That's a Match

Monday, March 26, 2018


Now that the dust has settled, I feel like I can finally sit down and write about the culmination of years of hard work that occurred on March 16, 2018. All the travel, the money, the time, the miles walked in heels, the handshakes, the dinners, the sprints made through airports, the exhaustion, it all was for a single day in March that to most people was either just another Friday, or maybe just the day before St. Patrick's Day.

I suppose more specifically, it was for March 12th also, which is the day I found out that yes, I HAD MATCHED. I had a job, it was to be a pediatrician, and it was at one of the 11 places where I had interviewed. I was in a subacute rehab, sitting at a table with my attending and a third year student, hiding my phone in my lab, waiting for the email to hit my inbox at 11 am and I was a ball of nerves. When it finally arrived, right on schedule (thanks, NRMP!) I was so relieved to see "Congratulations..." at the beginning of the email. It was as if a weight had been lifted off of my chest and I could finally breathe a little again.

Then I had to wait four more agonizing days to find out my fate. It was torturous.

Finally, it was Friday morning and I was dressed and ready to go by 10:30, even though we didn't have to leave until 11:30. I eventually decided I couldn't sit at my kitchen table any longer, so I told Ken we should just go over to the banquet hall where the festivities would be occurring. The lobby was buzzing with tension and excitement, people just milling around because standing still wasn't an option. I found my med school best friend/wifey and her boyfriend, picked up our Match Day class t-shirt, and awkwardly took some photos by the Match Day poster.

Eventually, we were let into the hall and we found a table near a door in case anyone needed to beat a hasty retreat. Then, these sadists made us eat lunch and listen to a bunch of speeches before we could pick up our envelopes! At this point, I seriously thought I might vomit from anxiety. It was not great. I knew what I was hoping for and daresay, even expecting, but there was always a chance I could have gotten my last choice. I could barely eat, and of course there was no alcohol (womp womp), so the waiting was awful.

After more speechifying, it was finally letter time. We all picked up our envelopes from tables outside the hall and returned to our seats. I felt like I was holding a very carefully constructed bomb in my hands. The answer was in this envelope, on a single piece of paper. It was going to dictate where we would be moving and where I would be learning how to be a real, live, pediatrician for the next three years. It felt strange to be almost afraid of a piece of stationery, but there it was. My best friend/wifey was holding her envelope up to the light in an attempt to see through it. The envelope was sealed with a single piece of tape.

There was a dramatic countdown from five and envelopes across the room were torn open. Whoops of delight and laughter and shouts of joy started erupting as people discovered their matches and were clearly pleased. I held my envelope for a few seconds before carefully peeling the tape off. I unfolded the envelope and learned my fate.

It was not what I was expecting.

It was not my first choice. It was not my second choice. It wasn't my third, fourth, or fifth choice.

It was my sixth choice program.

Next to me, my friend was crying with joy because she had matched into her top choice, a very competitive Physical Medicine & Rehab program. I was SO HAPPY for her! But I was also so very sad for myself. I didn't want them to, but the tears came anyway. By this point, Ken had read the news and was sitting with his arm around my shoulder, not really sure how best to console me in a room full of celebrating people. Another friend of mine who had matched in the military match in December ran over to congratulate me and instead ended up wrapping me in a giant hug while I cried. I was in shock. I didn't know what to do, and I knew my mascara was running down my face. I turned to Ken and quietly said, "I want to go home." So we did.

The entire ride home, I was texting with my mom about the news. All of my non-medical friends and family were texting and messaging me with messages like, "WELL!?!" and "CONGRATS!" It felt so wrong for everyone to be so happy for me and proud of me when I felt like I had failed. Yes, I had matched, but it wasn't where I had dreamed of going, and now I had to take that in and be excited about it? It wasn't happening, at least not right then. When we got home, I got changed and laid in bed for awhile. I didn't want to sleep, I didn't want to be awake, I didn't want to exist. I wanted to put my brain in a jar and just take a damn break for a minute.

Instead, I pulled out the giant pile of residency program information I had accumulated from the interview trail and flipped to the folder of the program where I was going. To be perfectly honest, I couldn't remember much about the place, other than I had liked it well enough. I couldn't remember what electives they had, how many beds there were, or what their call schedule was like. I knew it was a small program, and everyone had been friendly enough, and that it was in Pennsylvania. So I took the time to reorient myself with the program. As I did, the interview day came back to me. The Program Director had been very nice and knowledgeable, and Associate PD was an amazing woman. All of the residents I had met were friendly and seemed genuinely happy with where they were working. I hadn't seen much of the area, but I knew enough to know that it was a nice place to live and that cost of living would be lower than where we live currently. Slowly, things began to pile up in the positive column.

Then I remembered that one of my brother's childhood friends was a Family Medicine resident there, so I immediately messaged him and we started talking about the program. He had nothing but good things to say about his interactions with the pediatrics teams, and reassured me that the area was great and that yes, there was a Target. A friend I had made during my post-bacc at Penn reached out and reminded me that she worked as a PA for the trauma service at the hospital where I had matched, and she was very happy there was well. I started to feel like maybe this wasn't so bad after all.

As the days continued to pass, I was finally able to get excited about this next step of my life. I started receiving emails from the program (lots and lots of emails) and saw pictures and names of the other people in my residency class. I was relieved that half of the group was male! (This is a rarity in pediatrics, it seems.) The PD and Associate PD seemed truly excited to have gotten us as residents, which was nice. The reality really sunk in when I signed my contract and sent back my letter of intent. I had a real job! Reality also slapped me in the face when I found out that orientation starts in early June and that we had a hell of a lot of things to do before we could move. But that's another post for another time.

So why am I telling you all this? Because it's important to know that not everyone gets their first choice on Match Day, and that it's really hard to see everyone's posts about how happy they are when you are simultaneously overjoyed that you have a job and devastated that it's not where you thought it would be. I learned that nearly 98% of the pediatrics residency spots were filled in the first round of the match this year, which is INSANE. I feel extraordinarily luck to have matched at all, let alone into my desired specialty. I know a lot of people out there who can't say the same thing, and my heart breaks for them. I'm telling you this because I feel like it's important to show that you can not get your first choice and still be okay. Obviously I haven't started residency yet, but I know that this program will train me to be a great pediatrician, and I'm sure that I will be able to accomplish my goals with that training. At the end of the day, that's all I can really ask for.


So congratulations to the class of 2018. We're going to be doctors, you guys!


Rebirth: Healing from a C-Section

Wednesday, February 14, 2018


I wrote about Aviva's birth story here, and in it, I talk about how I had an emergency c-section. What I didn't write about was how much having a c-section affected me. For many women, having a c-section is their preferred choice, or sometimes it's just the way things end up, and they're okay with it. For whatever reason, my c-section brought up all kinds of feelings, none of them good. Before I go on, I want to say that I am not judging women who have c-sections, either by choice or by necessity. This is about me and my feelings about what happened surrounding my birth. Okay? Okay.

After a diagnosis of endometriosis and PCOS, 2 miscarriages, and infertility, I had already spent a lot of time being mad at my body. Pregnancy, once it finally happened, was one of the only things my body has ever done right. It grew a whole human! That's why, when my body stopped cooperating at 6 cm, it was like an even bigger slap in the face. I felt like my body had abandoned me. Failed me. It was just one more failure in a string of already depressing failures.

I carried that failure with me for months after the birth. For a long time, I had trouble even accepting that I had given birth. I felt like one minute, I was 40 weeks and 2 days pregnant, with a very present, kicking, little person inside of me, and the next, someone had just... handed me a baby. There was nothing in between. There was no space during which I felt us become separate people. Instead, I had been unceremoniously sliced open like a fish and now instead of skin-to-skin and immediate breast feeding, I was lying on a table with my uterus outside of my body, being stitched back together. (I've assisted in c-sections. They're kind of barbaric. Useful. Effective. But... aggressive.) I didn't get to have my doula with me, I didn't get any of the things I wanted.

Except an alive baby, which is supposed to make all of this okay. And it does. But it doesn't take away the disconnected feelings and the grief I had about how it all went down.

When I found out that I would be having a c-section, a mere 20 minutes prior to when I was on the table, I was out of it. I had been in labor for 25 hours, I had a fever, I was in pain despite my epidural. I was exhausted. Most of all, I was terrified for my baby. I made the only decision I could make at that point, and that was to consent to the surgery. I know that I made the right decision, because at the end of the day, Aviva and I were alive and healthy, and that, they say, is all that matters. And it does! It matters the most. But what also matters is how it made me feel, and women's feelings are dismissed constantly. Since c-sections are so routine now, and everyone was fine, no one seemed to understand or even care that I was hurting. I felt like a failure.

I don't mean to sound ungrateful to modern medicine, because I definitely am, but there will always be a part of me that is sad about how I brought Aviva into this world. I will never get the birth of my first child back, and instead of an empowering and moving experience, it was cold and clinical. Just another procedure in a long line of procedures my doctor had done that day. I'm also afraid. Afraid that, if I'm fortunate enough to get pregnant and have a second baby (and an opportunity to attempt a VBAC), that it will happen again. I'll labor and labor and labor and end up with a section all over again. No one can tell me whether that will be the case, so we'll have to wait and see when we get there. No one can even tell me why what happened happened, which is frustrating because without a reason, there's no prevention that can happen. I know better than most that medicine sometimes doesn't have all the answers (Lord, I wish it did!), but when your own body is the mystery, it's hard to stay objective.

There's part of me that is so angry with myself for even having any of these feelings, because women are fed so much crap about how birth and mothering should be, and I would like to say I'm better than that, but it got to me and now here we are. I'm also angry with myself because I would never be this harsh to any other mother who had a c-section. Nothing gets under my skin more than when I read a birth announcement to the tune of, "After x hours of NATURAL labor..." Unmedicated birth is birth, medicated birth is birth, having a c-section is birth. Birth is natural.

I'm not sure if I'll ever "get over" having a c-section or whether I'll stop mourning the birth I didn't get to have. And you know what? That's okay. I can hold both the joy of having a healthy, alive, wonderful child and the sorrow of not bringing her into the world the way I wanted. I contain multitudes, as they say. We all do.


State of the Med Student: The Road to Residency Edition

Sunday, January 14, 2018

Photo by Glenn Carstens-Peters on Unsplash

As the interview season begins to wind down for me, I find myself with a lot of thoughts rolling around in my head. There are so many things to think about, and as I prepare to make my rank list, the gravity of the entire process looms large. This is the last part of this experience over which I will have some kind of control. After this, my rank list goes into a computer, gets fed into an algorithm, and on the other end, hopefully a match pops out, and that's where I'm going for 3 years. Craziness. So, as a way to try and organize my thoughts, as well as give you all some insight into the residency matching process, here's what I'm thinking about when I'm making my mental rank list.

Size of the Program

I've interviewed at teeny programs that take 6 residents a year, and programs that take 21 residents a year, as well as everything in between. The programs always ask what about their program made you apply, and since you can't say, "I literally applied to 100 programs because for the love of God, I just want a job," you have to come up with something. I usually went for the size of the program as one of my reasons, as it's low-hanging fruit. Also, it was true. I see good and bad things to having both small and larger programs. I like the idea of the closeness of a small program, but it makes me nervous about covering all the work with just 6 people. What if someone gets sick? Or goes on maternity leave? Also, what if I really don't like one of my co-residents? With only 6 of you, there's nowhere to go to get away from someone with whom you don't really get along. I like the idea of a larger program because there's more people to spread the work between, more people for coverage, more people with whom to make friends. But it's also potentially less personal and a little more likely for cliques to form. In the end, I'm coming down on wanting a slightly larger program than a teeny one, probably in the 12-21 range.

Call Schedule and Nights

Regardless of where I go, there's going to be call and it's going to suck. With the change in duty hour restrictions, interns can now take 24 hour call, which they used to not be able to do. I have mixed feelings about it, mainly, "Ugh, working 24 hours is going to blow," and "At least I'll get used to it?" and "Continuity of patient care is really important!" (Mostly that first one, though.) I'm also going to have to work nights. Fortunately, most of my programs have switched to a night float system, where you do 3 weeks of days and 1 week of nights, as opposed to taking a night every 4 days or something. I definitely prefer the night float situation, so that's a mark in the plus column for programs that have that.

Resident Education and Teaching

Every program is going to have resident education, because let's be real, the whole point of residency is to learn as much as you can so you can pass your boards. A lot of places still do noon conferences, which is nice because then you can eat your lunch (theoretically) while listening to a lecture. The downside is that it's hard to get off the floors to go to noon conference on time, and even though the time is supposed to be protected (which means no one gets paged or called), there's still a lot of phones going off and interruptions happening. Because of this, some places have switched to an academic half-day, where for 4-5 hours once a week, the residents go to educational lectures, seminars, workshops, etc. The time is easier to protect, because it's longer, and it's easier to block off an entire afternoon where the attendings or NP's and PA's take your phone, rather than an hour every day. But.... 4-5 hours is a LONG time to sit and be lectured at, so hopefully, more places will start doing case-based learning. I prefer the academic half day, myself. Also, places that have dedicated board prep education score higher on my list. Another thing to investigate is whether the attendings actually like teaching. The residents are the best source of information for this, and so far, I've heard both the positives and the negatives about the teaching faculty. I've also been fortunate enough to see some of the teaching in action, which is nice. Residency is where you truly learn to be a physician, so having teachers who are invested in that goal is really important.

Research Opportunities

While I know I want to do mainly clinical medicine, I do want the opportunity to use my MPH and actually do some research during my residency. More importantly, I'm going to need research to apply for fellowships after residency, and I want to be in a place that has good support for that. All programs require a Quality Improvement project as part of the residency, and some require further research beyond that. There are some programs on my list that have a lot of financial support for research, like paying for you to attend conferences if your research is accepted, which is a nice bonus. Other places provide a research mentor from the start, where some programs leave it on the resident to seek out a mentor. I definitely prefer a program with more research support, so looking at how many residents have had research published or accepted at conferences, as well as what kind of financial and institutional support is already in place, is a good way for me to stratify my programs.

Fellowship Success

I'm 99% sure that I'm going to do a fellowship after residency, so I want a program that has good success matching their residents into fellowships, especially at large, academic, centers. I also look at what specialties residents have matched into for fellowship, as (at least right now), I'm interested in heme-onc. All of my programs seem to be 50/50 split with residents going into primary practice versus those going into a specialty, so that is a good sign to me that the program is well-rounded and has support for both options.

Resident Wellness

No one is ever going to lie and say that residency is easy. I'm sure I'm not prepared for how hard it's going to be. (Maybe I am, because I'm convinced it's going to be the worst experience of my life, so anything that doesn't make me want to die every day will be a pleasant surprise...? This might not be the best approach here.) Anyway, knowing my own mental health journey, I know that I need a program that takes resident wellness seriously. This isn't just knowing that a program has random yoga classes, but that the administration is committed to combating resident burnout and that there is mental health support available through the health insurance. I'm pleased to say that most programs I've seen do take this seriously, which is definitely a tick in the plus column.

Benefits 

This is pretty straight-forward. Salary and insurance are pretty standard, but things like daycare on campus, money for books and technology, a moving allowance, and free parking are highly variable between programs. For some of my programs, I like one just as much as another, so the little "creature comforts" like those can make a real difference.

Location

This is admittedly not very high on my priority list, which is kind of nice in a way because I'm not beholden to stay in one area or another. It's becoming increasingly evident that regardless of where I match, we're going to be moving to a place where Ken will need to find a new job. (There is one program that is local, but I am not in love with it thus far.) Even if I did match locally, we want to move houses, so we're going to be packing up and going somewhere. There's a part of me that wants to stay in NJ, even if that means moving to northern NJ, because it means Ken can stay in the state pension system. There's also part of me that wants to go somewhere new, though. I've lived in NJ for my entire life (except for a few months here and there in college and then in med school the first time), and I feel like my "new family" and I need a new start somewhere else. Maybe now is the time to do that? It's so hard to tell!

Intangibles

There's a culture and a feeling to every program, and there's no way to quantify it. At least for me, there's always been an initial vibe for each place and it begins when I get into the town or city where the program is located. From the minute you meet the residents, you can get a sense for how happy they are. Even if they're exhausted, you can tell whether they're run into the ground or just regular residency tired. There was one program where I interviewed where it was 100% obvious that the residents were beaten down and were barely keeping it together. That, among many other reasons, is why I'm choosing not to rank that particular program. There have definitely been programs where I've fit in with the residents a lot more easily than others, and that definitely matters. The programs where I felt like I had known the residents for awhile within the first few minutes of meeting them score higher on my list than those where that didn't happen.

At the end of the day, all of the ACGME accredited programs have to have certain things. The training will essentially be the same. What will vary is how diverse the patient population is, how much pathology you see and how varied that pathology is, and perhaps most importantly, the people. The best advice I've gotten so far is to think about who you want to be in the trenches with when everything goes sideways. That is definitely something I've been able to get a feel for, and it's the hardest attribute to try and explain to other people. 

So, that's just a few of the things in my head as I mentally make and re-make my rank list. It certainly isn't all of them, and in fact, I have a spreadsheet that details everything. Of course, every time I look at it, I get slightly nauseated and close the file, so I'm not sure how much the spreadsheet is actually helping. My AP English teacher used to joke that she would take our papers and throw them down the stairs, and the ones that went the farthest got the A's. I'm thinking of doing that with all of the folders full of information from all of my interviews.

There are 38 days until the rank list is due, and 61 days until Match Day, so I guess I'll be freaking out about this until then. At least after the rank list is due, there's nothing to do but wait 23 days for my fate to be handed to me.

Until then, I'll be here, clutching my spreadsheet and probably throwing folders down the stairs. You know, normal things.


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