Friends, Formulas, and Finding Out

It's weird competing for residency spots with all of your friends. When I applied to medical school I didn't know a single person who was going through the same process. Now most of my Canadian friends here are scrambling for the same (extremely limited number of) residency spots.

Ugh.

Gah.

I hate that thought. I don't want to be sitting next to one of my good buds, on one of those uncomfortable steel framed chairs with the stuffing falling out of the cushion, waiting in line to be interviewed. How awkward will that conversation be?

"Residency, hey? One position at this school...*cough*...so....what is your rank list? How was Christmas?...Cold out there, hey?"

"Yep."

Also, at least one of the schools I applied to uses the following formula for interviews:

EE score: 20%
Personal letter: 20%
School marks/ranking: 20%
Research/publications: 20%

Then they interview the top "x" number and the interview is worth 20%. The schools rank list is based on that overall score.

So this is my worry...my true attributes and qualities don't necessarily shine when traditional formulas are applied. My complete lack of Canadian medical school interviews speaks to this. I mean, sorry, I haven't managed to crank out any major publications this year. Does that mean I am not going to be the most competent and safe and fun-loving resident you've ever had?! Hell no!

Maybe if the formula was:

Relevant health care experience: 20%
Culinary skills: 10%
Class ranking: 20%
Personal statement: 10%
EE score: 5%
Interview: 30%
Dentition: 5% 

Then I could rest assured that I'd have a job next year...!

Sigh.

Tick tock. Still a month of nail-biting to go...

How I currently feel...

Forced Silence

It's weird not being able to write about the biggest and most important development in my medical education to date. Tonight I finished the final touches on my CaRMS application (for Canadian residency program). All my documents are uploaded, fees paid (ouch), letters in, and programs selected.

Now all I do is wait.

And attempt to get a good night's sleep.

I'd love to write about all the thoughts I've been having on my future career prospects, what I really hope to match in, where I really want to live and study. But I can't! The truth is, this blog is so easily linked to my name if anyone wanted to do a quick google search on their future resident it'd only take 2 seconds to find a treasure trove of ABB rambles on life and career choices.

So, as part of the game I can't really say where I applied or what I applied to. If you're reading this, dear Program Director, then rest assured yours is the ONLY program I want!

It has been a helluva few months. Between studying for the EE, hospital presentations, the Case Competition, my placenta study, school work, and CaRMS applications I truly have not had 2 days off in a row since I came back here in July. Even when I went for a little getaway weekend trip to Cromane I was working on personal letters most of the time. Now I have less than 2 weeks left in this rotation and then I am back to Canada for 8 weeks! Yep. I haven't been home for Christmas for NINE years. It's going to be unreal. Yes, I will be working on a lit review and doing an elective in general surgery but I will also be getting in some skiing, hot yoga-ing, novel reading, soup making, spinning, visiting, sleeping, studying, and full-on relaxing. And hopefully...residency interviews!!

Ahhh, it's going to be so good.

I will start finding out about possible residency interviews in roughly a month. Will keep the blogosphere posted, so to speak. And also, I hope to finally write about life for the last few months. There have been so many wild ups and downs. I feel like most days I am barely able to process what has happened before the next wave hits. Life moves so fast, in 1.5 weeks I am officially halfway through final year.

Thanks for coming along for the ride!

My current mantra.

Silent High Fives

So today I found out that I passed the MCCEE (the first of about 42 exams that I'll be writing as part of my Canadian licensure). 

Yes, it is great that I passed but I need to score >95th percentile if I actually hope to be invited for any residency interviews in Canada (I know that I am prone to exaggeration but this is one time when I am just stating a cold hard fact). My actual score will be released in the next few days. I've already decided there is NO WAY IN HELL I am checking my grade while at the hospital. 

Today I was in the library working on CaRMS between tutorials (and saving lives, and stamping out disease) when I received the email that I had a "communication from the medical council". Instant armpit stains. Several of my Canadian compatriots were also in the library and it didn't take long for the ripple of "Shit what is my password? What is my username? How did you log on? Was it your email? Was it the MCC site or the PCRC site" commentary to pass through the room. Followed by a second wave of "I passed", "Did you pass?" and then quiet high fives and quick hugs and stifled "Woohooo"'s. 

Joanna broke half her remaining MARS bar in two and we toasted our quarter pieces in victory, mini as it was. 

I've been putting the whole EE thing in the back of my head, categorizing it as "A Worry I Can Do Nothing About". Things in this category are strictly not allowed to keep me up at night or monopolize my waking thoughts. But now, now it has surfaced and the thought of opening that web page next week to see my score already turns my guts to water. 

Living the dream. Living the dream. Living the dream...

Life style.

Because I have been working on my residency applications and trying to sort out my future career, I have spent a lot of time thinking about what the concept of "life style" means. Whenever I mention the areas of medicine that I am interested in people always comment on life style. Somewhere fitting in the statement, "You should go into family medicine, it's the best life style."

At which point I want to put 6 inches of duct tape on their mouths.

If I go into family medicine it will be because I want to do primary care and live in the hills, be involved in community and do some extra training in EM, OB/GYN, or sports medicine. It will not be for the life style. Please do not try to sell a career to me based on the merits of how good things will be when I'm not at my job.  I want to choose my career based on how much I will enjoy being at work. Tell me to go into family medicine because you love your work, the fact that you enjoy the variety in your patient population, the continuity of care, the portability, whathaveyou. Not because of the life style.

[Because I plan to take most of this post down before submitting my CaRMS application I am going to be totally honest here.]

I am applying to emergency medicine, obstetrics/gynecology, and family med. I thought long and hard about general surgery as well, but realized that I actually LOVE the surgical component of OB/GYN more than the heavy scope and gastrointestinal component of gen surg. So, at this moment I am not applying to surgery. When people ask, and I tell them my choices, I am constantly told that I shouldn't do OB because of the life style.

Instead of a verbal reply to that from now on I want to hand over the following quote by a pediatric cardiac surgeon, from the book Walk on Water by Ruhlman:

You go through med school and they say, 'Oh, don't be a surgeon--lousy life style'. It's a mantra in med school: 'Life style, life style, life style.' Do you go into emergency medicine or do you go into...life style? I see people doing things that are really hard and uncomfortable, but they do them anyway because they're passionate about their work. I want to do that. I see someone turn off his beeper because it's one minute after five o'clock--is that being a doctor? This is why surgery is the wrong choice for someone like that: no life style. That is what it comes down to, either you go with what you're passionate about, or you go with life style. 

I basically want to stand up and do a slow clap every time I read that passage.

It really is amazing, the responses I get when I discuss my future career aspirations. People will nearly always respond with a disparaging comment. It's reminiscent of when I was in the application process for medical school, actually. I would often get, "Why would you want to do medicine?" or "I almost did medicine but then decided I wanted a life and family instead", "Medicine is so hard to get into", I could go on.

I said to one of the OB's at work a few weeks ago that I was applying to obstetrics. His response, "So, you don't enjoy sleeping through the night then?"

What is the matter with these people? Hellllooooooooo?!

My career will be a big part of my life. If I love my work I will consider myself to be blessed with an amazing life style.

That is, of course, if someone will give me a residency first!! :)

CaRMS Chest Pain

You know that feeling you get when you realize you may have made a major, life plan threatening mistake? When, in an instant you feel the blood drain from your face and limbs, and your stomach takes up residence in the back of your throat?

Yeah. I had one of those recently.

I was calmly working away at CaRMS, putting in all of my volunteer, work, clinical experience. Filling in dates, ticking boxes, clicking on drop-down menus. It was Saturday night at around 1am and I was starting to get very tired, losing my ability to focus. But I was buzzing from reading program descriptions and fantasizing about where I might be a year from now. So I kept on a little longer than I probably should have.

I wanted to finish this last section and then go to bed. I came to the program selection area and when I saw the big shiny "SUBMIT" button I figured it was just with regards to payment (my application far from being finished).

So I hit "SUBMIT" and then realised that I had, in fact, made a very large mistake. My body was instantly unsure of how to contain it's fluids. Sweat soaked my shirt, then I nearly vomited and peed myself at the same time.

In my mind I saw myself spending 2013-2014 with a micropipette in some dimly lit lab, tucked away under a hospital stairwell somewhere. Hiding from both the bank and my mother. I then remembered hearing stories of people who didn't match due to clerical errors, and those who missed a form here, a deadline there. I saw myself becoming a CaRMS urban legend.

I frantically sent a FB message to my friend Rob who went through this process last year, I think the word "crisis" may have been heavily overused.

Robert say, "nothing you can't fix". Grasshopper calm down.

He may look like a normal guy, but he's actually a little CaRMS Confucius. An Online Residency Application Oracle. Despite being on the drive home from a shift in Detroit he kindly messaged me back and called me as soon as he got in, talked me down from my window ledge and explained that all was not lost. I actually think I would have gone crazy if I'd had to wait until Monday at 0900h EST to call the helpdesk. By about 0300h my breathing had retured to my lung bases, gastro and urinary symptoms had disappeared and my tremor had resolved. It's nice to have 24h free support line!! So thaaaannnnnnnkkkkksssssss ROB!!!! (He is one of the 10 of you that hasn't given up on the blog!)

Oh I cannot wait to have this all finished and to start finding out about interviews.....eeeeeeeeeep!

Back to the land of tick boxes and drop down menu. Tedium, thy name is residency applications!!

My Achilles is Actually My Heel

I have problems with my feet.

If you are a long-time reader you may recall "Uncle Fester" from my Himalayan trip training days...or my Summer of Cellulitis last year thanks to a hike in the eastern Reeks..Well it appears that the hills of Ireland have once again bitten me (okay, it was actually my new fell running shoes...)

Ahh, nice views, nice spot for lunch...say, I love my new shoes!

La la la ridge running so fun, these shoes are so great! Mud claw's forevveeerrrrrrrr!!!

I may vomit if I have to put a shoe on ever again. 

Consultant Crushes and Medical Miracles

I'm not going to get too sentimental about all this. Just hear me out.

There are a lot of things we get wrong in medicine, a lot of things we can't treat, cure, or figure out. But today in clinic I had the opportunity to meet some children who are living (playing, giggling, bright eyed, rose-cheeked) proof that modern medicine can be amazing. Similar sort of feeling to a day I blogged about 2 years ago.

I met a child who had a catastrophic birth with many complications, but because of the swift and expert interventions provided (including total body cooling) has managed to develop with no deficits in any area (physically or cognitively). Today she is an adorable, intelligent, able bodied little bean who seriously rocks pink UGG boots.

Another child who was born with a fatal cardiac anomaly, had surgical treatment, and also is now a happy-go-lucky perfectly healthy little man. I couldn't help but send mental props to the cardiac surgeons like Lillehei* who trialed, and failed, and failed, and developed and perfected surgeries like the repair of Tetralogy of Fallot or the Norwood procedures. If those men hadn't risked their careers and their emotional fortitude 50 years ago, today these children would have died at birth or after short and difficult lives.

My awestruck gaze was only sharpened by the fact that I was working with a seriously butt-kicking-ridiculously-intelligent-biochemistry-genetics-pediatric-metabolic-disorder-expert-ball-of-awesomeness consultant who loves to teach! I hoped some of her brain power might waft over in my direction if I sat close enough to her in clinic (without being too creepy and really invading her personal space).

And so, I return to my reading and eventually the newest episode of "New Girl".  Oh and yes, I am working like mad on my CaRMS application and my new research project. I have a whole post on recent CaRMS trauma in the works...but for now...I'll just say that today was a good day. A perfectly timed reminder of why I am putting myself through all of this.

*Read "Walk on Water" by Ruhlman and "King of Hearts" by Cooley if you really want to know what I am talking about. Both fascinating and unreal stories of larger than life pediatric cardiac surgeons.

Hark! A Child Cries in the Distance!

I love going into the maternity hospital for work.

Ireland was apparently the first country in the world to have one. Every day I have to dodge new dads in the parking lot trying to juggle car seats and flowers, handbags, suitcases, and "IT'S A BOY!!" helium balloons. Women (mostly waddle) around in various brightly colored bathrobes, either trying to break up the boredom of being admitted, or in the hopes of getting things going in the labor department. Giant bellies, little bumps, nervous nulltips, exasperated over-termers populate the antenatal clinics. It's quite the humming baby factory.

On the labor ward every couple of hours a new admission would walk casually up to the desk with a mix of fear, sometimes excitement, expressions of pain, or lines of fatigue on her face. While being checked in some would have to pause and lean heavily on the nursing station if a contraction took over. Others went shooting by in a wheelchair pushed by an admissions midwife, hair blowing back behind them with the "don't push yet!!!" instruction barked by a senior midwife...a few minutes later we'd hear some hollering followed by the gusty cry of a new arrival to the planet. I could just smile to myself because at that moment only infinite possibilities exist for that baby.

Of course, of course we've seen sad outcomes, unexpected premature deliveries, undiagnosed syndromes and malformations. But even those, which weigh heavily on the staff, give me inspiration from the grace and strength exhibited by the families of those babies.

What a place! What a privilege.

Hello, World

No, I haven't drowned in a giant puddle of amniotic fluid.

I am loving life here in OB/GYN but just absolutely wrecked and savaged by work right now. Did nights through the weekend so am currently on my 10th day in a row at the hospital, am working on a Grand Rounds presentation for Friday, applying to CaRMS, writing up assignments...oh and I started collecting data for a new study yesterday.

I have a mouth full of canker sores and an ever-expanding derrière due to stress and lack of exercise.

But I'm good. I'm gooooooood.

Stories to come. Once the dust (er....fluids?) have settled.

In the meantime: birthing babies = awesome. 

Well Put....

After examining the tummy of a very pregnant lady we were ushered out into the hall to be pimped by our Registrar. He asked my friend what his findings were and to describe the fetal position.

Friend: Well....When I was feeling her abdomen I couldn't really tell if I was feeling the head at the top or if I was feeling the back and feet. So...at the fundus I palpated either the head or the feet.

[You really can't fault that logic.]

[This was just before I got the fetal lie completely wrong.]

[Figuring out fetal lie, position, and presentation is harder than it looks.]