Interview: University of Southern California

First Impressions: Even before coming to LA I had heard stories about USC, namely how the hospital was too large and cramped (5 patients per room!) and that residents were on q4 call for most of the year. 5-6 weeks before the interview, I got an email from USC saying that they recently moved all their patients and staff from the old hospital to a brand new hospital, and that we would be taking a tour of the new hospital since we'd be doing our training there.
Pre-Interview dinner: None, but I did drive around LA and met up with a friend in Burbank for cheap sushi ($3.95 for a six-piece spicy salmon roll!) and lots of anime-related fun.
Interview Day: I had to take a shuttle from the parking lot to the Outpatient building near the hospital, but instead I got off at the county hospital and asked where to go from there. I ended up having to walk up several flights of stairs across the campus and ended up asking a medicine resident I met in the courtyard where the department of medicine was. We had a big group of about 20-25 applicants, not unlike UIC. Looking among the applicants, I saw that we came from a wide range of places. There were three DO students, students from more prestigious programs like Stanford, Yale, and Cornell, and then everything else in-between. It really was a mix of students from all backgrounds. Most of the applicants, however, had strong ties to LA and or else wished to return to California after going to med school in a different state. I was probably the only person there with no ties to California.

The chief resident, Antonio, came to speak to us; he had a loud voice and an overly-enthusiastic personality to match. He told us why he loves USC and is staying to do his fellowship there before turning our attention to the program director. The PD welcomed us and spoke to us for about 30-40 minutes about the program before taking everyone on a tour around the brand new county hospital, which just opened six weeks ago. Indeed, the hospital looked very nice, with mostly private rooms and wide spaces, large windows with more natural light, and a great view of downtown LA that also includes the Hollywood sign from one angle. But it was clear that the hospital hasn't been "settled in" yet; the walls were too plain (no paintings or decorations), the halls seemed relatively quiet, and the call rooms had a bed, a table with a phone, and not much else. Eventually they'll put more computers in the call rooms and everywhere else, but right now they're still settling in. Throughout this tour, the PD walked extremely fast, often leaving us in the dust; one applicant commented that he walked faster than most surgeons he knew. Another thing no one appreciated: today was an unusually cold day in LA (about 40s-50s), and the PD made us stand outside shivering while he spoke to us about the transition from the old to new hospital. Couldn't he have done that indoors?

After the tour around the county hospital, Antonio met us in the courtyard and escorted us back to the conference room, where there were bagels and fruit waiting for us. Thank goodness, too; I hadn't had breakfast that morning and I was originally afraid that this would be a repeat of Sinai Hospital (no breakfast, starving until lunchtime). One by one, Antonio called us out of the conference room to escort us to our interviews while the others waited in the conference room and chatted with residents who came in to talk to us. My first interviewer was an internist who didn't shake my hand b/c she was recovering from a cold. She asked me some of the usual questions, like what brought me to LA, and I told her I was looking all over the place but liked USC b/c of the diverse pathology and learning opportunities. At any rate I don't know if I made a favorable impression on her or not; there were times, looking back, where I seemed a bit hesitant. My second interview was with one of the other chiefs, who was apparently chosen to speak to me because he was a DO. He was really nice and assured me the program was DO friendly, and said he didn't get his internship approved by the AOA b/c he didn't feel he needed it. I don't know how much weight my interview with him had, but he seemed confident that the match always favors the applicant so that I should just relax and ahve fun at my interviews. He specifically said that he chose USC because of the q4 overnight schedule b/c he learned best by following up with patients throughout the night, and that on a regular day, he could leave as soon as his work was done, sometimes as early as 2:00 pm, so he got plenty of time off. "Night float doesn't mean you work less hours," he said. It gave me a lot to think about.

With both interviews done, I was free to sit among other interviewees and chat with the residents. They had good things to say about the program, of course, and about LA in general. LA really is a charming city, despite its horrendous traffic, especially today with its sunnier skies and the palm trees lining the streets. After lunch, the chairman spoke a few words and then we were unofficially dismissed for the day. Several people left to catch flights out of LA, and Antonio took the rest of us on a tour to "Mother County," the old county hospital which, until six weeks ago, had housed all the patients that were now in the brand new hospital.

I'd heard stories about how ghetto the old hospital looked, but I had no idea how ghetto until I walked through the doors. It was really like something out of a history book. The halls were dark, there was writing on the walls that clearly dated back to the 1930s or 40s, and lots of old pictures dating from the early 1900s or late 1800s. We walked into one of the patient rooms which had one tiny window, one closet-sized bathroom, and five beds separated from each other by curtains. "These curtains are going up for auction next week!" said Antonio. "Anyone watch Fear Factor? Would you be willing to lick one of these curtains for $30,000?" All of us were amazed that as little as two months ago, there were actual patients in this poorly-lit museum of a hospital room, and I could see now why some people got scared away from USC because of "Mother County." The old hospital is a historic landmark and can't be torn down, but plans are in the making to consolidate all business in the hospital to the first 4 floors (it's a 19-story building). Thank goodness they're in a newer hospital now.

Overall Impression:
Pros: LA, lots of diverse pathology, good training for either primary care or fellowship, brand new hospital with great view, allowed to leave hospital whenever you're finished. Plan to rank high.
Cons: Large program (54 categoricals per year), q4 overnight for 7-8 months

My Own Personal Star Encounter

I wasn't planning to write about this because it sounds very unbelievable, even to me, but it really happened.

Everyone knows I'm crazy about anime; it's something I've never tried to hide. Last October, after my psych rotation ended, I drove to Houston to attend my first anime convention, and it was there that I met and befriended Kyle, a voice actor famous for his roles in popular anime such as Naruto, Dragonball Z, Bleach, and Gurren Lagann. He's one of the few voice actors I've heard of who really invites anime fans to become his friend (others just sign autographs and end it right there), and we found common ground in both being from the DFW area. We occasionally chat on AIM and I ran into him again at two more conventions (anime cons are like a drug; once you attend one, it's hard to stop). When I told him I was coming to LA for an interview, he suggested meeting up for lunch at Burbank, then said if I wanted to, I could go to work with him and sit in on an anime recording session. No way was I going to turn that down.

Once I got to LA, I briefly visited Hollywood and then drove on to Burbank to meet Kyle for sushi. Then at 2:00 pm we went to the recording studio where Kyle showed me around the soundproof recording booth (it was small!) and let me see what a typical script looked like. The director and sound engineer welcomed me to the studio and let me have a seat where I could see all the action. Clips of the anime (whose name I won't reveal) were played in their original Japanese, and then Kyle would record his own lines in English. Precision was everything; he had to match the mouth flaps of the animated character, and if his emotion was not what it should be, the director would tell him how to improve and then have him redub his lines again. This was the first time I got to see dubbing in action and I was totally engrossed with what was happening. It's not every day a normal person can set foot in an anime dubbing studio.

After one hour and 22 lines later, it was time for a break, so I met Kyle in the hallway and he asked me what I thought about dubbing so far. Just as we were chatting, someone else walked into the hall and greeted Kyle by name. "Hey Johnny, how's it going?" said Kyle. When I saw who it was, I think I froze. OMG. No way. This man was at the top of the list of voice actors I've always wanted to meet, not only because of the voices he provided in Bleach and Code Geass (which I watch faithfully), but because I'm a huge fan of his music. Johnny is the lead singer of his own band, Eyeshine, and I've listened to both of his CDs so many times that I can sing along to most of the songs by heart, with "Waterfall" being my favorite. More people know him for being a former Power Ranger, but I liked him more for his anime work and music. And there he was, just a few feet away chatting with Kyle.

Johnny had a recording session at 3:00 pm, apparently, so while he went to another soundproof room to get ready, Kyle gave me a knowing look as though asking if I knew who that was. I nodded my head, but had no idea what to do. What do I say to the man who has one of the most famous voices of the anime world? And even if I had it in me, I refused be one of those crazy fangirls I'd seen at conventions who scream and swoon at the sight of a VA. That only freaks VAs out, and that was the last thing I wanted to do. Finally Kyle said, "Have you met Johnny yet?" and I said, "No." So as Johnny came out of the room, Kyle said, "Johnny, this is my friend [crescendo]."

"Hi, nice to meet you," I said, and we shook hands as Johnny said hi as well. "I have both your CDs, actually," I said. "Really?" he asked, interested, and I added that I was a regular at the Eyeshine forum, particularly the Bleach section, and he said, "Awesome. We're working on our 3rd CD, actually." I asked when he thought it would be released (because I plan to buy it for sure). "We're hoping to have the final version by the end of the month, but it probably won't be available on the website until late January," he said. "We're still working on the melody of one of the songs, it's not quite right yet." At that point the secretary came in and told Johnny that the president of the company wanted to see him, and as he left Kyle joked that Johnny was about to get a yellow slip (meaning he's getting fired). "They can't fire him, his voice is too valuable," I said, and Kyle agreed.

The break ended, and Kyle finished the rest of his lines in about 30 minutes. I didn't see Johnny again before we left, but afterwards as Kyle was giving me a ride back to my car, I said, "I didn't come off in a bad way, did I?" Kyle said, "No, you did good. He really seemed interested when you said he liked his music." I hope so. Voice actors hear all the time that fans love their voice, but voice acting is just a small part of what Johnny does. Not many anime fans know that he has a band, or that he wrote the lyrics to most of his songs, and I think that by listening to his songs, fans get a real appreciation for what kind of man he is. One of my favorite songs, "Not Really Good," was described by him as a "cry for help through struggles of being a believer." Not many people can put such personal struggles down in words, much less a song, and that impressed me. There was so much I would have liked to tell Johnny about how much I loved his music and voice over work, but sadly there wasn't enough time.

Even as I write, I still can't believe all of this happened. I have no proof that I even set foot in a dubbing studio, just a few snapshots of TV studios around Burbank as Kyle drove me around to see the sights. But I have my memories and a warm fuzzy feeling that hopefully won't fade anytime soon. Especially if Eyeshine comes to a convention in Texas before I graduate; then I can finally get my CDs autographed =)

The Test for Perfect Pitch

This afternoon I watched an anime movie titled Full Score of Fear, in which the main character investigates the murders of students at a music academy (anyone catch the musical term in the title?) Interestingly enough, the culprit also planted a bomb inside a pipe organ, and the main character was able to find the bomb only because he noticed that one of the notes played by the organ was consistently "flat," or slightly off-pitch. He was able to do this because he had absolute pitch, aka "perfect pitch," the ability to identify or recreate a musical note without an external reference (i.e. a piano). Most of the viewers probably thought, "Huh? That note was flat?" because the alteration in pitch was very slight, but fortunately, I was able to pick it up.

I don't know when I realized that I had perfect pitch, but I think it was sometime in high school. I could always tell when someone was playing out of tune, and what I lacked in dynamics, I made up for with near-flawless intonation. I can identify single notes pretty well, but chords are more of a problem b/c I haven't had the proper training for it (1-2 years of piano). Even still, I had to wonder just how "perfect" my sense of pitch was. So when I surfed the web and found an auditory test to determine whether or not I had perfect pitch, I knew I had to take it.

After filling out a brief questionaire, the computer began producing different tunes in succession. I had 3 seconds to identify each note after I heard it and click the appropriate "key" on the virtual keyboard. There were 80 tunes altogether, 40 piano tones and 40 "pure" tones, and sometimes the notes were so high or so low on the spectrum that I honestly couldn't tell what they were, or else I ran out of time before I could identify a note. When my scores came out, however, I scored a 30.25/40 on pure tones and 31/40 on piano tones. That's well above the Absolute Pitch cutoff point at 24.5, confirming what I already know regarding my sense of pitch.

Now whenever interviewers ask me to tell them something interesting about myself, I can with all honesty say that I have perfect pitch, and with the data to prove it =)

Interview: Exempla St. Joseph's Hospital

First Impressions: I had driven by St. Joe's (as the hospital is known) back in August when I visited my sister, so I knew it was a fairly good size (550 beds), and I'd also heard good things about the program from one of my ICU residents, who'd gone to med school at CU. My sister lived about 30-40 minutes from the hospital but I was fine with commuting. Had to wake up before 6:00 a.m. to make a 7:00 a.m. interview but it was fine.
Pre-Interview dinner: A meet-and-greet was held downtown at a bar called Lodo's, former Mattie's House of Mirrors back in the day when the 2nd floor was a brothel), and I was among the first to arrive. Imagine my surprise when I saw a familiar face: Jeremy! He'd interviewed at St. Joe's earlier that day and would be interviewing at CU the same day I had my St. Joe's interview. He seemed really enthusiastic about the program and said that Denver was the farthest east he's applying (geographically). Our only regret was that we couldn't attend Kasha's memorial service. A lot of residents attended the social, and all of them were nice and helpful. Jeremy and another applicant kept talking about how great morning report was, so I knew I'd have to see it for myself.
Interview Day: This was the smallest interview group I'd ever been in; there were only six of us altogether. The reason for this was that the PD interviews with every applicant, but it turned out to be a good thing b/c we all got to know each other sort of well. We first had breakfast with one of the interns, Carolyn, and she let us to the cafeteria and told us to get whatever we wanted. We had to write down the amount we spent at the cashier table. Fortunately my food did not cost the most. We chatted for a while with Carolyn about the program before the PD, Dr. Gibbons, came in to speak to us. He went into more detail about what the program had to offer and then turned us loose for interviews. My first interview was with him. He was very nice and didn't ask any hard questions, just what drew me to "St. Joe's" and other common questions. He did read aloud some comments from my Dean's letter and my rec letters, and like an idiot I said, "Wow" when I heard some of the things Dr. RR wrote about me. Even still, Dr. G assured me that based on my application I am definitely competitive for a spot at St. Joseph's, and that was good. In between interviews, my fellow applicants and I sat together and chatted about random things. Then I went to my next interview, which was low-stress as well. My interviewer asked how I heard of St. Joe's and seemed pleased when I told him that an ICU resident I worked with (Tony G) had graduated from CU and had many positive things to say about the hospital. "It's nice that people have heard of us outside of Colorado," he said.

After all interviews, we went to attend morning report, which was unlike any other morning report I'd ever been to. One resident, Travis, immediately said that he had an "awesome" case to present despite good-natured teasing from his peers, and the case was interesting (skin lesions secondary to drug toxicity). This was followed by two other interns reporting on interesting patients they had seen recently, and each time, someone was asked to interpret the patient's EKG and CXR, or whatever tests are necessary. One case showed a brain contusion that looked like an epidural hematoma (except you can see brain tissue), along with a skull fracture and contrecoup lesion secondary to trauma. Yikes. But through it all, the residents were laughing and joking amongst each other and with the attendings when appropriate, and this, to me, was what "camaraderie" was. One of the guys even compared it to "being in college again." Someone once said that the residents at St Joseph's are among the happiest in the area, and I was seeing that now with my own eyes that it was no exaggeration. Also during morning report, specialists will come in when needed to do some teaching, which I thought was cool. Usually only general medicine internists attend morning report.

After morning report the three prelim applicants went with a prelim intern on a tour while the categoricals followed Matt, the chief resident whom I met last night. He showed us the call rooms (nice view), the clinic, the ER, the ICU, and even the work-out room (which he said was lousy but I thought it was much better than the one at my school so no complains from me). Lunch was, once again, at the cafeteria where we got anything we wanted, and Matt introduced us to a 3rd year (he called it "turd year") who's actually found a job at AMH effective next fall. He went to UTA for undergrad so he was familiar with Arlington. Noon conference featured a lecture on "altered mental status" which I thought was useful. The lesson of the day: know how to recognize locked-in syndrome.
Overall Impression:
Pros: Denver, good training for either primary care or fellowship, genuine camaraderie, nice call rooms, closely affiliated with University of Colorado
Cons: Small program (9 categoricals per year), not university-based

Loss of a Classmate

Last night while surfing around on Facebook, I got a PM from Ilona asking if I'd gotten an email about Kasha and if she had really died. Me: WHAAAAAAAAT?! I had not gotten any emails about anyone dying (apparently Eryn only sent emails to a select few), and I did some sleuthing of my own and read the latest Facebook statuses to see who else might know something about this. Seeing Amber R online, I asked her what happened, and she sent me a link to an online article. It said that Kasha and her husband were both dead, victims of an apparent murder-suicide, and that Kasha had been shot multiple times.

I couldn't believe it. This was too surreal. Last January during my surgery rotation, a woman was brought to the JPS ER with GSW to the eye after her husband shot her before turning the gun on himself. She didn't survive, and I later read online that she and her husband left behind a 4-year-old daughter. Even back then, I wondered how men like that could be so selfish and cruel. And now, especially after visiting the Holocaust museum which vividly detailed the many crimes men commited against other men, I find myself wondering why this happened, and to Kasha, of all people, who had so much going for her. Ranked high in our class, applying for a dermatology residency, mother to 8-year-old twins...it really is such a waste.

Dr. Moorman held a meeting at Luibel at 4 pm today so that we could discuss what had happened to Kasha, so I went and found many familiar faces there: Jenny, Mike W, Jeff, Hunaid, Lauren, Kim, Carisa, Asuka, both Ambers, and Rick, to name just a few. I could see Rachel, Blakely, and Lori being interviewed by CBS in the atrium, so I stayed away from there. Amber L, Molly, and Venessa were crying hard. Desiree and Kate, Kasha's closest friends, were nowhere to be found. At times I felt like I shouldn't even be there because Kasha and I were mere acquaintances at best. But then I remembered Kasha introducing herself to me on the first day of orientation, volunteering with her at the Juvenile Diabetes walk and seeing her take balloons home for her twins, saying hello to her in the halls, and decided that I had to stay. Even though I didn't know her as well as others did, the fact remained that I knew her, and that was enough.

Dr. Moorman thanked us for coming and offered us a chance to ask any questions or just share memories of Kasha. There was awkward silence for what seemed like a long time, and then Amber said there were many unanswered questions at the moment. Rick took the microphone and told of how he ran into Kasha five weeks ago and how despite her high GPA and research experience, she was still worried that she wouldn't match into derm, and he'd assured her that she would. He said that when he thought of how Kasha's kids were now orphans, it made him angry because they would have to live with the knowledge of how their parents died, and that the direction their lives will take now is not what Kasha envisioned for them. Molly then said that she thought it was unfair for this to happen to Kasha (something we all agree with) and that Kasha deserved her DO degree posthumously because she earned it. Blakely told of how she ran into Kasha on the interview trail and how they'd spent time chatting about why they wanted to do derm, and in Kasha's case it was so that she could have time to spend with her family. There's to be a candlelight vigil held at the Atrium this Thursday, but I'll be in Denver at the time so I won't be able to make it. In the meantime, there's going to be a toy drive for Kasha's two kids, and the family will let us know if there'll be a memorial service in Texas (according to Molly, Kasha is going to be buried in Louisiana) And of course, our yearbook will be dedicated to Kasha, and the class officers will find a way to honor her at graduation.

Dr. M was there, as well as the EAP counselors, and he said that grieving is a part of healing. One of the EAP psychologists said that it's not important that we get over Kasha's death, which we never will, but that we get past it. Easier said than done, when I could hear people sniffling and blowing into tissues behind me. No one will be getting past this anytime soon.

*sigh* Why did this have to happen?

Interview: University of Illinois at Chicago

First Impressions: This was not my first time to Chicago, and since I had more time to explore, I browsed through Chinatown, went to the top of the Sears tower and walked along Michigan Avenue.
Pre-Interview dinner: This was more of a Happy Hour Q&A at the Illinois Bar and Grill located near the underground campus of UIC. Since I forgot the map and only knew vaguely where it was, I took the shuttle to what I thought would be the closest stop to the bar and started walking. Imagine my dismay when I realized that it was at least a mile's walk from the station, and I was practically an icicle by the time I arrived at the bar (temps were in the low 20s). There were a lot of people in there already, and someone offered me a beer, which I took. It only took a few sips to warm me up. =P

This was definitely the worst pre-interview event I'd ever been to b/c all they offered for food was beer, sodas, onion rings, okra, and chicken strips. I did get to meet a lot of nice people, and we got to chat with one of the chief residents and future chiefs about what UIC was like. It was hard to tell who was an applicant and who was a resident until one girl pointed out that the residents were wearing pagers. After the crowd thinned out, another applicant was kind enough to drop me off at my hotel (he knew that I'd walked from the train station)
Interview Day: This morning I took a cab to the UIC Medical Center, and there I found myself among about 30 other applicants in the same room. This was the largest group of applicants I had ever been with at one time, but it turns out there were a lot of people interviewing that day. Not just categoricals, but also prelims and IM/EM applicants. Of these applicants, there were nine of us from Texas (but I only knew of 2) Morning report covered a patient with what appeared to be a cold but turned out to be something more serious. The PD talked about the program and then the categoricals and prelims were split into groups of two to be taken to interviews and tours, respectively. "Bring your coats," said the chief resident leading the tour, because we were expected to walk outside at some point. The hospital itself was pretty old (it opened in the 1970s) but was very brightly lit, though we didn't get to see the call rooms or cafeteria (at least, not that I remember). We then had to walk outside to the brand new VA hospital (nicknamed the "Taj Mahal"), and the wind was so cold I asked some Chicago natives if that was normal. "Not for December," said one woman from Rush University. "It's usually not this cold until January." At least I was wearing pants; some girls were wearing skirts with only hose to protect their legs from the cold. The VA was beautiful. It was not like any other VA I'd ever seen, and one applicant commented that it didn't even smell like a VA. It looked like a normal hospital, with all rooms private (like the new JPS building). Definitely a selling point for the program.

My two interviews came after the tours. From the start, the program coordinators told us that we were paired with interviewers with whom we'd have something in common. My first interviewer was a pulmonologist/critical care attending whose son is a student at LECOM; he asked me to explain osteopathic medicine to him and when I answered the best I could, he nodded his head as though he's heard the same explanation from his son (I hope that's a good thing). He did say that OMT has its benefits, pointing to his neck as he said so; I imagine he'd been on the receiving end of some HVLA, hehe. He did say that the PD likes to add some variety (i.e. DOs) to the class, so I'm going to take that as a good sign. My second interview was a DO, and he'd been to Texas some months before to interview at our school for a position of some sorts. He asked some application-specific questions and seemed interested when I told him of my background in music. I've found that it's been really useful to bring up my experiences as a violinist; it makes for some good conversation. He ended the interview with, "Do you have any questions for me?" and even though I wanted to ask him my usual questions, I didn't because we were running out of time (I was the last applicant to come out) Hopefully he won't think badly of me for it.

Lunch was delicious, and afterwards we were free to go. I had plenty of time to fetch my luggage and get to the airport, only to find that my flight got delayed by 45 minutes. =(
Overall Impression:
Pros: University, fewer months in general wards, emphasis on specialty medicine, teaching month as a PGY3, sim labs, option of getting an MPH for free, living in Chicago
Cons: None that I can think of at the moment =)

Interview: Case Western MetroHealth Medical Center

First Impressions: MetroHealth provided a five-page list of hotels with discounted prices, and I ended up choosing a hotel in downtown Cleveland that provided shuttle service to the hospital and cost only $80 per night, which allowed me to spend two nights there since I planned to fly to Chicago the morning after my interview. It only cost $2 to ride from the airport to Tower City (a downtown shopping center), where I then rode a free trolley to the hotel.
Pre-Interview dinner: Dinner was held at the Metropolitan Cafe downtown, which was easily accessible by taxi. There were four residents and about 5-6 applicants there. We were given a menu from which we could choose one of about 5-6 entrees, and I chose the highly recommended Atlantic salmon. The residents were very nice and had great things to say about MetroHealth, and one of the 2nd years gave me and another resident a ride to the hotel afterwards.
Interview Day: Since I was staying an extra night in Cleveland, I didn't have to wake up earlier than usual to pack and went downstairs to take a shuttle to MetroHealth. There were about 10 of us total, and the PD came and talked to us about the program and what it has to offer. "I could spend the entire morning telling you stories of patients I've seen here," he said, and I found he was very friendly in that respect (which was good, since my first interview was with him). Overall I think my interview with him went very well. He gave me time to ask him questions before he asked me anything, and the questions he asked were pretty specific to my application. He asked me if I'd met the PD at UTMB-Austin, whom he's met on several occasions, and he asked me what novels I've read. I told him I liked mysteries but admitted to never reading any Sherlock Holmes novels, so he recommended them and said that Sir Arthur Conan Doyle (the author) was a physician as well. Interestingly enough, I remembered from one of my favorite manga/anime series that Sherlock Holmes could tell a patient's profession just from looking at his hands, so we talked about that. The PD said that he has looked at patients' hands to see where calluses are to tell their profession, and I commented that years ago, my hands could have revealed that I was a violinist (fingers slightly longer and thinner on the left hand, calluses at the tips). At any rate it was a great interview.

My second interview was with one of the chief residents, who had gone to med school at OUCOM. Since she was a DO, I asked her some DO-specific questions like whether or not I should get my osteopathic internship approved. She was very nice and seemed very interested in hearing about my Borders without Boundaries trip when I told her that some towns have no doctors and had to rely on a helicopter 90 miles away to transport them to the nearest hospital should a situation arise. We had a tour of the general hospital area with some residents and then ate lunch before the chiefs took us on a tour to the medicine floors. The medicine floors are located in totally circular buildings (seen above) which provided an interesting layout of the rooms, but it was a nice touch. Overall I had a very favorable impression of MetroHealth.
Overall Impression:
Pros: University program that's mostly resident-run (PGY3s make all the decisions and have 1-1 time with the attending), similar to county hospital, "supervised autonomy," night float, faculty mentors assigned to each resident, good fellowship placement.
Cons: Not sure yet if I want to live in Cleveland.

Interview: Johns Hopkins University/Sinai Hospital

First Impressions: I arrived in Baltimore from DC via the commuter train MARC, but since it was dark by the time I arrived I just took a taxi to the hotel. I was also in a crappy mood b/c I'd realized early on that I'd accidentally lost my purse and cell phone (but thankfully not my wallet) at Union Station in DC; I even knew exactly where I lost it, at a newsstand where I bought a few things. Only later would my sister call the newsstand and learn that they'd found my purse, and after getting my address they mailed it to my house via overnight FedEx. Thank goodness.
Pre-Interview dinner: None. The hotel I stayed at was in a tiny shopping center called Cross Keys that was nowhere near any tourist attractions. I was sad about not getting to see the Inner Harbor and other landmarks of Baltimore, but I did have some crabcake at the airport afterwards.
Interview Day: This morning I joined 2 other applicants in the hotel lobby for the hotel shuttle to take us to Sinai Hospital. This was a 500 bed hospital recognized for its work in endocrinology, cardiology, and neurology, among other things. There were 15 of us in all, of which half were IMGs. To my dismay, there was no breakfast offered, only water and sodas, and since I only had a small salad for dinner last night, I was hungry for most of the morning. Not cool. Every other program I've been to provided a continental breakfast.

Aside from the usual forms, we were given a questionaire asking why we applied to Sinai and what we were looking for in a residency program. The morning began with a powerpoint presentation given by one of the chief residents. ICU is q3 overnight while CCU is split into 12-hour shifts (day and night). They have two main teams on wards, a private team and a general teaching team, and call is q4. Afterwards we each got one interview apiece. My interviewer was nice, but she also asked a few tough questions that caught me off guard.

--What is the biggest change you anticipate when transitioning from med student to intern?
--If the attending caught a mistake you made on the wards and called you on it, what would you do right then, and how would you deal with it after you go home for the day?

I don't know what type of response she was looking for, but I said that if I did make a mistake on the wards, I'd do what I could to correct it, and when I go home, I'd relieve stress by writing in my journal. Needless to say I don't think the interview went well at ALL.

After the interviews, we went to "morning report" at about 10:30 a.m. (latest morning report I've ever been to), where we got to see the residents play "Medical Jeopardy." The applicants didn't get to play, but we made guesses and discussed answers amongst ourselves. Some of the questions were in "Name that structure" format, so when a cell with an Auer rod appeared onscreen we all knew what the diagnosis was. Other questions were much harder, i.e. "Name at least 4 characteristics of metabolic syndrome," but it was a lot of fun. When Jeopardy ended, we were split into groups of two for tours. Six of us followed Helen, an intern who was very nice and had many postive things to say about Sinai, but the tour was not well organized at all. From what I saw, however, Sinai really is a beautiful hospital. It was originally a Jewish hospital so a great percentage of the patients are Jewish; before residency a rabbi comes to educate the residents on the Jewish faith and how to respect their beliefs in medicine (i.e. Jews don't believe a person is dead until the heart stops being, even if they're brain dead). We also saw a little pharmacy cart rolling down the halls with no one pushing it, and Helen said those were actually robots that carry medications from the pharmacy to the nurses' stations. The robots each have a camera that allows them to see what's ahead of them and stop if anyone is in their way, and somehow they are able to navigate through closed doors and elevators as well. The downside: the robots are slow and sometimes it may take 3-4 hours to get medicine, definitely not good if the patient has thrown a clot or is having a hypertensive emergency. Helen told of how she once waited 5 hrs for coumadin for a patient with a PE, and by the time she finally convinced the pharmacy to send some coumadin up in person, the robot had arrived.
Noon and beyond: Our tour was supposed to end at 12:30 but we walked around until 12:40 (Helen kept showing us places like the radiology department that we had no interest in seeing) and probably would have gone longer if one of the applicants hadn't reminded her that we were supposed to be at lunch at 12:30. Thank goodness, too; aside from water I'd been NPO for over 12 hours and I was really hungry. By the time we returned to the conference room, the other group had already finished their lunch. During lunch I chatted mostly with a guy from China whose first choice is Sinai b/c he already does consulting work in this area. He said that as an IMG, he knew that his chances of getting accepted were much lower than that of an American grad. "I give 100% at every interview," he said. "I call the program coordinators before the interview and ask who I'll be interviewing with, and then I read their profiles so that I know everything about them, as well as the program, when I go for my interview." Wow...that's perseverance. Later on this same guy shared a taxi with me to Penn Station en route to the airport, and after we dropped him off the driver told me that the guy had tried to steal the taxi for himself while I was changing in the bathroom. "I think he just wanted a free ride," said the driver. Talk about being selfish! I was the one who had ordered the taxi to begin with, and I extremely grateful that the cab driver and the Radisson clerks had put that guy in his place; looks like he was an opportunist as well as a brownnoser. I hope he does get into Sinai.
Overall Impression:
Pros: Nice hospital, decent fellowship placement, free parking and board review, Baltimore has relatively cheap cost of living
Cons: >50% IMGs, the medicine robot (I don't want my patients' lives to depend on a robot), unfamiliarity with the Baltimore area (since I didn't get a chance to look around), negative impression of interview.

Interview: Washington Hospital Center

First Impressions: No housing provided, so I booked a room at a Red Roof Inn near Chinatown. When I arrived, the desk people found no trace of my reservation, but still gave me a room at a discounted price. After lunch in Chinatown I visited the Holocaust Museum (which was really good) and walked toward the Capitol before turning around and trying to find the White House. It was cold and drizzly, and my feet got tired so I gave up at 1400 Pennsylvania Avenue (2 blocks away) and just went back to the hotel to rest. Still, from what I saw DC is a beautiful city downtown, and there's lots of museums to visit for free.
Pre-Interview dinner: None, so I went to a sushi restaurant across the street from the hotel.
Interview Day: I had to wake up at 5:45 a.m. (4:45 a.m. in Texas, ugh) to get ready, check out, and arrive at the Metro station by 6:30 to take the train to the station closest to Washington Hospital Center. There I joined others in boarding a shuttle bus to WHC. The hospital itself is HUGE (800+ beds if I remember correctly), the largest in the DC area and has the 13th highest patient volume in the US. There were about 18 of us total, prelims and categoricals combined, and I noticed that most of the categorical applicants were IMGs while the prelims were all US grads. Morning report was done on a tablet laptop that was then projected onto the screen, so we got to watch the chief resident go through the differentials with us. They also ranked differentials in terms of greatest likelihood, which I thought was interesting. Afterwards we were split in groups of three to follow the teams on attending rounds. My assigned "attending" was also the chief resident who gave morning report. We only saw about two patients with him before he left, and when I asked why, the residents said that the attendings round on the patients admitted to the teaching service, but the residents are on their own when taking care of the private patients. And there's no pre-rounding, which sounded a bit odd to me.

The PD then gave us a 1-hour long presentation about WHC and highlighted all its positive traits before interviews began. I was the first person to get interviewed by the PD, and we had a nice chat about what I'm looking for in a program and my past orchestra experiences (she'd overheard me and another applicant talking about being violinists when she came to get me). She said she'd always wondered what a conductor's gestures meant, and since I took a conducting class before I gave some examples of what a conductor does and how essential he is to the success of a performance. She thought that was interesting. My second interview was with a cardiologist who focuses on cardiac MRI. His first question was, "What can I tell you about the program?" but he really didn't have any questions for me. He did say that he liked my personal statement, so I tried to play up on that and told him about my hobbies including having perfect pitch, which has helped me in hearing heart sounds and murmurs (again, playing up to his cardiology background). He plays guitar so he seemed genuinely interested in that and said that if I ever come back to WHC, I should play for him. Unfortunately this breakthrough took place in the last 10 minutes of the interview, and if we're judged by the first 5 minutes of the interview, then it was too little too late.
Noon and beyond: We had lunch with the residents, all of whom seemed very friendly and genuinely liked being at WHC, before going on a tour around the hospital. The cafeteria was nice, and they had a Sim Lab (which I feel is a plus in most programs) and private call rooms, plus an on-site gym. There was also a portion of the hospital that looked like a 5-star hotel (for the patients willing to pay for it) but we couldn't see it b/c it was closed. There were also lots of cath labs; cardio seems to be big at this hospital. Afterwards, at the closing, we were asked to go around the room and each name something we learned about WHC and whether or not we had any concerns about the program. Since I was one of the last people to give my thoughts, it was a bit awkward to come up with something no one else had already said. A lot of the IMGs from India were concerned about whether or not they could take the 4 weeks of vacation all at once b/c if they're going to travel to India, they want to be there for a good amount of time.
Overall Impression:
Pros: Highly ranked hospital, large patient volume, decent program size (about 24 residents per class), good fellowship placement and research opportunities on site, q9 call on wards, 1 month elective in PGY-3 devoted to teaching (which I think I might be interested in), sim lab, faculty mentors (I think), Washington DC.
Cons: Not a university program, has non-teaching services with private attendings (which may or may not be a problem since private attendings usually tell residents what to do), >50% IMGs

Interview: Northshore University Health Systems

First impressions: When I first got an invite from "Northshore University Health Systems" I had no idea what program it was until I learned that it used to be called the Northwestern McGaw program (which is what it still says on ERAS). This year they changed sponsors from Northwestern University to the University of Chicago, and so they dropped the Northwestern name and became "Northshore." Yesterday I flew to Chicago and then rode the CTA (aka the "El") to Evanston, where the main teaching hospital is located. Evanston Hospital was only 3-4 stops away (via the Purple Line of the CTA) from my hotel, so the day before my interview, I went there to see what it was like and found this:


Pretty nice, right? I like all the greenery around the hospital.
Pre-Interview Dinner: None, so I took the train to Chinatown for some cheap beef noodle soup and spent about 15 minutes at an anime gift shop ogling at plushies and action figures before deciding to buy a poster for a fellow Bleach friend and fan.
Interview Day: There was some snowfall this morning which put me in a happy mood (this is fine powdery snow, not sleet like we have at home). At the hospital, there were 10 of us total, of which I was the only one from the "South" (everyone else was from Illinois, Nebraska, North Dakota, New York, to name a few). There was one girl from UNE-COM so we chatted a bit. We met the chairman and the program directors who were all extremely friendly and welcoming, and everyone asked me how I liked the weather here. There were four program directors and three interviewing faculty so they took turns calling us to their offices for interviews. My first interview was with an ER attending (don't know why they asked him to do IM interviews), and one of the questions he asked me was where I saw myself in 10 years. Sadly I wasn't able to give a clear response b/c right now I like all aspects of IM (general practice, hospitalist, possibly subspecialty), and I think I need to work on that answer. No one really knows whether the PDs prefer to hear that we want to specialize or go into primary care. The second interview was with the chairman, who immediately asked me if I had any questions for him. I asked him what he liked the most about the program, and somehow I got prompted into telling him how being a violinist set standards that have helped me succeed in medical school (i.e. working together as a team, practice makes perfect, etc.) which must have sounded totally cheesy. Still, I think I clicked better with the chairman than the ER doc; who knows how they'll rank me.

Whenever we weren't in interviews, we chatted with one of the chief residents as well as a future chief. I asked about cost of living and they said the salary might not let you buy a house, but you can rent a decent sized apartment for sure. "Of course, living in Texas is cheap," said the future chief. *sigh* Don't I know it. When most of us had finished our interviews we went to an intern conference in which an endocrinologist grilled the interns on diabetes drugs and their effects on the body. She made an interesting point that patients on metformin should take calcium supplements or else they'll end up with VitB12 deficiency; that's something I've never heard of before.
Noon and Beyond: Afterwards we had lunch with several residents before going on a tour around the hospital. Let me just say, the hospital is nice. There are concierge services and everything is computerized; the nurses' stations are large just because there aren't any paper charts cluttering the desks. And there are computers everywhere; Evanston Hospital has been paperless since 2003 because they have an EMR that works. More importantly, all the residents I spoke to are genuinely happy at the program, with my tour guide (a CCOM grad) saying it was probably the best in the area. The tour finished at 1:30 pm, and I managed to catch the next train back to the hotel and pick up my luggage. Sadly the next southbound train left just as I was hurrying toward the station, so I had to wait for the next one. I left at 2:15 and didn't get to the airport until 3:45 (the train made a lot of stops along the way), and my flight was at 4:15 so I was running through the airport like a madwoman just to make it on time. *sigh*
Overall Impression:
Pros: Top teaching hospital, very DO friendly (at least 5-6 residents each year come from CCOM), good location (just north of Chicago, near Northwestern University), friendly faculty, decent fellowship placement, opportunities to rotate at University of Chicago, 100% EMR
Cons: 50% private attendings (which may or may not cause disagreements with patient care), possibly long commutes to 2nd teaching hospital 30 minutes north of Evanston, not sure if I want to live in Chicago (can't decide based on a one-day visit)

Interview: UTMB-Austin

First Impressions: No housing provided, but they did sent out a list with hotels with discounted prices. Dina had an interview the same day as me so we shared a hotel room at the Ramada Inn near Highland Mall.
Pre-Interview dinner: None, so I went to Mimi's Cafe with friends from undergrad. Dina didn't arrive until after 9 pm because ob-gyn had a dinner.
Interview Day: The morning started off with the PD telling us about the latest changes with the hospital, namely the negotiations between Seton, UTMB, and UTSouthwestern for UTSW to take over sponsorship of the hospital b/c UTMB is currently having a financial crisis with the hurricane and all. But even without the hurricane there were already plans for UTSW to assume control; I knew of this way back in August. The PD seemed confident that the residency itself shouldn't be affected, only the name.

I interviewed with the PD and another hospitalist, and I don't know if I was able to impress the PD or not. I asked several questions about fellowships and UTMB-Austin's attempts to get them started at the hospital, as well as the impact UTSW would have once it takes over, but not much more. I did get a few questions about my time here (the PD said she was sorry she didn't get a chance to meet me in August, as she was on vacation part of the time), and I told both of them about a case of disseminated gonorrhea I saw at Brackenridge. My 2nd interviewer asked me about research from undergrad, and I stupidly said I didn't remember much about the project. Afterwards, we went to morning report and then snagged a team to go on rounds with. Another applicant, Yessica, and I ended up joining the post-call Red team; one of the interns, Joe, was someone I'd worked with on my very last day of my AI, and he sort of remembered me. The attending was Dr. D, the ID doc who always dressed casually; today was no exception since she had on boots and a denim skirt. I did see Dr. C during morning report and was surprised to see him in a suit. My whole 3 weeks with him, he always wore slacks and a polo shirt, never a suit. I wondered what the occasion was.

I never saw Greg or Zach (probably a good thing in the case of Greg), but I spotted Yan in the elevator and we exchanged cheerful hellos. "You're back!" she said. "For interviews?" Yup. After she left the elevator I explained that I'd done my AI here, and Dr. D said, "No wonder you look a bit familiar." During rounds we saw a group of people in white coats with SETON on the pocket walking around, and we wondered if they were board members inspecting the hospital. "No wonder Dr. C's wearing a white coat," said one of the interns (yup, he changed his suit for a white coat by the times rounds started), and Dr. D grumbled why no one warned her, as she was dressed way too casually. I called Dr. C's name as he passed by (our teams were going in separate directions) and he waved back, calling out, "Good to see you!" We finished rounding early so Yessica and I went to the 4th floor workroom and chatted with Ulka, the resident, about the program. Then one of the future chiefs, Manpreet, took us back to the IM offices to wait for Jeff (one of the chiefs) to take us on a tour. Knowing that we'd rounded with the teams, he showed us the ER, the library, the dining room (with Odwallas) and the clinics (which look VERY nice) before turning us over to two residents to take us out for lunch.
Noon Conference and beyond: Two residents, a third year named Rachel and a prelim intern named Justin, took us to the Brick Oven for lunch. I ended up sitting closer to Justin than Rachel, so I heard more about him telling the other two prelim applicants about what prelim year is like rather than Rachel telling the others about what categorical IM is like. Food was definitely good though; too bad I didn't know about Brick Oven in undergrad.
Overall Impression:
Pros: Austin, laid-back atmosphere, free breakfasts and lunches (Odwalla fridge, hehe), friendly people, "easier" program due to a cap of 18-19 patients per service, decent pathology.
Cons: Variable fellowship placement (depends mostly on the applicant; IMGs have more difficulty getting fellowships), questionable research opportunities, not challenging enough.

Interview: UTHSCSA

First Impressions: Like Scott and White, UTHSCSA is very generous to its applicants. They provide a hotel room for each applicant at the La Quinta Inn located not far from the hospital, and when you check in they also give you a gift box containing shortbread cookies, chips, and salsa (very San Antonio-ish) Even though I went to bed earlier, I still had trouble falling asleep; I don't think I sleep well on king-sized beds b/c there's too much room. Needless to say I was sleep-deprived in the morning but tried not to let it show..
Pre-Interview dinner: About five residents met us at Mamacita's, a Tex-Mex restaurant next to the hotel. The IM program paid the bill, which included the entree of our choice and a slice of cheesecake from the Cheesecake Factory to go. I sat near two applicants and two residents, but sadly none of us were particularly talkative. I ended up chatting with the applicant beside me (who was from Taiwan) most of the time.
Interview Day: One of the chief residents met us at the hotel lobby at 7:00 a.m. and we took the La Quinta shuttle to the hospital. We were escorted to a little classroom where we got breakfast and the PD spoke to us about the program. Then we went to morning report, where we had the most interesting case I've ever seen to date. A 58-year-old woman with metastatic breast cancer presented to the hospital with nausea, vomiting, diffuse abd pain, and lethargy for the past two days. The differential ranged from everything from gastroenteritis to bowel infarct to hypercalcemia (which some of the attendings were quite certain of, until the calcium levels were found to be low). Then the powerpoint went up with a picture of a snake at the bottom, and one resident behind said, "Oh, is this the one who eats snakes?" As it turned out, rattlesnake eggs are a folk remedy cure-all in Mexico, and the patient's husband had been giving her the eggs to keep her cancer at bay. As a result she developed Salmonella arizonae, a type of Salmonella not usually found in humans. Wow.

After morning report, half of us went on a tour of the university hospital and VA (me) while the other half went to their interviews. I recognized a TCOM grad (intern) at the VA. My interviews, I thought, went very well. My first interviewer, one of the assistant program directors, said that she liked my personal statement and most of the questions she asked me were specific to my application; we even talked about sudoku. My second interviewer was interested in my past as a violinist (he was impressed when I told him about caroling at Plaza), and we even chatted about Joshua Bell (famous violinist) for a few minutes. It was a very comfortable conversation with both interviewers and I went back to the common area with a smile on my face. Hopefully they thought favorably of me.
Noon and beyond: Lunch was catered to us and dessert was...pumpkin cheesecake, which I'd normally be happy about if I hadn't had the same pumpkin cheesecake at Mamacita's last night. I shared a table with two students whom I'd also be seeing tomorrow at Austin, and the resident at our table was very nice and helpful. I ended up liking this program more than I originally thought.
Overall Impression:
Pros: Top rated university hospital, diverse population and pathology, Spanish heavily spoken but nurses are good about translating if need be, good fellowship placement (UTHSCSA likes to take their own residents), emphasis on teaching and educatoin
Cons: Hospital appears old, no Spanish interpreters (yes, I worry about that), not sure if I want to live in San Antonio

Interview: Scott and White

First Impressions: Scott and White is very generous to its applicants. They provide a hotel suite for each applicant at the Hilton Gardens Inn located across the street from the hospital for free, and when you check in they also give you a mug full of candy (which I've promised to give to Dina since the only candy I like nowadays is Hi-Chew). The beds are pretty comfy but the pillows were too soft; it took me a long time to fall asleep, and other applicants had the same complaint. I saw several family medicine applicants there too, including Liza and Clark.
Pre-Interview dinner: One of the chief residents met about 11 of us at the hotel lobby and drove us to a 2nd year residents' house via van. There was potluck BBQ so we ate our fill and then hung around chatting with residents. One 3rd year told me he'd trained at JPS for 2 years before deciding he liked IM better than FP, and he asked me about the new Patient Care Pavilion and what became of the old ICU and Tele units. Overall the residents seemed happy at Temple, especially with their training; >60% go into fellowship.
Interview Day: The residency coordinator met us at the hotel lobby (all 15 of us) at 7:10 a.m. and we got to the hospital via S&W shuttle. We went to morning report, where the program director introduced us geographically by school (all TX schools were represented except for UT-Houston, to the disappointment of one resident) before launching into a case of renal artery stenosis, which was engaging and fun. Then we had a powerpoint about the program (which is provided online so I'd seen it before) before going to our first interview. I met with a hospitalist whose first question to me was, "Do you have any questions about the program?" She was very nice, but did not ask me many questions, and overall I didn't feel as though she tried to get to know more about me aside from confirming that I was a violinist (she used to play, too). After that interview we hopped on the van and traveled to the VA hospital and then drove around town so we could see neighborhoods where residents usually live.
Noon Conference and beyond: Interviewees were ushered to the front of the line and got to eat first. Today was Cardio board review, so everyone got a keypad and got to vote on answers that were posted on the overhead, CIL-style. I'm glad to say I got several of the answers right. Afterwards, a resident took us on a tour around the (new) hospital. I thought I walked past Delip near the cafeteria but he looked right through me so now I think it might have been his brother instead. After the tour, we had one last exit interview for any last minute questions but I was all questioned-out so it only lasted about 10-15 minutes. *sigh*
Overall Impression:
Pros: Large tertiary hospital, diverse population and pathology, Spanish not required, good fellowship placement, 100% board pass rate for the last few years, emphasis on education
Cons: Temple, less-than-satisfactory interview experience

Radiology: Catching up

Yesteray Dr. G and I spent a good 20 minutes (at least) on one X-ray of a femur that looked like it had a Codman's triangle as well as another bone lesion that have been fairly stable for the last year or so. The problem was making sure that it really was an enchondroma and not an osteosarcoma, so we pored through textbooks trying to find images to tell us we were right. Dr. J poked his head in and didn't seem too impressed, so in the end we agreed the findings were harmless but require followup. Other notable things I saw included a pericardial cyst and a hiatal hernia. We also had a 23-year-old girl come in with a fibroadenoma, but whether or not she wants to get it removed will be up to her b/c she doesn't have insurance. Technically she could always go to JPS, and while I'm sure the ob-gyns there would do a great job, I don't recommend it just b/c JPS takes forever to get things done.

Nothing really happened today aside from the usual scans. Dr. G and I have found more to talk about as far as whether or not we should take tests that'll tell us whether we'll get cancer in the future. With my family history I can understand not wanting to know, especially at my age, about future cancers, but I would like to know my chances of getting diabetes and whether I can beat that. A drug rep came to talk to us about a new type of gadolinium-based contrast used to enhance liver lesions, and they treated us to Marble Slab ice cream. Not just the small cup, either; they gave us the round bowl. The flavors offered to us were vanilla, strawberry, and cheesecake; I got cheesecake with strawberry fruit topping (hey, got to stay healthy somehow) while others topped their ice creams with whipped cream and chocolate syrup. Dr. J got seconds, and when we teased him about it, he said it was okay because he worked out earlier that morning. That was incentive for me to work out after dinner.

Tomorrow I'll be driving down to Temple for my 1st interview. Hope it goes well.

Radiology: Pharm Lecture and Hypoglycemia

Most Fridays at 9:00 a.m. the oncologists and radiologists get together to discuss their latest patients and come up with ways to treat them (it's called "Planning Clinic"). Dr. G and I went to the auditorium today (I saw Dr. A and he waved hello), but in lieu of a planning clinic, we had the chief medical officer of a pharmaceutical company called Tragara talk to us about the development of a COX-2 inhibitor that can be used to improve survival rates in certain lung and pancreatic cancers. Being a molecular bio major, I was used to seeing and interpreting the many charts and statistics included in the presentation, but when Dr. G was paged to read a mammogram, she never returned to the auditorium. Later she told me that all the research findings were way over her head and she didn't understand them well. Makes sense; radiologists don't need to know about the latest advances in cancer drugs like the oncologists do.

Later we were called to the PET scan prep area (where patients are given some tagged glucose and told to rest for 45 min before the scan) because a patient was "having a reaction." When we saw the patient, he was sitting in the chair with sweat covering his entire face, and he did not look comfortable at all. His blood sugar was 89, but he was also a diabetic who hadn't had anything to eat for over 12 hours. The techs tried to give him orange juice but he complained that his stomach hurt, so they tried a piece of chocolate bar instead. Apparently that did the trick, because by the time a nurse practictioner and an oncologist came downstairs to see him, he felt much better and wanted to proceed with the scan. Apparently this was his first bout with hypoglycemia. Dr. G wondered why he didn't keep any sugary snacks on him in case this should happen, but I think he's learned his lesson.

Normally after injecting a patient with glucose they're supposed to stay still for up to 45 minutes so that their muscles don't use glucose (we only wanted the essential organs and tumors to uptake the glucose), but because he didn't move much, the scan was pretty good. And we soon found out what his problem was: his entire stomach lit up on the PET scan. It turns out he had a giant cell lymphoma of the stomach and the stomach wall was extremely thick. No wonder he had abdominal pain! Fortunately, said Dr. G, some stomach lymphomas can be treated with the same drugs used to treat H. pylori, so maybe he'll be spared from chemo (not too likely with the size of his tumor though). We called Dr. J to the room to see the scan but he wasn't too impressed b/c he'd seen it already (the patient's oncologist had shown him the CT yesterday). Ah well.

Radiology: Misidentification woes

I went back to radiology full time (meaning: looking at scans with Dr. G), and already it's off to a bad start. I've neglected my CT image studies so whenever Dr. G pointed to an object and asked me what it was, 4 times out of 5 I got it wrong. When she pointed at the thyroid I kept saying calling it the "thymus," and when half of it was missing, I had no idea what I was looking at. I mistook a giant lymph node for the IVC and couldn't tell the difference between a bladder and a uterus. *sigh* The list goes on. Tomorrow there's going to be a meeting between the oncologists and the radiologists as they discuss their patients and treatment plans. That should be interesting.

Our lady patient from Iowa has turned out not to be the perfect patient after all. I thought she was so on top of things by traveling to Texas every year for CT and PET scans, but we recently found out that she hasn't had a mammogram in at least five years. Apparently she figured that as long as her CT and PET scans were clean, there was no need for a mammo. Fortunately her oncologist forced her to get one before she left, though I can understand her way of thinking to some extent. Cheryl also shared the story of a woman who insisted on getting a breast MRI even though an MRI is NOT a good screening tool for breast cancer. She credited a MRI with diagnosing her cancer b/c she had a dimple in her breast and the tech had put the ultrasound probe directly over it (therefore finding the cancer) but to find tumors with U/S is like finding a needle in a haystack. Even Dr. J was unable to talk her out of getting the U/S, which was done for her peace of mind and not much more. *sigh* Where cancer is concerned, it's most important to keep the patient happy.

Radiology: Ultrasounds and Mammos

Today I spent the day mostly with Cheryl, one of the radiology techs who specializes mostly in ultrasound and mammograms. We spent the morning in the U/S lab; among the cases I saw was a man with polycythemia presenting with a slightly enlarged spleen (and an incidental kidney cyst), a woman whose oncologist felt a breast lump (but U/S revealed nothing), and the lady from Iowa whose pet scan I saw yesterday. She needed her thyroid scanned b/c she had a family history of thyroid disease and currently has two nodules, of which one was biopsied this afternoon. (sadly I won't know the results). I also stopped by nuclear medicine to watch Mercedes prepare a patient (whose MRI I observed) for a MUGA scan, which measures ejection fraction. First you draw a sample of the patient's blood, tag the RBCs with isotopes, and then reinject it into the patient and follow the tagged RBCs to the heart. Then you measure the diameter of the left ventricle in systole and diastole to calculate the EF, which is great if it's above 50% (optimum). This is done prior to chemotherapy because chemo treatments have been known to cause heart disease, and the MUGA gets a baseline heart function to use as comparison later. This week is Radiology Tech week so we've been getting free breakfasts and lunches for the last few days. This morning the chef husband of one of the radiation therapy techs cooked custom omelettes for everyone, and lunch was Panera Bread. In the afternoon I was assigned to Marcy for mammography. The first patient was an 83-year-old lady with cancer of unspecified origin (though a note said it was bile duct cancer), and she had trouble getting to the machine b/c she was wheelchair bound. "Should I bring my husband in?" she asked, and we said we'd be okay (her husband's 85). Mammograms look painful; I'm not looking forward to those. Lauri actually commented that she doesn't want any of the current techs doing her mammos when the time comes. After her mammo, the patient had to wait in the hall for her bone scan, and I decided to keep her company by talking to her. We must have sat there for about 10-15 minutes just talking; the radiologists walked by a few times and I wondered if they thought I was slacking off by talking to patients instead of watching more mammograms (Marcy brought another patient to the room while I was talking). The patient was very nice though; she told me that her husband was a general surgeon with the US army and told me of all the places they traveled to, including Malawi (in Africa) where her husband was able to do all kinds of surgery he wouldn't have been permitted to do in the states (ortho, heart, etc). We had one more mammogram patient but when Cheryl asked if she was S.G., the woman somewhat rudely replied, "Yes." Then Tina pulled Cheryl aside to warn her that S.G. had caused some trouble at the front desk asking when she'd be seen after less than 5 min of waiting, and that she kept asking for a specific tech who just happened to be on vacation this week. It was agreed that I should not sit in on S.G.'s mammogram, and later Cheryl said that S.G. had once again asked for Nancy, the tech on vacation, but later grudgingly agreed to let Cheryl to her mammo. Tina flat-out called S.G. a b****, but Cheryl was more sympathetic. She said a majority of the mammo patients formerly had breast cancer, and every year they come to the center stressed and scared about the possibility that their cancer has returned. They wanted all variables (in this case, the lab tech) to stay the same so there'd be no room for error. Fortunately for S.G., her breasts looked fine. With that, my three-day tour around the departments has come to an end. I'm really glad I got to do this; since I understand the procedures better now, I think I'll be able to view each CT, MRI, and PET in a new light. I told Lauri that I enjoyed getting to spend time in each department (and meeting the techs), and she said she also wanted me to see understand that images take time to process, and that some doctors don't realize that when they complain about missing scans or XRs. She also told me that she gets at least one call a day from my classmates asking to do a rotation at the cancer center, but most spots are already full. January is a particularly popular month, and a friend was able to snag that spot several weeks ago. =) Tomorrow it's back to the dark rooms for me.

Radiology: PET scans, bone scans, and elections

Today I spent the morning in the PET scan area with Anthony, one of the techs. We had three patients total, and I saw each one of them through the whole process. For those not in the know, PET scans are used to look for tumors, and they're done by injecting radioactive glucose (the isotope is fluoride, pretty harmless and doesn't cause any allergic rxns) into a patient, waiting 45 minutes, and then scanning them for about 18 minutes. The patient is fasting, so any metabolically active structures will quickly uptake the glucose. Brain, kidneys, liver, heart, and bladder aside, any other focal lesion that lights up is suspicious for tumors. Because the dye is made of glucose, patients also require a finger-stick to check glucose levels before the procedure. If the blood glucose is greater than 200, then the patient has to reschedule. Fortunately none of our patients were diabetics. The first lady is actually from Iowa, but flies down to TX once a year to get scanned. She said her original oncologist back home didn't care for her suffering due to chemo, so she was referred to one of the breast cancer oncologists here (the one who reads all the scans). He gave her a fanny pack that administered chemo around the clock so that her side effects were less severe. Another lady had a huge pulmonary nodule, but it didn't light up as much as a tumor is expected to light up, so it may just be a fatty tumor instead of cancer. For the last patient, Anthony let me push all the buttons to move the scanning table and adjust the settings for the machine, which was pretty cool =)

In the afternoon I went to Nuclear Medicine and met Mercedes, the tech, who was doing bone scans. The way it works is that she brings patients in two hours prior to their scan to inject them with technitium, which works the best 2+ hrs after the injection, and in the meantime they either wait in the waiting room or get other procedures done (MRI, CT, etc). There was a period of time where we had nothing to do for an hr, so Mercedes and I just chatted about random things like the election, kids nowadays, cell phones, and bad patients (always a favorite topic). She'll be doing a MUGA scan tomorrow morning which I probably won't get to see (I'll be working in the ultrasound and mammogram areas), but I'll stop by and see the results for sure.

And of course, today was Election Day. I personally did not care for either of the candidates, and it was no surprise that Obama won. Time will tell whether the country made the right decision.

Radiology: CT and MRI

Today I rotated through two departments: CT in the morning and MRI in the afternoon. The two CT techs, Claudia and Tina, were very nice; Tina and I spent a great deal of time talking about our pets (and animals in general) while Claudia talked about her daughter who wants to be a pediatrician. I remember wanting to be a pediatrician as a pre-med, but medical school changed all that =) It was cool getting to see how the CT worked and how patients prepare for their scans (i.e. drinking lemonade-flavored barium to visualize the stomach and later getting an iodine contrast injection after their non-contrast CT is done. Patients who have had allergic reactions to iodine in the past are put on a "13 hr prep protocol" in which they start taking measured doses of Benadryl and methyprednisolone thirteen hours before their scheduled scan. It works pretty well in most people, but some people require as much as a 3-day prep before the doctors decide to go without contrast from then on. Most patients get three scans: one "scout" scan where the entire chest/abdomen/pelvis (whatever you want to visualize) is scanned, one non-contrast scan, and one contrast scan (the latter two with cross sections). Sometimes, if there are suspicious cyst-like lesions in the liver or kidney, there is a "delayed" scan done to see if it takes up the contrast dye (cysts take up dye). Most of the CT scans I saw today were benign, which is good for the patients.

There was only one patient scheduled for MRI in the afternoon (but she needed two separate scans), so I went with Marcy, the MRI tech, to the waiting room to take the patient to the MRI. As it turns out, the MRI machine isn't even in the building; it's housed in one of those one-room temporary structures outside the building. The patient was a woman with stage II breast cancer (recently diagnosed) who'd undergone a bilateral mastectomy with metastasis to two nodes. She also had a history of falling, so in addition to a head/neck MRI she was also getting a lumbar MRI to assess for nerve compression. The MRI was a very loud machine with a tiny tunnel. The patient's head was covered with a cage-live device at one point; if that doesn't make one claustrophobic I don't know what does. Fortunately she was given Ativan before the procedure and handled it nicely. As we waited for the scans, Marcy told me about breast MRIs and how they can be used to detect breast masses that haven't been spotted yet. She said that just because only one breast has noticeable cancer doesn't mean the other one is cancer-free, and showed me several breast MRIs to make her point. That definitely makes me worried, since I don't think breast MRIs are the norm in cancer detection just yet and I'm sure there's many women out there who could benefit from it (but don't get them done).

After the MRI, Marcy took the patient around to all the other departments so she could see how small their tunnels were (CT, DEXA, PET scan) in case she got claustrophobic again. I sat in on the end of a PET scan before going back to CT, where Claudia proceeded to show me some of the more interesting scans they've had like an intussuseption, bone mets in the sternum (looks like a knob sticking out of the chest), and one where the peritoneal organs were totally riddled with mets. =( Cancer is nasty business.

Radiology: Happy Halloween!

Dr. G was out of town today, so I spent the day working with Dr. J instead. I think I learned a lot more today from Dr. J than I have with Dr. G b/c he would ask me questions while examining the images. He'd ask me if I talked about different MRI resolutions, or what the density values of bone, fat, and air were, and if I didn't know, we'd talk about it. It was also Halloween today, so a few people came to work dressed up. One X-ray tech had her birthday today so at lunch there was free food and an ice cream cake (needless to say I overate and gained back all the pounds I've lost since joining a gym). It was also the last day of early voting (sadly I didn't take advantage of early voting when I was doing my geriatrics rotation), so when I went to the nearby recreation center there was a 30 minute line (and I saw my parents about 5 min away from the polls). So yes...I voted. We'll see if it's effective.

Radiology: A Diwali lunch

This afternoon Drs. G and J (the radiologists) ordered Indian food for the department to eat for lunch as a way of bringing Diwali to the workplace. The restaurant they ordered from was Star India in Arlington, and it was pretty good. Not too spicy =) Oncologists were invited too, but only 2-3 showed up. Thank goodness there was enough food for everyone. Dr. G won't be coming to work tomorrow so I'll be with Dr. J. I haven't worked with Dr. J before; hopefully he'll be nice.

Radiology: *zzz*

Another typical day at the radiology department (though it was interrupted by a fire drill). Dr. G and I spoke to Lauri, the med student coordinator; it looks like I'll be doing solely radiology only this week, and then next week I'll start spending about 2-3 days in different departments like CT, MRI, mammography, etc., just so I understand what's going on. Sounded good to me. Since I've been studying CT cross-sections of the thorax (haven't got to the abdomen yet), lots of images make more sense to me now. At one full body scan Dr. G asked me if I noticed anything unusual (i.e. see any "hot spots" that indicate cancer?) There was one solid region in the pelvis that lit up big-time, so I tried to figure out what it was. From the back it looked like he only had one kidney, but from the front...ohhhhhh, it was a horseshoe kidney! It was my first time seeing one of these so I was excited to recognize it for what it was. Dr. G said that since we see mostly cancer here and I'm interested in IM, she'll try to show me some CXRs and CTs of more common medicine disorders like cholelithiasis, pneumonia, and more. That'll be helpful =)

Radiology: Busy Diwali

This morning when I arrived at work I looked into the car next to mine and saw a cocker spaniel (white with brown ears) sitting in the driver's seat looking sad and forlorn. I waved at it, and it just looked at me. I didn't know how long it had been sitting in the car and wondered if its owner was inside getting a mammogram or CT done. The weather was pretty cold this morning (40's), and while I was sure the dog wouldn't freeze to death (with its fur and all), I didn't want to just leave it there either. I told Dr. G about the dog as soon as I walked into her office, and after asking me where my car was parked, she told security to check on the dog to see if we can find its owner. *sigh* Why on earth would you bring your dog with you to a doctor's appointment and leave it in the car? Surely it can stay at home unattended somewhere.

Today was Diwali, the Indian "Festival of Lights," (Happy Diwali!) and with Dr. J out of town to celebrate with his family, Dr. G was the lone radiologist today. We spent the morning going over CTs and MRIs as usual, and every once in a while Nancy, the mammogram tech, would call Dr. G to tell her to check on a mammogram or two and assign BIRADs to them. After lunch I was given some time alone to read a book on interpreting CTs (and have gotten halfway down the thoracic column so far) before sitting in on Dr. G's PET scan readings. Unfortunately we didn't get through all the scans until 5:00 pm because of multiple distractions. There were times when previous PET or CT scan reports were missing and had to be called in to AMH to get faxed over. Other times Dr. D (a well-known breast cancer expert in this area) would pop his head into the darkroom and ask Dr. G to bring up his patients' images so he can see them for himself (he, as well as another breast cancer specialist who recently retired, prided himself on taking the time to see the images and letting Dr. G explain what was going on). Dr. G, however, saw this as a distraction because whenever Dr. D came in (I saw him 3-4 times today), she had to drop whatever she was doing to pull up his patient's files, and then play catch-up on the files she'd been studying prior to his arrival. "This is supposed to be my Diwali!" she lamented (fortunately she gets a three-day weekend this week). And by 5:45 pm, we still weren't able to go through all the CTs on her desk, so she called it quits. "This is private practice, I can set my own schedule," she said. "And whatever I can't finish today, I finish tomorrow." Sounded good to me.

And this is why I can never do radiology. I don't want to sit on my butt all day in a darkroom looking at images and talking only to other doctors, nurses, and techs. I like being around people, talking to patients, walking around. =)

Radiology: Day One

This morning when I arrived at work I looked into the car next to mine and saw a cocker spaniel (white with brown ears) sitting in the driver's seat looking sad and forlorn. I waved at it, and it just looked at me. I didn't know how long it had been sitting in the car and wondered if its owner was inside getting a mammogram or CT done. The weather was pretty cold this morning (40's), and while I was sure the dog wouldn't freeze to death (with its fur and all), I didn't want to just leave it there either. I told Dr. G about the dog as soon as I walked into her office, and after asking me where my car was parked, she told security to check on the dog to see if we can find its owner. *sigh* Why on earth would you bring your dog with you to a doctor's appointment and leave it in the car? Surely it can stay at home unattended somewhere.

Today was my first day of radiology at the local cancer center in town. I first had to wait about 15 minutes for the nurse/program coordinator to meet me and take me to the back room to introduce me to my preceptor, Dr. G. Dr. G seems nice enough, but she soon made me feel like an idiot by asking me if certain CT images looked normal. When I admitted that I didn't really know what "normal" looked like she suggested that I read a book on MRI and CT cross-sections because I "have to know normal anatomy" in order to really do well in radiology. *sigh* Anatomy was one of my worst subjects in 1st year med school; this is not going to be easy.

After one day, I know for sure that despite the cushy hours and high pay, I would never want to do radiology for a living. Dr. G spent the morning reviewing CTs, MRIs, and mammograms and doing dictations after each image study, and in the afternoon it was the exact same thing except we were looking at PET scans for signs of metastasis and tumor. The darkness of the rooms did nothing to help me stay awake, and there were many times when I'd nearly doze off and be confused whenever Dr. G asked me a question. It didn't help that my mind started playing tricks on me, and on the cross-section CT scans I'd see shapes of dogs, ducks, and even faces (don't laugh). Especially on the PET scans; one scan had three dark spots against a white background that made me think I was looking at a ghost (Halloween around the corner, anyone?) The PET scans were pretty cool to look at because they light up at areas of high metabolism. So on every PET scan, the brain, the heart, the liver, the kidneys, and the bladder all light up to some extent; it's more important to find small focal areas in places that should not be lighting up.

There are two radiologists at the center, Dr. G and Dr. J, and when I'm not with one I'll be with the other. There's no set schedule for where I have to be each day; the radiologists want me to spend different days in different departments (i.e. mammography, PET scan, CT scan) while I'm here in order to see how images are obtained, but apparently I get to choose the days. After having each day planned for me for geriatrics, this takes some getting used to. I'll also probably have to make up a day since I plan to take 3 days off for interviews during this rotation, but seeing how I only live 5 minutes from the center (and have December off) I don't expect any problems. Because Diwali is this week, Dr. J has tomorrow off, and he told Dr. G that there will be a lot of "Mary's" tomorrow. At first we thought he said "merry" but he said, "Merry for me, Marys for you" since we have about 6 patients named Mary tomorrow. Good to know =P

Geriatrics: Exam and Exit Interviews

This morning we had our geriatrics exam, which wasn't too bad and hopefully I got at least a B on it. There were several questions from slides I had not reviewed, and afterwards people complained that they spent too much time studying the slides than necessary. I have no regrets; glancing through the slides probably helped me on 3-4 questions, which can make the difference between pass and fail. Afterwards, we went to the GAP clinic for exit interviews. First was a group interview with Dr. JH in which she asked for feedback on the programs and what we should do to make it better. Anita had a lot to say about how much she disliked the EMR system (electronic medical records) b/c her attending made her and Lora scribe for her while she saw the patients. Later, when my turn came to express my thoughts, I said that I was never taught signs of active dying that I could use to see in my hospice patients (though we got a brief lesson on that last year in family medicine). I then came to the defense of EMR by saying that I was able to enter in all my data during the patient visit so that afterwards all Dr. JK had to do was sign off on my note. After hearing all the complaints of doing nothing but scribing and how some of my classmates got bounced around from one attending to the other, I'm extremely grateful that I spent the majority of my rotation working with just one attending (Dr. JK), and that Dr. JK allowed Corey, Justin, and me to see patients alone rather than with her.

Next were individual interviews. Dr. JH saw 5 students and they popped in and out of her office really quickly. By the time the last of those classmates left, there were still 4 of us waiting to see Dr. JK. Finally it was just Justin and me waiting for Sara to finish her exit interview. Sara was in the office for a long time. My interview went well; Dr. JK asked me what grade I thought I should get for my rotation, and I said "Exceeding expectations" (89-94) b/c I felt I worked hard and was able to connect with my patients (and I mastered EMR to some extent). To my relief, Dr. JK told me that all the attendings I worked with gave me an E (in OWL terms, hehe), and she agreed with them. Nice way to end the rotation =) To treat myself afterwards, I stopped by the Cheesecake Factory and took home a slice of pumpkin cheesecake. Who needs EtOH when cheesecake tastes so much better? =)

Geriatrics: Last Day!

This morning was the last day of hospice (and geriatrics). Justin, Corey, and I went to JLWest, where Dr. M got charts for two new patients and said I got to take my pic. Upon hearing one of the nurses saying that one patient was leaking sputum through his trach, I decided to see the non-spitting patient, who turned out to be a man my parents' age with metastatic renal cell carcinoma. He was not in good shape when I saw him; he was unresponsive, tachycardic, and tachypneic. His initial resp rate was recorded as 50 breaths per minute, VERY rapid. When Dr. M went to see him, he was surprised by how much the patient had deteriorated from 4 weeks ago, when he was in the hospital alert and complaining of uncontrollable pain. There were also little notes in his chart saying that his mother was the MPOA (medical power of attorney) and that his son and his girlfriend have been living off his disability checks. Very dysfunctional family, apparently. Justin's cardiac patient whom we saw at Harris on Monday was actively dying; her radial pulses were nonpalpable, her feet were cold and slightly mottled, and the pinna of her ears were relaxed. When the radial pulses are absent, death usually occurs in the next eight hours. We all felt bad for the husband, who had hoped that she'd live to their anniversary, but he was very accepting of what was happening and planned to call his children to come over. Our other patient from Tuesday is still alive, but her family is concerned about whether or not she will die soon b/c they're missing work days to be with her to the end. Dr. M's advice was to play it day by day. My own patient from Tuesday, a man recovering from stroke and a partial craniotomy; seems to be doing very well; I don't think he should be on hospice yet. If anything, he should be in a skilled nursing facility, but Dr. M said you can't be in skilled nursing and hospice at the same time. "Of course, he could always leave hospice to go to skilled nursing," he said, then come back to hospice when he really feels the end is near. After a lecture on pain meds, Dr. M let us go for the rest of the day. AWESOMENESS. Still, instead of studying, I took a nearly 2 hr nap. *sigh* At this rate I just want to pass.

Geriatrics: Presentations and more

We had group presentations today over articles we were assigned to read. Justin and I had to talk about using non-pharmacologic treatments in dementia patients, which was pretty straightforward. Grand Rounds covered pediatric CNS tumors (pretty interesting), and then we drove to Harris. Justin arrived before me and went with two palliative care physicians from Universal Hospice to see some patients while Corey and I went to see the rest with Dr. M. We had one new hospice consult, and then we went to different floors where Corey and I each split up to see a patient before reconvening (usually Dr. M saw Corey's patient first and then went to find me). One patient was a lady with a history of psych issues and an open wound in her left ankle (she requested that we give her more than 10 Dilaudid pills since that's what JPS gave her once and it wasn't even close to enough); she was to be discharged as soon as she found SNF placement so Dr. M didn't go see her. The next patient I saw was the lady I wrote a consult note for on Monday; her pain was slightly better but we decided to put her on a Fentanyl patch in the meantime. Corey and I got out at 3:30 pm; Justin's car was still in the parking lot when I left. Looks like we got lucky.