The Lone Coyote is Back

As promised in the final post, I am posting here since I finally got the new Lone Coyote MD blog up and running. We'll see how it goes with my time being much more limited, but I hope it will be as fun to write as this blog was.

All Good Things Must End

I survived my second week of residency. There were some really low points, but some highs as well. Some of the tests I approve are looking a bit more familiar, I am mastering a new electronic medical record, and have started reading my own protein electrophoresis tests. Of course, I still feel lost a good percentage of the time and often need to say "I don't know but I will get back to you," when clinicians call. But I have also had some very nice interactions where I felt like I was being helpful in teaching someone about a test to order or calling out important results in a timely manner that will lead to better patient care. It is nice to feel useful and I can see that being a consultant can be very rewarding.

But unfortunately as the days have gone by I have come to see that continuing to blog is going to be difficult with the demands on my time. The learning curve is so huge in pathology I need to come and read, and I have Step 3 looming ahead. Plus, I am not in medical school anymore, so it is time to wrap this particular blog.

While I am happy that I made it to the end of medical school relatively unscathed, found a specialty, and matched at a great program, I am really sad to stop writing here. This blog has been my outlet through the incredible highs and lows of the past several years. It started as a place to vent, and a way for my friends and family to keep in touch with my life. I always tried to keep it real and to bring out the humor that I saw around me. And slowly my blog grew into something bigger as more people started reading, commenting, linking to and emailing me. I have been honored and thrilled that what I have written spoke to other people and was helpful for readers.

What is next for The Lone Coyote? For now, I need a break from medical blogging. I need some time to let the dust settle and see if it is even feasible to continue medical blogging in residency. There is a placeholder for a new Lone Coyote medical blog at http://lonecoyotemd.blogspot.com
that I may start on sometime in the future. I will post both here and at that site if I do decide to ever get it up and running. And I do hope to turn this blog into a book someday (if you are a publisher, agent, or know someone in the business who can hook me up, please let me know). I figure I will leave the blog up in the meantime to hopefully provide information for people out there looking to learn about what medical school is about.

In the meantime it would be impossible for The Lone Coyote to stop writing completely. So if you've enjoyed my non-medical musings hop on over to The City and Other Random Musings to continue the adventure.

It has been quite a ride. 772 posts. Medical school. And even a bit of residency too. Thank you to all of you readers for your support and for joining me in my travels through the world of medical training. I wish you all the best in your future endeavors, be they medical or not.

Reflections on the First Week

It is a national holiday today so the lab is closed and I am off. My first week was pretty short--only 3 days--and I am pretty grateful for having some time to ease in. I have already realized that pathology residency is going to have a very steep learning curve since it has a whole new base of knowledge to master. Luckily, they expect us to come in pretty green so there is a lot of help from senior residents.

By the end of third year of medical school I had gotten fairly good at being organized on the wards. This week I found that some of the organization systems I had used then have no use in the clinical lab. The standard "to do" lists with their little check boxes will still be helpful for making sure I do not forget certain tasks that will always need to get done during the day. But most of what I need to do depends on what kind of calls I get from clinicians, how many "critical" lab values come back and need follow-up, and other random issues that come up. It definitely lacks the structure of a day on medicine or surgery, or even a day on surgical pathology.

The hospital I am currently at has one of the smallest and saddest cafeterias I have seen. But, the food is free for residents, so I have been eating my free lunch everyday. Since not much is gluten-free, I have an iceberg lettuce salad with oil and white vinegar (yes, you read that right, cheap white vinegar) dressing, yogurt, pudding, and bottled water for lunch. Apparently, I have a food allowance for breakfast and dinner too, but I am not sure I can take eating there more than one meal/day. It is free and I am grateful for that, but there is only so much iceberg lettuce one can eat and I will be there for 2 months. One resident suggested I stop by daily on my way out and stock up on bottled water and chips to last the rest of the year when I am at other hospitals. I just might have to start doing that next week.

I Survived

I survived my first day of residency. It was about 10 hours plus about an hour and a half of total commute time between multiple sites. Not too bad. I did feel utterly lost and clueless for most of the day since most of my time spent learning how to act on clinical rotations in medical school did little to prepare me for rotating through a busy clinical lab.

We had some more orientation stuff this morning, and will continue to have some more during the week. It is mostly about how to take call, which mainly involves responding to blood bank issues. I desperately need to brush up my hematology lab stuff tonight and to learn about protein electrophoresis. There's a lot to learn about the clinical lab.

I still have to get some basic administrative stuff taken care of, like computer access at the multiple hospitals I will be rotating through. It will make life, and my daily task of approving lab tests, way easier once I can actually get some information about the patients. The techs I met seemed very nice and were familiar with lost new residents appearing in their lab every couple of months. Lab techs are the equivalent of nurses in terms of education and training, so they can really be quite helpful.

Anyway, I need to go and read, which I think is going to be the story of my life for the next 4 years.

GLBT in Residency Applications

This post is really an addendum to my earlier one today. I realized after posting that this issue arose again when applying to residencies. Basically, the things to consider are the same as when debating whether to be out when applying to medical school. What does differ is that residency programs are generally smaller in size and you will be spending a lot of time with your co-residents and faculty. So a potential conflict with one interviewer takes on much greater magnitude if that person will essentially be your boss or a key part of your social network for the next 3-8 years.

An interest in GLBT health issues or patient populations may be well-received at some programs in fields like family medicine, internal medicine, and psychiatry. It may not be as well-received in other specialties, and in some fields, like my own, pathology, it may not even be that relevant. That said, I personally was out on my residency application since one of my med school activities to list on ERAS was the GLBT group at my school. I also figured that since I would be interviewing with most of the attendings at each program and some residents that I would be working with, I would rather just put it out there, so to speak, and see what response I got. If it was poor I did not want to sign on for four years at that program. Overall, it was a non-issue and not discussed at most places, and where there was a questionable response I was glad I had that information when making my rank list.

GLBT in Medical School

In honor of Pride Weekend, I figured I would write something about gay, lesbian, bisexual, and transgender (GLBT) issues in medical school. This is a hard topic to address because it is very broad and because one would hope that it would not really need addressing in the 21st century. But I know when I was a premed I was concerned about how being a lesbian would affect my medical school experience and I could not find much information out there. If you head over to Student Doctor Network, a lot of the threads asking for advice on being GLBT and applying tend to deteriorate into troll-fests and debates about other issues. So with that in mind, here are a few thoughts that hopefully will be helpful to someone out there.

Is medical school GLBT-friendly?

It really depends on the school. And within that it really depends on the class itself. Likely at every school there will be some people who are GLBT-friendly and some people who are not. You can try to get a gauge on it by seeing if the school has an active GLBT student group and if they include GLBT health in the curriculum in some form. AMSA has a GLBT listserv, housing list for interviews, and some other information you can use to try to get in touch with students at the school to get some idea.

Should I be out on my medical school application?

This depends a lot on your personal experiences and your comfort level. Usually it gets boiled down to two arguments: 1. med school admissions are random and competitive as is and you should never risk putting something that could be controversial on your application 2. you should be out because if they are not okay with it, you do not want to be at that school anyway. In reality, it is not that simple. The person who reads your application/interviews you may or may not be representative of the school as a whole.

If you are unsure of what to do, I would ask yourself a few questions: did being GLBT play a big role in your desire to become a physician? If it did, then maybe you want to include it in your personal statement. If it did not, then focus on the experiences that did motivate you to become a physician. Did being GLBT affect your academic performance in some way that you think may impact your application? If so, maybe you want to talk about it on your secondary where it allows you to explain extenuating circumstances. Were your activities/leadership roles in GLBT organizations or healthcare settings? Then you likely will want to list them on your application and talk about them at interviews. If you are worried about these experiences hurting you, maybe you want to slightly modify your descriptions of them ie, "I worked with a youth group and mentored high school students" rather than "I worked with a GLBT youth group and mentored GLBT high school students."

The bottom line is if you are going to be out just make it relevant to part of the application and you are less likely to encounter problems. Remember, if you list it on the application, you need to be ready to talk about it at the interview. This goes for GLBT issues as well as anything that someone might find controversial, ie, volunteering at/protesting in front of an abortion clinic or involvement in political or religious groups. You really never know what someone might or might not take issue with. So think about how comfortable you are talking about these topics at an interview and let that guide you. For the record, I was out on my applications where it was relevant and it was never an issue at any of my medical school interviews. It was generally discussed briefly, like all of my other stuff, and then we moved on.

What will my dating life be like in medical school if I am gay?

I imagine it will not be that different than that of your straight classmates with one exception. They will have the bulk of the single classmates of the opposite sex as potential dates, while you will likely find that there are few other GLBT students in your class. So your potential dating pool in medical school is likely to be small to non-existent. You may want to consider this and pick a school in an urban area with an active GLBT community, or a med school that is connected to a larger university community so you can meet people outside of medical school.

Will the school offer benefits to my same-sex partner? Should I ask about this at my interview?

The good news is that you can often find the answer to this by looking around on the school's website. Whether you ask about it at the interview really depends on your comfort level as we discussed above. Another option, if you are not comfortable asking in person, would be to anonymously email or call the university's HR office to find this out.

If I am in a same-sex marriage, civil union, or registered domestic partnership in my state, will it affect my financial aid?

It should not have any impact on your federal loans because they will not recognize the marriage and view you as a single person. It could potentially affect your eligibility for state or institutional loans if your spouse's/partner's income is recognized and considered. You'd have to check with your financial aid office.

Oriented

I survived my first day of orientation. It was a general orientation and started with 4 hours of really boring talks about all kinds of administrative stuff--HIPAA, disaster planning, reducing medical errors, work hours, and stress. I got to meet a few of my fellow residents in pathology, which was cool to finally put faces to the names. Everyone was nice and seemed a bit overwhelmed but excited to finally be getting started.

After the morning of boredom, we were scattered to complete a number of tasks like fingerprinting, clinical skills workshops, the benefits fair, and getting an ID badge. The whole thing was a bit of a circus with long lines for everything. Luckily, I managed to hit the benefits fair at a lull and got some good information from the folks there. I also got through the clinical skills stuff pretty quickly and now am checked off as competent to use syringes, draw ABGs, start IVs, and do many other things that I am sure will be not used very much in my particular training program. Then it was on to get an ID badge which took well over 2 hours to get. It was a strange bonding experience with the other residents and fellows in the line as no one could figure out why it took so long. Oh well, at least it is done and I do not have to go back to get it another day.

We were given our long white coats. It was really strange to put it on and see the coat reaching down almost to knee length. After four years of the short white coat, this is going to take some getting used to.

Now I have a few days to do all of the online orientation stuff I need to do on my own before it all starts next Tuesday. It's going to be a busy next few days.

Is It Worth It, Part 2

One piece of advice that I heard over and over when debating whether to go to medical school was, "if you think you can be happy doing something else, do not go into medicine." Overall, I think this is good advice and should be pondered when considering any career path. Unfortunately, the nature of choosing a career is that we make decisions based on the information we have available. In some cases this may be sufficient to make an informed decision, and in other cases it may not be. Looking back on my medical school experience I can now see that I wrote off entire specialties based on bad encounters on the wards that may or may not have been representative of what life would really have been like as that type of specialist. The same thing can apply when deciding whether to go to medical school. Your sources of information will run the range from physicians gung-ho to bitter and jaded, so try to get a variety of people to talk to.

In deciding to go to medical school I definitely thought about all of the other career paths I had thought about doing. Now that I am done with medical school, I have spent some time talking with friends who have taken those alternative paths and it is clear that the other paths all have their pros and cons as well and that,like with medical school, it is easy to fall into them without getting sufficient information about what life on the other side of the training is really like. When I look at what my alternatives could have been, it looks like going to medical school has left me in a decent position and I do not regret not pursuing any of the other paths.

I considered the PhD route in both the humanities and in the biological sciences. It seemed very appealing intellectually and would have been supported financially meaning little to no debt at the end. But the costs were also there, namely the lack of jobs, especially in the humanities which meant having to move anywhere if you were lucky enough to land an academic job with tenure. In the sciences it seemed like doing years of low-paying post-doc work after the PhD was becoming the norm as drying up grant funding made academic jobs harder to come by. I never had much interest in industry jobs and heard government positions have also been slashed. So this route seemed to make little sense for me. My friends who chose to go the PhD route all seem to have mixed feelings--excitement about the work and research they do, but tons of stress about their financial futures and the job market.

Then there was the law school option which I have discussed in the past. Suffice it to say that I am glad I did not go to law school. I tried working the corporate job but knew within a few weeks it was not for me. My friends who went the corporate route have been unhappy for the most part. Their comfortable salaries do not seem to make up for mindless, unfulfilling work, office drama, and general corporate b.s. Those who did have "fun" jobs at tech companies have generally been laid off with the crashing economy. Government work also seemed like corporate work with more bureaucracy, better benefits, and lower pay. Some of it was fulfilling, some of it was not.

So overall, they all have their pros and cons. Medical school and being a physician is not perfect, but clearly neither are any of the other things I considered. Think long and hard and pick a field that will annoy you the least and leave you the most fulfilled at the end of the day. In the end, medicine, like everything else, is a job for most people. Hopefully, it will be a stimulating job with a comfortable salary. If you can find that elsewhere, you might not want to go to medical school.