Back in when I did my MICU rotation in August 2011, I had the same three patients throughout the entire month. One was a cirrhotic guy who had a massive GI bleed my second day of MICU but survived and had the best mental status I'd ever seen in any ESLD patient. Another was an alcoholic who literally drank up until she had a massive variceal bleed and ended up in the MICU with end stage liver failure. We ended up making her condition worse by getting her a G-tube (the ascites kept leaking around it) and putting her on colistin when she had a resistent bug growing in her blood (killed her kidneys and put her on CVVHD) The third was a large 400 lb guy who initially presented with a fall, developed a COPD exacerbation and refused BiPAP, ended up getting intubated and developing a buttload of complications like MRSA bacteremia, necrotic bowel s/p exp lap (which, given his girth, did not heal well). The three of them were like seesaws throughout my entire month of MICU. One day, the cirrhotic guy would crump while the others seemed to be headed in the right direction. One day, the alcoholic woman felt well enough to flip everyone off and tolerate trach collar; the following day she had to go back on the vent due to new sepsis. One night my COPD guy accidentally fell out of bed despite being on a vent and hooked up to numerous IVs (we still aren't sure how that happened), dislodging his Hickman and bleeding all over the ground (heparin drip). I had high hopes that one of them would make it out of the MICU before I did, but they were still there on my last day.
My two ESLD patients ended up dying, though the alcoholic woman was at least able to make it out of the hospital to hospice. The COPD guy walked into my clinic today, and to see him awake, walking, and talking was amazing. When I think back to how he was in the MICU, how he required monster doses of sedation (until we discovered Risperdal) to keep him from bucking the vent and reopening the barely-healing wound from his ex lap, how he developed ARF and needed CVVHD (which was, fortunately, temporary), how his abdomen grew a highly resistant bug that later became septic, there were times when we thought he wouldn't make it. He told me himself that he had no memory of those 2-3 months he'd spent in the ICU (probably a good thing), and that he was extremely grateful to be able to walk and talk again (he'd required a trach and PEG). His abdomen has healed, though the granulation tissue still looked a bit friable. I was surprised he hadn't followed up with surgery and told him to call them for an appointment. One of my friends who had him on the floors (when he drank the water used to swab his mouth while still NPO on a PEG tube) called him a giant POS, but I was just happy he survived. Considering all the people I've seen die in the MICU, he was one of the lucky ones.
There
Wednesday, February 22, 2012
Monday, February 20, 2012
Looking Ahead
Wow...it's been a long time since I've written on this blog. Kind of sad, considering how from age 11 to 22 I wrote (yes, WROTE, not typed) journal entries almost every day detailing life from elementary school through college. In med school I switched from writing to blogging, but my entries throughout residency have been minimal at best. Years from now, I'm going to go through my old journal entries and lament that I barely have any entries documenting my residency years. Part of it was that I was afraid that anything I put on here would become a HIPAA violation, especially now that I was a practicing physician. I may try to write a bit more later on.
The biggest thing I had to deal with last summer was not matching into heme-onc fellowship and wondering what my next path would be. The question I had to ask myself was, "How much do I want to be an oncologist?" I had always been interested in oncology even as an undergrad (cell/molecular bio major learning about carcinogenesis, targeted gene therapies, etc.), but my reasons became more personal in med school. My mother was diagnosed with breast cancer during my first year of med school (few people knew outside of my family, as we wanted to keep it private, but she has now been in remission for 5+ years) I also remembered telling my orchestra director several days before she died of colon cancer that someday I hoped to be an oncologist and help people like her. I had high hopes for myself, thinking that my background and personal experiences would help me get into a heme/onc fellowship. Finding out I didn't match was a huge slap in the face (or, as I told my friends later on, a big fat "F*** you."), and I wondered what went wrong. My reaction on Match Day was not normal either; the ones who didn't match pretty much sulked all day; I smiled and looked on the bright side: at least I can move back to Texas! That got me thinking: maybe the people at the programs could tell I didn't want to be on the East Coast bad enough. Maybe my real goal all this time was to come back to Texas. One door closed, but another one opened.
My chief residents still sent me emails whenever they heard of any heme-onc fellowship openings, but by then I'd already decided that I no longer wanted to pursue a fellowship. I'd never been a huge fan of research, and the idea of spending time and money to reapply was something I no longer wanted. And while I personally feel I'm more suited for clinic, I liked the acute care setting better and decided to apply for hospitalist positions in Texas. I worked on my CV, looked up job opportunities on PracticeMatch.com (and browsed through those endless emails from recruiters for opportunities to practice in Texas), then applied to positions that sounded interesting. I ended up getting 3 interviews, 1 in Dallas, 1 in Austin, 1 in Round Rock.
I went to those interviews in early February and immediately noticed how different applying for a position is than applying for residency for fellowship. I didn't have to do anything to sell myself. My first interview in Dallas didn't feel like an interview at all. One of the attendings showed me around the hospital (1000+ beds!), and then we had lunch with the other partners. I asked a lot of questions, but not once did the interviewers (it was very informal) ask me anything about myself. I was prepared to list my strengths and weaknesses, say why I was applying to their program, but instead, they did all the talking. Clearly they needed me more than I needed them. I knew if I went to this program, I'd be expected to work hard.
My interviews in Austin went pretty well. I had a brief info session with the president of the company, then drove to the hospital where they needed to hire more physicians. The schedule here was Monday through Friday with every 3rd weekend on call, but work hours were flexible (you can leave once all your work is done). I also found that I had a good rapport with the attendings there; there was a good vibe amongst us that was reminiscent to what I felt at my Drexel interview 3 years ago (and helped me decide to rank them high on my list). It was in the 60s and beautiful in Austin that day. After my interview I dropped my luggage off at the hotel and then walked around Town Lake (now called Lady Bird Lake). I also got to meet up with Dina for dinner; we went to Uchi, which was AMAZING.
My Round Rock interview also went well. The doctors here have a 12-on 9-off schedule where they only rounded on the first 5 days, did rounds/admissions the weekend, and then only admitted the remaining 5 days. It was an ideal schedule for someone who needed a lot of free time (i.e. family with kids), and I found myself really liking this program as well. It was, however, a smaller program (6 physicians working per day), and I didn't have that same rapport with the attendings that I did in Austin. I liked all three of the programs pretty well, and I dreaded having to make a decision between them if I should get multiple offers (which, of course, was better than having no offer at all!)
Both Austin and Round Rock offered me contracts within a week of my interviews. I was shocked by the fast turnaround; how was it that I failed to impress anyone during my heme-onc interviews, yet with medicine they actually wanted me to work with them? It felt good to be sought after, for once. Deciding between the two programs was a huge challenge because they were so different from each other in terms of workload, salary, and call schedule. In the end, I decided on the program in Austin. They are a well established hospitalist group in Austin and provide care to different hospitals and rehab centers throughout the city. They are looking to hire a total of 5 new doctors this fall; I would be the 4th. And assuming the other new hires are MDs, I would be the first DO in the practice. And for me, that would be a huge accomplishment, showing that DOs can (and should) be able to practice wherever they want, and how they want.
Looking back for the past seven years, I can hardly believe it's finally come to this. My parents had tried their hardest to talk me out of medical school (and TCOM, once they found out it was a DO school and were fed lies about how DOs face great discrimination in the medical field), fearing that I would someday be doomed to practice medicine in a small town because no one would want to hire me. Fortunately I've proved them wrong, and now they couldn't be more proud =) I'm proud to be where I am =)
The biggest thing I had to deal with last summer was not matching into heme-onc fellowship and wondering what my next path would be. The question I had to ask myself was, "How much do I want to be an oncologist?" I had always been interested in oncology even as an undergrad (cell/molecular bio major learning about carcinogenesis, targeted gene therapies, etc.), but my reasons became more personal in med school. My mother was diagnosed with breast cancer during my first year of med school (few people knew outside of my family, as we wanted to keep it private, but she has now been in remission for 5+ years) I also remembered telling my orchestra director several days before she died of colon cancer that someday I hoped to be an oncologist and help people like her. I had high hopes for myself, thinking that my background and personal experiences would help me get into a heme/onc fellowship. Finding out I didn't match was a huge slap in the face (or, as I told my friends later on, a big fat "F*** you."), and I wondered what went wrong. My reaction on Match Day was not normal either; the ones who didn't match pretty much sulked all day; I smiled and looked on the bright side: at least I can move back to Texas! That got me thinking: maybe the people at the programs could tell I didn't want to be on the East Coast bad enough. Maybe my real goal all this time was to come back to Texas. One door closed, but another one opened.
My chief residents still sent me emails whenever they heard of any heme-onc fellowship openings, but by then I'd already decided that I no longer wanted to pursue a fellowship. I'd never been a huge fan of research, and the idea of spending time and money to reapply was something I no longer wanted. And while I personally feel I'm more suited for clinic, I liked the acute care setting better and decided to apply for hospitalist positions in Texas. I worked on my CV, looked up job opportunities on PracticeMatch.com (and browsed through those endless emails from recruiters for opportunities to practice in Texas), then applied to positions that sounded interesting. I ended up getting 3 interviews, 1 in Dallas, 1 in Austin, 1 in Round Rock.
I went to those interviews in early February and immediately noticed how different applying for a position is than applying for residency for fellowship. I didn't have to do anything to sell myself. My first interview in Dallas didn't feel like an interview at all. One of the attendings showed me around the hospital (1000+ beds!), and then we had lunch with the other partners. I asked a lot of questions, but not once did the interviewers (it was very informal) ask me anything about myself. I was prepared to list my strengths and weaknesses, say why I was applying to their program, but instead, they did all the talking. Clearly they needed me more than I needed them. I knew if I went to this program, I'd be expected to work hard.
My interviews in Austin went pretty well. I had a brief info session with the president of the company, then drove to the hospital where they needed to hire more physicians. The schedule here was Monday through Friday with every 3rd weekend on call, but work hours were flexible (you can leave once all your work is done). I also found that I had a good rapport with the attendings there; there was a good vibe amongst us that was reminiscent to what I felt at my Drexel interview 3 years ago (and helped me decide to rank them high on my list). It was in the 60s and beautiful in Austin that day. After my interview I dropped my luggage off at the hotel and then walked around Town Lake (now called Lady Bird Lake). I also got to meet up with Dina for dinner; we went to Uchi, which was AMAZING.
My Round Rock interview also went well. The doctors here have a 12-on 9-off schedule where they only rounded on the first 5 days, did rounds/admissions the weekend, and then only admitted the remaining 5 days. It was an ideal schedule for someone who needed a lot of free time (i.e. family with kids), and I found myself really liking this program as well. It was, however, a smaller program (6 physicians working per day), and I didn't have that same rapport with the attendings that I did in Austin. I liked all three of the programs pretty well, and I dreaded having to make a decision between them if I should get multiple offers (which, of course, was better than having no offer at all!)
Both Austin and Round Rock offered me contracts within a week of my interviews. I was shocked by the fast turnaround; how was it that I failed to impress anyone during my heme-onc interviews, yet with medicine they actually wanted me to work with them? It felt good to be sought after, for once. Deciding between the two programs was a huge challenge because they were so different from each other in terms of workload, salary, and call schedule. In the end, I decided on the program in Austin. They are a well established hospitalist group in Austin and provide care to different hospitals and rehab centers throughout the city. They are looking to hire a total of 5 new doctors this fall; I would be the 4th. And assuming the other new hires are MDs, I would be the first DO in the practice. And for me, that would be a huge accomplishment, showing that DOs can (and should) be able to practice wherever they want, and how they want.
Looking back for the past seven years, I can hardly believe it's finally come to this. My parents had tried their hardest to talk me out of medical school (and TCOM, once they found out it was a DO school and were fed lies about how DOs face great discrimination in the medical field), fearing that I would someday be doomed to practice medicine in a small town because no one would want to hire me. Fortunately I've proved them wrong, and now they couldn't be more proud =) I'm proud to be where I am =)
Tuesday, August 23, 2011
Earthquakes and Medical Emergencies
I started my MICU rotation yesterday, and while it's my second time being in the unit as a resident, I still get nervous in the MICU. One of my more "stable" patients was a 54 year old man with end stage liver disease with peritonitis who is still on the liver transplant list despite all his current comorbidities. My attending even asked if we could call him out to the PCU today, but the fellow disagreed, saying that every time he was called down to the PCU, he always returned quickly due to hypotension.
Thank goodness he stayed, because shortly before 10 a.m. I got a call from another resident saying that he was coughing up "lots of blood." I broke from rounds to see what was going on, and there was my patient, his gown and sheets drenched with bright red blood, and there was more coming out of his mouth and trach. My first thoughts: "Holy $#&!" Even worse, he recently had all his central lines removed due to fungemia, and all he had was one peripheral. This was the worst thing that could ever happen to this guy, and I was in fear for his life.
Fortunately one of the MICU attendings was already in the room, yelling for the fellow to get a central line kit and at us to order octreotide drip, Nexium drip, and above all, blood products. Rounds were completely forgotten in light of this emergency. While the fellow put in a central line and the attendings put in a Blakemore tube (which I'd never even HEARD of until today), the rest of us tried to handle everything else from running to the blood bank for blood products, putting in orders, making phone calls, etc. The first year GI fellow was nervous about doing her first scope for a variceal bleed (the patient had known varices and had bled in the past), and the GI attending tried to make it all sound exciting. In the first two hours we transfused 8 units of RBCs and who knows how much FFP and platelets (remember, end stage liver), and through it all the patient remained conscious. He knew very well what was happening, and that, I thought, was the scariest thing of all. Knowing that he was in trouble, and that he could die.
The GI attendings couldn't find an obvious source of bleed, but went ahead and banded what varices they did see just to be safe. Once he was stabilized, it was nearly lunch time, so several of us went to the lounge to eat. Suddenly, the floor started moving up and down, almost like we were on a ship, and a closet door started swinging. "What is that?" someone asked. "You guys feel it too, right?" "Is that an earthquake?" It certainly FELT like one (I'd experienced earthquakes in Asia before), but whoever heard of earthquakes on the East Coast? "I love how we're all just sitting here," one girl half-joked, but it was surprising how calm we all were. The earthquake only lasted about 20-30 seconds, and after it ended another girl (who happened to be from Cali) ran into the lounge and said, "Did you guys feel that?!" Yup, sure did.
For a lot of people this was their first earthquake (my college roommate was in DC and told me that she immediately ran out of her building when she felt the first tremors), so it was pretty frightening for them. One of my friends initially laughed when her ER patients told her that the ground had shook and thought they were just high on crack; only later did she realize that there was an earthquake and she hadn't felt it. Our lounge was on the 12th floor of the hospital; I'd always experienced earthquakes while in a high rise so I have no idea whether it's safer to evacuate the building or just stay put. At any rate, an earthquake on the East Coast was certainly bizarre. And now there's a hurricane on the way? What the heck...
Thank goodness he stayed, because shortly before 10 a.m. I got a call from another resident saying that he was coughing up "lots of blood." I broke from rounds to see what was going on, and there was my patient, his gown and sheets drenched with bright red blood, and there was more coming out of his mouth and trach. My first thoughts: "Holy $#&!" Even worse, he recently had all his central lines removed due to fungemia, and all he had was one peripheral. This was the worst thing that could ever happen to this guy, and I was in fear for his life.
Fortunately one of the MICU attendings was already in the room, yelling for the fellow to get a central line kit and at us to order octreotide drip, Nexium drip, and above all, blood products. Rounds were completely forgotten in light of this emergency. While the fellow put in a central line and the attendings put in a Blakemore tube (which I'd never even HEARD of until today), the rest of us tried to handle everything else from running to the blood bank for blood products, putting in orders, making phone calls, etc. The first year GI fellow was nervous about doing her first scope for a variceal bleed (the patient had known varices and had bled in the past), and the GI attending tried to make it all sound exciting. In the first two hours we transfused 8 units of RBCs and who knows how much FFP and platelets (remember, end stage liver), and through it all the patient remained conscious. He knew very well what was happening, and that, I thought, was the scariest thing of all. Knowing that he was in trouble, and that he could die.
The GI attendings couldn't find an obvious source of bleed, but went ahead and banded what varices they did see just to be safe. Once he was stabilized, it was nearly lunch time, so several of us went to the lounge to eat. Suddenly, the floor started moving up and down, almost like we were on a ship, and a closet door started swinging. "What is that?" someone asked. "You guys feel it too, right?" "Is that an earthquake?" It certainly FELT like one (I'd experienced earthquakes in Asia before), but whoever heard of earthquakes on the East Coast? "I love how we're all just sitting here," one girl half-joked, but it was surprising how calm we all were. The earthquake only lasted about 20-30 seconds, and after it ended another girl (who happened to be from Cali) ran into the lounge and said, "Did you guys feel that?!" Yup, sure did.
For a lot of people this was their first earthquake (my college roommate was in DC and told me that she immediately ran out of her building when she felt the first tremors), so it was pretty frightening for them. One of my friends initially laughed when her ER patients told her that the ground had shook and thought they were just high on crack; only later did she realize that there was an earthquake and she hadn't felt it. Our lounge was on the 12th floor of the hospital; I'd always experienced earthquakes while in a high rise so I have no idea whether it's safer to evacuate the building or just stay put. At any rate, an earthquake on the East Coast was certainly bizarre. And now there's a hurricane on the way? What the heck...
Friday, August 5, 2011
PGY-3
It's been six weeks since the start of PGY-3 year. It still feels weird to be a "senior" resident and have interns look up to my classmates and me as the source of all medical info when in reality I still feel like I don't know anything. My upper-level residents have either become fellows or moved on to become attendings/moonlighters at other hospitals, and I miss having them around whenever I have questions. Fortunately my classmates are (for the most part) great about helping each other out, and I know I'll miss them terribly once we finish residency.
Since I didn't match into fellowship, I now have to start looking for a job. I've pretty much decided to go back to Texas to be closer to family; the question is, where. I've pretty much narrowed my job search to DFW, Austin, or Houston areas (preferably within 30 minutes of these cities), and there's no shortage of phone calls or emails from recruiters. The question is, which city do I want to be in most? I know Austin and DFW the best, so they're taking precedence over Houston right now (not to mention jobs in Houston are probably more competitive) I've gotten emails from Baylor Health systems, so I know I could always apply there. Just have to get my CV in order.
And yet, despite my plans to return to Texas to practice medicine (might be easier said than done, who knows? Maybe I'll fail the medical jurisprudence test and not be able to practice in Texas), I'll definitely miss the East Coast. For all its humid summers and icy winters (snow is beautiful when its falling, not when I have to shovel my car free to get to work), I've grown a bit fond of living in Philly. I'll definitely miss the tax-free shopping and weekend trips to New York, Baltimore, or DC (only 2-2.5 hrs away!), and this year I plan to make the most of my time here and enjoy it to the fullest. My friends are already asking if they can visit me in Texas and go out for some "real" BBQ, which I'd be all too happy to do.
But first...gotta find a job.
Since I didn't match into fellowship, I now have to start looking for a job. I've pretty much decided to go back to Texas to be closer to family; the question is, where. I've pretty much narrowed my job search to DFW, Austin, or Houston areas (preferably within 30 minutes of these cities), and there's no shortage of phone calls or emails from recruiters. The question is, which city do I want to be in most? I know Austin and DFW the best, so they're taking precedence over Houston right now (not to mention jobs in Houston are probably more competitive) I've gotten emails from Baylor Health systems, so I know I could always apply there. Just have to get my CV in order.
And yet, despite my plans to return to Texas to practice medicine (might be easier said than done, who knows? Maybe I'll fail the medical jurisprudence test and not be able to practice in Texas), I'll definitely miss the East Coast. For all its humid summers and icy winters (snow is beautiful when its falling, not when I have to shovel my car free to get to work), I've grown a bit fond of living in Philly. I'll definitely miss the tax-free shopping and weekend trips to New York, Baltimore, or DC (only 2-2.5 hrs away!), and this year I plan to make the most of my time here and enjoy it to the fullest. My friends are already asking if they can visit me in Texas and go out for some "real" BBQ, which I'd be all too happy to do.
But first...gotta find a job.
Wednesday, June 15, 2011
End of One Road
Today was a pretty long-awaited day, the day I would find out whether or not I got accepted at a heme/onc fellowship program. The results would be posted at noon. I was in clinic at the time and logged into NRMP around 11:55 am. When I had a chance between presenting patients to my preceptor, I quickly refreshed the NRMP page and saw this:
Ouch.
To say I was shocked was an understatement. I had 9 interviews and gotten pretty good vibes from at least 2-3 programs. When I interviewed at my home program, I was told that the program director (who wrote my letter of recommendation) had thought very highly of me and would rank me high. Based on those words, I had (mistakenly) assumed that I had a spot here no matter where I ranked it, and I had high hopes I wouldn't have to go that far down my list to match. My friends thought I was guaranteed a spot here, but we were all wrong.
Surprisingly, I took the news better than I thought I would. I'd had misgivings about applying for fellowship from the start, since I liked both heme-onc and internal medicine, but thought I'd at least give it a try to see if I'd match. When I saw that I didn't match, there was a brief second or two of surprise and disappointment, but I was never truly unhappy. After all, there are so many opportunities available within internal medicine, whether it be a job as a hospitalist or as a primary care provider (again, I can see myself doing either). In fact, after I told my parents the news, I was already thinking of cities in Texas where I'd want to practice (i.e. Austin!), and suddenly not matching for fellowship wasn't such a terrible thing.
Most of my friends did match at their fellowship of choice, and I was genuinely happy for them. A whole bunch of us went to a sports bar for drinks after work, and it was fun to find out where people matched and share in their joy. Several of my friends came up to me and said things like, "I'm sorry." "What happened?" "I thought for sure you'd match somewhere" or my favorite, "You okay?" Yes, I am okay. If I wasn't okay, I probably would have gone straight home from work, curled up in a ball, and cried my eyes out. If I wasn't okay, I wouldn't have gone out with my friends to celebrate their achievements. Please do not feel bad for me. I did my best and have no regrets about how things have turned out.
Some people have already assumed that I will reapply for fellowship in another year or so. "Don't give up, you'll match next time." That's still up in the air. At this time, I have no plans to reapply for fellowship. Since I know I'll be practicing internal medicine in another year or so, I'm going to focus on that for now. And of course, I'll be making a six-digit salary while my friends are still on a PGY-4 salary =P
"We are sorry, you did not match to any position."
Ouch.
To say I was shocked was an understatement. I had 9 interviews and gotten pretty good vibes from at least 2-3 programs. When I interviewed at my home program, I was told that the program director (who wrote my letter of recommendation) had thought very highly of me and would rank me high. Based on those words, I had (mistakenly) assumed that I had a spot here no matter where I ranked it, and I had high hopes I wouldn't have to go that far down my list to match. My friends thought I was guaranteed a spot here, but we were all wrong.
Surprisingly, I took the news better than I thought I would. I'd had misgivings about applying for fellowship from the start, since I liked both heme-onc and internal medicine, but thought I'd at least give it a try to see if I'd match. When I saw that I didn't match, there was a brief second or two of surprise and disappointment, but I was never truly unhappy. After all, there are so many opportunities available within internal medicine, whether it be a job as a hospitalist or as a primary care provider (again, I can see myself doing either). In fact, after I told my parents the news, I was already thinking of cities in Texas where I'd want to practice (i.e. Austin!), and suddenly not matching for fellowship wasn't such a terrible thing.
Most of my friends did match at their fellowship of choice, and I was genuinely happy for them. A whole bunch of us went to a sports bar for drinks after work, and it was fun to find out where people matched and share in their joy. Several of my friends came up to me and said things like, "I'm sorry." "What happened?" "I thought for sure you'd match somewhere" or my favorite, "You okay?" Yes, I am okay. If I wasn't okay, I probably would have gone straight home from work, curled up in a ball, and cried my eyes out. If I wasn't okay, I wouldn't have gone out with my friends to celebrate their achievements. Please do not feel bad for me. I did my best and have no regrets about how things have turned out.
Some people have already assumed that I will reapply for fellowship in another year or so. "Don't give up, you'll match next time." That's still up in the air. At this time, I have no plans to reapply for fellowship. Since I know I'll be practicing internal medicine in another year or so, I'm going to focus on that for now. And of course, I'll be making a six-digit salary while my friends are still on a PGY-4 salary =P
Monday, May 30, 2011
Making A Rank List
So it's May 30th, and the deadline for submitting my rank list is tomorrow. Although I certified a preliminary rank list weeks ago, I haven't actually sat down to really think about what order to rank my programs in until now. Back when I submitted my rank list for residency, I knew what my top 3 were. It was just a matter of ranking them in an order I was happy with. I was very happy to match at DUCOM for residency, but there was a time when I had UIC ranked higher than DUCOM because I just wasn't sure which city I preferred to live in. Philly or Chicago? A few friends thought I should have ranked UIC higher because it had the "better name" and for some, better location. In the end I ranked DUCOM higher than UIC because Philly was 1) not as cold as Chicago 2) Cheaper cost of living 3) Free parking in Center City Philly 4) Better Chinese food 5) Close proximity to cities like New York and DC (which I've visited several times since moving here)
Regarding fellowship, I have no idea what my top 3 choices are. There's not even a clear cut number 1 choice. Almost all my interviews are in the Northeast, with the lone exception in Florida. And while I really liked the program in Florida, I don't know if I'd like the city (it's pretty much a small college town), and an intern who went to undergrad there said that there's little to do there if you're not a student. Some of my friends are encouraging me to go to New York. If my ultimate goal was to live in New York City, then the choice would be obvious, but I just don't have that urge to live in the city. Some of the programs I like are in smaller cities, and yet, I feel like I need to be close to a large city so that when I'm not working, I will have lots of things to do to occupy my free time. New York would be perfect for that.
Then I need to ask myself, how much do I want to stay in Philly? When I first moved here I didn't think too much of Philly, but now that I've spent more time here, I've come to really like it. It's within driving distance to New York and DC, there's lots of places to shop (and eat), and there's a great orchestra downtown that I've gone to listen to several times. I'd miss that if I had to move. Three of the places I interviewed at are in/around Philly, so if I really wanted to stay in Philly, it's an easy choice. But just because I want to go to a program doesn't mean I'll get in.
*sigh* Decisions decisions. I just hope it'll all work out in the end.
Regarding fellowship, I have no idea what my top 3 choices are. There's not even a clear cut number 1 choice. Almost all my interviews are in the Northeast, with the lone exception in Florida. And while I really liked the program in Florida, I don't know if I'd like the city (it's pretty much a small college town), and an intern who went to undergrad there said that there's little to do there if you're not a student. Some of my friends are encouraging me to go to New York. If my ultimate goal was to live in New York City, then the choice would be obvious, but I just don't have that urge to live in the city. Some of the programs I like are in smaller cities, and yet, I feel like I need to be close to a large city so that when I'm not working, I will have lots of things to do to occupy my free time. New York would be perfect for that.
Then I need to ask myself, how much do I want to stay in Philly? When I first moved here I didn't think too much of Philly, but now that I've spent more time here, I've come to really like it. It's within driving distance to New York and DC, there's lots of places to shop (and eat), and there's a great orchestra downtown that I've gone to listen to several times. I'd miss that if I had to move. Three of the places I interviewed at are in/around Philly, so if I really wanted to stay in Philly, it's an easy choice. But just because I want to go to a program doesn't mean I'll get in.
*sigh* Decisions decisions. I just hope it'll all work out in the end.
Monday, May 2, 2011
May 1, 2011 at 11 pm...where were you?
Everyone remembers what they were doing on Tuesday, September 11, 2011, and when they found out about Al Qaida's attack on the World Trade Center and DC. I was a freshman at UT, just coming out of my 8 a.m. calculus class when I saw people gathered around a TV that screamed, "BOMBING ON CAPITOL HILL." That was an early mistake of the press when American Flight 77 crashed into the Pentagon. I remembered sitting in front of the TV with my roommate watching footage of the planes crashing into the WTC and the towers falling afterwards. I remember the deathly quiet that fell upon campus in the following days, as no one knew which city would be targeted next. Austin was an attractive city to attack if one really wanted to target President Bush. He had been the governor of Texas for years, and his daughter attended UT.
Last night I checked my Facebook while working (it was my last night working the 7pm -7am shift) when one friend's status caught my eye: "" Disbelieving, I checked CNN.com and saw nothing about such a story. Then my fellow nighttime resident got a text from the Associated Press, and she said, "Hey, you're right! Bin Laden is dead!" We then recalled hearing earlier that President Obama was planning to address the nation; fortunately we had finished our admissions at the time and hurried down to the resident lounge to watch the president speak. We were joined by several other residents, and when Obama finished speaking, all we could think was, "Wow."
The following footage of the people cheering in DC, New York, and the Phillies game (yes, fans there were chanting, "USA!" despite the game already dragging into the 12th inning) was uplifting. Most of the revelers on the streets were college students, who were only in elementary school ten years ago. It was encouraging to see that the September 11 attacks made such a huge impact on them so that they were the loudest among all those celebrating. Although I'm not really one to celebrate the death of another person, I was sure that the families of those who had lost loved ones to September 11 could find some closure in Bin Laden's death. And if that's the case, then the cause was a good one.
Last night I checked my Facebook while working (it was my last night working the 7pm -7am shift) when one friend's status caught my eye: "" Disbelieving, I checked CNN.com and saw nothing about such a story. Then my fellow nighttime resident got a text from the Associated Press, and she said, "Hey, you're right! Bin Laden is dead!" We then recalled hearing earlier that President Obama was planning to address the nation; fortunately we had finished our admissions at the time and hurried down to the resident lounge to watch the president speak. We were joined by several other residents, and when Obama finished speaking, all we could think was, "Wow."
The following footage of the people cheering in DC, New York, and the Phillies game (yes, fans there were chanting, "USA!" despite the game already dragging into the 12th inning) was uplifting. Most of the revelers on the streets were college students, who were only in elementary school ten years ago. It was encouraging to see that the September 11 attacks made such a huge impact on them so that they were the loudest among all those celebrating. Although I'm not really one to celebrate the death of another person, I was sure that the families of those who had lost loved ones to September 11 could find some closure in Bin Laden's death. And if that's the case, then the cause was a good one.
Friday, April 1, 2011
Lankenau Hospital
First Impressions: Lankenau Hospital is located in Wynnewood, a suburb just outside of Philly; I've driven past it on several occasions to go to shop at the nearby farmer's market. It was a community hospital; one of my upper levels said he'd interviewed there for residency but hadn't been impressed when the intern kept answering pages and was too busy to really tell him about the program during the tour. I hoped the fellowship program was different.
Interview Day: What is going on with the weather here? I thought it was some sort of April Fool's joke when I saw huge snowflakes falling outside, but fortunately it didn't stick. There were three applicants total; the program director welcomed us and took us to Grand Rounds. The topic was rheumatology, and the speaker was a UTSW-trained rheumatologist from Baylor in Dallas, which was a pleasant surprise. Afterwards the program director told us a little about the program for about 1 hr, and then the 3rd year fellow took us on a tour around the hospital. The hospital itself was nowhere as large as HUH, but more spacious and well-lit. Amusingly enough, I was most impressed with the variety of food in the cafeteria; fresh sushi daily! =P Prior to interviews we attended tumor board at noon conference, where I noted that the camaraderie among the residents and fellows was really good. I had two interviews, one with the PD, one with another attending. I appreciated that the first attending had prepared a list of questions to ask me based on my CV; he even asked me questions about my dean's letter, which was a big surprise. The PD asked me a list of questions that she asks everyone. Among the tough ones were "Tell me something about yourself that's not on your CV" and "Tell me something your patients taught you." Not sure I answered the second question well, and the 1st one took me a while, but I said I had perfect pitch.
Overall Impression: Pros:
Cons:
Interview Day: What is going on with the weather here? I thought it was some sort of April Fool's joke when I saw huge snowflakes falling outside, but fortunately it didn't stick. There were three applicants total; the program director welcomed us and took us to Grand Rounds. The topic was rheumatology, and the speaker was a UTSW-trained rheumatologist from Baylor in Dallas, which was a pleasant surprise. Afterwards the program director told us a little about the program for about 1 hr, and then the 3rd year fellow took us on a tour around the hospital. The hospital itself was nowhere as large as HUH, but more spacious and well-lit. Amusingly enough, I was most impressed with the variety of food in the cafeteria; fresh sushi daily! =P Prior to interviews we attended tumor board at noon conference, where I noted that the camaraderie among the residents and fellows was really good. I had two interviews, one with the PD, one with another attending. I appreciated that the first attending had prepared a list of questions to ask me based on my CV; he even asked me questions about my dean's letter, which was a big surprise. The PD asked me a list of questions that she asks everyone. Among the tough ones were "Tell me something about yourself that's not on your CV" and "Tell me something your patients taught you." Not sure I answered the second question well, and the 1st one took me a while, but I said I had perfect pitch.
Overall Impression: Pros:
Cons:
Thursday, March 24, 2011
Thomas Jefferson University Hospital
First Impressions: I got a voicemail from the program coordinator one week ago saying that they had an opening in their interview schedule and asked if I'd be able to make it. I originally said no because I was on call that day, but after thinking about it I called them back and said I'd find a way to be there. Fortunately since my interview was in Philly and would end at 1 pm, the chiefs gave me permission to miss half a day of MICU and then return to complete my call. I hadn't heard too much about Jeff except that its fellows worked very hard and that the program liked to takes its own residents into their fellowship.
Interview Day: I thought seeing snow in Stony Brook in late March was unusual, but as I walked to my interview there were big fat snowflakes falling from the sky. There were only 3 applicants at the interview (one of whom I'd met at Montefiore), and the program coordinator was quick to tell us about the program and, more importantly, how we were graded on our interviews. We got a copy of the "grade sheet" every interviewer gets; basically, the ideal applicant would have board scores in the top 10%, have rec letters from prominent leaders in heme/onc, excellent personal statement, strong interest in research and academics, etc. If I had to grade myself, I'd rank smack-dab in the middle, and wondered how they even selected me for an interview in the first place. I think the only thing I had going for me was my personal statement. There were four interviews total. The first was with a hematologist who was infamous for cutting interviews short if he didn't find you worth his time. Fortunately we were able to talk for the full 20 min, though I could tell he was very hard to please. The second interview was with the program director, who was a HUH grad and commented that HUH grads usually do well in the heme/onc program at Jeff. The other two interviews passed by in a blur. Afterwards we had a tour of the hospital (which was well lit and nice) and infusion centers, then had lunch while a fellow spoke with us. We were done by 1:15 pm and I was able to get back to work before 2 pm. The resident who covered my morning shift said it was the easiest call ever for him.
Overall Impression: Pros: Diverse pathology, 5 fellows a year. Located in Philly, associated with Kimmel Cancer Center. Very strong in hematology.
Cons: Weaker in solid tumors, emphasis on research, likes to take their own residents, no free parking in Center City (which my own program offers)
Wednesday, March 23, 2011
Stony Brook University
First Impressions: I met a guy from Stony Brook at my RWJMS interview and had asked him back then what the program was like. He said there was more emphasis on clinical practice, less on research, but that it was a great program. I drove to Stony Brook the night before my interview accompanied by a classmate's fiancee, who was a PGY2 at Stony Brook and needed a ride back home. She was able to tell me where to go since my GPS was not working, and let me tell you, the night sight of NYC from the Verrazano Bridge was amazing.Interview Day: It was snowing/raining as I drove to Stony Brook University Cancer Center, which seemed a bit bizarre for March. Incidentally I ran into the guy from RWJMS outside the entrance, and he said, "Welcome to Stony Brook." There were 5 of us total interviewing that day; two of which were from Stony Brook. The other two applicants I'd met at the Drexel interview just last week; both of them had interviewed at Jefferson (my next interview) just two days. We had a brief overview of the program from the PD before one of the fellows took us on a tour of the hospital. The hospital consisted of two round towers connected by a walkway; all the floors had a circular pattern. I immediately made note of the Starbucks on the ground floor ;) There was also a VA located about 30 min away where fellows do their continuity clinic (and have plenty of autonomy while doing so), but we didn't go there.
We had two interviews each today, and I think I got extremely lucky with my interviewers. The first was a breast cancer specialist not too far out of fellowship, so he was extremely easy to talk to. We chatted about breast cancer, non-fiction books dealing with medicine (i.e. the infamous House of God), medical TV shows, and more. My next interview was with an attending from the VA who also happened to be Taiwanese, so we talked briefly about places in Taiwan worth visiting. He made it clear that he wanted to know who I was as a person, not about how much reseach I've done (thank goodness), and asked questions about my life and my family. He took lots of notes about me, and when I told him why I wanted to specialize in heme onc (my mother was a breast cancer survivor), he looked impressed and said he would like to see me here next year. O.O That is the most positive feedback I have ever received at any interview.
Overall Impression:
Pros: Good balance in both heme and onc, diverse pathology throughout Long Island, 3 fellows a year. Autonomy in decision making and patient care at the VA. Emphasis on clinical training. Friendly fellows and attendings. Located 1 hr away from NYC and JFK International Airport. Long Island known to have famous beaches and diverse outdoor life.
Cons: Stony Brook seems a bit isolated, surrounded by small suburbs. Still, there are Starbucks, Barnes and Noble, and even a Cheesecake Factory nearby, so it can't be too bad.
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