jenniferhawke.com

I wish I could think of a title for this post that didn’t have to do with the impending baby-ness. I wish I could think of anything in my life right now that isn’t affected by the impending baby-ness. It’s like a huge, dark cloud that casts shadows of bright and beautiful sunshine-y rainbows over everything. Like looking at your life through a kaleidoscope and not quite understanding how it works, but thinking “dang! that looks cool! and so purdy!”

So yes, this post is supposed to be about school. But somehow it’s about the baby too. Welcome to my baby blog.

It’s a slow morning at the clinic and I thought I’d bring my laptop along. In hindsight, I’m actually not sure why I brought my laptop today. I never bring it to work and prefer to read random textbooks or review notes in my spare time instead. For some reason, I packed the old* iBook G4 in my diaper-bag-turned-bookbag with the thought that I might have some time that needed occupying at some point… We have two hours and 20 minutes between patients. So here I am.

Today is my last day on Neurology. I am closing out the month, this rotation, and my pre-maternity leave elective rotations in one fell swoop just a few short hours from now.

I have completed 18 out of the 30 required elective rotation weeks in my 4th year. When I come back to finish rotations in December(ish), I will have three electives (12 weeks) plus Pedatrics (a 6-week 3rd year core that couldn’t be scheduled earlier) to finish up before I get my MD in June.

To put it another way, I have 18 weeks + 1 day left in this short white medical student coat. Which is a good thing because it’s starting to look a little worn out.

Somewhere in the midst of all that studying I was doing for the USMLE Step 2, I transitioned from a third year medical student to a fourth year. There wasn’t a big momentous marker, but it’s actually kind of a huge deal. I’m in the home stretch! I’m in my LAST YEAR OF MEDICAL SCHOOL. My parents are probably falling out of their chairs with excitement at the thought of me having a PAYCHECK not paying tuition sometime in the near future. I know I can hardly believe it.

Other big changes that come with being a senior fourth year:
- picking which rotations you want to spend time in
- applying for residency programs
- knowing more than you did this time last year when you were just starting out
- moving from “history & physical” skills that you so recently perfected into “assessment & plan” thinking

However, an even bigger transition is just around the corner. The Before and After line in the sand that is about to be drawn down the middle of our lives in a few short weeks is much more definite than the transition between 3rd and 4th year… Very soon, Brandon and I will go from husband-and-wife medical students to mama-and-papa medical students.

Yah. That kaleidoscope. Pretty trippy stuff.

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*7 years old this fall! As I was preparing to type out the praises of this sturdy and long-lasting machine, it promptly crashed into some sort of unrecoverable mode that required a PMU reset.

Since I shared my Step 1 report, I figured I could post these as well.

The top part correlates to my performance on the Clinical Skills (CS) exam in Houston. The bottom displays how well I did in each section of the Clinical Knowledge exam. You can see my Renal/Urinary score improved a lot from Step 1, but what the heck happened with Immunology??

I think it’s funny to see that my Professional Manner is better than my Spoken English and I have no idea how anyone can score well on Data Gathering with the time constraints on the clinical encounter.

At any rate, all of those fancy X’s mean I’ve successfully completed 3 out of 4 parts of the United States Medical Licensing Exam. Step 3 will come sometime next year. Hopefully after I have landed a Real Residency Job with a Real Residency Paycheck.

Well, it’s the middle of August. Which means you have probably already received your token and registered with ERAS. Now it’s time to register with NRMP.

ERAS stands for Electronic Residency Application System and is the online software responsible for taking care of your personal statement, photo, CV details, MSPE (Dean’s letter), official transcript and letters of recommendation. Your school will submit the last three. The rest of the application is up to you.

NRMP stands for the National Residency Matching Program and is the governing-organizing-electronic-doo-hickey application that sorts through all applicants and residency positions with a fancy math algorithm. This year, NRMP registration opens on Sunday, August 15th.

Each of these steps is bringing us closer to the end of summer and closer to the submission of our applications to residency programs! September 1st is just around the corner!

We are back! From Kansas City!

A fellow MUA student, friend and current Chief Resident of a Family Medicine program somewhere in the Midwest recommended that Brandon and I check out the National Family Medicine Conference if we were at all interested in matching with a FM residency program next spring.

Wow. What great advice!

No matter what school you went to or what country you’re from, if you’re interested in matching in FM you absolutely must attend this conference. It is well worth the time and money. Hosted by the AAFP each year in Kansas City, there are literally hundreds of information booths, residents and program directors from across the country. It is the perfect way to network new contacts and narrow down the program that will best fit your goals and dreams.

It also doubled as a nice little get-away for Brandon and I on our almost-anniversary weekend. We wandered through the neat Power and Light District, ate amazing BBQ, and watched a movie in the most incredible theater I have ever experienced. It was so incredible we had to go back the next night for another movie!

Feel free to drop me a line if you have any specific questions about the AAFP National Conference. Suffice it to say, if you are a 3rd year med student planning to match with a FM program in 2012, you need to put this event on your calendar for next summer.

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photo: Snapshot of the Kansas City Convention Center from our 10th floor hotel room at the Marriott.

I knew that going to a Caribbean medical school would have its drawbacks. I knew I would have to work harder and smarter to get the crumbs fallen from slices of bread that are readily handed to my Canadian and American med school counterparts. I figured the stigma would be strongest while doing clinical rotations in the USA and was pleasantly surprised when I was welcomed with open arms by every attending I met along the way. Nobody has looked down on me or claimed I didn’t go to a “real” medical school. I’ve received nothing but genuine praise, sincere acclaim, and occasional surprise when rated on my performance in the hospital and clinic.

Now, for the first time, I’m actually embarrassed to say I’m an MUA student.

Also for the first time, I’m realizing that working harder and smarter may not be enough.

My recent application to do an elective clerkship rotation at an unnamed program in an unnamed state somewhere in the Midwest was dismissed straight away because of where I went to school. Even after submitting my CV and Personal Statement, the faculty committee elected to maintain their new blanket policy of not admitting MUA students into their program. While the program director was very polite and nice and I appreciated their honesty and candidness, my initial reaction was to be embarrassed. Of course I am disappointed — and that felt natural — but I was surprised at how embarrassed I felt.

How can they know I’m not good enough for their program because of where I went to school??

Upon further reflection, I’m not entirely disappointed at the way things turned out. The program is in a pretty remote area without a lot of other programs available for Brandon to choose from when he matches in 2012. During this residency application and interview process, I know that having certain doors close will be as important as others opening in determining the best place for us to end up next year.

Still. How can they know I’m not good enough for their program because of where I went to school??

The answer to that question makes me nervous as I prepare to submit my residency application to a variety of programs in a variety of states. How many other program directors and faculty committees will dismiss me straight-away without a second look because I went to MUA? How many places won’t even give me the chance to provide a second (or first!) impression?

I guess we have to believe that the Perfect Program (both for me and our family goals) will be looking to fill their program with students based on individual merit and personality, not stereotypical stigma based on poor performance by previous students.

I guess we have to believe that we’ll end up exactly where we’re supposed to be.

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photo: Brandon and I in our sparkling new short white coats, full of optimism on Nevis after completion of Basic Sciences.

… in a word (or actually three): can be hard.

I’m disappointed that I have encountered several areas where previous MUA students that have “gone before” have made life more difficult.

Exhibit A: The current rotation I’m on was very nearly closed to students permanently because the last student that rotated through was horribly unprofessional and uninterested. He didn’t show interest, didn’t show knowledge and didn’t even show up! We have several med schools in this area with students from all over. Where was this particular student from? MUA!

Granted, Interventional Pain Management isn’t for everyone, but there is an interesting mix of neurology and anatomy with a wide variety of clinical patient encounters and in-hospital procedures to keep anyone on their toes for a mere four weeks.

Plus, it’s an elective. If you’re not interested in it, do something else. Simply punching the clock late in your 4th year because you want to finish electives and don’t really care what you do is NOT the way to go about it. Your actions (and inaction) affect more than just yourself.

And I don’t think most MUA students really realize that.

Exhibit B: I am currently trying to arrange a 4th year elective clerkship with a (super secret) program somewhere in the Midwest. The polite response to my email inquiry was to ask what school I attend. Apparently the program adopted a blanket rule this year and only accepts students from LCME/AOA/CA accredited schools for clerkship rotations. When did this rule pop up? Sometime after two MUA students rotated through!

Are you kidding me??

The stigma against Caribbean medical schools is dramatically receding every year. One of the attendings I work with said the majority of residents in his anesthesia program in Florida were from foreign schools and they all worked very hard. Harder than their American counterparts. Most of us work hard because we know we have to (especially to land a competitive anesthesia residency) and the rest of us work hard because we want to make the most of this opportunity to follow our dream.

And yet, I’m not advocating that everything you do should take into consideration other students around (and months behind) you. It’s okay to be selfish and make choices that help YOU get the most out of the thousands of dollars you’re paying for med school. It’s your money, your reputation and your career. The main ingredient that seems to be missing is integrity.

Thankfully, there are many students from MUA that swing the balance in the other direction. We have a lot of hard-working students that want to become great doctors and I am proud to call them my classmates and friends.

Still. What is it about that one rotten apple that can spoil an entire barrel?

It’s Friday and my attending is performing procedures in a tiny rural town south of the city.

Which means it’s 11am and I’m still at home. I guess this should sort of feel like a “day off”, but I am knee-deep in three projects and hoping to finish two so I don’t have to work on them over the weekend.

1) Opioid-Induced Hyperalgesia
This is a biggie project (complete with fancy PowerPoint slides!) that I will present to the attending and his entire staff at the end of the month. As an Interventional Pain Management team, they obviously get a TON of requests for prescription narcotics. Hyperalgesia is literally a hyper-active response to pain and a well-known side effect of chronic opioid use. The attending I work with does not prescribe narcotics and refuses to promote their long-term use for pain due to the many side effects that end up clouding the clinical picture and making things worse.

2) Peripheral Neuropathy
This is a mini-topic that I presented yesterday and have to prepare a (hopefully non-boring) single-page write-up for. As a downtown hospital in the Midwest, we see a ton of diabetics, alcoholics, and homeless people with poor nutrition: three very common causes of nerve disorders.

3) Complex Regional Pain Syndrome
Another mini-topic that I presented last week, CRPS is a confusing and devastatingly debilitating disorder. Patients present with excruciating pain in a single limb that is disproportionate to the inciting (often mild) event. They are often unable to bear the touch of even their clothes, socks or shoes without shocking pain. The pathophysiology is still mostly theoretical and unknown, making treatment a difficult moving target.

These projects reminded me of a couple of assignments I had while on my Family Medicine rotation last fall. Today’s photo is from a pamphlet i made for my FM attending when he asked me to read and present a little something on hair loss (two links there if you want to see the bigger versions). I also made one with Luke Skywalker and prostate cancer (again, two links to bigger versions).

In February, I started preparing myself to get ready to eventually take the USMLE Step 2. This meant I had to figure out how to pay for it and needed to sort out some name change details.

In the beginning of March, I paid for a couple months of review questions at USMLE World. At that time, I thought I was about 2 months out from the exam date.

In the middle of March, I shared with you my proposed 8 week schedule. I figured that with rotations still underway, I would have time to study for about 4 hours each day during the week and 8 hours on the weekend. I kept pretty close to that schedule and finished all topics and every USMLE World question by the end of April.

Closer to the end of March, I finally booked my Clinical Skills (CS) and Clinical Knowledge (CK) exams. Due to scheduling conflicts, I didn’t get CS as early in May as I’d hoped and, in turn, had to push back CK a little bit.

And here we are nearing the end of May. I am taking the CS exam this Thursday in Houston. CK is almost exactly one month away.

Monday morning, I was supposed to show up for my first day of a 6-week Pediatrics rotation. Unfortunately, the attending isn’t taking on any students right now. I met with the Graduate Medical Education office here at the hospital and she shuffled up my electives to round out the summer for me. Basically, I will be take three electives (nephro, pain management and neuro) instead of two electives and one core. The time fills up pretty much the same and still gives me ample room to breathe after baby arrives in the fall.

But! Back to the study schedule! That exam is looming hard and fast.

All of my academic advisors keep telling me that my Step 1 score is “okay”, but I need to “do REALLY WELL” on Step 2 to improve my chances of matching in the spring.

Okay, then.

Even though we have a baby on the way this summer, at least I’m not planning a wedding or anything.

I need a job next spring. And if I need to “do REALLY WELL” on this exam in order to get that job, then so be it. I haven’t worked my butt off in awhile and I’m sure it could use the exercise.

And if I can’t take time off from school, I should probably take time off from the internet.

Have a great month! Seeya in July! xoxo

PS: I will continue to log my weekly pregnancy updates and will publish them when I get back. If you need to reach me by email, I am hoping to check-in once a week.

previous rotations: Obstetrics & Gynecology, Family Medicine, Internal Medicine, Surgery

daily schedule:
9am – 5pm

actual daily schedule:
9am – noon-ish on quite a few days (this was SO helpful to my Step 2 study schedule)

what to wear:
Professional. White coat was optional at the centre I worked at, but I wore it anyway.

what’s in my pockets:
I didn’t use my pockets for anything other than lip gloss and mints. I did bring a book bag full of study materials for in-between downtimes.

patient notes you will be asked to write:
The centre I worked at had converted almost entirely to electronic records. I didn’t write any notes on this rotation, but I did do a lot of patient presentations.

what to study:
Kaplan and Saddock’s Synopsis should be your bible.

a few unforgettable things learned along the way:
In Oklahoma, mental health facilities are prohibited by law to house or treat patients with mental retardation (MR). The (probably correct) justification is that the MR patients often end up as victims. But when the department of health services is dragging their heels to help a family with a violent autistic adult in their home and they just can’t take any more abuse, where does the family turn? And how can a Crisis Centre turn them away?

curious things other students do:
I was the only student on this rotation. I guess the most curious things I did were to consistently show up on time, offer to stay late, ask questions that I actually thought about and couldn’t find the answer just by looking in a textbook, and try to show interest in a specialty that otherwise didn’t get my biological med school clock ticking. I want to go into primary care and it’s unbelievable how many of these patients (substance abuse, depression, etc) will first present to their Family Med doc.

Hopefully we can help them before they end up at the Crisis Centre.

As I was selecting tags to categorize this post, I realized I can rarely write about money without also including school (obviously), marriage, and family. Our families have been such a huge support through our med school careers that I can’t thank them enough for their generosity.

Many of you have been following this blog since I first got into med school (and before) and you have been an awesome source of support and encouragement over the years. Some of the toughest and darkest times for me come around — not when a big important exam is looming — but when threats of money woes and funding cut-offs rear their ugly heads. I hate worrying about money. HATE it. Hate it more than just about anything else. I know that’s easy enough to say because I have more health and happiness than I know what to do with, but I would rather worry about almost anything other than money.

Since so many of you have been such awesome cheerleaders, I thought I would give you a quick update on the money front and how we’re getting closer to that graduation goal. The story is a little rambling, but probably similar to the way I would tell it to you over coffee (decaf) or cocktails (virgin).

A couple of months ago, Brandon was turned down for the first time for student loan funding from our school. After guarantees from the school that funding would be available and receiving money for five semesters, we were a little surprised and taken aback. What now? Even without thinking about rent and cost of living, we were automatically $40,000 short for Brandon’s next 4 semesters.

Last month, my mom went into our local bank branch to pay my tuition. I was about $30 shy and she topped off the $10,000 for the rest of this semester. The bank teller knows my mom (and me through her) very well and was surprised that I was so short of cash for tuition. “She should really re-apply to extend her student line of credit. She’s $40,000 short of what Canadian students receive! I don’t know why she wouldn’t be approved,” the teller told my mom.

We applied for that money and were turned down last summer. The bank told us they changed their policy and no longer lent money to Canadian students that were attending schools outside the US and Canada. Without an eligible co-signer, I was stuck. Why would we apply again this year? What could possibly have changed?

Thankfully, right around the time the bank was turning us down last summer, I qualified for the maximum amount of student loan funding available from the Canadian government — just over $20,000 — enough to pay for two semesters of tuition without touching the cost of living. My mom and dad sent me money when they could and I put it all into a savings account. When the third semester’s tuition came due in April, there was almost $10,000 in there. Just about $30 short of what I needed. How amazing!

So, while my tuition has been paid for, I haven’t been able to contribute to household expenses or rent. And I haven’t had any sort of personal cash flow, which I hate to admit drives me more than a little crazy. Brandon does an amazing job taking care of his family (rent, internet, gas, electricity, dog food, gas, Twizzlers) with his MBA student loans and part-time-job-with-overtime-hours at the Halfway House. I had a job for a little while writing for an online search engine company, but without a US social security number they could only pay me for up to $600 worth of articles. I made as much money as I could with them and they cut me loose telling me to “keep in touch when your green card is approved because we love your consistent and reliable writing!”

Which brings us up to this month:
- Brandon is short $40,000 for his tuition.
- His parents check into getting a second mortgage on their house.
- MBA loans and overtime hours keep us fed with a roof over our heads.
- 2010-2011 Canadian student loan applications are coming up in June and will be disbursed in August.
- I hope to be approved for another $20,000 from Canada student loans for my final two tuition payments.
- Our next tuition payments are in due in August ($10,000 x 2).
- The 4Runner needs plates in July ($1000).
- I am eligible to apply for a Permanent Residence card ($1000).
- Med school residency applications open in the summer ($750).
- I will have to travel for interviews in the fall ($??).
- We have a baby on the way ($?!)!

Aaack.

Sounds fun, no?

So, when my mom mentioned her conversation with the teller and how “it couldn’t hurt” to apply again, I was all ears. What did we have to lose? I mean, really. Right now our best hope was buying Powerball tickets.

I re-applied for the extension on my student line of credit. I was paired up with the awesome account manager that had to deliver the bad news of rejection when she worked with me on the very same problem last summer. She is pretty amazing. If you’re in Saskatchewan and need an RBC Account Manager, I know just the gal! This time around she sounded insanely busy, but got my application rolling with just a verbal confirmation over the phone.

Two weeks later, she faxed me documents that required an official signature because we were APPROVED!

I didn’t quite believe it fully until I saw the change in my online banking statement.

Credit line available funds: $40,000

I think it’s pretty amazing that we were approved for the exact amount Brandon needs to finish school. Unfortunately, it means I still can’t contribute to household expenses or go out shopping for new dog toys, lawn chairs and bedding plants, but we got what we needed. And the way everything always seems to come together confirms my belief that we are on the right track.

Two days I will be heartily celebrating in the next year:

1) December 2010 – The FINAL tuition payment
10 semesters at about $10,000 each (give-or-take a bit with the CDN-US exchange) is a big chunk o’ change.

2) July 2011 – My first PAYCHECK since June 2004
7 years of lost wages at the salary I was making when I quit the video game industry is around $350,000 (not including bonuses or raises). Toss in extra debt for my undergrad years and that puts me at least $500,000 behind where I would be if I hadn’t decided to go back to school.

Yah, people become doctors to get rich. Right.

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photo: From a billboard in Vegas. Taken during a trip with Christina and Carol in 2006.