One day when I was laying on the floor watching my friend fold adorable little onsies, I got a phone call telling me that my aunt, who I had lived with at one point in my life, had been found dead in her apartment.  I started sobbing and asked to be taken to my parent's house since I couldn't drive. We found out that she had died from a heart attack in her sleep and that her dog also passed away around the same time, right next to her. I have been told that animals often die a sympathetic death, but this occurrence confirmed it for me. I had spent a lot of time with my aunt and my cousin and we were very close. I couldn't accept the fact that she was gone and that she would not be around to meet the twins. 

At that point I started looking back over the obstacles that I had encountered while attempting to go to medical school & I started to wonder if maybe I should give up... Maybe all of these things were a sign: the ectopic, my grandmother passing, a twin pregnancy, the death of my aunt. Brian and I actually talked about  my quitting school and staying home with the kids and teaching skating again. We went so far as to contact the school's financial aid office to find out what would happen if I dropped out. What we found, was that we would owe over 150K and therefore could not afford for me to quit. If the obstacles that I had encountered were trying to tell me something, then I would need to win the lottery in order to follow their guidance and drop out. I didn't win the lottery, so I continued to go to school. 

I was 3 weeks shy of completing 2nd year when the twins were born. They were born at exactly 33 weeks gestation. A bit too early to be strong enough to handle the world, but tough enough to make it with a bit of medical support. We contacted the school and informed them of their early arrival and told them that they were in the NICU and that they would remain there until they were stable. We also sent them a doctor's note stating that I would not be able to return to school for 4-6 weeks since I had to have a C-Section. 

Molly Kaye (named after my Grandma); just a few hours old.
16 inches long, and weighing under 4 pounds

Benjamin Christopher a few hours after arriving to the world.
19 inches long, and 5.3 pounds

A few weeks later I got an email from the dean of medicine granting me a 1 year leave of absence from medical school in order to spend time with my tiny babies and help them grow and get strong enough to face the world. At that point in time, I needed the break since I wasn't feeling much like facing the world either...........

Our family with Double Dan, the man who helped us make Millions!!!!

It's ALMOST over!!!!

With a couple of weeks left before I FINALLY graduate from Medical School, I have started to reflect upon the last 5 years (yep, it took me 5 years- you will see why soon) in my mind & remember what the process of becoming a doctor has really been like. I wish that I would have started writing a blog much earlier so that I would have a written account of the whole process instead of attempting to patch together a string of fragmented memories. Unfortunately, I didn't blog back then, so all I have to work with in my attempt to compose a memoir of my path to doctor-hood is a collection of very thick binders, half a million flash-cards, thousands of dollars worth of books, a few photos, multiple gray hairs, and flashbacks of some of the occurrences that have impacted me in some way. (oh & did I mention that 301 thousand dollars worth of student loans that will serve as a monthly reminder for A VERY LONG TIME...)


As I reflect upon my time at KCUMB, the one thing that I can say is that I could NEVER do it again!!! If it weren't for the support of some of my very close friends, my amazing husband, and my family there is ABSOLUTELY NO WAY that I would be graduating on May 19th. In fact, I often wonder if I would be sending out grad party invitations if I  had chosen to go to a different medical school. The professors, staff, & other students at KCUMB have been an amazing group of people to work with. I have had more than a few major life issues blindside me over these past 5 years that would have made most people walk away from their training all together, but with the help of all of the wonderful people in my life & the blessing of attending a compassionate medical school, I have been able to stick it out. The professors & staff members have not only been a vital part of my education, but many of them have become some of my closest friends & will hopefully play a vital role as such for years to come.

Looking Back

Year 1: Classrooms, Labs, Exams & MANY Books

So, here is my attempt to summarize my medical school experience in 3-4 blog posts:

White Coating Ceremony

 1st Year:
On the 1st day of medical school I woke up in a hospital. I know that students are suppose to spend a lot of time on the floor, but this is probably not exactly how it is suppose to start. The rest of the new students were sitting in an auditorium taking notes & highlighting away & I was laying in a bed, hooked up to IVs, in horrible, pain panicking about missing my 1st day. This is NOT the way to start medical school!!!!

I had suffered from a ruptured ectopic pregnancy the evening before classes started & was rushed to the ED in hypovolemic shock (massive blood loss). (I am sorry if you are one of my close friends or family members & are just hearing about this for the 1st time; it was not an easy thing to deal with & it has not been something that my husband & I have wanted to spend much time talking about since it happened. I almost died that evening. They had give me a 4 unit blood transfusion (your entire blood volume is about 5-6 units) & open my abdomen emergently to stop the source of the bleeding. I ended up surviving surgery, but losing a portion of my uterus & my left fallopian tube.

All of that is shocking, but the most shocking part is that I was between 12-16 weeks pregnant & had no idea. I had been using birth control pills for almost a year, so pregnancy is not something that we had intended. Even though we were not wanting a baby at that time, the idea that we had lost one was almost too much to handle for us. The only part of the entire ED visit that I remember is hearing the heartbeat on US when they were looking for a source of my shock symptoms.

So, I spent my 1st week of school as a patient instead of a student doctor. I bet that I learned a lot more about medicine & being a good doctor that week than I would have learned in class.....

Thanks to an amazing OB/GYN from KCWC who came in on a Sunday evening to save my life (who I must mention had just found out she was pregnant earlier that week), and some great people at school I was able to make up the work that I had missed & complete 1st year with a decent GPA. The rest of the year was pretty normal (for a med student)....

I remember spending about 12 hours a day attending classes or labs or studying. There were a few firsts for me that I  NEVER forget:

• Med School Prom: Yes, we had a prom during medical school. This was a really big deal to me since I had never actually been to prom before. Our school has one every spring. Brian & I attended the prom my 1st year, but never made it back after that one. We had a blast & would have loved to attend others, but somehow life got in the way....

Med School Prom

• Gross Anatomy: I will NEVER forget the 1st time I worked on a human cadaver. I don't know what exactly happens with the first cut, but in some way I feel that it changes a person. Dissecting a cadaver is a privilege, that very few people ever have the opportunity to experience. While it is an honor to be a part of a gross anatomy dissection, the act of actually cutting into human flesh places a very strange and heavy burden on a scientist. By picking up a blade and cutting into someone's family member, you are crossing some sort of line that is not intended for the weak of heart (or stomach). After my 1st lab, I felt an incredible pressure on my shoulders to learn everything that I could while working on our cadavers so that the people who donated their bodies to us would not have done so in vein. I also felt some strange division begin to develop between the enthusiastic new medical student that I was the day before and the scalpel holding student doctor that I was becoming.  When I left the lab I really wanted to discuss what it was like to actually dissect a human being, but I had a very hard time finding someone who wasn't either in medical school, or who was already a graduate who would share in my enthusiasm. I guess that the lyrics to a certain song come to mind when I think about how anatomy lab can change a person ("The first cut is the deepest..."). The first time I left cadaver lab I felt different, it was the 1st time that I actually understood how serious the commitment of being a doctor was, and how much of an honor it was to be able to attend medical school; I also realized that there is something that separates people in white coats from people in street clothes....it's that imaginary line that white coat wearers cross every day when they invade the human body in ways that most cannot even begin to imagine.
• Some of my favorite anatomy lab moments: 
• On Halloween we had a HUGE practical & I remember walking around the lab carrying half of a leg around trying to memorize all of the parts at 5:30 in the morning. It didn't even dawn on us that it was Halloween until someone walked by wearing a costume...then I realized how strange it was to be carrying around a body part.
• On one of our early exams we had to learn all of the bones of the body. Not only did we need to be able to identify them by sight (& spell their names correctly), but we also had to be able to identify them by feel. So, during the exam there was a station with a black box with a hole in the side of it. You were to stick your hands in the box and name that bone. Someone actually made a youtube video about this exam: "Bone in a Box."

• Score One for Health:  Score One is one of the coolest things that I was able to do during the first 2 years of medical school. It is a program sponsored by KCUMB and The Deron Cherry Foundation that provides medical screening to underprivileged children in the KC area. Once or twice a semester different groups of students from our school would board busses that would take us to various elementary schools in the surrounding area where we would spend the day doing physical exams on the students at the school. It wasn't the ideal medical care situation for these youngsters, but for most of them it was the ONLY medical care that they had ever received. We would all gather in a common area and kids would line up holding a small folder and go from station to station to have their blood pressure and weight checked, an eye exam, a dental exam, and a full physical. We were always accompanied by students from local nursing programs and the dental school who would help with the examinations. We were also monitored by a group of KCUMB physicians who were there to answer questions and assist us when we found an abnormality. When something was found to be wrong with one of these children they were given a referral slip to get treatment from local providers who were offering aid. I will never forget some of these little ones:
• I asked one patient who their doctor was & the sweet little thing looked up and replied "you are." She was 7 and had never been to the pediatrician.
• On one visit I saw 14 kids with teeth that were so rotten that they no longer felt pain. Rotten teeth are black and misshapen. Most of these kids didn't have a toothbrush.
• I saw multiple cases of ear infections, untreated diabetes, signs of physical abuse, ring worm...and many other horrible things that no child should have to suffer from

I always left those afternoons feeling sick to my stomach, but I felt a bit better knowing that we had helped these children in some way.

So, that pretty much wraps up 1st year. It wasn't the most fun I have ever had, but I lived through it!!!!!

Scars...

I am currently on my cardiology rotation & today I encountered a patient situation that nearly brought tears to my eyes. This patient made me wonder how people can cope with some of the horrific events that they are faced with in their lives & if they ever really heal from such painful incidents. This caused me to reflect upon some of the occurrences in my own life that have caused emotional distress so severe that I wondered if I would ever be able to go on. The fact that I am here now blogging about this topic, made me realize that every person deals with disaster, loss, & pain in their own way & that the healing process from such events is very similar to the process that the body goes through after injury; once damage has been done, the body will never be the same &  every assault leaves a permanent scar.

Code Blue Baby

Last week I was sitting having lunch with a nurse practitioner, when over the intercom we heard "code blue, L & D." Since this is a cardiology rotation, I must attend every code while I am at the hospital. So, we both jumped up & ran to the elevator to join the crowd of people rushing to the 3rd floor. We both looked at each other, sighed & said, "I really hope it isn't a baby." We both have young children at home & both had a difficult time conceiving those children, so seeing sick or dying babies is not something that either one of us can handle very well. 

When we got off of the elevator, along with the 12 other medical professionals who were headed in to help, we heard the nurse announce "it's the baby, it wasn't breathing when they pulled it out." Now, I am not usually one who scares easily & I have never refused to participate in anything medicine wise that I was allowed to, but this time it was different. I looked around the small ward & saw 2 young girls sobbing, 5 doctors suiting & scrubbing up, nurses running around frantic & I slowed down, looked at the cardiologist that I am working with & asked if there was any way I could be excused from participating in this code. Without hesitation he kindly replied "this isn't the case for either one of you; please go round on the other patients." So, the nurse practitioner & I looked at each other and quickly headed for the door before he could change his mind. We went on with the rest of our day like it had never happened. I guess that was our way of coping with the fact that some mother, just like ourselves, was going through a hell that neither one of us would ever want to imagine.

There was no mention about this baby again until today when we found out that they are working on pronouncing the newborn brain dead so that they can harvest it's organs for transplantation. When I heard this I felt ill & I started to wonder how the poor mother would ever recover from such a horrible event. Her pregnancy had been completely normal, she was young & healthy, this was her 1st child & her entire family had rushed to the hospital to be there when the baby arrived. Now, 1 week later, there is an empty nursery, fully of clothes, & a mother who will have to bury her first born child before he/she could ever even leave the hospital. 

I don't know why this case bothers me so much. I have seen people die before; I was standing right there when my own Grandmother took her final breath 2 years ago & I have been present when time of death has been called many times since then. I have even been doing CPR or intubating patients when the time came for intervention to stop. Don't get me wrong, it bothers me when people die, but for some reason it REALLY gets to me when it is a child or a baby. Most of the people I have worked with who have passed away had all had a life, maybe not the life they had planned or wanted, but they had lived. This poor little baby never even took it's 1st breath. Why would a woman have to go through the pain of carrying a baby to term only for it to die upon delivery, without ever having any life at all?

I discussed this with one of my closest friends & she informed me that it bothered her more when it was an adult who passed on; especially if it was a mother with young children. Apparently she had gone through some personal event in which a young woman died shortly after giving birth. After a bit of discussion, she said that she thought that the reason that we felt so differently about this was that she was able to get pregnant very easily & had never had a sick child, while I had a horrible time getting pregnant (that's a whole different story to blog about later) & spent the 1st month of my kids life in the NICU. So, I guess that the way we feel about the death of our patients is effected by the scars that we have collected from our own personal assaults.

This was my little Benjamin, the 1st time I saw him. I cannot begin to explain the pain of not being able to hold your newborn baby, or the horrible fear that Brian & I endured for the 1st month of this little guy's life. He was born at 33 weeks, unable to breath without assistance, weighing 5lbs 3oz. I wasn't able to hold him until he was 3 days old. There were multiple events that occurred over the first few weeks in which we were forced to question his survival.

This is not how I imagined that his first baby pictures would look. I had always pictured a room full of balloons & flowers & all of my closest family & friends waiting to greet us and celebrate the arrival of the twins. They weren't able to meet any of their extended family or friends for a long 6 weeks.

This is Molly, during her "car-seat challenge," a test that all premies must undergo before they are allowed to leave the hospital. She was 3 weeks old & weighed a whopping 4lbs. When we bought these car seats I thought that their 1st use would be to take babies home in. We didn't take these guys home for another 9 days!

* **The pictures of the twins are just a few of many that were taken during our stay in the NICU. At the time, I was so worried about the health of my babies that I didn't realize how much that month would effect me later on in life. While we were there, I saw some horrible things. I saw a set of twins born at 27 weeks, who were being stabilized to transfer to another hospital; you could see through their skin. I saw a woman come to visit her newborn who had been in a car accident the night before. She was due to deliver twins, but one baby was crushed in her pelvis on impact. I saw another young woman stand by an incubator while the machines that were helping her baby survive were turned off. Those were just 3 of the worst cases that I can remember. As I look back on these events, I realize that each & every one of them has changed me in some way. I guess that you could say that these events have become permanent scars, that will forever influence the way that I view the world & react to other events that I encounter.....

***They now believe that the baby discussed in this blog may have had Osteogenesis Imperfecta, a genetic disorder that causes extremely fragile bones. For more information, & ways to help families effected by OI visit: Osteogenesis Imperfecta Foundation

Family Medicine?!?

Well, the match is final & I will start residency at Truman Medical Center-Lakewood in Family Practice on June 29, 2012. On Friday, March 16th at 12:00 pm, I received an email titled "Where did I match?." I looked at the title of the email, my heart began to pound, my hands began to shake & I held my breath as I opened it. I can't even begin to explain what I felt when I read the words "Family Medicine."

At first, I was overjoyed at the fact that we would be staying in KC where our kids can grow up with their grandparents. And then it hit me; this is the rest of my life, my career, something that I will do forever. Did I really want to be an FP? I guess that I should give a little background into my interview season and rank list...

At the beginning of this year when it was time to apply for residency I had a really hard time deciding on what I wanted to do. People would ask me: "which rotations did you enjoy the most?" or "what type of lifestyle do you want?" The truth was that I liked almost all of my rotations & lifestyle is not something that I have ever given much thought to since I have really never had a "life." Between skating, medical school & raising twins, I really had no idea what a life-style was. I talked to everyone I knew about different specialties & I got a million different opinions. In the end I knew 4 things:
   1. I hated radiology, neonatology, and geriatrics
   2. My family, husband, and kids would be crushed if we had to relocate to a different state
   3. I didn't have the scores to become a dermatologist, otolaryngologist, or orthopedic surgeon
   4. Nobody that I talked to was 100% satisfied with their career, and 80% of them were not doing what they had originally applied to do

So, with those 4 things in mind I filled out my ERAS and applied to:

• The top 4 specialties I enjoyed the most (Surgery, OB/GYN, Otolaryngology, Family medicine)
• Programs that were located within driving distance of the grandparents
• a few out of state programs where my husband was okay to relocate to, but ONLY IF WE HAD TO
• some way out of reach programs like Bringham, and Yale (just for kicks, since you pay a flat fee for 10 programs per specialty)

****a little aside here for anyone who might be reading this post: First off, I am being completely honest here & I hope it won't be held against me; I realize that most people do not speak of their rank list and such, but I really want to remember this stuff later & I want to share it with other med students who might feel the same way that I do. I think that brutal honesty is the best policy & I wish that everyone would be this honest & free. I think that if people were truly honest about who they are & what they think the world would be a much happier place. (people always think that the grass is greener on the other side, but I have noticed that a lot of the grass that we are looking out is planted in BS! - if we knew the truth about some of the people who we envy, we would like our own lives much more)... Secondly, Most students do not have the same priorities that I had when they are going through the match process, so do not view my experience as the norm!*****

Now, on with the story: A few weeks after the applications went out I started getting interviews. I also had a strange mix up with some of my rotations & ended up doing a rotation in Plastic Surgery, a specialty that I had never considered applying to. The only times I had ever even thought about plastics were when I looked in the mirror, or when I watched Nip' Tuck. Within the first 3 days of the rotation, I was madly in love with the specialty. It wasn't all about skinny girls, who wanted bigger boobs or thinner thighs; it was about making the abnormal normal again. We put peoples fingers back on, we removed a cancer that took up over 1/2 of a mans lower lip & made it so that he would be able to move his mouth somewhat normally; we removed 10lbs of breast tissue off of a woman who could barely stand up, we helped women who had lost their breasts due to cancer feel whole again....& we did so much more! I LOVED working with my hands, I loved the instant gratification of being able to actually SEE the results of the work that I had done. I loved the fact that the surgeries were long & focused on detail; every little stitch had to be just right! So, I went home & applied to one more specialty. I knew it was a long shot, since there are only around 110 spots in integrated plastic surgery programs & only the top students are selected for a position, but I had to try. I also had to try to move the rest of my rotations around so that I could spend more time doing plastics before I graduated (in case I never got to do it again). I contacted my school & began moving things around ASAP. Unfortunately, I was unable to get a rotation at KU for their plastics program, after applying 3x.

A few days later I was scrubbing in for a case & met a bubbly little blonde girl at the scrub station. She introduced herself & told me that she was a resident in the KU plastics program! I told her how much I loved plastics & she helped me get a 2 week rotation at KUMC! I was super excited & while I was there they actually offered me an interview. Again, I knew it was a long shot, since the other applicants were at the top of their class, some with 20+ publications, multiple oral/poster presentations, went to Ivy League schools, & some even had patents! I only had 2 publications, 3 presentations, & I will not be graduation at the top of my class. I still had to try. I might add that there are 2 ways to become a plastic surgeon: 1. through the integrated plastic surgery programs; 2. by doing a traditional general surgery residency + a plastic surgery fellowship. 

So, interview season progressed & I interviewed for some wonderful programs. I decided to put 10 of them on my rank list. It was easy to decide what to put #1, the long shot of course, but I had no idea what I should put from 2-10. I loved surgery & working with my hands & the program at UMKC felt like home to me; I loved the Cleveland Clinic & Creighton; OB/GYN was surgical & delivering babies is such a joy, but above all I LOVE my family & my kids & I cannot imagine making them unhappy.

So, I typed up a list for my family that included:

• the program name, location, specialty
• average work hours for the program (surgery 80 hrs/wk, non-surgery 60-70)
• length of residency (plastics 6 or 8 yrs, general surgery 5, OB/GYN 4, FP 3)

Then I did what would shock almost very medical student, program director, & physician on the planet; I asked them to rank the programs from 1-10 & I had my sister add all of the numbers together & average them. Then I logged on to NRMP, entered the programs in the order created by the averages & hit submit. Since I am being totally honest here, I will go so far as to share how the top 5 came out:

1. KUMC Plastics
2. Truman Medical Center General Surgery - Categorical
3. Truman Medical Center OB/GYN
4. Cleveland Clinic General Surgery - Categorical
5. Truman Medical Center Family Medicine

The rest of the programs were either out of the area, or preliminary programs (1 year only, w/o a guaranteed position after that year). I was very satisfied with that list. To me, it was sort of like an arranged marriage, since it was picked by the people who know me the best & who have my best interest at heart. I have read many times that arranged marriages have the best outcomes & lowest divorce rates, so I thought that my rank list made logical sense. I would do it the same way, if I had to do it all over again!

So, why was I so stunned when I opened the email? Why did I have so many mixed emotions? I can't entirely explain any of this, all I can do is try to explain what I have been feeling since I opened that email & continue to work through the fact that this one email will guide the rest of my medical career. As I said before, I was overjoyed to be staying in KC, I was also very happy that I would be training in such a wonderful program where I some of my closest friends are training.  The rush of thoughts that entered my mind after I posted my placement on Facebook, went a little something like this: "oh my goodness, I will never operate....I will not be spending my days in an OR...FP is really difficult, you have to know about every single disease & every age group....am I smart enough to do this....is this what I am suppose to do?" And then, the tears came. I don't know why I cried; most of the people in my class were on their way to go celebrate; or were they?

Since that day I have spoken to many of my classmates & it is true that a good percentage of them were rushing off the party the minute they got the email, however, I have found that there are quite a few of them who have been feeling similarly to the way that I do. Some of them found out that they would not be able to live in the city where their family is, some wouldn't be doing the specialty they desired, & some didn't match at all. I have also spent many hours trying to understand my own feelings about the match & my placement. Unfortunately, I am still not sure why I am not as overjoyed as I should be & why I have so much uncertainty about my future. However, I have recently found out who the other members of my residency class will be & I am SO HAPPY to be a part of such an amazing group & I am also thrilled with the fact that I will be able to spend more time with my kids than I would be able to if I were doing a surgical residency. Other than that, I am still not sure what to think. I have decided to focus on the fact that in a few short months I will be a doctor & I will no longer be collecting student loan debt! With that in mind, I think I will go start planning a graduation party!!!

*Anyone else have any thoughts about the whole match process? Does it work? Is there a better way? What percentage of applicants are happy with their results? Anyone else want to share their experience with the match or with finding their specialty?

***Again, I do hope that this post is not taken out of context in any way! I am not unhappy about my placement, I think that family medicine is an amazing field & I am sure that I will enjoy every minute of my training. I just wanted to document an honest history of how I became the family practitioner that I will be someday!***

What if I wasn't going to be a doctor???

After completing my last post about match week I started to think about what I would do if I didn't match at all. Then I started to think about what I would do if I wasn't going to graduate from medical school in May. I thought about this for a while & came up with a bunch of different options: skating coach, house-wife, teacher, zoo keeper, nurse, photographer, boutique owner, writer.... the list went on and on and on.

What I came up with is that I think I would be a few things; above all I would be a mommy to my twins & look for flexible ways to make some money while maximizing my time with them. What I realized is that I really enjoy planning parties, making crafts, and decorating kids rooms. I started looking through some of my old pictures on facebook (right now, I will do just about anything to take my mind off of the match) & I saw pictures of some of my wedding & parties that I have planned since the twins were born & I immediately remembered how much fun I had putting all of the details together for each event.

I also saw pictures of the twins 1st bedroom, their new rooms, & some of the cute little crafts that I have made. Then I looked back over my last few blog entries & became fixated on the "Pinteresting" post. I loved trying to re-create some of the recipes & craft projects that I have pinned. I realize now that I might have to end my Pinterest addiction due to some questions in legality that were brought to my attention by a close friend of mine, & I instantly felt comforted by the fact that I would still be able to spend time searching Etsy for craft ideas! Looking at all of these pictures made me focus on the fact that I take A LOT of pictures & if I am not taking pictures, I am paying to have pictures taken of the twins or my family!

So, there you have it, if I wasn't in so much debt from student loans I would be a craft making, party planning, picture taking Mommy....
But, wait a second, I do all of those things now!

Here are pictures & brief descriptions of events that I have planned & crafty things that I have made recently: ( I will post more of them on another page soon)

A Craft inspired by something I saw on Pinterest:

I made a cabinet for Molly's doll clothes (or her costumes) out of an old dresser!

 * I have been so stressed out about Match week that I haven't been able to sleep. I found an old dresser in the guest bedroom, went to a couple of craft stores (Micheal's & Hobby Lobby) , and after the twins went to bed I made a cute little cabinet! The whole project cost about $15 & took 3-5 hours. Molly loved it, so it was time well spent. 

A Valentine's Day Tea Party

 * Like I said, I love planning parties so, this year I had a Valentine's Day Tea Party for the twins. I purchased a lot of the supplies from Oriental Trading Company & various web sites, invited a few of the twin's little friends & fun was had by all! 



Okay, that is enough for tonight - I have dishes & laundry to do. I will start a new page for parties & crafts soon. Sweet dreams!

Match week is finally here....

On Friday I received an email from the NRMP (National Resident Matching Program) stating that the "NRMP has determined that I am SOAP-eligable." It went on to explain that at 12:00 EST on Monday I would be notified (via email, or on the NRMP website) as to whether or not I was matched. If un-matched, I will be able to participate in the SOAP to apply for unfilled Match-participating program spots....

So, what does all of this mean? For all of those who are in the medical field & have been through this process, you fully understand the joys of the match - so you might want to stop reading now & switch on the TV or find another blog to read; for the rest of you, here is a brief overview of the "Match."

1. The Match is the process by which graduating medical students are placed in residency programs. No, graduating medical school doesn't make you an instant doctor; you still have to go through a very long, strenuous residency training program, before you can practice on your one & make a decent living. Residents work 60-80 hours a week and earn 46-50K a year. Sad, isn't it. And, you don't just get to pick which type of doctor you want to be; you have to apply to a specialty & go through the match & hopefully get a spot in the specialty you select, or you end up doing something else. So, the saying "What do you call the person who graduates last in her medical school class?" has a totally different meaning once you have made it into a medical school class. This year, I think they are calling them "pediatrician, or family medicine doctor;" but, that seems to change with which specialty is popular at the time. My mother still says, "at least you will be a doctor." I just roll my eyes & laugh! To 4th year medical students going through the match, that is the worst thing you could say. The results of the match can turn a person who wants to be a neurosurgeon into a proctologist....

2. Early in 4th year, graduating medical students fill out a very detailed application on ERAS (Electronic Residency Application Service). This application is torture; it requires test scores, very detailed personal information, recommendation letters, and a personal statement explaining why you want to be the kind of doctor that you want to be. The personal statement is the hardest part for most students; some even hire ghost writers to help them with theirs. These writers charge around $250 to write a statement for one student. Some examples of personal statements can be seen on this site: USMLE Web.

3. A few weeks later the application process actually opens up & allows students to apply to residency programs all over the country. ERAS has a list of all of the programs who are taking applicants & the student clicks on the programs that they want their application sent to. Keep in mind that none of this is free. I can't remember the exact fees, but I know that you can apply to 10-12 programs in one specialty for one fee and then each additional program in that field is another charge & each additional specialty is an extra fee also. It usually runs another couple of hundred dollars.

4. A month or so later, students start receiving emails through their ERAS account inviting them to interview with programs or telling them that the program is not interested in interviewing them. Some programs never respond to applicants at all. Once the student is invited to interview, if the student accepts the interview they are responsible for all of their travel expenses and must wear a suit to every interview. This is where the match starts to get pricey. I know students who have spent 10-12K traveling to interviews. I, myself did not spend that much!

5. The interviews go a little something like this:
      1) the night before the interview there is a dinner where you meet the residents and sometimes the staff who are involved in the program. This is suppose to be a casual affair, where you can feel comfortable asking the residents whatever you want "off of the record." However, I can tell you that it is rarely comfortable & everything that you say to a resident is "on the record."
      2) the next day you put on the suit and head to the hospital. You are interviewed by anywhere from 2-10 program members; they could be residents, staff physicians, nurses, or secretaries. The interviews can be very informal, or incredibly stressful. Most of mine were very laid back, the people just wanted to know if they could stand being around me for the next few years. However, one of my interviews was super stressful. I was asked to talk a surgeon through an entire surgery from start to finish; he wanted me to explain the first time that I met the patient, how they presented & exactly what happened in the OR. He even wanted to know which areas were prepped & how long the case took. The same interviewer asked me how many friends that I had on facebook!
     3) Sometime during your day of fun at the hospital you are given a tour, fed, given some papers, and given one more opportunity to talk to the residents.
     4) at the end of the day, you are exhausted & run home to write down everything that you can remember about that program so that you can rank it properly when the time comes. Well, that is what you are suppose to do, anyhow...

6. At the end of interview season, which is usually early February, students are asked to submit a "Rank" list. This list is compiled of the programs that they interviewed & lists them from the student's #1 choice all the way down to their last choice. It can ONLY list programs that the student actually interviewed at. The programs also submit a list of the candidates that they interviewed and are willing to have attend their program. Some students end up on a DNR (Do Not Rank) list, and some students place programs on a similar list as well.

7. Once the lists are turned in the students start to worry. We worry that we ranked the programs in a good order, we worry that we won't match, we worry that we chose the right specialty and on and on and on.....Finally, on March 12th (or thereabouts) the initial rank has been computed by some high-tech algorithm & students find out if they matched. Like I said they find out IF they matched, not where they matched.

8. If a student matched into a categorical (full) program then they wait until the 16th to find out where they matched. If they matched to a non-categorical program (a program that starts with post-graduate year 2 training, or something like that; I won't get into all of this in-depth stuff, because it would take me another hour to explain it) or if the did not match at all then they enter the SOAP. The SOAP use to be called the scramble, because unmatched students scrambled for open spots for 4 days. They changed the name this year; but I am not going to get into that either, because it is a long story & I don't want to type all night!

9. The SOAP: unmatched students are given access to a list of programs with unfilled positions. These programs are located all over the US and are in many different specialties. The applicant then fills out another application and submits it to the programs that they are interested in. I think you are limited to the number that you can apply to, but I haven't read the entire SOAP rules (YET). The programs then interview selected applicants via phone, skype, or in person if they are in the same area. Then on March 16th, at the same time as the rest of the students, the SOAP students are notified as to whether or not they will be participating in a residency program next year & if so, which program.

10. So, what happens to people who don't match at all? The answer to that question is "I have no idea & I don't want to find out." Unfortunately, there are a lot of graduates who do not match; I am currently praying that I am not one of them.

So, there it is, the match in a nutshell. I hope that gives at least a decent overview of how doctors become specialists & can give a glimpse into what makes medical students so stressed out.
Here I sit, at 12:25am on March 12th, blogging about an email that I have been thinking about for 4 long years; an email that will change my life forever; an email that will be in my inbox today at 12:00 EST; an email that will either cause me to go into SOAP mode or introduce me to 4 more days of waiting.....

*If you are really interested click here for more information on the match from MomMD, or search the web & find all sorts of information on the subject!

....68 more days until graduation!!!!