my first complaint

yep. it took one day. my very first patient of my career complained. she told the clinic director that i didn't listen to her and i rolled my eyes at her. i suppose the second is entirely possible, but i know i didn't mean anything by it. but believe that i listened - and i remember. anyone who knows me well knows that!

what she actually didn't like was that i didn't treat her problem the way she wanted me to. i wanted to investigate her problem and she wanted a quick fix. a quick fix that i thought would be dangerous. my attending stood by me. and so did the clinic director. i acknowledged what i might have done wrong. i accepted criticism on day 2.

did i forget to mention i stayed late on my very first day to fill out paperwork for this lovely lady??

new beginning

today was the first official day of doctoring. i walked into a room, looked right at a patient and introduced myself as dr. m. without laughing. not a bad day overall.

it is a bit surreal to take over someone else's patient population. this led to unexpected and rather surprising paperwork and emails today that required answering. how on earth am i really supposed to know is mr. white should or should not have his benzo refilled. thank god for my marvelous nurse. who, in addition to knowing the computer system inside out, shows incredible guidance in helping stupid interns.

if the rest of this year is like today, even if far busier, i will be a happy happy dr. chica.

oh and i got to staple a head. :)

new percentages

i started this to record, really for myself, how far along in medical school i was and now that is over. i reached 100%. now i find that a new discrete part of my life begs to be recorded. so we go back to 0% family physician - and in 3 years, i will hopefully be competent and even good at it.

i don't wish my life away by any means, but i like the discreteness of a three year block.

so here we are - looking forward to a year of 4 months of FM service, 2 months each of peds, surgery and OB, 1 month each of ER, NICU. a third licensure exam. meeting a whole new group of colleagues and patients. learning a new city, a new state.

a new life.

i'm ready.

100% there

a lot has gone on since last i posted.

1. Finished fourth year - after that family med month, there was inpatient psych (which i really should have blogged about), anatomy, research, university health (a wonderful rotation - no, really!!), pharmacology, trauma surgery, and family medicine offsite. then, that which i thought had become impossible happened...

2. i graduated. yep. i'm 100% there. that's me STM, MD. you know, if we put my other letters i'm, STM MD MA - which I think makes me a hallucinogen.

3. so those interviews...i ended up doing seven - Cincinnati, St. Joe's/MCW, Smiley's/Univ. of Minn., St. Joe's/Univ of Minn, North Memorial/Univ. of Minn, Tufts, Palmetto Health. i cancelled two - one in milwaukee and one at UofL. don't think i could be a cardinal anyway. was hard enough to be a tarheel.

aaaanyway, ranked five. matched at #1!! starting residency at St. Joe's/MCW in just a few weeks. yippee!!

4. moved to milwaukee. obviously necessary considering the job thing. that's more or less where i am right now. surrounded by the smell of cardboard. slowly the boxes are getting unpacked and our fabulous duplex is looking like home. i have never lived somewhere that i could just throw the windows open and cool my home. it's lovely. yesterday, we drove downtown and j hadn't seen the lake yet (um, that would be lake michigan). when i said, hey there's the lake (like you could miss it), he said no it's not, we are going the wrong way. um, seriously dude? i know i have no sense i direction, but there is only one gigantor body of water around here.

so far i love it here. i suppose we shall see what happened with odd hours and little sleep. j is still looking for a job or basking in the glow of being the doctor's husband. he is officially the househusband until he finds a job, once i go to work. he desperately needs to learn to cook.

i won't lie. this isn't the easiest thing i have ever done. i'm scared and underconfident. i'm worried that my patients won't get good care if i am the one providing it. i keep reminding myself that residency is an apprenticeship - right now i know a very little about a lot of things but my knowledge base will change. i start on ER, the OB, then NICU....NICU?!?!? i have assurances from a good friend that i can make it.

Travel and training

A few days from finishing the first rotation of my fourth year, I feel I should pause and consider. I am finishing a month of family medicine clinic - which was really a lot of reading time and a little clinic - a schedule for which I am amazingly thankful. Because they allowed me some free days I have been able to study for boards, sleep, and go back to having a normal life.

I have also had the privilege of remembering why I really do love family medicine - the variety of ages, genders, family structures, pathologies. I can't get bored, which is good since I tend toward it anyway.

I continue to plan residency interviews - truly surprised at how many I have been offered. I admit to overwhelming underconfidence where this is concerned, but I didn't expect to hear so quickly. The first programs didn't wait for grades or all my letters of rec. I have scheduled at University of Minnesota (x3), Medical College of Wisconsin, University of Cincinnati, University of Pittsburgh, Tufts, Palmetto Health in SC and am waiting for dates at University of Louisville and Aurora Healthcare in Milwaukee.

Step 2 CK on Thursday and then I am free of exams until February (I think). One weeks until psychiatry AI. Looking forward to it.

And so it begins

I am now officially one week into fourth year which means, for anyone keeping track, that I am 75% doctor. What else does this mean? - Well, that I have eight rotations to finish in seven months, two boards exams to take in the next three weeks, residency to apply for, interview for, and try not to freak out about among other things in my non-medical school life.

First, third year. It's over. 'Nuff said. I am not going back to that, ever. I truly hated five months of it, the rest was actually fine. If I had to specialize in what I did those five months, I'd quit. Without regard for debt or self-worth. I would quit medicine. Without regret.

Luckily, I don't have to do either of them. Which brings us to residency applications. ERAS - the bane of fourth year existence. That which keeps fourth year from being quite the mythical promised land that classes before us have waved as taunts. I dutifully took time away from surgery studying to work through the application, find letter writers, write personal statements. Last weekend, I completed the mad dash through finishing it, so I could get the application posted. On Monday I submitted the application and on Wednesday morning I posted my personal statement (thanks to family and friends who obediently read not one, but two, drafts). Then I sat back to enjoy my family medicine clinic rotation and await November when my Dean's letter is submitted and the interview offers trickle in.

How laughably delusional and naive I apparently am. After submitting my personal statement at 10 am on Wednesday, I received an email about noon from one of my programs. I thought, how mice off them to let me know they got my stuff. WRONG! I mean, they did let me know, but then, THEY OFFERED ME AN INTERVIEW. Got that? Within three hours of finishing my application I had an offer. From a program I like. That has, by the way, been followed by five more since. I am stunned and completely excited. I have heard from three of my favorite programs. I can't believe it. Within four days of putting my application up. Wow.

The list so far (all categorical FM right now - I won't hear from the combined for a bit):

University of Cincinnati/Christ Hospital
Tufts University
Medical College of Wisconsin - St. Joseph's Hospital
University of Pittsburgh - St. Margaret's Hospital
Aurora Health - Milwaukee (I'm turning this one down - it's a funny subject for a later post)
University of Minnesota - I don't know which program yet

Worst fear....almost

The first choice that any medical student makes is usually medicine or surgery. And we joke that particular temperaments go with that choice. I knew when I started school that I would be medicine; I just don't see myself as a surgeon. I really do see myself as the doc who treats your chronic high blood pressure and heart disease and knows when your granddaughter graduates from kindergarten or the doc who delivers your baby, then takes care of mom, baby and dad besides. I never saw myself as wielding weaponry for the hack and slash of guts.

Here's the revelation. I love surgery. Who's surprised? Well, I was afraid of that - that I would find that I really like the OR, the cutting, the guts. I love the immediacy of patient relief after having a gallbladder out or the feeling of accomplishment when a patient's biopsy comes back showing you got their whole tumor out. It's a rush.

Now no worries. I am not changing my mind. I stand by family medicine/psychiatry. But if I were 25 or if I were single, I might change my mind right now. However, I took the time a couple years ago to really consider the type of life I want to lead and surgery isn't it. I can't stand the idea of five years or more of this schedule.

Besides, family practitioners get to cut! and deliver babies! and have long term relationships with their patients!

Whew - saved by the skin of my teeth!

Decision making capacity

Don't worryl I have not lost capacity. Nor have I lost sanity. Yet. But the big decision is looming. What to do with my life. Really the decision is made. Combined family medicine-psychiatry. I want to do both, hands down. I can't make up my mind.

Making that decision apparently causes everyone else in the whole friggin world to question my capacity. Not just "why do you want to do that?", NOOOOOOoooooo.

More like -

Why do you want to do family medicine?
Why do you want to do psychiatry?
Why do you want to do both?
Why not do internal medicine, med/peds, triple board....insert specialty here?
You don't need to study psychiatry - have my patients are head cases.

So here's the answers...

Why do you want to family medicine?

Because this, above all else, feels like the model of medicine that not only treats the whole person, but also considers the greater community outside. This is preventative medicine, acute care, peds, OBGYN, geriatrics, epidemiology, ongoing patient relationships. Because I adore children and old men and reproductive age women and teenagers and where else would I get to see all of those populations but in family medicine. Where else can I cut, counsel, prescribe, advise, recommend, befriend.

Why do you want to do psychiatry?

Admittedly, most doctors deal in some capacity with psychiatric issues. Some even spend time with med management. A lot fo pediatricians find themselves in the position of needing to be the main go to person for their patients psych issues. And I could do a lot of work with psychiatry as a family practitioner. But my desire to do psych is two fold. First, I love therapy and I think that people are reticent to try it when there is the possibility of a quick pharmaceutical fix. Who can blame them? Getting patients to do the work, find the introspection, change their lives to cope would be wonderfully fulfilling. Allowing patients the option to medicate appeals to me. Second, being able to treat my patients bodies and minds is highly appealing. A truly holistic approach to medicine.

Why do you want to do both?
Simply? I can't decide between them and I have the amazing opportunity to do both. More than that? Ultimately in addition to practice, I want to teach. I can think of nothing that would make me a better teacher than the combination of these two disciplines of medicine coupled with my experience as a teacher.

Why not do (insert specialty here)?

This is always a fair question. Only it never happens as an innocent query. Instead it is about pummeling me into choosing something else. Suck it up....

Internal Medicine - no kids
Med-Peds - no gyn
Triple Board - no adults, except in the psych part and three specialties in five years, scary
OBGYN - too much surgery for me
Neuro - um...you need to ask? we haven't spoken in more than a year
Surgery - it's awesome and I would if I were younger

I won't lie. Making this decision was difficult. Every time I eliminated something, I made pros and cons. Then I mourned it's loss (except neuro). Then I moved on.

Now there's applications, personal statements, letters of rec, work, school, interviews to be done. And life to be lived. Let's go!!