Could be the end of Interview Season?

So I finished my last scheduled interview earlier this week. In total I had 6 interviews, and while I would like to at least have had 9 or 10, the fact of the matter is that you only need 1 nod and you are in your residency.  This last interview was a little more challenging as I was asked questions that I did not anticipate and therefor did not prepare. So I will talk a little bit about how I prepared for my interviews.

To begin with, I applied to as many places as I could have within a 1-1.5 hour driving radius as the boss (aka the wife) told me that we are not moving. Or at least, that is the DEFCON 1 option. So when I received the invitation I ensured that I was prepared.

I started off by going to the website of each institution and program. I spent at least 1 hour looking around the website. Looking at the community that they tend to serve,  seeing how many patients they see annually, looking to see if the hospital has a special niche. For example, is it a level 1 trauma center, does it have a cancer center, is it known for bone and joints, etc. Then I looked at the services that were offered to the community. What kind of resources were available? Then I looked at the residency program. I wanted to look for the curriculum. How long was each rotation, was there elective time and if so how much and where. Look to see where graduates of the programs went to, what type of specialty did they get and where. What kind of benefits are there, do they give you a stipend for books, meetings, conferences, if I was able to find out who I was interviewing with I did several searches to see if they had published any literature. And I read the papers when I could. And finally, I made sure that I thought about and wrote down at least 7-8 questions.

What I have found with this strategy is that the people that you interview with realize that you took the interview seriously. That you made the effort to research them and you care. I always say that if you do not have any questions, then you did not prepare enough because there is no way to know everything about the program.

So now, as in medicine, comes more waiting. The Osteopathic match is not until February 14th. So until then I have to wait. I need to sit down with all of the information I garnered from the interviews and I need to put together a ranking list for the match. In the meantime, I will be continuing to go on rotations. I will be happy to do something other than emergency medicine. I did some family medicine, I will be doing some internal medicine, infectious diseases, cardiology. I need to set up a surgical subspecialty and I may just do it in plastic surgery. I am so looking forward to being able to spend more time at home and relax before residency starts. I cannot wait,  just over 5 months to go.

Right now I am doing something I have not done in a long time. Read for entertainment.

The importance of "Me Time"

Hello there fellow non trads and a happy thanksgiving. This holiday marks a very important milestone in anyone who is in school. For the most part, it is the first real family holiday since Labor day or even 4th of july and people are going to want to talk to you and to see you and to find out how you are doing in school. Most of the time you are going to be telling the same story to multiple people. In addition, this marks the start of finals. It just seems as though time will get to warp speed once thanksgiving comes around and next thing you know, it is time for finals and then winter break. So if you have been putting off reading that chapter or writing that paper, get em done.

This brings me to my topic today. Now as non trads, especially those of us with families, our days are spent either at school or at home. And during that time we are either spending it with classmates and then when we get home, there are families that need our time. However, we tend to neglect a very important person. Ourselves. And surely, yours truly has and is very guilty of this as well.

The importance of having some me time is that you get to decompress. There is no one who is bothering you about going to the bathroom, being hungry, wanting to go home, buying a toy, talking shop, or having to deal with family issues. Rather you get to go to where you want to go, drink what you want to and let your mind settle down and enjoy some solitude. It is also important that you change where you have the me time as to not make it mundane. Little cafe's are wonderful. And if you can, try not to bring school work as this is NOT me time. Maybe, bring nothing and just listen to some music on your ipod, close your eyes and listen to the music at starbucks. Or even, bring a journal and write down your thoughts and feelings. You will find that you will not be resentful, and that you will actually be rejuvenated by the experience.

A question was asked about pattern recognition, let me explain.

When studying try to put things together in a pattern. In biology you know that A=T and G=C and that everytime you see a DNA sequence you will automatically know what the complementary sequence would be. In as much, when studying, you will recognize that when going from DNA to a protein, the pattern is always DNA to mRNA to tRNA to Protein. So if a question asks you about a defect where a protein is not made, you know that there will be something wrong in the pattern and you can recognize it. Same thing for chemistry, you know that the pattern for combustion is always "something + oxygen=carbon dioxide and water" it is always that. So if there is a question about why combustion has not occurred, or if the equation is not balancing you can know that the problem lies with one of the 4 elements of combustion. The same goes with medicine. If you know that if a person who has chest pain needs to be evaluated with an EKG,  blood pressure, pulse, oxygen saturation, chest x-ray, get a past history of the chest pain and their medical history and social history and if they are consistent with a cardiac problem, then you can recognize the pattern of treatment is nitroglycerine, morphine, aspirin, beta blocker (if not contraindicated), ACE-inhibitor, oxygen. And you know that the labs you are going to run are a Complete blood count, basic metabolic pattern, cardiac enzymes, arterial blood gas, etc. That is because you recognize the pattern of treatment. Eventually is becomes second nature but you must repeat, repeat, and repeat to know to recognize the pattern.

In the above example, if the patient with chest pain is a woman in their 40's and you find out that they just got off a plane from Australia, then the pattern points to a blood clot. On the other hand, if the patient is in their 40's and their father died at 51 from a heart attack and her uncle had his first heart attack at 48 and she has high cholesterol, the pattern points to cardiac.

I hope that this has answered the question about pattern recognition. If not, let me know and I will try to explain it better.

Now, off for some "me time"

With that in mind, I am off for some "me time".

Some Study Skills

Hello there fellow nontrads. I am officially done with my ICU rotation and starting on Tuesday I will be at my combined EM/FM rotation. Also next month I have 3 interviews making it a total of 6. And the countdown to match day has begun (February 14th).

So I decided to write about study skills since in the past I wrote about time management. Now as nontrads, many of us have not been in school for a while and have either lost the study skills we once had or never really had them to begin with. And usually that translates to poor performance on exams. Most of the time though, we have the information in our head but we are so nervous about the exam that we blank out. And I think that these ideas can help with all types of educations.

The secret is..................Repetition, Repetition, Repetition, Repetition, Repetition. The more times you read about it, the more it will sink in. Once you start with Repetition, the second secret is pattern recognition.

For example: When I would start a class, I would take notes and listen as well as I can. Of course, during that time I would miss some things because I was writing notes. But that was alright because I was recording the class, In the old days (1990's) I used a portable tape recorder. Then, on my way to work, I would pop the tape into the car and listen during my commute to/from work. Then at least I would hear what the teacher was saying. And because I was not writing anything, I did not miss anything.  In addition, I would then transfer my notes from the presentation I wrote all over to a notebook in outline form. This forced me to read the notes several times as I was writing them. However, before I would start a new set of notes, I would read all of the notes that I had written up to that moment. As the semester went on, of course that took longer and longer to do. Then before the exam, at least 2 weeks before. I would put all of my notes together into a review sheet and study that.

So how would I not get distracted? Good question, I would listen to white noise.

In the past, I would listen to a recording of a thunderstorm. It was enough to break the silence and not let my mind wander. Now with my ipod, I downloaded the whitenoise app and there are plenty of white noises to use. Presently, I have been using an mp3 that my friend had told me about that helps with brain waves and what not. I noted it in a previous post.

To prepare for an exam though, I would hunt the internet for inline quizzes and exams. You need to play with keywords. And I was able to take practice tests to see where I was lacking.

I hope that this helps fellow non trads. You can do it. Just keep your eyes on the prize. As always, below are some books that I think would help. Until next time. And if I do not see you sooner: Happy Thanksgiving. Enjoy it, you deserve it.

Interviews have begun

Hello there fellow non Trads. I have been really tired to update my blog recently. You see, I have been on my Intensive Care Unit month and basically I am working 12 hours a day for 5 days. Then I have to come home and help out with the kiddies and the wifey. So as you can see, being a non trad with children and in medical school is not very easy. In fact, it is downright tiring. However, that is not to say that it is not rewarding.

One thing that I did find out is that I truly enjoy critical care medicine. It is so important when it comes to the Emergency room that they are almost one and the same. However, there is more to critical care than meets the eye. And since I have also applied to Internal Medicine residency programs, if I do match into IM rather than EM, I am going to do a fellowship in critical care/pulmonology. however, there lies the rub. What do I tell my wife? This is something that us non trads have to deal with that 99.999% of the other medical students do not. We have to talk to our spouses. Unlike EM and straight IM, being a critical care doctor will require 3 more years after residency for a fellowship. And that is going to be a hard sell to my wife.

Recently, my 2nd oldest has been having a hard time with her spelling. Mostly in part because neither myself nor my wife have been sitting with her to help her with her words. My fault, because after a long day in the ICU I just want to crash and my wife has the other kids that also need help, be fed, be changed, etc. This is another uniqueness with us non trads, especially those of us with kids that other medical students do not have to worry about. Not only do we have our school events, but our kids have theirs. There is back to school night, parent teacher conferences, plays, book fairs, play dates, you name it. Not to mention homework. So this has to be added to the scheduling process. For that we have "Central Command Calendar"

Basically, I went to Staples and I bought a laminated erasable calendar and white board markers. Then each person was assigned a color of marker. Now we have 2 months of activities that we can check. I write down my schedule so that everyone knows what time and where I will be. Also, I will know when the other events are. Everything has to be put on the calendar. Doctor's appointments, interviews, playdates, dinner dates, etc.  Now we have everything scheduled and it can easily be seen.

Time to take my eldest to Karate, be back soon non trads.  Here are some ideas for pre-meds.

As for pre-meds: let me know about questions and I will reply with them as soon as I can.

Passed the BOARDS!!!!!!!

Well, I received my board scores and I passed COMLEX II!!!!!!!!!!!!!!! What a relief that was. I do not have to take that exam again. And while it was not very very high, it was a respectable pass and even higher than my step I score.

What did I do? Well, first and foremost I ensured that I did practice questions. In total, I did 2,500 practice questions using question banks from COMBANK and COMQUEST. I also used the kaplan website, which my school gave us a subscription to (gave us, it was really added to out tuition). In addition I used a variety of books to study from including the kaplan set we received. The books included are listed below. Now all I have to do is wait for the PE score.

One of the hardest things was to keep on telling my 4 year old that I could not play candyland with her.  But I promised her that when I finished my test that I would play with her. And as a non trad, it is VERY important to keep your promises. Your family is your support and if you let them down, they will be hard pressed to support you in the future. So when I promise my wife that we are going to go out on a Saturday night, I find the babysitter and I we go. When I tell my daughter that I will play with her, I make sure that I do it.

I am now in the start of interview season for residency. Because my wife does not want to move unless we have no choice, I selected to give myself a 1-1.25 hour driving radius for which to apply for residency. So far, I have 4 interviews and with my board score back I am hoping to get several more.

Remember non trads, you can do it. You really need to be patient and you need to fulfill the promises you make.  Below are the books I used for boards review, including step 1.



   

Back in the ED

So I started back on rotations the other day and I am on nights right off the bat. My girls by now are used to Daddy leaving after they go to bed and coming home when they are up watching cartoons. They are great about being quiet enough for me to sleep in the morning. Although, by the time I wake up, the day is 1/2 over. Luckily this is not a common event.

Now that most of my exams are over, I can take the time that I have off and spend it with the family. We went to Ocean City, NJ last week and this week the girls went to the zoo with my in-laws. I, of course, was sleeping so I did not go. But we are looking forward to doing things as a family again. Now that the weather is nice, we can go pumpkin picking, carve the pumpkins, and enjoy walks around the neighborhood. One big question that many non traditionals with kids worry about is not being able to spend time with their kids and feel that maybe their kids will be upset. Well, let me tell you something that I did last week that will illustrate how far from the truth that is.

Last weekend, it was after my boards exams and I was watching my kids play out in the front yard. Since we live right near the public library, I know when it is open or closed. Well, at about 6pm, the parking lot was totally devoid of cars. So I finally told Michelle to get her bike and I will teach her to ride 2 wheels. Since there are no cars there, she does not have to worry about hitting any cars. After maybe 20 minutes, she got it and took to it like a duck to water. And every chance she gets she rides her bike. Now here is the best part, she comes running at me when I get home from the hospital and is yelling "Daddy, I was riding my bike on 2 wheels and it is great. Did you see me when you got home!!!!!!" she is in heaven.  Of course, I have 1 rule that is not allowed to be broken. No helmet, no bike.

Aviva on the other hand did not want to ride her bike. Although I will still insist she learn to ride on 2 wheels. Rather she wanted roller blades. The other day, it was her turn for the daddy and me outing. So without telling her, we went to Target. When we got there, I told her she can buy her roller blades and she was excited. But the best part came after we bought the blades. We sat down at the starbucks, her with a hot chocolate and me with a decaf and we chatted. There was no rush, and there was nothing else. MY attention to 100% hers and we talked about only what she wanted to.

As you see my fellow nontrads, there is no reason to think that your children will be may at you because you are in medical school and constantly studying. If you make the time, and believe me you CAN make the time and you SHOULD make the time, then they will love you for it. You cannot study 24/7, your brain needs a break.

A little plug, my best friend turned me on to a great CD to help with studying. I have used it every time I studied and I felt more focused and seemed to remember things a bit better. It is not an end all be all in that if you listen to this with your pathology book under your pillow that you will be acing your exams. You still need to put in the work, but this CD will help break the silence and not be distracting. I will continue to put material on the blog with items that I felt worked for me. Remember,  just because it worked for me does not mean it will work for you. (My disclaimer).

COMLEX is over

So I took my COMLEX CK on Friday. I started the exam at 9am and I finished at 5:30pm including all of the breaks. In the end I took my time, unlike the COMSAE and never finished before time was up. I always reviewed some of the questions that I worried about but unless there was a very good reason I refrained from changing my answer.  I will not know the results of any exam for 4-8 weeks. In the meantime, there is nothing else I can do but to relax for the next few days until I start my next rotation this coming Thursday. 

I also need to prepare for my upcoming interviews. I found out who I am interviewing for 2 of them, now I need to find out who I am interviewing for the last. Then research them and prepare my questions. I also have to go out and buy a new suit for these interviews. 

With only 7 months to go before graduation, I am so glad that this part of my life is coming to a close. Where I can finally practice medicine and my family can finally be financially stable. I was talking with father who is working his tail off,  as he always has. Hopefully my parents will move down to Cherry Hill soon so that we (my family, my brother's family, and my parents) can all be together more easily. My father has always wanted more for us and I am glad that he is happy. He has worked very hard and he sees his hard work paying for in both my brother and I. 

This weekend was also very nice because I fulfilled a couple of promises to my girls. My 4 year old, Rebecca has been asking and asking for me to play Candyland with her. And because I was studying it wrenched my heart out to tell her No. But, as promised, Saturday we played 3 games of Candyland. And she was in heaven. This is what I try to tell other parents who want to go to medical school. That at times you are going to have to say no to your kids but then you need to fulfill promises and do it with you entire heart. When I prepared the games, it was with my 3 eldest girls. I prepared a snack tray, got them milk and we played. They had a lot of fun beating me all 3 times. And that is worth it. Yesterday, I promised my wife to take a day trip and we did. We went to Ocean City NJ. It was a really nice place, and there was a bonus for me: The Corvette Show!!!!!!! At least 50 corvettes of all ages were on display. And while we did not play mini gold, we did go to the little amusement park there and I rode a couple of rides with my girls. In the end, it was a very lovely day. One of the best times was being able to take Aviva, my 9 year old on the bumper cars and all I did was step on the pedal. She did all of the driving. While I wanted to take Rebecca, I could not because she was too small. So I took her on the Carousel instead and we talked about the bunny she was riding and where she was going on that bunny and what the name of the bunny was. Michelle went on a "free fall" type of ride and while she was scared on the ride, she was excited enough to go again. I wish my had a camera to take pictures. I guess I will go on e-bay. 

 Again, Quality time over Quantity of time. that is what you need to remember while you are in school and you have small kids. They will not remember that you spent 6 days with them but that entire time all you were doing was watching television or folding clothes. But if you spend an afternoon with them playing a board game while you take a break from studying, THAT they will remember forever and THAT is what they will want to do with you. My 6 year old is already picking out the next board game. I will pick up another board game and we can go it again. 

It will be nice to be able to give them more as I move on in my career. It will take time, but we will be there. 

The day after and 1 more to go

So here I am, status post taking the COMLEX PE (physical exam). It was just like what I did at school and I am glad that I was able to practice with my friend for a couple of weeks. I was able to get just about everything I wanted to do in the given time. But there were a couple of notes that I could have written had I had more time. But there is nothing I can do now. So I am 50% done with my COMLEX II. Now the big one is coming on Friday.

I have been studying my head off. Doing >2000 questions. Hopefully it will yield at least a decent passing score. I need to remember a couple of things that I learned after taking on the COMSAE or the self assessment exam: #1. Take my time. There is no need to rush. I should adjust my speed to maximize my time and use all the time given to me. And this is very big. It will give me a chance to think and to you ensure that my answer makes the most sense. Of course there will be questions with conditions that I have never heard of, but those I will just try and move on. #2. I reviewed and prepared. The material is in my head, I just need to access it.

It will be nice to not have to study all of the time now. I mean of course I need to keep up with my reading for my rotations but at least COMLEX will be behind me and hopefully done with. That will leave me more time to spend with the family. We are hoping to have a nice family outing on Sunday and I promised Rebecca that I will play Candyland with her, and I will.

One of the hardest parts of going to medical school right now is not having enough time to spend with my girls. But they also know what I am doing this for and that it is almost done. Sure it would have been easier to do this right after college but I was young, Idid not do well during my first year of college and more importantly, there is NOTHING I can do about it. I cannot travel through time and fix it. It is done and that is that.

I am keeping my eyes on the prize which is match and then graduation. After that, I have some plans but I want to first think about the immediate future.

Test Day!!!!!

I am taking my first of 2 boards this afternoon. Today is the CS or clinical skills portion of the boards where I will be seeing standardized patients from 2:30pm-9:30pm.

then on friday is the CK, clinical knowledge or written portion. I have been studying my brains out and my practice session (1/2 of a real exam) was not stellar at all. It was a pass, but it is with a very small margin and I am totally freaking out. There are 6 areas that need work. And started working on them right away.

I just need to remember to calm down, calm down, calm down. I should take all of the time alloted to me as there is no extra points for finishing fast.

I guess I am very frightened that I will fail the exam and all of the hard work that I put in during these last 4 years will be in vain and I will be in a ton of debt. Last night I was hard pressed to get a good night's sleep. Nerves from both exams were not allowing my brain to get some rest.

I have done everything I could to prepare and I have to have faith in myself that I will succeed. Just like the MCAT, I cannot let this exam psych me out. It is a stepping stone to my career. I have the key, which is the knowledge in my head and now I need to open the door.

Thanks for listening.

COMLEX PE Eve

So at this time tomorrow I will be at the National NBOME clinical skills site taking my PE exam. Meaning that 1/2 of my exams will be over. I have been practicing with my friend for the last month and tonight I will practice a few more with my brother before calling it an evening and relaxing my brain and getting into the zone for tomorrow.

I have had many patient encounters before tomorrow. Not just in my rotations but my school had provided me with a great foundation for what I am about to experience. But still, an exam is an exam. Especially one that your future hangs on.

In less than a week, in fact in 4 days I will be taking the CK portion, the written portion. To date, I have done 1725 practice questions and my averages are around the range I want them to be. Part of the secret may just be to have the confidence in myself that I will pass the exam and that there will be questions on there that I will never know the answer. I am not sure if they are going to throw out those questions or they are designed to separate the men from the boys, so to speak. However, the hardest part of this whole month of studying was not the studying, but rather was to tell my girls "no" when they wanted to play.

Of course, one can say "I will have time to study later, but my children will never be this age again." And while that is true, you need to ask yourself "If I were working a 9-5 job, they would not even be asking me to play because I would be at work right now". Which is why I am a proponent of the quality time versus quantity of time. This weekend, I will certainly rest my brain before getting ready for my Emergency Medicine rotation that starts on Monday. In addition, I need to start preparing for my residency interviews that are coming up.

Hopefully once my board scores come in, I will get more interviews as program directors see that I have passed.

After the boards, the nerve wracking over where I will match will begin and once that comes and goes, then the fun will begin and relaxation can really start. Until of course indentured servitude of internship year starts. But hey, I will be doing what I have always wanted to do and that is be a doctor.

1 Week to Go

So I am here, 1 week before the written COMLEX and 4 days before the Physical Assessment Exam. I have been hitting the books hard. And I mean doing anywhere from 150-250 questions per day and focusing on my weak points.

I have also been successful in maintaining my promise to myself of not changing answers once I select them. Now I am moving on to ensuring that I think the question more thoroughly. So what does this mean? Well, this means that I do not answer the question until I have thought about the patient in the question and see whether or not the data that is supplied in the question makes sense. For example, if the question is going to ask about a diagnosis in a patient with chest pain and trouble breathing, but the pain is in a 23 year old girl who is on birth control pills, I want to make sure that she is not having a pulmonary embolism. So my question would be if she smokes. Well, if the question tells me that she does not smoke, it still does not rule out the potential for the problem. But if the question tells me that she recently had a viral infection, well now I am more than likely going to find out if she has any fluid around the heart rather than look for a blood clot in her lungs. But I still want to.

I have also found that I have gotten more out of reading the explanations rather than just reading the book. Which is why I plan on doing more and more questions until the last possible minutes. Which will be Thursday, mid day. I have also been going to bed early so that I can be well rested. I would also like to give props to my best friend, Ian, who introduced me to a set of musical sounds that has helped with my concentration and retention of information.

However, I still cannot wait for the exams to be over so that I can go back to some semblance of a normal life, get back to seeing patients, and hopefully get good score so that I can get more residency interviews in my first choice rather than my backup.

8 months and 8 days to go. But who is counting......

A couple of weeks to go

I cannot believe that there are only 2.5 weeks to go before I take my boards. I have been studying like a mad man and yet it never feels like it is enough. I know that I have the knowledge and the studying is helping me stir the brain and get the material out. However, I seem to have 1 issue that no amount of studying can help with.......

I have to STOP changing my answers!!!!!! For the love of G-D, my first instinct has been correct more often than not, yet I seem to second guess myself because I over think things when I review the questions. I even wrote a note on my note book: STOP CHANGING YOUR ANSWERS!!!!!!

Any way. That will happen from now on. I have been reviewing my practice tests and have been ensuring that I answer the questions correctly for the right reasons. I am sure that I will do fine. In the meantime, I have scheduled 3 residency interviews for October and I hope that once I get my board scores back and they are acceptable that I will receive more. I am limited by geography because we have planted roots in the South Jersey area and do not want to move. So I applied to programs that are about an hour away.

We are entering my favorite time of year. The Fall and the 'ber months (September, October, you get it) and I cannot wait for the weather to get cool and we can sleep with the windows open (I do anyway, except in the summer) and can smell the leaves on the ground and the nights come sooner. Then one of my favorite holidays will be upon us; Thanksgiving. This year it will be at my parents' house which is great because frankly, my wife and I are beat. From having my schedule and a new baby we are spent. And then for the first time in probably 2 years we are actually going to be home for Chanukah.

Things are progressing nicely. Although it would have been much much easier had I done it right the first time. Funny thing. In my last rotation, one of the Attending Doctors and I were in the same Dorm during freshman year in college. She on the 4th floor and I on the 2nd floor. So if I did things right the first time, then I would have been an Attending by now. However, I believe that things happen for a reason. I am sure that I have said it before but I will say it again. I was so unfocused when I was in college that had I been accepted to medical school I may have well failed and then I would be without recourse to be a doctor. Now that I am older, I am more focused, probably because I not only have matured but I have worked hard to get here and have even more to loose if I do fail. Funny thing is that many patients think that I am 26 years old. The last thing they believe is that I am 36, a husband, and father of 4.

This week was back to school for my kids. Even little Amy is going to the babysitter. Here is a picture of them on the first day.

1 month until boards

In less than 1 month I will be taking my COMLEX Physical Examination and in 1 month I will be sitting for my COMLEX written examination. The nerves are starting to get ramped up. Although I was told that this was going to be easier than step 1. I am hoping that this is true, but I will be studying my tail off anyway.

This is my last week of my Emergency Medicine rotation for this month. Next month I have off so that I can study for boards. I intend to study for 10-14 hours per day and I need to complete about 2000 questions so that I can feel more confident than I am now. It will be hard with the girls but then again they are going to be in school, sort of. It is weird that the day after the first day of school, my kids have off because of Rosh Hashana. But it is what it is. Having the kids at home and having Emily being overwhelmed is certainly hard for me to handle. I am trying to make everyone happy but it is very hard. Emily is burned out from working and taking care of 4 kids and the house, the girls are having a hard time with me not being home and competing with a newborn for our attention, and Emily and I have not had any time to reconnect after the baby or even have dinner out. And while we both know that this is just temporary nothing ever makes it any easier. We just have to plug through it.

So far I have 2 residency interviews. I am hoping for several more as my options are somewhat limited to geography, however things should work out. I am a believer that things happen for a reason. Heck, I believe that if I went to medical school right after college, even to the Caribbean, I would have failed out. I was not as focused or goal oriented as I am today. Yes, I know I am writing a blog but that is not an everyday thing. But this is not to say that if I had my way I would have.

The other night, Emily and I were watching Hot Tub Time Machine. And no, it was not the best movie I have ever seen but it was a fun movie to watch and relax after a 12 hour shift in the emergency department. And if I could, I would go back to August of 1992 and start college over again with the knowledge of HOW to study, be focused, and concentrate on my studies rather than other things. But I can't do that. So there is no point on focusing on that. I do my best to never look back. My eyes are in the front of my head so I can see forward and that is where I am concentrating on.

Need to keep on spending as much time as I can with my family and to let them know that they are very important to me. I tell the girls that it is the QUALITY of the time I spend with them that is important and not the QUANTITY. I ask them where they want to go (as long as it is not Chuck E Cheeses, that gets an automatic VETO), and we go. We get a little snack and we talk. About anything THEY want. They get my 100% attention and to them, it is the greatest thing in the world. Now, if I can only get that done with my wife then things will be somewhat better. She is missing the dinners as a family. So, I discussed it with her and we can have family dinners while I study for boards. After that, it would depend on my shift. There is nothing that says that we MUST have a family DINNER. We can have a family breakfast or even a family brunch. Depending on my schedule, I think I will being back Daddy's Diner once boards are finished so that Sunday mornings can be something we do together.

Any way, just over 9 months until graduation, 10 months until I start residency, 1 month until boards. Amazing how counting down the years is now counting down the months. I cannot wait until I start with days then hours.

And so it continues

So I finished my first Emergency Medicine rotation and I am one week into me second one. This department is more of a community hospital so there is not a lot of trauma coming in. In addition, there are a lot of nursing homes in the area so a lot of what I am seeing is Geriatric and because of the Crisis and Detox unit I am seeing psychiatric emergencies as well. Certainly much different pathology than before.

I also started my Residency application by submitting my application to various Osteopathic programs. I am waiting to submit to the allopathic programs too. In the meantime I am studying for boards which I take towards the end of September. I am almost done with the first run through of the material and am hoping to start the second run through this week. I need to get through a lot of questions, my goal is more than 2000 questions by the time boards comes along.

Have 4 kids is certainly more a juggling act than it was before but we are getting into our groove. The only issue is that money is even tighter than before and I am waiting for the financial aid office to increase my cost of living so that I can take out more in loans. However, we are getting some assistance from the state since the loans are not considered to be income and my wife is not making a king's ransom. The way I think about it is that I paid into the system for all of the years that I was working and now I am collecting what I am due. But in about a year from now all of that assistance will disappear because I will be working as a resident and we will no longer qualify for state assistance.

I cannot wait for the glorious day of graduation and then residency to start. Then we can start moving forward with our other plans. Including upgrading our house. Wow, for more than 10 years I have been studying for this moment and it is almost here. I have been in school for almost 30 years and I cannot wait to stop. Though I will never stop learning, I will never have to be a student again.

Back and Recharged.

So last night was redemption night. After 3 days off to recharge, so to speak with 3 very active kids and a baby, I worked last night in the ED.

Not only did I ensure that I was very proactive and wanting to show that I am a hard worker but I also wanted to gauge from the residents whether or not what the attending said had any merit. I have come to the conclusion that no. I do belong in the ED and I do work hard and I am very proactive.

Everyone asks me how I can do it with 4 children at home. And while I work very hard at medical school and try to spend time with everyone, I have to give all of the credit to my wonderful wife. She is like a single mother when I am either studying for boards or when I am on my rotation.

I try to spend time with everyone as much as possible. And I try to do it in a fun way and not feel that I am obligated, because I really want to spend time with my children since in the next blink the house will be empty, but I want them to feel that I WANT to be there. So the other day, when I was off I set up my laptop and had my photo program and my itunes open so that each girl can have a "photo shoot" with the music of their choice. Then we looked at all of the pictures together and put stories to them and even played music in the background to them. And while the whole thing took about an hour, they loved it and I will always cherish it.

You can spend all day with your children and if all you are doing is watching television or are on the computer, it will not matter because that is not quality time. I believe in quality and not quantity. Sure when I am done with school it will be a little more and when I finish residency it will be even more, but my girls will not stay 9, 6, and 4 until I am done. The above pictures are only 3 of the many we took during the "photo shoot".

3 weeks into my EM rotation

So it has been a couple of weeks since I started in the Emergency Room. During that time, I have had the pleasure of seeing all kinds of things. Of course, the complaint that I have seen the most is Abdominal Pain, which is what has always been the highest complaint in the ED.

I have also seen a couple of traumas. One was a man who was shot by his wife and the other was a little girl who was hit by a car. I learned a lot from those 2 situations. First of all, the main role that the emergency room has in those situations is to stabilize. The man who was shot, the most important thing to check is to ensure that his airway is stable, he can breath without any problems, and that his circulation is intact and is able to maintain a blood pressure. The whole thing took about 1 hour and he was completely stable and sent home with the bullets still in him. We do not take bullets out because it causes more problems than if you left them in.

The little girl had a broken leg and was transferred to a children's hospital.

Most of the other issues were medically related. I was able to drain a few infections and start numerous IVs. However, I did not do some other things such as central lines or arterial blood gasses.

I did learn several things so far. First and foremost, I need to be more confident. This is where I am lacking. I know my material and I do a decent job getting a good history, I just need to be more confident and with years of leadership experience, I should be able to do this more easily. However, this being my first EM rotation I think it just takes a little bit of time. Second, I need to realize that I am only to focus on the cause of the patient being here and if that is going to threaten their lives. If I happen to notice something else and it is not imminent they can follow up with their regular doctor.

Now after 3 days off and a recharge I am going back into the trenches tomorrow and show what I am really able to do. This rotation also exposed me to the inner city emergency room. Next week I start at the community hospital. Let's see what happens next.

Day 1 in the ER

So today was the first day of my 4th year rotations and also my first day of my first Audition Rotation in the Emergency Department. All I have to say is WOW!!!!! I love it. In a matter of 30 minutes, the ED went from having 1 patient to about 15-20. Today I saw Dental Pathology, Palpitations, musculoskeletal chest pain, high risk pregnancy with pelvic pain, sickle cell crisis, cellulitis. It took me a little bit to get my sea legs back after not seeing patients in about a month and a half while I was studying for boards. But I have to say, after each patient I was getting better and better. A couple of times I was nervous, I said I did not get meds and allergies when I actually did. Now that the butterflies are out of my stomach, tomorrow will be my time to shine.

Well, here I am

A little bit about me in this issue to give people some background about me.

I graduated from college in 1997 with a degree in biotechnology. this was the final degree I decided on as during my freshman year I had about 4 majors and they were all in the second semester. When I began college I was a gung-ho premed. I was in biology 101, math, english, the rest of the basic freshman classes except for chemistry because I did not want to bog myself down. I came from a high school where I was in the top 20% of the class (#81/312). I was also very good in the sciences, especially biology. So I was expecting to do really well in biology. However, there was something that I was not prepared for and it was going to come back and haunt me.

I was not prepared for how to manage my time, nor was I prepared to start doing poorly in my classes. I was used to be an A/B student and nothing lower. I would read and understand. Here I am in college and I am struggling. Not only that, but since I never attended a high school party and I was away from my parents or any authority figure I wanted people to know that I was fun to be with so I went out every weekend and got drunk. I would hand out in the campus center or my dorm room but I would not be able to focus. At the same time I was pledging so that took up my time as well. In the end, I did really poorly in my first semester including failing biology. This was my first F in my academic career ever, and I was especially devastated that it was in biology. So I convinced myself that I did not like school and that I would drop premed and try to do something else.

I went ahead and changed my declaration from biology to human ecology to environmental planning and design to Landscape Architecture. I retook my english and math and passed it and registered for Landscape Architecture classes for my sophmore year.

During the fall of my sophmore year, I had a running start. I did well in my exams and really liked what I was doing. I was convinced that this was my real calling. My roommate was a biotechnology major and I saw how he was struggling with organic and thought to myself, am I glad that I do not have to deal with that. This semester turned out better than my last 2 but I had straight C's. The worse part was that I was not accepted to the Landscape Architecture program and ran back to my apartment crying thinking that I should drop out of school.

It was then that an ambulance call came in and as an EMT, with time, I went to station and went on the call. I was back in my element and successfully treated the patient. It was then that I realized that medicine WAS my true calling and it was time I shaped up and got cracking. By this time, it was already the spring of my sophmore year and I immediately went to the Pre-med dean and had a meeting with him. After the meeting the first thing I did was to extend my graduate year by 1 and drop every single one of my classes and register for my pre-reqs. I also dropped every one of my EC's and began.

Over the next few years I took classes over the summer. I retook biology and got a B in it. But there would be a lot of problems. Ths issue was that I still did not know how I needed to study. I had tried many, many different things. The main issue was the I was able to explain things to my roommates but when it came to the exams, I would blank out.

I tried studying in silence, but my mind kept wandering. So I tried studying to Jazz, no good. Classical, no good. In the library, no good. I tried 20 minutes intense reading and 10 minutes off, nothing. Finally, at the end of my junior year I got it right. My girlfriend had a tape of a thunderstorm and I borrowed it. I went to the library and put it on. When I lifted my head for the first time, I was amazed that an hour and a half went by and I remembered everything that I read. It was at this session that I decided to outline the chapter. Finally, I found my niche. However there was something missing.

In the spring of 1996, I signed up for the MCAT. I was planning on taking it and felt that since I was taking organic chemistry and physics that I would already be studying for it, so why should I bother studying extra (I now know that this was very, very foolish but hey, I was young). My parents could not afford kaplan or TPR so they sent me to a small, no name prep course that was horrible. I would up getting a 24 (VR 9, PS 7, BS, 8 VR P).

At the time, I really had not idea what it meant to apply to medical school. It turns out my roommates' girlfriend's mother worked at a medical school and got me a meeting with dean of admissions who suggested I retake the MCAT. So I did and again, did not prepare. I did worse 20 (VR 6, PS 6, BS 8, WS S). I called the dean and she suggested I get a masters degree.

I wound up graduating and starting my life. I figured medical school was a distant memory, but maybe. I finally landed a job in a lab 1.5 years after graduation and it was here that the last peice of my studying puzzle was placed. I taped the lectures of the one class I went to. During my commute to/from work I would listen to the tapes. I would up remembering everything better and did very well on the tests and scored a B+.

Life went on and I got married and had my first kid. I would up getting a job at place where they pay 100% tuition reimbursement and my boss was asking if I would be going for a masters or a PhD. Since I could not find a part time PhD program I setteled for a masters program. I started going to school in 2001. In fact, my first day of class was supposed to be on 9/11. A year and a half later I was a sporting a 4.0 and during a trip to Tampa, Florida I told my wife that I really wanted to go to medical school and she said fine. However, we agreed that we would keep this between us.

I also learned how naive I was at the application process when I was in college in addition to how to properly prepare for the MCAT.

To date, I have a 3.4999 in graduate school with a missing grade due to my thesis, which I should be defending in March. I retook the MCAT in August of 2004 and scored a 22 (VR 7, PS 6, BS 9, VR R). I applied to 14 schools and was rejected by all. I restudied for the MCAT and scored a 29 (VR 9, PS 10, BS 10, WS Q). I reapplied to 9 schools, all DO and was accepted by 2, my top two choices.

Here I am, 3 years later and am about to start my 4th and final year of medical school. One little surprise though, our 4th daughter arrived almost 2 weeks ago. That has added the benefit of having less sleep that I did before but in a good way. Because I can bond with her while either giving her a bottle or changing her and waiting for the bottle to arrive. Either way, we get some Daddy:Amy time.

I hope you enjoy my blog and as I enter my final year of medical school and start the process of looking for a residency position I will write often. So don't be a stranger.

Doc.