Pathology Residency Here I come

I matched into pathology at Emory University today!

Very excited, it is one of the best programs in the country, I am shocked they accepted me! Very goof program!!

Medical School Cost: Break down by Year of My Medical School Costs

I was able to find my sum total of tuition vs housing cost at school. Refund is what I got back per fall/winter/ spring to spend on food, power, cell phone, car , and all other bills.

True Cost of Medical School: My Personal Story

 

The crux is: If we are doing rotations in 3rd and 4th year, why the price goes up so much. IF anything, it needs to be cut by about 10-15,000 dollars in 3rd and 4th year.

I am not sitting in lecture listening to professors in 3rd and 4th year. My biggest goal in life outside of being a good doctor is to lobby congress and the US government to reformat tuition fees for medical schools in the future.

As a 4th year, I know what I want to go into and I have 2 more months of required rotations and paying incredible money for these. It's not a matter of seeing how the system works, I have seen that all through 3rd year and half of 4th year. They fail to realize the financial impact on us as students.

3rd and 4th year of medical education tuition fees needs to be changed.

Medical School Debt: I don't understand these numbers!

So, I just completed a questionairre administered by the AAMC, which they give all graduating medical students.  On completion of the survey they give you links to the survey data from prior years (can be found here: AAMC Graduating Medical School Survey Data). So I clicked on the link and started reading the data from 2013. I graduate this year (2014).

I was shocked to find the following above, as seen in the picture! 2013 medical student graduates have an average medical school debt of $135,084. Either a majority of medical students lied on the survey or everyone in school is getting alot more help from parents and scholarships than I ever imagined.

Personally, I am out $307,000 as of 2/14/14. My interest goes up every day, so my total gets a little higher every day.  I have no idea where the AAMC questionnaire figure is coming from. If I was only out $135,000 at the end of these 4 years that would be a huge sigh of relief.

My best guess is that students have either parents rich enough to pay for all of it, or maybe they had income before college and saved up enough.I know this:  there are not THAT many medical school scholarships.

Letters behind a name are pricey! I paid roughly $150,000 per letter, M and D. I will be there soon and that makes me happy. Also, my parents paid for my entire undergrad studies and apartment, so I came in debt free. I cannot imagine being a soon to be medical school graduate with $60,000 in undergrad debt (that is a low number) and then pay for Medical school on their own as well. I am blessed my parents took care of undergrad for me. They also bought me a 2012 Volkswagen GTI for graduation (it is in mint condition). I cannot complain about my situation, but I simply want to point out that the number on the survey seems fictitious.

Do I regret going to medical school because I am out over $300,000 dollars? At times I have been. I think as I get into residency and start doing what I enjoy that I will not regret it one bit. Overall though, I do not think I would change my decision to go to medical school. I have told many friends, family and strangers that I if I could do it over, I would instead have gone to pharmacy school. How true is that? I don't know. I may write a blog on that in the future. 

Side note: I somewhat envy the students in medical school who had Mommy and Daddy pay for medical school along with their cell phone bill, car insurance, groceries, etc while in medical school! They need to be judoslapped for they do not know the value of the dollar! ( I am NOT saying these students are ungrateful, but trust me, they do not know the value of the dollar as someone who has to pay for every little thing) That is just my 2 cents on medical school debt.

-MD in 14

Needs Repair: The True Story of Free Healthcare, Status of Cook County Hospital January 2014

I am a 4th year medical student, I just completed my Subinternship at Cook County Hopsital in January.  I just wanted to post a couple of thoughts before I forget about them. To sum up the status of that hospital and system, two words, as seen by the picture of the two toilets I have attached: NEEDS REPAIR.

The picture I posted is two toliets (one urnial, one toliet) in the SAME bathroom on one of the main medicine floors at Cook County Hospital. These 2 signs were there for all 4 weeks of the rotation, I kid you not. Also, one of the major flourescent lights in the same bathroom was out for 3 weeks of the rotation and half of the bathroom was dark. This is NOT a joke. This is John H. Stroger/ Cook County Hospital in 2014.  This is a broken and out of order hospital.

The main thing I noticed about the Cook County Hospital, which I noticed during there my 3rd year in December 2012, is the ancillary staff are overall horrendous!  The attending doctors and the residents are all hardworking and amazing people, but the nurses, phlebotomists, and some of the lab personnel.

I will never forget when the pneumatic tube system, used for sending specimens to the lab was broken for 3 hours or so, I walked down a tube of blood  to the laboratory and told the woman who handles processing that the tube system was down, her response was: "I know it's down. Good and I don't give a damn". There was no need from her part to phone anyone to fix it or tell me help was on the way. It meant less work for her and so she didn't care. This sentiment is the epitome of the attitudes of the ancillary staff at Cook County.


 Other things that occur: phlebotomy, the people who are supposed to draw blood rarely do their  job on time. This delays all patient care. They are some of the laziest people I have ever seen. I used to draw blood, it is not hard work. It rarely gets done right at Stroger/Cook County.

The transport system meant to get patients from place A to B is horrendous. They are all lazy people and people never get to procedures and appointments on time because of these workers who have a horrendous attitude to do any work.

A good proportion of nurses are LAZY and many times are flat out rude when you ask them about patient issues. They are mostly middle aged, african american sassy women. The rest are either philipino or Indian.

I will never forget this encounter:
My patient needed a urine sample before she went for CT scan. My resident told me to go see the nurse in person and remind her to get it as soon as possible because it was ordered 5 hours ago and still had not been collected. So, I go to the patient's room and run into the nurse outside of it. I ask her if she could collect the specimen as soon as she could. Her response: "Do you know where the urine cups are?" You can collect it yourself."  My response: "I am sorry that is your job, I am not doing it!" This attitude is seen on a daily basis. It is because the nurses are unionized by the government and thus it is very hard to fire them for poor work ethic.

County is a poorly managed, GOVERNMENT RUN hospital.  Anyone who supports UNIVERSAL healthcare needs to rotate or shadow at this abysmal hospital for 1 month. Those people will change their mind about what GOVERNMENT healthcare entails.

My last opinion on County: I have a MASSIVE amount of respect for the residents that complete their training there. You have to be incredibly patient to deal with the constant bullshit of that institution. Patience that I do not have.

anyways, County was a good learning experience as far as interesting patient cases go. As a place to work or train? I could not do it.

-MD in 14

Preliminary Rank List for Pathology today!

I just got done doing my preliminary rank list for pathology! The deadline for submitting and certifying the list is February 26th 2014.

According to data from the 2013 NRMP match data: 

-Applicants matched to their 1st choice 49.6% of the time. 2013 was the FIRST time that this number was less than 50%!

-In the years 1997-2005 this number was much higher! In those years the average percent chance of matching into your first choice was about 57-58%.  It is a whole 10% less this year! Things are getting more competitive. I am glad to be going into pathology because the crazy competition for pathology has not gotten as intense as other specialties.

-If you take the the percent matched into 1st, 2nd or 3rd choice the percents from 2013 match:
49.6% matched into their first choice, 15.2% matched into their 2nd choice, and 9.7% matched into their 3rd choice.  So for me to get choice 1-3, I add all those up which is about a 75% chance of matching into 1 of my top 3 choices! I am happy with this, since all 3 of my top 3 choices are awesome places! See the photo to see more details:

My top 3 rank list:
#1 University of Minnesota Pathology
#2 Medical College of Wisconsin Milwaukee Program
#3 Emory University Pathology

I will be happy at either 3 of those places and my chances of getting in are high if we go with the statistics!

-MD in 14 

The typical Cook County patient

I am on my sub internship as a 4th year at Stroger Cook County Hospital in Chicago. This hospital deals with the undeserved, the poorest of the poor in Chicago. This note I found on the second week of my rotation by an attending doctor, greatly sums up about 50% of the patient we care for at this  facility:

"I saw him today and know him very well from before as multiples times before, whines about being examined, refuses blood work and threatens to leave AMA. I have informed him that his condition is potentially lethal and he should cooperate. At times becomes verbally abusive."

It describes a patient I was taking care of. He had heart failure and was admitted for worsening of his heart failure. He had edema in his feet and an extremely difficult time breathing. 

Stroger is a special place, blood draws never get done because they are not enough phlebotomists. The ones that they do have are lazy (I used to be one I know what it takes to draw blood, and it is simple job). If a patient is in the bathroom or not in there room for a minute, the phlebotomist will put "patient refused blood draw", just so they do not have to work. 

The transporters are also horid. They never want to take their patients to their procedures on time. 

But overall the patient you see are shocking. For example, in the last week alone I have seen 4 patients on my team with chronic hepatitis C with liver Cirrohsis killing them slowly. I have also seen a case of a patient with Hepatitis B who has a tumor called hepatocellular carcinoma, this tumor comes in patients with chronic hepatitis B infection. It is a very rare tumor and the patient I saw had a highly advanced tumor. 

My current patient is homeless and we think is faking symptoms so he has a place to stay. A test for arm weakness is to raise the arm over the head and let it drop. If the patient is truly weak and has no use of an arm, the arm will hit them in the face. If they are faking, when you let go of the arm over their face, they will let it drop, but before it hits their face, they move the arm so it misses their face. My patient keeps doing this. He is here for a home, and I do not blame him. It was 1 degree today, and maybe 5 degrees yesterday, and that was not including wind chill. 

Cook county Hospital is a crazy place to work. Very eye opening to see how sad the conditions some people are in. We are fortunate to be middle class and have insurance and have good care. Cook County, patients do have good doctors and residents, but its the facilities and the stage at the disease most patients are in, that there is not always alot of hope.  

-MD in 14 

Neat ER patient

During my rotation at Cook County of Chicago in October-November 2013 I encountered many different patients, I remember one evening I had the following different patients: a  a beautiful young girl, in her low 20s, who was a heroin addict that shot heroin into her legs, she came in with a gigantic abcess on her right buttock with over 80cc of drainage of pus. The same night, a 20s something prisoner came in with a bloody lip, he had blood all over his prison jumpsuit, it looked scary, but it turned out to be just a simple cut. The same night a homeless man was in the ER who needed 26 staples removed from his abdomen, 1 month earlier he had bowel removed for IBD and had an exlap for it. He didn't remove the staples or his Foley catheter because he couldn't get a car to the Emergency Department. That was crazy.

Now, my favorite patient over the course of the rotation was this Asian gentleman in his 80s. He came in on my first overnight at Stroger, around midnight.  

He presented with 1 week of constipation/ no bowel movements and a sensation of bloating.  No nausea or vomiting, no fever or chills.  After our work up in the ED, it was determined he had a large bowel obstruction, and indeed he did. It was MASSIVE.  

His large bowel dilated to a maximum of 12cm! Unbelievable.  The cause of his large bowel obstruction turned out to be sigmoid volvulus. Everyone was afraid, including the surgery team, because usually  an obstruction like this in an eldery patient screams cancer. He turned out to be very lucky. He was taken to the colonoscopy clinic and the obstruction was decompressed.   

That patient, I will never forget. He was just plain fascinating.   

-MD in 14 

1st Residency Interview

It is 12:14 am, I just got done with my first residency interview TODAY, on Friday 11/15, its shortly past midnight, so the post looks like its from Saturday.

Anyways, I interviewed at a school in Kentucky, called Louisville University.  My 1st interview jitters are out.  I felt really good about the interview.

I drive down on Thursday, its about a 5.5hour drive to Louisville, got in around 10pm, and then read about residency in my hotel room (courtesy of the program, which is awesome!) until about 230am. I couldn't get to sleep on time since I am on my ER rotation, so my sleep is all screwed up. I had to wake at 6am,  get dressed and eat, and catch a shuttle to the campus at 7am. It was brutal waking up.

The day went quick too! I was there with one US student, and then 3 IMGs, one from Iraq, Iran, and Egypt. It was cool to see the diversity of our group! I was a bit anxious leading up to the first interview, but thankfully for beta blockers I was not that bad at all! It was interviews with 5 different doctors, the first being the program director. As unreal as this sounds, he is 80 years old. He is a boss. He was very friendly, first he talked about the program for about 5-10 minutes, then he asked me about my birth in Russia, and my thoughts on ban on Russian adoption. He also asked me about my summer orthopedic research project. Easy!

2nd interview: with a resident, a chief resident. He asked, why pathology, "What are you looking for in a pathology program". "What fellowships are you interested in". Again easy.

All the rest went like this too, all asked "Why pathology" and one asked "What is difference and similarity btwn AP and CP?",  and then another asked again "what are you looking for in a program".  Very straight foward questions, no curve balls. It went quick.

Then at noon the five interviewees and the 2 chief residents went for lunch at a nice place called "Mayan", I had a great tasting hamburger.  Then we went back and met some more residents and talked with the director as a group, again very laid back.

I feel like it went well, it was exciting!

-MD in 14

I am a 4th year medical student

It's been so long since I have written anything. Lots has happened, mainly:

1) I successfuly finished my entire 3rd year without failing a rotation or a shelf exam
2) I passed Step 2 CK with a good score
3) I changed my mind from going into Emergency Medicine into Family Medicine

I am currently on a 2 week family medicine rotation, which I just started. I began yesterday. Immediately I knew it was for me. The pace is much better than the ER, I know what people are coming into the office with, and I get a better chance to talk to people.  Yes, some of the stuff may seem run of the mill and somewhat boring, for example a blood pressure check, or a follow up for diabetes. However, just from my first day I have realized it's not about the disease, it's really about the person, and getting to talk to them, so even a mundane Diabetes melitus check up is interesting because of what the patient has to say, their story. I also enjoy sports physicals as mundane as they may be, its neat talking to kids about the sports they are pursuing and seeing the excitement in their face!

I saw about 20 patients yesterday with my family doctor, and not one bit was I stressed out as I was in the ER. I loved the ER, I learned alot, but the schedule, going from morning to nights, to evenings and then back to mornings and re doing that cycle was too much for me. Also, the constant speed and pressure in the ER got old quickly for me. Family is just a better fit for me.

So as of now, I am applying for family medicine programs. I have started my residency application process through a website called ERAS. It is like applying for medical school, you submit all of your information and upload letters of recommendation via this website. Oh and its like medical school because the fees for sending out each application are ridiculously expensive as well!!

-MD in 14

My First Code Blue Experience

My first code blue of 3rd year that I was in and got to see from start to finish was on my neurology rotation. It was a friday night and I was on call, which means I had to stay till about 8:00pm. I was dreading staying, but started studying to use the time wisely. All was quiet until about 6pm the over head system said Code blue 12th floor, Code blue 12th floor. I knew that was us and I  ran to the code blue with my team, my heart pumping. We got there before everyone and got to see the start to end of the code. The process was awesome.

The controlled chaos of 20 people in one room working smoothly to get this guy revived. He had a brain bleed initially for his reason at the hospital. He also had kidney failure and had to get dialysis every day, and he became unresponsive during the procedure. It was cool to see the doctor standing at head of bed coordinationg everyone, telling the nurse to push epi, and to push magnesium, and to push bicarb. They stopped every 2 minutes or so to check for a pulse and a shockable rythm and would do CPR. I almost did chest compressions, but I stepped back and just watched the process. Next time I will do compressions. The guy made it. It was super cool to see the process. It made me realize i really want to do ER. I love Codes!

-MD in 14 

First post of 2013 (3rd Year Impressions)

It has been literally months since I last wrote. My main excuses are I am too tired or I need to study. This is a major lol, since I still find time to play Call of Duty and watch TV for a little every night. Ha ha! Anyways, I am at home today, it is January 2nd 2013. I am cleaning up my papers from my last rotation and getting organized, and opened my "Internal Medicine" notebook to find something I wrote on the first day of the rotation of Internal Medicine. This was my last rotation of 2012. I have done 3 rotations thus far, they are in order, Surgery  (July 2012- Sept 1 2012), Pediatrics (Sept 2012-October 10th 2012 or so)  and then my last rotation was Internal Medicine which lasted until Christmas break.  Anyways, my note I found was:

First Day patient rounds at cook county-
-1 patient with crack/cocaine abuse
-1 heroin user
-1 women just out of jail 1 month ago
-1 man who is currently a prisoner and has possible TB
-2 patients who do not speak a lick of english

I'll never forget that. It was the 2nd half of my internal medicine rotation. I had completed 4 weeks at Rush, and just started Cook County. I had heard it was different and eye opening, but that was far from what I imagined. I have never seen any of those at Rush, besides some non english speaking patients. But, this was crazy. Cook County was eye opening. It was foreign, it was scary that first week.

Then, I got used to the system, but not entirely.  It's mainly poor people who cannot afford healthcare, and many, many prisoners. It was sad because many of the people were in really bad shape by the time they got to the hospital because they let the diseases go for a long time since they cannot afford to pay for anything. The patient that left the biggest impression on me, and it is hard to type this without some tears in my eyes, was a young women, I would say she is more of a girl, she was close to me in age, if I remember right, around 24 or 25. She had blood cancer called leukemia. She had it treated several years ago, but it had come back, and much stronger this time.My team told me that she was not going to make it.

She was going to die, and they said they said it was because no one would treat her, and the treatment available at cook county could not help. She needed a bone marrow transplant, and cook county does not do that operation. I remember the moment I had to go draw her blood one day, and her arms were black and blue from the constant blood draws. They were checking her antibiotic levels since she had something called neutropenic fever. I was the one that went and drew the blood for these levels every day. One day, her mother just broke down in a stream of tears as I was telling A, the patient,  (cant say her real name, so A will have to be it) that I was drawing her blood. So, I put my supplies down and walked over to her, and hugged her. She cried some more, even more heavily. She was spent.

 Her mother had been at A's side every day, almost every hour of the day. I had never seen a time she was not in the room.  I'll never forget that hug. It took all my might not to cry. That hug had an impact on her, and a major impact on me. This woman's daughter was dying in front of her. Every time I went in there she struggled to eat because the cancer had messed up her esophagus. She was also constantly in sweats and always looked  uncomfortable. I am crying as I write this. She's 24 years old and dying. The few times she smiled really made me realized how precious life is.  That is the most profound memory I have at county hospital. It makes me realize how small my problems I have are. This profession really humbles you. I complain about having to study or long hours at the hospital. It is nothing compared to the people we take care of. 

Anyways, rotations have been going well. It's hard, but very cool at the same time. I start neurology next Monday. It will last for one month. I only have 3 rotations left this year, and then I am done in April. It has gone FAST. so fast. I cannot believe I am almost a 4th year. I have really enjoyed it.

-MD in 14

M3 Rotations Wake Up Call

Ok, so I havent written for a while, wow. Its the end of september today, and Iowa plays Minnesota at home for homecoming game, minnesota is 4-0 going into this game, we are 2-2 after losing to central michigan last week. This game is going to be huge!

So up to this point in 3rd year Ive done one whole rotation, surgery, and half done with my 2nd rotation, pediatrics. So, I got my evaluations back yesterday for surgery and also back for some pediatrics. And I am worried and kind of shocked.  Worried about whether the couple of bad evaluations will affect my residency. A couple of the doctors didnt say good things about me, well at least it will get me to pay more attention and shape up for the future rotations! Here are the nice kind words that I am talking about!!

Keep in mind, for this 1st one, I was late ONCE and I didnt know what JP was at the end of the 1st week, or didnt know she had it because I thought it was taken out, I don't know, it was a small thing, or at least what I thought was a small thing, that this DOC thought was a MAJOR deal. WOW.
Doctor 1:

“Keep reading -You need to understand a few things. First, there is a heirarchy in medicine and as a med student you should respect that. This applies to the 4th year students. They know much more than you about everything, so taking their advice would be a great idea. -No one is perfect. Respond more openly to feedback/criticism. Everyone makes mistakes, but it's how you repsond to this criticism that will determine how you do throughout your career. -you need to pay more attention on rounds and throughout the day about what's going on with our patients. Perfect example: we had a pt who had a JP in that we had been seeing for 5 days. When we discussed it, you claimed to not know she had a JP in place. This is unacceptable. To be a successful doctor you're going to need to pay much more attention to what's happening on rounds and less attention to your iPad. -The more interest you show, the more people will want to help you and teahc you. No one wants to take time out of their day to teach someone who isn't paying attention or doesn't care. However, if you show understanding and appreciation for their teahcing, you'll find that everyone (nurses, residents, attendings, etc) will take as much time as is needed to teach you and help you with things -Punctuality is an extremely important part of medicine. It's disrespectful to be late for anything, especially as the med student. -Try to be a better team player. Medicine, and especially surgery, is all about teamwork. If people can't trust you to do your job, the team falls apart. -None of this is a criticism on you as a person. This is just some feedback very early in your career that hopefully will help you to improve significantly as you go on. You're a good person. You just have to work on some of these things.”

The other two DOCS are below in what they said, and keep in mind I would "dissapear" when they told us nothing was going on, and we could go read, etc. I would go to the library, and so this is what came of that:

1  has not quite made switch from being a 2nd year medical student working on academic aspect of medicine to a 3rd year medical student on the wards. Max would disappear at times without informing or checking in with team. Work on being more of a team member within the health care team and with other 3rd year medical students.

Needs to work on being a team player. Is enthusiastic and enjoys being a part of team but at times did not take direction or suggestion well.  Anyways, I guess thats just life, I am going to work hard to learn from this and be better! Its just so crazy seeing how a little thing can become such a big thing. Anyways, I am going to go study a little now before the hawkeye game