Thursday, July 14, 2016

So...Where Do You Want To Do Residency?

Jonathan and I get asked this question ALL. THE. TIME.  And while it is an innocent question, it is not a simple answer.  I've been dying to kind of flesh this out here on the blog, so here goes.  Hopefully this makes things a little easier to understand (I say that to myself as much as anyone else... ;)...):

Where Are You Applying?

Well the easy short answer (that I usually give people) is EVERYWHERE.  With a recommendation for International Medical Graduates (which we are) of 150-200 programs to apply to (depending on your board scores), there's no quick answer to that question.  The easier answer is where are we NOT applying.  We are not applying to any programs in California.  Why?  Because there is an additional cost to apply to programs in California and different requirements.  So no programs there.  We are not applying to any programs in Florida.  Why?  Well...because we hated living in Florida.  Period.  End of story.  Not planning on hanging that albatross around my neck again.  Here is the preliminary list according to states.  We will add a few more in the coming weeks, but here's an easier way to paint the picture for you:

North Carolina-3
North Dakota-1
New Hampshire-1
Rhode Island-2
Washington, D.C.-2

So clearly there are lots of options and programs all over the country.  If you're wondering why some states have more and some states have less, the quick answer is that some states (like Oklahoma for example) don't have many or even any Internal Medicine residency programs.  Other states (like Texas and Massachusetts) have lots...

Where Do You WANT To Go?

Seems like an easy enough question to answer, but really it's not.  The rule of thumb in applying to residencies is that you should always keep an open mind.  We had friends who matched in 2016 who really REALLY wanted to match somewhere in Georgia.  She even did all of her rotations in Atlanta!  But when it came time for residency interviews, she didn't land a single one in the state of Georgia.  That's not to say that she wasn't "good enough" to match in Georgia.  It probably means that no programs in Georgia were accepting IMGs (International Medical Graduates) or that there weren't enough spots to go around.  They ended up in a program in North Carolina and they were perfectly happy with that!  So for Jonathan and I, we have made a priority list (per the advice of a wise professor).  This way, when the interview invitations start coming in in October-January, we know which ones to put at the top of our list.  So keeping in mind that we could end up matching just about ANYWHERE in the United States, I'll satiate your need to have *some* sort of parameters and give you our top 10 programs in no particular order:

Mercer University in Savannah, GA (I'm secretly loving the idea of living in Savannah)
Union Hospital in Baltimore, MD
St. Agnes Hospital in Baltimore, MD (this is where Jonathan is currently rotating)
University of Oklahoma in Tulsa, OK
University of Oklahoma in OKC, OK
University of Arizona in Tucson, AZ
University of Kentucky in Lexington, KY (we fell completely in love with Lexington in March)
UTHSC in Houston, TX
Methodist Hospital in Houston, TX
Carillon Clinic in Roanoke, VA

Now keep in mind that these are our top 10 programs *in our minds*.  They have all accepted Ross students in the past, but that doesn't mean any of them will accept Ross students for the 2017 match.  There is absolutely NO telling what could happen this fall.  We could interview at all of those or NONE of those.  And even if we interview there, it doesn't mean we get to go there.  We submit the applications September 15th and then we wait for interview invitations!

So Then What?  What Happens After Interviews?

So after we interview at these places, we get to pick which one we want to go to right??  Wrong.  After we have been invited to, accepted, and attended all the interviews we want (the goal is 10-15, but some people get/take more, some get/take less), we submit a Rank Order List in February.  Basically what that means is that say for instance we take 12 interviews.  We would rank those 12 programs from 1 to 12 in order.  Number 1 would be the program we most want to match with, and number 12 would be the program we are least interested in matching with.  Lots of things must be considered here.  1) How well did you gel with the attendings and other residents in the program when you were there for your interview?, 2) Did you get a request from the program director to "rank them high"?, 3) How is the location? (for us we have to consider how family friendly the area is and what the cost of living is like), 4) How is your opportunity for learning in the program?, 5) How do your board scores stack up among the normal applicants that get accepted?, etc.  Lots to think about!  

Each program then ranks the students they interviewed according to the number of spots they have.  Then both ROL's are submitted to the National Residency Match Program algorithm and the spots are fleshed out from there.  It's kind of like The Draft! Then on March 14th we get an email saying "Congratulations You Matched!".  That will be such a relief!  But we won't know WHERE we matched until the following Friday March 17th.  Then our great adventure begins!  From there we have until July 1st to choose a place to live, move in, and get acquainted with the area.  We are tentatively planning to probably move wherever it is that we match at the beginning of June so that we can get properly acclimated before Jonathan starts his residency on July 2nd...

Jonathan Graduates in October Right?  What Will Y'all Do Between Then and July 2nd?

Good question!  Since October and November are big interview months and then the holidays in December, we will basically be "taking time off" during those months and focusing on residency interviews.  Starting after the first of the year, though, he will be working in some capacity for AllianceHealth Deaconess in OKC.  Probably doing some scribing for doctors or other "scut work" so that we can afford to live in those months leading up to residency!  We will cross that bridge when we come to it. Suffice to say, for now, that we've got it all figured out.  Or as much as we can at this point!  We are both very anxious for this next step in this arduous process. We are ready to make money we don't have to pay back (even *if* a large chunk of it has to go to paying off student loans), we are ready to settle into ONE place for THREE years, we are ready to plug into a church with more permanency, we are ready to SETTLE DOWN!  But in the coming months we could use your prayers, good thoughts, good vibes, whatever ya got!  This process is tedious, stressful, and overwhelming.  There is a lot to be done and only a few weeks to do it (9 weeks to be exact...September 15th is our submit date!).  We will keep you posted on our process as we go along...

I keep telling Jonathan that, even though I know this whole process is super stressful for him, for me it kind of feels like opening a fortune cookie.  We get to consider living anywhere in the country for THREE years of our lives (did you catch the 2 programs in Hawaii??).  It's just as exciting as it is daunting!  We can't wait to see what 2017 brings!

Wednesday, July 6, 2016

When Grief Speaks, What Does It Say?

It has been nearly 6 weeks since Bernice's passing.  Still seems very surreal that she is no longer here.  In the wake of her death and all that burying a loved one entails, I have stayed too busy, really, to let my real grief speak.  After we laid Bernice to rest, Nicole and I set out cleaning and organizing in the house.  Cleaning out closets, cabinets, junk drawers, storage elements, etc.  It kept our minds busy and occupied.  We would stand back and say, "Oh Bernice would LOVE to see this closet all cleaned out!", or "Man I wish Bernice were here to tell us about all this cool stuff!".  There were times when going through her things made her absence feel heavy for me.  But in all honesty, tackling those projects was a bit of an avoidance for me.  I could pretend that I was just doing these things that were really on HER to-do list so that when she got back she would be so excited!

But now I'm back here in Baltimore.  You'd think being removed from the house, not driving by the place she is buried, not walking into her empty bedroom every'd think those things would help ease my pain.  But what I'm experiencing right now is different.  My grief is talking to me in a way that I didn't expect.  Or maybe I did.  I'm a perfectionist by nature.  It's in my blood.  So now that I've had a minute to myself...a minute to breathe and to grief sounds like this:

I fell so naturally into the role of caretaker.  When the last thing on earth she wanted was to have her sons or her husband see her in such a state of mind and body, it was me who stepped up.  Not in a "see look what I did" way, but more in a "I was made for this" kind of way.  We came to Oklahoma City late in the evening on Sunday May 15th.  Monday morning rolled around and she was "healthy".  I knew she was in pain, I knew her blood counts weren't normal, I knew that we could hear any day that "there was nothing else that could be done".  But still I didn't think I would be saying goodbye to her less than 2 weeks later.  I had no idea, not even subconsciously, that her body was literally wasting away.  And so I stepped into that role to buy her time until we could find a solution.  I offered what little "wisdom" I had to help her make decisions about her body, about her mobility, about her hygiene, about her treatment.  I helped her to and from the bathroom, in and out of bed, in and out of the shower, in and out of clothes.  I desperately searched for protein shake recipes that would help her retain as much nutrition as she could while her body was refusing to allow her an appetite. I tried my darndest to remember which pills she was supposed to take and when.  I called my Daddy and asked him if he would be willing to fly me back and forth between Baltimore and Oklahoma City to help take care of her while she underwent "heavy treatments" until we could get back in October.  He said he would be happy to, but we never got there.  She died 13 days after we arrived...

As my mind has begun the process of, well...processing, what I'm hearing on loop in my head is "Rachel, what else could you have done?".  Did I feed her the right things?  Did I say the right things?  Did I help her the way she needed me to?  Did I do the right things?  Did I ask the right questions?  Did I do ENOUGH?  And then the minutia begins eating my mind alive.  "Rachel, you left the room to nurse Greysen at 11:15 when she was so restless.  When Patrick came back in to get you  15 minutes later and said, 'I think you really need to just come back in', had she already gone?".  I find myself poring over whether I was there when "her soul" left that tired body.  Was I holding her hand when she left?  Or was she searching for me and I wasn't there?  She drew her last breath at 11:49 PM.  I was by her side when she did.  But was I there when she needed me?  The easy answer is yes, but my grieving mind begs to differ.  The perfectionist in me screams "You could have done it better!"  And while no part of me wanted to see her suffer a minute longer, I find myself frequently asking myself if I did the right things, if I did things right, if my actions caused her to leave us quicker than she should have... 

I wish I had never stepped out to nurse Greysen, even though I was back before she died.  Even though I was right next to her when she drew her last breath, I still wish I had just thrown modesty to the wind and nursed him at her bedside so I could continue pressing her hand to my heart as the life spiraled out of her.  I wish I'd had the guts to tell her "You're dying" when she asked me "Why don't I feel better?".  She needed me to say those words and I couldn't bring myself to say them.  I wish I had taken more pictures of her and me together.  There aren't nearly enough...

So for me, when my grief speaks, it says words like IMPERFECT, GUILTY, REGRET.  At times its excruciating.  Now, am I a puddle on the floor every time those words well up inside me?  No.  I am a Mommy after all, and Greysen needs me to keep it together.  So I will...and I do.  But there is a loop in my mind that will hopefully fade with time.  I expect the play button on it will be pressed more than once in the coming years...probably when I least expect it.  But for now, as I wade through those last weeks I had with her.  As I pick through the happy times we spent together.  As I spend time reading her journals and the letters and emails she wrote to me over the years.  As I learn to function in a world she no longer lives in...

I let my grief speak as loudly as it wants to.  Because I know that eventually the acute pain that I feel right now (when I let myself feel it) will soften over time.  Her absence will never not be apparent, but I hope and pray that as the years pass I will be able to look back at those precious final 13 days and KNOW that I have nothing to regret, nothing to feel guilty about, nothing to beat myself up about...

Sometimes I still hear her telling me, "Sweetie, you're doing great.  You're doing everything right.  You're the daughter I prayed for.  I love you so much!"  And when I do hear that in my mind, I like to push the repeat button on it.  It's a much better loop...