Free Book- Iserson's Getting Into A Residency (with bonus thank you cards!)

I know, I know.... I just can't stay away from this blog. I am moving in just a few weeks and have a few things that I will no longer need and am trying to find suitable homes for. Case in point, this book!

Isersons-Getting into Residency (amazon)

Today is your lucky day because you my dear reader can have it for free, free I tell you!

A friend recommended this and while I found it fairly useful I only wish I would have gotten it before 4th year. I think early in the clinical years is the perfect time....

Leave me a comment if you have a blog or profile with email that I can notify you by. Otherwise email me (see my profile for my email address). Deadline is Memorial Day- May 27th. 

I will have a drawing and the winner will get Iserson's plus a brand new pack of Thank You cards because I want you to have it all.

P.S. If you are interested I may have other clinical give aways. Pocket surgery cards or The Sanford Guide to Antimicrobials, anyone?


my bags are packed, i'm ready to go....

Medical school is over and this blog title doesn't really apply any more. It is time for me to move on. I will continue to blog over at http://neurochick-kiddoc.blogspot.com and hope you will join me.

Thank you for reading and commenting.

Spice Island Queen


Addendum: Reflections of a a medical student who went abroad for her MD

I have wanted to write a post about what it was like to be an IMG and the pros/cons of going off-shore for an MD for some time. Yes, officially I am done with this blog but for those future SGUers that may be reading later or lurking this post is for you...

My List of 10 Things to Consider:

1. SGU or another Caribbean medical school (but be careful because they are not all created equal) offers you a chance to earn your MD, a CHANCE to become a doctor. Getting accepted and going to SGU is by no means a guarantee that you will achieve your dream. I think this is an important point to make and for future and contemplative students to understand. I could tell you about a boy that came to SGU but left after a term because it was just too hard, I could tell you about a girl that left her fiancé to attend medical school and could not figure out how to be in a relationship with 1500 miles between her and her betroved. I know a student that left and is now in PA school. I personally know several people that despite graduating are unmatched and trying to figure out a way to secure residency in 2014. The say the hardest part of medical school is getting in. That may be true for US schools but I would not same the same for SGU.

2. Medical school is hard. You have to want it. And you have to be doing it for yourself. Otherwise, see above.

3. Even if you succeed and graduate, you MAY NOT MATCH. This is the truth and it is sucks. So if you have options, are young or simply don't want to be in this situation figure out how to get into a US Medical School. Go to DO school. Get into a medical masters program and try again. Being an IMG is a disadvantage and unfortunately this situation is only going to get worse.

4. You are one of many. The class sizes are large and growing each semester. There were 418 students at my white coat ceremony and another 86 that joined us second year from the Global Scholars Program in the UK. That means I am one of 500+ students in my term. The good- you can find your own click, study group, friends, out of 500+ this just happens. The bad-you never know everyone, you may rotate with fellow classmates that you never knew on the island. The professors and faculty will not know you unless you happen to do research (which is no small feat during the basic science years) or go to office hours incessantly. Individual attention is not going to be given to you so if you need small class sizes or personal help think twice before choosing SGU.

5. Your medical school only exists as an umbrella. Once you leave Grenada there is no campus, no SGU events or official student get togethers. You must seek out your own mentors and get advice on how to apply for which residency. For me this was not much of an issue as I was already decided that I would do Child Neuro and Dr. Boyfriend had gone through the whole process so I had support and mentors from my past research job, etc. For some students this was difficult and they struggled figuring out what they were going to do, what to apply for, how many program to apply to, etc. US medical schools tend to have academic advisors and small groups of students that meet throughout the four years and this type longitudinal support is lacking at SGU.

6. Medical school is DIY. I am sure that this is somewhat true for all medical schools but being an IMG in a class of 500+ students accentuates this aspect. There is no personalized instruction or mentoring. Sure you have an assigned faculty advisor but this is mainly lip service. I  was able to meet with mine a total of two times in two years.  One of the meetings was a lunch for all of the advisees. My advisor did not know my name. When I emailed him, his secretary responded. I had friends that had slightly more involved academic advisors but it really comes down to the fact that there are SO MANY students and that you are only on the island for two years. Resources are limited in this regards. Once I left the island I thought maybe I would find a clinical mentor but since I rotated at nine different hospitals and was continually moving this was a difficult proposition.

7. You have no medical center home.  I was continuously changing hospitals during my clinical years.  I rotated in county, state, community, private, and inner-city hospitals and saw a variety of patient populations. In doing so I learned different ways of accomplishing similar tasks. I believe this was a huge advantage and as I interviewed for residency I was able to apply my knowledge of different programs and know what I was looking for. Learning a new computer system or finding my way around the hospital was no longer a daunting task but simply part of each new rotation. Sure it was a pain to live out of a suitcase and move every 4-12 weeks but I liked the variety and exposure. For some, this is a disadvantage and there are work arounds.  Note, you can choose to stay in one area but if you do this then you are limited to some of the less desirable places to train, in my opinion. I think moving around gives you a more diverse education better chance to network, etc. This worked for me but it was not always ideal.

8. You get to live in a foreign county. This was good and bad. I loved the experience and enjoyed Grenada. Many of my classmates did not. I missed my grandmother's funeral. I missed many birthday parties, weddings and family Holidays. There was no option of going "home for the weekend". This means that I was freed from many social obligations but it also meant I missed out on those special family moments. I lived away from my husband for two years and we joked about our "marriage by skype" this worked for us, but it was difficult.

9.  You will most likely enter primary care or IM. This is simply a fact. If you desire to become a neurosurgeon or a dermatologist than SGU is not for you. Sure a token few in the top 5% of the class will match into a couple of highly competitive residencies but the vast majority (over 70%) are going into Family, IM and Pediatrics. Surgery, ER and anesthesia are possible but very competitive. This is the reality of becoming at IMG. (Note-I based my calculations on the 2013 match list with a denominator of approximately 700.)

10. You will be in debt (unless you are a trust fund kid or have independent wealth of course). This is really not unique to SGU as all private medical schools are expensive but living in a foreign country and having to move around during 3rd/4th year adds to the expense. My medical school debt is over $350,000. I just finished my exit loan counseling and my monthly loan payments will be over $2000 (which is the graduated 20 year plan.  Note, you do have the option to defer these loans during residency and accumulate more interest or pay based on salary but these options only apply to Federal Stafford loans not any Direct Plus or private loans you may have taken to subsidize expenses or apply to residency, etc.)  Also note #9. As a PCP you will not make the big bucks to pay off your loans so unless you do a loan forgiveness program you will most likely be paying off your education for a very long time. I never really thought of this aspect or spent too much time worrying about the debt that medical school requires as money was not my reason for choosing the field. Yet I now believe this topic is worth the mental exercise.

If you can be happy doing something else, do it. If not, well then choose carefully, have a plan and may luck be with you!


The End...

The time has come. This is good-bye.

It is hard to believe that I started this blog over four years ago. It hardly seems possible that so much time has passed. I went to Grenada. I came back to the States. I took Step 1 and 2 and CS and did my clinical rotations. My grandmother passed away. My father had heart surgery. We got a puppy and he turned one. I figured out what I wanted to be when I grow up. I applied and matched into what I believe will be be perfect residency program for me. I made amazing life-long friends while I ventured to a foreign country and back. I regret none of it and would do it again in an instant.

Medical school is over. Complete. No more. I don't even think I know what that means. Someone called me "Doctor" yesterday and I started to correct him but then as I thought about it, well technically.... wow. I don't think that has sunk in yet. I mean I feel that I am done with being a student. But am I ready to be Neuro Chick-Kid Doctor? I don't know but I hope so?!?! Regardless of how I feel I WILL be. And in just seven weeks time.

I finished my last rotation and today I get my diploma (officially it is dated today, I won't actually get it in the mail for another week I suspect.) The graduation ceremony is still a month away but by then I'll have moved to Texas and started residency. So this is it.

I don't have anything profound to write or an amazing finish for this blog. But thank you for reading and accompanying on me over the past four years.

I do plan to continue blogging and will post a link to my new blog soon but for now, good bye. I am signing off. Cheers!


Not a fairy tale but something like that

Life may not have fairy tale endings of happily-ever-after.


Plus, there is happiness if you know where to look.

I have just two days of medical school left and I recently found out that my first medicine patient is home and no longer on dialysis. This is good news, the best news possible! I expected for him to be on a kidney transplant list or worse by now. But instead he is living his life and his kidneys are functioning well enough to allow him to skip dialysis. He is so young and has so much life ahead of him. I can only hope that he gets to live it.

I also found out that one of my neurosurgery patients is making amazing progress at rehab. Prior to being a neurosurgery patient he was an amazing, smart, able-bodied father and grandfather. And then he fell off a ladder while doing some home repairs. He left the hospital with very limited control of one extremity and was largely non-communicative with a trach and G-tube in place. I  really didn't know know what kind of life he would live again.  However he is now in a wheelchair, wheeling himself around, as well as eating and talking. I saw a video of him yesterday and could not believe it was the same patient that graced the service the entire month I was on.

I am so glad I have some happy patient stories to end medical school with. (I have plenty of not so happy endings to share too, but not today.)

Today is about reflecting on the good.

The amazing, brave and resilient patients I have met.
The thoughtful and helpful nurses and staff.
The dedicated professors and attendings.
The mentors that have taken the time to inspire and help me become who I am today.
My wonderful support system: my husband, my parents, my dear friends.

I did not get here by myself. The end of medical school is around the corner but it is not my celebration alone. I appreciate everyone who helped me along the way. There were dragons and they were slain.

Life may not be about fairy tale endings but my end of medical school is happily-ever-after or close enough to it for me.


"she's a hyper little bird"

Evidently these are the words that my attending spoke about me yesterday as I stepped ran off the elevator. I think it was a compliment?

It was a busy day and we had just finished rounding for the morning when I saw my dear patient's husband (from IM-TSS elective 2 months back) standing in the elevator bank.  CC was one of my FP (favorite patients) and she was on the service the entire time I was a student.  Over the course of the month I got to know her and her husband well. CC is dying and due to a very messed-up health care system will likely spend the rest of her life in the hospital... She was admitted in December so it has already been months despite the fact that a SNF or Rehab Hospital would be much better for her and her family.... They are not ready for Hospice and due to her health conditions would require around the clock nursing services and a hospital bed to go home which her family is unable to provide. She even has "good" insurance but has been denied from 17 different facilities (at last count). I can't even begin to explain how mad this makes me. She sits in the hospital trying not to die from something iatrogenic while we wait for emergency Medical to be approved so that maybe we can find placement. Anyhow, it has been almost two months since she was "my" patient but I still stop by and see her occasionally and check up on her. And I hadn't seen her husband in awhile and wanted to check in with him. So I jumped off the elevator and my attending turned to the other student to discuss my behavior.

But back to Cardiology. I am starting to enjoy the service more now that I only have 8 days left! And it has been busy which I much prefer to the alternative of sitting in the library waiting for my pager to go off. Better just to run around all day and see 11 consults (3 of them solo and before 10am) and be called a "hyper little bird" then to do nothing or pretend to study EKG arrhythmias in the library while not-so-secretly wishing I was anywhere else. Yesterday was busy, but good.

This morning I am reflecting on a number of things but mainly I am just trying to be appreciative of what I have, the experiences I have been blessed with and the life that I get to live.

Time to go to work and live up to my attending's words now... Happy Hump Day to you!

And just because this made me smile. It is a bit late but in honor of the match being over and no more "maybes" enjoy this.


total apathy and mid-night realizations

I have the worst case of senioritis. I am so unmotivated to go to work and once there I really have to try to care because right now I just don't. I am doing a month of cardiology as my final elective and while it should be interesting and good review on reading ECGs I simply find it torturous to be tied to a pager waiting for the next consult to come in. I really don't have much love for CHF or the intricacies of transesophageal echocardiograms. I am going to be a Child Neurologist and I am SO excited to see kids and think about the brain, however adults and their hearts, not so much.

I wrote these words a day or so ago and while they were true at the time and remain so there is a small caveat. I think that 90% of why I am "checked-out" other than the about to graduate thing is that I am bored to death. I actually had a real-bonafied, my patient is having an STEMI consult and the ER really did need a cardiologist and I woke up from a dream thinking about my patient. And the fact that I was at work almost three hours beyond the normal pager time didn't even bother me. Because I do like medicine and learning and when I feel important/needed/useful and even more so feel that the patient is benefiting from my time then I am more than happy to be at the hospital. It is just that up until yesterday most of the consults were a waste of time.

Seriously, I've had consults such as: patient with new onset V-tach, non-symptomatic, unsustained for 8 beats in the middle of the night. Please evaluate. Guess what? Motion artifact. You wasted an hour of my time and 10 minutes of my attending's time so that we could tell you that your consult was BS. I guess this was due diligence and now I will hopefully never make the same mistake so I did learn something but this happens all the time!

Surgical clearance consults. Yes, they have to be done but please don't ask Family Medicine to do the consult and Cardiology to do the same consult. We both show up and then feel obligated to do the consult because you asked but we are just duplicating each other's work, wasting time and using resources that could better be used for say that patient that is having an MI or the new admit. And this is all so that maybe you will get your surgical clearance a bit earlier from one of the services. Not cool.

Consults for medical management help. Unless you have actually tried all of the evidence based medicine guidelines for managing said problem and are actually asking for help because the patient is especially complicated please don't consult cardiology for every CHF patient on hospital day 1 that may need more medication. The attending cardiologist will not give you firm medication recs. if you haven't at least tried for 24-48 hours, so why bother to ask?

And in other news... I am thinking of changing blog names and sites. My island days are behind me and residency is around the corner. But if anyone has particular SGU questions or would like a final post or two before I do so, let me know.

I'm off to Houston tonight to hopefully secure an apartment and tour my new city. So that is exciting.

Only 10 more days of medical school left!
Happy Friday!


"I get to be a doctor!" and catharsis

I think it is finally starting to sink in... And I am SO excited. Happy. Relieved. Thrilled to be done with applications. Secure, finally knowing what I am going to do for the next five years. Over the moon to say that I am going to be a Child Neurologist. All of it.

I am going to be a Texan and while I am still not sure what to think of that part, it does not matter because in five weeks I finish medical school and in just than two months I start residency. And that makes it ALL worth it. I am not saying that it was easy or that the hard work is over, but I am going to be a doctor and for that I am grateful, appreciative and humbled...

But for those who ever doubted me I have a few words.

Dear Dean Z,
You were my first doubter and hater. You promised me/us: the pre-med class of Freshmen, that only one out of ten would enter medical school and that we should just give up before we even took organic chemistry. You convinced many a classmate that she should enter law school, find another major or simply do anything else, yet you didn't convince me. You did however make is seem like going abroad for a semester or taking a science lab course over the summer would seal my fate of not being a competitive applicant. I am sorry I listened to you...  I did not go abroad because of you.... I regret that now because it wouldn't have made a difference, I would still be here today and would have had an awesome life experience in the meanwhile. But I didn't know that then. However, today I am here as a matched medical student and all your doom and gloom  didn't stop me. Sure I cried leaving the pre-med office more times than not, but I made it despite your prophecies. What you didn't know is that you cannot squelch true passion and that now matter how many times you told me I would not make it, I was not hearing your words.

Dear Biology Professor and Student Advisor,
You told me that a Child Psychiatrist was overqualified to talk to children. I didn't believe you then and I still don't believe you now. You were a horrible student counselor and I am glad I left your office and never went back.

Dear Physiology Professor,
I came to your office to discuss my grade and standing in your class. You asked me what my plan B was. I told you I had none. You didn't think this was smart and so I thought about your question and tried to come up with a plan B, but the thing is, I really didn't have the heart to do anything else and luckily I didn't have to. Sure my Plan A took a few more years to achieve than I had originally planned but I met my husband, lived in NYC and grew up a bit in the process, I have no regrets and no plan B!

Dear Child Neurology Interviewer,
You asked me how as an IMG I expected to match. And maybe you were trying to protect me or nicely say that I was not a competitive applicant... but yet you were interviewing me, so why was that? You also asked me who in my family was a physician and clearly didn't like my answer. Maybe you only want residents of physician families and groomed US Medical Student graduates but that is okay, because I don't want to be a part of such a program and that is why I ranked your program last. I guess it is lucky for both of us that I matched elsewhere. You are welcome!


Happy Residency Fate Day aka Match Day 2013!

I'm matched!

And if you have matched too, congratulations!

If you are looking for the SGU Match List then look no further. Of course it is a work in progress but it is being updated so keep refreshing. For those that matched things look good! Congrats on all of your hard work and the fruition of your labor. Enjoy today, you deserve it!

For those that did not and were unsuccessful in SOAP my sincere and heartfelt sympathies to you. It is not fair or right that you should finish four years of medical school and not match into residency, it angers me that SGU cannot do more to help its students and that it is expected that a certain number will not match and that this is "okay". It is not and I am sorry! Please know that I do care and realize that it could have been me... Keep the faith and fix what needs to be fixed, next year you will be successful.

As for me, it is official, we will be moving to Texas as I have matched in one of my top choices at UT Houston in Child Neurology. I am very excited and feel that this program has many strengths and will be a good fit for me! I am a little hesitant to move to TX and am not sure what I think of Houston but we are doing this. That being said, I'm accepting any and all advise on where to live, dog parks to visit, how to make the most out of Houston, etc. We may need to adjust to the humidity and hot weather but I'm sure we will manage. What can you tell me about Houston dear reader?

I'm off to celebrate but just wanted to let everyone know, in case you don't have Facebook or access to me that way. Congrats again to all my classmates and thank you for your support and encouragement.


only a day / countdown recap

Last, but certainly not least, on my 12 day countdown bring us to the horse capitol of the world. Home of blue grass music, bourbon and the Wildcats.

Lexington, KY

I'll say it, it was a pleasant surprise on my interview trail. I spent a few days and thoroughly enjoyed my visit.

And should you ever find yourself in Lexington, here is Spice Island's Guide-
Where to Eat: 
-Shakespeare and Company, a fun place for dinner, drinks or dessert!
-Doodles Cafe, best bet for brunch!

What to do: 
-See at movie at Kentucky Theater, a  throwback movie theatre where you will be treated not with advertisements or previews but real live organ music while you wait for the movie to start!
-Visit Horse Country by going to Keeneland Horse Track, I ran a 5K while I was there but I'm sure attending a horse event would be nice too!
-Go Blue and attend a college game at UK, go Wildcats!

Now a recap for those of you following along in this crazy adventure that is my life (and possibly yours too). The match is tomorrow and I am beyond excited. Wondering where I'll end up? I am!

12 cities, 12 possibilities and tomorrow we will find out where our new home will be...  I really have NO idea which it will be, but it has to be one of these:

Boston, MA
Brooklyn, NY
Buffalo, NY
Houston, TX
Loma Linda, CA
Lexington, KY
Oakland, CA
Rochester, MN
Springfield, MA
St. Louis, MO
Stony Brook, NY

Best of luck to all my friends and colleagues. Medical school is about to come to an end!


Texas and Two Days!

Two days until the match and Texas is on my mind.

Houston to be exact.

Home of Texas Medical Center.
Home of Mission Control for NASA.

My future home? Only two days and I'll have an answer to that question.

And now, just for fun...


waiting and clues

Three days and I'm getting bored of my own countdown so here are three clues:


It would be an easy move....

4 days, but who is counting?!?

It is official that I have matched but the question remains, where?

What if I match in So Cal? Only 106 miles down the road from San Diego. Just ten minutes from where I am currently finishing my medical school rotations. House hunting would be easy. There would be no change in climate and we could spend our weekends in San Diego or LA.

Did you know?
-Inland Empire is known for its Oranges and was originally named Orange Empire.
-One could ski at Bear Mountain and surf at Long Beach in the same day while stopping at home for lunch.


Give me five!

Tomorrow I will find out IF I matched. Friday I will find out where. So I guess this is my final double countdown day.

For the SGU Match List look no further. Right now it just has those that have pre-matched or matched in Canada. It will be updated on Friday and thereafter. It always takes awhile but the link remains the same.

Five days and today I'm thinking of Minnesota.

Things you should know about my MN rank:

1. The program rocks.

2. Gypsy girl is from MN and she is awesome so I think her state must be awesome too.

3. The State abbreviation is the reverse of my home state. NM. MN. I think this is kind of cool.

4. There are over 10,000 natural lakes in the state, but NONE in Olmsted county where Rochester is located, go figure!

5. Home of this lovely couple: Fran and Marlo Cowan, married for 62 years when this was filmed. And what is better than that?


Under the Arch and I don't mean McDonald's!

Six days left and six programs left to think about.... Let's go to Saint Louis for the day.

Sunrise: 6:22a
Current Temp: 67 F 
We can go visit the Chess Hall of Fame, grab some coffee from Kayak's and then take a stroll through Forrest Park...

Saint Loius is also home of Purina Farms, so if I match here Sancho can become an agility dog in 2013!

Down to single digits... From here to there!

So the countdown continues....

9, 8, 7-

I  know missed a few posts. The days have slipped away due to the craziness that is my neurosurgery rotation.  I have had little time to do more than work/eat/sleep/repeat. Things learned on Neuro Sx this time so far include 1) Do NOT fall off a ladder 2) denial is a powerful thing but if you are loosing your vision or hearing (or both) the proper time to see a neurosurgeon is probably way past! 3) Being in the OR is fun if you get to operate on the brain, it is humbling, amazing and so cool.

Of the cities/programs I've been contemplating these three share the common denominator of being general pediatric programs. I would be happy at any of them. Sure I want to do Child Neurology but I also realize I am more of a pediatrician than a neurologist so spending three years instead of two to do a full pediatric residency would not be a bad thing.

And since they are all great peds programs, all academic, all awesome I have to do something to contrast them so here are a few random pics and facts.

"From here to there and there to here, funny things are everywhere." 
-Dr. Seuss

Springfield, MA

-Birthplace of and home to The Dr. Seuss National Monument and museum
-9% Registered Republicans
-Hoop City (Basketball was invented here)

Oakland, CA

-47th largest city in the US
-# of dog parks: 5
-260 sunny days per year

Albany,  NY

-The Capitol of NY since 1797 and longest continuously chartered city in the US
-Home of a very good college friend of mine and super awesome med school classmate of Dr Boyfriend, both of which have amazing families that we love (aka we have people here!)
-Santa Claus, and the first celebration of the feast of St. Nicholas in America, probably originated in Albany (imported from the Netherlands). -Reference here

Just six days to match, I'm excited, are you?


My love for Child Neurology was born here

Countdown to residency fate day: 10 days

The setting: Stony Brook, Long Island

The reason to rank: Dr. Krupp = Pediatric MS Center= My falling in love with Child Neurology

In the video is Dr. Krupp, my mentor and the reason I am applying for Child Neurology. I worked in her lab for three years before medical school and the study describes some of what I did and the importance of neurocognitive testing in this pediatric population. A friend recently told me that this sounded "so completely motivating and boring at the same time". Exactly, my friend, exactly!


Brooklyn also starts with B...

11 days until match and my countdown continues...

The second city that Dr. Boyfriend and I co-habitated in was none other than NYC. We lived in Manhattan for three years while Dr. Boyfriend went to Medical School at SUNY Downstate and I worked in Midtown. Thus if I were to match at his Alma Mater we would have no problems living in Brooklyn and readjusting to the big city life. I like NYC and while the last time I was there I was a bit of snob insisting on Manhattan living or bust, I think I could embrace the Brooklyn borough just fine. I have many friends still in the NYC area not to mention Dr. Boyfriend's entire family. And most importantly it is THE CITY so it is kind of hard to be too down-trodden about this possibility.

The list of Brooklyn awesomeness would be long so I'll give you the short version. Or skip my list and just watch the montage. Brooklyn to me in a nutshell is Park Slope, coffee options galore, Prospect Park, 24 hour everything, good food, diversity, familiar grounds, brunch options that never end, driving distance to that other B city I just so happen to love and so much more.

That's all I've got for today.


B is for....

Best (city, ever)!
Boyfriend (the person I feel in love with in Boston almost 11 years ago)
BC sucks (sorry Nutmeg)!
Boylston Street.
Bunker Hill.
Big Dig.

12 days until the match, 12 possibilities and today I'm dreaming of Boston...


Best of the NYT in article and video. Also my PSA re: MELAS because today is rare disease day!

I cannot help but share the following... After a rather disappointing day at work I needed to have my faith in humanity restored and the NYT has come to the rescue!

You have to read this article: We found our son in the subway. I always love Townies and Modern Love and this article is like the perfect mix of both. It is a story of  family, a story of love and it makes me happy. Life is strange that way, it just somehow has a way of working out....

Or if you would rather watch a video than this is the one: Finding the visible in the invisible.
So amazingly cool, it will make you appreciate the awesomeness of science, I promise!

And as a little bit of a public service announcement, today is rare disease day. There are so many rare diseases and the families they are affect are great in number and ways. As you know I am going to dedicate my career to Child Neurology and there are "just a few" rare diseases in that category. I know a young man who was originally diagnosed with MS (multiple sclerosis) but is now thought to have MELAS however the diagnosis can only be made via genetic testing which is extremely expensive and my young friend has recently turned 18 and does not have insurance.... He is looking for a research study or some way to be diagnosed or treated but he lives in Oklahoma and doesn't have the means to travel super far without some type of travel or financial assistance. I don't know what to do for him but since it is rare disease day I'm posting his story and hoping that maybe the right person will read this. If you have any ideas or know of any ongoing studies, please let me know!

That is all I've got for today. Hope your faith is restored too...


Because I like lemonade....

I am an optimist. I may be accused of being a Pollyanna and sure I most often have on rose-colored glasses (literally, I have rose-red glasses!) but I like that about myself. I don't enjoy being depressed or anxious and I really do want the best out of life, for myself and for everyone else.

And while I like being positive I also have huge expectations. I expect the most and best out of others (and myself) and thus am quite often disappointed. Rarely can a person measure up to my ridiculous expectations and for sure I am the worst culprit of falling short. But the thing is, I can often empathize with the person and see the good in the situation and move on. Being optimistic means I forgive and forget and yet still expect better next time.

What am I trying to say? I'm not sure I even know... this post may be a bit of a ramble but I suppose I just want to say that I realize how lucky I am. I do not take my life and the opportunities I've been given for granted. Sure I've worked hard and going to medical school was not the easy path for me. I sacrificed much for this life/career but I've never felt entitled to it. I realize that a certain amount of luck and genes and a ton of support from my parents, husband, friends has made where I am today possible. Yet I have to say that the struggles, the work, the time invested has been worth it. And for the most part I've enjoyed it and I think know I will love being a doctor! So that is good...

I am so grateful that in just a few weeks (okay 2 and 3/7 weeks, aka 17 days) I will find out where I matched (granted that I do, but the optimist in me doesn't actually believe that not matching is a possibility). And in 17 days we will find out where we will be moving and living and working for the next five years and that is oh so exciting!

Also, I was also going to share some big news with my family and friends on Match Day. You see I am 8+ weeks pregnant and had planned to announce both at the same time. However the pregnancy is not viable and so I'm going to be medically induced this weekend and that kind of sucks. Because I was excited to be pregnant and it was mostly good. The polyuria, constipation, sore boobs, insomnia and fatigue not so much... But the knowing I was pregnant and the minimal morning sickness. The possibility of a brand new baby was inspiring and exciting and good. Of course it was also a bit scary and the timing was less than ideal. It won't be so horrible to NOT be 6 months pregnant when I start residency. There is something to be said for establishing oneself as a person/resident and making an impression before being the "pregnant resident" so for that reason I can say there is a silver lining. Oh and I am very happy to be drinking my two favorite beverages again (coffee and wine). I didn't miss them as much as I feared but I welcome them both back with welcome arms. Being caffeinated on 3 hours of sleep is a definite positive and I do love me some Pinot Noir so I can't say I'm sad that I no longer have to abstain with dinner....

So yeah, lemonade really is okay.

I guess that's all I've got for now. Happy Hump Day!


dog days and date nights

I'm in San Diego for the weekend and it is glorious.

I spent the day with my puppy. We went to the dog park and farmers market. I gave hime a bath and made the apartment smell nice (not like a dog). I visited Dr. Boyfriend at work for lunch and lounged around all afternoon reading, painting my nails and watching West Wing on Netflix.

And right now it is time for date night. We are going to a hot new restaurant and then maybe a movie, depending upon how long dinner takes and how awake I am. Either way, I'm just happy to be here.

20 days until match. The waiting continues but life goes on.

Happy Saturday and weekend to you!


One week and one day

Until my ROL (rank order list) is due...

This part is torture. The waiting. I went on a second look today and now I have absolutely nothing else to do but hurry up and wait! (31 days until match, but who's counting???)

I pretty much know how I am ranking programs but still that doesn't mean that I don't spend the greater part of each day trying to decide if #3 should maybe be #6 and #5 should move to #3.... Does it matter more where I live or how the adult neuro year is structured? How important is the PD? Do I want to be at an ultra-academic setting or something more service orientated? Resident run or educationally focused?

These are the questions that I am pondering again and again. #1 and #2 are set and have been for some time. #11 and #12 have no hopes of moving up. But the rest of the programs are in limbo and seem to change positions in my mind by the hour.

So that is it. I'm stuck in limbo. Kind of like how several of my patients are "stuck" in the hospital waiting for placement. All I know is that our health care system is very inefficient. Because the cost of staying in the hospital when you have no active medical issues is enormous. But SNFs/Rehab Centers do not want to accept certain insurance plans or Medicaid and thus the patients are "stuck."

I'm worried that one of my patient's is going to get pneumonia and die before she is placed. And there is no reason for this.  Her nurse is mad at me because I dared write an order for her to be out of bed every day (she suffered a stroke and thus needs assistance to ambulate due to severe right sided hemiparesis). And PT/OT should be coming daily to do rehab with her but they do not have the time or resources to do so, thus she sits in bed on neutropenic precautions because she just finished chemo and I'm very worried that she won't survive this hospital admission. Which is now a week too long and looking to last much longer as per case management as she has been denied from 7 SNFs thus far.

And if that isn't enough, I have another patient that is a ward of state, also waiting for placement. She has been hospitalized for over 3 months and the last 2 months are in excess of her medical needs but she is stuck too.

Being stuck kind of reminds me of my Family Medicine Inpatient rotation at this same hospital and this post which I wrote over a year ago. I guess some things never change. Every year students wait for the match and every day patients sit in the hospital waiting for placement... We are all stuck in our own way but at least I know when my waiting will be up which is more than I can say for my patients. So for that I am grateful. I may complain but I realize how much of a privilege and honor it is to be able to wait for the match and to match and I do not take any of this lightly.... And I still have a week and a day to play with my ROL!


Residency Fate Day Countdown

Just 14 days until rank order lists are due and 37 days until Match Day! Very exciting. And kind of scary, but mostly exciting.... In a month and a week I'll find out where I matched and where we will be living for the next 3-5 years. And then before I know it intern year will be here and I'll be doing what I have only dreamed of up to this point.

Right now I'm doing at IM-TSS (Internal Med, Teaching Selective Service) in Cali and trying to remember all the adult medicine that I have not had to practice or use in months! I think my brain has atrophied during 4th year. It is truly sad how little I remember. I know that I used to know all about CHF, Renal Disease, Liver Failure, you know, the bread and butter adult medicine stuff... but I just don't have the immediate recall and end up having to look up EVERYTHING. Kind of embarrassing as I'm a big, grown-up MS IV. Yet it seems my medical knowledge is a file cabinet that has to be opened and indexed constantly, it is not a ready to read book like I want it to be. Not yet. But I guess that's why you have to do residency... to learn what you have learned and to practice and practice.

On the bright side I love, love, love talking to my patients, explaining diagnosis, getting code status confirmed, calling consults, writing order and just generally acting like a doctor. IM-TSS is a Hospitalist run service with no residents which means the MS IVs are the acting residents. It is like a sub-I without resident support. But I love that part of it. And the taking care of my patients part. I don't love it when my patient ends up needing to be intubated and upgraded to the ICU. But he is okay and I don't think I could have done anything differently or prevented his intubation... Medicine is awesome and I am humbled daily to be reminded that this is what I get to do with my life.

Residency Fate Day countdown is underway.... 37 more wake-ups to go!


Up in the air I go...

One more interview, one last trans-America trip, one concluding night in a strange hotel, one final trip exploring a new city.

I am at the airport ridiculously early because I opted for one of those group Shuttle van services to the airport and I guess I'm flying at a not very busy time because I got my own personal town car ride to the airport for fraction of the cost of a cab... and I'm more than two hours early, which is after I cleared security! Less anxiety provoking than leaving my house at this time and taking a cab, two trains and a shuttle bus to arrive in the same spot when boarding is already in process. And I even managed to score one of those comfy SW lounge chairs/charging stations at my gate, so I really cannot complain.

It will be nice to be done with interviews and finished with traveling. Of course the ranking and waiting part is going to be torture but still, it will be nice to have this part behind me. And then I can actually stay in Miami and enjoy it for almost two whole weeks before I am headed back to Cali for the remainder of fourth year.

My Genetics rotation continues to be awesome. If you are at all interested in Medical Genetics or Pediatrics then I recommend this rotation. Miami Children's is wonderful and it is a great place to spend a month. I had to apply for the rotation over 6 months in advance and follow up via emails and phone calls ad-nauseum to ensure I got the elective but it was more than worth it.

I have lots of thinking and ranking and pondering to do, but I'm waiting until this interview is over to really start.... stay tuned!


Interview trail rehash and random updates on my current state of mind

Greetings from the trail! I had my 3rd to final interview yesterday and am staying for the weekend to hang out with friends that just happen to live here. Now that the interview season is almost over it doesn't seem so bad. Tiring, yes. Expensive, absolutely. But sometimes fun (I did get to explore quite a few new cities/areas) and always informative. Places I expected to like and rank highly disappointed me. Places I really didn't have any expectations for turned out to be amazing or have the happiest residents and most involved Program Directors. I have no idea how I'm going to rank places. I know which programs I loved and which ones I would rather not have to deal with but all of the middle is a muddle. And since I am applying for  Child Neuro and each place has one or two spots per year it is like fellowship in that I could realistically match at my #5 or #8 and so that is hard.... I just have to make a list and leave it up to the NMRP computer to do its thing. But until then I am agonizing daily...

62 days until Match. Not that I'm counting. Dr.  Boyfriend's iPhone is though, so I get periodic reminders. He is more anxious  than I am which makes sense because the match going to determine where we end up, where he has to find a job, where we live for the next 5 years. I view this as fun and exciting. He views it as nerve-wracking and scary. Reality is probably somewhere in the middle. (But then again I am the girl that moved 15 times in my first 16 years of life and will have rotated at 9 different hospitals by the time I graduate from medical school, so maybe change is not a huge deal to me.)

In other news, I LOVE genetics. My attending is awesome. The patients are super interesting and I am learning a lot. Clinic is just so much better than a textbook. So far (in my only 2.5 days of patients because I've been away interviewing) I've seen at least one of each diagnosis: Neurofibramotosis, Beckwith-Wiedeman Syndrome, Gaucher's Disease, Osteogenesis Imperfecta, Klinefelter's, Potter's Syndrome in utero, William's Syndrome, Trisomy 21 and cleft palate as well as rule outs for Marfan's and Legius Syndrome. And these are just the confirmed by genetic testing diagnosed patients. There were others that are still being worked up. So interesting, so cool, plus Miami Children's is a great hospital and I love what I'm doing. That's all I've got today. Happy Saturday!


What I am doing


Behind the Beautiful Forevers by Katherine Boo, as well as Although of Course You End Up Becoming Yourself: A Road Trip with David Wallace Foster by David Lipsky (The subject of the NYT Book review from which I have previously quoted here)

A Genetics Elective at Miami Children's (I arrived in Miami over the weekend and it reminds me of Grenada which is nostalgia inducing, humid, warm, living with roommates again fun.)

My new city as this is my first time in Miami. So far I've found a great diner for breakfast, the grocery store (IGA!!! just like Grenada) a Spanish Restaurant that serves okay Tapas and a friend from the island that is here this month too. I know my life is just so hard.

Today to Cali for an interview and again on Friday to upstate New York for yet another interview. Only four more to go. Now let's just hope I can take off from my elective for all of them.

Learning to Knit-
(I needed a new project for take off and landing time on the plane when I couldn't read my Nook)
It is not going very well, I think I need an initial lesson with a real person, the read and follow directions in 2D is not working for me... Poor Sancho, he is going to get a very ugly sweater indeed, and he's a dog, so he'll have to wear it!


On life.
On love.


My life.

The Match.


Write here, right now/ right here, write now!

My New Year's resolution?


To write. Which I already do. But I want to write more. More deliberately. More frequently. Just more.

And to read. Read more of substance and more of the authors that know how to write.

I think this is a perfect place to start...

New Year's Resolution Reading List: 9 Essential Books on Reading and Writing | Brain Pickings / via @brainpicker

Wishing you a happy, well read and well written 2013!