Yesterday, I
attended one interview. It apparently went well, as the fellowship director casually (but informally) remarked, “I still need to talk with the other people who interviewed you, but I would welcome you to this program.” He actually looks like a significant character from The Simpsons, though I shan’t elaborate further.
One person asked me about lindy hopping and all three interviewers asked me about a Mickey Mouse webpage (the actual character; that’s not a condescending adjective) I maintained in the past. (It was rated #2 on Google, right behind Disney.com. When the hosting company I was using merged with another hosting company, all of the content was lost. That was over five years ago. But it apparently stimulates curiosity and makes for interesting conversation.)
noticed that East Coast doctors don’t necessarily dress better than West Coast doctors. That’s the rumor, anyway—East Coast is formal, West Coast is not; East Coast insists on suit jackets and ties for men, West Coast tolerates blue jeans.
Well.
There were (medicine) residents walking around this hospital in corduroys and sneakers—and not formal-looking corduroys and trendy sneakers. So all this stuff about the East Coast doctors looking pretty at work—well, not really.
observed that all the psychiatrists wear long, white coats. I suppose that this, too, is an East Coast phenomenon. (And, in my black suit, I clearly looked like a pawn on the wrong side of the chessboard.)
was surprised with the opulence of the administration wing of the hospital. Chandeliers, polished brass, dark wood, high door frame—and that’s the entrance of the wing, not the actual wing itself! Having spent time in hospitals in three major West Coast institutions, I must say that I’ve never seen administration so overtly decorated. Usually it’s just tucked away into a non-descript, concrete building.
Otherwise, all hospitals look the same. They all begin with an organized, grid-like plan, but eventually become discombobulated structures as additional wings are added, current wings are redesigned, and neighboring buildings are connected.
tolerated the thick humidity in the subway tunnels. It’s like attending a dance… but not actually dancing. Or moving. And still feeling the condensation pool on the skin.
purchased chocolate chip cookies from the outdoor market in Union Square. From O.D.B. Bakery in Chatham, New York. Made with wheat flour. It’s a good cookie.
enjoyed the sun. Not only was the sun out (unlike in Seattle), but it set later (as Seattle is at a higher latitude). I did not anticipate noticing this difference—only when I was sitting in a park (waiting for my interview) and watching the shadows of the tree limbs sway in the sunlight did I realize the extent of the grey cloud cover in the Pacific Northwest. It’s significant.
wondered if people in New York tend to be people who are interested in people. While strolling through the Union Square market, I saw a small crowd of people hovering around someone who was speaking loudly. (This small mob irritated another small mob of people who were annoyed with their deceleration as a result of this bottleneck.) I peered over the crowd and noticed an aging, balding man squatting on a crate while he slowly peeled a carrot.
“This is no ordinary peeler,” he said with panache. “This is the best peeler you will ever see.”
While walking away, I smiled. There was no question that it was an ordinary peeler. Everyone knew this. And yet these people still persisted in watching him peel a carrot. Maybe they were simply gullible. Or bored. Or maybe I am projecting my own interest in people onto other people. It’s a psychodynamic defense, you know.
had dinner with my cousin. He originally wanted to take me to a Japanese barbeque place (Gyu-Kaku), and though we had (last minute) reservations for 9:30pm, we were told at 9:00pm that the people who had reservations at 8:15pm had yet to be seated. And thus we jumped into a cab to Koreatown and wandered into Shilla. The food was delicious.
I last saw my cousin (a financial analyst) about two years ago and I remain impressed with his manners. He has also commissioned me to introduce him to female doctors for potential dates if/when I end up in New York. He’s a good kid. I guess I shouldn’t refer to him as a kid, since he’s in his mid-20s and is already making a whole lot of money. He could feasibly pay off all of my student loans with his year-end bonus. It’s a bit ridiculous.
22 Sep 2007 | 3 comments.
Here is New York.
11:00am, 20 September 2007. Sea-Tac.
Well, I have to say that I’m pretty disappointed that the airport doesn’t offer free WiFi. I guess I shouldn’t be surprised; it is, after all, an airport, and not a coffee shop. The Tully’s down the way has WiFi, too, but that is also restricted. So much for the freedom of the internet.
So I’m sitting a few hundred yards from my gate and facing one of those gigantic floor to ceiling windows that overlook the placid lake of concrete that defines the airline terminals. It’s a cloudy day out. It’s probably going to rain. I’m sure there will be plenty of precipitation when I get back.
My friend took me to the airport. She shared with me the experiences she has had as the psychiatric consultant to a family medicine clinic. She has told me some pretty alarming stories about the prescribing practices of some of the physicians in that group and, from what we can tell, the docs mean well, they just aren’t executing care in the most optimal way possible. (For example, she told me about someone who was receiving risperidone 8mg at bedtime for sleep. First of all, risperidone is an antipsychotic, not a hypnotic. Secondly, risperidone at 8mg is even hefty for someone with a diagnosis of schizophrenia. This medication was apparently one of several psychotropic drugs on this patient’s regimen.) As she told me about the eager enthusiasm the family medicine docs had for learning more about psychiatric diagnosis and treatment, I felt thankful that we were having this conversation. It is priming me for my interviews.
I have six interviews in nine days. I’m fortunate to have that many interviews (and condensed into that amount of time), though I worry that I shall be tired and potentially irritable by the time I interview at the sixth program. (Of course, simply because I am going somewhere “big”, I am now also worried about extremely low frequency events: “What if I fall down while walking down the hallway during rounds? What if I enunciate a little too clearly and spit on the person who is interviewing me?” etc.) I’m hoping that my eyes won’t glaze over in boredom/apathy/overwhelm (that’s not a good look on me).
While standing in line to get through security (why do we all put up with this 3-ounce fluid rule?), the person who checked my ID (her stamp was “37″) looked at me sternly after looking at my driver’s license. Yes, I could be a terrorist because I don’t exactly resemble my ID: I’ve since changed my hairstyle. Plus, I smiled at her. She didn’t smile back.
I’m getting into New York City later than I’d like; the flight schedule wasn’t particularly accommodating. Time change is interesting. I daydream/wonder about how we make up for lost time—or, really, if we ever make up for lost time. I’m “losing” three hours in traversing the country, though I will “get them back” when I return to Seattle. My mind begins to spin stories about a man who dies three hours before he should, specifically because he relocated to a place that is three hours ahead. This, of course, assumes that we are all slated to die at a specific time. Maybe we are. Maybe we’re not. Or how about someone who, in a desire to live as long as possible, is constantly flying East so that the days pass, though physiological time does not. If I end up in New York, I wonder how losing those three hours will affect me—could I have done something remarkable with those three hours? Could I have produced something? Could I have made a significant impact on something or someone had I not left for New York? Maybe; maybe not.
It’s hard to believe that 24 hours from now, I’ll probably be finishing up my first interview. And right now, I’m still sitting in the airport in Seattle.
I’m also having doubts about doing this whole New York thing, which doesn’t surprise me, only because it seems to be coming into fruition. I’ve met wonderful people in Seattle and have developed fantastic relationships with a lot of people. Yes, the same thing can happen in New York City, but it won’t happen immediately. I’m fortunate that I already know people in Manhattan, though why would I choose to leave my social network in Seattle? It’s not that I will lose these friendships and yet, if I end up in New York, it won’t be the same. I just wonder.
9:15am, 21 September 2007. Starbucks.
It is sadly ironic that I am sitting in a Seattle institution while in New York. It is also just plain sad that New York City doesn’t offer free WiFi in its coffee culture. Seattle has spoiled me with its liberal, free-WiFi-everywhere approach to purchased beverages. This has also shown me my great reliance upon the internet to provide me with information (like where I can find free WiFi in this city—anyone have any recommendations in the Upper West Side and Lower East Side? or should I simply resign myself to the public library?).
I got into New York City later than expected, since the plane circled above JFK for about half an hour due to overcrowding… and then the plane circled around the terminal for about fifteen minutes due to overcrowding. I’ve recently seen a patients with pulmonary embolisms and deep vein thrombosis (blood clots from the legs—usually—getting caught in the lungs once they break apart in the leg veins) and was a little too overconcerned about that. But since my legs do not hurt, are not swollen, and I am breathing just fine, I think I’m going to be A-OK.
After escaping the thick, heavy heat of the subway stations and finding cool relief within the subway cars, I was struck with the screeching of the cars on the rails. My mind’s eye envisioned banshees chasing the subway cars through the tunnels, while we all sat listless and unimpressed. I discreetly looked around the car and was surprised to note that there was only one white person (out of about twenty) in the car. (The proportion increased the closer one got to Times Square.)
There are a lot of people in New York. (Stating the obvious is part of my charm.) I arrived at my hotel a little after 11:30pm last night and the subway cars were still full. A couple with their kid was wandering out of what I think is a small grocer (the poster in the window said something about pineapple ice cream). This morning, while wandering around in search of breakfast (the bagels here are quite good), I passed at least three schools and trailed behind several gaggles of grade-school kids wearing backpacks that they could easily fit into. (Kids start school later here, too.) Drivers were already laying on their horns in an effort to get to where they are going (though to no avail); dogs and their walkers were meandering past marked trees; runners, aglow from their morning run, strolled past with earphones in place. Men in suits, women in dresses, students with fashionable shoulder bags, potentially psychotic people muttering to themselves outside of liquor stores. Garbage men loading mountains of filled black garbage sacks into their beeping trucks. Delivery men wheeling towers of boxes across crosswalks. People, people, people everywhere.
This visit to New York seems different from my last visit—I am more impressed (and overwhelmed?) with the sheer volume of people here (these canyons that I walk in while staring up at the walls of all these apartment buildings!). I am also wondering—seriously, rather than dreamily, as I had in the past—if I could actually live here (if given the opportunity, of course—don’t wanna jinx myself). So far, I don’t feel out of place. Then again, I never have.
My first interview is rapidly approaching. It is going to be a warm day and I’ll be tromping around (with poise and grace, of course…) in a black suit. (sigh)
But first, I shall buy some fruit and snacky type things. People weren’t kidding when they said that there are grocers on every corner.
21 Sep 2007 | 12 comments.
Writing About Cookies Mitigates Anxiety.
In all truth, I’m not that obsessed with cookies. While I do have a fine appreciation for the small confection, I am able to experience joy even in the absence of cookies.
Yes, really.
I’ve applied some mild pressure to my contacts in New York City to take me out for cookies (when, in actuality, I am more excited about spending time with friends—the cookie is merely a decoy). One friend has extended a grand promise about
[t]he best [chocolate chip] walnut cookie in the city. Plus then there’s cupcakes, cannolis, tiramisu, danishes, donuts, bagels, must I go on? I know for you though, it all end [sic] and begins with cookies.
Fellow residents have made reference to my fondness of cookies in residency-wide e-mails:
Feedback and opinions, like chocolate chip cookies, are always welcome, throughout the year.
The chair of the department recently remarked that I need not worry about competing with him for cookies during meetings.
“I don’t really like cookies, anyway,” he nonchalantly remarked.
I personally find that to be a character flaw.
You can imagine my delight upon learning about The Cookie Guy: The Most Irresistible Bachelor.
(For what it is worth, I can resist him easily. I don’t find him cute. I also expect cookies to have deeper voices (yeah, I know…). I am also not drawn to his body habitus. Maybe I’m too picky.)
18 Sep 2007 | 7 comments.
Unsolicited Advice to Residency Applicants.
So, you are in your final year of medical school and will soon begin life in post-graduate training (because overeducation will help you lose weight! have more confidence! get you a lot of dates!). You’ve selected a specialty. What are some things to look for while you attend your interviews in your black suit while clutching your black, leather-bound folder? What are questions to ask of the people you meet? What are some things you ought to consider that may significantly impact your training experience?
How many clinical sites are in the program? The more clinical sites generally means more exposure to clinical diversity. If you train only in a community hospital, you’ll learn to manage common medical events, but you’ll miss out on more exotic cases. If you only train in a private sector hospital, you’ll become familiar with the medical problems of people who have money and/or insurance, but miss out on the indigent population and people who can’t afford healthcare (which includes a lot of people). The number of clinical sites will affect your clinical experience and “fund of knowledge”.
However, the practical aspects of clinical work become complicated with each additional clinical site. If you are in a specialty that includes an outpatient component, your clinic may be at Orange Medical Center, but you may be on an inpatient rotation at Apple Hospital. Getting from Apples to Oranges could be frustrating, particularly if you cannot chart for Apples while at Oranges. Keep in mind the practical aspects of travelling from one site to another: Is there a shuttle system? How reliable (and efficient) is public transportation? If you drive, how is traffic between Site One and Site Two? What about parking?
Furthermore, the more hospitals involved in the residency program could potentially mean more call. Although the number of residents in any given program is directly proportional to the number of medical centers in a residency, that doesn’t mean that there are necessarily enough residents to permit a decreasing call burden as one advances in the residency. (For example, there are many psychiatry residents in the country who do not take any call as third- and fourth-year residents. This sounds almost obscene to those of us who do.)
What do the current residents have to say about the residency program director? If the residents generally malign the program director, then this does not bode well for the residency. Find out the reasons for the disdain: Does the program director ignore resident comments and complaints? Is the program director more concerned about his/her status in the academic hierarchy rather than resident welfare? Has the program director repeatedly refused to advocate for residents?
If the residents say little about the program director (”who?”), this is also worrisome: Does this mean that the program director is never around? Does s/he (purposely?) limit contact with residents? How do residents deal with residency-wide problems?
Obviously, not everyone is going to like everyone else (including the program director), but you want to look for a program where people respect the residency director.
How involved is the department chair in resident education? This is difficult to suss out and doesn’t seem entirely relevant, but the department chairperson does indirectly affect the resident experience. If the department chair doesn’t care about resident education, that means that the chair will not support the residency director. (See the previous point.) If there are attendings who are atrocious towards residents, but are nonetheless producing excellent research or are otherwise bringing in The Big Bucks, these attendings will continue to participate (or not, if that’s the problem) in training residents.
If the chairperson meets applicants during residency interviews (whether formally or not), this is encouraging. If the chairperson interviews applicants, this is also encouraging.
Do the residents like each other? This is obvious. You don’t want to work with people who can’t tolerate each other.
Does the residency try to make your life easier? Much of this may actually depend on the School of Medicine, as that is where each residency obtains much of its funding. This is what I mean by “make your life easier”:
- Do you have to pay for your own meals while on call? Does the residency reimburse you for meals? Do residents have a “meal card” that they can use with ease while on call to get food?
- Do you have to pay for parking? (This adds up.) How far are the resident parking lots from the hospital and clinics? Does the residency offer a voucher for public transportation (bus pass, etc.) so you can travel at a discount or, even better, for free?
- Does the residency provide (cheap) options for health insurance? dental insurance? life insurance?
- Are residents permitted to participate in a savings program? Will the institution match the donations you invest?
- What provisions are in place to maximize your safety? Will security officers walk you to your car at your request if you’re leaving the hospital at a late hour? Can you get a ride to a safe bus stop?
- If an electronic medical record is in use, does the IT department want your feedback? Can you chart from your computer at home? If not, why not? If so, do you need extra software, security clearance, etc.?
- Do residents have an “education fund”, where the residency provides money for the residents to purchase books or attend conferences? How much is in that fund? Does it roll over with each year?
What is the balance between service and education? Ask the residents how the residency provides education. (The incorrect answer is: “Oh, we kinda run the hospital.”) Is there dedicated time for residents to attend didactics? Do these formal teaching sessions occur on a weekly basis? monthly basis? as needed harangued basis? Who teaches the residents? Are the attendings in clinical settings invested in resident education, or merely invested in scutting out residents? Are there case conferences? journal clubs? Who organizes them? Who attends them? (It doesn’t count if the residency “offers” them, but the residents feel too saddled with work to actually participate in them.)
Do you want to moonlight? Most people don’t go into residency with this question in mind and perhaps I am not in the best position to address this: I do not moonlight, as I much prefer having time over money. However, if you have plans to start a family, want to pay off your loans as soon as humanly possible, desire to purchase property, or otherwise want to bring in the BLING BLING to charm the ladies (…), inquire into moonlighting opportunities and difficulties. Some residencies (or, more commonly, the associated Schools of Medicine) won’t let you moonlight within the clinical institutions in which you work (e.g. the ER). Some residencies won’t let people moonlight within a certain geographical distance. Driving fifty miles to work on a weekend sucks. (Refer back to the first point about clinical sites: These other psychiatry residents who do not take call as senior residents are often moonlighting within the clinical institutions and thus are (1) providing call coverage anyway and (2) making BANK while doing so.)
What do you like to do when you’re not working? Do not be mistaken: As an intern, you won’t be doing much other than working, sleeping, and performing necessary ADLs (Activities of Daily Living—bathing, eating, etc.). However, as you progress in your training, you should have more time away from work. If you love to fish, attending a residency in a land-locked area is not a good idea. If museums and viewing plays are sources of joy in your life, a rural residency probably won’t sustain you.
Of course, you can cultivate new hobbies wherever the Match sends you. The opportunity to immediately continue your interests upon relocation, however, allows you to build your (non-medical) social network rapidly. And you may find that your non-medical friends, in engaging you in your non-medical hobbies, offer invaluable support when the fangs of medicine have latched onto your soul and are draining you of your Life Force.
Best wishes to the medical students currently applying for residency slots. May you be offered way more interviews that you can attend and courted with enthusiasm and vigor. The Match will come sooner than you think.
16 Sep 2007 | 7 comments.
Neurotic in the Best Way Possible.
“We’re walking along 8th Avenue, approaching 39th Street,” my Ph.D. friend said.
“Who’s ‘we’?” I asked. I personally don’t like talking on the phone with someone who has company, primarily because I wouldn’t want to be the company listening to someone yap on the phone.
“You and me,” he brightly answered. “What the @#$%? That car just totally ran a red light”—I could envision him gesturing to the offending motor vehicle—”people here in New York are angry today.”
I laughed at him. This was the first time we had enjoyed a telephone conversation with each other since his relocation from Seattle to New York City nearly two weeks ago. He had already peppered his speech with several expletives, though I figured that he wasn’t entirely aware of it.
After we had passed 41st Street, he again interrupted himself and blurted, “*&$% it—okay, I get that you have places to go, but that doesn’t mean you have to ^%!#ing bump into me. I get it that you’re trying to assert your space; yeah, maybe the only way you can establish your #&!@ing dominance is by walking in a straight line down the sidewalk and yes, I’m walking in a straight line down the sidewalk, but even though you think you’re important, that doesn’t mean that you can just run into other people. What the ^*#@ is wrong with some people?”
We both knew that he wasn’t truly upset; he was merely providing social commentary about life on the sidewalk in New York. However, over the past two years, I had come to recognize that the number of expletives he uses is directly proportional to how irritable he feels. In the two weeks prior to the completion of his dissertation, he was constantly mouthing off. Following the defense of his thesis, he uttered not one profane word over dinner.
“And the tourists here!” he exclaimed. I laughed at him again—he hasn’t lived in New York City for even a full week and he was already offering invectives about tourists! “They walk so slow! If I know where I need to go, I wish these ^*@!ing tourists would move out of the way so I could go!”
He paused.
“People here have walk rage, they really @*$@ing do,” he commented.
“You’re going to do so well in New York, you know,” I said, smiling.
“I hope so,” he answered. “Sooo… how are you?”
“Well,” I started, replacing the cap on the pen that boasted merlot ink, “when you called, I was writing down subway directions for all the places I need to go—”
He started to laugh at me. “You’re so cute.”
“I’m not sure that it’s ‘cute’,” I answered, looking over the four sets of directions I had already scribed. “I know it’s neurotic, but I have several interviews and I want to make sure I know where I’m going, you know.”
“You’re writing down subway directions. Wow. I didn’t know that you could reach that level of neuroticism—”
“Really? This surprises you?”
“Well, sort of—though I mean ‘neurotic’ in the best way possible, of course.”
Oh pul-lease.
I looked down at the small stack of index card-sized sheets and glowed a bit with pride. I didn’t share with him the level of detail in these directions, for fear that he would soon mean “neurotic” in the worst way possible.
The directions on these sheets are color-coded. The first line, written in a colored (but not grey) ink, indicates the starting and ending locations (e.g. JFK → hotel). The number in the parentheses immediately following the end location indicates the estimated amount of travel for the trip (e.g. 45”).
The bulk of the directions are written in grey ink in neat print (sometimes my penmanship is illegible; sometimes it’s enviable). I used the appropriate ink color for the various subway lines (red ink for the 1, 2, and 3 trains; yellow for the N, Q, R, and W trains; etc.). I’ve indicated what is the stop immediately prior to the stop I need, so I have some warning as to when I am supposed to exit the train.
Immediately following the directions is the address of my destination, written in the same colored ink as the first line.
Underneath the address is a small map that features labelled streets (in black ink) and a small “x” in a circle (in the same colored ink as the address) to visually mark the desired location.
“I can’t wait for you to come to New York!” my friend said. “We’ll have so much fun once you get here.”
Neuroticism: It’s an irresistible charm.
15 Sep 2007 | 5 comments.