In 2013, I ...

... survived a 2,122 mile road trip with my mom.
... survived another 926 mile road trip by myself. 
... flew 55,032 miles.
... conducted some pretty exciting research and created life-long mentors.
... presented said research at 3 different conferences.
... had frivolous fun during the research year. 
... read A LOT of books (thanks to checking out kindle books from the public library).
... completed a whole bunch of knitting projects!
... watched my classmates match into residency and graduate medical school.
... had my heart broken into splinters.
... finally, after over 6 months, am beginning to feel my heart mend.
... celebrated with multiple friends as they [finally] gave birth to very much desired babies.
... grew comfortable riding a bike and then completed a 70 mile bike ride.
... moved back to the South, and found it better than I remembered. 
... reconnected with old friends and made many new ones.
... embraced the last full year of my 20s. 
... stepped out of myself and took chances  - with mixed outcomes.
... began to internalize and eagerly anticipate the excitement that 2014 promises!

Happy New Year ya'll!  May 2014 be full of blessings and dreams come true!

End of the road?

Yesterday may have been my last residency interview.  It was great, as a lot of them have been.  I've been fortunate in that I think I'd be happy at over half the programs I interviewed at.  Two I love, 2 I like a lot, some others I like, 1 I very much don't see myself at.  Unfortunately, with the amount of interviews I had, my chances of matching are around 90%.  Good, but not good enough. 

So now I wait.  Wait and hope that it wasn't my last interview.  Hoping that a few more programs, especially some of the 4 I think would be an excellent fit with interview days left, will have pity on me.  Hope that the people on the interview trail who keep saying they plan to cancel their January interviews due to already being burnt out do actually cancel.  Please, cancel already.  Let me go instead.  A little more confidence that I'll match will be an excellent holiday gift. 

And now I enjoy the holidays.  I rest after 16,000 miles of flying and thousands of dollars spent.  Rest after numerous baby presents knit on planes, books read, and work somewhat haphazardly done from afar.  Oh, and I work on the manuscript I was supposed to finish this past month.  

Happy holidays ya'll.

Tears for a life too short

I can't stop crying for a boy I never met, but who's story I have been following for the last year and a bit.  He was diagnosed with AML at 6, his battle chronicled in poetic detail,  and died over shabbos. 

He was a superhero.  His parents, Rabbi Phylis and Rabbi Michael, are beyond superheros.  Time and time again they have gone above and beyond to bring good into this world.  Throughout this whole process they seem to always keep others in mind, trying to give back to those they encountered every step of the way.   It is this selflessness that continues to inspire me.  Even in circumstances horribly beyond imaginable, goodness and light can be sought.  There is always work to be done. "36 rabbis shave for the brave" St Baldrick's fundraiser is underway, now in Sam's memory, with a lofty goal of raising $180,000.

Sometime around the beginning of medical school I remember reading a study that doctors tend to be much more uncomfortable with death than the rest of society.  We may be comfortable with our own mortality, favoring much less invasive end of life care, but we can not except it for others in our lives.  I don't remember where I initially read it, but in times like this, I wonder about it.   Are we predisposed to medicine because we want the tools to stop death, or does medical training teach us that death is failure?

Regardless, 8 year olds are not supposed to die.  Parents are not supposed to bury their children.  For all that love Sam, z''l, and for all the others' who have had to bury children prematurely, my heart breaks for you.  I can not even begin to imagine what you have been through.  Know that I will try to carry your tragedy into my practice as a doctor - hopefully making me more compassionate, empathetic, and aware of the limitations of my art. 

Waiting game

I've never had much luck with wait lists.  It started all the way back when I applied to boarding school for 9th grade.  I didn't get off that wait list, didn't get off for college, or for medical school, and it now appears I didn't get off the wait list for my first choice residency program who is having their last interview day today.    I know from previous experience that it all works out okay.  I ended up where I am now because of the way things turned out.  I'm pretty proud of the place I'm at. 

Still,  I'm worried.  I feel pretty confident that I'll match.  I just have a good gut feeling about it.  However, I don't have any interviews in the cities I was most interested in moving to and I still don't feel like I have enough interviews overall.  The median number of places ranked for US seniors that matched in ob/gyn last year was 11.  I'm below that number.

The most frustrating part is that on the interviews I've gone on, especially the local ones, they make comments assuming that I have my pick of residency.  Clearly they are only looking at my CV and not step scores.  My CV and recommendations alone make me look like a pretty stellar candidate.  If they saw my first failed step 1 - then they'd know the truth that I'm pretty screwed in this process.  I'm still going to make a damn good doctor, and hopefully be a ob/gyn, but likely not in the location(s) I had originally imagined for myself. 

I can't believe it is already December.  I can't believe I still have so few interviews.  I don't really know how I'm going to last until match day on March 21st.  Trying to take deep breaths and keep waiting. 

dream versus reality

Last night I had my first vivid dream about this whole residency process.  I was offered an interview off of the wait list for tomorrow (for a city I happen to be) and then was offered 2 other interviews.  It was such a lovely dream! 

And then I woke up... and so far, today has brought none of those things.  Finally starting to give up the last glimpse of hope that a spot will open up for tomorrow.  Boo.

The most repetitive lesson of medical school

1. If it doesn't make sense, or you don't know how to do it, fake it 
2. Just keep faking it and moving forward
3. If you fake it long enough, it will eventually make sense / you'll figure it out
4. As soon as it makes sense it will be time to move on to the next thing that doesn't yet make sense*
5. Repeat

It amazes me how many times this cycle has repeated itself during my medical school experience.  And yet, it still continues to repeat. 

*Sometimes, you actually have to move on before you realize it makes sense, but then you move on and that last thing just "clicks".  Slightly out of order but the process still holds true.

11.14.13

41,975 blood tests
6,570 injections
1,551 pump site changes
92 endocrinologist appointments
26 thorough eye exams
23 years of living with type 1 diabetes

Today is world diabetes day.  I wouldn't be who I am without diabetes, and for that I am thankful.  But I wouldn't wish it on anyone.   With the newest research coming out, I'm finally letting myself believe that there may be a cure in my lifetime.  I'm excited to see how this research evolves.

MS4 pickup lines

Said to me tonight (in a supportive, platonic, way): "You would be at the top of my interview list if i were a PD!"  Which got me thinking about what other fun pickup lines might exist around residency applications and being a MS4. 

Maybe my mind is just in a really convoluted place. Why not have fun with it though?  What ideas do you have for MS4 inspired pickup line, dear reader?

November is starting off on a bad foot

I just got a rejection for one of my top programs.  Far from my first rejection, but this is the first rejection that I'm really really upset about.  Seriously worried that I don't have enough interviews to match, especially enough interviews outside of the South. Hopefully the month can only improve from here?

Also, being on a rotation where I'm supposed to be self motivated and self-paced is turning out pretty poorly.  Week 1 has mostly been made up of sitting on the couch, watching TV, and taking naps.  It's funny how much I get accomplished when I am busy and how little I do when I'm not.

Greedy for interviews

Before I submitted my application, I found myself saying "I'll feel better when I have my first interview" to which a friend replied "Nope, you'll just keep wanting more".  She's right.  One interview invite, or two, or three, is nowhere near enough.   It is never enough.

A little over a month into the residency application process and I have far from enough interviews scheduled.  In fact, I have about half the interviews I need/ want.  I'm growing increasingly fearful that I wont get anymore invites or off any of the wait-lists.  Especially seeing as the last week has brought only rejections and I've never before had luck with getting off a wait-list.  With each passing day I grow ever more fearful and anxious.  I find myself worrying that these people reading my application, who don't know me as anything other than a pile of papers, will stand in the way of the future I want.  I wish there was a way to show them what kind of kick ass ob/gyn I will become, if only they will give me a chance.  And to make them understand why I need to leave the South for training.

Maybe tomorrow will bring another invite or two?  Or an interview from one of the wait-lists I'm impatiently sitting on?  Please?

Not enough lexapro in the world

I'm pretty sure there is nothing that can cut through the dense anxiety that has built up around waiting for residency interviews.  I am trying my best to limit the amount of times I check my email (goal: no more than every 5 minutes), replace stress eating with healthier activities (goal: stop buying chocolate and go to the gym), and have conversations that are not related to interview invites (goal: talk about something else, ANYTHING else).  I'm doing decently well on going to the gym but failing by compulsively checking my email and preservative in conversations with friends.  Things like student doctor network's discussion board where people post what invites they are getting absolutely does not help in any way.  I know it is limited to a few obnoxious people positing anyway and is not reflective to what is actually going on, and yet, like an addictive drug I keep going back for hits.  It is the only connection I can find with what is going on behind the magic curtain. 

I got to spend this weekend back in my old, premedical school, stomping ground.  I've gotten to cuddle infants and chase toddlers that have been born while I have been nose deep in books.  I am finally seeing houses that have been purchased and roots that have been planted while I've been on the wards.  I feel blessed to be embraced so warmly back by this community, but also, even more aimless and unsettled.  Where will I be come June?  Will I still be on track to a career as an ob/gyn?  Will I be living in a city of my dreams*?  Will I be making friends with my co-residents or feeling like I don't belong?  So much unknown.  Ah! 

I keep thinking it'll be better if I get 1 more interview invite.  And then I do, or I don't, and it doesn't feel better.  I just want more.  More.  MORE.  Plus, then I get a rejection or two, or three as was the case last week, and I want to curl into a ball and cry.  Clearly rejections are going to come, but why can't all the invites come first? 

Is this process crazy making for all 4th years or am I am exception?  I no longer seem to have a grasp on reality.  


*there are currently 4 or 5 cities of my dreams.  So far I have a single interview in 1 of these cities.  I am desperately hoping for more.  At least 1 interview in each city, and maybe even 2 or 3 in some of these cities.  Please? Pretty please?

6 months

6 months ago I was just starting to accept the newness of a breakup from the woman I hoped to marry
Today I am still struggling to heal, but the edges aren't as ragged as they were

6 months from now (2 days ago to be exact) I will match into a residency program
Today I am patiently anxiously waiting for interview invites, and continuing to grow increasingly anxious every day

An emotional 6 months behind me and an emotional 6 months to come.  Praying that I have the strength to turn the anxiety into productive energy.  That I exercise instead of eat, that I force myself to go out instead of cowering in the corner, that I embrace the blessings to be found in uncertainty.   May the next 6 months be filled with continued healing, travel, and adventure!

Another 4th year milestone

I certified and submitted my ERAS application today to an obscene number of programs.  Somehow, miraculously, my personal statement was completed and all my letters of recommendation were uploaded in time.  After all the dramatic buildup, it felt hugely anticlimactic.  

Now I get to sit by the [smart] phone and anxiously await [interview] dates. Here is to hoping that the next few months are filled with many plane flights, cross country journeys, meeting many new people, and seeing old friends along the way! 

In the meantime, tomorrow I'm reestablishing care with a therapist.  I know that I'm going to need good support in place to get through the guaranteed uncertainty of the coming months. It was strange to realize in shul yesterday that I have no earthly idea whatsoever where I will be next year for the chagim. I'm trying to embrace all the possibilities and am optimistic that the therapist will bring some useful tools too.  And the adventure continues...

A week in the life of a MS4, edition 2 (August 19 - 25)

Yesterday: Rough.  Very rough.  Lots of tears from patients and nearly some from me too.  Got feedback on how I've been doing on the rotation.  Mostly good, some not so good.  Ate a bowl of cereal for dinner as there was no energy for anything else.

Today: So much better.  Got to scrub into a pretty wonky [and awesome] c-section.  Tripped on my own shoes when walking around the table to put in closing stitches.  Broke scrub when the nurse [who I adore] reached up to catch me.  Thankfully the atending had already left the room and the residents still let me close once I was re-gowned and gloved.  Got lots of complements in clinic.  Intuited a much needed hug from a staff member who seemed very appreciative when I asked if she wanted one.  Small achievements make me feel like a rock star!  Pretty sure this sub-i is inducing some type of manic/depression emotional roller coaster.... oh well.

Tomorrow: Responsible for 2 presentations.  1 is a formal hour long thing for the whole maternal fetal medicine department, the other is a quick 5 minute topic on patient care that I will likely filibuster.  I'm sitting here writing this blog post instead of prepping for either.  Or sleeping.  Oh, sleep!

Day after tomorrow: When is that? Yep.  I can't think that far ahead.  Let's just get through tomorrow first, and hope it is more reflective of today than yesterday. 

After what may seem like kavetching, I need to reaffirm though that I am LOVING every minute of this.  High intensity, high volume, patient centric chaos is my drug of choice  I feel so lucky to get to do this each and every day! 

I should carry Kleenex in my white coat

3 patients cried on my shoulder today.  All for very good reason.  All I could do was listen, hold their hand, look at them in the eye, confirm that it all just sucks and unfortunately no there is no answer for why, and offer Kleenex.  There were a few points where I almost started crying right along with them.  A shitty, rough, complicated day indeed.  A day that requires a long bike ride or a glass of wine - neither of which I had energy for after 14 hours of running around the hospital and knowing that I have to do in again in less than 8 hours.  You know what though?  I love my job.

It weighs heavy on me, maybe too heavy, but I am so glad that at least I can be there to offer a Kleenex. 

Friday of firsts

Friday afternoon was full of firsts.  I got to wear the intern pager and triage all pages, which remained exciting for exactly 2 pages before it began to feel cumbersome and slightly annoying.  Then, suddenly, all the residents had to step off the floor, some to a c-section and others to an event upstairs.  My chief left me in charge!  Me!  For what felt like days (likely somewhere between 30 minutes and an hour) I watched tracings of actively laboring pts, freaked out over a minor decel, assessed a pt who showed up to triage, returned pages, and didn't kill anyone!  I think I proved myself capable.  The fact that they trusted to leave me in the first place, I think shows that they trust me.  Feeling much better than last week though concerned what a new herd of residents will bring in tomorrow.

Sub-i self evaluation

1. I want to be the best sub-I they have ever had, to be perfect
2. I get loquacious when I'm nervous
3. I seem to always be nervous during my days on the wards
4. When I get loquacious, I tend to talk about myself or tell personal stories that relate to whatever is going on
5. I'm pretty sure no one wants to hear these stories & I should just shut my mouth
6. But then I get more nervous, and more loquacious
7. Even when I make a conscious effort to not be loquacious, I still manage to over talk & over share
8.  I blame it on being an extrovert & wanting to connect --> I want to connect to people
8.  I LOVE obstetrics and get excited that I get to be doing this
9.  My excitement makes me seem young (according to the PGY2 who couldn't believe I'm older than him because I'm so "eager")
10. Partially because I love what I'm doing, and partially because I don't really know anyone in this city, 14 hour days at work are amazing but weekends off are proving rough
11. After this experience, I would highly recommend doing aways in cities where you have connections.  Without such connections, this feels way too isolating and more nerve-racking. 
12. I try way to hard to seem smart, knowledgeable, & capable which makes me less of all 3 of these
13. If nothing else, my goal is to at least be helpful in order to make my residents' lives easier
14. It is pretty difficult to be useful at a new institution where you can't even find your way through the hallways of the hospital or figure out how to use their computer system
15. I am far from perfect
16. I strongly believe that only perfect sub-Is honor, and therefor there is no chance I will honor
17. I fear that high-passing my sub-I(s) instead of honoring will mean that I don't match in OB/GYN
18. Again, back to #1, I wish I was perfect

A week in the life of a MS4, edition 1 (July - August)

Tomorrow: - Last day of this first away sub-i
                   - First residency interview (at the program I've been doing the sub-i at)

Weekend:   Pack up from where I've been living all year into my car

Early Next week: Drive 3000 miles in 3-4 days

6 days from now: Start next sub-I at a totally different program type of program, in a totally different State, in a city I've never really spent time in, with totally different expectations of me that I do not yet know.

Oh, and all the while, I need to be working on my ERAS application.  

And this my friends is med school.  As soon as you get comfortable in your current situation, you're shoved into something new & different that you're totally not prepared for.  The strange part?  I am so grateful for this life and love it all.  Bring it on!

Halfway through

I'm 2 weeks into my first, of two, audition rotation.  It's both wonderful to be back doing full time patient care and also making me realize how much I forgot over the past year.  I couldn't even remember how to write a procedure note today!  Opps!

Mostly, it just feels like I am on a proprietorial first date.  Complete will all the nervousness, uncertainty, over-analyzing, and retelling of the "he said/ she said" to close confidants.  I just want the program to like me and ask me out on another date (or to match for residency)!

July 1, 2013

First day of my first away rotation.  So far, so good. 

ERAS opened today, so it is also my first day of officially starting the residency application process.  

A year from today (hopefully) will be my first day as a resident. 

Object Permanence

Last month, after reading Julia Levy's article about going on 30 first dates in the month before she turned 30, I decided that I also needed to set such a goal.  Mine: to have 30 first dates, or at least new introductions, in the next 10 months before I turn 30.  This is my way of dealing with the most recent breakup.  This is also my way to telling the world that I am fully open and willing to meet someone special (again). 

Really though, I'm scared of turning 30 single.  I'm even more scared of starting residency single.  What if I end up in a place without queer Jews to date?  When will I have time to meet people in residency?!  What if I meet someone living elsewhere, and neither of us can move until residency is over?  Who will support me through the hell of the transition into residency?  Who will be the first person I share my match results with?!  Anyhow, I digress.

One month into this mission and I'm at 2 of 30:
1. The first was an email introduction from a friend which has led to some nice conversation back and forth.  It is enjoyable but who knows when we'll ever actually meet face-to-face... Pointless?  Maybe.  But a least the emails are fun to write and read.
2. The second was a coffee date this morning with someone I met online.  She was lovely and conversation was easy, but, and it is a big BUT, I'm only here another week before embarking on 2 months of aways.  She's only here for the summer.  Is she worth changing my schedule around (sacrificing sleep) to try to see her again?  I don't think so.

Now I'm wondering if this is a futile mission all together.  My 4th year schedule has me pretty nomadic for the entirety of the year.  While I am not opposed to long distance relationships, long distance dating is a whole other creature.  An unconquerable beast.  How does one date and start a more serious relationship when they don't have any stability to their life and everything is a big unknown?  Knowing what my schedule looks like, and how people react when I talk about my plans for the year, I can't imagine there is any possibility that I won't still be single a year from now.

This one time, during brain surgery...

Today I had the opportunity to watch a neurosurgeon remove (debulk would be a more appropriate term) a really nasty & invasive brain tumor.  The following conversation occurred during the surgery:

Neurosurgeon (NS): What year are you?
Me: I'm a 4th year, sir.
NS: First, don't call me sir.  Second, what are you going into?
Me: Obstetrics
NS: Really, ob/gyn?  That's too bad.  When I first met you I had thought you very intelligent. 
silence

Then, post surgery:
Me: Thank you for letting me scrub in.
NS: Of course.  It was great having you in the case, and nice meeting you.  I still think you're making a stupid specialty choice though!

And so begins the ob/gyn bashing that I have heard so much about.

On another note - two interesting new stories today about reproductive health.  First a story on the Turn Away Study and the second was ACOG bringing attention to HR 1797, the District of Columbia Pain-Capable Unborn Child Protection Act, which is progressing in the house.  This bill would ban abortions after 20 weeks, leading to more "turn aways" and issues with access.  While it is specific to DC, it could set an ugly precedent. So glad that this is how congress is spending their time, and our tax payer money, instead of doing things like dealing with the ongoing sequestration.  Ugh!

Pride

I was sitting in the car this afternoon with my mom on the way home from the airport (I'm home for a quick weekend between finishing my research year and resuming MS4), when she retold a story about an encounter that happened this week where someone wanted her to sign a "gay rights" petition.   She retold how she told the organizer "yes, I support gay rights, my daughter's gay."  

I've been out to here for 13 years and never once have I heard her say those words.  What a long way we've come...

Happy pride ya'll!  Instead of going to dyke march & pride, I'm spending this shabbos resting and enjoying some quiet time (& kick the cold that has been trying to attack all week).  The next 11 weeks are going to bring a whole heck of a lot of transition back to med school and being my best on away rotations.  Time to rest up before the fun begins!

Where will I be in August?

Fifty percent of my away rotations (July) have been settled.  August seems to still be up in the air though.  I got a loose offer from one Midwest program and then a formal offer from another.  The latter is where my now ex-girlfriend is on faculty.  I had applied in hopes of being with her, and then in stubbornness of wanting to prove to her that she made a mistake in dumping me, but now am starting to think wiser.  I imagine it will be tricky to do well on an audition rotation while also navigating being in the same space as someone whom I am deeply in love with and want to make a life with, but who doesn't love me back.  Plus, I'm pretty sure she's the only queer Jew in the city that I'd want to date - meaning that even if I LOVE their program - the city doesn't hold much promise for other parts of my life such as, um, dating.  

The first program isn't as strong as the program with my ex, and I'm not as interested in it.  It does come in a city with more queer Jews though.  Also, while the first program sent me an email offering me a space, there has been no formal follow up and they aren't responding to my attempts to gain more information.  I need to give program #2 an answer by Friday. 

I was just informed that a program I was holding out hope for is filled for my first choice for August, and was instead offered Oct, Nov, or Dec - none of which work for me.  I called the coordinator back who has put me on a wait list for another August rotation in ob/gyn at their program, but I wont know about that until at least Monday.  Two other programs I have applications in for wont even begin reviewing them until next week. 

What do I do?!  Anyone have a crystal ball I can borrow? 

The wheels on the bike go round and round

I did it!  I rode 65 miles on my bicycle over the past 2 days.  Sure, I walked some hills, and swore as I struggled to ride up others, but I still managed to do it!  I gained confidence on the downhills and learned to appreciate the modernity of flat roads through cow pastures.  There was only one small, almost comedic, fall off the bike on the second day when I was way past exhausted.   And you want to know what?  I got up and rode 16 more miles afterwards. 

All and all it was a beautiful weekend and a successful ride.  I challenged myself to do something I never really could have imagine doing before.  I gained confidence on my bicycle.  I embraced being completely cut off from cell service and email for a full 3 days.  I ate copious amounts of delicious food that was very locally produced and cooked with intention, in a room full of Jewish environmentalist.   I led a tisch Friday night that filled my spirits with songs, torah, and blessings.

At one point over shabbat, I realized that I was very much surrounded by the community that I have built over this past year.  This research year really has brought a lot of unexpected joy and connection.  Such a wondrous experience to end a year of personal growth.  I feel so very grateful.  Sore.  And grateful. 

Now, what next big ride should I train for next? 

Goal: stay up right, don't get hurt

The charity bike ride is this weekend.  It will be the biggest physical challenge I think I’ve ever attempted.  That is assuming that I ride more than 20 miles.  Therefore, I’m terrified.  I am so touched that my friends and family have donated so much money to support me, which I interpret to be either because they believe I can do it or they are in shock that I’m even trying. 
 

Seeing as I was basically a non-bike rider at the start of this (not learning to ride a bike until I was 19, never having ridden more than 2 or 3 miles at a time, and not having been on a bike in 3 or 4 years) I have 2 main goals:

1)      Stay on my bike

2)      Don’t get hurt

Actually, as long as I don’t get hurt, I’m not really sure staying on my bike is even that important.  The full ride is either 80 miles or a 120 depending on the course you choose.  My housemates are all doing the shorter 80 mile option and so that’s what I’m planning on too.  Even if I only make it one day, 40 miles, that will still be a new achievement for me.  Need to focus on small victories and not be disappointed when I don’t complete all 120 miles… that can be next time, right?

I just want to have fun.  Really, I want to not be anxious about this ride and to have fun.  Sun, endorphins, friendship & comradely, a post-ride massage scheduled – this really could be fun! 

Away rotation purgatory

Somehow it is May and I am in my last few weeks of my research year.  How did that happen?  Seriously, how? 

My last month here is overly scheduled: trip home for mother’s day, presenting preliminary research at a conference, charity 120 mile bike ride, finishing my public health thesis, and scheduling next year.  That last one is turning out to be a painful.  

I, like most medical students, am a type A planner – a control freak.  Scheduling away rotations leaves no room for control.  No transparency, no answering of emails or call, and no standardization of timelines.  Whoever thought of VSAS, and whoever decided aways are important for the residency application process, clearly finds pleasure in torturing medical students. 

So many moving pieces depend on if, when, etc. I schedule aways.  When do I leave the city I’m living in?  Do I drive, do I fly?  What happens to my car?  Where is all my stuff going?  Will I be able to keep the rest of the schedule I have booked with my home institution?  Or will everything need to be flipped around to make time later for aways… Ugh!  Uncertainty = anxiety. 

I’m just looking for 2 “yes”s.  July. August.  Two little away rotations at two different places.  Hopefully in ob/gyn.  So far I’ve been given “no”s from two places for July.  “Yes”s will come after “no”s, right?

UPDATE (5/20/13): July has been scheduled!  So, unbelievably, relieved.  Now I just need August to work out.

Dear ACGME,

As a 4^th year medical student I highly value the work that you do in ensuring my training in residency will be sufficient.   However, I am horrified to learn that you are proposing the removal of family planning training guidelines for family practice residents.  Many US women go to a FP as their primary healthcare provider for comprehensive health care – from the treatment of acute sickness to the delivery of their babies and everything in between.  The vast majority of women in the United States use contraception.  Now, if a FP isn’t trained to provide their female patients with counseling on contraception, pregnancy options, and the such, where are these women expected to turn?  It is an equation that makes no sense at all and will lead to subpar care for many US women, especially poor women and those in underserved communities. 

Please do not change the requirements for family planning physicians.  Women count on their providers, and we as providers need to be trained in how to provide comprehensive reproductive health care.  If we’re not trained, then who will be?  It is your responsibility as an accrediting organization to look out for our best interests as future physicians and the best interests of our future patients. 

Thank you,

PAIT

 

I wrote my letter - now where is yours?

 

ACGME is debating cutting family planning training for family medicine residents.  They are accepting feedback through tomorrow.  Please speak up, and ask everyone you know passionate about this issue to do the same. 

Comments are being accepted at familymedicine@acgme.org.  Also, the Reproductive Health Access Project has an online campaign going here.  More information can be found here.

And tangentially related, what is going on in Kansas is disturbing.

Passing stones

I'm pretty sure I had my first kidney stone this weekend, which also means this weekend went nothing like it was planned.  The presentation was classic: sudden onset severe flank pain radiating into my pelvis, nausea without vomiting, clamminess without a fever, and urinary urgency.  Of course, the pain started on my way home from work on Friday night, right after all the doctors' offices and urgent care centers had closed, and right before the start of shabbat. 

 I went through the differential: kidney stones, pyelo, appendicitis, hemorrhagic ovarian cysts, ovarian torsion.. but was very aware that the pain was primarily flank pain.  I called my med school roommate to calm me down, talk through the differential, and come up with a plan.  800mg ibuprofen, hydrate as much as possible, use a heating pad, reevaluate in a few hours.  The pain escalated but the heating pad made it bearable.  Our shabbat dinner guests arrived.  One guest encouraged me to call my PCP to talk to the on-call doc.  It turns out my own doc was on-call, strongly felt that I was passing a stone, and advised I go to the ER for IV fluids, stronger pain meds, and a confirmatory CT scan. 

A friend drove me to the ER.  We waited an hour, in which the waiting room became increasingly filled with people who appeared to have all types of communicable germs.  I couldn't sit comfortably or stand in one place and so I paced in the corner.  I hadn't yet even been triaged.  I wished I wasn't such an honest person, knowing that had I reported my chief complaint as chest pain + SOB, I would have been seen immediately.  I freaked myself out about a CT, about exposing my ovaries to needless radiation.  And so after an hour I checked myself out of the que and we left, knowing that either it was a stone and would declare itself or something would get significantly worse and I would be back.

The next 24 hours were a slow mix of adjusting the heat pad, re-dosing on NSAIDs, drinking as much as I possibly could, peeing, sleeping, and trying to read a book.  Not how I had planned to spend shabbat.  My urine turned cloudy a few hours after the pain began- furthering my suspicious that it was a kidney stone.  And then, sometime last night, the pain stopped.  It has left my body sore and exhausted, wondering if maybe I made it all up?  That's the downside of not having a confirmatory scan or seeing a physical stone pass... now I always get to wonder if it was a stone or not.  Really, could I have imagined all of the last 36 hours?  And it is a pretty compelling story indeed...  But, the true question is, would I believe a patient that came in and told me all of this? 

30 things before 30

I turn 29 very soon, very very soon.  Here is my bucket list of things I want to accomplish before I turn the big three-zero.  I'm posting it publicly to keep me accountable.  I imagine that a lot of these things will absolutely happen and some will not.  What fun would it be to have a completely obtainable list?  Here is to a year of adventure and personal growth!

Health:
1. Challenge myself physically (current plan is a 120 mile bike ride)
2. Learn a new sport or exercise
3. Have an a1c < 7.5
4. Learn to consistently use, and fully utilize, a CGM / my dexcom sensor
5. Loose the last 20 pounds to fully get to my goal weight

Career:
6. Have a manuscript published
7. Finish my MPH requirements
8. Get a job (match into residency)
9. Graduate medical school (should happen within a month of turning 30)

Community & family:
10. Send at least one real (snail mail) letter to a friend each month
11. Call my grandmother more
12. Reach out to my borther
13. Reach out to my cousins
14. Be more patient with my mom
15. Talk to my dad

Religion: 
16. Create a ritual for clinical practice around performing births & abortions
17. Say yes when asked to lead kiddish
18. Read from the Torah again
19. Davin in shul at least once a month
20. Wrap tfillin at least once a month
21. Join a chevra kadisha

Misc:
22. Address my fear of heights
23. Travel to a new place, besides residency interviews
24. Renew my scuba certifcation
25. Go on at least 1 date every two months
26. Do at least 5 touristy things in the city I go to medical school in
27. Spend a night out dancing without caring that I can't dance
28. Learn embroidery 
29. Stop wearing clothes that I've had since high school
30. Relearn Spanish

And one for good luck:
31. Save the world 

March: women's health, gay marriage, & liberation

image from: http://www.motherjones.com/politics/2013/03/anti-woman-march-madness

 

 

You should read the whole Mother Jones article on the absolute political chaos that is currently going on.   This is bad.  Very bad. 

 

Also, from today's Daily Women's Health Policy Report, this article gives more insight into the horribleness that is being voted on in North Dakota.   Even scarier.

 

Plus, tomorrow, the Supreme Court hears the prop 8 case and the DOMA case on Wednesday.  All the possibilities of what might happened, which The New York Times expertly delineated, make my head spin.  It is going to be a long wait until June.  I wish I could be a fly on the wall for the debate & discussion between the judges.   

 

In the meantime, I'm going to disappear into the world of freedom and liberation with Passover.  I'm grateful that this year off from medical school means I can actually celebrate Jewish holidays with friends and family; without [too much] guilt that I'm slacking or making someone else cover for me.  I realize that this might be one of the last years, at least through residency, that I can take off and travel for the holiday.  May it be a true festival of freedom this year!

 

Sybil's death

Being a few days after the showing of Downton Abby season 3 episode 4, I hope I'm not spoiling it for anyone.  However, consider yourself warned that this could be a spoiler for someone living completely under a rock, or maybe in 3rd year or residency or some other all life-consuming activity.

Sybil's death brought with it a flood of emotion for me.  I always find myself crying when a character dies regardless of the medium.  This dates all the way back to my obsession with "doom and gloom" and reading Luriene McDaniel books in middle school.  I still love books that make me cry and I often find myself crying in movie theaters (though airplanes are the only movie theaters I have time for now a days) so it comes as no surprise that tears flowed as Sybil died. 

The flood of emotion though was because of HOW Sybil died- in childbirth, from eclampsia.  While skewed in accuracy, especially with modern monitoring and treatments for pre-eclampsia and eclampsia, is still brings light to the gravity of birth.  Evolutionary pregnancy and birth have to happen for us to continue and so it does, but it does with great risk.  According to the CDC, "at the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications".  Reported rates in Brittan were closer to 40 in a 1000 births.  Today, the rate is closer to 12.6 per 100,000 births in the United States, putting us at a rank of 21st in maternal mortality.  21st!!!  That's pretty shitty.  The rate is even more horrific in other parts of the world, and often from preventable and/or treatable causes.  We need to do better.

I believe the episode also brought to light the fact that practicing medicine is an art and not a science.  It requires knowing your patients and trusting your instincts.  Doctors are human and make mistakes.  Communication between doctors, patients, and families is key.  So are medical surrogates, medical power of attorney, and living wills.  If you don't already have one, take this as a sign to make one!  Have conversations with your loved ones about what you might want/not want to happen to you if you are ever in a situation where you can't decide for yourself.  Talk about organ donation. 

I know, I know.  It's only a television show.  Maybe I'm reading too much into the plot, or transposing too much of my daily life into it.  Oh well, so be it. 

Also, before anyone starts blaming western medicine on the risks of childbirth (I too have seen Business of Being Born), that is not what I'm implying.  To say this again: birth more often than not is VERY safe and does not require much, if any, medical intervention.  But, when things go wrong, they tend to go wrong fast and can have dire consequences.  Even during my 3rd year clerkship I saw both the beauty of birth and the devastation from horrible unexpected tragedy.  I try to focus on the beautify and fragility of human life in this amazing feat of the body; humbly remembering that I cannot always be in control of, or know what to expect from, every situation.

7.7!

While not the best number ever, and not even the goal, I'm proud to announce that my A1C last week was 7.7!  This is 0.7 lower than it was at my last visit.  In fact, lower than it has been since I started medical school!  It's been a long time since I've had my A1C in the 7s...

Controlling my diabetes in medical school has been challenging at best.  I don't test my blood sugar nearly enough.  I keep myself slightly high on the wards out of fear for hypoglycemic episodes while dealing with patients or in surgery, or just fear of taking out my pump to bolus in front of residents and attendings.  I don't change my pump often enough and therefore have a higher than average rate of kinked tubes, pulled out sites from tape giving up, and ketonic episodes. I use expired insulin because I don't have time or energy to refill my prescription.  Stress alone bumps up my numbers because of excess cortisol release.  Basically, I am so busy trying to learn to take care of others' health that I neglect my own. 

But, oh, at last!  The golden 7.0 A1C is in sight!  The even more allusive 6.0 [in order to contemplate pregnancy] is right beyond it.*  Between ordering a shinny new continuous glucose monitor (that I hopefully wont be allergic to), a new bicycle to exercise on, and adopting a low-er carb diet... I guess we'll just have to see what my next  A1C has to say for itself.

*Not that I intend to get pregnant right now, or anytime in the near future. But it might be on my 5-10 year plan... It better be, after all, I'm already 28 and well aware of the risks involved with increasing egg age.

Forty years later, the same damn fight

Next Tuesday will mark 40 years since Roe v. Wade, and yet, access to safe abortions is majorly limited.  Women's rights in the US are being chipped away at daily, little by little, state by state, with no safety net in sight.  I'm honestly scared to see what happens with the abortion debate over the next 40 years.  If we continue on the current trajectory... I don't even want to imagine.  I'm going to keep fighting for my rights.  Are you?

Here are what other people are saying 40 years after Roe v Wade:

Happy Birthday to Roe v. Wade—What's Left of It

Forty years after Roe v. Wade, most under 30 don’t know case was about abortion

Roe v. Wade at 40: Most Oppose Overturning Abortion Decision

Roe at 40, in 2 Charts

Abortion poll: Keep Roe v. Wade

If Roe v. Wade Goes

Recalling the world before Roe v Wade'


Resources / Take action:
ACLU's list 
Unitarian Universalists (UUs) list

PS totally frustrated that when researching events and articles for this post, the anti-abortion movement has a FAR greater amount of content online (as least in a google search) than the pro-choice movement.  Arg!!! 

Ugh!

That moment when you have a brilliant and inspired research idea, only to search google scholar/pubmed/etc to find that it has already been done,  and done exactly the way you wanted to do it.  Ugh! is both validated that it was a good enough idea to be published and yet disappointed that someone beat me to the punch. 

2013, mixed feelings

I have totally mixed feelings about this New Year.  2012 was an emotional roller-coaster.  The death of my grandmother, a rather jarring car accident, 2 trips to the Emergency room (as a patient), all the emotions of 3rd year clerkship, a hard break-up, then meeting someone new (and extraordinary), deciding to take a research year, moving to a new state, 2 cross country road trips, a trip to India... it has been a BIG and overwhelming year.

2013 was supposed to be the year I graduated medical school.  A huge part of me wishes it still would be the year I graduate medical school.  Instead, it is now becoming the year I figure out 4th year electives, begin residency applications, and try to *hopefully* get a publication out of all this research.  Ideally it will also be a year full of seeing my family, nurturing my relationship, taking better care of my health, and finding time to have fun.  Maybe I'll also make some art and learn some Spanish.