AMK 2017 Birthday

After wrapping up my last two months of medical school ever (ending with a sub-internship in internal medicine and a month of vascular surgery) in Cincinnati, OH, I trekked through the glorious Midwest towards Nebraska, to my home for the next five years stemming from my radiology residency training.

My expedient trip was motivated to be reunited with my future wife and to celebrate – her birthday, my match results, heck, even my birthday. It has been a rare delight to spend time with her during our hectic schedules, and, with my lull in training, I was afforded the pleasure of planning another delight for her.

First, I coordinated with her friends to set up an incognito get together at a new restaurant that we had yet to try – Stirnella Bar & Kitchen. While they coordinated the dinner, I assembled a scavenger hunt consisting of rhyming clues that I scattered around the city at locations significant to us. Each clue designated a subsequent destination, and at that location she would find another clue. Because she was turning 27, I wrote out 7 clues and placed them in envelopes. I then delivered them to said locations, with instructions given to the hosts or greeters at each memory.

After the game was set – everyone knew to meet us at dinner, the clues distributed, her lectures concluded – the fun began. Amanda drove home to an empty house, with the starting envelope in place on her table. She quickly put together what I had made, and she began deftly solving the clues and walking down memory lane – where we had our engagement dinner, where we had a photo shoot, our first beer together in Omaha, etc. Judicious use of the location tracking app Find Friends was involved.

One place – the Joslyn Art Museum – had no attendant (or people out, for that matter) on account of the hours and the weather. I had placed this as the second the last clue – clue #6, and I met her there to give her the clue (as the clue detailed) take her to the surprise dinner.

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The sixth clue at the spiral head.

We headed to the restaurant and she was overjoyed to meet the group of her friends who had gathered for her day.

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Stirnella Bar & Kitchen; a new memory

Finally, we headed home and had a slice of cake we had made per this fun video.

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Funfetti cake!

Residency interviews: Terminal velocity

In this post – my last post about medical school – I want to focus on how I approached residency applications and interviewing. Your school will have their advice and approach, but it’s important to put everything in perspective. It’s you applying, not your mentor or your school. You are personally responsible for your life and your match. Do your research and know your timelines from the original sources (e.g. NRMP, ERAS, ECFMG, etc.).

Electronic Residency Application Service

With that said, I think it’s paramount to put your best foot forward when prepping your application on ERAS. Step one requires some planning, but if you can, have all of your papers and exams and scores in before submission time. My CS and CK were both completed and scored before apps opened up. When you submit, you want as complete of an application as possible. Moreover, you want to submit on the first day possible. Just as programs may filter you out of their interview pool because you’re not from their state, they can filter you out for not being punctual enough to submit on day one. Obviously, this isn’t to say that you won’t match if you don’t do this, but it’s a small step that helps immensely in terms of getting interviews from my personal experience, and anecdotally as well.

With that, in the experiences section, it’s solid to have some sort of publication or research on your application. It serves two points – one: it shows you are capable of producing quality work, and two: it gives you something to talk about during interviews. Plan ahead; it may take 3-8 months to push something through a publication pipeline. Participate in poster sessions. Volunteer. Enter everything as directly as you can on ERAS, as it will likely be read and checked by the institutions you’re applying to and reviewed beforehand.

Another, more critical, item that requires some planning is securing good sources for letters of recommendation. There are many strategies to this, and it suffices to say that three unflinchingly strong letters at minimum are needed. Letters are a finicky topic, especially when you’re starting out clinicals and have no tangible value to the team. Here are some tips:

  • Ask for more than you need so you can have a backup letter or two.
  • Be aware of the specific program requirements; some programs require up to 2 dedicated letters from a certain specialty (e.g. surgery).
  • If you feel it’s appropriate, you may preface your time spent with your preceptor by stating your intentions – “I’m going into a certain specialty, and I intend to work hard and hopefully get a letter from my experience with you this month.”
  • Ask for a letter even if you don’t know how to get it uploaded. A fresh impression of you is much more important and will yield a better letter than a stale one.
  • Lastly, put yourself in the shoes of the letter writer. What would they expect to see from someone for whom they were writing a letter?
    • Hours and hours of time will always be rewarded – be well-read, always present, and always willing to do tasks.
    • As you progress through your rotations, you’ll be able to make an impact on the team you’re on as well as impress your mentors. I’m saying you’re more likely to get a good letter near the end of your third year rather than fresh after USMLE 1.

Next, the daunting personal statement. I would suggesting writing from the heart, and writing 2 or 3 versions. This is going to be a fair amount of work, especially if you’re not a very expressive writer. Once you have your multiple PSs ready, get ready to have your heart torn out. Send it to your friends and peers for editing, and always ask which one they like better. After a few rounds of this you’ll have something worth submitting. Write your story, write why, and know why you want this next phase of your life.

Those are the major components of your ERAS app – the scores, the letters, the personal statement, and the open-ended ‘experience’ section where I listed any publications, posters, volunteerism, or other stuff. Additionally, there’s a sort of nebulous ‘Hobbies’ section on ERAS. I’d recommend sounding colorful and not generic. It’s a small section that you might overlook, but adding a bit of spice to it goes far – it’s pretty much there so you can put stuff that might be too silly for the formal experience section like you’re into sumo wrestling or whatever.

Program selection

Simple principle here, with some caveats. A larger net catches more fish. Cast a wide net. The rule of thumb is for every 10 places you apply to, expect 1-2 interviews. I would say this held true for me. If you have a few specific geographic areas, you can focus on apps there rather than apply all over. It’s very specific to who you are and what you want – are you willing to live there for the next 3-7 years? I applied very broadly, which was costly. I felt it was needed in my case, though, because I applied to Radiology, which can be a mixed bag in terms of competitiveness.

The thought, which I discussed with my significant other, was that we’d rather go matching anywhere than go unmatched overall. I suspect most rational people have the same logic. Our preference was in the Midwest, where we had largely done our respective clinical years. I knew I did not want to go into any other specialty, so I committed and only applied to Rads.

Submission

Submit on day one, have everything in, and don’t forget to register for NRMP, which was (when I did the 2017 Match) separate. Additionally, don’t forget to update your NRMP ID in ERAS once you register.

Interviewing

Respond in a timely fashion to interview invites. They can go fast, and some places have the dubious practice of sending out more invitations than there are spots available, allowing for waitlisting for the people who check the invitation later. That being said, you’ll hopefully hear back with a steady flow in invitations. It is quite a feat to juggle travelling and scheduling all the dates and times and travel. The most I managed was 3 interviews/week in different cities. More than that and it would have been too tight.

  • Realize that there are only a finite amount of days and spots that you can travel to and interview, so if somewhere you want to go to more comes up, try and switch dates around, Programs are flexible when you call and ask in person.
  • Uber and Lyft are your lifelines.
  • If you can group together a geographical area, renting a car can save costs.

Perhaps one of the finer points I can make is that it’s critical to send out emails reiterating your interest in programs. I sent out over a hundred emails to program directors and GME offices. Again, this takes some time and effort, but it gives you the best shot at landing an interview short of rotating there or someone vouching for you.

There are plenty of resources on how to interview, so I’ll skip that bit, other than to say be natural and talkative – no one is going to hire the quiet, surly applicant.

Rank Lists and Match

Sometime in February, you’ll finalize your list of places. Go with your gut instinct as to where you fit best. It’s hard to find a metric otherwise. I suggest you check out the NRMP stats on your likelihood of matching based on the number of places you rank to give you a realistic sense of what will happen on match day. Certify your list and wait as the sands of time slowly seep and creep until Match Day arrives.

Hopefully on that Monday you’ll get some good news. You’ll then wait until Friday for the real results.

Closing thoughts

It’s an exhilarating process to go through, with such a candid mix of emotions you’ll feel. You will grow as a person after exploring the country on a quest to find a program you like, and you’ll see what the world has to offer. You’ll come away with stories and experiences of your own, to cherish and to laugh at. You will come to a crossroads and feel doubt. You will feel indecision. You will overcome this by the virtue of the process. And, with the weight of the culmination of toilsome years of medical education, you will rise and succeed: to smile and feel the warmth of tangible success in your chest at the end of it, and to continue your personal odyssey of self-realization and healing.

Perhaps in the world’s destruction it would be possible at last to see how it was made. Oceans, mountains. The ponderous counterspectacle of things ceasing to be. The sweeping waste, hydroptic and coldly secular. The silence.

The Road, CM

That night in the hospital I walked in and out of the hospice ward ten or twenty times, and my eyes and hands moved through the necessary tasks. Well into the night and deeper in my brain, it came to me that as hospital workers, we were being paid to trail along behind Death as he escorted frail, wasted bodies over difficult miles, dragging their loved ones along with him. My job was to meet the traveling party at its designated way stations and faithfully provide fresh supplies for the journey. When the weary group disappeared over the horizon, we turned back, knowing that another agonized family would be arriving soon.

The doctors, nurses, and I didn’t cry because the bewildered husbands and stricken daughters were crying enough for all of us. Helpless and impotent against the awesome power of Death, we nonetheless bowed our heads in the pharmacy, injected twenty milliliters of salvation into a bag of tears, blessed it again and again, and then carried it like a baby to the hospice and offered it up. The drug would flow into a passive vein, the family would draw close, and a cup of fluid might be temporarily removed from their ocean of pain.

Lab Girl, HJ

So, where are you from?

“So, where are you from?” It is a question I have been asked well over a dozen times in the last few months. While my answer is not as complicated as some of those I know, every time I gave my response, I felt somewhat of a cringe. What had prompted this question was a major transitional point in my life – the bridge all budding doctors face as they end their time in medical school and jump to the next set of obligations bundled together and termed ‘residency.’ While walking down this bridge, you are forced to meet many strangers, and in the dense fog of the unknown, you will occasionally bump into them and shake hands, stumble over them and fall down, or just miss them by a hair’s breadth and not really interact with them at all, except maybe other than to be aware of their presence and the potential encounter that could have been.

“Something inexorable seeds itself in the place of your origin. You can never escape the bonds of family history, no matter how far you travel. And the skeleton of a house can carry in its bones the marrow of all that came before.”

– CB Kline, A Piece of the World

When asked this question of my origin, I felt it necessary to give some temporal and spatial rendition of my life, so as to frame myself and my experience of 26 years into a few short sentences and rehearsed chuckles. After every answer, though thorough, I was not sure if I was correct. Sure, I was born in the city of Baton Rouge, Louisiana. I went to school there and then lived in New Orleans for a time. Despite this, I do not feel an intrinsic connection to that place. I lived on an island for 18 months for the first half of my medical education, but I would consider that rock in the middle of the sea anything but home. The largest continuous stretch of time after that was spent in Kansas City, Missouri for my clinical rotations, which was, of course relevant to mention for the purposes of an interview for a position for medical residency, but otherwise held no strong ties in my heart.

My better half, whom I met while in New Orleans, is situated in the quintessential Midwestern city of Omaha, Nebraska, where I have spent many wonderful weekends, though rarely longer than that. When I reflect on my origins, I feel as though the places that I have mentioned above, while encompassing my geographical history, do not do justice to my cultural heritage. My parents, immigrants from the western part of India, have always emphasized this part of themselves upon me, and I would be doing them a disservice if I did not mention that my skin is tan brown and I speak and understand Gujarati. Ironically, when I do reveal my origins – that I was born in the deep Southern United States – often I am told that I have not even the slightest hint of southern drawl.

Perhaps the reason I have been ruminating so much on the question of “where are you from?” is because, like many people in my shoes applying for the next big endeavor in their lives, I have become keenly aware of my sense of identity, which many can – and do – conflate with origin. The phrases “I am a Midwesterner” or “I’m a Manhattanite” certainly paint very different pictures, and when an interviewer is trying to ascertain the core components of an individual, the base layer painted by my city of birth can overshadow even the strongest of second or third coats if those coats are not painted thickly or skillfully enough. My origin and my identity, in my mind, are distinct, though not wholly separate. I suspect with the next iteration of my training – my residency – this will change, and I will adopt my program as part of my identity, mainly from the perceived effort and hours spent at the institution.

Ultimately, like in many arguments or discussions, the critical point – the “fromness” of a person – is very subjective and can be defined in many ways. Obviously, “where are you from?” is a fairly innocuous ice breaker, and I am thorough enough with my response to answer it properly and provide other points of discussion to move forward.