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!