My husband deployed 3 weeks ago today. Before he left, I said a silent prayer that the following 3 things would not happen while he was gone:
1. Sudden demise of a major, cannot-live-without-it household appliance
2. Vomiting illness
3. An ER visit for me or my kids
In those 3 weeks, we have had 2 distinct vomiting illnesses tear through the entire household. One of them, in my 3 yr old, was severe enough that we wound up in the hospital with a very scary clinical situation: dehydration, distended tender belly, anion gap metabolic acidosis, elevated LFTs, and alarming lethargy. Fortunately, after lots of fluids and antibiotics, she is now back to normal. Oh, and did I mention that our washing machine began a slow, spiral of death within 12 hrs of my hubby's departure and ultimately took its last breath in the midst of wave two of vom-a-rama, leaving me to wash about 2 dozen loads of vomit-soaked bedding and clothes in total in our tub, wring them in the washer (which would still spin until close to the end), and then dry them...ALL NIGHT LONG on more than one occasion.
Deployment is really not going so well for us. Or so I thought.
But today, I had a fantastic day. Why? I bought a new washing machine over the weekend, and I did four loads of laundry today. Ordinarily, that would not be cause for celebration, but today I felt like whistling a little tune as I watched our clothes gyrating around. Even they looked happy in there. I could have sworn my sweater was flirting with my jeans. And no one vomited. In fact, no one has vomited for 4 days now. And, although I was in a hospital today and my clinic ran hours late, I was on the right side of the stethoscope. Amazing how a little badness can make a whole lot of ordinary look pretty fantastic.
But the real reason that I am feeling on top of the world is that I have found my safety net when I was beginning to think I was flying without one. In the midst of illness and household crises,not to mention general deployment sadness, we were invited to dinner by other Navy families (thanks, KC!) and preschool families we didn't know especially well before. I had acquaintances who heard about what was going on show up unannounced at our door, asking to take our vomit-soaked laundry to their house to wash and dry and return it to our home (!). I watched in awe as our clearly exhausted nanny stepped up with a smile and came to the ER after working a full day with vomiting kids to take my non-sick kids home for dinner and bed so that I could focus on taking care of my desperately sick one without guilt or distraction. And I had busy family members volunteer to drop everything and get in the car or on a plane to come to us as fast as modern transportation would allow if I said the word. Suddenly, I feel strangely lucky that my husband is deployed. Surely these kindhearted, generous friends and acquaintances and relatives were out there all along, and I could have seen them if I had looked hard and long enough, but it took deployment and all the minor crises that ensued to bring them into focus for me. It has dawned on me how much a little nugget of goodness can resonate with someone who is in a crisis, however defined.
Today in clinic, I saw an elderly woman with newly-diagnosed metastatic breast cancer. Through a series of unfortunate self-fulfilling medical prophecies, including misreading of a CT scan and erroneous interpretation of pathology slides, she had been told that her cancer was widely metastatic, required urgent, very aggressive chemotherapy, and that she would almost certainly die within 6 months regardless. I had the distinct pleasure of telling her that while she does have metastatic cancer, it involves only a few spots on her bones, appears biologically quite indolent, and should be easily treated with one pill a day that won't cause nausea or hair loss or any of the things she fears terribly. As she teared up for the first time, about 30 minutes into our visit, I took her hands and said, "Listen to me. It is far more likely that you will die WITH this cancer than OF it. You are going to live for many years to come." It was one of those moments that every cancer patient coming to a large medical institution for a second opinion (and every oncologist seeing such a patient) silently dreams and prays will come to pass, but which very seldom does. Today, she and I shared a moment of joy that was like nothing I have ever experienced in my life except at a birth. In a way, it was a kind of birth. It was her life, unwittingly stolen by a devastating comedy of medical errors, being dusted off and handed back to her. At the end of our visit, she said to me, "I have had people coming out of the woodwork since this diagnosis making such offers of help to me and my husband...you wouldn't even believe it, if I told you some of stories. And now, I feel on top of the world even though you confirmed I have metastatic cancer. Who would have thought such bad news could sound so great? Weird. I know that probably doesn't make sense to you at all."
Actually, today, it makes perfect sense.
Wednesday, April 1, 2009
Vote for a future colleague! Vote for love!
Mothers in Medicine, our help is needed. Kirby is a MS3 who is a dedicated reader of this blog. She and her fiancee are finalists for a free wedding...but needs votes to win! You can read about their story and vote on the right sidebar for "Kirby and David" at the website. It takes only a minute to vote but could mean making the dreams come true for a future mother in medicine. Voting ends the morning of Sunday, April 5.
I just voted. It took me all of 0.2 seconds.
Good luck, Kirby and David! You'll have to promise to post pictures of the wedding here if you win.
I just voted. It took me all of 0.2 seconds.
Good luck, Kirby and David! You'll have to promise to post pictures of the wedding here if you win.
Tuesday, March 31, 2009
Mother of the patient
I thought maybe my 14-month old son woke up on the wrong side of the crib from his afternoon nap. He wasn't acting like himself. He had no appetite. He was burning up. And he was breathing noisily. I had thought he was getting better from his cold that started several days ago but now he looked sick.
I took out my stethoscope and listened to his lungs. Coarse breath sounds, rhonchi, and wheezes. It sounded awful in there. In my little baby boy. My sweet, angel of a boy. It seemed so wrong that such sounds would be coming from his lungs.
I grabbed his sister's albuterol inhaler and spacer and gave him a couple of puffs. Which did nothing appreciable to his breathing. He also wasn't the most compliant of patients.
It was Sunday afternoon. Of course. It would be the ER. Now, or in the middle of the night, I thought.
I made the executive decision to have him be evaluated in the ER. We should go. Now.
At the front desk, I insisted to be the one to fill out the triage paperwork (as opposed to my husband, not in lieu of the nurse!) Reason for coming: wheezing, tachypnea, fever. I needed to "sell" him as someone who needed to be a priority. I needed them to know I knew.
Rectal temperature in triage: 102.9 F. Pulse 180s. O2 sat 93% (!) RR 42/min (!)
It wasn't very busy and we got into a room right away. They set up a neb for him right away and had me administer it to him, knowing that I was a physician.
JL did NOT like the nuisance mist machine all up in his business all the time and fought it sadly, crying, twisting. I watched as the nebulized mist battled his thumb that was firmly planted in his mouth. He was burning in my hands.
I told the ER physician right away that I was an internist. We needed to be on the same page. Because of that, her way of dealing with me changed, giving me a lot more power in the physician-parent relationship. She told me her thoughts, but then wanted mine, and ultimately left certain choices up to me. X-ray or not (no). Antibiotics are not (yes). I couldn't bear the thought of his little body soaking of radiation - and for what? To definitely know he had a pneumonia? Would I be satisfied if it was negative to not give him antibiotics (no)? But, I worried about some focus of bacterial infection since he was getting better from his cold and then turned for the worse. Bloodwork or not (no). Ceftriaxone IM x 1 (no).
I appreciated having the chance to weigh in so heavily, although I do wonder if I was completely clinically "on" given my duress having a sick child in my arms. Not any sick child. My sick child. But we decided this would be our management. He would be given an acute follow-up appointment in the peds clinic the next morning.
At the follow-up, the pediatrician examined his ears and saw a very clear-cut ear infection in his right ear. This was never done in the ER. I had wondered to myself if someone was going to look in his ears for the sake of completeness, and even entertained the idea of taking a look myself with the otoscope in the room, but quickly brushed the thought aside when JL had pried open the red biohazard container of the floor exposing some kind of urine hat. Plus, the ER physician didn't think it was necessary.
Perhaps I led the ER physician down a diagnostic pathway due to my own suspicions, and maybe coming from me, was persuasive enough not to veer her too far off that path. I know how to give a compelling story for whatever process I think is going on. Isn't this only natural? But, I'm wondering whether she would have done exactly the same with a parent who wasn't a physician. Would she have been more complete? Would she run more tests?
Anyway, JL is doing better, on antibiotics. He's defeveresced but still with a "junky" chest exam. His antibiotic dose was increased since apparently the dosage is higher for an ear infection than pneumonia (wow, peds was that long ago).
And I'm left wondering how much I help and how much I complicate when it comes to the health of my own children. I hope it's heavily weighted towards the former.
I took out my stethoscope and listened to his lungs. Coarse breath sounds, rhonchi, and wheezes. It sounded awful in there. In my little baby boy. My sweet, angel of a boy. It seemed so wrong that such sounds would be coming from his lungs.
I grabbed his sister's albuterol inhaler and spacer and gave him a couple of puffs. Which did nothing appreciable to his breathing. He also wasn't the most compliant of patients.
It was Sunday afternoon. Of course. It would be the ER. Now, or in the middle of the night, I thought.
I made the executive decision to have him be evaluated in the ER. We should go. Now.
At the front desk, I insisted to be the one to fill out the triage paperwork (as opposed to my husband, not in lieu of the nurse!) Reason for coming: wheezing, tachypnea, fever. I needed to "sell" him as someone who needed to be a priority. I needed them to know I knew.
Rectal temperature in triage: 102.9 F. Pulse 180s. O2 sat 93% (!) RR 42/min (!)
It wasn't very busy and we got into a room right away. They set up a neb for him right away and had me administer it to him, knowing that I was a physician.
JL did NOT like the nuisance mist machine all up in his business all the time and fought it sadly, crying, twisting. I watched as the nebulized mist battled his thumb that was firmly planted in his mouth. He was burning in my hands.
I told the ER physician right away that I was an internist. We needed to be on the same page. Because of that, her way of dealing with me changed, giving me a lot more power in the physician-parent relationship. She told me her thoughts, but then wanted mine, and ultimately left certain choices up to me. X-ray or not (no). Antibiotics are not (yes). I couldn't bear the thought of his little body soaking of radiation - and for what? To definitely know he had a pneumonia? Would I be satisfied if it was negative to not give him antibiotics (no)? But, I worried about some focus of bacterial infection since he was getting better from his cold and then turned for the worse. Bloodwork or not (no). Ceftriaxone IM x 1 (no).
I appreciated having the chance to weigh in so heavily, although I do wonder if I was completely clinically "on" given my duress having a sick child in my arms. Not any sick child. My sick child. But we decided this would be our management. He would be given an acute follow-up appointment in the peds clinic the next morning.
At the follow-up, the pediatrician examined his ears and saw a very clear-cut ear infection in his right ear. This was never done in the ER. I had wondered to myself if someone was going to look in his ears for the sake of completeness, and even entertained the idea of taking a look myself with the otoscope in the room, but quickly brushed the thought aside when JL had pried open the red biohazard container of the floor exposing some kind of urine hat. Plus, the ER physician didn't think it was necessary.
Perhaps I led the ER physician down a diagnostic pathway due to my own suspicions, and maybe coming from me, was persuasive enough not to veer her too far off that path. I know how to give a compelling story for whatever process I think is going on. Isn't this only natural? But, I'm wondering whether she would have done exactly the same with a parent who wasn't a physician. Would she have been more complete? Would she run more tests?
Anyway, JL is doing better, on antibiotics. He's defeveresced but still with a "junky" chest exam. His antibiotic dose was increased since apparently the dosage is higher for an ear infection than pneumonia (wow, peds was that long ago).
And I'm left wondering how much I help and how much I complicate when it comes to the health of my own children. I hope it's heavily weighted towards the former.
Sunday, March 29, 2009
No, Mom, Billy DOESN'T want to stay for dinner
While sitting at the dinner table, someone brought up maggots (I know! – but such is life with two boys of a certain age; disgusting subjects at dinner are the usual fare alongside the main course). Eldest quickly mentioned how skeeved he would be if a maggot were to touch him. Of course, I had to jump in with all of the medical uses for maggots, especially when used to treat decubitus ulcers or other poorly healing wounds. I casually discussed the role the maggots played in debriding the dead tissue and how most patients would likely consider maggot therapy rather than dismissing it out of hand, especially if faced with a potential amputation. I buttered a slice of bread as I chatted about how maggots stayed away from healthy flesh; concentrating on my broccoli, I failed to recognize how quiet my dinner companions had become. As I started in on the medical uses of leeches, I looked up from my plate to see three faces staring at me in horror. Mouths agape, eyes wide, silverware down; my family finally burst out as one: “That’s revolting!”
Er, yes, I guess some might view it as such. Apparently it’s time to brush up on my sense of acceptable dinner conversation, which has at this point been warped by too much discussion around the themes of farts, boogers, loogies and the occasion poop.
Baseball, anyone?
Er, yes, I guess some might view it as such. Apparently it’s time to brush up on my sense of acceptable dinner conversation, which has at this point been warped by too much discussion around the themes of farts, boogers, loogies and the occasion poop.
Baseball, anyone?
Thursday, March 26, 2009
Seriously, I wanna know...
Do you have a favorite season? Does your favorite have anything to do with work/school? Winter for Pediatricians is like tax season for accountants - busy! In the spring, we are starting to pull out of cough, cold, flu season, but the days in the office can be unpredictable. Having just had a run of influenza at our house, I'd say home is unpredictable, too. Fall was my perennial favorite for many years - still some daylight when I left the office, boys in the groove of school, family vacation during Fall break. Our school system changed their schedule a few years back and did away with the Fall break - shattering it into several teacher work days scattered through the semester. Vacations shifted to Spring break to compensate. I've found myself looking forward to summer more and more - the more free-form home schedule, warm weather, flip flops (wish I could be OSHA compliant in them at work!) and lighter schedule at the office even with partners on time off. So my answer: Summer!
photo credit: seseo.wordpress.com/2009/01/
Tuesday, March 24, 2009
"Match Day" book give-away follow-up
In a highly technical method of randomization (comments printed, cut into slips, and picked blindly from a bowl), ten readers of Mothers in Medicine were contacted last week to receive their prizes. Amazingly, quite possibly all of the commenters whose name is "Katie" got selected by some strange twist of bowl-drawing fate. What are the chances? (Okay. Could calculate but...)
Thanks for joining in on the fun.
(Shout out to Jenny, MS2 in NYC: claim your book! Email us with your address!)
Thanks for joining in on the fun.
(Shout out to Jenny, MS2 in NYC: claim your book! Email us with your address!)
Monday, March 23, 2009
Mom's Apple Pie
I have a confession to make - but first, a little story.
That day we went bearing pie - home-made apple pie, to be exact, by special request, for an open house during which we would get to peruse all the kids' family history projects and enjoy culinary delights from the various cultures represented in the class.
My son had been worrying (needlessly, despite reassurance and encouragement) about this project for weeks. He was worried about getting the work done on time. Worried about messing up the illustrations. Worried about revising the final draft. Worried that I wouldn't have time to make the pie and he'd be the only little boy whose mommy was a dismal, neglectful failure.
Well, by golly, I was determined not to disappoint him, even if I had to stay up late post-call or get up early pre-call to do it. As it happened, not only was I able to make the pie at a reasonable hour, right on time for the open house, but also my call schedule was such that I didn't have to be at work till mid-afternoon on open house day, so he was able to have both parents there.
My son visited me in the kitchen while I was preparing the apples. He sometimes tries to keep me company because he's concerned I might get lonely (he hasn't quite grasped the concept of enjoying time for oneself).
"I told all my friends you make the best apple pie in the whole world," he said.
How cute is that?
"Well, that was very kind of you," I replied.
"It's the best pie ever."
"I'm so glad you like it."
Peel, peel peel.
"Is it hard to make?"
"Not especially," I said. "Once you get a feel for when to add water to the dough, and how much to add, it's not a hard recipe to follow."
Dice, dice, dice.
"Do you like making apple pie?"
Hmm. How to answer that?
"Parts of the process can be a little tedious, to be honest," I said. "But it's not bad - I don't mind," I said quickly, to reassure him.
"I love your apple pie," he said.
I never did learn in anatomy class where exactly the "cockles" of my heart might be, but they were definitely warmed.
On the day of the open house, as we approached the front lawn of the school we caught sight of other parents coming from different directions on foot with their children, carrying covered dishes and trays and plates, all heading toward the front entrance. There was something so village-like about it. A pleasing aroma of book paper and crayon drawings wafted over us as we entered the school building, making me nostalgic for my own elementary school days, when I could focus my attention, as these kids were doing, on things like "daily life in colonial times" and haiku.
The atmosphere at the open house was one of friendliness mixed with the pleased-as-punch pride of children who have done well at something. There was so much food the teacher had to set up a second table. We ate, visited the desk exhibits, mingled with parents, mingled with children; some families even visited their friends' open houses in other classrooms.
We opened our son's Family History Book and smiled as we read his tell-it-like-it-is descriptions, written in his painstaking scrawl. On the cover he had drawn a Philippine flag and a French flag, as well as maps of both countries. In the upper left corner there was a small, muffin-like item with steam rising from the top.
"That's a pie," he explained.
Several pages into the booklet it appeared again: a little pie in the margins.
My confession is this: making my husband and children happy with pie is the "accomplishment" that brings me the greatest satisfaction in life.
Even their deeply appreciative inhalations as they enter my kitchen filled with the smell of baking pie make me feel like I'm on top of the world, like I've made their day a little better. Yes, I graduated with honors from an Ivy League university. Yes, I got a medical degree. Yes, I am reasonably successful in my practice of medicine. Yes, I've had the chance to travel, learn languages, study music, get advanced degrees, receive a little recognition for things I've written, and all that. But nothing brings me greater joy than those moments when my husband and kids are eating well, savoring with relish a pie I've just made. Am I crazy? Perhaps. Crazy about them.
It's funny - cooking is, by definition, the creation of gifts that can't last. The moments we take to enjoy meals together are fleeting, as are the meals themselves. But those moments are worth the world to me. And somehow the gift does last, I think - I hope - in ways I'm sure I can't see or predict. I'm hoping that somewhere in the margins of my children's lives there will always be a little pie sketched in - an unquestioning, nourishing trust in their parents' love, a capacity for sharing and for happiness, a corner of freshness and warmth.
Sunday, March 22, 2009
I hate boys!
Sorry, I need to vent:
A resident I know recently came back from maternity leave with her second child and happened to mention to another resident (a single male resident) that she was tired.
His reply: "Why are you tired? You just had a vacation!"
Hearing that story really made my blood boil. Of course, all women who have kids know that maternity leave is not a vacation by any stretch. I still remember mine as one of the most exhausting and stressful times of my life.
But what really got my angry about this was not the thoughtlessness of the comment from a single guy who really has no idea, but it drew attention to the fact that the most unreliable residents in our program are the single guys. The female residents with 2+ kids are always on time, considerate, hard workers, etc. The punctuality and attendance issues we have at our morning lectures are 100% attributable to the single male residents. Or "the boys", as I call them.
You would think that with no family to worry about, the boys should be able to be Super-residents. They should be the first ones into work in the morning and always willing to stay late to help out. They certainly shouldn't need to whine about covering an extra clinic here or there. Yet I'm finding that the opposite is true. The boys tend to be incredibly unreliable and the first to complain about coverage issues.
Of course, I'm generalizing. I know there are a lot of single guys who are great residents. But it really makes me angry when someone who can't even show up on time in the morning belittles a working mother of two for being tired.
A resident I know recently came back from maternity leave with her second child and happened to mention to another resident (a single male resident) that she was tired.
His reply: "Why are you tired? You just had a vacation!"
Hearing that story really made my blood boil. Of course, all women who have kids know that maternity leave is not a vacation by any stretch. I still remember mine as one of the most exhausting and stressful times of my life.
But what really got my angry about this was not the thoughtlessness of the comment from a single guy who really has no idea, but it drew attention to the fact that the most unreliable residents in our program are the single guys. The female residents with 2+ kids are always on time, considerate, hard workers, etc. The punctuality and attendance issues we have at our morning lectures are 100% attributable to the single male residents. Or "the boys", as I call them.
You would think that with no family to worry about, the boys should be able to be Super-residents. They should be the first ones into work in the morning and always willing to stay late to help out. They certainly shouldn't need to whine about covering an extra clinic here or there. Yet I'm finding that the opposite is true. The boys tend to be incredibly unreliable and the first to complain about coverage issues.
Of course, I'm generalizing. I know there are a lot of single guys who are great residents. But it really makes me angry when someone who can't even show up on time in the morning belittles a working mother of two for being tired.
Wednesday, March 18, 2009
Welcome to Match Day on Mothers in Medicine
Welcome to our 5th (!) Topic Day at Mothers in Medicine: Match Day. Today, we'll be featuring posts about our experiences with the big day.
As promised, we are also giving away 10 (!) copies of the book "Match Day" by Brian Eule. (See reviews by myself and Fizzy earlier this week). To enter, leave a comment to this post with your email address and we'll select 10 random readers to receive a free copy sent to them! You have until midnight tonight to leave a comment, so spread the word, tell your friends, score a copy!
And, good luck to those going through the actual match who will be finding out tomorrow at noon EST!
Posts will be publishing regularly throughout the day. Scroll down to see the posts....
As promised, we are also giving away 10 (!) copies of the book "Match Day" by Brian Eule. (See reviews by myself and Fizzy earlier this week). To enter, leave a comment to this post with your email address and we'll select 10 random readers to receive a free copy sent to them! You have until midnight tonight to leave a comment, so spread the word, tell your friends, score a copy!
And, good luck to those going through the actual match who will be finding out tomorrow at noon EST!
Posts will be publishing regularly throughout the day. Scroll down to see the posts....
Match Day: Part 1 and 2
My match day was March 17, 2005.
Our match day was done in a "let all hell break loose" kind of fashion. The envelopes were at different tables organized alphabetically, and we basically trampled each other in an attempt to get our envelopes.
Inside the envelopes, was a tiny strip of paper. That 1 cm high strip of paper had our whole future on it.
I matched at my first choice on my rank list, at a primary care program close to where my husband would be working. I was so thrilled that I cried (well, a few tears) and hugged my friends. Ironic, considering I wanted to drop out of that program within two days of starting. It took me six months to get up the nerve to tell my program director that I wasn't coming back next year. No way, no way, no way.
Match #2 for me took place a year later. I didn't do it through ERAS because I was already a resident. I was on evening cross cover and as I sat in my scrubs on the couch in the empty resident lounge, waiting for the other residents to sign out to me, I got a call on my cell phone. It was the program director at the PM&R program where I had interviewed a few weeks earlier.
"We've decided to offer you a spot for next year," she told me.
No fanfare, no trampling, no hugs, no tears, no green Hawaiian leis. But there it was: a spot for me in my dream program.
Now I'm nearly three months away from graduating from this program. I feel blessed that I had the opportunity to train in a field that I love. And I don't throw around words like "blessed" very often.
Our match day was done in a "let all hell break loose" kind of fashion. The envelopes were at different tables organized alphabetically, and we basically trampled each other in an attempt to get our envelopes.
Inside the envelopes, was a tiny strip of paper. That 1 cm high strip of paper had our whole future on it.
I matched at my first choice on my rank list, at a primary care program close to where my husband would be working. I was so thrilled that I cried (well, a few tears) and hugged my friends. Ironic, considering I wanted to drop out of that program within two days of starting. It took me six months to get up the nerve to tell my program director that I wasn't coming back next year. No way, no way, no way.
Match #2 for me took place a year later. I didn't do it through ERAS because I was already a resident. I was on evening cross cover and as I sat in my scrubs on the couch in the empty resident lounge, waiting for the other residents to sign out to me, I got a call on my cell phone. It was the program director at the PM&R program where I had interviewed a few weeks earlier.
"We've decided to offer you a spot for next year," she told me.
No fanfare, no trampling, no hugs, no tears, no green Hawaiian leis. But there it was: a spot for me in my dream program.
Now I'm nearly three months away from graduating from this program. I feel blessed that I had the opportunity to train in a field that I love. And I don't throw around words like "blessed" very often.
Pediatric Match Day
“Should I stay or should I go now?”
The Clash
I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.
But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.
Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.
My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.
The Clash
I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.
But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.
Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.
My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.
(match day) - which day was that?
Not sure why but I can hardly separate out in my mind my own match day (in the 1990's) and my husband's a few years later. Earlier today I asked him to remind me about the circumstances surrounding our opening those fateful envelopes. I don't think it's post-traumatic stress-induced amnesia, since we both were happy with each of our matches, despite the hurdles coordinating the geography and job prospects without a true couples match. Perhaps my MIM status has resulted in a loss for specific details; I now more holistically just remember that it ultimately all worked out for the best. Then again, my coffee cup is usually half full.
What's coming back to me now is how silly I felt mentioning "my boyfriend" during interviews leading up to match day, since we'd actually been (living) together for many many years prior to actually getting married. Sometimes I mixed it up by saying "significant other." We did become domestic partners so we could co-habitate in the med school dorms, us and a few thousand gay New Yorkers. In any case, most of the hard part was us figuring it out beforehand, crafting the list, and then once we met our match we planned accordingly. After all, the culture in medicine is to train for 3-4 years, and then make a decision to move or stay. Then you train for several more years and then make a decision to move or stay. And so on. Fortunately for us, the "move or stay" has always involved staying in love.
What's coming back to me now is how silly I felt mentioning "my boyfriend" during interviews leading up to match day, since we'd actually been (living) together for many many years prior to actually getting married. Sometimes I mixed it up by saying "significant other." We did become domestic partners so we could co-habitate in the med school dorms, us and a few thousand gay New Yorkers. In any case, most of the hard part was us figuring it out beforehand, crafting the list, and then once we met our match we planned accordingly. After all, the culture in medicine is to train for 3-4 years, and then make a decision to move or stay. Then you train for several more years and then make a decision to move or stay. And so on. Fortunately for us, the "move or stay" has always involved staying in love.
Now, it's just another day
I debated with myself for a long while about whether I wanted to post my recollections of matching. I've realized while looking back my memories of this time have become far hazier than I would have ever imagined possible. I'm sure that circumstances at the time might have had something to do with it - I was recently engaged (the prior November) with a wedding planned for early summer (when I conveniently had a few weeks off following graduation). In the midst of dress fittings and cake tastings, I waited to hear what would occur. I recall vividly who I interviewed with, and still recall the vaguely funky smell in an outer office as I waited to meet with one of the administrator/physicians who would potentially determine my fate. As it turned out, when it was time to decide, I limited my choices of where I wanted to train due to my upcoming marriage; when faced with what seemed to be starting a career versus starting a life, I chose the latter.
Now, many (many, many!) years later, I have had few (if any) regrets. OK, I wish I would have traveled more and if I knew then what I know now, would probably have structured some of my early experiences differently. But I received a very good education in my little community-based program and have never felt limited in what I could strive for.
So dear students, although today emotions run high and nerves are shot, in the long run this day will become just one of several pinnacles you'll scale. Looking back, memories of my wedding, the birth of my sons, and numerous career highlights are crowding out any recollection of the anxiety I'm sure I felt when Match Day rolled around for me. And I think that's as it should be.
A
Now, many (many, many!) years later, I have had few (if any) regrets. OK, I wish I would have traveled more and if I knew then what I know now, would probably have structured some of my early experiences differently. But I received a very good education in my little community-based program and have never felt limited in what I could strive for.
So dear students, although today emotions run high and nerves are shot, in the long run this day will become just one of several pinnacles you'll scale. Looking back, memories of my wedding, the birth of my sons, and numerous career highlights are crowding out any recollection of the anxiety I'm sure I felt when Match Day rolled around for me. And I think that's as it should be.
A
Match Day Purgatory
The months that led up to Match Day were pretty stressful for me. I was in that med school relationship purgatory where my boyfriend (it makes me feel 11 to say that word) and I were in a serious relationship but we were not engaged. If we were engaged, I had imagined wistfully, submitting my rank list would have been so much easier. I would rank the program at my medical school #1 without a doubt since he would still be there, finishing up an MD-PhD. Even though I REALLY liked a couple of other programs that were in other cities. One city on the other side of the country.
But Christmas and Valentine's Day and other perfectly fine occasions for him to pop the question and appear on bended knee came and went and I was feeling a little - how shall I say - frustrated. To put it nicely. In actuality, I was going a little insane. I remember initiating serious conversations about this: where are we going? We need to do some planning. You know, all of those conversation starters that cause men to start sweating and looking for the nearest exit. But I needed to know: is this the real thing? Do I put this relationship before my real program preferences? I thought other programs might be a better fit for me and what I wanted to eventually do.
In the end, I ended up ranking the program at my school first. I also had a lot of positive feedback from the program, leading me to believe it would be pretty much of a sure thing. Yet, still, I was nervous on Match Day. What if there was a computer glitch? What if they were just telling me I was a shoo-in? What if I ended up somewhere far away?
He was with me as we gathered with all of my classmates in the big hall. I had picked up my sealed envelope from a faculty carrying the envelopes for students with my last name letter. We stood around in informal clumps, around friends and some family for the magic words at 12 noon, informing us that we could open our envelopes and find our fate.
It was time. I opened the envelope and pulled out a surprisingly small slip of paper with only the name of the program I had matched into: My school's.
It was not a surprise or an elation but a relief. A huge relief.
Some classmates were more vocal. There were shouts of joy, a buzz of "Congratulations", there were hugs and hugs all around. It was a very emotional, joyful moment. In the beginning.
But when the dust settled a bit, and the flurry of happiness fluttered down, I started to notice that not everyone was happy. Some of my classmates were quiet, bummed. Some look like they were spun, confused, trying to be positive. And some were in tears. A good friend of mine, in fact, was in tears. It wasn't all happy.
But like that, all of us were going somewhere. Some to places they dreamed about. Some to places they wished they had never ranked. And I, was staying.
In the week to follow, my boyfriend and I took our planned student-budget trip to San Francisco, touring Napa Valley, taking mud baths in Calistoga, driving down the Pacific Coast Highway and stopping occasionally for impromptu picnics.
He proposed.
But Christmas and Valentine's Day and other perfectly fine occasions for him to pop the question and appear on bended knee came and went and I was feeling a little - how shall I say - frustrated. To put it nicely. In actuality, I was going a little insane. I remember initiating serious conversations about this: where are we going? We need to do some planning. You know, all of those conversation starters that cause men to start sweating and looking for the nearest exit. But I needed to know: is this the real thing? Do I put this relationship before my real program preferences? I thought other programs might be a better fit for me and what I wanted to eventually do.
In the end, I ended up ranking the program at my school first. I also had a lot of positive feedback from the program, leading me to believe it would be pretty much of a sure thing. Yet, still, I was nervous on Match Day. What if there was a computer glitch? What if they were just telling me I was a shoo-in? What if I ended up somewhere far away?
He was with me as we gathered with all of my classmates in the big hall. I had picked up my sealed envelope from a faculty carrying the envelopes for students with my last name letter. We stood around in informal clumps, around friends and some family for the magic words at 12 noon, informing us that we could open our envelopes and find our fate.
It was time. I opened the envelope and pulled out a surprisingly small slip of paper with only the name of the program I had matched into: My school's.
It was not a surprise or an elation but a relief. A huge relief.
Some classmates were more vocal. There were shouts of joy, a buzz of "Congratulations", there were hugs and hugs all around. It was a very emotional, joyful moment. In the beginning.
But when the dust settled a bit, and the flurry of happiness fluttered down, I started to notice that not everyone was happy. Some of my classmates were quiet, bummed. Some look like they were spun, confused, trying to be positive. And some were in tears. A good friend of mine, in fact, was in tears. It wasn't all happy.
But like that, all of us were going somewhere. Some to places they dreamed about. Some to places they wished they had never ranked. And I, was staying.
In the week to follow, my boyfriend and I took our planned student-budget trip to San Francisco, touring Napa Valley, taking mud baths in Calistoga, driving down the Pacific Coast Highway and stopping occasionally for impromptu picnics.
He proposed.
It's A Match
Match Day. It was a day that I viewed with trepidation (Will I go where I want to go?), anticipation (Where will the next chapter of my life begin?), and exhilaration (I would finally be done with medical school!) Match Day was a day that, before you entered medical school, you had no idea even existed. I hate to borrow the comparison to sororities once again, but Match Day does work almost exactly like sorority rush. Your senior year of medical school, you interview at many different programs, searching for (what you think is) your ideal fit for a training program. You have to make decisions about community programs vs. university based programs. Small programs vs. larger programs. City or rural? Academics focused or procedure focused? I'm oversimplifying for the sake of keeping the post a reasonable length, but you get the picture. Then, at the end of the interview season, you sit down and rank, first to last the programs in which you would like to train. The residency programs do the same, ranking applicants from most wanted to least wanted, and yes, they do have meetings where they put your picture up and talk about your pros and cons...just like rush. Then, all of the information from both the students and programs is plugged into some kind of nebulous computer database matrix-type-thing, where the magical "match" actually happens...each student to each program, according to mutual rankings. Thankfully, you are somewhat unaware of the gory details of the process when you are interviewing. All you know is that the decisions that you make when writing your match list will profoundly affect the rest of your professional life. No pressure.
For me, I was fortunate in the fact that I didn't have to worry about a couple's match (trying to match to the same place as your spouse or significant other). Mr. Whoo was delightfully mobile with respect to his professional life, so we didn't have the constraints of specific places that we just *had* to be. We picked a general area of the country in which we knew we would be happy, and concentrated on applying to the programs in that general area. I was also fortunate that I wasn't trying to match into a super competitive residency like dermatology or radiology (or, the "lifestyle specialties," as they are called), and I really had no interest in the rigorous academic programs. I was more concerned with learning how to be a general community Ob/Gyn, could not care less about research or academic prestige. For me, I primarily searched for community based, procedure heavy programs in a large region of the country. I looked at how the attendings and the residents interacted with one another, and I was really interested in finding a program where the residents actually seemed to *like* one another. As far as match criteria are concerned, mine were quite modest. I ranked 8 programs, 2 of which I loved enough to place them interchangeably in rank order.
Match Day itself was rather overwhelming. There was lots of pomp and circumstance, and even more nerves and jitters. There was a big ceremony outside, then we all went into the main lecture hall (where we spent the whole of our first two years as students, sort of poignant). It was there that we received the envelopes which held the direction for (did I mention?) our entire professional lives. To add extra fun, each of us was called individually up to the front of the entire room, filled with friends, students, and families to open our envelope in front of *everybody* to read aloud the program and specialty to which we had matched. The only prior knowledge that you had going up to this point was whether or not you *had* matched, so the reactions ranged from ecstatic, to barely concealed bitter disappointment. It was a little awful and a lot wonderful. On the whole, my class matched well, so many of us were rejoicing together. When it came my time to grab my envelope, I could barely squawk out the words on the paper, I was so overcome. I vaguely remember cheers and applause as I blindly made my way back to my seat. I had matched into my first choice...my path, once shrouded in mystery and doubt, was suddenly, sunnily clear.
After our class had opened the last envelope, there was a cake and punch reception (to which we brought flasks to generously spike the punch). We shared happy and sad tears, and there was a sense of relief that it was all *over,* when, in fact, it was just beginning. I found out that two other classmates had matched into residencies at the same place in which I did. This was kind of amazing, since we were coming from a big, academic med school in a location nearly a full day's drive from the smaller, community-ish program to which we all matched. It was comforting to know that there would be a couple of familiar faces in that new, unfamiliar territory. That night we all hit the town together as a class, and acted decidedly not like budding young medical professionals, but like the kids that we actually still were. For all the toil, sacrifice and tears that we had endured thus far, with even more looming on the horizon, all was right with the world on the day that we found our match.
For me, I was fortunate in the fact that I didn't have to worry about a couple's match (trying to match to the same place as your spouse or significant other). Mr. Whoo was delightfully mobile with respect to his professional life, so we didn't have the constraints of specific places that we just *had* to be. We picked a general area of the country in which we knew we would be happy, and concentrated on applying to the programs in that general area. I was also fortunate that I wasn't trying to match into a super competitive residency like dermatology or radiology (or, the "lifestyle specialties," as they are called), and I really had no interest in the rigorous academic programs. I was more concerned with learning how to be a general community Ob/Gyn, could not care less about research or academic prestige. For me, I primarily searched for community based, procedure heavy programs in a large region of the country. I looked at how the attendings and the residents interacted with one another, and I was really interested in finding a program where the residents actually seemed to *like* one another. As far as match criteria are concerned, mine were quite modest. I ranked 8 programs, 2 of which I loved enough to place them interchangeably in rank order.
Match Day itself was rather overwhelming. There was lots of pomp and circumstance, and even more nerves and jitters. There was a big ceremony outside, then we all went into the main lecture hall (where we spent the whole of our first two years as students, sort of poignant). It was there that we received the envelopes which held the direction for (did I mention?) our entire professional lives. To add extra fun, each of us was called individually up to the front of the entire room, filled with friends, students, and families to open our envelope in front of *everybody* to read aloud the program and specialty to which we had matched. The only prior knowledge that you had going up to this point was whether or not you *had* matched, so the reactions ranged from ecstatic, to barely concealed bitter disappointment. It was a little awful and a lot wonderful. On the whole, my class matched well, so many of us were rejoicing together. When it came my time to grab my envelope, I could barely squawk out the words on the paper, I was so overcome. I vaguely remember cheers and applause as I blindly made my way back to my seat. I had matched into my first choice...my path, once shrouded in mystery and doubt, was suddenly, sunnily clear.
After our class had opened the last envelope, there was a cake and punch reception (to which we brought flasks to generously spike the punch). We shared happy and sad tears, and there was a sense of relief that it was all *over,* when, in fact, it was just beginning. I found out that two other classmates had matched into residencies at the same place in which I did. This was kind of amazing, since we were coming from a big, academic med school in a location nearly a full day's drive from the smaller, community-ish program to which we all matched. It was comforting to know that there would be a couple of familiar faces in that new, unfamiliar territory. That night we all hit the town together as a class, and acted decidedly not like budding young medical professionals, but like the kids that we actually still were. For all the toil, sacrifice and tears that we had endured thus far, with even more looming on the horizon, all was right with the world on the day that we found our match.
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