I'm starting feel like life is getting back to normal. However, I still have mail and magazines stacked around the house. And my diet and exercise routine aren't up to snuff. After all, it's not like things are "back to normal".
I started a new job on Monday. My plastic surgery rotation is going to be interesting, but I don't get to do anything since these are patients paying cash for a celebrity plastic surgeon to work on them. And there isn't a whole lot of wound care going on, it's all cosmetic procedures.
I've seen four "Quicklift" facelifts over two days. Very interesting procedures and a very lucrative business model. Dr. K. has patented the procedure with a partner, so they get royalties from othe surgeons around the country and can exclude the run-of-the-mill surgeons from messing up the procedure's reputation. A local news host had the procedure done and was back on TV in two days. Can't get better marketing than that! Anyway, I have enjoyed talking with Dr. K., his surg tech, the anesthetists and the circulating nurses, all of whom have been great. And the results are fantastic. Heck, I might have to get one of these in 10 or 15 years!
If plastics wasn't so darn competitive I would probably put up with the long, difficult residency/fellowship and go for it. I can see myself doing these procedures easily. The cosmetic operations make the mint and the reconstructive stuff makes you feel good (or at least removes the guilt). Plus you're working with a great patients (healthy, cash pay and frequently already very attractive), being creative and owning your own business. Dr. K. advertises the "eyes of an artist" while employing 21 people (most part-time) and operating his own private, JHACO approved, surgical suite. No surprise here I'm sure, but he drives a nice Porsche as well. Not bad!
Becky and I went to Maricopa's pre-interview dinner on Monday night with a big group of current residents and fellow applicants. Dave Levin from my class was there as well. He's been rotating there for two months, so I was the one asking all the questions. Becky was a bit bored, but we had an ok time. The dinner was just mediocre.
The interview on Tuesday went well. I really like the Program Director, whom I met in Seattle at the ACEP Residency Fair. The tour went fine. It's a county ED, but not a bad as I feared. They will be building a new one well after I'm done with Residency, but the current one, curtains and all, will suffice. I was pleasantly surprised by how well the department is funded and how strong the leadership throughout the county system. I feel confident I could get a great education there. The regional (southwest USA) burn center is a unique factor I like. They teach EM residents how to do fasciotomies and skin grafts! Finally, we would save a ton of time and expense because we could stay in our current home. The commute is much more doable than I thought and many residents live further away than we do now.
Maricopa will definately be in my top five, likely in my top three. The big decision comes down to whether we want to put Hopkins #1. Becky and I have been talking a lot about that lately.
Today I mostly relaxed. I could have gone in for office visits of patients following up on surgeries. But understandably Dr. K. doesn't want a student in the room when he's having potential patients baring their souls and skin as he makes his pitch. So I stayed home and finalized travel plans for the COMLEX PE test at the end of the month and my five remaining interviews, three in New England and two in Ohio. I still need to cancel MCG. But right now I'm torn between finishig Wired magazine or playing an Xbox 360 game...
Thursday, November 29, 2007
Friday, November 23, 2007
Finished Christiana and the audition rotations
Today was my last shift at Christiana. It was a little short since I took off at 1pm to get errands done before I fly out tomorrow. One memorable case was a guy with a "surgical belly" from, we believe, his second bowel perforation. He had the first repaired last month, but it didn't have nearly as much free air, free fecal matter or perotinitis. These are happening because mets from his stage IV lung cancer are eating holes through his intestines. And he's a young guy.
Over the last week I've had several good cases at Christiana. Good traumas, some acute injuries and some interesting work-ups. Yesterday in Wilmington we had a homeless lady with Pyoderma Gangrenosum. She was a sad case that used alcohol and crack to self medicate on the street. The bandages we took off were at least two weeks old. They were black and the smell of rotting flesh lingered around the ED for hours after she was admitted. The ulcers were easily the worst I've ever seen. Her breasts, back and left hip were craters. If she would try to take care of herself and stay on her medications it wouldn't have gotten nearly this bad.
On Tuesday I had my Christiana interview. It went better than I expected. I really liked the answers to my questions. There's some great new changes like a $5M sim lab and one-on-one teaching rounds. And the EM department is very strong with the hospital organization. I really enjoyed meeting the Assistant Program Director as well. Right now, it feels like it will come down to whether we want a 4-year program with fellowship (i.e. Hopkins) or 3-year program that really takes care of its residents (i.e. Christiana).
Hopefully Becky and I can come back in January for a second look at the programs and areas (homes, schools, job opps for her).
Now though I have to pack. I'm getting up at 2:30am to turn in my rental and catch a shuttle to the Baltimore airport. My flight leaves at 7am and gets me into Phoenix around 2pm. Then we have a late Thanksgiving meal with Tucker and his family at our house. It's going to be a long, tiring day tomorrow.
Luckily I've managed to get 8-9 hours of sleep the last couple of nights. I'm starting to feel like myself again. If I had to use one word to describe the week it would be exhaustion. The lack of days off, numerous interviews, stress of setting up interviews and getting rejections all caught up to me. I've also done a terrible job of keeping shape.
I'm going to have to spend some serious hours in the pool and on the bike to shed a few pounds and get back into shape upon returning to Phoenix. But on the plus side, I'm halfway through my interviews!
Time to pack and try to get a little sleep.
Over the last week I've had several good cases at Christiana. Good traumas, some acute injuries and some interesting work-ups. Yesterday in Wilmington we had a homeless lady with Pyoderma Gangrenosum. She was a sad case that used alcohol and crack to self medicate on the street. The bandages we took off were at least two weeks old. They were black and the smell of rotting flesh lingered around the ED for hours after she was admitted. The ulcers were easily the worst I've ever seen. Her breasts, back and left hip were craters. If she would try to take care of herself and stay on her medications it wouldn't have gotten nearly this bad.
On Tuesday I had my Christiana interview. It went better than I expected. I really liked the answers to my questions. There's some great new changes like a $5M sim lab and one-on-one teaching rounds. And the EM department is very strong with the hospital organization. I really enjoyed meeting the Assistant Program Director as well. Right now, it feels like it will come down to whether we want a 4-year program with fellowship (i.e. Hopkins) or 3-year program that really takes care of its residents (i.e. Christiana).
Hopefully Becky and I can come back in January for a second look at the programs and areas (homes, schools, job opps for her).
Now though I have to pack. I'm getting up at 2:30am to turn in my rental and catch a shuttle to the Baltimore airport. My flight leaves at 7am and gets me into Phoenix around 2pm. Then we have a late Thanksgiving meal with Tucker and his family at our house. It's going to be a long, tiring day tomorrow.
Luckily I've managed to get 8-9 hours of sleep the last couple of nights. I'm starting to feel like myself again. If I had to use one word to describe the week it would be exhaustion. The lack of days off, numerous interviews, stress of setting up interviews and getting rejections all caught up to me. I've also done a terrible job of keeping shape.
I'm going to have to spend some serious hours in the pool and on the bike to shed a few pounds and get back into shape upon returning to Phoenix. But on the plus side, I'm halfway through my interviews!
Time to pack and try to get a little sleep.
Friday, November 16, 2007
Tough week with four interviews!
The Drexel interview went well last week. I'm still trying to schedule a second look at their CCU where they complete about seven months of training. It's a solid program with good people in downtown Philadelphia.
Over the weekend I had a couple really good shifts at Christiana. I finally got to see some of the trauma and procedures that I knew could be found here. I saw two motor vehicle deaths and was allowed to listen to one of the Attendings talk with the family. It was a good learning opportunity and I am glad I sat through it. Tough to explain to the adult children how family members died unexpectedly, but it's something that Emergency Physicians have to be able to do.
Then I had most of the week off to complete three interviews. I only worked on Thursday at the secondary hospital in Wilmington. It's a more urban location and patient population. I had a good time there as well. I also got a chance to talk ask one of the residents a lot of questions about Christiana. I'm looking forward to my interview on Tuesday so I can ask the leadership some questions.
Monday I drove to upstate New Jersey and had dinner with the Morristown residents. They were incredibly nice. During the interview, I got the feeling that it's a small residency with very nice people that has a family feel. You get lots of face time with Attendings. The residents and attendings are very close. Morristown is also a nice area for families. For trauma you go to Newark, NJ to see penetrating trauma.
Wednesday I interviewed at Cooper in lower New Jersey. It also impressed me more than I expected but for different reasons. The Program Director is very impressive and I like their unique track system where you use your RRC required scholarly project to concentrate on an area of interest that you can list on your CV. The trauma and pathology is more acute for the patient volume than most places. Camden, NJ is a very poor area with lots violent crime. It would also give us the option of living near Philadelphia so Becky's job opportunities would be great.
Friday, today, was the most surprising of all. But first, I had to get to Baltimore. I got off work in Wilmington at 4pm last night. The resident dinner was at 6:30pm. I thought that would be plenty of time to drive down about 65 miles with a quick stop at my hotel room to change out of scrubs and grab a bite to eat. Well, the Wilmington traffic was horrible. It took me over an hour to get 7 miles from the hospital to my hotel room! So I spent an hour chilling out and hoping rush hour traffic would die down a bit. After all, I was going into Baltimore so it should be against traffic. However, construction on the main freeway, I-95, turned a 57-mile drive into a three and half hour parking lot. I kept thinking it would speed up once we passed some fatality accident. But they just kept reducing lanes after miles and miles of more stop than go traffic. Six lanes reduced to one for no apparent reason! They didn't seem to be doing any work on the road at all!
I arrived at the hotel, Mt. Washington Conference Center, at 10pm. The bar where I was supposed to meet the residents was the closest place to get food so I walked thinking I was going to foot the bill for a very late dinner. After inquiring though, four residents were still there. All the other applicants had already headed home. We talked for two hours over a couple glasses of Guiness, which greatly helped me recover from the drive down. The appetizers filled me up at well. I got six and a half hours of good sleep.
Hopkins itself is incredible. Their are three cranes there right now building the largest hospital expansion in history. A two billion(!) dollar expansion including a new ED. However, it won't be ready until early 2011 according to the latest estimates. I really liked the residents, including the three D.O.'s there now. No overblown egos, just lots of nice friendly people, many of whom are world renowned for writing our textbooks are publishing prominent studies. The Mt. Washington offices are opulent and were effective at demonstrating how well funded the Emergency Department is. Friday is conference day at Hopkins, and the training seemed very good. Then we took a tour of the city even though most of the applicants knew the city as well as our guides. It's a nice place of about 650,000 that would offer a reasonable cost of living with lots of opportunities for Becky. The Hopkins ED was fairly plain, but seemed more than adequate for a place to get good training. And finally the interviews were, like everywhere else, low key and a friendly Q & A session with equal time for both parties to ask questions.
I left really impressed. They are now a four year program, so the decision really comes down to whether that fourth year will pay for itself either financially or in new opportunities. I think it would, especially with the Hopkins name backing it up. And they have 12 tracks to choose from, which I don't think could be offered at any other institution. Education, administration and ultrasound are the most interesting to me right now. In the end, I would put Hopkins at the top of my list of places I've interviewed so far. My top four will probably end up being UConn, UMass, Christiana and Hopkins but I have no idea what order they will ranked. Cooper and Maricopa may also make it in there.
Lots to think about. It's been a very stressful week nailing down four of the five interviews while I'm here in the MidAtlantic region. Plus I nailed down St. Vincent's and Case Western/Cleveland Clinic in January and Maricopa in two weeks back in Phoenix. I also got a number of rejections. The only one that is really disappointing is OHSU. MUSC was equally surprising, but not nearly as disappointing. Financially my current schedule will be much more doable with only two more trips. The amazing thing is that the numbers are working exactly like I was shooting for. Five interviews while I'm here at Christiana and ten total. I actually have eleven if I don't cancel MCG, plus I'm still on the waiting list at three programs and there's five or six I haven't heard from yet. But I'm pretty satisfied.
My Tuesday interview is just me for three half hour sessions with the Christiana leadership. I'm a little nervous about that one since it will be just me with no warm and fuzzy introduction to the program over lunch. At least I have one of my two days off this month the day before it. What a month!!
Over the weekend I had a couple really good shifts at Christiana. I finally got to see some of the trauma and procedures that I knew could be found here. I saw two motor vehicle deaths and was allowed to listen to one of the Attendings talk with the family. It was a good learning opportunity and I am glad I sat through it. Tough to explain to the adult children how family members died unexpectedly, but it's something that Emergency Physicians have to be able to do.
Then I had most of the week off to complete three interviews. I only worked on Thursday at the secondary hospital in Wilmington. It's a more urban location and patient population. I had a good time there as well. I also got a chance to talk ask one of the residents a lot of questions about Christiana. I'm looking forward to my interview on Tuesday so I can ask the leadership some questions.
Monday I drove to upstate New Jersey and had dinner with the Morristown residents. They were incredibly nice. During the interview, I got the feeling that it's a small residency with very nice people that has a family feel. You get lots of face time with Attendings. The residents and attendings are very close. Morristown is also a nice area for families. For trauma you go to Newark, NJ to see penetrating trauma.
Wednesday I interviewed at Cooper in lower New Jersey. It also impressed me more than I expected but for different reasons. The Program Director is very impressive and I like their unique track system where you use your RRC required scholarly project to concentrate on an area of interest that you can list on your CV. The trauma and pathology is more acute for the patient volume than most places. Camden, NJ is a very poor area with lots violent crime. It would also give us the option of living near Philadelphia so Becky's job opportunities would be great.
Friday, today, was the most surprising of all. But first, I had to get to Baltimore. I got off work in Wilmington at 4pm last night. The resident dinner was at 6:30pm. I thought that would be plenty of time to drive down about 65 miles with a quick stop at my hotel room to change out of scrubs and grab a bite to eat. Well, the Wilmington traffic was horrible. It took me over an hour to get 7 miles from the hospital to my hotel room! So I spent an hour chilling out and hoping rush hour traffic would die down a bit. After all, I was going into Baltimore so it should be against traffic. However, construction on the main freeway, I-95, turned a 57-mile drive into a three and half hour parking lot. I kept thinking it would speed up once we passed some fatality accident. But they just kept reducing lanes after miles and miles of more stop than go traffic. Six lanes reduced to one for no apparent reason! They didn't seem to be doing any work on the road at all!
I arrived at the hotel, Mt. Washington Conference Center, at 10pm. The bar where I was supposed to meet the residents was the closest place to get food so I walked thinking I was going to foot the bill for a very late dinner. After inquiring though, four residents were still there. All the other applicants had already headed home. We talked for two hours over a couple glasses of Guiness, which greatly helped me recover from the drive down. The appetizers filled me up at well. I got six and a half hours of good sleep.
Hopkins itself is incredible. Their are three cranes there right now building the largest hospital expansion in history. A two billion(!) dollar expansion including a new ED. However, it won't be ready until early 2011 according to the latest estimates. I really liked the residents, including the three D.O.'s there now. No overblown egos, just lots of nice friendly people, many of whom are world renowned for writing our textbooks are publishing prominent studies. The Mt. Washington offices are opulent and were effective at demonstrating how well funded the Emergency Department is. Friday is conference day at Hopkins, and the training seemed very good. Then we took a tour of the city even though most of the applicants knew the city as well as our guides. It's a nice place of about 650,000 that would offer a reasonable cost of living with lots of opportunities for Becky. The Hopkins ED was fairly plain, but seemed more than adequate for a place to get good training. And finally the interviews were, like everywhere else, low key and a friendly Q & A session with equal time for both parties to ask questions.
I left really impressed. They are now a four year program, so the decision really comes down to whether that fourth year will pay for itself either financially or in new opportunities. I think it would, especially with the Hopkins name backing it up. And they have 12 tracks to choose from, which I don't think could be offered at any other institution. Education, administration and ultrasound are the most interesting to me right now. In the end, I would put Hopkins at the top of my list of places I've interviewed so far. My top four will probably end up being UConn, UMass, Christiana and Hopkins but I have no idea what order they will ranked. Cooper and Maricopa may also make it in there.
Lots to think about. It's been a very stressful week nailing down four of the five interviews while I'm here in the MidAtlantic region. Plus I nailed down St. Vincent's and Case Western/Cleveland Clinic in January and Maricopa in two weeks back in Phoenix. I also got a number of rejections. The only one that is really disappointing is OHSU. MUSC was equally surprising, but not nearly as disappointing. Financially my current schedule will be much more doable with only two more trips. The amazing thing is that the numbers are working exactly like I was shooting for. Five interviews while I'm here at Christiana and ten total. I actually have eleven if I don't cancel MCG, plus I'm still on the waiting list at three programs and there's five or six I haven't heard from yet. But I'm pretty satisfied.
My Tuesday interview is just me for three half hour sessions with the Christiana leadership. I'm a little nervous about that one since it will be just me with no warm and fuzzy introduction to the program over lunch. At least I have one of my two days off this month the day before it. What a month!!
Monday, November 05, 2007
First Interview: tomorrow at Drexel
The first week at Christiana was good. Nothing about the program swept me off my feet, but everything has this unspoken confidence of doing things right. A resident would get a good education here, but the program has also shown me that I could get a good education at many programs. The only question mark in my mind is how they handle their volume with only two trauma bays. Their older design reminds me of UConn except I think UConn had four with two pairs back-to-back.
The attendings and residents have all been good to work with. I think I have been doing a good job based on the limited feedback offered thus far. I need to remember to ask for feedback directly at the end of each shift. Yesterday I had a chance to work with the Program Director. Since I had never met him I didn't even know who he was until a resident pointed him out. That was annoying. But it went well otherwise. His parting comments included mentioning that 80% of their interview invitations go out today. So I've pretty anxious all day.
I finally just started phoning up programs to ask what the status of my residency interview applications was. The only one I got through to anyone was Christiana. The Program Director wants to get some feedback from my attendings and residents before deciding whether to give me an interview. Not what I had hoped, but if I continue doing a good job I believe I'll get an interview while I'm here.
Dean's Letters went out on November 1st, last Thursday. I expected a rush of interview invitations and even rejections by now. But nothing until an hour or so ago when I received an invitation from Cooper in New Jersey. That's number seven. They are an inner city program across the river from Philadelphia, where I'd most likely live. Not a ton of volume, but lots of trauma and serious illness. I'm trying to get that scheduled while I'm here as well. However, the ones I really want to fit in, UMaryland and Hopkins, haven't responded yet :(.
Tonight I'm driving to Philadelphia for an informal social with Drexel residents. The interview is tomorrow at 11am. I'm trying to prepare my questions, review the program information online, etc. but it's been difficult with the anxiety of waiting to hear from all the other programs I applied to. Well, time to stop procrastinating with this blog and go back through all my first year research. I'm certain to get asked questions on it.
The attendings and residents have all been good to work with. I think I have been doing a good job based on the limited feedback offered thus far. I need to remember to ask for feedback directly at the end of each shift. Yesterday I had a chance to work with the Program Director. Since I had never met him I didn't even know who he was until a resident pointed him out. That was annoying. But it went well otherwise. His parting comments included mentioning that 80% of their interview invitations go out today. So I've pretty anxious all day.
I finally just started phoning up programs to ask what the status of my residency interview applications was. The only one I got through to anyone was Christiana. The Program Director wants to get some feedback from my attendings and residents before deciding whether to give me an interview. Not what I had hoped, but if I continue doing a good job I believe I'll get an interview while I'm here.
Dean's Letters went out on November 1st, last Thursday. I expected a rush of interview invitations and even rejections by now. But nothing until an hour or so ago when I received an invitation from Cooper in New Jersey. That's number seven. They are an inner city program across the river from Philadelphia, where I'd most likely live. Not a ton of volume, but lots of trauma and serious illness. I'm trying to get that scheduled while I'm here as well. However, the ones I really want to fit in, UMaryland and Hopkins, haven't responded yet :(.
Tonight I'm driving to Philadelphia for an informal social with Drexel residents. The interview is tomorrow at 11am. I'm trying to prepare my questions, review the program information online, etc. but it's been difficult with the anxiety of waiting to hear from all the other programs I applied to. Well, time to stop procrastinating with this blog and go back through all my first year research. I'm certain to get asked questions on it.
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