Where to start...

I moved home from New York City in mid-December and I've been running ever since.  There were so many relatives that I have not seen (some since before I started medical school) and I still had to go to more residency interviews in January.  I have learned that I hate traveling but I like vacationing---I don't like taking driving trip, flying or basically any means of transportation that lasts more than a few hours, but I do like exploring a new corner of the world once I get there!

Well, lets just jump to the exciting parts.  At the end of the interviewing process, I had to make a "rank list" of all of the programs that I interviewed at--from my top choice down.  At the same time, the programs were making a rank list of their applicants.  Then a computer does some magic and "matches" me with the highest ranked program on my list that ranked me highly enough on their list so that I match into their program.  I submitted my rank list in early February and had to wait until March 12th to find out if I had matched.  An email was sent at 12:00pm EST on Monday, March 12th, but it only told you if you matched or if you did not.  Here is a copy of mine:

"Congratulations, you have matched!"


 I had no idea where I was going, but I knew I would be a pediatrician.  It was such a relief to know that I had a job.  I had been offered a position outside of the match (meaning that I would have signed the contract and cancelled my other interviews), which I turned down so I was anxious that I made the wrong decision until I found out that I got a job in the match.  The first couple days I was so excited that I got a job and I was dreaming of where it could be.  By Thursday, I was ready to know where I would be living for the next three years, but I wouldn't find out until Friday at 1:00 EST.  I was almost certain that I would be headed back to the Northeast, most likely New York City, so I was surprised to find out that I matched in the west: Viva Las Vegas!

I believe that applicants (and programs) do not find out where they matched until Friday because they do the SOAP (supplemental offers and acceptance program, which was formally the 'scramble').  The SOAP is like a mini application season--resubmit applications, offer of phone interview, rank list and offers--that occurs every few hours from Tuesday until Wednesday (or Thursday) afternoon.  It sounded like a horrible process and I am so grateful that I didn't have to go through it.  I believe the information of where people matched is withheld until Friday because many medical schools have "match day" parties and they want to give everyone a chance to go through the SOAP before the party.  I might not be right about that, but it makes sense to me.

As you can probably tell, this process is extremely stressful and you can be a great applicant, but still not match.  Since this is a once a year job application process, if you don't get hired, you wait until next year and do the whole process again.  They say that every year further from graduation you are, the harder it gets to match.  I cannot find the statistics from the 2012 match yet, but in 2011 30,589 applicants vied for 23,421  available first year and 2,737 second-year residency position  (some residencies have you do one year in a general specialty like internal medicine or surgery then you move into your very specialized field like radiology or ophthalmology).  From the information I can find, there were even more applicants this year and I don't think that the total number of residency positions changed much.  I am so lucky and grateful to have a residency spot for next year.

After learning that I matched, I had paperwork to get started.  I had to sign an agreement saying that I would be going to Nevada (part of going into the match is signing legally binding documents that state you will go wherever you match, if you don't you are in huge trouble--there are a few rare situations where you can apply for an exception, like if you get extremely ill and cannot start residency). Next, I had to start filling out my medical license application information.  It was so strange to fill in the line that says "physician's name" with mine. It was surreal.  Also, much of the information sent to me was addressed to Dr. Nicole or Nicole, M.D., which still makes me smile to see.  I have dreamed of being a doctor since I was five years old and I have been working for years, but it still doesn't seem real yet.  I expect that after the first few months or year of residency, I'll be more comfortable being called doctor.  I have been advised by several nurse friends and other doctors that I must start residency by being called "Doctor" to make sure that I set myself up as a physician (rather than just someone else in the hospital) and then continue my hard work to earn my co-workers and patient's respect.  I have worked hard to earn my doctorate and now I need to live up to the title of doctor!

Planes, Trains and Automobiles

I have been very fortunate to have lots of residency interviews, but that also means I've had to do tons of traveling and will continue to travel for interviews until February 2012.  I have taken planes, trains and automobiles...the only mode of transportation I'm missing is a boat!  I hate the traveling and scheduling of everything--it's so much harder than the actual interviews! Most of my trips have been, thankfully, uneventful; however, there have been a few interesting trips so far.

Chicago:

My interview in Chicago was suppose to finish at 1:30, but we didn't finish until 2:30.  I had to catch an airport shuttle at my hotel at 3:30, which was about 10 minutes from the hospital.  The residency coordinator called me a taxi at 2:30, but one did not arrive.  I stood outside the hospital (in November) for an hour and a half waiting for this cab.  I kept calling the coordinator and I called the taxi company and even another taxi company.  No one could or would help me.  Needless to say, I missed my airport shuttle.  I saw a taxi coming toward the hospital at about 4:00 and begged him to take me to my hotel to pick up my bag then to the airport.  I was told by multiple people that there was no way I'd make the flight given Chicago traffic.  However, this taxi driver said it was no problem and I was at the airport by 4:40.  I don't even think he was speeding.  He had been driving taxi in Chicago for over 30 years and knew the roads.  I made my 5:30 flight with time to stop and grab a snack.  I wish I knew his name so I could write a letter to their union or licensing board: he was amazing!

Long Island:

The LIRR (Long Island Rail Road) is great, but I had to leave my apartment at 4:00am to my interview by 8:00am and I had no idea where I was going.  I decided to take a taxi, which was very expensive, but at least I didn't have a four hour commute (I was going out to Long Island when everyone else was coming into Manhattan so the trains were not coming frequently in the direction that I wanted to go).  I did take the train back and it was mid-afternoon so it took 2.5 hour due to the frequency of the trains, but I wasn't on a schedule so it didn't matter at that point.

Philadelphia:

I took the Greyhound Bus to Philly, which I've never done before.  Port Authority (the bus terminal in Manhattan) is full of the stereotypical bus rider.  Farley talked me into taking the bus rather than Amtrak because the bus is cheaper and initially he was going to go with me just for fun (he finished his rotations a couple weeks before me due to my schedule).  He decided not to go, but I was stuck on the bus.  The bus was fine and the trip was smooth, but waiting in line had me nervous.  Once I got to Philly, I had to walk across the street and take the SEPTA (train) to the airport, where the hotel shuttle picked me up.  I had no problem getting around the public transit in Philadelphia, but I realized I'm starting to become a New Yorker: I was annoyed by the slooooow trains. The interview was out a bit early.   I was able to do the same commute (shuttle bus to airport to train to bus depot) and make it back to the bus depot in time to take the 3:00 train rather than the 5:00.  We missed the Philadelphia traffic, but there is no missing the New York City traffic.  The trip would take two hours without any traffic and we could have done it except that the last two or three miles or so took more than an hour and a half.  I left Philadelphia at 3:00pm and arrived at my apartment a little before 8:00pm.

Buffalo: 

Now this takes the cake!  I was flying on a smaller commuter plane out of New York City.  We were about 10 minutes on our way to Buffalo, when they announced that we had to return to New York City.  I couldn't hear why (which was a good thing), but the flight attendant came around and told everyone it wasn't an emergency so don't worry.  Once we landed, which by the way was very smooth, I noticed many emergency vehicles surrounding the plane and they announced that we lost two-thirds of the power on the plane. The emergency personnel surrounding the plane made me nervous.  I suspect that they were preparing in case there were problems, but thankfully, everything was okay.  All of the passengers and crew boarded a new plane and everything went well except for a bit of turbulence, which I'll admit made me more nervous than usual.  

I hope that nothing eventful happens on my upcoming flights in January and I'm thankful that all of my travels have been safe, even if not as smooth as I'd like.

Residency Application

Farley and I have been in the middle of the residency application process since July. The application season opens in July when you can start working on your application and the application are first delivered to the programs on September 1st.  Then the waiting begins: will they or won't they interview us.  Luckily, Farley and I have both been offered a good number of interviews and most of them are in the same city, so we will likely get to stay near each other next year.  However, we will not know until March where we will finally end up.

I think the most stressful part of the application process is arranging the transportation and the hotels for the different cities.  When I was in Chicago, I almost missed my flight back to New York City because I couldn't get a taxi.  The interviews themselves have not been too stressful.  In fact, they are somewhat fun.  I get to see a new hospital, sometimes a new city, meet new people and imagine my life in this new place.  Sometimes, I get really excited at what I see in the future and other times, not so excited.  I am hoping that I end up in one of the places that really excites me and that Farley and I end up together.  I have been so stressed out this fall (and cranky), but I have to believe that things will work out for the best.

Back in the Saddle Again

I have been back in the hospital for eight weeks!  So much has happened, but I haven't been able to sit down long enough to write.  I started back in the hospital just four days after finishing my step 2CK.  My first rotation back was adult infectious disease.  I wasn't too excited to do another infectious disease rotation because I already did a pediatric infectious disease rotation (which I loved), but I wanted to be exposed to something new.

The first week of the rotation, the main doctor was out of town.  The doctor who was covering was nice, but he had a private practice so he didn't arrive at the hospital until late in the afternoon.  I enjoyed working with him, but I didn't see him too much.  When the main doctor came back, the fun really started.  She no longer had a private practice so she was a full time infectious disease doctor in the hospital.  The residents would divide the patients then we would go see the consults or new patients.  Late in the morning or early afternoon, the doctor would arrive and we would spend the next few hours seeing all the patients as a team.  I learned so much!  Some of the patients were really interesting and unusual, such as extra-pulmonary T.B.  I really loved the doctor that I worked with--she is a well known name in infectious disease and I feel so lucky that I had a chance to work with her.  It really was a honor.  I even attended a HIV conference at the Millennium UN Plaza Hotel!  The food was great and I learned about new diagnostic tests and treatment regimens.

After my month in adult Infectious Disease, I started my sub-internship in Pediatrics.  A sub-internship is basically when a 4th year medical students gets as close to being an intern (first year resident) as possible.  I was responsible for (helping) admitting patients, making daily plans, managing care and discharging patients.  Obviously, I was monitored closely by a resident, but I was responsible for getting paperwork done, getting old charts (if necessary), following up with the patients throughout the day, drawing bloods and basically anything else that needed to be done.

I had to do a week  (5) night calls, which was surprisingly fun.  There were two interns on call and one senior every night...well two interns for four nights and one intern for one night.  The first four days when we had two interns, it was super slow.  There were two patients at one point!  I spent part of every night rocking a baby, whose parents couldn't spend the night.  In the middle of this week of nights, the earthquake hit New York.  I work up about 2pm on Tuesday, August 23rd.  I thought that I overslept my alarm and that Farley was shaking me awake.  Then (logically) I thought someone was in my house shaking me until my bed started shaking again and I realized it was an earthquake.   I got up and watched the news for a while before going back to sleep.  Despite being from the west coast, I haven't lived through any substantial earthquakes, but I really wasn't concerned about the earthquake.  East coasters, on the other hand, were a bit up in arms.  Luckily, New York City was a-okay.  The last night of night calls was the only busy night: it was the night they were shutting down hospitals in the evacuation zones for Hurricane Irene.  We only had one patient transferred (as the hospital is far from any of the evacuation zones).  This patient was rater ill, not unstable, but had a chronic condition.  It is sad to see chronic conditions in children, but on the other hand, there are treatments available now whereas there were not before.  Anyway, I think a lot of people were a bit anxious about the impending storm because extra kids seemed to be coming up from the ER that night.  In the morning, I ended up taking a cab home  because the buses and subways were running more slowly in preparation for the shut down.  I got home and slept for a few hours before getting up and going to the gym.  My neighborhood was lucky and there was no damage--it was just a storm that lasted all day.  Other neighborhoods were no so lucky.

My first day back to the day shift started with a bang.  The subways and buses were still not running so I had to take a taxi again.  When I arrived at the hospital, I found out that is was change of service so I didn't have to present my patients (the senior residents were presenting as they were rotating).  There were a new batch of medical students starting and two very unstable patients (who happened to be coding back to back).  Needless to say, it was a rather exciting day and thankfully, both patients were okay.

Overall, I enjoyed my pediatrics sub-internship and I am happy with my decision to only apply to pediatric residency programs.  I submitted my application for residency during the middle of my sub-internship and I have heard back from four programs--50% interview rate--so far.  I applied to a bunch of programs so who knows where I'll end up...I just hope it is in the same city as Farley.