doc w/ Pen

journalist + medical student + artist

Tag: Residency

On this day …

I don’t normally look at the “On this day” posts on Facebook. I don’t normally spend much time on Facebook at all. But today, on a whim, I did. This came up, a 5-year-old memory:

As did another post from a dear friend exactly a year later, which I’ve copied below. If I remember correctly, the first sentence, in quotation marks, is her quoting me; the second sentence is her reaction to my words:

“Holy shit. That is an acceptance letter.”
I LOVE YOU

Discussing the MCAT on this day in 2013, and a medical school acceptance letter on this day in 2014 …

I’ve come a long way since then. I’m now discussing medical school graduation (in 13 months!) and where I will apply for my psychiatry residency (in 5 months!).

Thanks to all of you who have helped make this possible, and to all of you who have followed me on the journey. I couldn’t have done it without you.

Celebrate!

Every day, it gets a little more real. The fact that in just over a year, I’ll be a doctor.

Some moments, that timeline feels more concrete than others. Like today, when I logged in for the first time to my new best friend ERAS, the Electronic Residency Application Service.

I’m sure I will grow to loathe the purple, orange, and green color scheme of my ERAS dashboard, given how much time I will spend on this website. (And really? Purple, orange, and green? That’s a little much, isn’t it?)

But today, the colors seemed festive and celebratory. And so I am celebrating.

That’s right, I’m applying to RESIDENCY. Wow …

 

Picking among disciplines

“What do you want to be when you grow up?” It’s a common question throughout childhood. It comes from teachers and parents. It’s also a question we ask of ourselves. We dream into adulthood, trying on different career costumes, imagining what could be.

My own sense is that the question is in constant evolution. It can’t be definitively answered after high school, college, or even graduate school. Few people in this era complete a career with the same company. Each new promotion, each new employer, provide further clues into our professional identity.

When I decided to go to medical school after a career in journalism and publishing, I turned over a radically new leaf. I handed in my pen for a penlight, political sleuthing for a stethoscope.

Could I have imagined such a change in course when I first thought about my future? No.

As I approach the start of my fourth and final year of medical school, the original childhood question takes a far more specific turn: What kind of doctor do I want to be?

It’s pondered endlessly, ad nauseam, at times to the point of true nausea. As in childhood, my reply to the medical school version of the question has changed over time.

For as long as I can remember, I’ve made things with my hands, from beaded necklaces to stained glass windows to origami flower bouquets. So I initially pictured myself in a procedural specialty, something surgical, making the most of my manual dexterity. But I quickly realized that I much preferred waking patients to those under anesthesia. I also realized that the reporter in me craved stories, conversation.

In the context of my career history, filled with interviews and human contact, my chosen field — psychiatry — makes obvious sense. Admittedly it wasn’t the choice I’d imagined when I began medical school. In fact, it was among the fields I thought I wouldn’t choose.

But in a way, psychiatry chose me.

Before starting my psychiatry rotation, I’d rotated through obstetrics-gynecology and primary care (outpatient adult medicine). I’d loved aspects of each. In the ob-gyn segment, it was my two weeks on the labor and delivery service. Holding the hand of a mother-to-be, counting with her as she pushed out a new life. Talking, in between pushes, with her and whomever was there to support her (husband, partner, mother, sister, friend) about their hopes, dreams, and fears. During primary care, it was sensing the trust that patients put in their internist, who’d known many of them for years, knew their life stories and struggles as well as their medical diagnoses.

Not long into my psychiatry clerkship, I realized that in this one field, I could experience my favorite parts of my time in ob-gyn and primary care. I could talk about a patient’s hopes, dreams, and fears as well as develop ongoing relationships with them.

I could also use many of the skills I’d honed in my decade-long career before medical school. Psychiatry, like journalism, is about stories. It’s about developing quick rapport, asking the right questions, and being an active, empathetic listener. These skills are certainly not unique to psychiatry, but they are especially important in psychiatry, where a detail from the patient’s medical history, past hospitalizations, relationships, or living situation might be crucial to how you manage the person’s care. This background suddenly takes on immense importance because of the way past experiences shape mental health.

There is also an investigative aspect to psychiatry. One of the tasks frequently given to medical students on the psychiatry clerkship is to track down so-called “collateral” on a patient – to talk to a person’s medical doctor, therapist, psychiatrist, case worker, significant other, sibling, parent, or friend – to get a more complete picture of the person’s immediate situation. In psychiatry, as in journalism, you don’t rely on the story you get from one person. You approach information with healthy skepticism. And so you gather evidence from a number of sources and put the pieces together yourself.

Each field of medicine also has a vibe, a unique personality. Part of finding your place, I realized early on during my clerkship year, is finding your tribe. In psychiatry, I did. I found people whose personalities, interests, goals, sense of humor, wardrobe choices, and even favorite eyeliner color meshed with my own.

After completing my psychiatry clerkship, I was almost sure that I wanted to be a psychiatrist. After finishing other rotations, I’m entirely sure. Because the things I liked best about each of them also have a place in psychiatry. In neurology, my favorite patients were those whose illnesses blurred the lines between neurology and psychiatry. In surgery, I thrived under the tutelage of a particular trauma surgeon, one of the best educators I’ve ever met. He inspired me, on a daily basis, to learn and explore, to be curious. I’ve found mentors in psychiatry who do the same, and I find psychiatry’s subject matter inherently interesting in a way surgery concepts were not. In internal medicine, I liked the challenge of using artful communication skills to broach difficult subjects with patients and family members. I also felt at home in the role of being a comforter to those in distress.

While I’ve answered the next iteration in this serial question – “What do you want to be when you grow up?” – my future is by no means fully defined. First of all, where do I want to do my four-year psychiatry residency? And after that, do I want to do a fellowship for more advanced and focused training? Do I want to work with inpatients, outpatients, or a mix? What city do I want to practice in? I’ll find the answers to these questions and others, in time.

For now, I focus on what’s in front of me: finishing medical school, and finding the right place for me to become the best psychiatrist I can be.

 

Note: The original version of this essay appeared on the online magazine “The American.” You can read it here.

 

My post-medicine to-do list

While on my internal medicine rotation, I’ve done lots of steps and stairs, as my iPhone attests. But when the clerkship ends, I need to get back into a regular gym routine.

As I write this, I’m almost done with my internal medicine clerkship. Just 12 hours to go. Wednesday was my last day in the hospital. Thursday I crammed for my exams. Today I plow through a 110-question multiple choice test, and a 2-hour EKG-reading test.

It’s been an exhilarating, and exhausting, eight weeks. I’ve taken more ownership of my patients than in any other clerkship. I’ve gotten to know them better, and been more intimately involved in their care. All of that has been immensely rewarding. I’ve truly felt like part of the team, like I’m contributing in a meaningful way. It has also been devastating, for example when a patient took an unexpected turn for the worse, a turn from which they were not expected to recover.

The work schedule has been intense too. Monday through Friday were generally 12-hour days, counting both in-hospital time and time I spent chart-reviewing my patients at home in the morning. Saturday, we generally were let go a couple of hours early. Sunday was my day off. But not really. It was really my day to catch up on studying. Because when I got home Monday through Saturday, it was hard to bring myself to do more than 10 (maybe 20) practice questions before my mind shut down. Forget trying to read or memorize anything. So Sunday was my day to study. Doing “life stuff” got put on the back burner. “Survival” was my mantra.

It’s been too long since I’ve visited the Tiffany windows at The Met.

That means that this coming weekend, I have a lot of catching up to do. It won’t all happen in a day. Thankfully, next up is my four-month research block. This will be plenty of work too, but won’t involve the same crazy schedule. So here are some items on my to-do list, in no particular order:

Spend time at places other than the hospital and my apartment. I’m looking forward to seeing the sun (other than through a window), and visiting some of my favorite NYC haunts (like The Met), as well as exploring some new ones (like the 9/11 Memorial).

Spend time with my friends and family. I’ve done very little of that recently, given my lack of time and energy post-work. It’s time to catch up, both in person with those who live in New York, and on the phone with those who live elsewhere. (You know who you are!)

For too long, my vacuum has sat abandoned in my closet.

Clean my apartment. I especially need to vacuum. Now that I have long hair, fallen strands have a tendency to collect in little clumps along my baseboards. Scooping up the biggest ones with my hands is really not cutting it.

Do laundry. I mean ALL of my clothes, and in actual washing machines, not just emergency items in my bathroom sink.

Do my dishes. Regularly. The other morning, I had to use a fork to stir the sugar and half and half into my coffee. Not ideal.

Eat better. I need to get back to cooking regularly, rather than slapping together a ham sandwich for dinner, or picking up unhealthy take-out. (E.g., no more orange chicken from Panda Express, which is directly on my way home from the hospital.)

Exercise. While working in the hospital, I run around a lot, from floor to floor, so get in quite a few steps and stairs. But I need to get back to a regular gym routine, and back to doing my mat Pilates.

Meditate. This is something I’ve wanted to try for years. Medical school is stressful, and I know residency will be too. I think meditation could help with that. Ironically, all the stress lately has prevented me from trying something that might reduce my stress. So as I head into a less stressful block of time, I want to establish the habit so it hopefully sticks when I really need it next. A friend of mine recommended a couple of apps to try, including the Headspace app pictured at left, so that seems like a good place to start.

On a side note about stress, I’ve had multiple residents tell me that they much prefer the stresses of residency to those of third year. In residency your day off is actually a day off; you don’t have to study. You’re also not worried about constantly being evaluated by everyone around you, which is one of the major pressures of these clinical rotations (and something I plan to write a separate post about). A classmate said that one resident told her: “My worst day as an intern was still better than my best day as a third-year medical student.” I’m not sure everyone feels the same, but at least some of the stresses of medical school (studying for exams in the evenings and on your day off; having to always be “on” since you’re always being evaluated) will dissipate. And, I’m sure, be replaced with other ones.

Be creative. Using my hands to make things is such a rewarding outlet for me. I simply haven’t had the time or energy for it lately. I’ve missed it.

One of my new favorite songs, Snake River Conspiracy’s cover of The Cure’s “Lovesong.”

Write. I have a long list of essay ideas that I simply haven’t had time or energy to tackle. Several of them relate to things that have happened during my medicine clerkship. I look forward to sharing those experiences with all of you in the coming days and weeks, as I process all that’s happened lately.

Find new music. Over winter break, my youngest sister, Joy, convinced me to join Spotify. I’ve managed (barely) to keep up with the “Discover Weekly” playlist that Spotify sends me every Sunday night, saving the songs I like to a new playlist I aptly call “New discoveries to explore!” I’d like to delve into that list (which currently has 119 songs on it) and to investigate some of those artists and their albums more fully.

Watch TV. I don’t normally do much of this to begin with, but I haven’t even turned on my set in weeks. It would be really nice to relax on my couch in front of a good movie or TV show episode without feeling guilty.

My purchases at City Hops. Several of the beers are local, brewed here in NY state — pretty cool.

Learn about beer. And drink it, of course. For the longest time, I thought beer was simply gross. The closest I got was Mike’s Hard Lemonade. I stuck to wine, or my favorite, gin & tonic. Then I dated someone for a little while who enjoyed beer, so I would try what he bought. Turns out it wasn’t so bad, though still not my choice of adult beverage. Then my sister started bringing craft beers to family gatherings, and not only did I tolerate them, I actually liked them. It was a revelation. I’m particularly partial to IPAs, of all things. But the selection at the grocery store down the street is atrocious, and a six-pack costs about $5 more than it should. There’s a place called City Hops on 2nd Avenue not far from me. I’ve walked by it dozens of times, and often thought about going it. Yesterday I took a study break and did just that, and about $40 later, was the proud owner of seven different craft IPAs. I’m definitely drinking one tonight night to celebrate making it through medicine intact.

Pamper my plants. Many months ago, I bought some lovely houseplants from Home Depot, and some lovely plant stands online. The idea was to infuse a little bit of “green” in my environment as I live amid the concrete jungle. Unfortunately, I dramatically overestimated the amount of natural light that would be cast onto the corners where I put these plant stands. My poor plants became bedraggled over time. Luckily, they quickly perked up when I put them on my kitchen windowsill. But I can’t really enjoy them there. So I want to buy and install some grow lights, so I can put my plants back on their stands, where I can see them better, and enjoy them more.

My plants are fine on my windowsill, but once I get some grow lights I can put them on my plant stands (which are in places that don’t get much natural light, but are where I can see my greenery better).

The home page for FREIDA, the American Medical Association’s online gateway to exploring residency programs … *gulp*

Think more about my future. Before I know it, September will roll around, and I’ll be submitting my residency application. That means I need to figure out where I’m applying. And THAT means I need to do some leg work (well, more like “finger work” as I explore residency programs on the Internet). This is a little terrifying, as you might imagine. It’s also thrilling.

Clearly, I have a lot to catch up on. But it’s good stuff, fun stuff, stuff that’s rewarding in a different way than patient care.

Now, in anticipation of this upcoming reprieve, I wonder where my TV remote has gotten to …