Fall is in the air and you can smell the interviews

As most regular readers of this blog know, I submitted residency applications in September. I heard back from my first program a couple of weeks later inviting me to an interview. Michigan contacted me last week, and I got my third interview today. I think it's standard in emergency med to get most of your interview invites after November 1 when the dean's letter goes out. So, though I had moments of insecurity when others were getting more invitations, I feel like I'm par for the course and will get enough invitations to be able to make a good rank list.

I've been having an internal debate about whether or not to make my interview list public. I don't really know a good reason not to, but I feel like I shouldn't tip my hand yet. I'll do more blogging about individual programs as I visit them, but otherwise, I think I'll refrain from discussing the schools prior to meeting with them.

Anyway, my first interview is with Michigan, which is scheduled for Nov 13. As it is my current school, I have high hopes.

Update on dermatology

I've been on my dermatology rotation for about 2 weeks now, so I'm about due for an update. So far, the people I've been working with are fantastic -- all very nice and very smart. The only problem is that I've been bored with the actual medicine of dermatology. Lots and lots of moles being checked. Acne being treated. Lots of naked people. I'm learning a lot, but I think I'll stick with emergency.

Oh, oh. Big news.

Votes are in and Hugh Laurie barely edged Ben Carson as the person UofM med students would most like to have as their graduation speaker. So, we'll invite him and hope he says yes.

Done with anesthesiology

Finished my anesthesiology rotation this weekend. Now onto a month of dermatology clinic. Anesthesiology was good, though I got a bit bored with it towards the end. I practiced daily on my intubations, my arterial lines, and my IVs, all of which will be useful in the ED. I wasn't perfect at them, but I got better throughout the month. IVs are still a problem when they're on fat people or really old people or radiology attendings who are having surgery and keep telling me not to be nervous because he's an attending. Coolest thing I saw this month? I watched the anesthesiologist do a nerve block on a poor kid who had cut his hand off on a table saw. They were on the way to the OR to re-attach it.

A galaxy-rise of 400 billion suns

Maybe I just love Carl Sagan, but this auto-tuning video kind of touched me. Maybe I'm just a geek at heart.

Nominees for graduation speaker

Today we got an email listing possible graduation speakers and asking us to vote for who we want.

The list of candidates is Ben Carson, Francis Collins, Ezekiel Emmanuel, Paul Farmer, Hugh Laurie, Allen Lichter, Elizabeth Nabel. Bios below. Let's just say I'll be voting for the most entertaining of the possible speakers.

Ben Carson M.D. is a neurosurgeon and the Director of Pediatric Neurosurgery at Johns Hopkins Hospital. He was awarded the Presidential Medal of Freedom by President George W. Bush in 2008. Dr. Carson was born in Detroit and received his M.D. from the University of Michigan Medical School. At the age of 33, he became Johns Hopkins Hospital's professor and director of Pediatric Neurosurgery. He is the author of three best-selling books, and a video documentary and a television movie, both called Gifted Hands: The Ben Carson Story were released in 1992 and 2009, respectively.

Francis S. Collins M.D., Ph.D., is a physician-geneticist, noted for his landmark discoveries of disease genes and his leadership of the Human Genome Project (HGP). On July 8, 2009 President Barack Obama nominated him to the position of Director of the National Institutes of Health. He joined the University of Michigan faculty in 1984 and was a professor of Internal Medicine and Human Genetics. His notable work includes isolation of the genes responsible for cystic fibrosis, Huntington's disease, neurofibromatosis, multiple endocrine neoplasia type 1, and the M4 type of adult acute leukemia.

Ezekiel Emanuel M.D., Ph.D. is the Director of the Clinical Bioethics Department at the NIH. Currently, he is acting as Special Advisor for Health Policy to Peter Orszag, the Director of the Office of Management and Budget. He is a leading opponent of legalized euthanasia and a proponent of a Guaranteed Healthcare Access Plan. Emanuel graduated from Amherst College in 1979 and subsequently received his M.Sc. from the University of Oxford in Biochemistry. He received an M.D. Ph.D from Harvard University. He completed his residency at Beth Israel Hospital in internal medicine and fellowships in medicine and medical oncology at the Dana-Farber Cancer Institute.

Paul Farmer M.D., Ph.D., is an infectious disease physician and anthropologist, who earned his M.D. and Ph.D. from Harvard University in 1990. He is one of the founders of Partners in Health (PIH), an international health and social justice organization. He pioneered novel treatment strategies against HIV/AIDS and multidrug resistant-tuberculosis. His medical work is the subject of Tracy Kidder's book, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World.

Hugh Laurie is an English actor, comedian, writer and musician. He is best known for his his portrayal of Dr. Gregory House in Fox's television show, House. He has been won two Golden Globe Awards and has been nominated for several Emmy Awards for his performance on the show. Hugh Laurie's fictional television character briefly attended the University of Michigan Medical School for his medical training and met his future boss, Lisa Cuddy.

Allen S. Lichter, M.D. was dean of the University of Michigan Medical School from 1998 to 2006, when he stepped down to become
executive vice-president and chief executive officer of the American Society of Clinical Oncology (ASCO) in Washington, D.C., where he still is now. Dr. Lichter earned a bachelor’s degree (1968) and medical degree (1972) from the University of Michigan. He is internationally known for his research in the treatment of breast cancer. He was also responsible for shaping the modern curriculum of the medical school.

Elizabeth G. Nabel, M.D. is the Director of the National Heart, Lung, and Blood Institute (NHLBI) of the NIH. She received her M.D. from Cornell and completed her residency in internal medicine as well as a research fellowship in cardiovascular medicine at Brigham and Women Hospital. She joined the faculty at the University of Michigan in 1987 and became the Director of the Cardiovascular Research Center in 1992 and Director of the Division of Cardiology in 1997. While at U of M, she became known for her research in the fields of vascular biology and molecular cardiology and for her gene transfer studies of the cardiovascular system.

Who says there's no continuity of care in Emergency Medicine?

Today I gave anesthesia to someone I'd seen in the emergency room 3 months earlier. We recognized each other and caught up on old times.

Home stretch of anesthesia

I'm enjoying anesthesia, but I think I'm ready to move on. Most of the value I'm getting out of this is doing intubations, starting IVs, and other procedures. But I have to wait 2 or 3 hours during a case to get to work on the next one. Today also reminded me of why I didn't like surgery. I was on the anesthesia team with a couple of general surgeons who were doing the operating. They kept yelling at the scrub nurse and the circulating nurse, even berating one of them when something fell to the floor. The scrub nurse said, "I can't turn off gravity for you." Everybody was pissed and stomping around and slamming doors. Surgeons.

In anesthesia, I'll have an oral exam at the end of the week. My topic is about an obese patient with diabetes undergoing retinal surgery. I have to know all about possible anesthetic complications.

In other news, another facebook classmate let everyone know that he got his first interview request. Still nothing for me.

Time for insecurity

Two of my facebook friends have mentioned that they've received residency interview invitations already. I'm starting to feel a little insecure.

Anesthesia, day ... whatever

Apparently anesthesia is the most switched-into medical specialty. Today I worked with an anesthesiologist who had done 4 years of general surgery before turning to anesthesia. I've also worked with a number of anesthesiologists who've done some internal medicine training.

So far I've been enjoying the people more than anything else about this rotation. Everyone is extremely nice. I've been working with a new attending, Dr. K, from the UK these past couple of days who tells each resident that I work with what a great medical student I am. So, that's an ego boost. I'm also liking this rotation because I get to practice all the procedures I'll be doing in the ED. My IV rate on this service has been 100% on the first try (on my ED rotation it was more like 50%). I got to try an arterial line today, which I missed and the resident had to finish.

And I've been doing tons of intubations, which is putting a breathing tube down someone's trachea so that we can breathe for them while they're being operated upon. It's actually a tricky procedure. You start by sedating and paralyzing the patient so that they can't breathe on their own, giving you only a couple of minutes to do the procedure. Then you stick a curved metal blade in their mouth and mash the tongue down and lift the jaw (you're doing this standing at the patient's head). You lift the jaw toward the ceiling and you peek inside and see if you can see the trachea and vocal cords, which you can if the epiglottis is properly lifted out of the way and if the patient's not too fat, and if the tongue isn't flopping down, etc. Then you jam a tube through the trachea, being careful not to go into the esophagus which is right next door and being careful not to push the tube in too far and sealing off one of the lungs. You also have to be careful not to break any teeth.

Anyway, the cool thing about all of this is that you're the only one who can see what you're doing given that it's such a small space to work with. And you usually have 5 or 6 people watching you ready to push you out of the way if you're not getting it in time. I've been doing pretty well and have only been bumped out of the way 4 or 5 times. I'm batting about 60% on this. Today Dr. K let me do the intubation through the nose of someone whose lip was being operated on, which is even more difficult. And the patient was obese. I was able to get external pressure placed on the throat, call for the right forceps, and guide the tube from the nose into the throat and down into the trachea on the first shot. Pretty exciting.

Is this my welcome to middle age?

I visited my primary care doctor about 3 weeks ago for a checkup and it turns out that my blood pressure has remained mildly elevated despite me losing a little bit of weight and getting in better shape. So, I nutted up and agreed to start taking blood pressure medication. I also get frequent migraine headaches, so my doctor and I agreed to start on propranolol, a beta-blocker, which is a blood pressure medication as well as a migraine prophylaxis. However, since I've been taking it I've been more fatigued, depressed, and when I run I get a burning in my chest. I know all of these things are side-effects of beta-blockers. But my problem is, are these real adverse effects in me, or am I having these effects because I know how the medication works -- kind of like a reverse placebo effect?

Anyway, it's not helping much with the headaches, so I think I'm going to switch to verapamil, a calcium-channel blocker.

Looks like I'm making the right choice

University of Virginia has this website where you answer 130 questions about yourself and it tells you what medical residency you should go into. It's a little easy to direct it where you want it to go, but I took it and tried to stay objective. It said I would like emergency medicine the best. Here's my total list of results:

Rank - Specialty - Score
1 emergency med 46
2 dermatology 42
3 radiology 42
4 general surgery 41
5 obstetrics/gynecology 39
6 neurosurgery 38
7 pulmonology 38
8 gastroenterology 38
9 endocrinology 38
10 infectious disease 37
11 otolaryngology 37
12 orthopaedic surgery 37
13 thoracic surgery 37
14 urology 36
15 preventive med 36
16 physical med & rehabilitation 36
17 pediatrics 36
18 hematology 36
19 allergy & immunology 36
20 colon & rectal surgery 36
21 med oncology 36
22 cardiology 35
23 nuclear med 35
24 neurology 35
25 rheumatology 34
26 ophthalmology 34
27 occupational med 34
28 aerospace med 34
29 plastic surgery 34
30 psychiatry 34
31 general internal med 34
32 nephrology 34
33 radiation oncology 34
34 family practice 33
35 pathology 33
36 anesthesiology 32

Notice that my last ranked specialty was anesthesiology, which I'm doing right now. I do have to admit it's a little slow.

2nd day of anesthesia

It's been pretty fun so far. I'm running around from OR to OR tubing people and putting them off to sleep. There's only been 1 person I haven't been able to intubate yet -- she had a really floppy tongue. And I've seen some pretty cool surgeries that I haven't yet seen. I did mess up today when the resident told me to give the patient 5 mg of phenlyephrine and I gave 5 ml (which is actually 25 mg). She caught it though when the HR started climbing and was able to correct it. I felt terrible, but she was pretty cool with it. My name made it into the patient chart, though.

Residency application submitted

Well, I just this minute submitted my residency application. For some reason it's a little nerve-wracking. Like they're going to figure out I'm some sort of fraud. Next is really just the waiting game. I believe I'll start hearing back from schools regarding interviews some time in October with interviews to follow in the Nov/Dec timeframe.

First day of anesthesia

Well, vacation's over. I spent the month getting ready for residency application (being sent out tomorrow), working on the upstairs flooring, and playing lots of golf. Oh, and the Chelsea fair. Funny story: so, Jody and I went with the girls and our friends Lisa and Evan to the Chelsea fair. Along with dangerous rides, greasy food, and sketchy carnies, they also have those carnival games that you can play and usually win a tiny stuffed animal but be taunted by the giant one that no one ever seems to win. Well, Jody goaded me into trying to ring the bell with the giant hammer -- you know, like in the Archie comics. You hit the platform, and it shoots a little bullet up the wall and tries to ding the bell. Along the way the bullet passes little milestones that say things like "wow, you're a pussy" or "my grandmother hits harder than that". So, I stepped up whacked the shit out of the platform and my bullet inched up over "atta girl" and right solidly into "big boy" territory, maybe a little over halfway to ringing the bell. We got an inflatable big boy toy, and Evan recorded it all on his iphone for posterity. I'm sensing a new nickname in the works.

But anyway, vacation's over. I went in for my first day of anesthesiology. This will be my first course that is not reported on my transcript that goes out to the residency programs, so no pressure anymore. I got to intubate a woman prior to surgery today. Didn't break any teeth, so that was good. They asked me how much of the vocal cords I could see and did I get the tube up to the line. I dunno, I said, I just stuck the tube in the trachea.

Then, I got out at 12:30 PM. Good first day.

List of programs

Okay, here's the list of residency programs I'll potentially be applying to a week or so prior to the application being submitted.

• Alameda County Medical Center/Highland General Hospital Program, Oakland, CA
• University of California (Davis) Program, Sacramento, CA
• University of California (San Francisco) Program, San Francisco, CA
• University of Chicago Program, Chicago, IL
• Indiana University School of Medicine Program, Indianapolis, IN
• University of Kentucky Medical Center Program, Lexington, KY
• Maine Medical Center Program, Portland, ME
• Henry Ford Hospital Program, Detroit, MI
• University of Michigan Program, Ann Arbor, MI
• Mayo School of Graduate Medical Education, Rochester, MN
• Carolinas Medical Center Program, Charlotte, NC
• University of North Carolina Hospitals Program, Chapel Hill, NC
• Wake Forest University Baptist Medical Center Program, Winston-Salem, NC
• University of New Mexico Program, Albuquerque, NM
• SUNY Upstate Medical University Program, Syracuse, NY
• University of Rochester Program, Rochester, NY
• Oregon Health & Science University Program, Portland, OR
• Penn State University College of Medicine Program, Hershey, PA
• UPMC Medical Education Program, Pittsburgh, PA
• University of Tennessee College of Medicine at Chattanooga Program, Chattanooga, TN
• Vanderbilt University Program, Nashville, TN
• Medical College of Virginia/Virginia Commonwealth University Program, Richmond, VA
• University of Virginia Program, Charlottesville, VA
• The University of Wisconsin Emergency Medicine Program, Madison, WI

Step 2 scores in

I got my step 2 scores in today (the national certification test I took earlier this month). I passed, and I improved over my step 1 score, which I'm happy about. Today, I'll finish up my personal statement and put the finishing touches on my CV. All that will be left will be my letters of recommendation, and then I'll be able to submit my application.