I made it through my month of NICU. It was definitely interesting, and I think a good place to start overall. Now I am more comfortable with babies, and got a rough call schedule month out of the way when I was still somewhat well-rested. I have been trying to get my life back in order this weekend. On to clinic and wards cross-cover tomorrow.
Over the next few weeks I am going to be doing some housekeeping here and on the other Lone Coyote blog. We will see what comes of it...
Sunday, August 1, 2010
Saturday, July 10, 2010
Golden Weekend
My goal of surviving my first month in the NICU is working so far. I made it to my golden weekend relatively unscathed, except for being really tired.
First of all, I have to day that there is no doubt in my mind that I made the right decision in leaving pathology. The past few weeks have been really hard in some ways, but I am so much happier. It is like night and day, and the people in my life have all noticed.
So what has been going on for the past few weeks? I survived a *really* long period of orientation. It was much longer and more tedious than that at my previous program. Much of it was not all that useful, but it did allow me some good time for bonding with my intern class and some of the others in my program. That was probably the best part. I like my intern class--they're good people, and I think we will definitely have some fun in the next three years. We did get to do some fun stuff during orientation, like hiking, being taken out to dinner, BBQs, etc. My program has also given us some very useful sessions with orientations to different rotations and is taking some time to get us set up on the hospital's EMR. All of this is really helpful and a nice change from the "here you go, figure it out" mentality that I have encountered elsewhere.
I started in the NICU July 1. While I was expecting to be lost and useless, I was not really sure what it would look like. By the time rounds started that day, I had figured it out: I did not even speak the language. That first day I understood maybe 20% of the words being said. That is slowly getting better, but I am still pretty lost on the details of feedings and ventilators, which is the bulk of NICU. My basic function is to collect tons of data each morning on the babies and to read it out during rounds in a somewhat systems-based manner. Formulating a plan for my babies is a work in progress, and usually goes something like, "Baby A is a 24 day old male infant who is...uhhh... doing well on his current feeding regimen... I think we should, uhhh.. continue this." Overall, I think it is going about as well as it can, and everyone tells me that the 2nd month of NICU that I will do later this year is where a lot of things will start to seem much clearer.
I have had 2 call nights so far. They were polar opposites of each other. One was very calm and light, and we actually slept 4-5 hours. The other was really busy with sick-baby chaos erupting from every which way, and I felt lucky to get to lie down for an hour or so. It is definitely going to take some getting used to the q4 schedule again, and I have yet to figure out the best way to deal with the post-call day. Not sleeping at all during the next day seemed not to work well, and napping for a few hours was okay but made it harder for me to sleep early that night. If anyone has suggestions, let me know.
Well, I am off to enjoy my 2 days off. The 2nd half of this month is going to be much harder for me, since I have the bulk of days off early on. But hopefully by then I will be a little more comfortable with the work so it will flow a bit better.
First of all, I have to day that there is no doubt in my mind that I made the right decision in leaving pathology. The past few weeks have been really hard in some ways, but I am so much happier. It is like night and day, and the people in my life have all noticed.
So what has been going on for the past few weeks? I survived a *really* long period of orientation. It was much longer and more tedious than that at my previous program. Much of it was not all that useful, but it did allow me some good time for bonding with my intern class and some of the others in my program. That was probably the best part. I like my intern class--they're good people, and I think we will definitely have some fun in the next three years. We did get to do some fun stuff during orientation, like hiking, being taken out to dinner, BBQs, etc. My program has also given us some very useful sessions with orientations to different rotations and is taking some time to get us set up on the hospital's EMR. All of this is really helpful and a nice change from the "here you go, figure it out" mentality that I have encountered elsewhere.
I started in the NICU July 1. While I was expecting to be lost and useless, I was not really sure what it would look like. By the time rounds started that day, I had figured it out: I did not even speak the language. That first day I understood maybe 20% of the words being said. That is slowly getting better, but I am still pretty lost on the details of feedings and ventilators, which is the bulk of NICU. My basic function is to collect tons of data each morning on the babies and to read it out during rounds in a somewhat systems-based manner. Formulating a plan for my babies is a work in progress, and usually goes something like, "Baby A is a 24 day old male infant who is...uhhh... doing well on his current feeding regimen... I think we should, uhhh.. continue this." Overall, I think it is going about as well as it can, and everyone tells me that the 2nd month of NICU that I will do later this year is where a lot of things will start to seem much clearer.
I have had 2 call nights so far. They were polar opposites of each other. One was very calm and light, and we actually slept 4-5 hours. The other was really busy with sick-baby chaos erupting from every which way, and I felt lucky to get to lie down for an hour or so. It is definitely going to take some getting used to the q4 schedule again, and I have yet to figure out the best way to deal with the post-call day. Not sleeping at all during the next day seemed not to work well, and napping for a few hours was okay but made it harder for me to sleep early that night. If anyone has suggestions, let me know.
Well, I am off to enjoy my 2 days off. The 2nd half of this month is going to be much harder for me, since I have the bulk of days off early on. But hopefully by then I will be a little more comfortable with the work so it will flow a bit better.
Sunday, June 20, 2010
And So It Begins... Again
The last 2 weeks have just been pure craziness... all in a good way. My last day in my pathology program was about a week and a half ago. It all ended about as well as it could have. I was on "elective" for a few days and tried to get my stuff as wrapped up as possible. On my last day we had some cake, I turned in my keys, said goodbye to people, and left. It was sad in a way, but I also felt like a huge weight had been lifted.
Then we headed out of town for a few days to visit some of my medical school buddies who are getting through their residencies. Rabbit, Bender, and Delerium are doing well and it was great to see them and to change the scenery for a few days.
We got back and I had 48 hours before my orientation at my new program started. I had grand visions of all of the things I was going to get done before starting--home organizational projects, reading, brushing up on my Spanish, exercising. Suffice it to say, not all of that got done. Not even close.
I started orientation on Friday and I think this is going to be good. My gut reaction is that this is such a better fit for me than what I was doing before. Granted, it was just a day of standard hospital-admin lectures. But my new colleagues seem wonderful, and the senior residents are very cool and supportive. I have another 10 days of orientation before getting started in the NICU. Hopefully, it will help my brain get back into a bit of a clinical mindset before July 1.
Then we headed out of town for a few days to visit some of my medical school buddies who are getting through their residencies. Rabbit, Bender, and Delerium are doing well and it was great to see them and to change the scenery for a few days.
We got back and I had 48 hours before my orientation at my new program started. I had grand visions of all of the things I was going to get done before starting--home organizational projects, reading, brushing up on my Spanish, exercising. Suffice it to say, not all of that got done. Not even close.
I started orientation on Friday and I think this is going to be good. My gut reaction is that this is such a better fit for me than what I was doing before. Granted, it was just a day of standard hospital-admin lectures. But my new colleagues seem wonderful, and the senior residents are very cool and supportive. I have another 10 days of orientation before getting started in the NICU. Hopefully, it will help my brain get back into a bit of a clinical mindset before July 1.
Thursday, June 3, 2010
T-5 Days
Today was my last Thursday in pathology. It is hard to believe that this is about to end. This year has been very long, particularly since I knew fairly early on that I was leaving. But I have learned a lot, more than I could have expected in some ways. While reviewing some of my pediatrics books from medical school, I have realized that I have a lot of familiarity with a wide spectrum of diseases. Granted, I know next to nothing about management anymore, but hopefully this training I have gotten will be useful in some ways.
Last Friday was my last day of surgical pathology. It was my last day in the gross room and my last day venturing in to the ORs for frozens. I cannot say that I will miss either grossing or frozen sections very much at all. Lately, our pagers have not been working well, which has added another interesting dimension to the rather strained relationship that already seems to exist between pathology and the OR nurses and surgeons at this hospital. Let's just say when the callback after the first page begins with someone yelling, "we've been paging you for 30 minutes and you have ignored us," it does not bode well for the encounter.
Somehow, I had managed to make it through the entire year without having to gross in a leg. Maybe it was all of the Whipple specimens that I seemed to get without fail. Ironically, my colleagues who seemed to want Whipple specimens to get good at doing were spared. I digress. Anyway, we do get a lot of below-the-knee amputations, but often the PAs took care of them and I had never had to do one. Late afternoon on my last day my luck ran out. I was given a large leg covered with necrotic debris from chronic osteomyelitis. It was awful to look at, but it was pretty easy to gross since the disease, unfortunately for the patient, was so extreme.
At the end of the day there was no place to put the leg. It was too big to fit into a container and it could not stay in the gross room without formalin. I called the morgue attendant to come and fetch it, but it was the start of a long weekend so no one was there. Finally, the cytotech got wind of my predicament and tried to clean out some room in the already-very-full-of-chemicals cytology fridge. Meanwhile, another tech and I consolidated all of the trash into one can so that we could accumulate enough red biohazard bags to wrap the leg. I then spent my final few minutes of grossing duties attempting to stuff the leg into the crisper of the fridge. Yes, the crisper. It was a disgustingly appropriate end to my grossing experience.
Last Friday was my last day of surgical pathology. It was my last day in the gross room and my last day venturing in to the ORs for frozens. I cannot say that I will miss either grossing or frozen sections very much at all. Lately, our pagers have not been working well, which has added another interesting dimension to the rather strained relationship that already seems to exist between pathology and the OR nurses and surgeons at this hospital. Let's just say when the callback after the first page begins with someone yelling, "we've been paging you for 30 minutes and you have ignored us," it does not bode well for the encounter.
Somehow, I had managed to make it through the entire year without having to gross in a leg. Maybe it was all of the Whipple specimens that I seemed to get without fail. Ironically, my colleagues who seemed to want Whipple specimens to get good at doing were spared. I digress. Anyway, we do get a lot of below-the-knee amputations, but often the PAs took care of them and I had never had to do one. Late afternoon on my last day my luck ran out. I was given a large leg covered with necrotic debris from chronic osteomyelitis. It was awful to look at, but it was pretty easy to gross since the disease, unfortunately for the patient, was so extreme.
At the end of the day there was no place to put the leg. It was too big to fit into a container and it could not stay in the gross room without formalin. I called the morgue attendant to come and fetch it, but it was the start of a long weekend so no one was there. Finally, the cytotech got wind of my predicament and tried to clean out some room in the already-very-full-of-chemicals cytology fridge. Meanwhile, another tech and I consolidated all of the trash into one can so that we could accumulate enough red biohazard bags to wrap the leg. I then spent my final few minutes of grossing duties attempting to stuff the leg into the crisper of the fridge. Yes, the crisper. It was a disgustingly appropriate end to my grossing experience.
Saturday, May 29, 2010
Middle Earth
There is a small outdoor seating area near the cafeteria at the hospital. It has a few tables and looks out onto a nice view. The lawn beneath the tables is full of bumps and holes made by dozens of gophers. One has to be careful when walking near the tables because some of the holes are quite substantial and can envelop an entire foot or ankle.
I was sitting out there earlier this week enjoy a couple of minutes of fresh air and clear cell phone reception. It was lunchtime and most of the tables were occupied. A man came along walking a large dog on the leash. I am not sure exactly what type of dog it was, but probably a mutt mix of several breeds. The man sat down at a table and took out his stuff. He had the leash draped over the edge of the table.
All of a sudden I saw a little tan gopher head pop up in one of the holes. In a split second that dog leapt over the hole and started barking and veraciously digging. It appeared the gopher had gotten the quick head start it needed to burrow back underground. The dog was digging, throwing dirt everywhere, and stuck its whole head into the hole. His owner ran over and tried to pull the dog out of the gopher hole, but to no avail. That dog wanted the gopher.
The whole time the owner was pulling on the dog's leash and yelling, "Frodo, no, Frodo no! Frodo we aren't in Middle-Earth yet!"
I was sitting out there earlier this week enjoy a couple of minutes of fresh air and clear cell phone reception. It was lunchtime and most of the tables were occupied. A man came along walking a large dog on the leash. I am not sure exactly what type of dog it was, but probably a mutt mix of several breeds. The man sat down at a table and took out his stuff. He had the leash draped over the edge of the table.
All of a sudden I saw a little tan gopher head pop up in one of the holes. In a split second that dog leapt over the hole and started barking and veraciously digging. It appeared the gopher had gotten the quick head start it needed to burrow back underground. The dog was digging, throwing dirt everywhere, and stuck its whole head into the hole. His owner ran over and tried to pull the dog out of the gopher hole, but to no avail. That dog wanted the gopher.
The whole time the owner was pulling on the dog's leash and yelling, "Frodo, no, Frodo no! Frodo we aren't in Middle-Earth yet!"
Thursday, May 20, 2010
Burnt Out
Out With The Old
The end is finally coming into view. The last month has been busy and hard. It has been difficult to be motivated about the work I am doing since it will have little relevance come mid-June. Luckily, I am ending at one of our lighter rotation sites, so it is not quite the onslaught that I became used to on other rotations. Basically, I go in, do my work, and come home. There is no more attempting to read, looking at teaching slides, or preparing for unknown case sessions. I have definitely come to see that if I just went through the motions in this residency and just did service work, there is no way I would learn enough to pass boards and to know what I would need to know. Pathology is a reading-intensive field, which I knew coming in. Not really enjoying the reading was a huge red flag for me and a sign that I needed to get out. Other than that, I am trying to wrap up some research projects I have been working on. I am hopeful that some of them can eventually become nice line items on my CV, and one project even has a pediatric-focus so maybe could turn into something more down the line.
In With The New
I got my intern schedule and I will be starting in the NICU. I am sure it will be intense, but I am all for trial-by-fire learning and am excited to have a schedule that is more front-loaded overall. Life is definitely going to get even busier and I will have to re-adjust to sleep deprivation (yuck). But I am excited about getting back to the bedside and feeling more energized about work again. Right now I am wading through all of the paperwork and things that need to be done before starting a new residency. I had forgotten how much paperwork there was the first time around.
Thicker Skin, Broader Vision
One thing I can say for the experiences over the past two years is that I have developed a much better sense of how hospitals run. My current field is so administrative in many ways, and we deal with every specialty at some time or another. I have gained a much broader knowledge of the proverbial chains of command that all orders/decisions/etc must flow through. And, after all of the dealings that I have had with angry clinicians/staff, there is not too much that goes on behind the scenes that is going to surprise me. Of course I know that the new residency will have tons of its own stressors and different things to adapt too. But I am hoping that I will go in at least somewhat more comfortable than I was leaving medical school and entering my current program.
The end is finally coming into view. The last month has been busy and hard. It has been difficult to be motivated about the work I am doing since it will have little relevance come mid-June. Luckily, I am ending at one of our lighter rotation sites, so it is not quite the onslaught that I became used to on other rotations. Basically, I go in, do my work, and come home. There is no more attempting to read, looking at teaching slides, or preparing for unknown case sessions. I have definitely come to see that if I just went through the motions in this residency and just did service work, there is no way I would learn enough to pass boards and to know what I would need to know. Pathology is a reading-intensive field, which I knew coming in. Not really enjoying the reading was a huge red flag for me and a sign that I needed to get out. Other than that, I am trying to wrap up some research projects I have been working on. I am hopeful that some of them can eventually become nice line items on my CV, and one project even has a pediatric-focus so maybe could turn into something more down the line.
In With The New
I got my intern schedule and I will be starting in the NICU. I am sure it will be intense, but I am all for trial-by-fire learning and am excited to have a schedule that is more front-loaded overall. Life is definitely going to get even busier and I will have to re-adjust to sleep deprivation (yuck). But I am excited about getting back to the bedside and feeling more energized about work again. Right now I am wading through all of the paperwork and things that need to be done before starting a new residency. I had forgotten how much paperwork there was the first time around.
Thicker Skin, Broader Vision
One thing I can say for the experiences over the past two years is that I have developed a much better sense of how hospitals run. My current field is so administrative in many ways, and we deal with every specialty at some time or another. I have gained a much broader knowledge of the proverbial chains of command that all orders/decisions/etc must flow through. And, after all of the dealings that I have had with angry clinicians/staff, there is not too much that goes on behind the scenes that is going to surprise me. Of course I know that the new residency will have tons of its own stressors and different things to adapt too. But I am hoping that I will go in at least somewhat more comfortable than I was leaving medical school and entering my current program.
Thursday, April 22, 2010
The Match: Revisited
I have now been through the match twice. It has worked out well for me both times, so I cannot complain too much. But I must say that I still feel that it is a bizarre and rather draining ritual. I am not really sure if there would be a better way to apply for residencies. A colleague told me that a similar match system was used at her undergraduate university for people rushing sororities and fraternities. She said it worked out well for most people and that even if they felt disappointed on rush night, they usually realized in retrospect that they ended up in the best fit sorority for them. From what I have heard from medical school classmates, most people now seem pretty happy with their matches 2 years later. So I guess it does produce good results for many people, even if the process can be rather painful.
Here are a few thoughts on the match after the second time around. Hopefully, they will be helpful to someone out there.
1. Don't panic if the interview invites come late. Both times I received interview invitations from great programs after the dean's letter came out. Some programs send invitations later than others. Also, do not panic if other people have gotten invitations and you have not. It takes some time for programs to get through reviewing all of the applications.
2. The interview matters. Speaking from both sides of this process, as a resident and an applicant, I can say that the interview matters in this process. It really shapes both the program's and the applicant's viewpoints of each other. Having the best package on paper does not matter much if the residents from the interview lunch remember you as being combative, arrogant, or a total douchebag (all terms I have heard used to describe resident impressions of applicants who did not behave well at their interview lunch). And from an applicant's perspective having an uncomfortable interview or a bad experience with some aspect of the interview day can really color one's opinion of a program for the worse.
3. Do not believe everything the program tells you. Luckily, I felt like most of the programs that I visited both times on the interview trail were decent programs with program directors who sincerely cared about resident learning and development. That said, remember that the program is selling itself to you. No program will ever be perfect and without flaws. Residency training is an experience that is going to be painful at times, no matter how good a fit a program is for you. Knowing this, especially the second time through the process, made it easier for me to evaluate the programs more critically. Try to have realistic expectations of what they can offer you, so that you are not disappointed in the end.
4. Make sure the program matches your goals. This sounds obvious, but too often we are encouraged, especially in academic medicine, to solely focus on factors like prestige, fellowship placement, and research prowess when selecting a residency program. Think about your career goals and how the program will get you there. If you want to do a competitive fellowship then some of the above mentioned factors may be really important. If you want to work at a community hospital in primary care then things like job placement in the community and outpatient experiences during residency may be more important.
5. Look beyond intern year. On a related note, probe deeper into what the program will offer you in the long run. Ask residents if the program is supportive when they are applying to fellowships and looking for jobs. A lot of interview days focus on things like the intern year call schedule and how to transition to the city the program is located in. It is similar to the focus that many medical school applicants have on the preclinical curriculum when interviewing for medical school. The later years likely will be more influential on the direction of your career.
6. Talk to residents. Try to meet as many residents as you can and talk to all of them. See if you could really see yourself working with them. Determine if they seem happy, overworked, stressed, relaxed, etc. You may need to talk to residents outside of the program-sponsored lunch or meet-and-greet at the interview day to get the full story. Social events the night before can be a good place to get a decent sense of this.
7. Do second looks for yourself. There is a lot of debate about whether one should revisit top choice programs before making the rank list. I have been on both sides of this one now, as an applicant and as a resident lunching with re-visit candidates, and I really have no idea if it really helps an applicant move up on the rank list. There are some programs that emphasize re-visits at the interview day, so maybe at certain places it is more important to go and show interest. I am not really sure. Anyway, do re-visits if you feel they will help you make your list. I did two at programs I was having a hard time deciding between and it dd help me get a better sense of both programs. I got to meet more residents and to see the true work environment in real time. In the end, I thought they were helpful and luckily I did not have to travel too far to do them.
8. Assess the administration of the program. I have been lucky to be in a program with great administrative support for the past two years. Our program coordinators are awesome and I remember feeling that my interview day flowed really well. If the interview day seems disorganized, ask the residents how they feel about the program support. Things like getting a medical license and setting up computer access at various sites can be time-consuming, so having good administrative support behind you can be a lifesaver.
9. Trust your gut. Listen to that inner voice that tells you one place would be a great fit and that another would make you unhappy. First impressions are really important. I really think that we can pick up on subconscious cues while visiting places that influence our decisions. The vibe you get at the program is important.
Here are a few thoughts on the match after the second time around. Hopefully, they will be helpful to someone out there.
1. Don't panic if the interview invites come late. Both times I received interview invitations from great programs after the dean's letter came out. Some programs send invitations later than others. Also, do not panic if other people have gotten invitations and you have not. It takes some time for programs to get through reviewing all of the applications.
2. The interview matters. Speaking from both sides of this process, as a resident and an applicant, I can say that the interview matters in this process. It really shapes both the program's and the applicant's viewpoints of each other. Having the best package on paper does not matter much if the residents from the interview lunch remember you as being combative, arrogant, or a total douchebag (all terms I have heard used to describe resident impressions of applicants who did not behave well at their interview lunch). And from an applicant's perspective having an uncomfortable interview or a bad experience with some aspect of the interview day can really color one's opinion of a program for the worse.
3. Do not believe everything the program tells you. Luckily, I felt like most of the programs that I visited both times on the interview trail were decent programs with program directors who sincerely cared about resident learning and development. That said, remember that the program is selling itself to you. No program will ever be perfect and without flaws. Residency training is an experience that is going to be painful at times, no matter how good a fit a program is for you. Knowing this, especially the second time through the process, made it easier for me to evaluate the programs more critically. Try to have realistic expectations of what they can offer you, so that you are not disappointed in the end.
4. Make sure the program matches your goals. This sounds obvious, but too often we are encouraged, especially in academic medicine, to solely focus on factors like prestige, fellowship placement, and research prowess when selecting a residency program. Think about your career goals and how the program will get you there. If you want to do a competitive fellowship then some of the above mentioned factors may be really important. If you want to work at a community hospital in primary care then things like job placement in the community and outpatient experiences during residency may be more important.
5. Look beyond intern year. On a related note, probe deeper into what the program will offer you in the long run. Ask residents if the program is supportive when they are applying to fellowships and looking for jobs. A lot of interview days focus on things like the intern year call schedule and how to transition to the city the program is located in. It is similar to the focus that many medical school applicants have on the preclinical curriculum when interviewing for medical school. The later years likely will be more influential on the direction of your career.
6. Talk to residents. Try to meet as many residents as you can and talk to all of them. See if you could really see yourself working with them. Determine if they seem happy, overworked, stressed, relaxed, etc. You may need to talk to residents outside of the program-sponsored lunch or meet-and-greet at the interview day to get the full story. Social events the night before can be a good place to get a decent sense of this.
7. Do second looks for yourself. There is a lot of debate about whether one should revisit top choice programs before making the rank list. I have been on both sides of this one now, as an applicant and as a resident lunching with re-visit candidates, and I really have no idea if it really helps an applicant move up on the rank list. There are some programs that emphasize re-visits at the interview day, so maybe at certain places it is more important to go and show interest. I am not really sure. Anyway, do re-visits if you feel they will help you make your list. I did two at programs I was having a hard time deciding between and it dd help me get a better sense of both programs. I got to meet more residents and to see the true work environment in real time. In the end, I thought they were helpful and luckily I did not have to travel too far to do them.
8. Assess the administration of the program. I have been lucky to be in a program with great administrative support for the past two years. Our program coordinators are awesome and I remember feeling that my interview day flowed really well. If the interview day seems disorganized, ask the residents how they feel about the program support. Things like getting a medical license and setting up computer access at various sites can be time-consuming, so having good administrative support behind you can be a lifesaver.
9. Trust your gut. Listen to that inner voice that tells you one place would be a great fit and that another would make you unhappy. First impressions are really important. I really think that we can pick up on subconscious cues while visiting places that influence our decisions. The vibe you get at the program is important.
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