Drowning

(this was a piece that I wrote that was accepted to JAMA Pediatrics; I will post a link here when it is published)

Welcome to ERAS

So if you can't read the fine print here to the left, you should at least be able to appreciate that applying to residency programs is a little bit of a hot mess. The "match" itself is completely unnerving. Over the next few months I will apply to dozens of programs, hope to interview at about 10 to 12, and then "rank" these programs in order of my preference. Students all across the country will do the same, and then on March 21st, a computer will spit out where each of us will end up. I could match at my number one choice, my fifth, my last, or not at all.

Cray, right?

Alright, so here's how it all breaks down. The application itself is all through a single website (thank goodness), affectionately known as "ERAS." This is where you upload your CV, personal statement, and letters of recommendation. In addition, the medical schools will submit transcripts and their "Dean's Letter," which summarizes your schooling and explains the grading system. It also recommends the student as "outstanding," "excellent," "very good," "good," or some other modifier (there is no "bad" med student; that would hurt our feelings too much). Students are supposed to have everything ready by September 15th, and on that morning, we can click (and pay lots of money for) all the programs to which we want to apply. Residency programs can then begin downloading applications and sending out interviews.

On October 1st, our Dean's Letter is released to the schools. Apparently (and I'm not sure if I'm right about this), a lot of programs wait until October to send out invitations, once they've skimmed the Dean's Letter. Invitations go out, and students schedule interviews as fast as possible. This can be a bit of a cluster, because sometimes programs offer more invitations than actual spots (one of my close friends last year got an email from a program at 3am; she responded at 7am when she woke up, and all the spots were filled...). November, December, and January will be a great opportunity to accrue Delta SkyMiles.

Interviews are scheduled, and then we hit the "trail." Quickly, we start seeing a lot of familiar faces, as the same people keep popping up at all the same interviews. Other recruits are a great source of information, and many students bond on the trail (some even find true love, I hear, which is a little scary). After the trail, programs will have a "second-look" day for students who are interested. Before we know it, it's mid-February, and it's time to rank programs.

Skip to the Monday before the match. All applicants get an email letting them know if they have matched or not. If they've matched, it does not tell them where. This allows students who haven't matched to "scramble" into programs with empty spots. I don't know how this works, and I pray I don't have to find out. So that is all I will say about that.

On March 21st, we find out where we'll learn to become a real doctor. And it could be anywhere.

Everyone who's been through the process says, "Have fun! Enjoy it! It's just as much about you interviewing them as them interviewing you." Fiddlesticks. Actually, the interviewing could be fun; it's the scheduling that will drive me nuts. I don't want to be up at 3am every day to make sure I don't miss an opportunity at one of my top choices. And I don't want to spend all the money I'm going to have to spend. I just keep telling myself it will all be worth it...

I will update y'all on the process as it moves forward!

Surgery vs. Swimming

There is a flag in the surgical intern call-room, pictured left. This sentiment is oddly reminiscent of my swimming days (in fact, I think this is a direct quote from a number of my previous coaches...). Maybe this is why I am drawn to surgery; the similarities are abundant. Either that, or I am just a glutton for punishment. It's never made sense: I love to sleep 10 hours a night and I'm kinda lazy. Nevertheless, I keep choosing activities with horrible hours.

It has been a while since I've posted any countdowns or lists, so I bring to you the 7 reasons surgery and swimming are exactly the same. I encourage you to add to this list...

1. Four in the morning is considered an acceptable time to begin the day. Four is early, five is normal, and six is sleeping in. Three I just refuse to do. When I was in high school, I remember having to wake up at 4:11am to get to the pool exactly on time. Not a minute too early. I've never understood why we have to wake up so freaking early to get stuff done. In Surgery, it's because you have to start operating by 7:30 or 8am. Well, when I'm an attending, we'll start at ten! But getting home at midnight is as equally depressing as the pre-dawn wake-up.

2. Everyone falls asleep during class. If you're going to wake up at 4am or earlier, you aren't getting much sleep. One thing I like about surgery is it's go-go-go. Always moving, always working. But lectures and tutorials are sandwiched in between. The moment I sit down, my eyes start to droop. And I'm not the only one. Five minutes into a presentation, the interns' heads start to bob. The residents are pretty crafty though. In a big lecture hall, it can look like you are reading, but if you listen closely, you can hear a faint snore. The only difference between surgical lectures and college classes is I could straight up just skip the latter.

3. BEEEEEP, BEEEEEEP, BEEEEP!! Pagers beep, swimming clocks beep. They are both loud and annoying.

4. Everyone around you is just as crazy as you are. Swimmers are their own breed. I could walk onto any college campus right now and pick out who the swimmers are walking to class. Athletic gear, slightly slower pace, broad shoulders. The women have damp hair; the men have just bleached disgustingness going on. Med students are their own breed too, but surgeons are a cult. I shouldn't say too much, but spend enough time in the hospital and you'll know exactly what I mean.

5. You are always doing something incorrectly. I once talked to a sports psychologist who told me I was the quintessential trained rat in a maze. If you put a piece of cheese in the middle, I would run around the maze until I found it. Once I found the cheese, I would go back to that spot every time I was put in the maze. Even if there was no cheese, I would keep running to that spot, over and over again. So long as a piece of cheese was put in there once in a blue moon, I would keep running. She told me this is how I am with positive feedback and praise. I'll keep working for it. I'll bitch and moan when I don't have it, but I want that one piece of cheese, and I'll keep working for it, even if it's only thrown out every once in a while. This is the best way to get me to perform. All my best swim coaches understood this. This mentality is perfect for surgery. Most of the time you are meant to feel barely adequate, but every once in a while...

6. Everything is a competition. Whether its knot-tying or taco bell burritos, you want to be number one. Either the best surgeon, the fastest swimmer, or the burrito eating champion. And it's not just in the OR or the pool. Our annual swim team beer pong tournament at UNC was just as fierce as ACC Championships.

7. Nothing is more rewarding, but the grass is always greener on the other side. "I should've played tennis." I used to say that constantly (in fact, I still do). Swimming is like the worst sport ever. The hours are terrible, there's no career in it, chicks don't really dig it, and you completely lose out on a college experience.  But at its best, there's nothing better. Beating UVA is still one of the greatest experiences of my life. A number of surgeons have told me that if they could go back and do it all over again, they'd be radiologists or dermatologists. But then you see them when a life is on the line, and they love it. They love the rush. They would quit if they could, but they can't. Addiction.

To the Big House!

Rebekah likes to tell the story of our first day on Obstetrics and Gynecology (OB/GYN) as third year med students. There were three of us traveling up the elevator at Mission Hospitals: Rebekah, Blake Pemberton, and me. The ride up four flights from the parking garage was pin-drop silent. It was the first time she'd seen me with my mouth shut. She also says that I looked a new shade of pale, but I think that was just the lighting.

Truth be told, I was overly apprehensive. OB/GYN was the one rotation I was not looking forward to. It was my second clerkship, and though I was definitely nervous for Surgery six weeks prior, it was a different type of nervous. Everyone is nervy when they start third year. The comfort of the classroom is gone. Patients bite. Doctors bite. Nurses bite. Snakes bite. You realize you know nothing. For OB/GYN it was different. It was the kind of nervous I hope most 20-something males have when they realize that for the next six weeks they are going to be completely surrounded by female parts (in a clinical way). Lots of female parts, and they don't really know how they work...

Ma'am, I understand you are going through a lot of pain right now.
YOU DO NOT UNDERSTAND MY PAIN. YOU WILL NEVER HAVE A BABY AND YOU WILL NEVER MENSTRUATE!!!

This is how I imagined most conversations would go. Also I would have to not smile when people would say the words "penis" and "vagina" (I made it the entire six weeks without giggling by the way - Mom, I'm so grown up!).

Anywho, I tell you that story to help you understand how nervous I was for this Monday (and by "you" I mean future Robby who will change the story in his mind about how cool, calm, and collected I really was). Here, as a fourth year, I was starting perhaps my most important rotation in medical school, and I had never even been to UNC Hospitals, my home institution. I didn't know where anything was, didn't know if my badge would work, didn't know if I would be able to eat (i.e. where would I steal food from?!), etc. Pediatric Surgery will be my only UNC rotation on my transcript, and I also need to garner a letter of recommendation (LOR) from a surgical faculty member. The pressure was on.

So we met at 6am in the PICU on Monday, and my resident tells me to go print off a "list" (list of all the patients that are on our service). Zero clue how to do this. When I sit down at the computer, I realize I don't even know how to log-on to a generic UNC computer. I ask the nurse. Ohhhhh, so you are like "new-new." Here ya go, honey.

I am not a "honey." I'm just new-new.

The administrative mayhem this week went from bad to worse. Absolutely nothing worked. My badge didn't open any doors until I got a new OneCard, and spent 20 minutes on the phone with the hospital IT people. My parking badge was an epic fail, and I accumulated two parking tickets along the path to fixing that disaster. I couldn't view radiology images, and I couldn't find my way to the operating rooms. Oh, and there are two third year med students with me that know a heck of a lot more about the UNC computer system than I do. #FourthYearFailure

But the OR is the OR, no matter where you go. Clean, sterile, precise. The rules are the same everywhere. So, for the first case I scrubbed in on with the attending and chief resident, I was ready. It was a laparoscopic case, so I was able to operate the camera. I did not induce motion sickness in anyone. I held the trocars in place when they were inserting instruments. I knew when to turn the lights away. I knew how to scrub. And when the attending asked, I told him I was a fourth year going into General Surgery. He replied, "Oh, that makes sense. I thought you knew what you were doing in here..."

FOR THE WIN!!!

Unfortunately, I think that was my only victory of the week. There is a steep learning curve that I have to climb on this rotation, and as my resident says, "Our goal in Surgery is to make sure you always feel barely adequate." Excellent.