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).

Continue reading “How to Protect Your Online Reputation”

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!

Continue reading “How to Apply for Neonatology Fellowships”

Green Vesper

Vesper Martini
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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...
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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 ...
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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.

The Cloud and Medicine


Image representing Dropbox as depicted in Crun...
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I recently finished an elective in pediatric infectious disease elective, and just prior, was gifted an iPad 2. Combined with a portable keyboard, it became one of the most useful tools in my medical arsenal. I was able to type notes and save them with Dropbox, increasing efficiency since I type more quickly (and more legibly) than I write, enhancing note taking during lectures, and allowing me to reference textbooks while discussing a patient.

Many of my colleagues made mock-fun of me, but as Bryan Vartabedian writes on 33charts, the future of medicine is in physicians embracing technology. Another resident on this elective with me does not, using an old Blackberry without any of my “essential” medical applications (such as Medscape), and even he became smitten with using Dropbox to synchronize our notes. As this is a relatively new field, I’ve made sure to attempt to be HIPAA-compliant by only using patient initials and bed numbers in my notes.

Combined with applications like Dragon Dictation (free!), I can see how the old-style dictation into a phone that someone subsequently transcribes and sends back to the hospital will become obsolete. DD is pretty accurate for “regular” speaking, but its attempts at medical-speak are pretty humorous. Radiologists routinely use real-time dictation systems, but I’m sure both of these approaches have a hefty cost associated with them. A relatively small initial investment of an iPad and some as-yet-unwritten medical dictation system could revolutionize things, especially considering all the other functions it can serve.

I love living in the future.

Transcribing dictation with a Dictaphone wax c...
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After Yoga

Two teen monks were playing long flutes in the...
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Just finished a vinyasa workout from Zyrka Landwijt, so relaxing

My body is grounded, my breathing is calm, my thoughts flow easily

Even as I type this, I can still feel a connection to the ages

Almost sleeping, but awake

Just calm and serene, but knowing that I will be up and about in a few minutes

Looking around the room, I have so much clutter, but my mind feels calm and clutter free at the moment

I wish I could stay like this forever

Nothing will stick to me, it bounces off, I can do anything

New Year’s Resolutions… in April

Two New Year's Resolutions postcards
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Today is day 103 =  3-1/2 months = week 15 of this year, and where are we with our previously-new resolutions? My list has been:

  • Study Japanese everyday
  • Go to gym ~3 times a week
  • Do weekly budget
  • Iron clothes
  • Take vitamins

I’ve certainly not studied Japanese everyday, not even close… despite what Khatzumoto has to say about it, I haven’t been able to consistently do it with my work schedule (although that shouldn’t be an excuse).

I’ve intermittently been to the gym, although also not 3 times a week as prescribed, again, secondary to work… but at $500/year, it’s not something I should be ignoring!

I have keep up to date with my budget, with an elaborate spreadsheet for tracking debt/assets and using Mint.com assiduously.

As far as ironing goes, I do want to look good for work (and play!) and so iron when necessary, but it’s fairly common to see a dozen shirts draped over a chair waiting for the touch of steam. I got a new Rowenta iron (yes, a German-made one) so I’ll try to keep on top of that better.

And vitamins, even though I set an alarm every night to remind me to take them, I just can’t bring myself to pop in the Centrum… and calcium… and vitamin B complex tabs. They’re easy and certainly help since I don’t get any sunlight, and they sit right on my table, but… I have no excuse.

I know it’s a joke to make fun of new year’s resolutions and how no one ever keeps them, but what if we did? Imagine how much healthier a population we’d have, eating well and exercising, not abusing substances, doing jobs we loved, in happy relationships, Getting Things Done, living in clean houses, taking time to play everyday…