Speed Dating

I spent this past Thursday and Friday in Asheville, NC, interviewing with students and faculty for the third year pilot (see Why Asheville for the details). It was a very good (yet very tiring) 24 hours. Julia Brant, Daniel White, Lisa Webb, and I carpooled into town right after lectures on Thursday, arriving just in time to meet at Barley's for a meet 'n greet, pizza and beer provided. There, we slapped on some name tags and got to mingling with students and faculty, making the rounds and introducing ourselves to committee members and potential future attendings. From there it was off to bed for an early wake up on Friday, which would include seven morning interviews and a tour of Mission Hospital in Asheville. Seven interviews is the most I've ever had in a day, and it was certainly a great experience. I understand that residency interviews will be all day, times 10 or 12 or how many programs invite you to visit. So the morning was a good early prep for a life filled with continual residency, fellowship, and job interviews.

The sessions were very interesting, and are the cause of today's introspection. I think most went very well; the first three 30 minute interviews were more in depth, while the latter four only spanned 15 minutes (it was rapid fire, hence the title, "Speed Dating"). We were shuffled in and out of 14 different rooms with single or paired interviewers, who had just as long a day as we did, probably longer. Two areas of inquiry that kept coming up centered around my interest in health policy and my penchant for Emergency Medicine. The Asheville Pilot, which focuses on a "medical home," and a coordinated care learning model, has strong ties to rural health and outpatient care. I think EM and my political tendencies may seem to antagonize this structure. Being originally from Washington, DC, it is not unrealistic for people to see me as someone who intends to move back to the Nation's Capital with policy in mind. Originally, some of my classmates thought I had no intention of even practicing medicine (which absolutely can't be further from the truth), given my involvement in the Health Policy Interest Group. I reiterate here that my number one priority is to become a outstanding clinician, leaving policy as my second passion.

I believe that any time you can see the broader picture, that context begets knowledge. For many medical students (especially at UNC), that's what the Masters in Public Health is all about. One must understand the patient in the broader context of his or her disease. The idea is to be able to look more critically at the epidemiology. How does this disease manifest not only at the level of this patient, but also in the population as a whole? I have this same interest, but in a different scope. I think my DC upbringing, parents in public service, and political science background, have made me a "systems" person.  I want to how we can become better patient care providers in the context of the current business model. What does the Patient Centered Medical Home and Accountable Care Organization look like? How can we implement a lasting model? These are the questions I want to be able to answer.

This interest in policy is not incongruous with rural medicine. We need more physicians who are leaders and patient advocates. Medicine in the United States is still practiced in the outpatient setting. Most patients are not walking up to major academic health care centers as their primary care facilities. I don't believe the health of this nation rests on the Harvards and the UCSFs. I think it rests on access, coverage, integrated care, and preventative medicine, which are some of the biggest problems facing rural medicine. What I'm trying to say is, I think the Asheville program would have an strong influence on how I view medicine in this context. I think this experience could only enhance my understanding of the system, and would encourage my advocacy for rural health, whether that be 10, 20, or 40 years in the future. Our lives are shaped by each day's experiences.  I've been in DC for 18 years and Chapel Hill now for seven; there's more to the world than the big city and Blue Heaven.

I also realize that I need to take a step back, disconnect, and see the options out there. I really do enjoy what I've seen in Emergency Medicine; there's no question. But I also enjoyed my six weeks in surgery during undergrad, and my weeks in Pediatrics out in Boone, NC. I can't make any decisions until after third year, and I'll probably need some of fourth year to truly know what I want to do. I need my mind to be a blank canvas, letting each clerkship draw its own picture and make its own mark. But I understand my experience is in EMS and the emergency setting; I'm just not ready to be pigeonholed in one specialty just yet.

No matter what happens, I am going to get a fantastic education; it is important for me to remember that. A lot of amazing people applied for this program and it is competitive, but I will become an outstanding clinician in Asheville, Charlotte, or wherever else I'm headed. I've made a lot of choices in my life, and I've made a lot of mistakes. But when I choose to learn from my them, life seems to always work itself out. Two years ago, I thought that I really wanted to end up at Duke for medical school. Only now can I look back and see how silly that was. I remember trying to decide between Princeton and UNC for college; again, it should've been a no-brainer. Every time I've ended up in the right place, at the right time. Of course there are a few things I wish I had done differently along the way, but it all works out at the end.

I have much to look forward to in the coming weeks: the men's heath exam, Community Week #5, and spring break! Damn, time flies.

Big Checks

Today was a big day in the life of Robert A. Swendiman and Ronald W. Milam Jr.  (NB: It's officially "Robert" now.  It's time to take a leap forward and be a bit more professional.  "Dr. Robby" just isn't going to cut it anymore.).  Today I reached another milestone, and thus checked off another one of my life goals.  Today Ronald Milam and I presented a BIG CHECK.  As part of Community Service Day, Ronnie and I were able to officially donate three thousand five hundred twelve dollars and zero cents earned (that's 440 calendars sold) from calendar sales to the SHAC foundation (http://www.med.unc.edu/shac/).  And so we handed off a BIG CHECK to Dr. Steiner and the Medical Foundation (pictured upper left).  It is a great sigh of relief to have this project behind me, because despite having a great deal of fun for a good cause, it took a lot more work than expected.  I originally thought we were going to be able to sell this thing online.  Instead, Ronnie and I ended up spending a significant amount of time selling calendars in the Pit, at sororities (thank you Tri-Sigma and Kappa Delta!), and around campus (now thank you, Ronnie!)

But I did learn a lot in the process.  Here are a few of the 2011 Men of Med School Calendar pearls, i.e. things you should know if you're ever going to make a calendar yourself:

• Being "Mr. June" and cavorting around campus totally erases any previous associations / appellations one might have.  Around the Admissions Office, I used to be "Coffee Boy."  That's because the first time I met with Dr. Bashford in the summer of 2008, I brought in coffee for the whole office (Starbucks baristas do have some perks).  Then I became "Rapper Boy," after the release of 5 Star Nerve.  Today, all past achievements and transgressions have been forgiven and forgotten.  I am "Calendar Boy," and forever will be until Ronnie and I choose to do something even more grandiose... so it looks like I'm stuck with "Calendar Boy" for a while.  This can be good or bad.  I still am unsure as to whether this will affect my Match prospects for Residency.
• Secondly, the most important part of making a calendar is how you pick the 12 people in it.  I cannot tell you how many people wanted to know how the 12 of us were officially chosen.  When I responded by saying I just emailed 11 of my friends and they said OK, I was met with dismay.  Did you think these were the hottest 11 classmates?  Why didn't you let girls pick them?  Do you only have hot friends?  Are you gay?  Most people could not understand why there wasn't a more systematic selection process.  So choose your men wisely.  Otherwise you'll certainly hear it from the peanut gallery.
• If you ever want to advertise anything, post it on Facebook 100+ times a day.  You need to literally shove your product down consumers' throats.  I'm not kidding.  I would get sarcastic messages from people ("hey man, are you selling calendars or something"), but every one of them bought a calendar!  If you dangle your product in front of people (in this case, 11 hot men + me), people will buy it.  My only regret on this front is that I didn't tweet the calendar to the whole world.  We could have doubled our profits.
• Use Google Spreadsheets.  It's the bomb.
• Sorority chicks love charity calendars.  Ronnie and I walked into Tri-Sigma with a stack of calendars and two med school men (Eric Golike and Eric Formeister - Mr. July and Mr. November, respectively) with their shirts off, and we sold 20 calendars right then and there.  A funny presentation and some stethoscopes will literally have hundreds of coeds throwing money at you.  Yes, throwing money at you.  I felt dirty after I left because I thought I was a stripper.  Money was thrown at me.  I left with a pocket full of ones with SHAC's name on it.  Oh well, anything for a good cause, right?
• $10 is easier to sell than $12.  Carry a ton of change if you're going to use an odd figure.
• Pick a great teammate.  I couldn't have done it all without Ronnie.  He is the one who originally convinced me to buy 500 calendars, and then convinced me not to buy another 100 when my eyes got big.
• Pick a great charity.  Believe it or not, last week was the first time I volunteered at SHAC.  I am literally the last person in my class to volunteer, but I only finished EMS in January.  It was a wonderful experience.  It's a free clinic for the underserved and underinsured, and I learned a ton in the process.  First-years through attendings all coordinate care, and a lot gets done.  I couldn't be happier that Ronnie and I were able to raise so much money for a good cause.

I'm glad we did it.  I learned a lot about fundraising, advertising, photography, and philanthropy.  Maybe in the future I can be a part of fundraising on a broader scale.  As long as Facebook and Twitter still exist, there are no limits.

In an email from the Medical Foundation, Ronnie and I were thanked for our contribution for SHAC.  They also noted that they couldn't wait for the 2012 calendar.  I suggested that the faculty should take the lead on next year's edition.

D to the M to the O-T-T

Part VI in my med student illumination series features one of my favorite people in entire the world. D has been with me since the beginning. She has been an integral part of the Health Policy Interest Group leadership, we've co-oped numerous "On the Wards" patient visits during our Introduction to Clinical Medicine tenure, and now we spend a few hours every Monday and Thursday working together through Doctors In Training (aka DIT - I'll post on this when the lectures start in May, but it's an incredibly overpriced tutorial through Step 1 that steals money from poor medical students - that being said, we bought it anyway).  Anywho, D has suffered through a plethora of my patient interview follies, anti-Facebook rants (no, Mom, I did not defriend you; I deactivated the whole thing entirely!), and weekly Board review "pimp" sessions. But despite this, we work well together. Or at least that's my perception, and she continually brings out the best in me. The bottom line is, I can't believe I've taken this long to blog about D.  My most sincere apologies.

Now what I'm about to say is going to be shocking. I am speaking fondly of someone who (voluntarily) went to Dook. Yes, Dook, but do not let that fool you. D is a Carolina girl at heart, and I would've gone to Dook too if I had been a Robertson Scholar. (In fact, that would have been the only way I could've gone there, since my Pops told me he'd pay for me to go to any college in the country... except Dook). After finishing up what had to be a miserable four years in Durham, D decided to take her talents nine miles down the road, and began a Masters o' Public Health here at UNC. You see, D is also on the 10-year Tobacco Road program.  Four years at Duke undergrad, two years at the Gillings School of Public Health, and then another four at the SOM, (which means that 6 years at UNC > 4 years at Dook). That's a lot of Tobacco Road indeed, even for an out-of-stater.

Now I'm not going to list all the organizations she's running and extracurriculars that, well, she should be running. I'm tired of detailing all my friends overachieving-ness. It will suffice to say that D makes Ronnie Milam look like a couch potato. It's HIV/AIDS research this, SHAC that. Grant proposal this, Honors in that. Meeting here and there, and hey, she's fluent in Sinhala (look it up), and her Spanish isn't too shabby either. Overeducated and underpaid, D is a do-it-all to the maximum. If I were you, I'd go ahead and pencil in February 11, 2026 to your calendar, because that's the date when D is going to eradicate HIV/AIDS in Southeast Asia. And all these achievements are even more impressive considering that I'm not sure who's taller: D or Little Miss Klara Klein. Who knows why all my female friends are under 5 feet tall, but the old maxim remains true: good things do come in small packages.

In our most recent Introduction to Clinical Medicine class, we were subjected to the "challenging" interview. Basically the SOM hires actors as Standardized Patients (SPs) to help us develop our history taking and physical exam skills before working with real patients. The "challenging" interview was meant to pair us up against a difficult SP. Patients can be angry, histrionic, depressed, etc. and it's our job as future physicians to elicit a H&P no matter what. Students in our class were clamoring for D to show us how it's done, because she's just that damn good. The week before, we practiced the "counseling" interview - talking to an obese patient about losing weight or a smoker about quitting. Within five minutes, D had the latter patient off the patient's habit, and the rest of us ready to quit ourselves (even though none of us smoke we were ready to quit something). Some people just have an innate ability to connect with others, and D exemplifies this to a fault (it's a fault because she puts the rest of us to shame - throwing off the curve). Needless to say, our bout with the challenging interview did not go as smoothly. I opened with an introduction of Gary Burke and myself as second year medical students, and then asked the patient, "What's going on today?" He retorted, "Well, my name is Mr. Kenmore, IF YOU CARE!" (It was a rocky start, but we softened him up as time went on). D rarely makes these mistakes; she wrote the book on Sounding Empathetic in 20 Seconds or Less.

DIT sends us 15 questions each week. Every Monday and Thursday, D and I scoop out a study room in Bondurant Hall and get to work. We spend much of the time reviewing, quizzing, and participating in general mind expansion. Working on these questions alone would be fairly miserable, but when I'm having a bad day or I'm tired, D pushes me through a couple hours of work, and I always feel better at the end. It's a friendly competition to push each other through, and it makes me want to come back to our next session a little bit better and a little bit smarter. When I step back and think about it, I actually feel like I'm her patient and she's my expert physician. We make appointments to meet in the same, small, well-lit room. She uses a lot of big words. And I leave happier and healthier. I guess the only difference is I keep my pants on during the entire interview.

Honestly though, D is one of my favorite people ever ever ever, and it's been awesome working with someone who truly brings out the best in me.

Being "Cool"

The other day I found myself lounging at my favorite coffee shop, listening to a couple physicians and a 3rd year med student chit-chat about specialities, the future of medicine, etc.  The third year was eliminating specialties and residency programs based on the relative proximity to a coastline (is there time to sit on a beach as an intern?).  It's fun to play a mental "choose your own adventure" game as a means of procrastination. One of the physicians was trying to get the student to realize her true potential by taking the Internal Medicine route through to Hematology-Oncology or Neurology. This quickly turned into "picking a career path via the process of elimination." Dermatology has too many pimples, Internal Medicine rounds take too long, I'll become a drug addict if I become an Anesthesiologist, and so on and so forth. I stayed mute during most of the conversation, because recently I've realized that I really have no clue... about anything.

My Asheville application is a perfect example. There were three short answer questions and an essay. What is your name? Do you speak any other languages? What specialities are you interested in?  Then there was the long essay about "Why Asheville?"  Robert, No, and then the third question gave me pause. After much thought, I decided to go with, "Emergency Medicine, Pediatrics, and Pulmonary & Critical Care Medicine."  I think this is a nice way of saying, Well it's not like I haven't been paying attention at all!  Because I do have interests.  Yes, see!  I have lots of interests!  But in reality I have no freakin' clue.  I like EM. There are some really cool things about it that would fit my personality. Research in pre-hospital care would be ideal. But then I hear this or that from an ER doc or some other physician and it makes me think twice. I love kids too. At some point down the line I'd probably pursue a subspecialty in Peds, but not for a while.  And then there's Pulm  Of all the organ systems and pathology that we've done over the past year and a half, there's only system that I've truly enjoyed. One Block where I really looked forward to studying  I even read the textbook twice (Yes, Mom. I read it twice, even though you scoff).  And the best part is, I have absolutely no idea why I like it so much. It wasn't even my best Block this year. I don't know; the lungs just make sense. They're just... cool?

So what I guess I've come to realize is that I really won't know what I want to do until the end of third year, or maybe sometime into fourth  I'm certainly glad I'm taking a year off, because I'm probably going to need all of that time to make a decision  But will it really be a process of elimination  Do I literally go through each rotation and check them off the list? I've already done that with a few. Radiology? Too much time in a dark room. Dermatology? Too many pimples (I was serious about the pimples; I want none of that)  Optho? The one thing in EMS that I couldn't stand was when eyes were mangled  If I have to deal with it I will, but not on a daily basis please. Psychiatry? Well, I'm crazy enough, thank you  And then other things that I didn't even know could be cool I'm now considering, simply because one physician talked a good talk about it. The Chief of Anesthesia at UNC came in to chat with the class about a career in Anesthesiology, and I came out of there ready to go throw in some nerve blocks ASAP (NB: that didn't happen with most other speciality lunch meetings, believe me).

Bottom line: I literally will have no clue until I've done all my rotations. And neither do you.

Being around all this career talk has made me introspective. I started thinking about why I really came to medical school. Was it a process of elimination too?  I remember working in my Dad's law firm as a kid, sorting and alphabetizing client folders. A-k comes before A-l. Yes sir, I know my alphabet. I checked law off my list quickly after that, even though I think lawyers do do slightly more than alphabetizing and file now that we have computers. I nixed "scientist" off the list when I exploded my first thermometer in Organic Chemistry lab (with the help of my partner Becky Smock), because I was too impatient to wait for the compound to boil. I turned the dial up to 10 and mercury went everywhere (instructors said to use between 2 and 3 as the setting). I also can eliminate "rap career" pretty much every day when I look in the mirror. So why am I here?  I certainly came up with good enough reasons to get in during my interviews. I can go to the top of this Blog's page, just under the title "Language of Medicine," and reread part of my Personal Statement. Just based on that, it looks like I signed up to be a doctor only because, well, the profession looked... cool. Too bad I couldn't just say that during interviews.

Now I know it's more than that. I know there are a lot of reasons why I want to be a physician, but perhaps the most important one is that I think being a doctor is "cool." Everyday I can wake up and enjoy what I do because it's cool, and therefore, fulfilling. Traveling abroad to work with the underserved is cool, potentially affecting health policy is cool, and building relationships with other people every single day is cool too. So if I should do things that are cool, sign me up for Pulm & Critical Care I guess?

Time has gone by so fast, and we're almost to the half way point. I'm almost 25 years old and I thought I had it all figured out. But I guess I still really don't have a clue... about anything.