I’ve got 99 problems

It’s the third week of September. The DO residency applications have been open for a couple months, but the MD residency applications have just opened for submission a couple days ago.

I feel like everyone in my class has got their application stuff together, at least judging from the non-stop influx of social media posts I’ve been getting for the past week or so. Me on the other hand, am a hot mess.

I actually decided to apply to two specialties. I guess this isn’t entirely uncommon, but the biggest problem this is causing me (other than killing my bank account) is that 1.) I have to write another personal statement from scratch, and 2.) I’m short some letters of recommendation. Since I’m limited geographically, I’m applying to both the DO and MD match. This means my DO application for my second specialty is incredibly late and this isn’t even taking into consideration how late my letters are going to be. I know people that were getting interviews in July for this specialty, and I’m going to submit an application for it in the middle of September. Why?

Because I’m scared I’m not going to match if I only apply to one specialty. I’d rather drop the money now with a later application in a second specialty than realize in November that I don’t have enough interviews and scramble to apply to more programs as a last-ditch effort. Trying to add more programs then would really be too late. The real issue I had to think about was before applying to a second specialty was, “Could I see myself in this field? Would I be happy if I matched in this instead?”. And my answer is yes, mostly because the two fields are actually similar with a bit of overlap.

The anxiety is real- I’m having some problems sleeping. I seriously considered even taking a clinical/research year and applying for the match in 2018 so I could give myself a mental break, but I don’t think it’s feasible at this point. I feel like I’m stuck in a 50 foot deep hole where the only escape is to climb out. The problem is that I keep falling back in.

 

-NB

 

Audition 1, complete

I finished my first audition rotation. I’m not sure how my fellow sub-intern and I survived a whole month of it, but we did. Honestly I think that it was one of the rougher ones that we’re going to have. I anticipate the rest of my rotations from here on out to go smoothly.

I think I ended the rotation on a good note. I tried to work especially hard the last two weeks once I got used to everything so that I could leave a positive impression. I received good feedback from the residents, most saying they hope to see me back during their interview season- hopefully a good sign. Despite how hellish the rotation itself was, I’m actually kind of sad to leave. I’m going to miss the craziness of the floor, having my own patients that I can manage, being constantly judged and under scrutiny of my seniors (okay maybe not that). I even received a compliment from Ms. Never Satisfied Senior Resident towards the end. I’d like to think that she noticed how I improved, or at least that I tried.

I also did have a chance to sit down with the Program Director and talk to him about my interest in the program. I think the meeting went well. I mentioned in a previous post that one of my top choice programs essentially rejected me before I even auditioned. This is that program. I think some people will say that I’m being too over the top/neurotic by meeting with the PD, and I probably would have thought the same thing-  but this is audition season. Sometimes you just have to do what you gotta go, even if it makes you uncomfortable. I haven’t received an official rejection from the program yet so I’m going to try to be positive and say that I still have a (teeny tiny) chance here. And as long as I have even the tiniest chance of an interview, I’m going to go all out. Not just at this program, but any program that I’m interested in.

It’s not over until it’s over.

-NB

First 2 Weeks of Auditions

Now that I’m in the thick of my audition for this month, I though I’d write a little reflection of how it’s been going.

It’s been stressful. So very stressful.

An audition rotation is kind of like a 31-day interview. You need to be at the top of your game 100% of the time. You need to assume that all the people you interact with- nurses, interns, residents, attendings- are watching your every move. If you mess up on one thing, it will stick with them for a long time and it’ll be harder to make a good impression.

For the most part, I’ve been getting along with all the residents except for this one senior. Sometimes she’s incredibly friendly and talkative with me as we discuss random non-audition related topics. Other times (maybe when she’s more stressed out) she will call me out on things I’ve done that are not to her liking by prefacing with the phrase “You know, since you’re auditioning, you have to…”. I’ve directly worked with her several times, and each time I feel like a complete idiot. I always feel regretful about something I did whenever I work with her, because she always comments about what I’m doing wrong or what I should be doing better. I talked to one of the interns who told me that she’s notoriously not good with students, usually yelling at them or publicly humiliating them until they have to excuse themselves because they start crying. He told me that if the only thing she’s done to me is give me criticism, then it might mean I’m not doing as bad as I think. Yeah, we’ll see about that. I still have two weeks of my audition left and will mostly likely work with her at least one more time, so I’m trying to really take to heart what she’s told me so that I can show her I’m capable of improvement.

In regards to working with residents, I’ve been trying to anticipate their needs beforehand and be helpful as much as possible.

“NB, I need you to see the patient in Room 1 and write the admit note. Then tell me your orders so we can review them”

“I already wrote the note and I just finished the orders for your review”

“NB, I need you to get the patient to release medical records and add them into the chart”

“I already had the patient sign the release and the records are being faxed to us right now”

I feel proud of myself for being proactive and getting things done before I’m asked, but this is really all just common sense, and all the other M4s who are auditioning have been doing the same thing- it doesn’t really set me apart.

One thing that is putting me at a disadvantage though is auditioning at a hospital I’ve never been to. Some of the M4s I’m with have rotated here as M3s, and they know how everything runs and where to find what they need. Meanwhile, my co-sub intern (who also has not rotated at this hospital before) and I feel like we were being thrown into the rotation, especially during the first week. I think the hardest part was that everyone expects a lot from us since we are fourth years; they just don’t know that we’ve never been here before and that it’s all new to us. It’s almost like we are M3s all over again.

We’ve also found that there has been little to no guidance on how to do things. We were not given a on-service orientation. During the first week when a resident would tell me to do something, I would enthusiastically reply, “Absolutely, I’ll do that right now” while simultaneously thinking, “Okay I guess I’m going to wing this too”. I really depend on the nurses, axillary staff, and more experienced M4s to help me out. There is definitely a steep learning curve, I think even bigger than the learning curve between M2 and M3 year. It makes me wonder if my core rotation site provided adequate training to my past M3 self, or if this is just an incredibly high-volume, high-stress, figure-it-out-as-you-go type of hospital. I’m thinking more of the latter. It is a county hospital after all.

Something else I did was re-introduce myself to the Program Director. My interaction with him this month is pretty limited, so I’m thinking of scheduling some kind of meeting with him. I am interested in going to this program, so I hope it goes well. It could also backfire, or have absolutely no effect on my chances of matching here.

Anyway, deep breaths. We’re halfway done.

 

-NB

Boards And Audition Rotation Woes

They say that every medical student will have at least one moment of self-doubt, one moment where they wonder if this is all going to pan out. I recently had one of these moments a couple days ago.

I had to push my board exam back, putting me at a disadvantage when it comes to my applications since now programs will not get my scores until after October 1st. To make matters even worse, I’ve essentially gotten rejected from my top choice program-one that I’m going to be auditioning at. I got in contact with the program and pleaded with them to reconsider. However the person I talked to told me that since they’re the only program for that specialty in the whole state, they get an extremely high volume of applicants and because of that they have to essentially pre-rank applicants based on COMLEX level I and level II (which I don’t have) alone. I get that it’s competitive but to not even give me a chance when I haven’t auditioned yet seems a little unfair. Plus, this ‘requirement’ is stated nowhere on their website or in any email correspondence I’ve had with them.

Now it’s too late to cancel and pull another audition rotation out of my ass, so I’m pretty much just stuck. I still need a Letter of Recommendation from that institution, so I do still need to work hard. But it’s extremely discouraging to be getting bad news so early in the cycle.

I used to wonder if some of my classmates had slipped through the cracks of the medical student selection process. How did some of these people get through the interview? But nowadays I find myself wondering if I am the one who doesn’t belong here. Lately I’ve been feeling like a fraud.

I really, really, really hope this all works out in the end.

 

-NB

Clerkship Advice

Now that the M3s are about to start their rotations, I thought I’d put together some advice about clerkships and doing well on the floor. Personally, I did well on rotations and got great evals and comments. This wasn’t because I was some kind of magical social butterfly either; it was because I just wasn’t a freaking weirdo. And yes, you will encounter lots of weirdos this year (patients, other medical students, doctors, etc.). Below is a compilation of advice based on my experience from this year. As always, take everything I say with a grain of salt.

1. Third year is one big game. Everything is subjective. Your evals will be based off how much work the evaluator thinks you did or how hard he/she thinks you worked. This is why it’s important to be cognizant of what you’re doing at all times. If you think you’re slacking, chances are your evaluator thinks so too. Also, and this is huge, be smart about who you give your evaluation to.
2. Don’t take anything personally. You’ll learn to develop thick skin during rotations. Embrace any criticism that you’re given and learn from your mistakes. I advise against trying to talk back for the sake of ‘making a point’ or to prove that you’re ‘right’. Just take it, say thank you, and move on.
3. Be a good communicator and listener. Reply to your resident/attending/intern’s texts and answer their calls. If you’re going to be late or can’t make it to work, then let someone on your team know. It’s much better to at least let someone know then have people wondering where you are, even if you’re gone for a legitimate reason. In addition, pay attention and actively listen. People can tell if you’re not tuned in and sometimes they like to surprise pimp you. Nod, ask questions, whatever it is that you do to show people that you’re actually listening and paying attention to what is going on.
4. If someone tells you to do something, do it. It helps to keep a running checklist of things that you need to get done for people. As you finish each task, check it off. Even if it’s scut work, you should do it. Every little thing helps the team out!
5. Don’t lie. This is especially true on the physical exam. It always amazes me how many people falsify the PE findings. If you didn’t do it, don’t add it into the note! Just say that you didn’t do it. I’ve never seen people get yelled at for forgetting to do an exam, but I have seen people get yelled at for adding findings that they didn’t actually do.
6. Help others. Not just the residents you work with, but your fellow medical students as well. You never know who will have your back when you need it. Be nice to everyone, and help everyone out. Never ever ever put someone down or make someone look bad. That’s the quickest way to make everyone hate you.
7. Always be doing something. Don’t just stand around. If you’re in the OR, then help prep for the case. If your resident is typing a note, read about whatever the patient has. If there’s actual down time, then you should be studying for the shelf. You get the idea.
8. You’re only a third year. There’s only so much that you can do. If someone tells you to go home, then go home. It is not a trick. Same with if someone tells you to go eat.
9. Be prepared. Read about your patients, read about cases you want to scrub in on, bring your stethoscope or purple book or whatever other thing you need.
10. Don’t take crap from people. This includes residents, other medical students, PA students, nursing students, nurses, and other staff. This is still your rotation and you’re here to learn. If your intern is giving you problems, then talk to your resident. If your resident is giving you problems, talk to your attending. If your attending is giving you problems, then tell the school. If there are students who are being rude, inconsiderate, or are hogging cases/patients, then it helps to just talk to them about the issue first before going to a resident. I’ve only had a problem with students a couple of times, and each time it was resolved after I talked to them.
11. Every rotation has its own curriculum. It will take a couple days to get settled into each rotation and figure out what you’re supposed to be doing on a day-to-day basis. It helps a lot if there is another M3 or M4 on the rotation who can show you what you’re supposed to do and how to do it. It’s usually a good idea to ask an upperclassman or a classmate who has had the rotation before so they can give you tips and advice.

Anyway I think those are the basics, I hope it helps. Again, most of this is common sense. Good luck to all the soon-to-be M3s! You’ll do great.

-NB

Eureka!

I did it! I found my ‘Ah-hah!’ moment. I now know what I want to do for the rest of my life. For the sake of anonymity, I won’t specifically say what field. But it’s definitely one that I never thought I’d go into. It’s funny how things turn out.

In one of my previous posts, I mentioned that I was blindly setting up electives in a field that I hadn’t rotated in and was pretty much banking on liking it based on my previous rotations and what I’ve learned about myself from those experiences. It actually worked out pretty well since I ended up setting up the electives in the specialty I’m going to apply to. Good job, past me. If I had waited until now to apply to those spots, they would have been filled.

My class just took our last shelf exam of third year, which means a lot people are now preparing for what they’ve set up for July- either a board study month or an audition month. Most people are using it to study and many of my classmates are starting to move out of Florida to go back home. It’s kind of crazy to think that the next time I’ll see some of these people might be in 2017 when we’re graduating.

 

We’re so close to being done, and yet so far at the same time. I know the next ~6 months are going to be some of the roughest and most stressful months we’ve had to endure. But it’ll all be worth it…

right?

 

-NB

Preparing for M4 year

The class of 2016 just graduated a couple weeks ago, which means that my class is now in M3-M4 limbo. Our official M4 year starts in July. In case you live in the hospital like I do and no longer have any concept of time, July starts in roughly 4 weeks. In addition, the DO residency application cycle begins in approximately 6 weeks and the MD residency cycle starts in about 3.5 months.

<<Hyperventilates>>

If that wasn’t enough to stress about, I still haven’t finalized my fourth year schedule. I’m mostly trying to figure out scheduling conflicts between different rotations while simultaneously trying to wade through a ton of paperwork and email correspondence. You’d think that after so many years of elective rotations existing there would be an easier way to deal with all this.

On the residency application front, my MO’s for the next month are:

• Collect LORs from physicians in the field I’m planning on going into
• Write my personal statement
• Update my CV
• Take a professional picture

This is all really overwhelming, but I’m also excited to start what is supposedly both the most stressful and relaxing year of medical school.

Fourth year, here I come.

 

-NB

 

Children

Me talking to a 6 year old kid:

“Can you point to where it hurts?”

<patient points to bellybutton>

“I see. And does the pain radiate?”

“Does it what?”

“Oh sorry. I mean, does it feel like the pain spreads to other parts of your body?”

“Umm…no??

“Okay, and on a scale of 1-10, with 10 being the most unbearable pain you’ve ever had, how would you rate the pain?”

“Definitely a 10″

“Wow, okay. I’m sorry to hear that. We’ll do our best to make you feel better okay? I’m just going to chat with the doctor real quick”

The patient nods.

I step out of the room as the patient’s mother approaches me.

“I just want to say that I think it’s so great the way you talked to my little boy about his stomach ache. I’ve read online that it’s really important to speak to children like they’re an adult because it improves their social development. So thank you for that!”

“Oh…Uh..Yeah, sure. No problem”

The truth is I have no idea how to talk to children and pretty much just talk to them like they’re adults.

At this point I can definitely say I won’t be going into peds.

 

-NB

 

Voices

“Hey Mr. A. How are you feeling today?”

“I’m okay”

“That’s good to hear. By the way, one of the nurses told me that you’re not taking your medications”

“Yeah, that’s true. I refused”

“I see. Why is that? It’s supposed to help with the voices. Remember we want the voices to go away?”

“No…you guys want the voices to go away”

“You don’t?”

“No. I changed my mind. I don’t want them to go away anymore”

“How come?”

“Because when the voices go away I’m all by myself again. I’m lonely”

 

Pilonidal Cyst

“You saw bed 1 right? Tell me about him, briefly”

“Sure. Bobby is a 16 year old boy who is here complaining of a large pimple on his lower back. His mom said that yesterday it started to drain bloody pus.”

“Is the boy fat?”

“Uh…yes.”

“So what do we call this so-called pimple?”

I blankly stare at the attending.

“I don’t know”

“Sounds like a pilonidal cyst. Read about it when you go home and discuss with me tomorrow. Tell me about positive physical exam findings”

“Right. So on physical exam, there’s an open, 2 mm circular lesion draining blood-tinged pus. It is located midline in the—”

Buttcrack. The cyst was midline right in the kid’s buttcrack. But I can’t say buttcrack- that’s not the right medical term. How do you say it again? I know it’s gluteal something. Gluteal fold? No no, that’s different. Crap! How could I forget how to say buttcrack?!

I stare at the attending, hoping he gives me some kind of hint. He stares back at me, patiently waiting for me to finish describing my findings.

“It’s located uh…in the…uh…”

Don’t say buttcrack. Don’t say buttcrack. Don’t say buttcrack.

In desperation, I point at my own butt.

“It’s here. Except, you know, in the…uh…”

DON’T SAY BUTTCRACK

” …sacral area”

The attending raises an eyebrow.

“I think what you meant to say is gluteal cleft”

Damn it.

“Yes, the gluteal cleft”

He throws on his white coat.

“Okay cool. Let’s go drain it”