Oh, hello.

You probably thought I had forgotten about you, right? Of course I didn't. Things have just been really... busy. And un-busy.

I spent 4 weeks in NJ, and it was devoted almost 100% to looking for a house in Philadelphia. Of course, looking for a house consists of a few days of looking at a ton of houses (we saw 15+ each day!), and then tons of inactive time looking around the internet at MLS listings, Craigslist listings, and learning about the finances associated with buying a house.

I got really bored and unhappy and mopey on the inactive days. Eric commented that I'm really bad at being unemployed, and it's true.

I've been back in Louisville for two weeks, and the boredom is over. It's been non-stop action for the last 10 days. First there was Senior Week -- a trip along the Bourbon Trail, a trip to a winery, Senior Skits, a Bats game, a class cookout, Doctors Ball (aka Med School Prom), our awards banquet, and finally, graduation itself. As class president, I gave a speech -- in front of probably close to 2,000 people! -- and it went really well.

So I'm a doctor now! Yay! Finally! So far, it doesn't feel any different, other than using it in arguments with my mom: "I KNOW about the potential dangers of lead paint; I'm a doctor!" Haha.

This week has been split between wedding stuff and house stuff. On the house front, we had inspection on Monday, and submitted our request for repairs/price adjustment today. Let's hope the seller does everything we've asked; some of them are non-negotiable on our part, which means we'll walk away if they aren't done. That would suck, since we're moving in less than 3 weeks and need a place to live.

Lots of people have complained that we haven't posted any pictures of the house, but I'm a little bit wary of doing that too soon. I was definitely nervous doing so before the inspection; even now, I'd rather wait until we know the seller has agreed to our terms. And even after that, there's still the final approval of the mortgage to wait for (a friend of ours had problems with that, through no fault of her own; we've been following the saga via her Facebook feed). So you'll get pictures when I know for sure we can call the house ours :)

On the wedding front, I've been buying lots and lots of things, making final calculations to see if our money is going to cover everything we need it to (it's going to be close, but we'll make it!), organizing all the wedding crap we've accumulated as nicely as possible in the office, and cleaning the rest of the apartment. A good pre-wedding workout is to move 10 boxes of wine from your car to your building lobby, then from the lobby down the hall to the elevator, then from the elevator to your apartment at the end of the hall, and then from the door to the office. Repeat with 10 cases of beer, and again with 20 bottles of bar mixers, as well as all the other wedding stuff you've brought home. I'll get toned triceps by the end of the week, no problem!

I may not post again for a while, but at least this time I'm giving you warning.

-Dr. HWong14

Last. Day. Of. Med. School. Ever.

The end.


Haha, just kidding. Like I could ever leave anything that short. Today was my last day! My preceptor doesn't work Fridays, so I've had every Friday in March off, and this month was my last rotation, because, smart person that I am, I decided to save four weeks of my vacation for the last four weeks of school.

I AM DONE!

Now it's just full-time sleeping, reading for fun, wedding planning, and buying-a-house-and-moving preparations.

(I do have one silly multiple choice "test" on Monday and a 5-page, double-spaced paper on a historical medicine figure of my choice due next Wednesday, but those aren't that painful.)

A day late, no dollars short

I got my first choice, Pennsylvania Hospital!

It was really exciting to open the envelope and see those two words. I looked twice, gave a muted shriek, showed it to Eric, and gave him a big hug. Then I may have shrieked again, this time a little louder :)

Today has been a whirlwind of house shopping on Craigslist (Do we have a loan or broker yet? No...) and getting wedding crap done. After collecting and tasting samples from four -- count 'em! FOUR! -- bakeries this afternoon, we've made our final choice. And all evening, we've been going through music playlists from our DJ, various places on the web, and our iTuneses to pick wedding music. Whew! All while massively hungover, I must add, because the celebrating yesterday was hardcore.

Unfortunately, Eric leaves in the morning, and then I'm left to the neverending task of trying to straighten up this apartment, finish the invitations, and get a tiny bit of work done before the tiny bit of motivation I have left disappears in the next week. Because I only have ONE WEEK of school left! Smart me, I took the month of April off, which is among the best decisions I've ever made.

Yay!

Short and sweet

From:	"NRMP Staff"
To:
Date:	Monday - March 16, 2009 11:51 AM
Subject:	Did I Match?
Congratulations! You have matched. Check the Match Site at https://services.nrmp.org/R3/ on Thursday, March 19, 2009, at 1:00 PM eastern time to find out where you matched. Because you are matched, you will not have access to any information about unfilled programs.

Now I just need to wait until Thursday!

Scramble Day approaches...

I've been trying not to think about the impending Match Day, and for the most part, I'm doing quite well. OTHER people, on the other hand, keep mentioning it, and then I get this awful feeling in the pit of my stomach. Actually, it's more like the top of my stomach, because I think my ulcer is back, and I haven't restarted medicine for it yet. So with every mention of Match Day, a little more acid is released, and I feel a little more nauseated.

Tomorrow -- TODAY -- at noon, I'll get an email telling me which way I've gone. Matched or scrambled. If it's scrambled, Student Affairs will page me to get my ass into the office for some counseling and planning of the scramble attack. Like I said, I'm doing pretty well not thinking about it, but other people keep bringing it up.

This morning, I had a dream -- make that a nightmare -- in which I opened my letter on Match Day to find out that I hadn't matched. The process was clearly out of order, since you're supposed to find out on Monday, not Thursday, if you haven't matched, but that's the way nightmares go. I was crying in my nightmare (don't think I won't be crying in real life if this happens!), and I woke up with real tears on my cheeks. I immediately dozed back off, and the nightmare started all over again! This time, I opened my letter to find the name of my #4 program. I was instantly upset, not because it's a bad program (I actually really like it), but because (in my nightmare), I knew Eric would be upset, because it's not in Philadelphia. I woke up from that nightmare with palpitations, too.

To assuage my fears, Eric today looked up the Match statistics from 2008. I've looked at them before, but I always take away the bad message: 6% of people don't match at all (not even via Scramble). There were 7 open Ob/Gyn spots in the country this year after the match. Eric called me to talk about the positives -- 60% of applicants get their first choice, 80% get one of their top three choices, and 90% get one of their top four choices. 94% match anywhere. I countered with my negative statistics, and made him all depressed, also. Oops.

Ulcer's acting up again; time to go to sleep. In 12 hours I'll know IF, but not WHERE. IF is all I'm asking for at this point. Here's hoping for no more nightmares. It's disconcerting to wake up with real tears on your face.

You think YOU'RE unhealthy?

Just imagine if you were a 33 year old woman who just had a heart attack and two stents placed. That's what I saw in the office yesterday. That's what uncontrolled diabetes, hypertension, and hyperlipidemia will get you. Even worse, she knew she had all of those things and just didn't take any of her medicines, for months at a time. NOW she's going to be on top of all of her meds, but that's akin to, as my preceptor likes to relate, the person who quits smoking after he is diagnosed with end-stage lung cancer.

Yeah, time to get my cholesterol checked again...

Roses and pot pie

Check out what I scored at Kroger on Monday:

Valentine's Day leftovers for 75% off! First I saw the "Valentine's Day"-specific rose bouquets, and was going to buy 3 roses with some filler for $3.25 (originally $12.99), but then I saw, over by the regular flower display area, that ALL the roses were 75% off, so I got these beautiful terracotta-colored ones for $3.75 for a DOZEN, no filler (originally $14.99). Sweet!

They were kind of cruddy looking, but that's where working at a florist in college comes in handy. With some love, some lukewarm water, sharp scissors, and some floralife, they perked up immediately, and bloomed beautifully. The fact that they were already "past their prime" when I brought them home was OK, because they're all maximally open right now, and I'm leaving tomorrow morning for a long weekend, so I was able to enjoy them to their fullest potential.

And then, check out what I made on my (unexpected) day off yesterday:

Chicken pot pie, inspired by this Real Simple recipe:


The only thing that could have made it better (other than a little more salt; I didn't season it enough) would have been a cute casserole dish like the one in the magazine. I need more pretty baking dishes. NEED. On Sunday when I was cleaning out the refrigerator, I salvaged some almost-bad chicken breasts by poaching them in water, then stuck the cooked chicken back in the fridge (I intended to cook this recipe on Monday after I got the pie crusts, but things got put off...). I wasn't able to salvage the already-bad chicken thighs, so those got tossed. I hate wasting money like that.

Here are some action shots for you:
First step: Sauteeing the mirepoix (the celery was my addition, since I had some; but why would you write a recipe with just onions and carrots and not make it the full mirepoix?).


Last step: Eating! It's a store-bought frozen pie crust (the package came with two and I used them both) and I also added frozen peas, as per the recipe. We discussed pot pie today at work and decided potatoes would also be good in it (although I hardly ever buy white potatoes any more; what do you think of sweet potatoes in a pot pie?). If you added bell peppers you'd have a mirepoix AND a trinity!

As I was cooking it, I realized I was making a "lite" version of a regular white sauce, and I was annoyed I hadn't read the instructions a little more closely before starting to figure out what their method was. No butter?! Give me a break. I have to admit, though, that the pot pie was very good, aside from my too-little-salt error, and WAS very rich-tasting. And then I looked back at the recipe and saw the butter omission was on purpose. They meant for it to be a "lite" pot pie. Oh well. At least now I know that I know the method of making a pot pie sauce the right way -- BUTTER and flour, then some wine and stock and milk :)

Now I have a confession: A mere 24 hours later, that entire 9x13 pan of chicken pot pie is gone. I had it for lunch yesterday immediately after it was cooked, as a snack a little while later because it smelled so good and I'm a pig, for dinner last night while watching Lost (OMG, what happened to Aaron?!?), for lunch today, AND for dinner tonight. If I weren't leaving for 5 days tomorrow morning I might have let it last longer, but really, it was THAT GOOD and I didn't at all mind eating it so many meals in a row. I already said I was a pig, so we're covered there.

And with that, I'm off to Snowmass, for one final year of skiing -- I mean, learning how to be a better student leader. My goal: black diamonds without shaking in my boots! And since I'm a lazy fourth-year medical student with growing senioritis, I hope I DO get snowed in on Tuesday morning and have to stay an extra day... or two!

Rank List in!

Last night Eric and I finalized my residency rank list, and I stayed up late to submit it. It's in! It's done! The final deadline is Feb. 25 at 9 pm, but I'm not going to open the list back up before then. First of all, I'm going to be gone Friday-Tuesday, leaving me just Wednesday to play around with it, and second of all, word on the street is that people who make changes or submit close to the deadline have an increased frequency of 1) having computer malfunctions screw with their ability to submit and 2) having regret about last-minute changes. So that's it, I'm done.

What comes next? Between Feb. 25 and March 16, a computer program runs The Match and produces the results. On March 16, if you have not matched anywhere, you receive an email and start to cry. On March 17, you get to see the list of unfilled spots in the country and participate in The Scramble, in which you scramble to contact programs with unfilled spots and beg for acceptance. If you have matched somewhere as of March 16, you just breathe a sigh of relief that you don't have to scramble, and you continue to squirm until March 19.

On March 19 at noon, every graduating medical student across the country gets to open an envelope that contains the name of the program they have matched into. Most schools have a Match Day ceremony of some sort that involves some pomp and circumstance, food, anxiety, and alcohol. At noon, everyone opens their envelopes, everyone cries either happy or sad tears, and then the drinking continues. Whew! I get nervous just thinking about it. Oh, who am I kidding; I've BEEN nervous for months now!

So how exactly does the program match everyone up? Well, the basic tenet is that the match favors the student, not the program. That is, it will try to put each student in the highest possible program from his or her list, rather than filling a program's spots with the program's highest ranking members. Here's an article that appeared in JAMA describing the history of the match, why it was implemented, and how it has changed over the years.*

And here's a really good explanation of the matching algorithm courtesy of NRMP, the National Resident Matching Program, the body that runs the match. Here's a personalized example:

I create my rank list, with 3 programs. We'll call them Program A, B, and C. Each of those 5 programs has 5 spots to fill, each interviewed 50 applicants this year, and each program ranks its 50 applicants from most desirable to least desirable.

So say Program A, my #1 choice, ranks me as its 6th choice. Program B, my 2nd choice, ranks me as its 2nd choice. And Program C, my 3rd choice, ranks me as its 10th choice.

The computer first looks at my list, and sees that I ranked Program A first. At that moment, at the beginning of the algorithm, Program A has all 5 of its spots open, so I get put into one of them. I have tentatively matched. Then the computer moves on to the rest of the applicants in the pool. If 5 other applicants all ranked Program A as their #1 choice as well, and those 5 applicants are higher on Program A's list than I am (at #6), then the computer would bump me out of Program A and fill Program A with Program A's #1-5 applicants, since those applicants also chose Program A as their #1.

So now I'm unmatched again. Now the computer considers it impossible for me to match at my #1 choice, and moves on to my #2 choice, which is Program B. If Program B is already tentatively full, I will bump the lowest ranking applicant out, because I am Program B's 2nd choice. I think at this point it would be nearly impossible for me to not match at Program B and match anywhere else, so I should be all set.

But how could it be possible for me to match at Program A, if I'm Program A's 6th choice and they have 5 spots? Well, if Program A's top 5 applicants don't all choose Program A as their first choice, I have a window of opportunity. For instance, if Program A's top choice (we'll call him John) hated Program A when he went to interview and decided he would never in a million years want to go there, then he wouldn't rank it at all. So even though Program A really wants John, John absolutely does not want to go to Program A, and it is therefore impossible for that match to be made (see, this is where the match "favors the applicant's desires, not the program's."

So if John is out of the running, then I would become Program A's #5 choice, instead of its 6th, and I should get in.

Stressed out yet? Yeah, me too. Now multiply that until you reach reality, in which there were 3,475 programs with 22,240 available spots for 44,598 applicants (U.S. seniors, foreign medical grads, people who delayed entering residency for a variety of reasons, etc), and 20,940 matches last year. (Data and charts here.) Eek! Thank goodness computers are so fast and powerful these days!

Someone told me that this matching algorithm was originally designed for some sort of dating match-making, and I found another article that confirms this (from the Society for Industrial and Applied Mathematics). Another tenet of the match, aside from favoring the applicant's desires over the program, is to create a situation in which no applicant-program pairing prefers swapping with another applicant-program after the match is done. In other words, say I end up at my #2 and John ends up at his #2. If I ranked his program as my #1 and the program ranked me as its #1, but John ended up there; and at the same time, John ranked my program as #1 and it ranked him higher than it did me, then my program, John's program, John, and I would all prefer to switch around. This would be disastrous if it happened to multiple pairings, because then the match would not have worked as well as possible, and you'd have people switching around afterward. A logistical nightmare!

And yes, when I signed up for the residency application process this fall, when I registered with NRMP a few months ago, and when I submitted my rank list last night on NRMP, I agreed over and over again to adhere to the match results I am given. If I match somewhere on my list, I can not pull out completely, or approach other programs to try to switch. It's binding. I don't know what legal action might be taken, but you can bet I would never match anywhere next year if I tried to reapply. I'm sure I'd be blacklisted.

So what makes a successful rank list? Essentially, a longer list is better (especially if you're applying to something really competitive), because it gives you more options. If I only rank only one or two programs, there's a higher chance the computer can't stick me anywhere that works, so I might have to scramble. In order to rank a program, you have to have interviewed there. Then, you have to decide whether you want to rank it. The litmus test is to say, "Would I rather learn [my chosen specialty] at [Program X] or would I rather learn [my chosen specialty] in somewhere completely random (like Alaska, Alabama, Maine, insert random middle-of-nowhere place of your choice)?" A stricter litmus test is to ask, "Would I rather learn [my chosen specialty] at [Program X] or would I rather learn something completely different somewhere completely random?" (I often say, "psychiatry in North Dakota".) If that's your choice, you're likely to decide to rank Program X after all.

However, I interviewed at 16 programs, and have only ranked 13. The last three were just too horrible. Well, two were horrible and one I decided would be a big blow to my ego. And yes, I fully believe that I would rather become a surgeon or internist at some random middle-tier program (for one year, anyway, then reapply) than to learn Ob/Gyn at those three programs. They were that horrible. I think this is safe; 13 is a pretty long list, so I should be OK.

And finally, why the long wait between the ranking deadline of Feb. 25 and the results starting March 16? According to NRMP, they say that in those three weeks they take :

"a number of major steps to assure the accuracy of both the Match and the subsequent release of Match information. Those steps include:

• Checking the integrity and completeness of the data.
• Transferring the data to the algorithm module, checking it again, and running the Match.
• Verifying the results of the Match and transferring the data into the NRMP databases.
• Creating more than 60,000 individual reports for applicants, programs, and schools, and assuring confidentiality of the information. The reports are then posted to the Web in accordance with the Match Results schedule.
• In addition, time is allotted for unmatched applicants and unfilled programs to make decisions before Match Day." [ie, the Scramble]

I guess that sounds fair. You might also be interested to know that almost every year, someone tries to sue NRMP on anti-trust grounds. I have to admit, the whole matching concept is rather weird. But objectively, it is a fair and orderly way to evaluate programs, to have programs evaluate applicants, and to try to make everyone happy. If things were the way they used to be, in which I might get a telegram offer during my second year and have to reply in a matter of hours (well, it would be via email nowadays), that would be MUCH more stressful. You might agree to accept a position and never know if that's truly the best you could have done with yourself. Decisions would be made based on first- and second-year grades, which, while important, aren't necessarily good predictors of becoming a good physician. I can't even imagine the insanity. Yet somehow, lawyers, dentists, pharmacists, and a number of other professional students manage to find jobs without using a match. Who knows.

In any case, now it's just a waiting game. Twenty-six days until March 16, when I found out IF I've matched, and 29 days until March 19, when I find out WHERE.



*Subscription may be necessary to access the full article, but just comment if you want the pdf and I'll send it you. The citation is JAMA. 2003;289:909-912.

Abstinence is "not realistic at all"

I just read this CNN story on the interview Bristol Palin did with Fox News. She says that abstinence is the best option, but also believes that abstinence is not a realistic expectation for teenagers.

I fully agree. However, I connect those two thoughts with an acknowledgment that contraception is very important to prevent disease transmission and pregnancy. I don't know how Bristol reconciles her two beliefs, but she has a baby now, so you can draw your own conclusions.

Our society is fighting biology. We tell our 16-year-olds in the clinic that if we were living 200 years ago, they would be married and have kids by now. But instead, because we want them to grow up and continue their education, they need to put off having sex. They need to control their hormones. And if they can, that's wonderful (and believe me, I hand out the "101 Ways to Say No to Sex" brochure left and right); but if they can't, they need to know how to protect themselves from STDs and pregnancy. And no, the oral contraceptive pills most of them are on for out of control periods do not count.

So when that 16-year-old the other day (the one I had to clandestinely sneak instructions for emergency contraception to) told me she had had sex, and she said, "We talked about it a lot and decided we wanted to do this. I mean, we're both religious and we believe in waiting until marriage, but we also love each other and talked about this for a long time before making our decision," I couldn't laugh at her or point out the idiocy of her two opposing statements. That's how teenagers are. They know, at least to some degree, that they should wait, but it's also an unrealistic expectation for some people. Thank goodness she and her boyfriend have the heads on their shoulders to recognize that they don't want a baby anytime soon. That's all we can ask for, really.

So I will happily give out condoms and dental dams with explicit instructions on how to use them and why, and I will continue to put fear into teenagers' minds about what STDs are and what they look like and how they are transmitted. And how to use their OCPs as emergency contraception if they have them, or how to get Plan B if they need it. Because while no one wants 16-year-olds to have sex, when they decide to have sex, they're going to do it. Better prepared than not, right?

Pediatric and Adolescent Gynecology

Remember how I love, love, love pediatric surgery? And I like pediatrics in general pretty well, too. But I'm going into OB/GYN, right? Well, it probably wouldn't be much of stretch to imagine, therefore, that I am liking pediatric and adolescent gynecology a lot. A LOT.

There is such a wide variety of patients, which is always fun. And they are anywhere from young children, 3-4 years old, to young adults, 21-22 years old (my preceptor will see her patients until they graduate from college before she kicks them out to an adult gynecologist). Here is just a sampling of the patients I have seen in the last week and a half:

-Tons of girls with bleeding disorders. von Willebrand's disease is more common than I realized (even though I knew it is the most common inherited bleeding disorder). I can't imagine starting out my period for the first time and having it last 12 days and being so heavy I had to change my pad every hour. It's so nice to be able to help these girls, although in some in can be tricky to find
the right medicine combination.

-Lots of ethical gray-zone issues. Like the 10-year-old girl with special needs with heavy periods. "She has autism spectrum disorder," her mother informed me, "she was vaccine-injured as a child." At that point, it took all my strength not to just walk out the door or lecture her on why that was highly unlikely. (Have you seen the latest news on this, by the way? News #1, News #2). So anyway, her mother wanted to not only make her daughter's periods manageable, but wanted to get rid of them completely. And yes, doing this with oral contraceptive pills is perfectly fine, but the mother wanted to discuss permanent solutions. "Like what I had done," she told me, in reference to the hysterectomy she had in her 40s. 40s, not 10, thank you very much. "She has special needs, so she can't take care of herself, and I'm concerned about hygiene issues," the mom said. And while that's a valid concern for severely mentally limited girls, I ended up spending about 20 minutes alone with the patient because the mother wanted to talk in private with the nurse pracitioner. And in those 20 minutes, not only did I not see any evidence of this girl having ASD, I also got confirmatory (verbal) evidence from her that although she thought having a period sucked (which any 10-year-old would think), she in fact did bathe herself. And when I mean this girl didn't have ASD, I mean I would still have to see some intelligence/personality testing, but she was conversing with me like any other totally normal 10-year-old. Not so much mentally or socially withdrawn from what I could tell. No judge would ever allow that child to undergo a hysterectomy.

-A fair amount of sexual abuse, unfortunately. One girl that we saw today was being molested by her father before he was incarcerated for illegal drug issues (and her mom is incarcerated for robbery and grandma just got custody of the patient and her five siblings). Her older sister was also being molested and had the courage to tell someone. Both girls have genital warts now. Another girl was in the custody of her grandmother because her mother was the perpetrator of a neighborhood playacting fantasy, in which she would drug her daughter and the neighborhood kids with "something blue" and have them act out sexual activities with each other. It's very sad. One of the residents who works with us occasionally can't handle it, and becomes very emotional when she hears these stories. She has a 13-month-old and a 7-year-old, and I think it affects her a lot. I'm still as emotionally closed off as I've ever been when it comes to medicine, so it hasn't penetrated my emotional barrier yet, thank goodness.

-Lots of teenagers having lots of unprotected sex, starting at a very early age. When you start having sex at 13 and have had multiple sexual partners, you're just not mentally prepared to deal with the realities of STDs, let alone pregnancy. The nice patients I've seen are the ones like that who have decreased their sexual activity as they've gotten older, seeing the error of their ways. But all you can do is support their decision, try to make sure that they're making actual decisions and not just being pressured into sex by someone else, and give them the tools to prevent diseases and pregnancy. And screen them for STDs every time they come in. I like to reinforce that their romantic relationships need to be emotionally healthy, not just safe from physical abuse.

-A few older adolescents who are sexually active, but more in the realm of "reasonable" sexual activity, like a 20-year-old who has been dating her boyfriend for a couple years and is on the pill for period-control reasons but who has the fear of pregnancy and STDs stuck in her head and so still uses condoms (the best thing to do). These are patients I enjoy counseling on emergency contraception and period manipulation techniques. They're old enough and smart enough to have an intelligent conversation with, and they deserve to know all about how their bodies and medicines work so they can take control of their own health care.

-Sometimes it can be very tricky to work with adolescents. We have all our patients fill out a questionnaire every time they come in that assesses risky behaviors (tobacco, alcohol, drugs, sex, etc), and we discuss worrisome answers with them. Without their parents present. Yesterday, my 16-year-old patient wrote on her form that she wanted to discuss sex without her mother in the room. I got nervous, because I haven't had enough practice making that transition happen, and I'm not confident in being able to make it happen smoothly, so I knew I was going to have to deal with it. While we were discussing the patient's periods, her mom's cell phone rang, and she stepped out of the room. All of a sudden, I took advantage of the opportunity and switched gears: "I know you said you wanted to discuss some things without your mom. Let's talk about those now and when she comes back, we'll pick up with this menstrual calendar." So the girl told me how she and her boyfriend had decided to have sex for the first time, but they were using condoms, and she wanted to learn about her pills from a birth-control standpoint (she was on them for period-control), as well as about emergency contraception options if she ever needed it. As soon as mom walked back in, we picked up where we had left off ("So, how many pads are you using on your heaviest flow day?"), and when the phone rang again and mom stepped out for a second time, we went back to sex. In the end, I needed to write down some information for her, so when I went out to present to my preceptor, I wrote her two notes: one on ibuprofen dosing information, and another about emergency contraception. At the end of the visit, mom walked out the door first, and there was a moment when the patient and I were face to face. "Here's that information about ibuprofen I promised you," I said out loud, and then whispered as I showed her the second post-it behind it, "and here's a secret note for you." She nodded, smiled in thanks, and stuck the second note in her pocket. And mom didn't see a thing. Whew! What an adrenaline rush! It's like a spy operation sometimes.

-It's really heartwarming to see my preceptor do a pelvic exam on a pubertal girl, because she's so gentle and caring. "I'm a special doctor who specializes in dealing with girls' bottoms," she says. She gently gets them set up in the stirrups and sets up a mirror so the girl (and her mom, if the girl wants, which in this young girls, they all do) can see from up above (when I'm in the room, my job is to be the mirror holder). Then she points out all the anatomy. "The first thing I look at is your hair growth. This is normal hair growth, because it is in such-and-such a pattern. These are called your labia majora, which means 'big lips.' These are your labia minora, which means 'small lips.' This is where your pee comes out, and this is the opening to your vagina. Everything looks normal from the outside, and that's all we need to do today. As you get older, it will become necessary to do an internal exam to make sure all your girl parts inside are OK." That's so much better than having your first exam be in the emergency room, or even in an adult gynecologist's office. I wish mine had been like that! (And if they do need an internal exam, everything is just as gentle and informative along the way.)

-One of the funniest things I saw was a little 4-year-old who was having some itching down there (very common, just a little nonspecific vaginitis), and we set her up for a similar visual pelvic exam. In pre-pubertal girls, the hymen can be imperforate, and can set you up for an infection because urine can't flow out properly if blocked by the hymen. So we were examining her hymen, and she could see it in the mirror. She somehow figured out that if she tightened her rectum, it tightened her vaginal muscles, and made her hymenal opening squeeze shut. And if she relaxed, it opened back up. So all of a sudden she starts contracting and relaxing her butt to watch her hymen open and close. And finds it hilarious. It was pretty funny to see, but all I could think was, "Oh dear, now she knows a new trick that's she's going to want to duplicate at home..." Little kids are hilarious sometimes.

-We give the HPV vaccine to everyone. And I love it. I've been able to address every single patient's and parent's concern about it. "Well, I've heard about some of the controversy and I'm just not sure," a mom will say. And I respond with, "What concerns you about it?" and we address every concern as it comes. And they always understand by the end, that this is a good thing to do. I'm finding that I really like counselling patients a lot. Safe sex, emergency contraception, vaccination, you name it.

I had no idea pediatric gynecology even existed before a year and a half ago. Now I know that even if I don't go into it, I will definitely refer patients to a pediatric GYN without hesitation, because they provide such great child-oriented care in some very sensitive issues. And I highly recommend anyone who knows a child or teenager who need the services of a GYN to seek a pediatric specialist out. There's only one in Kentucky, and I'm working with her.

Also, here's a tip on a great book for pre-pubertal girls to get them ready for the transition to adolescence. It's called The Care and Keeping of You: The Body Book for Girls, by the American Girl company. Every 9-year-old should get it, and read it.

Snow Days

OK, so I was wrong and the weather people were right. We got about three inches Monday night, and another 3+ (I didn't really measure it) last night.

I've never seen snow like this in Louisville:



(It's kind of hard to see, but the falling stuff is real snowflakes, not rain. Video taken from my bedroom window.)

So I was going to drive to work today (when it's this yucky out, I deserve to drive and not walk), but this is what my car looked like, and I couldn't get into it:
The handle is completely frozen shut. I managed to chip the ice off of the lock itself, but I couldn't open the door to save my life. So I walked. I still have to go back out there and try to clean the car off this afternoon. Snow days were so much more fun when I was a kid.

Oh and guess what else was wrong about my last post: I wasn't an amazing medical student who went into the hospital to care for her patient on her day off yesterday. I slept in, and it was as divine as I thought it would be. I felt a little bit guilty upon waking, though, so I had my friend David look up the pathology results for me, and guess what -- they STILL weren't back! Guilt gone. They ended up coming back yesterday afternoon, but that would have been after I would have left, anyway, so no harm done. So I saw him this morning and it turns out that the guy does have cancer (not surprising), and it's probably not good, but he still needs a PET scan to look for mets, which will tell us how bad it is.

His lung cancer is almost 100% due to smoking, based on the kind of cancer it is and his smoking history -- 90 pack-years. Yikes! (A pack-year is the equivalent of smoking 1 pack per day for 1 year. So this guy could have smoked 1 pack/day for 90 years, but he's only 74, or 2 packs/day for 45 years, or 3 packs/day for 30 years, etc. In other words, he's a heavy, heavy smoker.)

So don't smoke, kids. Seriously. He's a really nice man, and his 5-year survival prognosis, depending on what this PET scan shows, is 1-30%. There is a 70-99% chance he will be dead within 5 years. That's really sad. Did I mention how nice he is? I don't like days like this.

To end on a slightly less depressing note, here are some snow day pictures from my commute.

In between the two rounds of snow, we had ice. The trees can't handle it, and all over the city, they're falling over and taking out power lines. I still have my power, thank goodness.


I like the icicles hanging off of the traffic light pole. I was walking in the middle of the street because the sidewalks weren't cleared and there were hardly any cars. Look at all those big, fat snowflakes that are falling!


I like how frozen trees look.


I can't remember what this tree used to look like, that is, whether it's a weeping willow normally or not. I love the look of weeping willows, so it's too bad I can't ever have one; it's bad feng shui.

And since that's another depressing thought, here's what Eric just bought me for my birthday:

source

With liners, so they can be used in the rain or snow. Versatility AND purpleness! (And no more walking to work in the snow/rain in my Danskos.)

Snow night?

It's supposed to snow tonight. Anywhere from 1-6", I've heard. I'll believe it when I see it.

Tomorrow is supposed to be my day off from work (1 day off each week, averaged over 4 weeks, remember?). I would LOVE LOVE LOVE to be able to sleep in, just this once. I mean, I normally don't work very long days this month -- if my team isn't on call, I'm usually in around 7, and out by 2 or so (today it was 1), and I'm not working very strenuously while I'm there. Actually, I take that back; we THINK a lot on medicine, as opposed to surgery, where we are doing things a lot. I prefer doing, which is why I chose Ob/Gyn, but both are tiring in long doses. Anyway, like I was saying, I don't work very long or very hard, but I still have to wake up early, and that's the part I don't like. So a morning off tomorrow would be divine. Small problem: my one and only patient is a 74-year-old guy who has a big thing in his lung. The top differential is tuberculosis vs. malignancy. Unfortunately, we've ruled out tuberculosis. They took a biopsy of the mass on Friday, and the pathology was supposed to be back today, but it wasn't. It will be back tomorrow. I've been taking care of this guy for almost a whole week now, and when I say I've been taking care of him, I mean it; I'm being a true acting intern for this case. He is my patient, really and truly. So I really want to be there tomorrow morning to find out the biopsy results and tell him and his family. I think they'll appreciate that it's coming from me. And that means no sleeping in. ARGH. On the bright side, I guess I'm really dedicated to my profession...?

I took part in a brain wave study this afternoon, for a professor in the Birth Defects department for a study about the origins of dyslexia. They took an EEG of me while I read different words, some jumbled and some not. I got $10, but the real reason I did the study is because they're going to give me a copy of my EEG. My very own! Yes, I'm a dork.

Happy Chinese New Year! Here's my ox-related story for the day: During one part of the EEG study, I was supposed to push a button if the word I saw was an animal. So, don't push the button if the screen says, "ftea," don't push the button if the screen says, "couch," do push the button if the screen says, "cats". What did I push the button for? "Beef." Yikes. I hope they don't ding me for that one, but believe me, I'm totally ready to defend it!

Done with interviews! Part 3

If you've actually read parts 1 and 2 of this series, congratulations; you're more of a glutton for punishment than I would have thought. But never fear, we're almost to the end!

Date: January 7, 2009
Program: Temple
Social Event: Happy hour at Penang, a Malaysian restaurant in Chinatown. When I was younger and we lived in Princeton, we would go to Edison, NJ, to the original Penang. It's a great restaurant, and I've never been to the Philly one, which opened about 5 or so years ago. But wait! Some quick Googling just now turned up the fact that they are different restaurants, but with very similar logos. This is the one I used to go to in Edison, which also has a location in Princeton and Bethesda. And this is the one in Philly. Regardless, what I actually need to tell you is that I didn't make it to the dinner, because the bad weather in Philly prevented my flight from leaving Chicago on time. I was actually pretty happy, as you might remember, although I was sad to miss out on the Malaysian food.
Breakfast: More pastries, including muffins and donuts.
Lunch: Wraps, potato chips, soda, and delicious brownies. This lunch was notable for the fact that as I was surveying the wraps, the vegetarian one all of a sudden looked extremely delicious, and I chose it. This is notable because, although I love vegetables, I am first and foremost a meat eater, and I always always always reach for meat when I'm out of the house. In the case of sandwiches, I first lean to roast beef, then to turkey. But this time, those grilled zucchini were calling my name, and they were really good. Afterward, I had a turkey wrap to top it off.
Where I stayed: Marjorie's apartment, for the last time of the season. She and her roommate were both gone.
How I got there: Southwest to Philly. I haven't flown Southwest to Philly too much, because from Louisville you have to stop in Chicago (whereas US Air and Continental both go nonstop from Louisville to Philly); I usually save Southwest for flying nonstop to BWI from Louisville. However, this time it was cheaper, and I decided I didn't care that it was going to take me an entire day to get from one city to the next, and it ended up working out for me, since I got stuck in Chicago and missed the social event.
Other notable events: I ran into Matthew, from the Drexel and Sinai interviews, again, and he gave me a ride back to Marjorie's apartment at the end of the day so I wouldn't have to ride the subway and walk in the rain; also, we discovered that we would be interviewing at GW together in two days! I had dinner with Duc at St. Stephen's Green and I had a really good chicken quesadilla that had great spicy poblano peppers in them. That night was notable because I had nothing to do -- no social events or pre-interview dinners -- and got to watch Top Chef and relax. At the end of the night, I got ready to take a shower, and a series of events unfolded that involved my legs suddenly breaking out in crazy hives. I popped some Benadryl, hopped quickly into the shower, and started freaking out because the hives were spreading up and down my legs (but not anywhere else on my body). I couldn't figure out what had caused it, but dug around Marjorie's medicine closet for some Benadryl cream, went to bed still slightly itchy, and woke up totally normal. The pattern made it seem like it was a contact dermatitis, but the only thing that had contacted my legs were my pantyhose from earlier in the day and my jeans, which I had been wearing for hours already by the time the rash started. Two days later, when rehashing it all to Eric yet again, it finally hit me: When I was getting ready to take the shower, I took off my jeans, then started absentmindedly scratching my legs while gathering up my toiletries from around the apartment. I still had poblano residue under my fingernails, so in the five minutes I was scratching, I deposited all that pepper oil onto my skin. The funny thing was, when I finally figured it out, I suddenly flashed back to a memory of me sniffing my fingers before taking a shower, and thinking that they still smelled (in a good way) of quesadilla. So there's a lesson for you: wash your hands before you scratch anything, and always after eating spicy peppers.
Cost of interview: $189, for the flight to Philly, WiFi in Midway Airport (hey, I was bored), and a couple of cab rides.

Date: January 9, 2009
Program: George Washington
Social Event: TGI Friday's by GW. Potato skins, crudite, and wings -- the usual. Of note, the program director was at the social, and was very social! I don't think that happened at any other interview dinner.
Breakfast: I grabbed breakfast from the hotel (banana, yogurt, coffee), and grabbed a croissant from the platter of pastries at the interview. Later in the morning, while we were waiting around for our actual interviews, there was another spread put out, including cheese (which I sat right next to), crackers, brownies, cookies, and more crudite. I ate more cheese that morning than I have in a while. But how could I resist -- they had babybels and laughing cow cheese in addition to the usual cheddar and swiss.
Lunch: They bussed us out to INOVA Fairfax hospital, where the residents do a significant number of rotations, and fed us lunch there. Lunch was weird: salad (fine), some sort of mystery meat that looked like stir-fried beef, but nothing else that resembled Chinese food, like rice; then there were some roasted potatoes. It was an odd combo. However, they did have fruit salad and really good cheesecake. On the downside, though: diet sodas only. Seriously, what is up with offering only diet sodas!?!!?? Are you assuming that's the only thing people drink (obviously not true)? Or are you insinuating that I should be drinking it (in which case, I take offense and get huffy!)? I hate hate hate diet soda. Yes, I fully realize that regular soda is full of empty calories, but I don't drink a lot of it, I only drink Coke for the caffeine, and I make up for it by limiting my calories in other ways (not that I've given you any evidence of this...). So that's my gripe about programs that only serve diet soda. Given how good breakfast and the snacks were, it was disappointing that lunch was so bad.
Where I stayed: Residence Inn on Vermont Avenue, just north of the White House. Driving around DC made me remember how much I love DC. Yeah, Philly's nice, but I really really love DC. Sigh. The Residence Inn was nice, although they only had wired, not wireless internet, but they did provide ethernet cords, thank goodness. The bed was really comfortable, but the towels were thin, scratchy, and small. There were tons of choices for breakfast, but I was rushing out and could only grab a banana and yogurt. Of course, the whole point of the Residence Inn is that it's for extended stay guests, so there's a kitchen and all that in the room, but I didn't need any of that. I got a good price for it on Priceline, though!
How I got there: Rented a car from Philly, and drove back to NJ for the night after the interview was over.
Other notable events: This interview was memorable because I didn't know I was going to have it until the last minute. I was supposed to interview at Abington on this day, and for a variety of reasons, I really didn't want to go, but was forcing myself to. GW was the only program I had heard nothing from (at least Hopkins and Pitt were nice enough to let me know I was rejected), and I assumed they were just too rude to inform me of my status. However, two days before Christmas, I got an email from GW inviting me for an interview on January 9! I accepted without hesitation and in the next breath sent an email to Abington to cancel. It was good, because I still had my crappy Temple interview to go to, but I was re-energized for January. (And don't worry, I wrote on my anoymous feedback form that they should tell people who are on the wait list that they are on the wait list so they don't wonder.) At the interview I saw Matthew again, as I knew I would. Saw another girl from Penn State who I had met before at Christiana. Saw another girl from Wayne State who I had met before at Christiana. And saw another girl from a Carribean med school who I had met before at Einstein. And so ended my six degrees of Kevin Bacon interview season experiment. I interviewed with Matthew 4 times, which was the most of anyone. I interviewed with Beth from Jefferson three weeks in a row, which was a lot of fun. I interviewed with Lisa from Penn State three times as well, and with a bunch of people twice. And a lot of people were concentrating in the same area as I did -- a lot of east coasters, and a lot of Philly and DC people. I didn't interview in NY at all, or I would have intersected with another whole set of applicants, I'm sure. I'm really sure I'm going to end up with co-interns who I met on the interview trail, and I'm excited to see who they turn out to be! Everyone I met was, for the most part, really nice and cool and smart. There was only one person I can identify who I would dread working with -- he goes to Johns Hopkins and I ran into him at both Maryland and Pennsy. He's an ass, for sure, but he's the only bad apple I met all season.
Cost of interview: $292, for a rental car to DC, Pricelining the Residence Inn on Vermont Avenue for $80, and the flight back to Louisville.


So there you have it. Ob/Gyn interview season 2008-2009, completed. I can't share my favorites with you yet, because it would be really embarrassing if I didn't match at any of them, but I hope you've enjoyed reading what I can share with you at this point. I'm the first person I know (who's not doing the military match, at least, which already had its match) to be done with interviews -- as of Friday, most people had 1 or 2 more to go. On the down side, I started in mid-October, whereas most people start in mid-November. On the up side, I am now DONE, whereas internal medicine goes well through the rest of January, and ER goes through February.

Now I just need to make my rank list, reconcile it with Eric's rank list, and submit at the end of February. Pretty soon I'll go over the rank algorithm with you -- it's pretty interesting, and mind-boggling to think of a computer running through the algorithm for every residency applicant in the country! For now, it's relaxation time and working -- but not too hard -- on internal medicine.

Done with interviews! Part 2

When we left off, I had completed seven interviews in six weeks. December was going to be much more busy, though.

Date: December 5, 2008
Program: Christiana, Delaware
Social event: The dinner was at the Washington Street Ale House in Wilmington, with a full open bar and great food, including sushi and good hummus. We ate a LOT at this interview dinner, and drank a lot, too.
Breakfast: I grabbed breakfast from the hotel before the interview
Lunch: I don’t really remember lunch too much in detail, other than the fact that there was a lot of food, a crudite platter, a gorgeous fruit display (I ate a lot of strawberries and pineapple), and TONS of desserts. There was a platter of dessert pastries, including cream puffs, of which I had at least two, and there was cherry cheesecake. There was only one guy on our interview, and he claimed he couldn’t eat any cheesecake because he was worried about his figure. And yes, he used the term “figure.” In response, about 5 of us girls goaded him into eating cheesecake and made fun of him for being a sissy. It was an odd role reversal for sure.
Where I stayed: Christiana was notable for being the only program that paid for my hotel room. (Actually, one other program offered to pay, but I ended up canceling that interview.) Eric picked me up from the Philadelphia airport, and we checked into the Fairfield Inn in Newark, Del. After we checked in, we got a call from the front desk – someone had dropped off a welcome package for us! It was like we were attending a wedding. The package was all the information about the program, as well as some candy, which Eric enjoyed.
How I got there: Southwest to Philly; then rented a car to get from Philly to Baltimore for the Sinai interview
Other notable events: Christiana was another interview where spouses and significant others were invited to the social event. After this interview, I decided it would be nice to go to a program that had a lot of money. (That second sentence is unrelated to the first.)
Cost of interview: $358 combined for this interview, Drexel, and Sinai, including plane tickets, car rental, and a couple cab rides

Date: December 6, 2008
Program: Drexel
Social Event: Dinner at a resident’s apartment. The food was barbecue sandwiches and fried macaroni and cheese. Even though those are totally southern things, I totally associate them with Philly, because I used to eat at a really good barbecue place in Manayunk and gorge myself on fried mac-and-cheese when I lived in Philly.
Breakfast: A full assortment of not only pastries, but also bagels, fruit salad, and food-truck-style breakfast sandwiches. Yum.
Lunch: None; the interview was over by lunchtime.
Where I stayed: At Marjorie’s apartment.
How I got there: Eric dropped me off in Philly the day before, after the Christiana interview.
Other notable events: I saw Lisa from Penn State (and the Jersey Shore interview) again, and met Matthew. I also met a Muslim guy from Elizabethtown, KY -- this was weird, because no one is from E-town, and because we tried to play the "who do we know in common in Louisville game" and it failed. Drexel's program is known for having a lot of male residents, and as a result, they get a lot of male applicants; there were more guys at this interview than I think at any other interview I went to.
Cost of interview: $358, combined with the Christiana and Sinai interviews.

Date: December 7, 2008
Program: Sinai, Baltimore
Social Event: Happy Hour at the Mount Washington Tavern in Baltimore. Crudite, wings, and some unmemorable hors d’oeuvres served during dinner time. But good wine and hard liquor were available!
Breakfast: Bagels and pastries.
Lunch: Sandwiches, chips, fruit salad, and cookies.
Where I stayed: With Paula again.
How I got there: Rented a car and drove down from Philly. I flew back to Louisville out of BWI on Southwest. I think it was this trip that earned me the last of the credits I needed for a Rapid Rewards roundtrip, which I’m using for our Napa honeymoon in May. At least one good thing came of all these interviews!
Other notable events: Only two residents showed up to the social event. It snowed as I got to Baltimore, the first snow I had seen this winter. I unexpectedly saw Jonah at the interview – he rotated at Penn this summer when I was there, and he and I have similar stories, in which our significant other is already in the Philly area and we are trying to join them. I had no idea I was going to see him at this interview, and once we got sick of the social event, we left the private room and went to the bar to get a real dinner and discuss our interview experiences. Of note, he relayed a story that Temple girl #2 had told him when he had met her at another program – I find it endlessly fascinating how you run into the same people on the interview trail! I also unexpectedly saw my friend Osman at this interview. Osman goes to UofL with me, and I had no idea we had both applied to this program, let alone chosen the same interview date! It was really nice to see him, because I hadn’t seen him in months. Finally, both Matthew and the Muslim guy from Drexel were at this interview as well, and in the final play of "six degrees of Kevin Bacon," it turns out that Osman knew the Muslim guy from Elizabethtown. (I need to note, so that I don't come off as completely racist, that I only mention that the E-town guy was Muslim because Osman is, too, and there is a running joke in Louisville that all "brown people" know each other, since the community is so small. The funny thing was, it was true this time!) This interview was held on a Sunday, which was kind of nice for scheduling, but also pretty rare. After the interview, my mom and sister met me and we had dinner together. My mom had just gotten back from Belgium, where she and my dad live, and I hadn’t seen her since March, so the timing was great. Also, right before this round of interviews, I got a notice saying my wedding dress had been delivered to my apartment, and I wasn’t there, so I was pretty anxious to get home and see it.
Cost of interview: $358, combined with the Christiana and Sinai interviews.

Date: December 13, 2008
Program: University of Pennsylvania
Social Event: None
Breakfast: More pastries.
Lunch: A waiter-served banquet lunch at the Inn at Penn – fancy schmancy! We had a mixed green salad with balsamic vinaigrette that was the consistency of dense mousse instead of the consistency of a vinaigrette, and then a chicken breast of some sort with roasted potatoes and sautéed veggies.
Where I stayed: At Eric’s mom’s house in Exton. I arrived in Exton a little before dinner time, helped clean out the basement some, and we ordered Rocco’s pizza again. We eventually found the 1949 version of Little Women, with Elizabeth Taylor, on TV, and I was completely entranced. I need to rent that some time to finish watching it.
How I got there: I drove to Pennsylvania from Louisville since I was now on winter break and would be driving between PA, NJ, and MD over the next three weeks and wanted to have my car with me. It snowed through Ohio, West Virginia, and Pennsylvania. I brought Moxie and Mojo with me, and they eventually made their way to Eric's apartment in NJ, where they are now and where they will stay until we find a new place to live this summer.
Other notable events: I can’t really think of any…
Cost of interview: $49, for a Red Roof Inn in St. Clairsville, OH (near Wheeling, WV) where I stayed as I drove east. I hate making the drive between Louisville and the east coast by myself, and if I'm doing it myself, I try to break it up over a night. Red Roof Inn is my new favorite on-the-road motel chain, because they accept pets for no additional fee, and the newly renovated ones have very comfortable beds, large towels, and great shower water pressure. I highly recommend them for your next budget motel stay.

Date: December 17, 2008
Program: Lankenau, Pennsylvania
Social Event: A real, sit-down dinner at Yang Ming, a Chinese restaurant in Bryn Mawr. The restaurant claims to be both authentic Chinese and fusion Chinese, but I found it to be not very good of either. Nevertheless, the food was pretty good, and it was completely free. We ordered appetizers, soup, entrees, and dessert -- the only thing that wasn't covered was alcohol, but that was OK because the dinner was so generous, and I didn't want a cocktail anyway.
Breakfast: We sat through grand rounds before breakfast was served, but luckily I had coffee with me. Breakfast was bagels and pastries, the usual. I think there was fruit salad, too.
Lunch: Pasta and chicken and hot roast beef that was meant for making sandwiches with but that I ate as an entree. There was a salad that had cheese on it and one of the residents asked if I would mind identifying it as either goat or feta for her. It was goat. She apparently doesn't eat feta. Oh yeah, there were also really good rolls (I eat hardly any bread usually, but when there are good rolls at a restaurant I tend to go nuts) and chocolate-covered pretzels and cookies for dessert.
Where I stayed: At Marjorie's apartment.
How I got there: Drove from Eric's place in NJ.
Other notable events: I saw a girl who I had met at Einstein, way back on October 31. I gave her a ride to 30th Street Station after the interview, and she took my email address. I hope she emails me; she was really fun.
Cost of interview: $0

Date: December 18, 2008
Program: Thomas Jefferson
Social Event: Happy Hour at Dr. Watson's Pub, near Jefferson. It was really crowded, and at first I had a little bit of trouble figuring out who was a resident and who was an applicant, but it was OK. The only food was a crudite platter and a dish of buffalo wings and mozzarella sticks. The mozzarella sticks ran out quickly, and it's hard to eat wings while standing up and trying to hold a cocktail plate, so I mostly stayed hungry while I tried to socialize, while not drinking too much beer. A full 30 minutes before the scheduled end of the event, the people from the bar told us we needed to clear out for five minutes so they could set up for the live band that was coming in next. Instead of waiting, Ananda, who I had met at Washington Hospital Center, and I left and grabbed a slice of pizza in the gayborhood. (By the way, I just want to say that I think it's awesome that GoPhila.com has totally embraced the term "gayborhood.")
Breakfast: You know, bagles and pastries.
Lunch: Wraps and diet-only sodas. Grr.
Where I stayed: At Marjorie's apartment.
How I got there: SEPTA to Center City, then walked a few blocks to the hospital.
Other notable events: Jefferson did not validate our parking, and does not give free parking to its residents. Saw the aforementioned Ananda, from the Washington Hospital Center interview; saw Welles, who I met at UofL and who goes to Jefferson; saw a girl from Cincinnatti who I met at UofL; saw two girls from VCU, one of whom I had met at Maryland, and one of whom I had met at Christiana. The program gave us a Big Bus Tour of Philly after the interview, which was quite enjoyable. Granted, I've done that exact tour before, but I had nothing better to do for the afternoon, and it was fun to see all the historic stuff again. After the tour, I dropped off our Save the Dates at the post office!
Cost of interview: A couple bucks for SEPTA tokens and a few bucks for a pay lot downtown for the happy hour.

Date: December 19, 2008
Program: Pennsylvania Hospital
Social Event: Dinner at the hospital the night before the interview. More Italian food -- lasagna and eggplant parm and salad. Beer and wine and soda and water.
Breakfast: Pastries and yogurt.
Lunch: Hot food. I don't remember what the entree was, but I know I had rice and steamed veggies and the food was good.
Where I stayed: With Marjorie again.
How I got there: Since Pennsy validated my parking and the hospital is a little farther south of Market than Jefferson, making traveling by SEPTA just the tiniest bit more annoying, I drove to the interview.
Other notable events: A bunch of people from the Jefferson interview the day before were at Pennsy, including Welles, the guy from Jefferson, and the girl from VCU who I had met at UMD. Lisa, the girl from Penn State, was there, and so was my friend Jonah, unexpectedly. The hospital is cool because it is the "Nation's First Hospital," with the first surgical ampitheater, the first Ob/Gyn residency program, was home to the nation's first intern, and has the oldest medical library in the country. It has a wall containing plaques of the names of every intern who has ever trained there. For history dorks like me, it was a really fun tour. The evening of this interview, Marjorie and I drove up to Princeton to have dinner with our friend Chris from high school, and the next day we met up with our friend Karen, and the three of us went bridesmaid dress shopping, which was a huge success - both Marjorie and Karen found dresses!
Cost of interview: $0

That concluded the second part of my interview season: 7 interviews in 3 weeks, including two sets of three-in-a-row. EXHAUSTING. It was over these weeks that I complained to Eric the most about how tired I was of interviewing, and how much I couldn't stand the thought of doing two more interviews in January. I talked to numerous people about how much I didn't want to keep my January interviews and wondered if it would be legit to cancel them (it wasn't; they were legit from a geographic standpoint, and it would have been really unfair to Eric to cancel them just because I didn't want to go anymore).

Done with interviews!

I can’t believe it – I’m done with interviews! It is a huge relief and feels wonderful. I’ll share with you my synopsis of the last 3 months, leaving the information about the actual programs out, just so I don’t play all my cards yet. What I can share, however, is what the interview days were like from a mostly food perspective. That’s the most important part after all, right?

Date: October 16, 2008
Program: Jersey Shore Medical Center
Social event: None
Breakfast: A platter of pastries and plenty of coffee and tea
Lunch: Subs and Snapple – the subs were notable for being delicious, Jersey-Italian-style subs, with tons of oregano, oil and vinegar and thinly sliced deli meats. Often imitated (especially by the Penn Station Subs chains in Louisville), but nothing beats an authentic one. I also remember eating a really delicious brownie.
Where I stayed: With Eric in Ocean City, NJ
How I got there: US Air to Philly, rental car
Other notable events: I forgot to bring my EZ Pass on this trip, and was using a rental car, so I had to grab a handful of change from the Ocean City house in order to navigate the Garden State Parkway. It was here that I met Lisa, who goes to Penn State.
Cost of interview: $349, including $75 to rent a car from Cincinnati to Louisville because I misread my flight confirmation, missed my flight from Philadelphia back to Louisville, and flew standby to Cincy instead. Stupid mistake.
*Note: the reported cost of these interviews does not include eating during the trip, since I didn’t feel like keeping receipts from all the random airport places I got food from. It also, for the most part, doesn’t include SEPTA (Philly) or Metro (DC) tickets, and doesn’t include tolls.

Date: October 23, 2008
Program: Washington Hospital Center
Social event: I missed the pre-interview dinner because my sister, who was picking me up from BWI, and I completely missed each other at the airport. She was waiting inside at baggage claim, and I walked out to the sidewalk. She left her phone in her car, and I called her for 45 minutes straight frantically, wondering why she wasn’t answering. By the time she realized she didn’t have her phone, went back to the car and got it, found me, and we reached DC, I had missed the entire dinner. I was worried because it was the first one I had had, I had been told how important they were from my point of view, and how important they might be from the program’s point of view, but it all turned out OK.
Breakfast: Breakfast the next morning was bagels and fruit and coffee and juice.
Lunch: Lunch was amazing – salad, baked chicken breasts, roasted potatoes, and some amazing desserts. I definitely stuffed myself that day.
Where I stayed: I stayed with my sister in her College Park house for this interview, and slept on a couch in the basement curled hesitantly on a college house basement couch amid fears of spickets (officially called camel crickets, but we call them spider+cricket=spickets in our house) jumping on me in the middle of the night.
How I got there: Southwest to BWI; Metro from College Park to the hospital
Other notable events: After the interview, I took the metro back to College Park and realized, after taking Shuttle UM to the campus, that I had left my cell phone on the metro. It was an adventure getting it back, but miraculously, I got it back! At this interview I met Gayatri, who goes to Temple, and Ananda, who goes to University of Vermont.
Cost of interview: $213 plus minor cost of Metro card

Date: October 31, 2008
Program: Albert Einstein, Philadelphia
Social event: None
Breakfast: Breakfast was unmemorable, but probably coffee and pastries again.
Lunch: Lunch was pretty unremarkable as well – some sort of sandwiches, I presume. I remember eating something that I thought was prepared weirdly or badly… like chicken salad that needed seasoning or something like that.
Where I stayed: At my friend Marjorie’s apartment in Philadelphia. She gave me a copy of her key on long-term loan since I would be staying at her place so often over the ensuing months.
How I got there: Continental to Philly
Other notable events: I was in Philly on the day of the World Series parade, but unfortunately couldn’t really attend – as soon as I was done with the interview, it was time to make my way to the airport, and in all of the parade madness, I almost didn’t make it. At Einstein I met Beth, from Thomas Jefferson, and we discovered that we would be interviewing at Cooper together the following week.
Cost of interview: $235

Date: November 6, 2008
Program: University of Louisville
Social event: The interview dinner was held that night, for both my group and the next day’s group. Dinner was pasta catered from somewhere local, bottles of wine, and a cooler of beer and sodas held at a resident’s house. It was a fun event and a nice, casual vibe. Spouses and significant others were expressly invited, but since Eric was in NJ, he didn’t come.
Breakfast: None; this was an afternoon interview, starting at 11:30 am.
Lunch: Lunch was sandwiches, a large bowl of kettle-cooked chips, and cookies. The sodas were all of the diet variety, and the iced tea was Nestea, which I don’t like, so I had bottled water. I hate diet soda. Also of note, the lunch was sponsored by a local bank, and it was made very clear that the lunch was sponsored, which I found odd. Can’t the department afford to pay for lunch for its interviewees?
Where I stayed: My own apartment
How I got there: Walked.
Other notable events: Along those financial lines, parking for the day was not reimbursed, not that it mattered to me personally, since I just walked to school like I normally do. But still, I found it really annoying, and thought it was a poor reflection of the financial stability of the department. At this interview I met Welles, who also goes to Jefferson and knows Beth.
Cost of interview: $0

Date: November 7, 2008
Program: UMDNJ – Cooper University Hospital, Camden
Social event: The social event was held that same evening at Bahama Breeze at the Cherry Hill Mall. Eric joined us for the social (again, spouses and significant others had been specifically invited), where everyone got two drink tickets for beer or wine, and the servers brought out tons of orders of appetizers, including quesadillas, jerk chicken wings, coconut shrimp, flatbread pizzas, and spinach dip.
Breakfast: This was another afternoon interview.
Lunch: Lunch was lasagna, a chicken-and-broccoli pasta dish, and buffalo wings (a weird addition) with garlic breadsticks and salad. Notably, the plates were paper, which meant all the pasta sauce leaked through onto the tables, and there weren’t enough serving utensils for the food. Also, it’s difficult to eat buffalo wings neatly while wearing an interview suit.
Where I stayed: Early the morning of Nov. 7 I flew Continental to Philadelphia, was picked up at the airport by Eric, and we drove to the hotel I had Pricelined for the night before. He stayed at the hotel the night before just for fun since I had booked it, and I got there with just enough time before checkout to take a shower and get ready for the interview. At the last minute, we decided I would “accidentally miss” my flight that night and we would Priceline another hotel, which was a great decision.
How I got there: Continental to Philadelphia
Other notable events: The first hotel I Pricelined was a Hyatt Place, and it seemed pretty nice – the shower was good, anyway. The night of the interview, we Pricelined a Wingate by Wyndham, which was comparable to the Hyatt Place but with better toiletries. Of note, they provided robes in the bathroom, so we pretended we were in a luxury spa and wore robes all night. I had a little bit of trouble getting my flight rebooked for the next day, but in the end I did it without any fees. I saw my new friend Beth from Jefferson and Gayatri from Temple again, and met another girl who goes to Temple (we’ll refer to her as Temple #2 because I can’t remember her name). Gayatri and I ended up coordinating a switch of our Jefferson interviews in December, which worked out perfectly for both of us.
Cost of interview: $255

Date: November 14, 2008
Program: University of Maryland
Social event: Was held at Lucy’s Irish Pub in Baltimore. The pub food was pretty good, your standard wings, spinach dip, etc. In typical fashion, it was appetizers-only, even though it was in the middle of the dinner hour.
Breakfast: Breakfast the next morning was more pastries and coffee
Lunch: Lunch was sandwiches and cookies. I remember the desks we were eating at (old-school elementary school-type desks, where the desk portion swings up to let you get in and out of the chair) were slanted, so you couldn’t put your drink on the desk lest it slide toward you and spill. I also remember I stole an extra Coke for the road before leaving.
Where I stayed: For this interview, I stayed at my friend Paula’s house near Arundel Mills (she’s a resident at UMD), and we went out that night to celebrate her sister’s birthday with Chinese food and bowling.
How I got there: Southwest to BWI, rental car to the interview
Other notable events: This interview was on a Friday, and I flew into BWI on Thursday. On Wednesday I was on call on pediatric surgery and met a visiting fourth medical student from North Carolina who was rotating with the pediatric and adolescent gynecologist (which I’m going to do in February). We got to talking, and it turned out she was also interviewing at Maryland on Friday, and we were taking the same Southwest flight the next day! What a small world. We shared the experience of having our plane in Louisville develop mechanical problems, at which point the Southwest crew deplaned us and reboarded us on the next available plane extremely smoothly and easily. Have I mentioned yet that I love Southwest? At the pre-interview dinner, I saw Beth again unexpectedly – we interviewed together 3 Fridays in a row! I also saw Temple girl #2 at this interview.
Cost of interview: $364

Date: November 21, 2008
Program: UMDNJ – Robert Wood Johnson, New Brunswick
Social event: The pre-interview dinner was at an intern’s apartment, and they brought in lasagna and delicious gourmet pizza and Yellow Tail wine.
Breakfast: I had breakfast at the hotel (oatmeal, hardboiled egg, fresh orange juice, and coffee) just in case the interview breakfast wasn’t very good (I’m not a pastry person, really), and it was a good thing, because breakfast was scrambled eggs and pancakes. Definitely not what I want to be eating before an interview – the risk of ketchup and syrup getting all over me is just too big!
Lunch: Lunch was great – pasta, chicken, antipasta, and baked desserts. I definitely like north and central Jersey for the Italian-American cooking.
Where I stayed: I Pricelined a room at the Staybridge Suites, which is an extended-stay place, and it was really nice.
How I got there: US Air to Philly, rental car to New Brunswick
Other notable events: On the way back to Philly, I took a detour and picked up Hoagie Haven in Princeton. YUM. It’s been so long since I’ve had the pleasure of devouring a Hoagie Haven chicken parm, and they had avgolemono soup to boot. I met Eric and his mom in Exton and we ordered Rocco’s pizza and went to Quizzo in Phoenixville, where we got second place, which is a $50 gift certificate (we often get first place, which is $100 cash).
Cost of interview: $339

That was the first seven interviews, over the course of six weeks. One interview a week for six weeks (plus the extra thrown in on week 4) was very tiring. For my first interview, I was coming off of night float, and that was my first day back on a daytime schedule in a month, which made the interview pretty exhausting. For the rest of the interviews in October and November, I was on pediatric surgery and, in order to comply with my attendance requirements, would take call two days before an interview, stay up all night, then fly to the pre-interview event on my post-call day and try to sleep on the plane. It was quite exhausting. After Robert Wood Johnson, I got a week off for Thanksgiving, and Eric came to visit me in Louisville. After Thanksgiving, it started back up again, with even more intensity…

Stuck at Midway

So here I am, stuck at Midway with an estimated departure time of 5:45 pm, instead of 4:05 pm. But guess what -- I couldn't be happier! You see, I've spent the last couple of weeks dreading the interview I have tomorrow, for a variety of reasons, but unable to cancel it in good conscience. Yesterday, I was really about to cancel it, but I was worried about coming off as rude on the interview trail (the program coordinators talk to each other on a listserv!). On top of dreading the interview itself, it was going to be kind of a pain getting to the airport today, and getting to the pre-interview dinner tonight on time, so it was going to be an all-around annoying experience.

But when I woke up this morning and turned on my trusty Headline News, they warned me that flights in the mid-Atlantic region would probably be delayed today, so I was sort of expecting this. My flight out of Louisville was delayed about 30 minutes, also, which was good because it allowed me to leave the hospital once I was actually done for the day, and not have to cut out early, and it allowed me to grab something for lunch -- key! I napped the entire flight to Chicago, so now I'm refreshed and not cranky -- also key!

Now, I'm not getting to Philly until 9 pm, which is when the interview dinner will be ending, so I can get to my friend Marjorie's apartment without worrying about a time crunch and trying to still make it to the dinner. Sweet! I still have to interview tomorrow, but I'm not feeling so mentally exhausted and filled with dread about it.

Thursday I'm doing a second-look visit at my top choice program (no, I'm not going to tell you which one it is), and Friday is my last -- LAST!!!! -- interview. Even though I'm completely tired of interviewing, I don't mind the one on Friday, because it's at a really good program that I had given up on after not hearing from them all season. But over winter break, they emailed me and offered me a spot for Friday, and I took it. I must have been on some waiting list and a spot opened up.

So my interview season is almost over, and next comes a few weeks of anxiety before Match Day. But before that happens, it's time for My Traveling and Residency Interviewing Tips, which I have developed as I have become an expert traveler over the last 3 months.

My first interview was October 16, which was very early in the interview season, at a small community program in NJ. I have to give this disclaimer about my interviews: I had very little trustable guidance about programs in the mid-Atlantic region, simply because my advisors don't know those programs as well. And I wasn't sure what I was looking for in a program or what my plans for my future Ob/Gyn career might be (fellowship or not, academia or not). So I identified my geographical region of interest, and applied to every. single. program. in that area, for a total of 31. I was really convinced I wasn't going to get any interviews at good programs, so I scheduled all the interviews I was offered at these tiny community programs as early as possible. So starting October 16, I went on one interview a week for 6 weeks straight. In week 3, I interviewed two days in a row. And every single one of those interviews required a plane trip east. After a week off for Thanksgiving, I interviewed three days straight on Dec. 5, 6, and 7, had another on Dec. 13, and had my most recent three on Dec. 17, 18, and 19, for a total of 16 interviews. Whew! (In case you're wondering, I got 12 other interview offers and either declined them right away or canceled them later on, was rejected by 2 programs, and never heard from one random, weird program.) So here is the routine I developed:

Figure out how to pack everything in carry-ons only. First of all, if you're just flying into and out of town for an interview, you don't want to run the risk of your suit possibly getting lost. Second of all, have you seen the new checked baggage fees on non-Southwest flights?? So I bought a really nice carry-on sized rolling suitcase with a suiter compartment (we needed one anyway; our old luggage was falling apart), and I bought a really nice new suit (I needed one anyway), and started a little collection of travel-sized toiletries. I will say that it's key that I use Bare Minerals makeup, because if I had to pack liquid foundation, the whole process would have been a disaster -- I fill my one quart-sized zip-top bag to the very breaking point! Find non-liquid versions of other essential toiletries, too, like makeup remover wipes instead of a bottle of makeup remover. Need travel sizes of high-end styling products? Check your local salon or Sally's Beauty Supply, or if you're really really lucky and know someone with a cosmetology license (like I do), tag along when they go to a licensed-people-only salon supply store. If you need to, get a small empty container and fill it up from your full-sized product container. If you happen to use products from The Body Shop, go into your nearest store, act like you've never tried the product you love before, and ask for a sample to take home -- they'll gladly give you one.

Wear shoes that are easy to remove while traveling -- it really slows things down if you have to tie shoelaces at the security line. I wore a pair of ballet flats usually, and they were dressy enough to wear to dressy-casual pre-interview dinners.

Are you an overpacker like I am? Quit that bad habit right now. Bring shoes that are multi-functional and lightweight, like flats. I wore my ballet flats (did I mention they're purple?) and packed my interview heels, and that was it, for the most part. Sometimes, like today, I wore my Danskos, because they're better for yucky weather. Decide what you're going to wear ahead of time, and pack only that. There will be no unexpected clothing needs on an interview trip, I promise. All you need is something dressy casual to wear to the pre-interview dinner, which can be what you wear to travel, your interview suit, and possibly a third outfit to wear on the plane ride home. Extra underwear and pantyhose, though, are always a good idea and they don't take up much room, so definitely pack extra. To pack shoes in a way that doesn't involve plastic bags (it works, but for some reason I don't like it as much), put each one in a shower cap to cover the dirty soles, and then you can put them anywhere in your suitcase. I actually swiped a bunch of bouffant hair caps from the OR instead, but same difference.

If you're still an overpacker like I am, make your second carry-on bag one that does double duty as your interview bag. I bought a huge laptop/work bag at Target to stuff the rest of my crap in and stash under the seat in front of me, and then bring it along to the interview to complete my put-together business person look (anyone who knows me knows I am not that person at all!).

Bring a snack and a water bottle. Forget overpriced airport water bottles -- bring along an empty bottle (you'll have to take it out of your bag to go through security) and fill it up at the airport water fountain. I've drank Louisville, Chicago, Philadelphia, and Baltimore airport water and I'm still alive, so I'm sure you'll be fine, too. Snacks like Clif or Luna bars are there if you need them, and can be a lifesaver.

Pack a breakfast. Instant oatmeal in a zip-top bag works really well. Most interviews feed you breakfast, but it might not be right away, and it might not be what you like to eat, so it's better to show up with some food in your stomach. But no matter where you're staying the night before, you'll be able to find some hot water and a spoon and a receptacle of some sort to make instant oatmeal in. Likewise, packing a couple teabags along can work really well in your favor.

If you're traveling on Southwest, check in 24 hours ahead of your flight to get a good boarding number. When you get to the airport, make sure you have nothing in your pockets -- at the very least, take all that loose change out of your pants pocket and shove it in your jacket pocket before you put your jacket on the security belt -- and have your boarding pass and ID ready. Check to see if your airport has instated the different speed lines at security. At the Louisville airport, there is an "expert traveler" lane, a "casual traveler" lane, and a "family and liquids" lane. The casual traveler line is always really long, and there is never ANYONE in the expert traveler line, even though they go to the same place! So I use the expert traveler line, get right to the front, and because after 2 interview trips I WAS an expert traveler, I can speed right through security. Keep your bag of liquids easily accessible and be ready to take your laptop out of your bag. Work quickly but efficiently and leave those clueless people in the dust!

My No. 1 recommendation is to bring a pillow with you. I have a comfy pillow I made a while ago as a throw pillow that is the perfect size for traveling. The scheduling parameters I had to work under to schedule my interviews and not miss too much school required me to travel on post-call days very often. So I'd go to work on day 1, stay the night on call and get very little sleep, get out of work post-call sometime in the morning of day 2, go home and get 30 minutes to 2 hours of sleep, grab my suitcase, and go to the airport, get to the destination city and have to go to a pre-interview dinner, and then do the actual interview on day 3, fly back home and go back to work on day 4. It was a very exhausting process, so being able to sleep on the plane both ways was a lifesaver. With a comfy pillow, an airplane blanket, and a large pashmina that doubles as a scarf and blanket, you can sleep in total comfort on a plane, I promise. It probably helps that I'm only 5'1" and can scrunch very comfortably into very small spaces, but still, you can do it, too. And if you're lucky and the flight isn't very full, you might end up in a row all to yourself, in which case you can lift up all the armrests, put on an eye mask, and lie down for glorious, wonderful sleep. I sometimes get weird looks when traveling with the pillow, and one time a guy in my row asked me to explain myself, but I don't care that I'm a 27-year-old woman carrying around a pretty striped pillow like an 8-year-old -- I sleep in comfort on planes, so there!

Keep your suitcase 90% packed at all times. In between trips, I would hang my suit up, take out my toothbrush, hairbrush, and makeup bag, and leave everything else in the suitcase. I washed my shirts and undergarments as needed, but made sure to have extras that I left in the suitcase at all times. That way when it was time for the next trip a week later, I simply threw my daily necessities and suit back into the suitcase and left. No wondering if I had packed toothpaste or deodorant or underwear -- the travel versions of everything stayed in their zip-top bag, and there were always extra clean undergarments pre-packed.

Bring your box of thank you cards along with you, and a book of stamps, and you can write your thank you notes after each interview while sitting in the airport. Believe me, once you're home, you won't have any desire to write them, so just get it done in the airport.

Make sure you sign up for all the frequent traveler accounts for all the companies you do business with! Booking so many flights with Southwest for interviews earned me a free roundtrip flight, which we're using for our honeymoon in June. I signed up to be eligible for quick service at the car rental companies I used repeatedly, so I could go straight to the front of the line. This applies to non-travel as well, but make sure you're using a credit card with a rewards program of some sort. Points, cash back, or miles, it's your choice, but make sure you're getting something back in return for all the credit card usage you're giving them!

And, as always, shop around. The residency program may give you a list of local hotels that offer "discount" rates for their applicants, but the discounts probably aren't that great and there's no real reason you have to stay where they suggest. Check Sidestep.com and don't be afraid to Priceline something else. For things like car rentals, check to see if you qualify for any group discounts based on memberships you already have. For instance, if you're a member of AMA or AMSA, they offer discounts when booking with certain car companies.

So those are my recommendations for being a pseudo-business traveler without the expense account of a real business traveler. And after 13 weeks of nearly constant travel, I finally understand why business travelers hate traveling. I never used to get it -- I loved flying, loved the excitement of traveling because it meant I was going somewhere fun, and the minor hassles happened so infrequently that they were truly minor hassles. But now? Now I know. So after this Saturday, when I fly from Philadelphia back to Louisville, I will not be flying anywhere for quite some time. Thank goodness. But in case you need to, I hope my travel tips have helped. I still have 45 minutes before my plane takes off -- this is the longest layover I've had all year, but like I said, I'm kind of enjoying it!

After these last two interviews, I'll share a little more about the programs I interviewed at and what I might be thinking as I get ready to submit my rank list. It's definitely exciting times!