Tag Archives: Medical School

Blogger once thought extinct, spotted!

I had a fun experience recently. We have medical students rotate through our family medicine clinic. We’ve had some great students recently, and I got along great with one in particular. She was waiting to find out if and where she matched in ob/gyn at the time. She since found out she matched in New England, and I think she’s happy, but bracing for the cold! I’m so happy for her.

On the last day she was at our site, she and I were saying our goodbyes. I get to work with a lot of medical students, but she and I had gotten a bit closer than most. I wished her luck in the upcoming match, which was a bit bittersweet for me, considering my crappy match experience. She said, “Now that the rotation is over, I have a confession to make.” I was really curious – I couldn’t imagine what it could be. “I used to read your blog all the time, when I was planning on going to medical school.”

I laughed and blushed, and was really surprised. I have only been “spotted” twice before, and both of those times were years ago, when I was still blogging regularly, once at a Medical Students for Choice conference, and once at a Lamaze Conference. I was planning on writing about her spotting me on here a bit earlier, but I had a little excitement in my life in between. Hope you understand.

I really like to work with medical students. I hope we get to interact with medical students at the new residency. I am pretty sure we will. I hope to incorporate teaching into my practice even after I am done with my residency. It reinforces material, and I end up learning just as much if not more.

Oh, and Happy Doctor’s Day, everybody!

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Floating

backyardAlmost seven years ago, I was sitting in a dive bar* with some friends from college. We had moved to different cities after our various undergraduate experiences, and rarely got to see each other. I sat across from them and another mutual friend and coasted on bliss. I relished the comfort and joy of having beer in a bar playing punk music with people who shared so many touchstones with me – concerts, people, places, parties. People with whom I could talk in shorthand. I felt connected in a way I hadn’t in years, years that seemed brimming with pregnancy, parenthood, divorce, work, classes, exams, but not a lot of effortless connection.

But, underlying that social happiness was a buzz of elation because I had just found out that I got accepted into medical school. It was an unexpected, against the odds, fantastic dream fulfilling surprise. I applied late in the application cycle, and had to fight to even get my application considered. I was told to retake the MCAT due to the scores being just too stale to count, even though it was safely within range to be considered. I crammed for the exam in 6 weeks. I hadn’t had a physics class in 5 years. I somehow even improved my score, but was told the application window had just closed. I begged my plight to the young chipper voice at the other side of the phone line who told me just to wait until the next cycle, and I would surely be invited to interview. “Please,” I pleaded. “I’m 34.” I got the interview. I brought the application administrative staff home baked cookies. No joke. And I make awesome cookies.

So, I sat there in the bar with a stupid grin on my face, and I was hyper aware of everything. The delicious beer, the laughter, the music, the horrible overpriced art in the decor, and the strange elation in my chest of a scary dream coming true at that brief, delicious moment in time that the dream is true, but isn’t reality yet. Medical school was just a bunch of fantasy and hopes, not grueling hours of studying and gross anatomy. I was able to spend a night out with my friends on a Saturday still, without the endless string of Monday exams to come for the two years. I promised myself to hold on to that moment, and to never take for granted how wonderful it was to have a dream come true.

Today, I am sitting in my back yard. I recently moved. My house is finally mostly settled. I have a lovely little spot just outside my kitchen on my tiny patio under the awning, with my fragrant potted rosemary bush and subtle wind chimes. The breeze still has a touch of that gorgeous March coolness to it that lingers every year in Miami just a few weeks longer than my cranky cynical mind thinks it should. There are birds and butterflies and bustling neighbors in the background. I have things to do – dishes, laundry, shopping, even more unpacking, but I have time. I don’t have the kids this part of spring break. I am on a light outpatient rotation. I was able to sleep in. I took a deep swig of my coffee and closed my eyes, and felt the breeze. I felt elated. Yes, it’s wonderful to relish these last lovely mornings before Miami gets unbearably hot and muggy. But, I have an underlying elation in my chest.

I got accepted into a brand new obstetrics and gynecology residency. I found out during the shortest and most wonderful interview of my life this Friday afternoon. I am more than halfway through my second year of a family practice residency. I applied to a very geographically limited number of obstetrics programs when I was finishing medical school. I interviewed at several, but didn’t match at any. There’s only one program within 500 miles of where I live and share custody of my boys. The next year, I applied again, and got invited to more interviews. These interviews were at wonderful programs in places where I didn’t know a living soul, like Macon Georgia and West Virginia. In the meantime, I was struggling through 80 hour workweeks that included 6 night shifts in a row. I rarely saw my kids. I rarely saw my friends. I rarely saw daylight. I slowly cancelled all of my out of town interviews, one at a time, as they approached, because I couldn’t see surviving an intern year in an obstetrics and gynecology residency, which would be more grueling than the one I was in, and not have the family support I did here. I also wasn’t willing to move and leave my boys behind. Again, I interviewed at the only local obstetrics and gynecology program. Again, I didn’t match there.

I worked through my second year of family practice residency this year without thinking of reapplying to obstetrics. A new program opened up in Kissimmee, which is about 4 hours north of here, and my oldest son said he wouldn’t move with me if I applied and got in there. This is the first time he said he wouldn’t even go. The interview season came and went, merely a wistful blip on my radar. The osteopathic match drifted by, and the allopathic match started releasing results this week.

Except, I just found out a week ago that a new program got approved. I have heard rumors and rumbles of new at least six new obstetrics programs being opened for over seven years of medical school, fellowship and residency, and none of them had materialized. I never heard a whisper about this program. What’s even more bizarre, I had done a 4th year rotation with the director of obstetrics there, and she must not have known of the possibility yet, and I just finished a four week rotation in their family medicine department with one of their medical directors, who didn’t mention it. Oh, and one more thing. THIS SITE IS LESS THAN A MILE FROM MY HOUSE.

After a flurry of emails, research and phone calls on my part, I procured a phone interview with the new obstetrics residency director and graduate medical education director. It was a five minute interview with two of the nicest people I’ve ever known for five minutes. They had my CV. They had been told about me by the director of obstetrics at the site, by the clinical education director at my medical school, and others. They wanted me, I wanted them, and the match already happened, so they could recruit me directly.

I was ecstatic. My dream came true, again. In fact, my dream from that night 7 years ago included my eventually becoming an obstetrician. That was the promised land at the end of my reverie that night at the bar. It was becoming harder and hard to access that place of joy and thankfulness when I struggled as a family practice resident. Part of the dream had not materialized. I hated to say “Sob, woe is me! I’m going to be a family practice physician!” and realized how stupid and obliviously privileged and ungrateful that sounded.

But today, the dream is realized. It’s still sinking in. And I still have a day well rested and quiet to sit and relish in the fantasy of getting my dream job.

“My goal in life is to unite my avocation with my vocation,
As my two eyes make one in sight.” – Robert Frost

So, one more cup of coffee. One more pause before I get to the dishes in the sink. Because this is the feeling I will be tapping into when I’m exhausted on the labor floor, when I’m struggling with learning a new surgery, when my kids and I are fighting because I’m exhausted and they are resentful because I don’t seem to have quality or quantity time with them. The breeze, the calm, the sounds, and the elation.

*I love that when I googled the name of the bar, a box popped up with information about the hormone prolactin.

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Should I go to medical school? An advice column.

Check out my post over at Mothers in Medicine:

Should I go to medical school?

It is an answer to a series of emails I have received over time asking me advice about the whole single parent medical school doctor used to be in the natural birth community thing.

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Reply turned post, single mother in medicine style

I am a contributor at the wonderful site Mothers in Medicine, and this week a guest poster wrote in to ask Do Single Mothers Go to Medical School? Please go read her original post and the other comments. Here is my very long-winded reply:

Hi! I am a single mother who just finished medical school. I would be happy to chat with you through email, if you’re interested. Please feel free to let KC know, and she knows how to get ahold of me. Also, you can read the posts I have written on here (click on the MomTFH link in the labels to the right–>) or read my blog at http://momstinfoilhat.wordpress.com. Not all of my posts are about being a single mom, obviously, but it is my constant reality as I write. As I hope you have discovered, it is easier and harder to be a single mom than you may have expected, and it does not dominate all of my thoughts, conversations and interactions.

OK, on to your questions. Let’s start with the simpler one. I took the MCAT after being out of the basic science classes for several years, too. I used a single review book and did OK. I happen to be a good test taker. If I had a time machine (Oh, geez! the things I could fix!) I would have taken a review course and probably scored higher. I think taking a targeted MCAT review would be higher yield for you than retaking all of your premed. That will also take quite a while. But, if you think having domestic good grades will improve your chances of admission, it’s definitely an option.

As for RN vs. NP vs. being a physician, that is really up to you, and I don’t think there is an easy answer to that. There are many days in which I wish I had the time machine and could go back and be an NP, but I may be a unique case. I am older than you, I want to go into obstetrics, and I didn’t match into residency last year. If I was a nurse practitioner / midwife, I could be working already, no residency required, and be doing everything I want to do as a doctor (I am not super gung ho about being a lead surgeon and am more interested in low risk obstetrics, obviously, but there are plenty of NPs that assist in the OR, just don’t lead surgeries).

Obviously, yes, single mothers do go to medical school. I was pleasantly surprised at the diversity in my class. I sat next to a grandmother all of 2nd year, and I was not the only single mom in my class. Also, single mothers do a lot of things that take them away from their kid(s). Many single moms work outside the home for long hours and have to rely on different forms of help and childcare. And, most of these single moms are not pursuing a life long dream, one that will most likely provide financial security and a fulfilling career. Moms have guilt, single moms have guilt. I don’t let that keep me from pursuing my career in medicine.

Medical school is not a bad situation to be in as a single mom. Especially the first two years. There are many schools that even stream most of the classes online, and do not have an attendance policy for many of the classes (mine did). Your clinical years may be more difficult. Your schedule can change from month to month, and I have had to ask a caregiver to show up at my house at 4:30 am some months so I can get to my rotation on time. Even more difficult, my schedule would change in a month. My kids were in school and had after school care from a trusted family member, so my main issue was the early mornings.

As for being able to handle it, I was the president of more than one extracurricular club. I won a research fellowship and full tuition scholarship. I was recommended and inducted into the humanism honors society by one of my attendings / professors. I qualified for the regular honors society, but I won’t go into the political BS that kept me from that group. I aced my boards and never failed a class. I am not just tooting my horn here; I am telling you that, if you work hard and have the aptitude and right attitude, you will do well.

I have written on my blog about my sometimes frustration with some of my former classmates. These are things my single, childless classmates have told me: I gave up using any washable dishes or glasses during medical school because I don’t have time to do any dishes. I gave up my dog to my parents during board review because I can’t take care of it. I don’t have time to do _____ activity or ______ club. I didn’t have time to take the required scrub class before rotations started because I wanted to go on a vacation. I need to take off a month because I am planning a wedding. I can’t make the meeting at that time because that’s when I nap. (Yes, for real) I would see some of these same students go to yoga 3 times a week, or party frequently, or get their mani/pedi once a week, or watch every episode of the Jersey Shore, or make what ever bargains or compromises they chose. So do I. (Make compromises. I don’t do any of those things on the list. I have a dog and two cats, I cook and use real dishes and plates, and I don’t get to work out often if at all, watch much TV, or take care of my fingernails, hairdo or other beauty routines often. I also schedule my naps, rare as they are, around my obligations, not the other way around). So will you, compromise, that is, regardless of your path.

As for divorce, moving, family support – that stuff is not easy. If you email me and are up for it, I can regale you with the soap opera that was my divorce and coparenting (they don’t call it custody anymore) agreement, and the sacrifices I had to make to be able to move if I matched out of the area. Single parents relocate all the time for many reasons. It is not fair to expect every single parent to remain, forever, in a 50 mile radius of where they divorced. There are a lot of moving parts to this, and I could write more words than this entire post already (seriously not kidding) about it. A lot of this depends on your ex. This battle was infinitely harder than medical school for me.

Anyway, I hope this wasn’t too much, and was helpful in some way. Good luck, and please keep us up to date.

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Reply turned post, midwives are hacks style

When I signed onto Facebook this morning, a link showed up on my feed from a page that I don’t remember “liking”, but, as it is called “Nurtured Moms”, I can see it being a possibility.

The link was to an article by OB Management examining collaboration between ob/gyns, nurse midwives, and CPMs / lay midwives. The original article is actually not that bad, and does encourage collaboration with midwives (mostly with CNMs) and higher standards and licensing for CPMs, which I support. It didn’t accurately give the background on the Flexner Report, the purpose of which was to weed out inferior MEDICAL SCHOOLS, not midwives. But, I didn’t bring that up because I thought it wasn’t fully relevant to the discussion.

The posting on the Facebook page included the caption:

Exactly. In fact, it is even worse than the article suggests.

It states, “The North American Registry of Midwives’ Portfolio Evaluation Process requires midwives to be the primary care provider during 50 home births and to have 3 years’ experience. The average ObGyn resident gets this much experience in 1 month.”

However, this is not the requirement one needs to meet to become a CPM; this is the requirement to be a PRECEPTOR of CPMs — to pass your “knowledge” on to others!! In fact, to become a CPM, you only have to attend 20 births as a primary care provider. Also, just this year, they added the requirement for a high school diploma. For the last 15 years, you didn’t even need one to become a CPM. The most recent requirements are here: http://narm.org/req-updates/

The first commenter said this:

People need to understand that high standards do not limit choice for mothers. It boggles my mind when I hear lay midwifery apologists insist that making CNM the standard would “limit mothers’ choices.” Limit *what* choice, exactly? Oh right, clearly they want women to be able to “choose” substandard care (CPM) even though the very best (CNM and OBGYN) is readily available to everyone. It’s disgraceful that in America we allow uneducated hacks to practice medicine on the most vulnerable citizens. The ACOG is right not to “collaborate” with lay midwives.

I posted this:

The requirements for direct entry midwives are higher than that in Florida. Also, ob/gyn residents are already licensed doctors by the time they get that experience. There is no requirement for any specific clinical experiences first, although most medical students do at least observe a certain number of births.

Also, ob/gyn residents are not on labor & delivery every month. It depends on the training program, but most involve less than 100 vaginal deliveries a year.

Don’t get me wrong. I am a supporter of adequate training for CPMs/DEMs/LMs. I am also a supporter of accuracy.

Commenter #1 replied:

Accuracy? Lay midwives’ “education” pales in comparison to that of legitimate medical professionals. That’s accurate. Split all the hairs about med school that you like– lay midwives are still substandard, full stop.

I replied:

I am not splitting hairs. I am giving accurate information. A first year ob/gyn resident on her first labor and delivery rotation may have never caught a baby herself. She is a “legitimate” licensed medical professional.

Again, I am all for adequate training and licensing for CPMs. I do not think it is fair to call them all “hacks” or “substandard”. I also don’t think it is safe for ob/gyns or ACOG to not cooperate with lay midwives, nor is it accurate. ACOG does acknowledge that birth center births have been proven to be as safe as in hospital birth, and they support birth centers as a safe site of birth in their position statement, and most birth centers are run by CPMs or other types of lay midwives.

The best way to make homebirth and other out of hospital birth safe, other than adequate training of midwives, is to ensure seamless cooperation with other “legitimate” medical professionals when necessary. Anything less is unethical and unsafe for mothers.

Full stop.

I am not sure I am going to go back to comment on the thread, but if you follow the link to the new qualifications, 10 + 20 + 20 + 5 = 55 births required, not 20.

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When good care isn’t emotionally driven care

Hello, folks! I am slowly getting over not matching. Slowly. I am trying to strategize for the next match. And, I’m trying to take care of myself, emotionally and physically, in the aftermath.

In the meantime, I am on my last rotation for medical school. It is a “rural selective”, which is a required elective at a rural or underserved location. I am fulfilling it at a local community health center in the women’s health department. Fun!

I am taking part in a day long orientation today. In one of the presentations, the speaker had a point on one of the slides about mandatory reporting, and included all domestic violence as falling under that category. I rose my hand and suggested that we had been trained that elder abuse and child abuse fell under that category, but other domestic violence did not. I couched that statement by saying it was controversial and I didn’t say I necessarily agreed (although I do).

One of the other attendees got very perturbed by my correction, and said I was wrong. I said I disagreed, politely. The speaker and several other attendees said they thought I was correct, and one pointed out that other vulnerable adults, such as someone with a disability, also fell under the mandatory reporting group. At the end of the speaker’s presentation, the offended woman called me out specifically, and again told me I was incorrect, but again, had nothing to back herself up other than her strong emotional response. Since this was a training on legal requirements of the job and privacy, and this population definitely would include adult victims of domestic violence, I decided to look up the law.

When I located the appropriate information, I read it out loud to the group. This nursing CEU was the first good site I found, and it had very complete information. I read this part:

Intimate Partner Abuse

Florida statute 790.24 requires healthcare providers to report gunshot or life-threatening wounds or injuries. Obviously, this does not cover the majority of injuries sustained in IPV. However, reporting suspected domestic violence without the informed consent of the victim is unethical and may cause the abuser to retaliate.

She interrupted me and said “SEE? You have to report gunshot wounds!” and I continued to read the rest of the quote. Then she angrily said “Well OF COURSE you need their informed consent!”, and I countered “Well, then that’s not mandatory reporting, is it?” She got more agitated, and started pacing the room, telling me I am saying to send these women home to get killed. I said no, and tried to explain, again, the rationale of establishing trust with the patient, many of whom are not at a place where they are ready to leave or press charges. She said she would definitely report ANY case she saw of suspected intimate partner violence, and said she didn’t want these women killed. I said that they may not press charges, and then may not trust health care practitioners again, and still get killed.

I know that IPV is a sensitive, triggering topic for many, including me. I was in a relationship with verbal and emotional abuse, and trust me, if people came on too strong about me leaving him when I wasn’t ready to, I avoided them in the future. I would not come to them when there was an incident, because I didn’t want a lecture of how it was my fault for staying. When we went over this in medical school (and I was still in my abusive relationship), one member of my small group said she was a victim of physical violence in a past relationship, and she would absolutely never press charges, she would lie to any health care practitioner or official about it, and defend him under any circumstances, when she was still in the relationship.

These victims already feel an enormous lack of control. It is not our job to control them or act for them. It is our job to be there for them on their terms. Even if it gets us emotional.

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Much more fun than studying

I am cramming for my last exam in medical school tomorrow. Scratch that, I am procrastinating instead of studying. I will be speaking at the VBAC Summit again this year, and had to write a bio. As much as I didn’t want to write about myself, it was much more fun than studying.

Hilary Gerber is a pre-doctoral research fellow who will be graduating from medical school in two weeks. After completing a traditional internship, she hopes to specialize in obstetrics and gynecology. Her fellowship research focused on evidence based labor and delivery interventions. Before medical school, Hilary gave birth twice with the help of midwives, once in a hospital, and once at a free standing birth center. She would love to have a home birth if it didn’t involve having another baby. She trained as a direct entry midwife and worked as a doula. Her article “Social Media, Power, and the Future of VBAC” was published in the Journal of Perinatal Education. Her sometimes dormant blog “Mom’s Tinfoil Hat” is not peer reviewed, however. She also has a studio art degree, has delivered pizzas, worked the graveyard shift at Denny’s, wrote a parenting blog for Mtv, and was in a band that is in the Rock and Roll Hall of Fame.

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So, in case you were wondering…

…I didn’t match.

There are probably many reasons why. I was geographically limited in two ways: my custody agreement limited me to the Southeast, and I only applied in cities where I knew people. I am an osteopathic student who was competing in the MD match. Obstetrics has been a very competitive match recently. I had excellent board scores, a research fellowship, and great extracurricular and leadership activities, but my grades were very middle of the road.

So, now what? I will be doing what is known as a traditional rotating internship at a local hospital, then reapplying for obstetrics residency. It will be much harder to interview as an intern with increased responsibilities. It will be harder to transition to my new residency, if I get one, with only days or weeks off at the end of the year, as opposed to the months I will have to ponder my temporary failure this year before starting as an intern.

Sigh.

I am tired of well meaning people asking me where I will be next year. I am tired of people telling me this was meant to happen. I am jealous, painfully jealous with a pit of hurt in my insides, of my classmates who are joyfully planning their futures. Of my former classmates (I graduated a year behind my original class because of my fellowship) who already have almost a year of residency under their belts. Of people in my profession who are my age and are well into their careers.

I didn’t post about it for a while because it was too raw, too painful. And, honestly, I don’t really want to talk about it. There isn’t much to say. It’s hard enough to deal with people I work with, people in my family, and people in my life who genuinely care asking me about it in a time released fashion. I know they’re asking because they want to share in what they think will be my good news. But, it forces me to rehash my pain over and over again, like someone with a new bandage being asked what happened by every new person they see. And, then I have to nod grimly and politely when they tell me that somehow, it was meant to be.

Please allow me to be self indulgently angry and defeated on my blog. This is not how my life was supposed to be at this point. I wasn’t supposed to be staring down the barrel of forty years old, not an obstetrician, just a single mom who is wondering if I can even keep my tiny 1000 sq ft house next year on an intern’s salary. Oh, and I just got diagnosed with a chronic disease that I am managing very well, but has a small chance of crippling me. I know I am extremely lucky to be (mostly) healthy and able bodied, with good support, and smart enough to have made it into medical school in the first place. I know that this is not the end of the world – I very well may match into obstetrics next year. I can also fall back on family medicine, and then do some obstetrics, eventually, in a rural area, possibly after doing an obstetrics fellowship. Or, I can finish internal medicine and then do a women’s health or family planning fellowship.

Sigh. I am not digging for reassurance. I just needed to finally get this out.

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Match Madness

I wrote about sitting and waiting for the residency match here at Mothers in Medicine.

We had to certify our match rank lists February 22nd. We don’t get informed whether we matched until March 12th, and where we matched until March 16th. I am sure at one point in time they used slide rules and pencils and paper to figure this stuff out, but I’m pretty sure this algorithm could be done on an iPad in 2012 in less than a minute. I think the NRMP just wants me to freak out and eat chocolate for three weeks.

(The Mothers in Medicine post above has links to explanations about the match, if you are one of the uninitiated.)

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First day at an “audition rotation” observations

I’m waiting on line to get an I.D. card for my new rotation site. It’s a family planning rotation at a program that has an obstetrics and gynecology residency to which I applied.

I’m really excited and nervous. So, to distract myself, here are some observations:

1. One of the streets bordering the hospital is named “Papanicolauo Way.” Yes, I will be taking a picture at some point.

2. They sell “The Club”, the old school car security device here in the security office. Geez, maybe I should have put my purse in my trunk.

3. When we were cruising through the school corridors among research labs with cool looking beakers, goggled research assistants, and radioactive materials and biohazard warning signs, there was a water fountain with an old, worn sign stating “This water is SAFE for drinking and cooking.” If there was no sign, I wouldn’t have been suspicious. Now, I’m not so sure.

I’ll be back with more clinically relevant observations.

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