The Single Surgeon

This is the rebranded blog of MedSchoolMind. Now I'm in my thirties, a surgery resident, and single. Read about surviving residency, trying to date with a chaotic schedule, and finding meaning in the world with only an ounce of free time a week.   [profilepic is artwork by @sassysurgeon on etsy]

[thesinglesurgeon]

What is a Boo Bop?

And what does it do to women (sometimes)?

Read my latest post about Boo Bops and the existential crises they have the potential to generate.

https://medium.com/@wardogg8/boo-bops-a79fa2938cad

[thesinglesurgeon]

A new post on a new platform

I published my first post on Medium.com

Take a look if you can =) It’s about COVID/work/death.

https://medium.com/@wardogg8/work-13b8159c9b02

[thesinglesurgeon]

Feb 28: Hot Jon

What did this picture cost me? 

A 1.5 hour drive down the Long Island Expressway on a rainy Sunday night. I was blasting Bronze Whale, my latest favorite artist culled from this weeks Discover Weekly playlist on Spotify. I had to gently swerve to avoid the crater-like potholes left behind from all the snow plows, the snow still hadn’t melted and gray heaps of it dotted the banks of the road and the lawns seen from the highway. I had a coffee next to me with sugar free vanilla syrup added, a new thing I was trying. It was 5pm but I was post-call from a boring 24 at the VA, of course someone needed an emergent chest tube at 2am. My sleep was like it has been for months: in chunks punctuated by achey backs in hospital beds, the intern calling for help, bloody bowel movements the nurses saved for us to see, hiccups and nasogastric tubes, and sometimes a code blue page.

I finally found this guys apartment building and the parking garage right below it (he sent me a picture of it when I got closer for QuikPark). I walked outside of the parking garage just to take a picture of the city skyline in the rain. The fog and the colored lights during a rainy sunset were perfect. It quelled my nerves. A first date. 

We had talked on facetime before, something I had dreaded but did anyway with a full glass of wine (carefully out of view, sipping subtly to not appear like an alcoholic). He was handsome, with really good hair. I think he used to have a speech impediment, he had to slow down to talk to me. He seemed passionate about his job, whatever it was (I swear I tried to understand it). Something about business solutions and IT and team management. I laughed a lot, and I didn’t roll my eyes once. Right before we hung up he asked when I could come and see him. 

Here I was now cruising down the highway, the bass reverberating through my bones, feeling sultry, but tired. My tiredness lived in me now, had settled into my bones. I sipped the coffee, something I carefully matched it with water intake during the day. It felt like liters of coffee and liters of water. 

His apartment was hot, it was uncluttered. He had 2 pictures on the wall and a lamp that changed color when has asked Alexa to change it. His bathroom had toothpaste still stuck in the sink. But the toilet was clean, so was his shower when I peered around the curtain. The view was amazing (see above). He was wearing a t shirt and shorts and socks. I had spent hours getting ready, to be honest, to look like I was always this sleek and clear skinned. Poor women of the world.

He talked to me confidently after he made Mojitios using mint from his quarantine project indoor garden. He wasn’t scared of me. I made up an elaborate lie that i had to go at 7:30 to pick up my friend at Penn Station who had been in town enjoying tapas restaurants with her friends from med school and she didn’t want to take the train home since it took too long. I had her call me at 655 reminding she would be ready on time. God bless her.

So this guy sat on the couch at 7:15, said I could sit down too. I did, but I was at least six feet away, maybe quarantine habits had sunk in hard. Our fluid conversation became jagged, I knew what was happening. I asked if he was afraid of COVID, he said “not enough to stop from kissing you soon.” He actually said that. And he scooted over, across the distance I had placed and kind of pushed me down and took over me and touched my face and neck and it was a good make out session. But I designed this so I had to go. I had mentioned it one hundred times. And he stopped and lifted up his body and said to me “please let me go down on you, please? Please? I want twenty minutes.” 

Was I dreaming? And also, how did I say no? I could feel my hair pushed into twenty directions. I could fell my lips burning from being rubbed against his stubble. I could hear my ragged breath, but I said no, in as cute of a way as I could, I pretended I just really had to go. We kissed goodbye, but he had this look of fascination in his eyes, his facade had been broken. I like that look, but I also feel like I won too early.

I left the apartment, I felt neutral, not on a high or in a low. It was misting outside, I put up my hood and walked for a mile. I found a pizzeria. I ordered a Margherita slice at 8pm in the rain.  I stuffed napkins in my pocket and walked outside, unwrapping the pizza. I will eat pizza in the rain in the city because I don’t care. It’s a story, it’s romantic, it’s artistic. I saw the yellow-white lights in all the apartments, people in all of them, sitting around tables, one guy with a guitar. Interesting curtains, weird wall hangings. And the voice I fight now everyday was very loud in the rain in Long Island City on this Sunday while I ate melted cheesy pizza dappled by raindrops: I want to be an artist. 

I found the parking garage. My brown boots were wet, my toes were getting wet. I paid 21 dollars for parking. 4 dollars for pizza. 3 hours of driving. I listened to the entire Bronze Whale album twice. I wondered what I could do about new resolutions in March, did I need a self help book now, why was I turning down a man begging to go down on me, who lost all his composure because he wanted so badly to give me pleasure? Was something wrong with me? Also, why do men beg me lately to come over, come inside, have sex? What happened to mixed drinks at pricey restaurants and being nervous about kissing by a car before saying goodbye? Was this thirties-something dating, or New York dating, or was I giving off thirsty sex vibes that made them all beg?

I drove home, and fell into a perfect sleep with the comforting admission that I am just overwhelmed right now, maybe all the time, and the only thing I can do is take it day by day, moment by moment, tackle what scares me (in small measured bites). I texted my friends I had shared my location with informing them I was alive, don’t worry, we will analyze this all to death with wine next week.

[thesinglesurgeon]

Things you need for M2 year

So what is M2 year? In most medical schools, its the transition from the super basic sciences to something more relevant to clinical medicine. But in some ways it’s very similar to M1 year: success comes from self-study, long hours at a desk, and culling through resources to find what works so you can pass exams. I thought M2 was much better than M1. I’m not sure if it’s because I was better at studying, “used to the abuse” of med school, or if the material is more interesting. I think the material is more interesting, it makes you feel like: oh yeah! I will be a doctor one day! We are talking about diseases and medicines and not very detailed chemistry! But there is a catch of M2 year. Yes, you have to pass your school’s exams, but what you really are preparing for is Step 1. 

Now, it’s your school’s job to prepare you for Step 1, but many med students I talk to feel fundamental untrustworthiness towards advice coming from med school administrators or PhDs. I would argue that most schools know what they are doing, but checking their average Step 1 scores or talking to upperclassmen could resolve, or confirm, your doubt about your school’s advice. Regardless of how good your school is at creating a curriculum that lines up nicely with Step 1, you won’t be successful unless you invest some serious effort into Step 1 prep. So with all this in mind, here are my tips for M2 year. It’s things that help your brain shape up for Step 1 dedicated time, but also cover the details you need to pass curricular exams. I studied my school’s resources (their notes and lectures) with equal effort of the resources below until dedicated Step 1 time:

Pathoma-the perfect supplement to pathology courses. It really IS the entire pathology course. I would watch topics before our path lectures, then reread the chapters when studying.

Sketchy Micro-yes, they have path and pharm now, but the micro part is absolutely essential for success. 2 years later, I still recall each and every bug clearly and remember all the weird nuances about them. I never tried path (I used Pathoma for that), and the Sketchy Pharm was pretty good, but the pictures and stories are inherently more complicated than micro (which is perfect, simple, easy).

Kaplan Qbank-this is not the best Qbank (UWorld is). But this one is pretty cheap and the explanations have something UWorld doesn’t: corresponding page numbers to First Aid. This is perfect for practice. Do 5 questions a day about whatever subject you are learning in path. Analyze the stem and the answers, read the description, and find the corresponding pages in First Aid and read and annotate. You won’t normally take this long to do questions, but it’s a good foundational start.

Willpower to start Step 1 studying amidst normal scheduled studying. this is hard to do, so you need a pretty solid plan. My plan was to go over Pathoma in order and make index cards about all facts I had forgotten (it took me 4 months and I made 2,000 index cards). But I reviewed cards along the way and when dedicated time came along, I had a solid foundation to build on.

Goljan lectures. These are “unofficial” bootleg audio recordings of a genius man giving a Step 1 review course to foreign grads. There are 40 hours worth of material. It’s tough, dense, compact, and takes a long time to get through it. But they are organized by topic in 1 hour “episodes” and they are AMAZING. I would listen to Goljan during our path course and only listen to corresponding lectures. This took about the whole year to do. During dedicated time, I walked outside (or elliptical-ed if it was raining) and listened to them again, at least 1 hour a day. It was a great way to get at least an hour of exercise each day, and his lectures are seriously amazing. You need to “acquire” these from the internet somehow...good luck.

First Aid. Duh, nothing to say here. Except: I only used this when I was doing Kaplan questions and when I did dedicated time. I didn’t have time to use this as a supplement to my regular course work, and I was really happy with my Step 1 score and grades M2 year.

Ways to stay happy/sane. By now, we all know M2 year is going to be just like M1 year. Hopefully over the summer you’ve had time to recharge and prepare for this very weird lifestyle of being alone at a desk for most of the day. My things to keep me happy were

a friend date night each week or two to the one cool restaurant in our town (with wine on tap!). Looking forward to an early cocktail hour on a Sunday night with my friends was great.

A mindless Netflix go-to. I am in my late twenties but I watched ALL of Pretty Little Liars and then Gossip Girl in M2-M3 year. The shows are silly and simple and were perfect for unwinding when I could not imagine reading another book (even one for fun).

Nature walks. I found out later in life I like to hike. I live in a flat place with not many amazing trails, but I found a few and would drive out to new places about once a month. It made me feel like an explorer and I LOVED the peacefulness that comes with a few hours of walking in the woods.

[thesinglesurgeon]

Interview Season Part 3: Practical Tips For Traveling

Spend the night in the hotel after the interview. This is makes the exhausting interview less tiring when you know you can sip wine at the hotel pool, explore the area, or sleep early after such an intense day. Plus, you can leave your crap in your room, eliminating another awkward step of packing up in the morning and lugging your suitcase around all day in your suit.

Get a credit card to use during interview season. To be clear, I don’t mean “get a credit card so you can spend even more money you don’t have.” What I mean is “you can get a sh*t ton of travel points, so take advantage of the rewards.” I got a Chase Sapphire preferred rewards card. I buy all the airline tickets, hotels, and rental cars with it, but I pay it off each week (granted, I pay it off with loan money, but it’s better than accumulating the 25% interest rate this card has per month). I picked this card because a bunch of articles suggested it was the best one for “beginning travelers.” You get 2x the points on travel, with no annual fee for the first year (then it’s $95 a year). SO far, I have like 10,000 points. Pretty cool.

Rent the car. It’s so much easier and less stressful than hoping the Uber picks you up, that there even is an Uber (one place I went to had zero card available one Friday night). You might have to pay for parking at a hotel, but I made reservations on Expedia in advance, paid at the counter, and ended up paying about $30-$50 a day for unlimited renal car miles. Also, my personal car insurance AND my travel credit card cover rental insurance, so I didn’t need to pay extra for that.

Don’t stay somewhere shitty. Yeah, the Hilton is more expensive than La Quinta, but at the end of you student loan days, another 1,000 you added because of stepping up to nicer hotel accommodations or SUV instead of economy rentals in New Hampshire in December will be worth it. I’m a thrifty and neurotic person, but I’d rather have a clean hotel than a questionable comforter with weird stains on it.

Underpack. I really struggled with this at first, I swore I would need 2-3 additional outfits for travel and exploring. But I really needed 1 pair of pants, a shirt, and a sweater. You don’t care if you wear the same thing 2 days in a row because you don’t know anyone, and even though airplanes are kinda gross, you’re not getting sweaty or actually dirty. So save the luggage space and pack light.

But I brought my own steamer. Is this weird? Yes. But I like it better than ironing and I use one everyday at home. I got this one from Target years ago and it still works great. Plus you can use it on interview social dinner outfits that may not be amenable to ironing, but can be steamed.

Also: roll your clothes into ridiculously small burritos to make room. This will really ensure you need a steamer (but will leave room for one!).

Pack 2 extra panty hoses if you are wearing them. You need one extra in your purse or portfolio (the worse thing is a giant run in your panty hose). Also, I’m not a fan of uber conservative dress, but pantyhose is nice because you don’t have to shave your legs at all. #easy

Only carry-on your bag. I had all clothes and shoes in a roller bag that easily fit into the overhead compartment. Then a backpack with my laptop, books, my portfolio (a purse was way too cumbersome to carry during the actual interview), and toiletries that went under the seat in front of me. Never check a bag, not worth the risk of losing your things. And never volunteer to check your bag no matter how many perks the airline offers you. 

Eat breakfast before the interview day. Enough places either had no breakfast or just not enough food. I would get up early, drive to the Starbucks in the town and get the spinach egg-white wrap they have (and coffee) and then get ready at the hotel. If the hotel had breakfast, I would eat there instead. Do not start the day off without food. If you aren’t a breakfast person, at least have a cliff bar with you at all times. I always had two in my portfolio. Sometimes lunch is hours after you have a skimpy breakfast and all you can do is think about your hunger. Just avoid this whole problem: eat BEFORE the day starts and bring a snack.

Just be early. I say this as a person who is almost always late. But for interview season just find a way to be early. I hung out in several parking garages because I was oddly early, but a few times I could not find the right building or made a wrong exit on a highway system and got seriously lost. Get to the hospital 45 minutes before you are supposed to meet. Just do it.

Clear your head. A great time to do this is while you are awkwardly waiting to walk into the hospital from your cozy rental car since you are so damn early. Listen to a personal fav song. Picture yourself as an awesome doctor that knows what they are doing. Think of you at your best, embody your awesomeness. Get your head clear, smile, and envision greatness, and the day will turn out great =)

[thesinglesurgeon]

Interview Season Part 2: Managing Your Invites (I think my best advice yet)

yes, this post is outrageously overdue. But now I have time to actually think about life. Fourth year is definitely the best year of med school, but it’s still med school. I think it’s overly hyped up so M1-M3 have something to hope for, but that post is for another day!

So after meticulously planning interview season, I have some golden advice for managing interview requests that I wish someone had shared with me.

Make a brand new gmail account with some generic “lastnamemedschoolname”@gmail.com. Go to ERAS, enter this as your primary email. Now ALL of your interview communications will come to you ONLY through this email.

Get your smart phone and tablet and whatever else you will be carrying in your white coat pockets with you from September-January. Turn off ALL notifications. No text sounds, no ring tone, no other emails can come through with sound. Have your other non-ERAS email only update when you reload it. No more home screen notifications for anything besides texts. Make your ERAS-email the only one that comes through constantly and WITH SOUND. Download the gmail app which I found notified me faster than through my phone’s email app.

Go to Student Affairs and change your schedule so you are on a rotation where you have your phone with you at all times. For me, that meant nothing in the OR. I chose to go on the SICU during the month of October. I told everyone that I was waiting for ERAS emails and I could not be away from my phone so I would not be going into the OR this month. I then held my phone near and dear to my heart during rounds. The SECOND I heard the classic gmail sound I politely left the rounding circle and went straight for a computer (or just opened the email on my phone) and wrote back to the interview invite within two minutes.

In my white coat pocket, I had four index cards with the months Oct-Jan penciled in as calendars. I would whip those out before typing back a date for an interview to make sure I did not double book. I added dates as soon as I made them onto these little calendars and then added them to my gmail calendar when I got home.

I always would choose the soonest date available on an invite unless I had something else scheduled. This ended up being really nice: I packed 19 interviews in and was done by December 7. I could not imagine trying to interview into January.

I cannot emphasize enough: YOU NEED YOUR PHONE NEAR YOU. I was late 2 minutes to UWash and I missed all open spots. My close friend missed Colorado’s invite on a Sunday morning. You also NEED TO TELL PEOPLE ERAS IS YOUR PRIORITY. Anyone that went to medical school will completely understand the importance of this. 

AS SOON AS YOU GET AN EMAIL, ANSWER IT.

No matter how insane this sounds, it isn’t too hectic in practice. All of my emails came during business hours M-F and most seemed to have reasonable dates or at least sounded flexible. But you will miss an interview that you really want. Or, worse, you never get an invite from a place you want to see and it’s already mid-November. In both cases:

email the program director and coordinator and ask for an interview. I did this three times and each time was offered an interview within 1 day. 

Our school actually advised against this and I’m glad I didn’t listen. Email people if you really want to see their program. Something simple and quick, making it as specific as possible to the program. It has worked for me 100% of the time as well as my friends that reached out for help, rescheduling, or an invite.

If you start to get a lot of invites (lucky you!), politely cancel. I felt weirdly guilty for canceling but it’s not worth the guilt. After I started getting invites from academic programs, I canceled the early community invites I had received. Something as simple as: Thank you for reviewing my application and considering me for an interview. Unfortunately, I need to cancel my interview scheduled for ***. Thanks, your name. Remember, someone might be desperately wanting your spot, so give it someone who wants it, and give them plenty of time to fill your spot (2 weeks at least).

Get a rewards travel card. I got SO MANY BEAUTIFUL POINTS and used it for an epic vacation later in fourth year.

I really wish someone had told me how essential it is to be on top of your phone, and let everyone know about it so they aren’t offended when you drop everything to answer your gmail ding. One day, ERAS season might not be a crazy mess like it is now, but the hard truth is you have to play the game or you miss out on big opportunities. Be a slight phone nut for three months of your life. It was nice because without a zillion notifications popping up (just my ERAS gmail!) I used my phone less overall. I unfortunately do have a weird jumpy feeling still when I hear the gmail app sound...but eventually that should pass!

[thesinglesurgeon]

Hey may I ask how exactly do you make notes and study with OneNote? I often get lost and confused with taking notes from lecture notes and other resources and index cards :( What about mind maps? How do you do them all? Do you make index cards after learning the material? Are there any particular resources that you like more than others? Thank you so much you are a huge inspiration!

Hi Anon!

It’s been a while since pre-clinical studying, but I still remember those days vividly! Here’s how I ended up doing my notes once I got into a good flow:

Download the powerpoints for the lecture in the morning before classes and save them as PDFs. I uploaded them into the Section for their subject (Pathology, Pharm) and made each lecture it’s own Page. I would title the Page whatever the lecture topic was. To reduce clutter, I had a new “notebook” in OneNote for each block and then closed it once the block was done.

During the lecture I would type whatever random notes the professor would say, highlight (using One Note) a word they seemed to emphasize, circle parts of images on their slides,etc. I would type next to the slides, not on them. Of course, the notes were not perfect by any means and I ignored all typos

At home that night, I had a post-it of all lectures I needed to review. That meant: going over the OneNote Pages of lectures from day and consolidating the notes onto handwritten 8x11 pages. I would not try to write every detail, but essentially map out the concept in an more concise way

Anki would be open, too. For every “memorize” fact, not intuitive concept, I would make a notecard. Things like interleukins that cause fever, tumor markers for different cancers, etc, got Anki cards

A few days later, I would review the handwritten pages with a highlighter and highlight things I had totally forgotten about or needed to literally stand out on the page. 

Anki review would happen each morning, for about 20 new cards a day, 50 review cards a day. I would adjust the amount to go over each day so I would complete wiallth new cards and only be reviewing at 5 days before the test date. 

Once I reviewed a 8x11 note page I made, I would put a tiny check in the top of the page. I would try to review each page about 5 times a block. 

The week of the test, I would look over the notes on OneNote again and make sure I didn’t skip over any huge topics or points in my consolidated notes.

I hope this helps! This worked well for pre-clinical years and I felt like I covered material thoroughly. Of course, I added SketchyMicro for Pharm studying and Pathoma for pathology studying. My school had exams written by our professors, so it was important to review their notes so I could pass. In clinical years, we took shelf exams, so I studied shelf-specific resources and only paid attention to lectures we had, but rarely took notes or reviewed them.

Good luck!

#medschool #study #studyblr #medblr #preclinical #studytips

[thesinglesurgeon]

The Interview Process Part 1-Picking Places, Planning Travel.

I’m almost done with the interview trail, thank goodness! I finally have some advice I can confidently pass along. The interview process is very overwhelming, and even though I went in with a very excited attitude, the whole process definitely takes the life out of you after a while. Since I’m still in the midst of the travel and interview whir, I thought I’d just focus on the parts of the process that are over and that I survived: picking places and planning travel.

It should be a no brainer that you submit your ERAS application (with all components completed, including letters) in early September before the Sept 15 deadline. This means you ask for letters in May and continuously “remind” people q2weeks to submit them.

The hard part is: where the hell do I apply? There are zillions of places!! AHHH! Here was my strategy.

Go onto Doximity Residency Navigator and sort your programs by reputation. They display results in chunks of 50 schools. I included all programs in the country just so I had a solid point of reference of how competitive programs were. Note: take this with a grain of salt. Doximity does have an explanation of how they rank based on “reputation,” and although I haven’t read it, it’s obvious that research output is part of the ranking. Remember that all ACGME accredited programs will (for the most part) have you graduate as a competent general surgeon. This “reputation” ranking really helped me gauge competitiveness, but not necessarily quality.

I would read through the top 50 programs and on a piece of paper divided into 3 sections (Top 50, 50-100, >100), I would jot down places that I heard where good, cities I might want to live in, etc. Think of this as a free write exercise, don’t read into it too much. Do the same with the next 50 and list the ones that strike your fancy in their respective column. For all programs over #100, I put them in their own column. I ended up with 50-ish places.

Now, you need to have a serious heart-to-heart with yourself and/or significant other. What one thing matters most? Some common answers are geography, affiliation with a med school, urban/rural, affordable real estate, near a major airport, etc. Just pick one thing to be your next sorting attribute. I picked geography/places that my significant other and I both like.

Then, under the original three columns, we drew a thick black line and labeled “Tier 1, Tier 2, Tier 3.” Now sort the previous columns based on your sorting attribute with Tier 1 being most favorable (example picture below).

Once you’ve reorganized schools into your personal tiers system, go across Tier 1 and apply to all of them. Then move onto Tier 2. In my picture example at the bottom, I would apply for sure to UVA and MedStar (and all other Tier 1s) before adding the Tier 2s to my application list. This way ensured that I had a well rounded application list that included competitive schools with “mid range” schools. I stopped once I reached 50 schools, a number I felt comfortable with. I didn’t apply to my “Tier 3 >100″ schools since I filled my numbers with Tier 1 and Tier 2 places.

Submit applications and wait. While you wait: make a new email address just for ERAS! This was the best advice I got. I made a gmail account with my last name and school initials. I updated my information on AAMC with that email. Then I silenced ALL ALERTS on my phone except that gmail account. I had my phone next to me at all times in Sept and Oct and each time I heard a gmail alert, I knew it was from ERAS. I was on SICU and told them I was waiting for invites. As soon as I heard the noise, I ran to a computer or used my iPad to reply within minutes (my phone struggled with loading some of the interview calendar apps). I got a spot for all my invites. I highly recommend this step!

Also while you wait: apply for a travel rewards credit card. Very important: do not ignore your balance. I need to pay mine off each month still, but I earned over $1000 from points I accumulated. The interest rates are insane, but so are the benefits, so approach this step with caution. I got a Chase Sapphire Rewards Preferred card after reading a few articles about good starter travel cards. 

Don’t rush to book hotels. Programs send discount codes sometimes a week before the date. I never had trouble getting a reasonable hotel price. Flights are another story. Southwest is the best since you can cancel, reschedule, etc with out losing any money and not being charged fees. A couple of my friends use skyscanner to look for deals too.

Make sure you have one interview outfit and one outfit for the business casual social events (more on outfits later). Put your shampoo and hair products into travel sized bottles. Make sure everything you need (including your shoes, lint rollers, etc) fits into a small carry on bag. You can then basically leave everything in the bag and just refill your toiletries as needed. I even got travel lotion, toothbrush, toothpaste, and threw everything in the bag and didn’t have to fully unpack at all this season.

Next time, I’ll write more about weird interview questions and tips for the actual interview day!

[thesinglesurgeon]

The Interview Trail: First Bad Interview

It’s really early in the season, but I had two interviews this week (Tuesday and Wednesday!). I’ve been driving all over New England in my little Toyota rent-a-car having a fabulous time looking at mildly changing leaves, jamming out to 90s rock (listed as a hobby of mine on ERAS), and enjoying cute little towns I keep coming across. First observation: there are way too many Dunkin Donuts over here. Where’s the Starbucks at??

That’t totally irrelevant to this post, which is to discuss my first crappy interview day. It’s compounded by the fact that yesterday I had a fantastic interview where it felt like I found my soul-program. I left glowing, and it made getting changed in my car in broad daylight (and needed to quickly cover up with my coat when an old man pulled into the spot beside me) and driving 4 hours down traffic on I-95 not too miserable. Then I woke up and headed to Bad Interview Place.

We met in the lobby at 6:45. The hotel I stayed at was pretty crappy, but it was the only place less than $180 a night in the town (!!). They don’t have breakfast set up until 7, so I grabbed a bagel for my purse just in case I needed sustenance. Well thank goodness I did. No one gave us breakfast, coffee, or water until TEN am! I was thanking the Lord that I had a crumpled old water bottle in my bag from yesterday that I filled up in the bathroom sink a few times. The worst part was watching EVERYONE else eat around us: we came in for the 7am morning report, 7:30-8:30 M&M, and 8:30-9:30 grand rounds that ended up going until 9:45. Apparently breakfast was assembled at 7:30, long after we were settled into our seats in the very front row. After the PD came to welcome our hypoglycemic comatose crowd, he said there was coffee and food in the back we were welcome, too. So we ate at 10. My schedule had interviews blocked at 10:20, 1:00, 1:20, 2. Let’s just say, nothing went according to plan and I was there until 5. But we’ll get there later. 

Interviewer #1: really nice guy. But he told me that the new mandatory research requirement is something I should consider since I’m a woman and I don’t “have forever” to have kids. He kept emphasizing how “women friendly” the program was, was irritated me immensely. I don’t think there should be such a clarification since I want men and women to be treated equally, i.e., differences are not advertised and highlighted. But I think he meant well, it just came out wrong. He also asked me “tell me about yourself” and then asked me what questions I had for him, which are the two most annoying questions ever.

Then I waited in this basement conference room for about 3 more hours before they transferred me to the next windowless room. Apparently the main room recently flooded, so they were holding interviews in the sim lab. I was interviewed in “the control room” of the sim lab which was cluttered with TV screens and cameras for evaluations. Someone else had their interviews in a glass paneled room full of mannequins on tables, and we could all see them. It was weird.

Finally lunch was set out at and some of us traveled upstairs to meet with the Chair and the PD. But there were no chairs to sit in, and there were 6 of us. The administrator felt like we were crowding her by standing around in close quarters (in a 75 degree room, the heater was broken. Oh, and the window was boarded up for construction, so this makes hour 6 where I still haven’t seen outside). She asked half of us to “go back downstairs.” Which we did by way of a basement tunnel complete with uneven flooring and exposed pipes. Eventually I was summoned back upstairs and the interview with the “important people” went well. They are nice humans and asked easy conversational questions. 

But while I had been waiting for an eternity for my interviews, we got to mingle with some of the residents. Only about 3 or 4 came to talk with us, and they seemed very weird. The chief was a little scrawny guy that was on the typical chief power trip and was “jokingly” rude to the PGY4. Some highlights from our conversation with them:

PGY4 said he cried everyday during intern year because “thats what happens everywhere.”

Chief said he was terrified to come to work every morning and if he didn’t know the patient’s ins/outs, they gave him extra call shifts. 

When we asked about how the relationship was with other specialties, the chief said he needed to “educate” the medicine residents often since they often had dumb consults.

Zero residents own homes since they can’t afford real estate in the area

The interview with the PD was especially painful. He’s just socially awkward, had the limpest handshake I had ever experienced, and flipped through my residency like a deck of cards. He paused at my boards scores and said with genuine surprise “Wow! You scored well!” He was also shocked when I mentioned I had been a teacher and a Marine before med school. Clearly he did not read my application in advance. 

Between interviews in the upstairs windowless room, the administrator told us it was important to be “nice so your license isn’t taken away.” She recounted all her favorite interns that were really nice and then hesitated before telling us an attending recently made a “big mistake” but since “he’s nice he probably won’t get his license taken away.” Ummmm, what?

By the time I finished talking to the Chair, I was ready to go. The leadership means well, but it was very very clear that this was not the place for me. 

Now I’m drinking “Fall Sangria” at an adorable vegetarian restaurant on a riverfront feeling amazing. I love the fall and now I’m even more excited to escape the sweltering south and enjoy these beautiful towns with delicious foods and cute old houses <3

[thesinglesurgeon]

Came upon your posts and came across a post you wrote as an M1 about the "crier." You might want to delete that, just because it makes you come across as someone who did not care for the crier (i mean it's fine if you didn't), but it makes you not seem like an ally for women in med. She might not have just be crying about school then... it also perpetuates shows a bit that you think maybe men are right to not give roles to women. I know you meant no harm, it just reads so wrong

Hey Anon, thanks for this comment! Your thoughts come at the perfect time, since I sat down the other day to write again about some interesting behaviors I’ve recently observed at the hospital. Perhaps I was harsh in my evaluation of this med student who would literally wail before (and sometimes during) tests during M1 year. I thought it was important to blog about since it was such an aversive experience to me, even I was shocked at my disgust at her behavior. But years have gone by and that memory has grown foggy, until my away rotation in August and my SICU rotation this month. 

Two separate medical students broke down in tears in front of me. Once, the coffee lady sternly said “no” when the student asked for coconut milk. She cried (although more subtly than “the crier”) in front of the entire team at our prestigious academic institution during a visiting clerkship. The other person broke down after rounds, and just in front of me, because she was sick of people interrupting her presentation. Both occasions made me feel very irritated and further confirmed my strong stance against blatant emotional displays at work. But then, the senior resident on our team also broke down, with a family who was ready to donate their brain dead father’s organs. She cried pretty hard, too. But that moment did not seem selfish or weak, it seemed appropriate and empathetic. I realized then what’s wrong with “crier” and the other people who wept at work: it was because they were personally irritated and made everyone else around them be a part of their bad mood or frustration. But when the senior resident cried with the family, there was nothing abrasive about it. She was sharing in sorrow, not forcing people around here to awkwardly deal with her own personal perceptions and frustrations. 

I still think it’s important for leaders to hold their sh*t together, especially in the medical field. Doctors are the leaders of the team, and its reasonable to expect them to control their own emotions and keep it out of the picture (unless, of course, they are sharing in the patient’s emotions). So I stand firm with my post about the crier. I bet there was more on her mind than med school. Same with the student who cried over coconut milk (obviously something else was bothering her). But I don’t think it matters. I think a strong leader needs to have the capacity to control themselves under stress. When we need to melt down and let loose (and it happens to all of us), finding the right time and place is important. My younger self wouldn’t agree with that, but now that I’m older I can think of very few excuses for emotional outbursting.

#askaquestion #m4 #medblr #reflections

[thesinglesurgeon]

I JUST SUBMITTED ERAS

I did it! I paid for my applications, had my application certified, and assigned all my letters and personal statements to programs! 

This is surreal. And awesome. I can’t believe my next step is waiting for interview offers...!!

[thesinglesurgeon]

It’s ERAS time (well, almost!)

I feel so confused that I submit my ERAS in just a few days. It’s mind boggling that the time is here, and I get so nervous sometimes I feel sick! But mostly I’m excited. I’m spending today going over the “experiences” AGAIN. I am really disliking the inability to bullet-list my descriptions, these impersonal paragraphs feel weird, but are necessary...right?

[thesinglesurgeon]

Away Rotation: Quick Tips

Stay somewhere you like, that is quiet, close to the hospital, and restful. It’s worth the $$.

Know the “go-to” textbook for the service you are heading to. Download it, read as much as you can before and during the rotation.

Be early, leave late. Give up all hope of having a social life or exploring a new city. Commit to being present at the hospital as much as possible. 

Know each patient inside out. I spent 2 hours each morning preparing a bible of each patient’s history. When no one could quickly answer what their lactic acid was on admission, I knew it. When no one knew how many days the patient had been NPO without clicking the chart, I knew it. Write it all down, stuff it in your pocket, and spit it out when you can so people know you are prepared. (NOTE: do not interrupt people, but if 1-2 seconds goes by and no one knows the answer, say it and save the team from getting scolded for not knowing the answer. The goal is to enhance the team, not steal the spotlight).

In your bag you need:

clinic clothes

enough food for the entire day

water bottle

compression socks, extra undies

a folder with printed book chapters, notes you’ve taken

the list for the last day or two (helped me remember the plans)

scissors (YOU NEED THIS!)

tape

lubricating jelly

marking pen

charges for all electronics

when you go home: straighten up your house, eat dinner, drink a bottle of water, shower, watch a dumb show (or whatever you do to chill), pack your bag for tomorrow, and go to bed by 8.

in the morning: make coffee, review all the patient’s charts, create a bad ass list with all lab values, and MAKE A PLAN for each patient. Even if no one asks you the plan, you 1) get great practice for intern year 2) can chime in with ideas if no one else remembered to mention the patients nasal cannula that is unnecessary or the fact they have no bowel regimen.

all day: say yes. Yes you will change the wound dressing, yes you will ask the nurse if the patient peed, yes you will scrub and retract for 5 hours with a shitty view of the case. Do it all, and do it smiling.

try to ask a question once a day that starts with something like “When I was reading [insert textbook title] last night, I was confused about why they recommend approaching the abdomen with this incision when I’ve usually seen it done another way. What are your thoughts?” These questions reveal you’ve read something, thought about it, and are curious about the topic. They also don’t pin the attending into some random fact-check convo they are not prepared for and gives them space to teach a point or discuss their experiences, something they enjoy more than nit-picky questions that are really just med students trying to show off. (NOTE: you are trying to show off here too, but in a less annoying way).

Be wary of too much caffeine. I became addicted to the hospital’s coffee shop cappuccinos, and I had serious shakes one day when the attending let me first assist on a case. I honestly didn’t realize caffeine could make you look so jittery, but I wished I was more careful with this!

Take care of yourself. For me, this was making meals once a week and therefore being able to eat healthy by meal prepping. I also did 20 mins of yoga a night, and would read recreational stuff before bed. You don’t want to become so busted and resentful too quickly, so create space for yourself when you can. Also remember this is only one month of your life that can make a huge difference in your future, so when you want to take a break and stay home, find the inner strength to truck along for a few more days.

Surgery people: help out in the OR preop. The attendings want to get going as fast as possible. Helping to move the patients, shave any hairy areas, insert a Foley, etc help to move the process along. HOWEVER, you want to be a doctor, not a scrub nurse, so when the attendings are in the room looking at a CT scan or discussing the case with residents, join the circle. 

[thesinglesurgeon]

An Away Rotation in Surgery

It’s finally done: the insane hours, only having 2 days off in a month, getting lost 100 times a day, and negotiating tasks with intense gunners at a top program has finally ended! As always, the exhaustion hits me long after a test/rotation is over. Here are some highlights, and low lights, of doing an away in surgery at a top 10 program:

Amazing cases. I got to see an ex vivo renal artery aneursym repair in healthy young person. Watching a kidney go blue on ice and reperfuse to a pretty pink was life changing. It was also pretty horrifying to watch the renal artery vein get chopped in half (on purpose), only to be put back together again by hand. I saw a surprising amount of ruptured AAAs (which ended not so surprisingly...), and saw an incredible open AAA repair that ended so well. Watching an aorta be clamped is mind boggling. 

Performing CPR two times interoperatively. It’s bad enough when the person is closed up and on a bed, but much more “oh shit” when you can see their internal organs being slammed around. Good news: in both cases, ROSC was achieved.

Some of the interns were f*cking gunners. Like a level of insanity I didn’t know existed thanks to my nice school not picking those types of people to attend. These people were so naturally nuts I wondered if they did cocaine in the mornings, but no, they are just really pumped 24/7 about getting things done **eye roll** Of note, the nutty interns were off-service interns. Otherwise, I would not be applying to this program. The gen surg people were really chill. Thank the Lord.

“Go find a marking pen” was like the hardest task ever. So was “get a sterile drape for a bedside procedure” or “wheel the patient up to the PACU.” I got lost literally every day, and once I accepted there was no way to fix that, it became a little less annoying.

There are no work hour restrictions for med students. No one pushed me to stay late or anything, but when I did, no one sent me home (and I got mega points for staying late for good cases). One night, I was there until 1130pm, and was back at 415am. I actually was pretty alert and functional, and now I’m less afraid of intern year.

Pimping is indeed ubiquitous, therefore predictable. I was surprised how similar knowledge expectations of med students were, even at the “big fancy schools.”

You’ll notice little things that make a big difference to you. For example, in my school we all dress up for M&M, residents do not go back to workrooms until protected time is over, every time someone interacts with a patient a little blurb is entered into the chart. At this other school, everyone looks homeless at M&M, protected time almost doesnt exist...they all run back to work when they dont have to yet, and patients only get 1 progress note a day per service. I actually like my home schools ways of doing those things, and will ask about that stuff during interviews.

Feel free to ask me any questions about doing an away rotation! 

[thesinglesurgeon]

Step 2 Success

I got my scores back yesterday and was really excited to see I scored really well! (>255)! I had to share some tips for Step 2 since I was barely stressed when I studied, worked out each day, went out to dinner often enough. It was basically the opposite experience of Step 1, thank goodness.

I set aside 4 weeks of dedicated time, but spent the first week on vacation with my boyfriend. I really only studied for 2.5 weeks.

For the first week, I went over OnlineMedEd videos on 2x speed. I printed out all the notes and got through a subject a day. I did not do peds, obgyn, or surgery (I just came off my surgery AI and had watched them then). Once I was done with the videos for the day, I made Anki cards on really specific points or numbers I needed help memorizing.

each morning I did 30 new Anki cards and reviewed 50-100

After OnlineMedEd was done, I did UWorld each day. I had already done UWorld during third year clerkships, so I reset it and did about 160 questions a day. In Step 1 times, I would never be able to move that fast through questions, but I was done by 2pm-ish each day.

I wrote down all the wrong questions in a spiral book, but did not make notes on correct question explanations, just read them.

I spent 3 days reviewing: all Anki cards, all OME notes, and my spiral notebook. I would also read select topics in Step Up to medicine.

I also reviewed the notes I made during third year each day. I think this was the key to success. I had little notebooks I would take bullet notes down about UWorld that fit into my pocket.

I was worried I focused too much on UWorld (questions, reviewing old UWorld notes, etc). However, on my second pass through the question bank, I had literally no memory of any of the questions, which made me feel like it was worth going through again.

OME was perfect for coming up with quick charts in your brain to cram in lots of information. It’s a really great review, but not a great primary source during clerkships. I still think specialty specific books + Uworld are the best strategy for shelf exams.

I worked out each day, made my meals each day (no meal prep on Sundays, I took the cooking time as a study break each day).

*gasp* I didn’t finish UWorld on the second pass, but I felt okay with it. I had about 500 questions left. I did them on random, which I didnt do during Step 1, but should have.

The day before: I reviewed my Anki cards in the morning, skimmed my notebook again. Went to the gym, went to see Incredibles 2, went to a massage, and packed a huge lunch/snacks for the test. 

Morning of: woke up at 6, did coffee, yoga, big breakfast, got there at 715.

During the test: did 3 question blocks, break, 2 blocks, lunch, 2 blocks, break, 1 block, done.

Me and a friend scheduled 3 days where we rented a room at school and did 3 blocks, break, 3 blocks, break, 2 blocks. We tried to build up stamina for test day, which was a great idea. 3 blocks in a row is tough, but we did it so many times as practice, the real thing wasnt bad at all. The worst part of our question days was reviewing them the next day, but I highly recommend focusing on building stamina.

Step 1 was the worst. I was nervous, studying felt like a prison sentence, and even though I liked my score, I felt beat up afterward. Step 2 was so much better (I think simply because we have more experience with shelf exams and Step 1!). I was not nervous, slept just fine, and had free time...and studied in only 2.5 weeks!! I hope you guys have the same experience and Step 2 is just an obstacle, not the scariest thing ever (like Step 1 was!).

[thesinglesurgeon]

Just got back from India.

Well, I got back 4 days ago, but the jet lag was pretty bad for me coming east-->west. I was there for 3.5 weeks and had absolutely no phone service, let alone wifi. It was the medical and cultural experience of my lifetime, and I really recommend finding a way to explore other cultures, especially medically, if you have the opportunity. To very briefly summarize my trip’s effects on me: I am millions times more grateful to be an American, I am stunned by the beauty of the natural world, I am amazed at the hardiness of the people I have met, and I learned so much about Buddhism and Hinduism that my brain actually hurt from the new religious concepts and I have way more empathy to why some people just can’t accept people that are different than them (do I support this problem? hell no. But I understand it so much better).

My friend from medical school and I traveled from NYC to Abu Dhabi, then to New Delhi, then to Chandigarh. We spent the time in Northern India, particularly in Spiti Valley. It’s a region of India rarely visited by Indian tourists and is very isolated because of the Himalayas. It’s culturally Tibetan, which made for amazing history lessons about the exile and about Trans Himalayan Buddhism. We traveled with a medical anthropologist and a PhD candidate in religious studies. We set up clinics in tents at local nunneries and schools. We dealt with scabies at one place, lice at another, tinea capitis at another. We saw horrific cavities and really sun damaged eyes...in teenagers. We passed out toothbrushes and sunglasses and had the Sanskrit translators walk them through how to use each. We also had vitamins for anemics and antibiotics for the common mouth abscesses, impetigo, and a few hand abscesses. 

The trip is coordinated by a man from the area, who now lives in Atlanta, which made me feel like this wasn’t “voluntourism,” but I’m never sure. Especially since there are local hospitals (granted, they are really far away), a question comes up if we are disrupting medical care in the region or assisting. I think providing antibiotics and basic supplies is helping, and we referred them to the big cities for more complicated problems (and hoped they would go eventually). It’s a fine balance between helping and hurting the complex system of human interaction and cultural norms when a bunch of white people show up in the middle of the mountains. However, the clinics come by each year now for about 12 years, so in a vague way you could argue there is continuity of care that we provide.

Some observations about India: 

-they have no garbage collection system, and there is literally trash everywhere. And cows everywhere. 

-It was so hot before we got to the mountains, but the women always looked so beautiful with their saris, long hair, and red lipstick. I would be drenched in sweat and they somehow all looked so graceful. 

-Northern Indians are very peaceful and kind. When they find out we were from “USA” they all wanted to eagerly shake our hands instead of the usual “namaste” prayer hands greeting. 

-there is no toilet paper anywhere. or soap. people wash themselves with their hands and a spigot in the bathroom (with no soap), and then continue on with their day.

-the stray dogs are really cute and nice, but you can see giant tics on them....yikes.

-learning to squat while going to the bathroom is an awesome workout. I feared falling into the holes, the muscle clench was real!

-The Himalayas are stunning. They are a “new” mountain range that is still growing, so they are seriously rugged. It’s a humbling experience to stand amongst them, you suddenly feel so small and so inspired. It almost makes sense how Buddhism was born their, the theory matches the serenity and power of the mountains. 

-You can get sunburned in the rain at 8am when you are at 17.000 feet elevation. That sucked. 

[thesinglesurgeon]

Retrospective advice to incoming M1s

Its that time of year when my med school’s facebook page is aflutter with incoming med students looking for roommates and tips on the best local dentist and dry cleaners. Some of them write quirky blurbs (”I’m looking for a roommate, my only annoying habit is that I sing really loud in the shower!”) that are cute but a little annoying, mostly because it reveals how oblivious they are to what’s coming their way. I’m glad they are giggling and excited, I was too. But hindsight is always 20/20 and here is some advice I wish someone told me (honestly, they probably did tell me and I just wasn’t listening):

Drop your ego at that door. Yeah, you need normal healthy self confidence to function in life, but stop imagining your amazing performance in undergrad matters, or will translate to success in medical school. This was the toughest pill for me to swallow. I had a 4.0 in a really competitive neuroscience program in undergrad. I was convinced I could handle med school. It’s true, we can all handle med school, but it takes some adapting and willingness to ditch your old ways and try new things ASAP. After 2 blocks of unnecessary struggling, I ditched my old habits (reading textbooks cover to cover and making handwritten outlines) and moved onto new ways (using OneNote for electronic notekeeping, making a shit ton of index cards, and studying the hard stuff first).

Be flexible, then stop. This is weird advice, but it’s important. You need to try new study techniques the first few weeks. Do you need to attend class or watch lectures at home? Do you need to print the powerpoints or are you good with electronic copies? Are you able to sit still and read though material, or do you need to quiz yourself instead? Try out everything, find what works, then stop! Once I realized index cards were my jam and studying home alone was better than at school, I was fine. But there are moments when people brag about their awesome strategy, or you think that the next block you’ll use a different study strategy because of some rumor you heard about the test. Once you find your flow, stick with it, and don’t cave into study FOMO and unnecessarily change what’s working.

Take what your classmates say with a grain of salt. In my class, everyone is nice and awesome. But people seem to naturally drop their opinions when not asked to, or say one phrase that rocks your world and makes you feel dumb and unprepared. I remember when someone asked me to explain a biochem diagram to them that we just learned yesterday. I didnt really understand it either, but instead of saying: “I don’t know about that yet either” and moving on, I felt like a total moron that I hadn’t studied that diagram yet, that someone else is ahead of me, that I didnt get the concepts yet, etc. Just chill. Don’t really listen to anyone talking to you about study advice or material. Make it the background noise.

Study everyday. This is obvious (or it should be). But I had some serious denial, and mega resentment, that I had to seriously study everyday. Just walk into medical school expecting to study each day, don’t assign resentment to it, and realize that once you get better, you can take days off. Once you’re a fourth year (like I am now!), you get each weekend off and life is good. This is temporary, so buckle down and study everyday and don’t get mad about it.

School is the most important thing. And teachers know this. Don’t get immersed in a million extracurriculars like in undergrad (you’re not expected to), you NEED to know this material so you can be a doctor. How cool is that? You have to know this so you can help people one day. That attitude helped me realize that studying isn’t just a mind-numbing task, but the gateway to a dream job, and it symbolizes my competency to be a physician. So take school really seriously, someone’s life might depend on it one day.

You can’t help others unless you can help yourself. So exercise, watch a great TV show once in a while, eat chocolate, learn to cook tasty dinners. Like the airplane safety videos say: secure your own oxygen mask before helping others. When I was a kid, I thought that was so mean to put on your own mask first and ignore the little kids or fragile old people around you. But my mom patiently explained that without your own mask on, you’ll be useless if you also pass out. So put on your own mask first, then go around and help others.

This goes by so fast. I remember each long night in my little cubicle in med school. I remember carrying giant binders in a heavy backpack, and getting up at 5am to get to the anatomy lab before class to practice. I remember being envious of fourth years, truly thinking it would never be me out there in the hospital, wearing scrubs and actually making sense. But it happens, and it happens so fast. So don’t fret, the first two years aren’t awesome, but they go by quick =)