The Match - to answer everybody's FAQ about this year

There's a process of matching to a residency this year. We have explained it...a lot. If you wonder how doctors apply for residency (yes, all doctors must go through this process), here's how. Or if you've forgotten how it works and are too afraid to ask us again, here's how. Or if you just have never even known that such a thing occurred, but by golly, you're going to know now, here's how.

We are currently in the 4th year of med school. This is our life this year. It is one big ball of stress! I think this gif depicts us this fall:

I don't know how numbers are for other specialties, but we are applying to family medicine. For each program, there are, oh, 6-12 spots available for residents for next year. And on average, each program receives about 100-200 applications for those spots. Obviously, some of this is people just applying to every program, so it's not necessarily 200 people deeply interested in each of these programs, and there are lots of family med spots across the whole country. But it is a little daunting to see those numbers when you apply.

So without further ado, I give you...THE MATCH!!!

I'd like to add that you don't need to rank every place you interview at. If you hated the program, you can leave it out of your rank list and then there's no chance of you going there.

FYI - the match is NOT the same as audition rotations - those are your normal med school rotations (2 or 4 week chunks, usually) that you do at program where you hope to go instead of back at your med school core rotation site. You still have to apply to the programs you audition at, but they will usually (though not always) offer you an invitation if you audition there. It's just so you/them get to know each other. That's an audition rotation. It isn't an interview. It's just a rotation. Some specialties/programs value those higher than others.

Calvin Walter

Henry came 9 days late. Calvin came 9 days early. I have two children now! This is Calvin's story.
        
Calvin's cesarean section was scheduled for 9:30 am on a Thursday. It actually started at 11:20. It was so easy. The only scary part was the dip in my blood pressure following the spinal block. I was laying on the table as they prepped me for surgery, and I can't describe how it felt except for what I told the anesthetist: "I feel like my body wants to fall asleep but I don't want to!" (James says that's what it feels like to pass out, but I've never passed out and never felt that before. For a few minutes I thought I might not wake up if I fell asleep.) The nurse calmed me down and told me that if I fell asleep it was okay, they'd monitor my vitals and make sure I was alive and breathing. They gave me medicine, my blood pressure sorted itself out, and I felt just fine.

James has done some rotations where he's seen c-sections, so it was fun for him to watch over the curtain and tell me exactly what was happening. Just a few minutes later, with lots of pressure pushing on my belly, they pulled Calvin out! "Woah, he's a big one!" said the doctor. There was no pain, but boy oh boy, I could feel every little jostle! Then came my favorite moment: Calvin's first cry. It's magical. It's spiritual. It is unlike anything else in this whole world.  I couldn't see him, but suddenly his whole presence filled that room. Another soul had joined us. This boy I hadn't met but had yet known so well for all these months was among us. I cannot even describe it, but I hope everybody gets to experience that first cry of a new soul, with the veil so thin, at some point in their life. He cried and coughed and cried and then they brought him around to see us. They let me touch his face and look at him for a while before James carried him down to the nursery. Born at 11:26 am, Calvin was 22 inches long and weighed 9 lbs 5.1 oz. I was expecting a much smaller baby. The estimates had put him at about 8 lbs even. Imagine his weight if he hadn't been 9 days early!

While they started stitching me up, a lifelong dream of mine was fulfilled: I got to see the placenta! I realize that this isn't everyone's lifelong dream, but I hadn't seen one in real life before, and so I asked them to bring mine over so I could see. It was worth it.

I knew they'd sedate me a little while they finished stitching me up, and it had been one of the biggest fears I'd had when anticipating the surgery. I have always had anxiety in my life, and the weeks leading up to the cesarean were very (often almost paralyzingly) scary for me. The night before Calvin came, James gave me a wonderful blessing that brought me so much peace. This helped me for the whole procedure, and so at that moment I was no longer afraid I wouldn't wake up.

And the rest was easy. I woke up and we got to my room before the pediatrician was even done doing the preliminary exam of the baby! Then the baby came in. We'd planned on either Walter or Calvin for his first name, and we settled on Calvin with Walter as his middle name. He was beautiful! Nothing was wrong. All was well.

He had some issues at first - jaundice and low blood sugar. We had experience with low blood sugar, but it got pretty extreme with Calvin. We could not wake him up enough to nurse, and the supplemental sugar water and formula weren't cutting it. Finally, with threats of an IV looming on the horizon, he got enough of something or other to help raise his blood sugar. The jaundice was a different story. We had to put him under bilirubin lights for two days and he eventually required an IV anyway because the lights weren't helping enough. We stayed in the hospital an extra day for his jaundice. They even thought we'd have to stay another additional day, but we were surprised and delighted when they let us go home!

My own recovery was unexpectedly fast. I'm still recovering some (no marathons or mountain climbing for a few more weeks at least!) but overall I feel wonderful. Nursing has been surprisingly difficult, but I think we're starting to sort it out. Calvin has Henry in the palm of his hand. We are a happy little family!

1 week

3 weeks old, playing with the webcam on the computer

2 weeks old. My three boys!

Mom and both sons squashed-in-the-back-seat selfie. I love Henry's face here!

The love will come, the pain will fade

As this next baby comes closer to arriving, I've been thinking about Henry's birth and about pregnancy. It's weird, isn't it, how much and also how little about birth is in our control? Today I'm thinking about what happened with Henry and what I wish I'd known. These problems may seem silly to you, but they were very real to me at a very intense and emotional time, and I hope that perhaps someone who has these same emotions may read this one day and realize they're not alone.

Henry was born via an unscheduled c-section. It wasn't technically an emergency, but if we had continued with labor it would have turned into one. It was a necessary thing. We would both be dead without it. Several things about that surgery stand out to me. I had been in labor over 24 hours with zero progress (I hadn't even dilated to a 1). I had always thought hospitals had pain options for labor, but mine apparently had one shot you could use (it worked for 45 minutes) but only worked once...or an epidural. Which they would not give until you were dilated to a 4. No options were available to me that night for pain; none had been available for hours since that shot earlier. I was done. I was drained. So there I was at 10 pm being told that for a number of reasons I almost certainly needed a c-section. What's more, they could do that then (10 pm ish) or re-evaluate in the morning (8 am ish) to see how things had gone. I guess now I realize I could have asked for one at say, 3 am, but it was late and we have a small hospital with staff who wanted to head home for the night. I felt like my options were: have a c-section now OR ELSE have a c-section after 10 more hours of this awful labor with zero pain options. My water had broken, and things needed to happen to protect the baby. I felt like I didn't really have a choice.

They prepped me eerily fast - I wonder if maybe the nurses thought it was an emergency cesarean? I know they were worried about the baby. I gave my consent for the surgery and in less than 5 minutes I had been prepped and was in the OR. It happened so fast, and that speed scared me.

I remember walking into the OR and sitting on the table for my spinal block. I have never been so afraid in my entire life. I did NOT want a c-section; that's why I had avoided being induced for so long! That's why the baby was 9 days late! I did not want one; it wasn't supposed to happen for me. I had never even once considered that it might, and I had done nothing EVER to prepare or learn about it. I sat on the OR bed and knew that I had no choice - I had to have this. This was the only way this baby could come out. It was terrifying to feel completely out of control. During the procedure, they discovered that Henry's head was too big to come out naturally - his head was so big it couldn't even enter the TOP of my pelvis, not to mention exiting through the narrower side! I remember hearing my doctor say as he first removed the baby, "Wow, there was NO way he was ever going to come out on his own." I know that if this had been pre-cesarean days, he wouldn't have come out. He and I would have died. I know this. The surgery saved our lives (which is scary to think about - another year, another country, another place, and we'd be dead). Of course I am thankful for a healthy baby. My grief was unconnected to his health; I was grieving something of my own.

Labor and childbirth were (to me) things I was supposed to participate in. Something I myself did, that I was a part of. Instead, it was a fairly traumatic experience that happened TO me, instead of WITH me. I felt betrayed by my doctors, my body, my baby. Mostly by myself. I had failed at doing the one thing my body was meant to do. I couldn't even give birth. I wasn't a real woman.

And when it took Henry and I a very long time to bond (several weeks, maybe over a month), in my head I connected it to the surgery. It was my fault I couldn't bond with my baby because I couldn't give birth normally. I didn't know that sometimes it takes longer for people and that this is normal. You only hear the stories of instant bonding. They would hand him to me in the hospital and he was just a baby, not MY baby. Just somebody's child. The good-intentioned comments of "Oh don't you just love him so much??" stung. I didn't, not yet, and I was afraid I never would. That seemed like another failure of myself. The guilt slowed things down.

People would say, "He's healthy! Be grateful for that!" And of course I was!! Of course! I was grateful we didn't die, grateful he was here. But that didn't mean I couldn't mourn something I had lost that was so important to me.

It took just over a year for me to no longer be upset when I saw people's birth announcements. "My wife just gave birth at home in our kitchen! She was in labor for 45 minutes and pushed for 3 minutes, no meds needed! What a rockstar!!" As though time in labor, pushing, and pain tolerance were in anybody's control. I wanted to scream at those posts. "I was in labor for 26 hours! I never got to push! Somebody took away my power to use my legs and cut him out of me! I had no control!" The posts hurt and they obviously weren't trying to. You don't hear many "she's a rockstar!" stories about cesarean recoveries, and I am so glad I had so much love and support from James. It took a very long time to not be hurt by my own experience when I saw that of others. And I don't wish that that person's life had had more pain; I just wondered if maybe I had been more like them, mine would have been a different story. But I know it wouldn't. It just took me a while.

And so if you feel like you're alone in mourning this, or if you feel like all mothers must bond immediately, it's okay. You're not alone. It's normal to have these feelings. The love will come, I promise. Just hang on. The pain will fade. Just hang on.

Henry! Henry! TWICE! Because he's 2 now.

Some fun things about Henry lately now that he's two:

• Henry loves construction equipment and semi trucks. Trains are fine, but they're nothing compared to "BIG truck!" or "backhoe!" 
• Ever since we went on a walk the day after a big rainstorm, Henry has been very into dead worms. He'll see one on a walk (or really anything that resembles it, like a stain, trash, or part of a leaf) and say, "Oh! Is a dead worm!!" He'll then squat down to look at it and will giggle while he keeps telling us he's found a dead worm. We told him he can't pick them up, so now he refuses to walk close to them or on them and will back up and go around them in a big circle (staring at them the whole time) to avoid them. We can use that as a way to get him to move along, too, "Henry, I think I see a dead worm up here! Let's go look!" He likes live worms (and slugs) even better but you just don't see those as often.
• He's also very into rocks. He likes to carry them around, stack them up, and especially throw them in water. He found a dead worm near the door to our storage room in our carport and brought over all the rocks from the garden to put on the ledge of the door. I like to think he was making a little shrine.
• We went on a brief trip to Pennsylvania recently for a test James had to take there, and in sharing a room with Henry as he fell asleep, I learned that he whispers to himself after we lay him in bed before sleep takes over. We heard him across the room whispering, "Hot dog...fruit snacks....cheeeeeeeseburger..."
• He's a very chatty fellow! He's using more words in more ways every day and I love love love it. Some of my favorite funny things he says are: "No WAY!!" (especially when he says it calmly..."Do you want a cracker?" "No way!"); "Help you" (we ask him often, "can I help you with that?" so now when he asks for help, he just says, "Help you?"); "come here" (this means he wants to sit on our lap); "Hold you" (he wants me to hold him while STANDING - the STANDING part of this is important); and pretty much anytime he tries to say "frog" or "fork" because he sounds like we're teaching him definitely non-toddler words.
• He calls watermelon "water-minute" and it's adorable so we don't correct it. He also calls being upside down "up-oo-san!" Other than these he's actually pretty good with the correct words (minus the inability to say Rs and Ls correctly).
• A few days ago he was drinking an open cup of milk and deliberately threw it onto his high chair tray. I told him that wasn't very nice, cleaned up, and gave him what remained in the cup. He then deliberately threw it on the ground and while I was cleaning it up I said, "Aww, man..." and he started repeating that. "Aw man! Aw man!!" Then as I cleaned up the ground, I looked up at him and said, "Henry, you're in trouble!" He said gleefully, "Twouble!!" I said, "What is this mess!?" He peered over his chair to the ground and said, "Is a oopsie!!"
• A couple of months ago, our cashier at the dollar store was a teenager with long hair and a scraggly looking beard. As we were leaving, Henry yelled, "Bye bye, Jesus!!" About 5 minutes later I realized I'd left my wallet in the store, so we called the store and he found it and kept it safe for us until we got back. Sounds like Henry can spot the good ones!
• Like any good two year old, he likes holding whatever I'm holding, always touching me in some way, making faces, and discussing farts. He will always rat you out if you fart, either in the moment or later. "Dadda, is a fart!" Even hours later. "Dadda, Momma fart!!" Thanks, kid.
• He has always been a big supporter of belly buttons. He likes to pull up our shirts to poke them. As my belly gets bigger with this pregnancy, he sort of understands that there's something about my tummy that involves a baby, and it's probably the belly button. I'll say, "Give the baby a hug!" and he'll pull up my shirt and rest his head on my belly button. Some pregnant women get the outie belly button as their stomachs get bigger, but my belly button just expands into a sort of cavern. Glamorous, right? A few weeks ago when Henry was looking at my belly button, he pointed to it and yelled, "Momma! A tunnel!"
• He loves being outside and he loves playing in water. He has some cups and toys for the bath and will happily spend 15 minutes playing in the bathroom sink with them. Taking a bath, eating watermelon, or eating fruit snacks are our number one bribes around here.
• When we found out I was pregnant but hadn't told Henry yet, he did something remarkable. I was laying on the couch and he came up to me, poked my belly, and said, "Baby!" And ran off to go play. I don't know how he knew there was a baby at all, or that it was in my stomach right then, but he knew!

Semester's End for a Teacher...the last one for a while (*sniff*)

Last week was final exam time for my students. I often like to write posts about the last week of classes, and this one is a little bittersweet for me because it'll be my last one on-campus for a while. I'm still going to do some online classes, but since the baby is due right when school starts in the fall, both recovery/newborn/childcare means I won't be physically in a classroom for a while, which is heartbreaking. Also I feel like I never mentioned on the blog or Facebook that our next baby is another boy, but we've told people we're around, so I feel like it's too late at this point and would be awkward to do a whole thing about it, so...anyway,in case you were wondering, boy!

As the end of the semester approaches, I find these memes to be very true:

Students say:

 

Teachers say:


The last day of class (or really the last few weeks, for that matter, and especially not one hour AFTER your final!!) is NOT the time to ask for extra credit. It's not the time to decide to drop the class and be annoyed when that turns out to be difficult. It's not the time for many things. I finally printed out this one (above) and put it on my office door. Maybe students coming to ask for extra credit saw it and it scared them off...! James says I should've made this (below) into a poster instead to scare students off, but life isn't Harry Potter (yet) so I don't get moving pictures on my office door:

One student's plea for extra credit did make me laugh, though, and fortunately it turned out to be easily fixed and not an extra credit problem after all: "No I have an 89?! I need an A worse than I need air to breathe. I will literally do anything for 1 more point. I will even babysit your child. Please Jesus."

I had wonderful moments and students this semester. My favorite moment, though, did not happen in the last week; it happened at the last test before the final, so about a month ago. I always have a few bonus questions at the end of each test, and due to spring break and weather/cancelled class, this particular anatomy test ended up being very, very long and difficult. Poor class. I'm sorry. But this girl's answers on the bonus section cracked me up:

 

And now for my end-of-year comments that I love so much and sometimes share on the blog...also brought to you by test bonus questions. I love my students and will miss being with them. These are from both my anatomy and intro to biology classes. Enjoy! (My comments are in parentheses.)

Question: What is your favorite part of the brain and why? (we learned about all the different small parts, like the pons, arbor vitae, medulla oblongata, hypothalamus, etc., so this is what I expected them to say. I should have been more specific!)

Answer: The left side. I think I am left brained. 

Answer: The ponds. (It cracks me up that all this time they thought the "pons" was "ponds")

Question: What was your least favorite topic we covered in anatomy this semester and why?

Answer: I didn't like that one chart we did to see if we carried the same genes as our parents. (We have done many charts in many labs. I love how ONE piece of paper in this whole semester is the worst part of the semester. I'll have to go back and review it...sounds pretty bad!)

Answer: Learning the domain kingdom phylum class order family genus species because it took me forever (I love how they wrote out all these words for this!)

Answer: Cells, I don't enjoy learning about cells!!!

Question: What was your favorite topic of the semester and why?

Answer: The brain because I could almost name parts of the brain that I couldn't do before. (Almost??) 

Answer: Review games before tests!

Answer: I believe they all had the same academic value.

Question: A picture of the rotator cuff muscles in the shoulder (it's pretty obviously the shoulder) and it asks what one specific muscle in the image is called. 

Answer: Leg muscle 

Answer: A hamstring

Answer: The humerus

Question: A picture of a vertebra and it asks them to label two specific parts of it.

Answer: they point to the spinous process (the part that sticks out the back) and label it "axon" (which is part of the nervous system, and NOT one of the two things I asked them to label)

Answer:  another person labelled the spinous process as the coccyx (that's your tailbone. It is not found in your vertebrae, and is also not one of the two locations I asked them to identify.)

Question: List the first three cranial nerves, their number in roman numerals, and indicate whether they are sensory/motor/both.

Answer: Well I know the 12th nerve might be the hypoglossal...

Floods and the Niagara of the South!

A few weeks ago, it rained 4.5" over Saturday/Sunday. (For reference, 1" of rain is the equivalent of ~12" of snow.) It rains a lot here, but this was more than usual. It caused lots of flooding, and many of my students were trapped and couldn't get out of their areas to get to school; in our area, one of the two ways out to the highway from our house was flooded over. In the pictures with the green cones (taken Monday afternoon), the road where you see water is normally a bridge over a medium-sized creek that is usually 5 feet or more below the bottom of the bridge. A friend had been over for dinner the night before this picture was taken (when it was still raining). Fortunately she had a big truck, but she said the water hit the tops of her wheel wells! The blocked road is the first two pictures; the third picture shows the field alongside the road on the other way out from our house that was not blocked. It's normally a grazing area for cattle, with this little creek off in the distance. The water comes clear up to the edge of the road!

This lake/swamp you can see is normally a cornfield.

This is the view along the road from the second way out from our house. The line of trees in the back is where the creek normally is.

The week after all this rain, we decided to go visit Cumberland Falls waterfall in Kentucky (it's only about 90 minutes away and claims to be the Niagara of the South, so how could we not visit?! Especially with all that rain - extra water is a bonus in waterfalls!!). The falls are 68 feet tall and 125 feet wide.

Henry absolutely loved it. He spent the entire time at the falls excitedly yelling, "Wattafall! Watta!! WATTAFALL!!!!! Play water?? Oh, is dirty! Watta!!" on repeat. He loved the noise, the dirty water, the rainbows in the mist (which don't show up in the pictures, sadly), all the climbing on rocks, and the huge waterfall. I hadn't expected him to like it that much, but I think if he could tell us his top 3 favorite experiences of his life, this would be up there, right behind the first time he tried fruit snacks and jumping on his friend's indoor kid trampoline.

This excursion was last weekend (one week after the flooding), and every day for this past week Henry has asked me this question when we get in the car in the morning: "Have fun waterfall today?" We may have to plan a return visit.







Here's a little video of the falls. They don't look that big on this tiny screen, but they were actually pretty impressive!

3rd year...in our experience

Every time we say, "Hey, we need to write for the blog," we then end that conversation with, "But what would we say? Nothing is happening!" Well, here's what's not happening this year of medical school for us.

• James has done a lot of rotations. After radiology, he did internal medicine, cardiology, pediatrics, urology, family medicine, and he just finished one in the ER.
• James has officially decided that he wants to become a family medicine doctor. He says he likes not knowing what's behind the door, he likes the variety, and he likes using all of what he's learned at med school instead of mainly just one subject of it. He also is the type of person (as I'm sure you know if you know him) to appreciate a long-term doctor/patient friendship where he can get to know people and help them over time instead of only when they have one specific problem or emergency.
• I got another job doing some medical writing that keeps me busy in the afternoons during Henry's nap. Consequently, the dishes (which honestly weren't terribly up to date on an average week) have entered a sort of "let's play chicken" mode where James and I unofficially see which one of us will crack first and do them and clean the kitchen. But then the other one feels guilty and grateful, so it evens out!
• We found out we're expecting another baby! I'm due August 12, but since it'll be a repeat cesarean, it'll be a week earlier, so you can expect updates on that about August 5th. This will put it right between my birthday and James's birthday.

• My semesters this year have been the best I've ever had here. I don't know if it's that my students are getting brighter and more lively or that I'm just getting more comfortable as we go along, but I'm really enjoying teaching!
• Third year of med school is my favorite by far (so far!). James does rotations now, and while he's still gone from home more than if he had a regular 8-5 job, it's SO much better than the last couple of years. Obviously it greatly depends on what rotation he's on and what doctor he's with, but credit where it's due: rural doctors are great to rotate with! Many of the local doctors only do half days on Fridays, or work in another town that's too far away for James once a week and will give him that day off, or will let him set broken bones/clean out abscesses/do CPR/intubate patients. It was rough to be assigned to stay here in our rural area for these years of school also, but it's worked out for us.
• Henry is doing and learning lots of new things, but I think I'll do another post about some of those soon. He's almost two years old. TWO. My curly toddler baby is getting big!
• We're gearing up for the fall. That is the busy time (inconveniently close to this baby's due date!) when James will be doing audition rotations (spending 2 to 4 weeks at a time doing a rotation at a place we hope to do residency at, which in this case is almost exclusively out west and not with me! Oh no!) and interviewing at residency spots. We will find out next March(ish) where we will be going for residency. That will be an adventure of a season for us, I think, with him gone and me alone with the toddler and the newborn, but we'll make it through!
• Our 4 year wedding anniversary is almoskt upon us. My phone reminded me other day of a moment about a month before our wedding when James sent me a message on Facebook. He said that marriage was going to be like this scene from The Hobbit when Bilbo dashes off to join the quest and says, "I'm going on an adventure!" How true that was, and how fun the adventure has been so far. I have to remind myself sometimes in this school journey that Bilbo's adventure wasn't all fun (camping in mud, almost eaten by trolls, talking to sneaky dragons, etc) and that's all part of the adventure. In fact, you could say the hardships are the best part of the story.
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