Showing posts with label residency. Show all posts
Showing posts with label residency. Show all posts

Monday, December 8, 2014

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

Saturday, September 20, 2014

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Monday, September 15, 2014

Why Is Residency So Harmful? (And What Can We Do About It?)

Genmedmom here.

I'd like to thank "J the intern" for her post on physician depression and suicide on 9/9/14, as it prompted me to read Pranay Sinha's excellent New York Times Op-Ed piece "Why Do Doctors Commit Suicide?" He discusses what may have contributed to two recent intern suicides, namely, the shock of graduating from well-supported medical student to overburdened resident drowning in the macho medical culture. He describes his early intern year as "marked by severe fatigue, numerous clinical errors [], a constant and haunting fear of hurting my patients, and an inescapable sense of inadequacy."

Ah, yes. Residency.

In the comments to J the intern's post, OMDG brings up as additional factor to consider: "the elephant in the room... sometimes doctors treat each other like garbage".

Yup, I agree with that one, too. No one is more cruel to the suffering than the suffering. Many of my own emotional injury during training was at the hands of my colleagues. But, I know that I lashed out as well. We all hurt each other. I'd like to expound on that, if I may.

I well remember being humiliated on rounds, Monday-morning quarterbacked by someone fresh and showered. I cringe as I recall snapping at my intern for waking me up to check on a patient she was worried about. I'd been snapped at in a similar way as an intern. I remember with sinking stomach the disdain and sarcasm I received when I tried to teach a medical student a very simple procedure, and then couldn't do it myself. I still get angry when I think about the patients who suffered as my residents tried to teach me paracentesis, central line insertions, lumbar puncture- and failed on their attempts. I know my anger showed then. When our colleagues rotating at a small outside hospital transferred a sick patient to us in the emergency room, and it turned out to be a case of lab error, no pathology, there was derision all-around: "They dropped us a turkey, guys." When I was worried about a sick patient and called for an ICU consult, the ICU resident came, and told me I could handle it. "Don't be a wuss. Be a real doctor."

The cruelty towards women was pervasive. A pregnant resident had an early miscarriage. Still bleeding, she asked to be excused from her outpatient clinic. The chief, a woman, said no. "Just think of it like your period," she said.

A colleague went out on maternity leave six weeks early, for premature labor. Another resident was pulled from an outpatient elective to cover the rest of her rotation on the floors. The resident who was pulled was very resentful, angry to tears. "Why the f-- would anyone want to have a baby during residency? Why?" Another answered, "I'll never understand it. It's so selfish."

It's well-known that medical training erodes empathy. It took years for me to recover from residency, to feel like I could even begin to take care of people again. Literally. I did a research fellowship for three years, in large part because I couldn't imagine returning to clinical practice.

But, why did I feel this way, when my residency program was well- regarded, with many opportunities to share, reflect, even write? Why were so many of us injured and angered by our experience? So many of us recall their training with a shudder, vowing "I wouldn't revisit those years for all the money in the world."

That's just not right. How can we change it?

Open discussions confronting the cruelty of medical training may help. As a medical student, I was rotating on surgery. A rural hospital transferred a very sick patient to us, someone who had been misdiagnosed and suffered greatly. As the case was reported on rounds, there was loud derision and disgust expressed towards the rural docs. But one senior surgeon, someone so intimidating and revered that just a movement of his hand silenced the crowd, quietly admonished:

"There's no point in criticizing. Your fellow physician took the same oath you did. Assume that they tried, and that they feel terribly. We have all made mistakes, and we will all make many more. Don't waste your time on judgment."

End of that discussion, and it made an impression on me. Don't waste your time on judgment. I think, as teachers, we need to stand up and say that, and live that. Be real doctors.

We also need to dismantle that confusing paradigm of training: You are here to learn, but you should already know how to do it. Sinha also illustrates this in his essay. You were a coddled student in June, and then the doctor in July. You feel like you're supposed to know it all, because everyone is acting like they do know it all. Everyone's got a front. To ask for help is to be weak.

I remember very early in training, asking how, exactly, to write a prescription. I'd never written one before.

Oh, the rolling of eyes, the quick snappish explanation. I was so upset, I didn't catch it all. I spied on other people writing prescriptions and copied them. Seriously, how the heck are you supposed to know how to write a prescription if no one's really taught you?

How are you supposed to know how to be a doctor, if no one's really taught you?

I'm interested to hear what others' experiences have been, good and bad, with an eye towards practical suggestions. How do you think medical training be reformed?

Thursday, December 26, 2013

MiM Mail: Deciding between residency programs

Dear Mothers in Medicine,

I've been an avid follower since the beginning of medical school, and am amazed by the amount of wisdom and advice that passes through. I'm currently a 4th year who is struggling with deciding between residency programs, and was hoping for some much needed advice.

I'm applying for PM&R programs, but applied to a limited area since my husband is a graduate student, and has a few more years of training left in the city where we live now. We met in high school, and had a long distance relationship in college, which was very difficult for both of us. We decided that we would never do that again, and made staying together a priority. We both compromised for medical and graduate school, and went to a city where we could stay together, even though the programs weren't otherwise our top choice. For residency programs, I decided to apply to the surrounding area, because I couldn't stand the idea of being separated.

I'm lucky in that there are a couple of PM&R programs in the city where we live, and a few in a city that's about 2 hours away by car, and an hour away by train. I'm currently struggling with my rank list - I love the programs that are further away, but it would require us moving in between the two cities, and each commuting an hour to 1.5 hours each way, or me taking public transportation, which can take up to 2.5 hours, taking into consideration waiting time for the train and delays. Fortunately I have a friend in the city that I can stay with on the rougher days. Since PM&R has pretty reasonable hours, and I would theoretically study on the train, I'm trying to convince myself that it wouldn't be so bad, but I'm having my doubts.

None of the programs that I've applied to are considered the very top residency programs for PM&R. However, the programs that are further away are better known, and I feel like I would get broader exposure and better teaching from the attendings. My main  question is - how much does the reputation/quality of the program matter in the long run for jobs and fellowships? Obviously there are requirements that have to be met for every residency program, and I've heard from many people that what you put into a program is what you get out. Could I get the same out of a higher quality program as I would out of a lesser known and weaker program, where I put in a lot more effort to self study and seek extra exposures?

Of course it would be easier to stay in the same city, where we have a house and are already settled. But I can't help thinking about the programs that are further away, since they seem like a better fit. I'm afraid that if I decide to commute for the programs that I like better now, the commute might take its toll on both of us, and I would end up regretting it in the end.

I've been agonizing over my rank list for a few weeks now, and still have no idea what to do. Any help would be much appreciated!

Thank you,

Stuck Between Two Cities

Saturday, September 21, 2013

My Brain Doesn't Work Like This: chronicles of an aspiring primary care provider in the PICU

I am in the throes of my first Pediatric Intensive Care Unit rotation. I was shocked that by Day 2 I wanted to run away and hide under my covers. Shocked that soo early into the rotation, I was hitting  the snooze button soo many times that my husband who sleeps through anything (except my occasional snoring and Zo crying) ordered me out of bed.

I am NOT that Resident. I’m not the one who hates residency. On most days I am so excited to serve patients and work with amazing colleagues. But I fear I have become THAT Resident. The grumpy one. The one who doesn’t want to be here. The PICU and its acuity has brought it out. Stealing the “oomf” from my life. Encouraging family members and friends have given me pep talks as I weep into the phone about how draining dealing with such critically ill children and their families has been; children with devastating neurologic damage or those with genetic syndromes with abysmal prognosis.

And top off the emotional heaviness with the fact that my brain just doesn’t work like this! The Attendings and Fellows are amazing. Without a single written note, they can recall doses of infusions from the prior week, what the Neurologist or Infectious Disease Consultant said 8 days ago, what I and other Residents said at every moment of the day, and various other details that I cannot ever imagine myself being able to recall without very detailed notes. Ventilators and infusions and cardiac physiology after a specific surgery, my brain screams out, “give me 5 minutes, 5 more minutes with the Peds In Review or Up-to-date and I promise I’ll have a detailed explanation!” but no, I have 2.5 seconds before I get the “you are dumb, hush up now” look. And of course I am now tachycardic and sweating and feeling hypoglycemic in the third hour of rounding.

I have tried to somewhat let myself off of the hook. I will never be a great PICU Resident, but I’m getting better and might even be pretty darn good by the end, nor do I endeavor to become a great PICU Attending. As an aspiring primary care provider and maybe even a Nursery or part-time ER Attending I will know how to keep critically ill patients alive until the Intensivists arrive. And even now, I am keeping my patients alive. I am learning how to more efficiently and effectively manage their acute issues and prioritize. I have come up with some good ideas and my brain works really well sometimes. But feeling adequate most of the time, just doesn’t feel good. And then my brain screams that it just can’t work fast enough to be excellent in this setting. And I acquiesce because it’s right and this is something I’ll just have to come to terms with as I snuggle even more under my covers while pressing snooze one more time. Because now more than ever, my brain needs its rest.

Thursday, September 19, 2013

Night Float - The Bad Beginning

A few years ago my family medicine residency program, realizing that duty hour changes(*1) were coming soon, decided to start a night float system (*2).  The new duty hour limits were not in place, so residents worked 14 hour shifts for 14 nights in a row (*3).  (Then we got one day and one evening off in preparation to return to work - on day shift.)

In case you were wondering, this was a horrible idea.

Just a few generalizations about night shift - when you work nights, you never, ever feel good.  You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing.  You feel disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday.

I know that six nights in a row can be difficult and taxing but 14 were just monstrous (*4).  By the second week, I started to lose perspective.  I was crying every night on the way to work.  I left home with my child in tears as well and my husband frustrated at being thrust into single parenthood with a very angry roommate.

I was angry – initially at the program directors, but gradually at the nurses, the other residents, and ultimately the patients.  I wondered why I was getting so many stupid pages, and why none of the other residents could do their own work without dragging me into it, and mostly why all these stupid people had to choose tonight for their shortness of breath/chest pain/drug overdose.   Not a good attitude.  Add to that the directors’ insistence that no one ever, EVER nap on nights even if all the work was done (“Because you have all DAY to sleep”) and their refusal to consider putting a day off in the middle (“Because it would disrupt the sleep schedule” (*5)).  By the end of that two weeks, I honestly hated my program and was wishing heartily that I’d gone with my second choice.

Then I reverted back to days and life improved tremendously.  I still had a chip on my shoulder for a while, though.

*1) No longer allowing interns to work 30 hour shifts.
*2) “Night Float” means that a handful of residents take care of the hospitalized patients all night so that no one has to work a 30 hour-shift.
*3) Yes, this means a 98-hour work week.  As long as they averaged the first week of night float with the week before it and the second week of night float with the week after it (and each of those weeks were electives), we still satisfied the ACGME requirement of <80 hours per week average.
*4) I don’t want to sound like I think I had the most difficult job in the world –  I just want to make a few points about how badly it went for me personally.
*5) By this logic, no one should ever take weekends off, because most people sleep in on those days thus disrupting the sleep schedule.  However, the program directors did not forego their own weekends off.

Sunday, June 16, 2013

Senior Resident, who me?!?

In less than 2 weeks I will be a Senior Resident. I cannot believe how far I have come. At a social event to welcome the Incoming Interns this week, one of the newbies turned to me and said “I have heard all about you, I can’t wait for you to teach me”.

Teach you?!? Who me?!? (I of course didn’t say this but the chuckle I gave probably betrayed me)

The wimp in me wants to jump back and put the brakes on the whole transitioning to a Senior Resident thing, but if I breathe slowly and reflect, I know I have been trained to do just this: be a freaking awesome Senior Resident.

Here is a list that I started working on today (while on overnight call) that lets me know I can do just this:
  • ran a real code blue situation my 1st week of Intern Year and the patient survived and did pretty darn well
  • learned how to manage and crosscover patients with a myriad of conditions from bladder exstrophy, to double outlet right ventricle, to constipation - in both an inpatient and outpatient setting, to neonates of mothers with positive drug screens for every illicit and abused drug you can imagine, to medical child abuse, to motor vehicle accident, to status asthmaticus, to poor weight gain/ failure to thrive, the list goes on and on
  • learned how to succinctly and efficiently sign out my patients and receive sign out from another resident
  • learned how to admit and discharge patients efficiently and effectively
  • learned how to work with all sorts of different people with different roles and aptitudes
  • learned how to “balance” work and life (meaning, I punt tasks such as planning my child’s birthday party when I can, I get help when I can meaning hiring a cleaning lady, I drink wine when I can, I laugh when I can, I sleep when I can, I travel when I can, I do my eyebrows/shave when I can, I catch up with my family and friends while commuting home when I can, this list too can go on and on)

So, regardless of how I feel in the moment, the Senior Resident in me has to take over in t minus 2 weeks. A pep talk that my father always gives comes to mind. He looks me straight in the eye and says “are you a man or a mouse?”. Obviously I’m neither, but I have been taught to return his gaze and yell “I’m a man!” So starting now “I’m a Senior Resident!”. Hoping the Transfer Center calls sometime over my call shifts this weekend so I can act like a Senior Resident while there is still a Senior Resident here to guide me.

Wish me luck!!!

Wednesday, August 27, 2008

I feel sorry for you

Last night we went out to dinner with a friend of my husband as well as his girlfriend. Both members of this couple were graduate students and didn't have any kids yet.

If you were to construct a Responsibility Scale to rate the obligations that various people have in their lives, I would say that being a medical resident with children would fall on the higher end and being a childless grad student would fall on the low end. The very very low end. Like, zero.

Naturally, the topic of my own career came up. When the friend discovered that I'm a resident, his first response was, "Wow, that must be REALLY HARD."

Then he added: "You must be EXHAUSTED."

Well, yes. It is hard and I am exhausted. But regardless of the hard truth of that statement, I absolutely hate it when people say that to me. Maybe in this case we could blame it on the fact that Melly had just thrown like five consecutive tantrums (damn teething), but it seems like that's the universal response I get whenever someone hears that I'm both a resident and a mother: sympathy.

I don't want sympathy. Not unless it comes with an offer of babysitting.

Sometimes I question my reasons for going to med school and if they were the right ones, but I have to say, I'm pretty sure I didn't go so that people would feel sorry for me. And I know I didn't get pregnant so that people would comment on how absolutely horrific and miserable my life must be.

Just once, when I tell someone about my job and my child, I wish they would say to me: "Wow, I'm so jealous of you. You have a wonderful, fulfilling career, and you have a beautiful daughter."

(And not be sarcastic when they say it.)