Expecting Again

Heading into my last week of general medicine in-patient work as an intern, with one more block of labor and delivery in-patient medicine in June.  In-patient rotations are the most taxing simply because they require one to work 6 days a week.  I find that generally I end up working 10-12 hours/day during the more chill, out-patient rotations, and 12-13 hours/day during the strenuous in-patient rotations, but the big difference in having a life is that the out patient (aka clinic) rotations are 5 days instead of 6 days per week, which just makes for a happier person.  The in-patient rotations however have their perks.  I feel more of a sense of control, every morning has a loosely structured schedule, and I get to accomplish my work however I want, I get sign-out (the low-down on what happened for my patients overnight and who got admitted to the team) from the night team, chart review, see my patients, start my notes, while chowing down on some breakfast; all this gets done in the first 3 hours of the day.  Then rounding (usually a sitting session – thank GOODNESS! Which is where we discuss the patients, their new labs or radiology reports, and their plan of care with the other team intern, the senior resident, and the attending… and sometimes our awesome clinical pharmacologist and a medical student or two), which takes a pretty variable amount of time depending on how much teaching or tangential talking we do … and the rest of the day disappears in a flurry of random tasks, some big some small, like running up to check an EKG or having a family meeting with the patient and their loved ones, or admitting a new patient from the emergency room, all which I must prioritize to ensure good patient care … and to ensure I don’t stay there till well after my 12 hour allotted shift time, which thankfully really doesn’t happen too often, usually only about once per week by about 1 hour.  The day is so busy and usually I do get some time to read or discuss learning points on my own or with my team, and those learning points are always so interesting because they are immediately relevant to what I’m doing and the decisions I have to make (or think I have to make but in reality, the real doctor, the attending, ultimately makes them, but hey I do have some say).

This is in contrast to clinic where I feel I have no control, I have to wait usually at least 20 minutes to see my first patient because it always takes that long for the medical assistant (MA) to screen them, and usually, since I am an intern, I have not even worked with the MA but once or twice so we are not used to each other and things do not flow very efficiently.  Then the day goes by quickly, yes, however I continue to feel I have no control over the day’s events, as each patient is a complete mystery, someone new I’ve never seen before, and who may or may not have a host of medical questions for me to address at our 40 minute appointment, which may seem like adequate time, but when you start by taking the first 20 minutes away, then add on trying to have a 5-10 min conversation with your attending in between interviewing, examining and wrapping up with the patient, which may at times require several iterations depending on the attending and how many things they want you to go back into the room to recheck, you are running behind by 30 minutes at a minimum at the end of the day and still have at least an hour’s worth of medical record documentation to do.  It’s far more draining than the in-patient work.  Perhaps spending more time in the clinic over the next few months will allow me to become more efficient and master the art of clinic flow.  Additionally, when second year officially starts, I’ll no longer have to take the extra step of precepting (or presenting my patient and the plan to an attending) except for patients in which I have questions or uncertainties.

Anyway, that about sums up the intern year schedule dynamics.  Somehow keeping sane most of the time, Andy-man and Mr. Darcy are ever a source of joy… and then there’s the excitement of expecting…


Yes we’re having another baby!  I just passed the big week number 24, also known as “vitality week” since it supposedly marks a statically significant difference in vitality between those who are born prior to verses after this date of gestation.  So I suppose I can worry a little less now.  I don’t know how to not worry, there is always something new on which to ruminate.  Did my water just break, or did i just pee myself?  Am I going into labor or is this just what running is going to feel like from now until I give birth? Knowledge on the subject of medicine and health only makes a person paranoid.

But anyway, there is a lot of excitement in the coming July, going to be finished with intern year, and Andy is going to be a big brother!  Also, another 3 minutes and it’s Easter, He is RISEN, he is RISEN INDEED, HALLELUJAH !



Quick Summary of How the Match Went!

For those of you who don’t know, I am now heading into the final week of this month long orientation to the Family Medicine Residency of …my top choice program! Fort Belvoir!  I was talking to a med student the other day (oh haha, I remember what it was like to be a med student…), just one year behind me in the process, and realized that I was already forgetting many of the interview trail details and tips I would have offered up just 6 months ago!

So before it’s all gone, here’s a “brief” synopsis…

RANK LIST: I wanted to be in Family Medicine, no 2nd choice specialties.  I wanted a military residency but also wanted to be in the D.C. area (as my hubby was there) so my rank list on the military application, which I had drafted up sometime in August, but was officially due by Oct 1st, looked like this…

#1. Fort Belvoir

#2. Civilian Deferred

#3-11? or so… Other military bases

My civilian/

SCHEDULING “auditions”/”Acting Internships”/”Sub-I’s”: I wanted to do my audition rotations as soon as I could, but also planned to do them after taking step 2 of the board exams, which I took end of May with just one week of scheduled exclusive study time, and I got a 608 (COMLEX, Level 2), think it went pretty well.  I chose to do them back-to-back so it would interfere with my school’s curriculum as little as possible and less flying around in theory AND some less jumping around for daycare for Andy.  I rotated at Eglin Air Force base in July and Fort Belvoir in August.  After scheduling these (which I did so in December the year prior), I also stuck an extremely stressful but extremely useful audition with the Georgetown Family Medicine Residency program in my schedule immediately before the one in Eglin – so I did that one in June.  I had to schedule that one through VSAS (visiting student application system) I believe.  If it wasn’t VSAS, then I must have done it by simply communicating with the Program Coordinator.  You can search for that information sometimes by just googling it, of course, but also on https://services.aamc.org/eras/erasstats/par/, ERAS (https://apps.aamc.org/myeras-web/#/landing … but your school must give you your application token to utilize this site), NMS (https://www.natmatch.com/aoairp/instdirp/aboutproglist.html) and http://opportunities.osteopathic.org/search/search.cfm.

CIVILIAN ONLINE APPLICATION: I applied to 34 allopathic residencies via ERAS, and eventually I also submitted an application for the osteopathic residencies via NMS, even though I applied for only 2 programs.  Applying to so many programs cost me a lot of money, probably about $500 total.  But I had no idea how many interviews I would get, and I wanted to have at least 10, with 3 of them being my top choice programs.  I started with fewer and gradually added some programs to my list as I did further research, and many of the programs in which I submitted very late applications, like all of the University of Pennsylvania ones that I randomly decided I wanted to apply to, never got interviews at, and they had like 3 different sites to which I applied.  I perhaps wouldn’t have applied for so many if I had done further research, and you can use sites like Doximity or the program’s website if often a good resource, but then again some programs have very limited info online, and sometimes you really have to go there and meet the people to understand what it’s like.  I submitted my finalized applications for both systems rather late – but I think did receive offers for a lot of interviews – 16 total, including all but 1 of my top tier programs!  So there is a tip for you – make sure you are aware of the soonest date you can submit your application so you can be first in line to get interview spots.  Although I will note that it kind of worked out for me, because by submitting my application later, I got the later interview spots which I was able to later cancel because after December 7th, I had my military match results, and knew I got Fort Belvoir.  Within about 2 weeks after submitting, I wrote emails to the programs that were among the top half in my list in which I didn’t get interviews, and this worked about 50%.  Just a note saying hey, I’m applying and really interested in your program, a couple tidbits about why that program specifically.  I know that one of the programs (University of Maryland) has a very allopathic-only type attitude, at least their faculty/residency selection would attest to this, also they don’t allow osteopathic students to audition, so this was a big clue to me to not bother applying, but I had to give it a try.

Some random tips –

  1. Always write your thank you notes! I also wrote some personalized follow up notes after the military match day, just saying that I’m so sorry to be withdrawing my ERAS application, and how much I enjoyed the program-just of course to my favorite programs/programs I really got close with like Georgetown and Grant Medical Center.
  2. Always go to the dinner/meal with the residents that are often included with the interview.  Unless you really cannot make it, in which case write them a nice email explaining why you are declining.
  3. Communicate with your school/home program because they may be assuming you’re planning to interview/apply there – I had an awkward encounter because I communicated in a rather delayed manor, but in my defense it wasn’t intentional and I was taking my time in getting my application/list of programs finalized… anyway it was frowned upon.

Some things I didn’t know until going into the interview season –

  1. You can’t rank a program that you didn’t interview with
  2. You can add programs to your ERAS application after you’ve submitted your first finalized version

So anyway, hopefully this helps a few medical students out there! Please post questions, I’d be glad to help you out!

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Before my Wright State interview at Good Samaritan Hospital

Snorkeling in Oahu

This past Sunday was tragically our last day in Oahu (during my post med-school/pre-residency sabbatical, part 2 – Hawai’i), but before we were to leave, we had plans to dip into the ocean one last time, along with some snorkeling gear, guided by James’ long-time friend, Jeff!  I was ever so excited for this, as the last time I had snorkeled was with some kiddy-gear in the Kennedy pool back-in-the-day during my childhood (looking back, that was an awesome toy!).  We met up at Kahe Beach Park, selected by our snorkeling-savvy friend.  It’s strategically located adjacent to an electricity plant, from which flows a large pipe of clean, heated water, about 40 feet below the ocean’s surface, thus creating a unique ecosystem, harboring an abundant and diverse gathering of fish and other wildlife for many-a snorkelers and divers to enjoy alike!


As I prepared for the day, packing and plunging into my bathing suit, I recalled Jeff’s words, “you guys are ok with going over 40-foot drop-offs?” and “when we get out there, the important thing is to breathe normal, don’t freak out!”  …I was starting to freak out…  a little anyway.  I couldn’t help but think about what I always think about now-a-days when I go off and do something semi-adventurous/risky, what will happen to Andy if James and/or I die (lovely imagination we parents have…)?  Jeff’s wife, Christina, so graciously offered to watch the now 16 month-old Andy for us.  Fortunately Jeff and Christina are close family friends and have all the contact info for James’ family… and at least James has a living will… mine is still on the to-do list… oops… need to work on that, I thought to myself.


Looking over the ocean, you could see its surface, over the spot to which we were aiming to snorkel, a small ripple of turbulent water created by the gush of warm water spewing from the pipe below.  Kinda freaky…. but I trusted Jeff’s advice to go there and was also comforted by the number of others snorkeling and diving around the area.


After all of this anticipation plus what I think was 4 trips from our spot on the beach back to the car to retrieve Andy-snacks, diapers, and other forgotten or unanticipated items, we finally grabbed our gear and headed for sea.  Wait, no, I had to go to the bathroom one more time!  Jeff had us wipe the inside of our goggles with a special solution for the fog.  We rinsed everything off, then slipped on the flippers, next pulled on the goggles.  We made sure the goggles were nice and snug… Then we were off!  Finally!  I was somewhat nervous about setting out, as I knew there were shallow rocks and coral, but the flippers provided great foot protection to walk or stand on the coral if needed, the waves were very small, and the coral was not really very sharp if you are just walking on it anyways.  Soon we were cruising atop the water, looking down at the fishies!  As we were new to the practice, Jeff had James and I practice our snorkel “dives” a couple times before heading out to deeper waters.  Mildly distracted by our GoPro camera as we attempted to document the adventure, we were a bit slow at first, but in short time caught on to the breathing and swimming patterns we needed to use.  We didn’t even have to travel 20 feet seaward before we encountered tons of beautiful fish and coral.  I began to feel my fears melt away as I dove down, over and over, getting up-close and personal with some of the breath-takingly exquisitely vivid wild life.

Jeff pointed to the itty-bitty little bubble shaped sacks in the water, “these are, blah-blah-blah’s, tiny little harmless jellyfish,” he shared (he told us their name, but of course my brain has long since discarded that info).  As the swim progressed, I began to doubt his claim to total harmlessness, as I felt all over my body tiny little stinging zaps throughout my swim.  They weren’t anything to cry about, and left no mark, so I carried on, not worrying about it too much.  Later during the swim, Jeff did say that he was getting stung too, and admitted he had spied several other tiny jellies with their tiny stingers out and about (some other species that of course Jeff knew the name of and yes I instantly forgot it as well) most likely encountered in such high frequency due to the nearing of the next full moon.


We soon approached the great pipe.  From the water’s surface, we gazed down what Jeff had said was 40 feet to the bottom of the ocean.  Dotting it’s surface were several divers sauntering around.  I could feel the sudden change of water temperature and my fears came creeping back to stifle my child-like mermaid-mode-joy, as I now imagined the possibility of rip tides and other scary current-things.  We converged at the water’s surface, “you can really feel that gush of warm water!” James said.  “Yeah, it’s kinda freaky!” I chimed in.  Jeff nodded, “Some snorkelers will dive all the way down to entrance of that pipe, but I prefer to kind of keep my distance.”  I was relieved to hear this.


giant outflow pipe from the electric plant

After maybe 60 seconds of discussion, we went back to take some pictures around the pipe only to find we had drifted nearly 30 feet from the pipe we were just looking over.  Oh boy.  But we swam back, took some pictures, took a minute to enjoyed the dense cloud of fish surrounding the entire area, and then headed south to look for sea turtles.  After maybe twenty more minutes of swimming and photographing around in the ocean with various beautiful golden, white, blue, and pink fishies, Jeff stopped to ask us if we thought we wanted to go on.  I responded to my motherly instincts, always tugging at me now, and said I was a little concerned about Andy, so we started to head back.


Those brief moments while we were kicking it back in were the fleeing moments of completely and total joy that I enjoyed during this swim, as I felt like I was really freed from all worry and could just savor everything.  I had already discarded the GoPro, so I didn’t have to worry about that, James and Jeff were no longer swimming off in separate directions that I had to keep track of, and Andy was soon to be back in my arms.  I savored the water rushing through my hair, the dawdling groups of fishies letting me join their little schools for a second, the speed and depth I could go with those powerful fins attached to my feet, and the clarity through which I could view everything!  I didn’t want it to end!  But at the same time by virtue it had to.  I can’t wait to go back again!

We never did bump into any sea turtles, unfortunately.  Jeff was much more dismayed at this, however, than I was, as the whole experience was awesome enough to write home about ;).  We followed up this glorious experience with some glorious sushi, and reluctantly said goodbye to our friends as we headed for our next flight: to Maui!

I Think I’m Coming Down with Something…

Lately I’ve had a very serious problem. Whenever I study a disease, I seem to have it. First it was diabetes because I felt like I had to pee every 30 minutes AND I swear I was having hypo/hyperglycemic episodes, next I had small intestine bacteria overgrowth because … well just trust me – I was definitely symptomatic! Next, I most definitely had and e. coli infection, the reason for which, I also wont go into, followed by iron-deficient anemia because I had extreme fatigue and wasn’t eating enough meat, and finally for a very short time I thought I might have mumps, because after hearing about the outbreak in Columbus (which I had just visited for the hubby b-day celebration!), I did my own research on the infectious disease, and guess what? My salivary glands started hurting (tell-tail sign for mumps!)!

Is there a diagnosis for one who over-diagnoses themself, I wonder?

School has been ok. I say ok and not great because last week was my full physical exam practical, from which I feel I am still recovering. A full physical means doing a complete physical examination on a standardized (paid, acting) patient (where you have to ask a million questions, test all the nerves, muscles, and you must do a pelvic/rectal exam – depending on the patient you get – its a surprise!). This should have been a simple enough task – we were given strait forward instructions and I practiced enough times to make it just about muscle memory but oh the anxiety was sky high! This is a very time-sensitive exam, and under the pressure to do everything from memory as well as in a short time span was largely contributing to that stress. I am so thankful right now that clinical skill exams are over with for some time now (hopefully that doesn’t mean forgetting everything I just crammed into my brain). The experience was very epinephrine and cortisol inducing!

I also have been struggling with migraines a lot this month. I had a really nasty one – exactly one week ago. It was full force and long lasting. I even took my max dosage of Relpax and it wouldn’t budge. After bearing through class, I went home, attempted a light cardio work out, took a hot shower, drank lots of water, and prayed!

Relpax x2 = maxed out!

Relpax x 2 = maxed out!

Thankfully, a couple hours after doing all that and after receiving lots of text/prayer support from James (beloved, far-away hubby) and my family, the migraine melted away – nausea and photophobia with it! Finally, I left my desk, where I had been sulking in my chair, cradling my head, moping to James on the phone, and from there I proceeded to go to the kitchen to put my new appetite to use… PRAISE the LORD!2014-04-15 18.20.12 2014-04-16 20.36.44

I made a decision recently to actually take part in a full time extracurricular activity here at my medical school. (BIG STEP FOR ME!).  Since starting medical school a couple things happened:

1. entered full-time (as in … about 85% of waking time) study mode

2. got married! X)

This changed quite a few things for me, especially because my darling husband resides (on at least 5 days/week) 2 hours away from me. Essentially I entered a commitment-o-phobic mode. I’ve since formed a habit of not attending club meetings and participation in volunteer activities has been very sparse compared to those of my undergraduate days. I have just been too busy! I hesitated to join this extracurricular because I relish my time! Its so valuable these days! I couldn’t help but feel like that much time (~4-5 hours/week) was too much to give up-especially knowing how much I like to take off to go to Dayton or just thinking about the added stresses I shall have next year with boards hanging over my head. But the extracurricular activity is an OMM (osteopathic manipulative medicine) honors elective. As a military student, I know I wont have the option to get extra practice in OMM through a fellowship, and I know I want to use this skill as a physician. The deadline passed for the application, and as soon as it did, I felt a sinking feeling of regret. I decided to sit down and email my mom a list of all the pros and cons of attempting to apply belatedly for the elective . After typing it all out, I was even more sure I wanted to do it deep down, but still needed that extra push – to which Mom gladly obliged – in her prompt email reply telling me go for it. I promptly wrote and email and personal statement to the professor and he has vocalized that I will be able to do it next year-yay!

On the way to Good Friday's service.

On the way to Good Friday’s service.

Everything is looking up: less than 6 weeks of school remain, and it’ll be summer before we know it! My toe is recovering nicely from my lil ingrown removal “surgery” (this is why you should never cut your toe nails on the sides at all!). Weather is sunny and warm!! Easter was wonderful – good times at the church, with the family, and some time for relaxing! I got my book and flashcard shopping for the summer all taken care of and have plans to take care of the military gear shopping in these next few weekends. Thanks for the comments, I miss everyone and wish for as many updates from y’all as possible!