I am a miracle made up of particles and in this existence I'll stay persistent and I'll make a difference and I will have lived it - Medicine for the People


Monday, September 30, 2013

It's been a bit quiet around the blog lately, mainly because there hasn't been too many exciting things happening in my life (I'm not complaining!) but I wanted to let y'all know that I haven't forgotten about you and that I have a few very exciting (for me, at least) blog posts in the works currently. I'll be interviewing at Rush Medical College on Wednesday, an experience I am looking forward to sharing with all of you and I'm hoping to do an interview of my own with a doctor involved in medical school admissions that I will post on here. I'm also still working on the LOI post but have been having a hard time getting enough personal feedback. If anyone has anything they'd like to contribute or if you have any ideas on other posts you'd like to see, please let me know! I'm definitely open to suggestions.

Some Encouragement For Your Tuesday

Tuesday, September 24, 2013

Hello lovely people, I hope you are all having the most wonderful Tuesday. I wanted to write a brief post specifically for those of you who are in the middle of the current application cycle because honestly, filling out secondaries can be an absolute nightmare. Most of you are probably faced with 10-30 apps that all require at least one essay (or five, depending on the school) on various topics ranging from typical (Please discuss a recent volunteer experience) to difficult (Write about how you would handle a bioethical issue as a physician) to downright strange (If you could re-name yourself, what name would you choose and why?). Writing well-thought out essays that are tailored to the individual school's values and mission can be exhausting and it's easy to get bogged down under the enormity of the task ahead. 

This is the important part of the post so pay attention - no matter how stressful it feels, you have to remember that your first priority is getting those apps out as soon as possible. Unfortunately, this isn't the message that most of you will hear. I was given terrible advice when I was filling out applications including the suggestion that a month or more was a perfectly acceptable time to sit on an app. Luckily, I listened to the one person who told me that if I could manage a short turnaround (days rather than weeks) I would be in good shape. Their logic was this: the earlier you send in your application, the less competition you will have to get an interview. It makes sense. It also shows the school that you are eager and excited to be applying. If the admissions committee member who reads your application has only read 50 or so others, that gives you a much better chance of standing out than if you are one of 500 and they will be impressed at how quickly you were able to put everything together. While not necessarily prominent, there is feedback out there highlighting the importance of good timing - check out this well-written and informative piece on why applicants fail to get into medical school and you'll see "submitting a late application" on the list. 

I'm not saying all of this to scare you, quite the opposite. I wanted to offer some words of encouragement because you CAN do this! For me, what really helped was setting a strict goal. I gave myself a week from receipt of an invitation email to fill out a secondary to submit it and I took this deadline very seriously. For the most part, I was able to submit before the week was up but there were one or two apps that took a little longer and that was OK, I refused to penalize myself, I just determined to try harder and do better. Overall though, I treated that deadline like it was set in stone. I didn't go out, watch TV, or relax until I was sure that I was up-to-date on sending things in. And you know what? It was awful, for a few weeks, but then I was done. In a very short amount of time I was completely free and it felt like a breath of fresh air. 

I really hope this helps anyone who might be lagging behind a bit or losing steam! As always, feel free to comment below with your own suggestions or if you have any questions for me.

PS I am still working on getting advice from current med students (and medical  professionals involved in the admissions process) on LOIs and I'm also doing a little experiment on my own so stay tuned for a post on that coming soon!

Ta da! I Am Officially An Employee of The Northwestern University Feinberg School of Medicine!

Monday, September 23, 2013

It's my first day (don't worry, I'm on my lunch break) and I am so looking forward to being finished with the new hire paperwork so I can get to some actual research! I've only been in Chicago for a few weeks but I was able to get connected with some amazing people at Northwestern who really took an interest in my research background and were instrumental in helping me find jobs to apply to in the clinical informatics field. I was offered a research assistant position on a patient-centered informatics project last Monday, which I immediately accepted and here I am today (sitting at a desk with THE MOST BEAUTIFUL VIEW!).

Some of the things I'll be doing are new, which is great because I'll have the opportunity to learn and grow as a researcher. The biggest change will be working directly with cardio patients who are involved in the study. While I loved my job at Partners, that was the one area where it fell short and I'm very excited to get experience working in the hospital. I'll also be part-time on a project that is focused on a local community health clinic, which I'm excited about because it will be a great way to get involved with public health in my own neighborhood! That's just a brief overview of the two projects but after I've plowed through the rest of the protocols I will post a bit about the actual aims of the studies and what I'll be working on in particular.

Finally, I cannot express how grateful I am to be settled into a new apartment in a new city with a new job all in less than a month. I absolutely could not have done it alone so THANK YOU to everyone for your support, advice, and assistance. I can't wait to see where this new adventure will take me!

Amazing view, Lake Michigan, Chicago, Northwestern University, Feinberg School of Medicine
Gorgeous view

Interview On Accepted.com

Tuesday, September 17, 2013

Another day, another interview, only this time I was the one answering questions! Check out my interview on the blog for Accepted.com, a website with professional advice and information on all things admissions related from school stats to personal statements to what you should wear on interview day. The Accepted blog is authored by an number of impressive admissions consultants who have had extensive experience in the field and are well-qualified to share their expertise.  I was very excited to share my story with them and I hope people enjoy reading about my journey to medical school as much as I enjoyed telling about it!

Letters of Interest - Tell Me What You Think!

Monday, September 16, 2013

As you all know from my last post I am incredibly excited to have received an interview invitation from Rush Medical College(!), but that doesn't mean that I'm not still constantly checking the status of all my other applications online and wondering what the next step is for all the schools that I haven't yet heard from. After I finished the long and arduous process of submitting all of my secondaries I realized that I don't know a whole lot about what to do next. As in, what happens after your submit your apps? I feel like there are really two ways you can go - you can breathe a huge sigh of relief and immediately take a brain-vacation from thinking about anything medical school related until you start getting interiew invitations/rejections or you can be an "active" applicant. Basically it's like when you apply to a job - some people just send out apps and then never follow up. I've always belonged to the school of thought that you should at least email or call the hiring manager of the company where you applied because this helps you to stand out and might give you a better chance of getting the job. This approach has always worked well for me and I'm wondering if it's something that applies to med school as well. Of course, this is entirely a theory I've developed on my own but I feel like it's something I've applied everywhere else in my life with relative degrees of success. Applying to medical school is a competition to show the admissions committees not only WHY you are well-suited to become a successful student at their school but also HOW MUCH you want to attend their specific school. With this in mind, I wonder how important it is to send out letters of interest. I know it is recommended to send updates to schools you are waiting on and there are definitely those people who feel that sending out an LOI was what got them an interview or off a wait list but then there are many others who feel that they don't help at all. So this post is to ask all of you - what do you think? I'd love to hear of any experiences writing letters to admissions during the application process - positive or negative! Please feel free to comment, tweet at me or message me on Google+. I hope to gather some advice and later share what I find in a Part II post. Thanks in advance, all of you wonderful readers (and current applicants/med students). And if you're still filling out apps, keep slogging, it'll feel amazing to be done!

Medical School, Admissions, LOI

I Got Invited to Interview at Rush Med!

Wednesday, September 11, 2013

I'm actually beside myself with excitement right now so this will be a very short post but I'm so happy to let you all know I got my first interview invite! I received an email from Rush Medical College today inviting me for an on-campus interview and immediately screamed so loud I scared everyone in the house. I'm thrilled that my first interview will be at Rush, one of my top schools for many reasons, most notably their dedication to community service and the fact that they're in Chicago (I wouldn't have to move!). I can't wait for October (interview month) and will definitely post about the experience! Thanks to everyone for their wonderful support. It's nice to know I have so many people rooting for me!

Interview With Dr. Saul Hymes - Pediatric Infectious Diseases Specialist

Thursday, September 5, 2013

I recently connected with Dr. Saul Hymes on Twitter and immediately got the idea to do an interview (it's the journalist in me). Two of my greatest interests in medicine are Pediatrics and Infectious Diseases and I was lucky enough to find someone who works in both fields simultaneously! Dr. Hymes graciously agreed to answer any questions I might have and responded to my long list with some fascinating, touching, and informative stories about his experiences as an ID doc. If you're interested in becoming a doctor or in going into Peds ID in particular then definitely take the time to read through the transcript because there's nothing like getting advice from someone who has been through it already. As always, any questions or comments are welcome!

1.    Please tell us a little bit about yourself – where do you work, what field of medicine are you involved in and what are some of your non-medical interests?

I am an Assistant Professor of Clinical Pediatrics at Stony Brook Children's Hospital/Stony Brook University School of Medicine in the Department of Pediatrics and more specifically in the Division of Pediatric Infectious Diseases. As a Pediatric ID specialist, I perform consults on children with infections--and that is absolutely as broad as it sounds: everything from cellulitis from MRSA to Lyme Disease to HIV to infectious complications of a bone marrow transplant and everything in between. In addition to inpatient and outpatient clinical work, I conduct clinical research on antibiotic use and bacterial infections, and I teach med students, residents, and fellows. I love my job, but when I'm not working I like to read--especially sci-fi/fantasy, I sing off and on in a choir, I blog at http://infectious-ideas.org, I tweet (@IDDocHymes), and I try to keep up with my wife and my two children, ages 5 years and 17 months. It's a busy life!

2.    How did you decide you wanted to be a physician?

I sort of always knew I wanted to be a doctor and I have no idea really why, as nobody in my immediate family is a physician. I have always been interested in science and biology in particular, and was weighing as early as 9th grade the pros and cons of a research (PhD) career vs. going the route of an MD. But more than that, I think it came down to my own models: I had a great couple of pediatricians myself who left a serious impact on me--George Lazarus and Barney Softness, both based in NY City where I grew up. Dr Softness even nurtured my interest and let me shadow him when I was in high school & college and helped answer my questions about why he had chosen pediatrics. It's always important to have good role models in a career and these two pediatricians were incredible ones! Once I got to college at the Univeristy of Chicago, I knew for sure and from there it was just a question of navigating the med school application process…oy, what a pain!

3.    Can you discuss your medical school experience briefly? What did you find most challenging/rewarding while going through the process of learning to become a doctor?

I had an interesting medical school experience. I attended Columbia University's College of Physicians and Surgeons in NY and while I got an amazing education and was incredibly well-prepared for residency, I also felt like a bit of an outsider. Many of the students were single and I was in a serious relationship with the woman who later became my wife, and was living with her rather than alone in the dorms. So it took me some time to navigate the balance of school and home socializing and find my niche of friends. That's an important thing to think about in choosing a med school--if you're older and married or even have kids, you may not want to be at a school filled with young singles…or you may--just keep this in mind.

Otherwise, medical school, for me was probably the same as for everyone--it was hard! The first two years were a ton of memorizing, some brutal, brutal exams, and a lot of stressing over grades once they were introduced in second year. Third year was hard because of the huge amount of knowledge you thought you'd already learned, but now need to relearn in a whole new way in order to actually apply it to patients--it's like taking a boggle cube, shaking it up after you've already found all the words, and then having to find the same ones all over again. But once things started to click, it was amazing. I was finally taking care of patients, which is why we all want to do this in the first place! This of course brought its own challenges--knowing something or not wasn't just a question of an exam question--it was answering a patient’s question about their med, or telling the resident the newest lab. Getting it wrong had major consequences and while you always double and triple checked, the importance of what you are doing really starts to be felt. And then 4th year was wonderful, as I could finally do things only related to pediatrics, and I chose some wonderfully fun and educational electives, including Pediatric ID.

4.    When did you realize you were interested in pediatric infectious disease? What drew you to that field?

I always knew I wanted to do pediatrics--that's what I went to med school to become--a pediatrician. I've loved babies and kids for as long as I can remember and once I got to med school, other than a brief dalliance with OB and psych, I continued to think pediatrics all the way. On OB, I realized I liked taking care of the babies more than the moms and almost contaminated myself and the patient by trying to turn my non-sterile back on a c-section to look at the baby once or twice…and on psych, I liked the patient's childlike minds, but I missed the actual children, as well as the actual organic medical problems.

I was first interested in "peds ID" as we call it during my second year micro class. I loved the infections--the bacteria in particle were fascinating, the antibiotics and how they worked and how resistance worked--this was all super-interesting to me. So knowing I was doing pediatrics, when the time came in 3rd year, I chose a 4th-year elective in pediatric infectious diseases. It was everything I'd hoped it would be. The patients were sick, yet treatable; we had the time to think and make differentials and puzzle through pathophysiology of an infection, rather than rush to make snap decisions as one does in the ER or the ICU; we saw patients everywhere in the whole hospital so we had to know a little (or a lot) about everything in the world of pediatrics--I loved specialties with this kind of general knowledge base that didn't focus on only one organ or part of the body.

However, when I got to residency at Mount Sinai, I was drawn to heme-onc--they too were sick, complicated, interesting, but very often treatable. And I liked the longitudinally of their care--the hematologist-oncologists were these patient’s doctors for years. They got to have their cake and eat it too, being specialists while still having years of longitudinality in their patient-physician relationships, just as I'd admired in my own pediatricians. Ultimately, though, when I did an elective early in second year of residency, I realized I liked the sick inpatients with their infections far more than the healthier outpatients just moving along the chemo protocol. What I liked heme-onc for was, in fact, the infectious diseases. And so I decided to do a fellowship in that instead, ultimately back uptown at Columbia, and the rest is (recent) history.

5.    What kind of cases would a doctor working as a Pediatric ID specialist come across? Is there any one patient in particular that impacted your development as a physician?

We sort of work on everything and everybody, as long as what they have is an infection. So as an example, a recent list of inpatient consults might be: a patient with Staph aureus bacteremia and a septic hip whose team needed antibiotic advice; a neurologically devastated ICU patient with persistent staph bacteremia and probably endocarditis; a 3 month old with persistent fevers that nobody could figure out the source of; an ER patient with Lyme disease; a 19-year old with a chronic toe osteomyelitis from Stenotrophomonas, an intrinsically highly-resistant bacteria; a baby born to a mother with HIV; a new onset lymphoma patient who the team worried also had a superinfection of one of her cancerous lymph nodes.

And a recent list of outpatient clinic patients might be: a teen with Lyme disease, a 6-year old with recurrent fevers; a 2-year old with MRSA colonization and recurrent boils; post-hospital follow-up of a10 year old with osteomyelitis; a travel visit for vaccinations for 3 siblings in one family ages 1, 3, and 7 all there prior to travel to Bangladesh; a mother whose husband was anti-vaccine but she wasn't sure and wanted data and advice on vaccines for her baby.

The one patient who impacted me most as a physician was a teenage girl I took care of with HIV/AIDS. She acquired HIV perinatally but in the days before routine newborn screening, so she was not diagnosed until age 8 and, for a variety of reasons including psychosocial ones, had a lot of trouble once she hit the teenage years with taking meds and following physician instructions. At age 17 she began to lose weight and have chronic abdominal pain and fullness; a CT scan showed she had huge abdominal lymph nodes and biopsies and blood cultures confirmed the diagnosis of disseminated mycobacterium avium (MAC). Already noncompliant with one part of her regimen, she did not take the anti-mycobacterial drugs we prescribed either and ended up dying after nearly a year of intermittent hospitalizations and attempts to get her on board with treatment. Her death was not a good one--we had known she was incurable for some time and had tried to do hospice care, but her mother would not agree. In the end she died in some degree of pain in the hospital, rather than at home, comfortable, with loved ones around--the "good" death we had all been trying to help her have. I learned more from this one patient--about HIV, about treating recalcitrant infections, about connecting successfully with difficult patients and families, about my own abilities to cope (see below) than I did from any other before or since.

6.    How do you deal with the emotional fallout from handling a difficult case or the disappointment of a negative outcome?

That is a fantastic question, and one without an easy answer, because everybody handles it differently. To some extent, we all go through the classic 7 stages of grief described by Elizabeth Kubler-Ross (worth reading about if you're going into medicine!), some of us more quickly than others. That means at various times I'll blame myself, or be angry at the parent or patient for making a particular decision, or yes, even deny that the outcome was bad--sometimes we tell ourselves that the patient was going to die no matter what so what we did or didn't do doesn't matter.  But ultimately, if there is a bad outcome or a difficult case that doesn't go the way we want--even if it's just that you fail to connect with a patient and they switch doctors but no bad outcome occurs--it's always hard and also always a learning experience.

For me, the important thing is to keep perspective and try to separate my life from work as much as I can. So I go home, I hug my wife and kids, I call my folks--I use the natural support structure of family and friends to help me stay grounded and realize that while, yes, this was a horrible thing for the patient or their parents or even us, their doctors, it does not need to rule my life. Of course if or when a patient dies it is a horrible experience. The department often holds a debriefing session for students and residents and fellows and even attendings involved in the case. And people cry and talk about it. And people get angry and upset. We are only human. Ultimately, having a good support network and a way to decompress--see a movie, play basketball, go for a run, drink some wine--allow you to move past it, go back to work, and learn from any mistakes you may have made. Those are mistakes that you or anyone else involved in the outcome will never make again!

7.    What do you enjoy most about teaching?

There are two things I really enjoy about teaching med students, residents and fellows. The first is the ability to give back to the system that produced me--I became a doctor thanks to brilliant teachers and mentors and so the least I can do is try to be 1/10 as good as they were. It gives me joy to see a student finally understand how MRSA is resistant to methicillin, or a resident truly 'get' why it is so important to be aggressive with antibiotics early in sepsis, or a fellow analyze a piece of basic science literature and apply it to their own research. In all of these moments we who teach see echoes of ourselves at the same stage and it is awesome to see somebody else trying and enjoying following the career that we've chosen and that we love.

The second is that I always learn when I teach. Learners at all levels--from premeds shadowing to fellows about to graduate--will always ask questions you never thought of, or reframe a problem in a way you didn't see it. Or they'll simply ask you something you don't know the answer to. And it's important to maintain humility and openness about that as a teacher--if I need to look something up myself, I'll say so. Sometimes I'll make the student or resident look it up and report back so they can learn from the exercise (I already know how to do a literature search but they may not), but sometimes I'll open the text book or go to UpToDate or another online resource and we'll both learn the answer right there. And learning is one of the most fun things there is!

8.    Is there anything important you’d want to tell a student who was interested in pursuing a career in your field?

I would say first, regarding medicine in general, you should be sure it's what you really want to do. I know that's trite and clich├ęd, but it is a long road and there are many other careers in the health sciences that are equally clinically rewarding like nursing, or being a PA, that are shorter easier, and cheaper re: cost of education. If you want to teach, if you want to do research, overall if you want to become a leader in the field, I'd say get an MD/DO--become a physician. Regarding pediatrics, you have to love kids, and you also have to love and relate to parents--you need to be willing to deal with nervous, anxious wrecks who think their kid (who may not be that sick) s dying, or who are confrontational, or tired, etc. And that's not to judge--I've been a parent of a sick kid in an ER and that's how I am too! But there's an added mystery to pediatrics--your patients can't always tell you a history that's as good as what an adult might give. So you get to use your brain more, your physical diagnosis skills, and you get very good at generating interesting differential diagnoses. Finally for pediatric ID, I would say you need to be a bit of a nerd. We tend to be a kind of nerdy, intellectual specialty. Most of us do research because we like to, but also because it's expected--there isn't a lot of clinical money in ID and often grants are needed for salary support or at least research is needed to convince your boss you're worth spending money on :-) And of course you need to love and be fascinated by the bugs! Overall, a career in medicine can be very rewarding, but never forget what it is--it is a job, and ultimately only a job. Even the greatest job in the world can never be more than partially fulfilling, and the rest comes from everything else. Make time for family, for friends, for life. Yes you can work hard, but find time to play no matter what field you choose or you will burn out faster than an old light bulb. And, a doctor who never lives in the world around them will never be very good at relating to patients--being well-rounded is ultimately one of the best traits a physician can have, because at the end of the day, the patients don't care what your board scores were or what school is on your diploma--they care if they like you.

Welcome to Chicago

Monday, September 2, 2013

Hello there, dear readers. I know it's been a while since I've posted but that's because I have been very busy moving! For the past seven years I have been living in Boston and had various committments tying me down; school, a job, my post-bac program. I loved the city but was beginning to feel almost suffocated with how comfortable I had become. I decided a few months ago to move out to Chicago to be closer to some wonderful friends and also to broaden my own horizons and now that I'm here, I'm so excited for this opportunity to learn and grow! Onwards and upwards, always.

So far, I'm loving it.

The Bean, Chicago Skyline, Willis Tower

PS Chicagoans, suggestions for places to go and things to do are always welcome :)