What they don't tell you about survivng your clerkships

Walking into a new clerkship can be completely terrifying. What makes it more terrifying is the fear that is instilled in you before you walk in the door. Horror stories about how you will have to spend every waking hour running around doing work, seeing patients, getting coffee for your attendings, being demeaned by the residents and doctors, not knowing any of the answers, waking up at three AM to get to work and not getting home until 10pm at the earliest. Having no life outside of your clerkships. But I think the worst part of all of this is going into it thinking "and so goes the rest of my life." Because if you work that hard as a student you must be working that hard as a resident right? Well let me debunk some of the myths. Yes, the above can be your life for the remainder of your third year, fourth year, and possibly even your residency. But you don't have to let it. Because clerkships, and residency, really aren't as bad as you think they are going to be. In fact, for most people medical school gets MUCH better once the clinical years start. I still hated my life, just not nearly as much. You just have to know a few things. Here is what I learned going through my rotations to make life a bit easier: You can go to the bathroom. There is time to take a small break and run off to the rest room to relieve your poor bladder. I was convinced I was going to have to hold my tiny bladder forever, was getting ready to buy depends pull ups just in case, when I realized that no one would really miss me for the five minutes it takes to use the rest room. Of course there are some exceptions. You can't run off in the middle of a code to go potty, even if you are just standing on the side watching. Leaving the OR to potty is also a bad idea. But go before the next case starts. Leaving rounds to go to the bathroom is permissible but frowned upon. So try not to make a habit of it. Take a break for lunch. Really, as a medical student you are not so important that you need to work through your lunch break. There is always downtime to go get some food. It is ok to ask to go grab some lunch. Again, use your common sense. A code is not the appropriate time. Always bring snacks in case lunch should get delayed for some reason. Bring a book or study material. There is always down time. And you won't always have a computer during that down time. Do not show up at 4am (again, except maybe for surgery). There is no reason to be there that early. And on most rotations, except when on call, you will likely be out between 5-6pm. Afterwards, you can sit and watch tv for awhile. Or catch dinner with friends. Do not make medicine your entire life, or you will go crazy. Study while you are on the wards during down time and then take some evenings off. If there is an upper level on the team, do not let the intern boss you around. Interns have little power. I've had a couple of interns who felt it was in their job description to boss me around and tell me all the mistakes I made and make me feel as small as possible. They are douchebags. Your intern looks good when you look good. Yes, they should tell you when you are doing something wrong, but in a helpful, we all make mistakes kind of way. And they do get to assign you tasks, but they are not your boss. The upper level is. Do not let anyone make you feel inferior. Remember, everyone is there to learn, and we all learn a different way. Your main job as a medical student is to learn. Occasionally you will have to do scut work, we all did. But that is not your main job. And you don't need to make a huge show out of learning, but do make an effort to demonstrate your ability to learn. For instance, if you don't know something and the attending asks you to go read about it, the next day do bring up that you took the time to learn about it, and ask if you are understanding it correctly. Do not make a huge show of the twenty different articles you read about it. You don't have to be a gunner, but you do have to show interest and some initiative. It is okay to not know things. No one knows everything. If you don't know something, DO NOT lie about it. Never say you did something that you didn't do. Because it may come back to bite you. Remember that we all make stupid mistakes. On one of my clerkships I was evaluating a guy with stomach pain and completely forgot to do the physical exam. When asked about the exam I just said "wow, I am an idiot, I didn't do one, let me go do it and I'll come back and finish this presentation." It was no big deal. I got teased, but not ruthlessly beaten down by it. If someone is making a big show of how amazing they are at your expense, it means THEY feel insecure and need to take it out on you. Don't let them get to you. Just do your best. This is all about survival, get through it and move on to the next one. Some of the rotations you will LOVE. they will be super exciting, you'll look forward to going, you'll enjoy the work. Others are so boring you want to poke your eyes out. And sometimes the one you love is the one others hate. Who cares, it's about what you like. For the ones you don't like, put on your happy face and remember it is only a month (or eighth weeks tops). And let yourself enjoy things. I even enjoyed some of my surgery rotation, and I hate surgery. But when I liked something I went with it. I actually hated very little of my rotations. I was surprised by the ones I liked. Go home when someone tells you to. Just do it. Offer to help one last time, then if told to go home again, just go. Pay attention to the lifestyle of the residents, their stress level, the work load, and the hours. Because these are things that help you decide what you want to do with your life. You can absolutely love surgery but hate the lifestyle. So then pay attention to things you enjoy that have procedures, because there are other jobs that involve procedures that you may be able to do without the hectic life of a surgeon. I, for instance, hate procedures and am so excited to finish my off service months so I can go back to the comfort of psychiatry where the only thing I have to do is talk and listen. And give drugs. Ah, the life. Also, don't feel bad about what it is you like. I know I felt like if I went into psychiatry I would not be a real doctor and why go through all of medical school to just go into psychiatry, and so I decided to go into peds instead, andthank goodness I didn't get in because being a "real doctor" is totally over rated. I would have hated being a pediatrician! I LOVE psychiatry. And I don't care who doesn't. Because it is my life, not theirs. So do what you love. Last bit of advice. You are still a human being with things that cannot always be taken care of on your one sunday a week off. So sometimes you have to schedule an appointment of some kind into the afternoon. It is okay. Don't take everyday of the week off. But go see your doctor. Take your car in. I once left work early to pay a parking ticket. It was embarrassing to ask for the time to do it, but it couldn't wait any longer. I also would sometimes leave work early for therapy if I couldn't get a later appointment in the evening. It is ok to do every once in awhile. And that's all I can think of right now. I'm back to feeling like a medical student now that I'm on internal medicine again haha. Except when we round I don't have to go into every patient's room, and when we are done with my patients I can go back to work haha.

do you really think I have nothing better to do than go to mandatory sessions?

This one is for you, "anonymous!" because that last one really was also for you. You also gave me the inspiration for this latest blog. Something else I'd forgotten I hated about medical school: mandatory sessions and evaluations. It's like they didn't think I was doing anything with my time, so had to fill up any little bits of freetime with extra sessions. Why do they do this? To torture me. I know it is a plot against me. Seriously though, why do they make everything so freaking difficult? And none of it seems to even matter. At my school we used to have "communications" session, where we had a difficult topic and had to do an interview with a standardized patient to learn how to talk about these difficult issues. I actually kind of enjoyed these sessions, except for the fact that they were ALWAYS the same week as a test. No matter how many time we filled out evaluations BEGGING them to switch days that never changed. I'm not sure how many nasty evaluations I filled out "please schedule these sessions, which are very helpful to our medical education, when we don't have a test the next day so we can actually feel like we are learning and not dreading being there." But alas, no change. At least those sessions were worth my time. I learned something, most of the time. There was the odd time that the facilitator felt he needed to give really specific feedback. Never again will I ask for specific feedback. Seriously this guy wrote down EVERYTHING I said to the patient and then repeated it all to me and judged every sentence. Calm the fuck down dude, I want to go home. Other sessions you are literally sitting there wondering why anyone thinks any of this is important in any way. We had multiple sessions that were supposed to cover things that we don't really learn while in school. Like hospice care. Or medical billing. Or...nope those are the only two that were even remotely helpful. The others were just sessions where I sat there staring at the wall, wondering why I couldn't go home. Why? Because there might be a sign in sheet passed around, and if your name wasn't on it, there was hell to pay. How did people get through medical school before iPhones? Because without phone solitaire, facebook, and text messaging I would have died of boredom. Also it was nice to get the "get your ass to class there is a sign in sheet" message if you were running late and debating coming. "On my way!" haha. The worst, worst worst worst though are the small group sessions where your facilitator really feels the need to spend EVERY second of the allotted time. LET ME GO! I don't want to hear any more stories or tidbits of information. I want to go home and stare at the walls and hate my life in privacy. Thank you. Even in residency we have didactics/lectures, and sometimes you just want to strangle the facilitator so that he will shut up and stop speaking so you can go home. And that one person who keeps asking questions. "any last questions?" NO! Everyone shut the fuck up and start packing up, because once you get them started you know they won't stop! And while I can fall asleep in a large lecture hall, it's more difficult to get away with things when there are only four people in the room other than the speaker. They usually notice that shit. So some things haven't changed since medical school ended. One is my crazy ability to fall asleep at any lecture. Journal club? Why yes I do need a mid day nap. Grand rounds? I actually look forward to them as "naptime." Didactic? Fellow residents have to poke me and throw me gum to chew to keep me awake. Another thing that hasn't changed: my time being taken up by stupid ass "learning opportunities." that I'm sure someone out there finds helpful but I do not. And I will never ever get used to attendings that need to perseverate when I could be going home. Weekends are not time to be teaching! They are time to round and get the heck out of there. The end of the day? Stop talking I want to go home. I don't learn anything at those times. Please respect my need to get home. But nothing is as bad as medical school, that is for damned sure. I have very minimal complaints about residency, so stick with it friends. And go into psychiatry! That's the life :-) Good luck and good night everyone!

For those of you who read my blog, I love you!

Just wanted to say a quick hi to all those blog readers out there. All five of you haha. I also wanted you to know that I love the comments you leave on my blog and I'm hoping that thisblog helps some of you feel less alone out there in medical school. I absolutely hated it, but I made it through. I am enjoying my residency in psychiatry. I really hope that it is worth it for all of you out there struggling through the process of medical school. I hope that everyone enjoys their decision to go through medical school and become a doctor. I'm not even sure I'll continue to love it, but for now I'm enjoying it. I'm glad to be out of medical school and hope things will continue to go well. You'll all be okay. And contact me if you feel any need to! I'm here for all of you! It's going to be okay, and the adventures of residency are a fun story all in themselves. Good luck out there!

That awkward moment between graduating and starting residency when you have no clue what to tell people you do

So it is official, I got to graduate. I am an MD. I am a doctor. I cannot believe it. I was waiting for something bad to happen but for once it didn't. I was allowed to graduate! Now I am sitting in my new apartment in my new city waiting for residency to start and I can't believe I am a doctor. It definitely hasn't set in yet. I was sitting in the spa the other day, filling out a form before getting a well deserved massage, and I was asked for my "occupation." I didn't know what to put! For the past four years I have put student. But I'm a graduate now. Yet I don't consider myself a doctor quite yet. Mostly because I have no real training yet. I've got this MD and I don't know how to do anything with it. Or even what I'm supposed to do with it. I'm not really unemployed because I signed a work contract but I haven't started my job yet so I feel unemployed. I don't feel a like a doctor. I'm terrified if I tell people I am one they will start asking me questions that I can't answer. So I'm a doctor, what does that even mean at this point? Here I sit, relaxing because I don't start intern year for another week, wondering how I am going to survive. I pretty much haven't done anything for the past three months. How am I going to start working again all of a sudden? How am I going to ever convince myself that I am a doctor. When does that happen? I totally feel like Eliot Reid on Scrubs when she could never explain what it was that she did. And JD was like "you are a doctor." I odn't feel like one. And my mom loves to run around telling everyone that I'm a doctor. And for about a day I loved it too. Now I am not sure I deserve the title. Awkward.

Scrambling fucking sucks, but you get over it eventually

What a freaking year! I'm sorry to my faithful follower for not posting in awhile, hope anyone reading this is doing well. What has been going on in my world since I last updated my blog? I high passed my cardiology rotation, which was impressive considering I half assed the shit out of it. Word of advice: if you can pick who evaluates you, pick the people who think you are doing a good job. I wasted a shit ton of money on interviews thinking I wanted to be a pediatrician. I thought I got really good feedback and did pretty well. There were a couple of places I absolutely LOVED and really wanted to go to. There were a few places I had nightmares about being matched at. I was exhausted by the end of my season, but overall I felt pretty good about things. I still had this slight nagging suspicion that I might not match, but it was just one of those "you've sucked at everything else, so why wouldn't you suck at this too?" type feelings, nothing really concrete to support it. I even got a really great email from my number one choice, from one of the people who interviewed me saying she was so happy to have met me and really thinks I'd be a great fit for the program and that everyone really liked me and I was a delight and blah blah blah. So at that point I was getting pretty confident that I was going to get my top choice. I even started apartment hunting, just little things on craigslist and whatnot, just to see what the market was like. Boy did I jinx myself. DO NOT START LOOKING AT APARTMENTS UNTIL YOU MATCH. Because let me tell you, overconfidence is a silent killer of medical students. Here is how match week works, for those of you who are getting close to your fourth year. In February you put in your rank list. Then you sit there until the middle week in March, twiddling your thumbs and wondering where the fuck you are going to be spending the next 3+ years of your life, and rethinking every decision you've made, and questioning your judgement, and wondering why you are STILL in medical school and if you are ever going to get out of there alive, but really probably not doing much else with your time. Then, it is finally Match Week. Monday you get an email saying whether or not you matched. Friday, if you were lucky enough to have matched, you open your envelope and find out where you are going. You spend the rest of Match week feeling smug and complaining about how you don't know where you are going yet and it is just so exciting. Fuck you. Here is what happens when you don't match. First hand experience here ladies and gentlemen, you can't find better information than this. You get an email from the NRMP with a subject line that says "did I match?" and you get all excited and get butterflies in your stomach and then you go somewhere private to open it just in case and the first thing you see is "No. I'm sorry but you did not match." Similarly to opening that email that says you failed the boards, you read it at least five hundred times over and over again, not believing it, wondering why this is happening to you, and generally are in a state of complete shock. Then you realize you've got to go fix your life AGAIN. If you are an idiot like me, you're in the middle of a rotation (luckily just watching movies) so everyone knows that you didn't match. And by everyone I mean 14 people. Then all your excited friends start texting you to find out if you matched, and you get to start telling people that no, you did not. Then you burst into tears and call your mom because really life cannot be any worse. But then, you pull yourself together. Not because you are strong and amazing, but because you have no other fucking choice. Four years of medical school are about to go flush themselves down the toilet if you don't scramble into a spot. They created a new system for us, and let me tell you, it is actually kind of nice. You go upstairs and find all the other people that had to scramble (hey buddy, fancy meeting you here) and sit down with your speciality mentor and cry for a bit. Then you get this list of all the open programs that you can apply to. You send out your application and wait. Later that day the schools start calling you. Because they are freaking out too. Holy shit we have open spaces! We must fill them! You spend a day and a half doing phone and skype interviews and then on Wednesday morning you hope to GOD someone liked you enough to take you, or at least that they are desperate enough to take you. Wednesday you sit down with your computer and the first round draft begins. If you are lucky (like I was) you get an offer right away. Some get more than one option and can choose where they want to go. Some unlucky bastards don't get accepted anywhere and have to wait two hours to see if another offer comes in. Luckier people find out where they are going on Wednesday, go home and spread the good news, and pass out for the next day. Masochists like me decide to still go to Match Day brunch and try to be happy for others while secretly hating them just a little for the ease with which their lives pass. What else happens that week? On Monday I got many "you'll do great we love you" texts from friends. I also went to a brunch place and had the most awesome French Toast with cinnamon and caramel and deliciousness to drown my sorrows. I then went back to my house and refused to talk to anyone except the few schools that called me. But, I also made a very important decision. Fuck pediatrics. Maybe the reason I'd been freaking out so much for the past couple of months is that I didn't actually want to be a pediatrician. Maybe all my wonderful experiences in psychiatry, my love of difficult situations and talking to people, my fear of procedures and hatred of much of medicine, were really a sign that I wasn't supposed to go into the field I thought I was supposed to. Bright side! I changed professions before it was too late. All that debating about whether or not I should go into psych instead of peds was decided for me. Peds didn't want me. So try something else. So I re-applied to pediatric programs and applied to psych programs. And I only heard back from psych programs (well, one peds program but that was it). And psych sounded nice. Good schedule, nice people, lots of options. And you wonder why you spent thousands of dollars interviewing when you could have just scrambled in the first place (risky, don't do it) and you try to cheer yourself up. The rest of the week is spent reminding yourself that everything happens for a reason. Because it does, I'm likely to be happier in psych than I would have been in peds. This may have been a sign from God to change my course (why he couldn't have told me BEFORE is beyond me), and I'm really probably going to enjoy my new field more. That doesn't change the fact that you feel like you've been punched in the face so hard you are amazed nothing broke. It is the worst blow to your professional self esteem. And you wonder, what the FUCK did I do wrong at my interviews? Because although I heard many a "any program would be lucky to have you" at the end of the day not a single one wanted me. And that is a hard thing to get over, even if you are happy with where you end up and how things worked out. It may have all been for the best, but it is the WORST way to find what is for the best. Every action for the last four years has been re-thought and re-played and I wonder why I suck so damn much. They tell you that the scramble is completely anonymous, the only people that know are the Dean of Student Affairs, you, and the program you join. But that is a load of horseshit. Because people text all day on Monday "did you match? did you match?" and you have to make the choice: do I lie? Or do I just own up to it? Also, you've spent a lot of time talking to people about where you interviewed and where you liked, so come Match day, if you mention some place you've never talked about before, people figure it out. Also, if you change specialities like I did, people figure it out. But, you can fuck with people a little bit, which is always fun. I enjoyed seeing the expression of people's faces when I told them I was going into psych and they were like "wait, I thought you wanted peds" and I just walked away. Or the guy who when I told him where I was going said it was a nice place and I blurted out "I don't know, I've never been there." And he was like "except on your interview you mean." And I was like "nope, didn't go there. Didn't have an in person interview there. I've never been." I really wish I'd just left him to wonder, but I eventually told him where I was going. Match day, for those of us who scrambled, SUCKS. But it shows a nice level of maturity to go to it. And it is nice to see everyone else so happy. Even if you want to die a little inside. Screams of joy, some tears are not of joy, everyone excited to start their new lives. Not everyone is happy on match day, but it sure feels like it. So forever I'll be the girl who scrambled, just like I'm the girl who failed the boards. No one has to know, but I'll always know. I am happy to be going into psych and into the program I'm going into. It's going to be awesome. But I will likely never fully get over the hurt of not matching. I spiralled into a crazy depression, one I hadn't felt since failing the boards. It sucked. But I lived through it. And I'm moving on. Moral of the story: things suck sometimes, but you get past it and move on. New adventure, about to begin. This hell called medical school is almost over. To all of you getting ready to embark on your fourth year, good luck. I have no useful advice to anyone that I'm willing to share, because I don't want anyone to end up in my position and I feel like my advice would just put you in that position. So do what you think is right and be ready for whatever comes your way.

I'm pretty sure I'm being ball blocked

I'm very frustrated right now. With the man. The institution. What the hell is going on? I'm trying to create positive change on campus and I feel like I'm being blocked on all sides. Like there is some force that wants to silence me but not let me know I'm being silenced. I'm being put to a task with no ability to move forward, but they are trying to convince me that I'm an integral part of the team. I'm being humored. That's the word I'm looking for.
I understand that I'm loud and crass and tell it like it is. I complain about things and I'll point out the shit that is going on. Hence this blog right? But I'm also trying to help fix thing. Trying to help keep other medical students from going through the same shithole experience that I went through for the past four years. I want people to be better, I want this institution to improve and thrive. I want this to be a place we can all be proud of. But my methods aren't as PC as people would like them to be. So I get black listed.
There is something going down on campus that I should be involved in. I've been trying to create a mentoring program for TWO YEARS now, and no one has stepped up to help in any way. I've been met with resistance. And now here is a group of other students popping up, trying to take over my baby and do it their way, without letting me be part of it. It's a conspiracy I tell you, and I usually don't believe in conspiracy theories.
Well, if you don't want my help you aint gonna get it! Just tell me to my face and stop wasting my time, because I have other things I could be doing right now! Like catching up on old episodes of Friends. And going to the gym. And RELAXING. So what's the dealio?
Hmmm...
something sketchy is going on around these parts! And I won't rest until I get to the bottom of it. Actually that's not true. I'm just going to stop trying to help and let them figure it out for themselves. Don't want my help? Fine, you won't get it.

"Any residency program would be lucky to have you."

I never thought I'd hear such a complement on my interview trail, especially not at my home institution. Today was my sixth interview, the one I was least excited about. I am definitely done with this state, and feel like you have to have had really positive medical school experience to want to stay at your home institution for residency. That's right all, I'm a fourth year. And it is kicking ass, now that I'm in the middle of it. I haven't blogged in awhile, but lets just say that things haven't been getting much easier from all the rants I've posted so many time before. I had a horrible sub-I experience that left me feeling like the worst student in the history of medicine, and very close to dropping out of school. Yes I say that in almost every blog, but here I was, finally decided on peds, excited to get started,ready to prove myself, and instead proving that I'm just an idiot with no talent and no ability to be a doctor. The sub-internship is a difficult place to struggle. You feel like you should be good at something and when you aren't, you wonder about your career choice and the rest of your life. And when you are in a state with only one option for a pediatric residency, you don't realize that just because one program doesn't work for you doesn't mean you aren't going to find one that does.
I spent a good portion of the end of my third year and beginning of my fourth year thinking that residency was going to be this hellish experience that I was just going to have to get through and hope that real life practice was better. Considering I've spent the past three years hoping everything was going to get better it was kind of a depressing thought to resign myself to more years of horror in the hopes of things getting better. Luckily, I figured out that part of the problem with the program at my school was that it was just to big,and I didn't like big. I wanted to go back to small. So I started looking for smaller programs, and I've found some amazing programs to apply to.
during the interview process I've found that I could conceviably be happy in any of the schools I've interviewed at so far. Really, honestly, happy and enjoying residency. I've even found a program that I think is perfect for me, even if the location is less than ideal. Who knows though, maybe I'll love the town once I get there.
But what really surprised me throughout this experience is that I'm a really good residency candidate. Yes, me, failed boards, bad attitude, and inability to learn. Why? I'm not quite sure. Apparently all the other stuff I've done in medical school has turned out to really work in my benefit. Maybe I'm just applying to places that want something more than a boards score. Or maybe, just maybe, failing the boards and struggling through medical school has actually made me a stronger, more in tune with myself person. Maybe the fact that I have to explain over and over again why I failed the boards and what I learned from it is actually working to my benefit. And I'm finding that saying "failing the boards sucked, but was actually a blessing in disguise" isn't just some line I'm spouting, it really is true. I mean, I'd rather not have failed the boards, but what if I had just barely passed? Where would I be now? Still thinking I'm the dumbest, most unteachable person in the world? Because now I can see that maybe I'm not as smart as everyone else, but I'm sure not dumb, I just learn differently. Would I have learned that I learn differently if I had never been forced to face that fact? Interesting...
When I started picking school to apply to for my residency, I wanted school that wouldn't care quite as much about my failure as they did about the fact that I do have some things to contribute to a program. However, being a student allowed me an interview at a top ranked program. A wonderful, courtesy, you go to the medical school we are affiliated with but have no chance of actually getting into here interview. And to be honest, for as much as they probably don't want me, I didn't want to go there either. I don't think they have ever accepted a boards failure before, and while I'm more than willing to be some program's token Muslim, being the token board failure didn't seem like something to be bragging about. So when I got to my interview today, I was expecting the worse. I was all geared up for a fight. I seriously, genuinely thought that they were going to sit me down in my interviews and say "why in the heck should we even consider you? Because right now as it stands, you don't have a chance in hell. You know that right? You would never get in here." Or some variation of that theme. And I was nervous about it, but also kinda ok with it, because it's a mutual understanding that I don't belong there.
Well, as in most times when I've geared myself up for a fight, everything actually went really smoothly. And strangely, though nothing I heard today made me think this progam would be a good fit for me (even though it is a FANTASTIC program, with some of the best facilities and learning opportunities a student could ask for), I left glad that I had gone. I remembered my bad experiences there, but I also saw it through the eyes of other applicants, and really wanted to want to go there. That makes really great sense in my head. I loved the state of the art facilities, I remembered how much I felt like if I had sick kids I'd want them treated there, and I appreciated what the program had to offer. But most of all, I had two amazing interviews with physicians who made me feel valued. My interviews were the opposite of what I'd been expecting. Two amazing physicians from an amazing, highly ranked program with all the applicants they could possibly dream of, telling ME, little old me, that I was an amazing applicant with great experiences and insights. And at the end of the my second interview, the doctor said any program would be lucky to have me.
When it comes right down to it, I still don't think they are going to rank me very highly on their list. I mean, come on today we had students from Duke interviewing. I can't compete with shit like that. But I left there feeling like someone who, with hte right amount of training, can go out into the world and do something special that others might not get to do. And that was one of the best feelings I've had in a long time.
So, for those of you who read my blog (which I'm sorry I haven't updated in awhile) and feel like I do, that everything is falling apart and there are just so many more years of hell in front of you, remember that everything that is happening now is worth something, making you stronger, and helping you to become the best doctor you can be. And that isn't just smoke I'm blowing up your ass. I really am starting to think it is all going to work out.