July 1 – The Start of Something Wonderful

Some in medicine look upon July 1 with fear and trepidation, worrying about patient safety & the need for increased vigilance, but most can remember their own first day on the wards, of the wonder and excitement that permeated every place, every person, every step. Though more seasoned practitioners may fret, surely those starting out are more anxious, hoping for the best but fearing the worst, wondering when an attending or program director will say “You! We made a mistake, you’re not supposed to be here!” As a now PGY-5 in my second year of training to become a neonatologist, I’ve had many mentors and role models, and I’ve thrice had the privilege of working with new medical students and interns, trying to impart some of the knowledge and experience I’ve gained.

Although July 1 is the magical date, many residents start in June and I just had the good fortune to guide a new pediatrics intern in our NICU stepdown unit. The enthusiasm and desire to learn that she brought to work each day was contagious and I found myself equally excited, striving to teach her as much as I possibly could in this, her first week of residency. After going off-service, I emailed her some feedback and she replied “Thank you again for making my first week as an intern seriously the best I could have imagined!” I say this not to brag or to boast, but to emphasize the impact that we in academic medicine have upon our learners. I’m told that families remember the exact words that their doctors use, and I think the same applies to medical trainees.

It’s easy to become jaded and to wonder, “how can they not possibly know that?!” and to just “do it yourself” instead of helping more junior learners. But the director of my residency program kept a decoration on his desk that I think captures my sentiment and can serve as a guiding principle to all those in a position to mentor and guide. It said “those who can, do; those who can do more, teach.” It’s certainly more difficult, but the effort is rewarded many-fold.

And to those starting upon this wonderful journey, I’ll only paraphrase words that I hope you’ve already heard: Cherish this special time, and keep your sense of wonder and excitement, for time’s arrow flies in only one direction, and for goodness’ sake, have fun!

How to Protect Your Online Reputation

The Scope of the Problem

Given the recent events in the internet security world, I am pleading with you to secure your online identity. For those just joining the fray:

In the space of one hour, my entire digital life was destroyed. First my Google account was taken over, then deleted. Next my Twitter account was compromised, and used as a platform to broadcast racist and homophobic messages. And worst of all, my AppleID account was broken into, and my hackers used it to remotely erase all of the data on my iPhone, iPad, and MacBook.

I’m sure you’ve seen commercials like these regarding identity theft, and, funny as they are, they probably leave you slightly troubled… even if you think “that could never happen to me” (NB: I don’t have Citibank Identity Protect and do not endorse their particular product in any way).

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How to Apply for Neonatology Fellowships

Neonatal Intensive Care Unit

Neonatal Intensive Care Unit (Photo credit: Army Medicine)

I thought I would share my experience applying for neonatology fellowships. The process is generally more independent than its residency counterpart: there are now a handful of applicants (like 2-3, or in my case, one) instead of the 30+ who applied in Pediatrics from my medical school.

If you know a faculty member who recently went through the match (a key factor – two of my mentors obtained positions outside of the match before it was formally adopted by my program), then by all means use them! Residency and fellowship applications/interviews are similar and some of the same approaches worked, but it is definitely a different game.

Submit on time

Last year, ERAS opened December 1 and I was advised to have the application in by the end of January – I actually submitted on February 15 and ended up doing fine, but there was 1 program that I couldn’t interview at because of dates. The 16 others that I did were clearly not a problem ^_^

Obtain strong letters

As with the residency application, you should balance (a) seniority and (b) personality – aim to have letters from senior faculty who know you (easier said than done). Some programs also require a residency Program Director letter, and some encourage a letter from a PICU attending. This year (and probably next year too), the NICU uses its own letter of recommendation form, so you should give your letter writers (a) the LoR cover letter, (b) the NICU-specific form, (c) your CV and personal statement, and (d) plenty of time!

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You Know You’re a Resident When…

  • You knock before entering any room
  • You expect the lights to go on when entering any room
  • You kick a sink to turn it on
  • You are impervious to “do not enter” signs
  • You think a 60-hour-week is a fairly light
  • You go into acute renal failure OR starvation mode when at work
  • You wash your hands BEFORE you go to the bathroom

Green Vesper

Vesper Martini

Image via Wikipedia

Ever since watching Casino Royale a few years ago, I’ve become a fan of the Vesper martini (and is the sole reason I own a bottle of Lillet blanc). And I had my first taste of absinthe at Bar 89 (yes, the one with the cool bathrooms) around the same time, just after it became legal again in the US. Thus, you can imagine my delight to read the Wikipedia article describing a “green vesper” variant of that cocktail.

I’ve strayed a bit from the original recipe, using what spirits I have one hand, so forgive me a bit for using Tanqueray and  Svedka in place of the originals, with a half-measure of Pacifique absinthe.

What a punch! The refreshing herbal gin followed by an almost biting sting of anise made for an exhilirating libation, one that I will surely return to on a regular basis (alternating with various single malts, of course!).

The ED Graveyard Shift

Emergency Department of Edinburgh Royal Infirm...

Image via Wikipedia

So I just finished a 10hour overnight shift in the emergency department and it wasn’t as bad as I thought it would be. It was fairly quiet, slow but steady, and starting off, I did forget to ask a few of the questions I should have, although I saw patients in a reasonable amount of time.

Before going in, I was pretty nervous since I would be the only one there besides the attending to take care of anyone/anything that walked through the door,and as confident as I am on the inpatient unit or in the neonatal ICU, the ED and the primary care settings really get me nervous. It’s partly a matter of efficiency since the inpatients will be there for you to get to when you get to, whereas outpatient, you have to get the data you need and give the answers you’re supposed to give within a set period of time; you have to be comprehensive within that limited time frame.

For a detail-oriented person such as myself, although the patients, in general, are healthier in the outpatient setting than the inpatient setting, I get caught up in trying to ask ALL of the questions. I also tend to be a little too patient-centered and let them lead the discussion, instead of asking the questions I need to ask to have a working knowledge of the situation. Thus, I usually come away unsatisfied because I took forever and still missed things.

However, all in all, I did reasonably well, and have gained a little bit of confidence. Now just 2 more nights and then a brief respite for Thanksgiving!

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Personal Finances

Anderson Stuart Building, housing the Medical ...

Image via Wikipedia

As I have alluded to in previous posts, I have recently become interested in personal finance and investing. Cash flow is now net positive (as opposed to in medical school) and for the first time, I have the opportunity to spend earned money, rather than federal loan money.

Like the writer of Debt Sucks,if I publicize my financial situation and become accountable to the ether, I might have a greater impetus to eliminate my debt, so here goes…

My post-medical school debt is $86,800, fairly low, considering the national average is ~$158,000. I was fortunate in that my four-year BA from an Ivy League university was only about $12,000, thanks to very generous scholarships (need-based).However, life during medical school in Manhattan cost a bit more than was provided in those loans, so I entered residency is with ~$8500 worth of credit card consumer debt. A few months into residency, I got into a very minor car accident (at literally 10 mph) that ended up totaling my inexpensive compact, I ended up financing a new car, something that every personal finance book tells me not to do, but given that I needed a car ASAP, I had little choice.

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