First Impression of Richmond, VA

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The James River winds through Richmond, VA and serves as the city’s playground. On a sunny day you’ll find folks lounging on river rocks; testing the rapids in rafts and kayaks; and biking, walking, and running on the riverbank trails. From the numerous walking bridges across the river, you can watch osprey dive, great blue herons fish, and geese and ducks eat bottoms up.

When you turn away from the river you find yourself wandering along streets lined with old brick buildings including row houses and factories-converted-to-apartments. Murals are scattered throughout the city. Parks and green spaces are more numerous than tall buildings.

Downtown Richmond is quiet. There isn’t much traffic – even at the peak of rush hour the traffic is manageable. There’s a boarded-up window or “for lease” sign every couple of storefronts on the primary street at the heart of the city. Neighborhoods with different vibes sit like cars on a Ferris wheel around Richmond’s often sleepy downtown.

Richmond could be called the city of highway sampling. Numerous highway bridges crisscross through the city. Under these bridges are blocks filled with restaurants and parks. When you use Google maps to navigate almost anywhere in or around Richmond, you’ll find yourself driving on several highways for less than 1 minute each.

Richmond is easy living. It’s urban enough that there are big name shows yet it is quiet enough that you can often hear birds singing. Without many tall buildings, Richmond feels more like a large town than a big city. I suppose “big city” is relative. I like having a 6th floor apartment that feels like a penthouse because a 6-story building is tall in my neighborhood.

From my mini balcony I have a lovely view of the sunset. From my apartment windows, I can watch the numerous lightning storms that come from the south-west to dazzle the city. I guess living in a hot and humid place leaves ample opportunity for any cold front to make the air zippy-zappy. I’ve never seen so many lightning storms in such a short period as I have living here.

After about 3 months in Richmond, I’ve found my favorite ice cream place and some go-to walking routes. There’s still a lot left to explore and learn about the city, but it already feels like home. It doesn’t usually take me long to settle in a place, but Richmond was an especially easy transition.

This Is How I Started Residency

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Starting residency was like a flash flood. Beginning from the first day, I was overtaken with more work than I knew what to do with. As a new doctor in a new healthcare system, I found myself equally challenged by creating care plans for my patients (like deciding which medications to prescribe them) and implementing the plans my supervising doctors and I devised (like ordering medications in the computer system). I completed tasks more slowly than I imagined possible. My patients were well cared for because I was part of a team, but my work hours lengthened in a way that the saying “burn the candle on both ends” was created to describe.

All of us headed to residency (regardless of specialty) are warned that it will be challenging. Each person experiences different challenges and different low points. Residency is hard for everyone because the hours are long and there’s a lot to learn. So, when my work hours exploded like water through a broken dam, I wasn’t surprised. I was surprised by how my program responded.

As my hours lengthened to a point where I was exhausted and just barely surviving, my chief residents stepped in to help me develop ways to become more efficient. Senior residents observed me throughout a shift and offered advice on how I could streamline my workflow. People on my team and other teams helped take some tasks off my plate so I could focus on learning the computer system better and on writing patient care notes quicker. I was given a little extra time off to catch up on sleep because I was on track to work far more hours than permitted by the national governing body that oversees US residency programs.

At first the extra help and attention made me feel like a failure. I tried to keep my spirits up because I’ve struggled to overcome big obstacles before; I always learned more from those experiences than I did from experiences where I didn’t struggle. Similarly, past experiences have shown me that it’s okay to accept help. Still, I wondered if I was going to learn enough or as quickly as I should if people helped me more than some of my peers. I wondered if I’d get better at being a doctor.

On my extra time off I reviewed my senior residents’ feedback. I reorganized my view of the electronic health record system to make it easier to access all the information I knew was important. I took time to recharge. When I returned to work, I was still a new doctor. I hadn’t changed much from the days prior. Yet, I found myself checking things off my to-do list without the help I’d required before my recharge day. With a little more sleep behind me, I was able to see how much I’d learned in my previous days of working – something I hadn’t noticed when I was exhausted.

As I reflect on my first two weeks of residency, I don’t look at them fondly. I do think that I’m a tiny bit better at being a doctor now than I was two weeks ago. I appreciate my past self for prioritizing a work culture of support and collaboration when applying to residency. I know that there are many hard days to come before residency is over. However, my experience during these first weeks made me confident that I will be able to overcome future hard patches when they come – not completely alone, instead, with a program supporting me as I find my path forward. Feeling like my residency program genuinely wants to help me become the best physician I can be gives me confidence in the residency training process and makes me excited for who I’ll become by the end of it.

This is how I started residency. The future will tell how I end residency.

Bones on the Trail

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Each year, July 1st is the infamous day when new doctors who just graduated from medical school (called “interns”) start taking care of patients for the first time as physicians. This year I’m among these new doctors. It’ a momentous day for the interns because it’s a huge milestone and a huge transition. Some words that come to mind in anticipation of the experience are “excited,” “terrified,” “happy,” and “ready.”

I’ve been mulling over what I think about starting residency. As I’ve reflected, a story from a hike I did in New Mexico came to mind. I think it captures my mixed feelings of starting this phase of the Doctorhood Quest.

New Mexico, June, 30, 2021

My partner and I arrived at our lodging place in the late afternoon so we had just enough time for a short hike but not so much time that we could dillydally. We looked up some nearby trailheads and settled on one just down the road. We were staying in a flat valley lined by near mountains on one side and far-off mountains on the other. It was spring so even though there was no mistaking that we were deep within the New Mexico desert, the shrubs were as green as they could be. The cactuses were blooming.

We started off walking across the flat valley floor following a road through the shrubs. We stopped often to take pictures of the desert flowers that lined our path and kept a lookout for elk because there were many in the area. We laughed and joked and chatted as we often do when hiking. Our mood ranged from jolly to ecstatic. The beige and browns of the dirt and rocks contrasted against the blue sky; sage-green shrubs and cactuses; and yellows, pinks, reds, and purples of the flowers.

The road neared the bottom of the mountains and narrowed to a wide footpath. We didn’t know the trail, but we had a GPS map and a general sense of the trail’s course. We were timing ourselves to ensure we turned around with time to get back to our car before complete darkness. We knew before starting that we wouldn’t be able summit if we wanted to be home by sunset. It was our first hike together in New Mexico, the western US states, and mountain lion country.

We wanted to have fun while also exercising caution. We’d learn later that trip exactly how scary things can be in the big mountains, but that would be a lesson learned on a different hike. We were experienced hikers, but we’d primarily hiked in New England and never in the western US (except as children under our parents’ watchful eye). The short mountains of the northeast are different beasts than the giants of the US west.

As the trail narrowed, we entered the woods and left behind the shrubs and flowers of the open desert. We soon crossed a small stream. There, on the far side of the stream was an elk carcass in the middle of the trail – it was mostly skeleton, almost picked clean. We paused and became quiet. The bones were a reminder that there were big predators in these woods. We debated if we should continue and decided we would. We stayed loud and watched our surroundings more carefully than before. We were especially attentive to our timing and made sure we got back to our car before darkness fell.

We had the skills and knowledge foundation to successfully complete the hike. The difference was the terrain and responsibility/higher stakes that came with a more complex hiking environment. Hiking in new, more intense territory isn’t such a bad analogy to becoming a resident after being a student – just like with hiking, as a resident I’ll draw on previous skills and knowledge as I take on more responsibility and learn more about my craft.

Yes, I Can

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I listened to a song about a job interview that went poorly on repeat while I struggled to complete a new workout that I’d written for myself that day. Perhaps the song about the interview resonated with me because I was in my own transition or, perhaps, I just liked the beat. The workout would have been easy for certain versions of my past self. However, recently I’d led a life that didn’t involve intense workouts like this one and, so, the workout was challenging me. “Back to the beginning,” I thought.

I couldn’t ignore the metaphor of my physical fitness and learning medicine because the parallel captured the sentiment I’d been hoping to write about as a reflection of what, exactly, medical school had been like in a broad sense. I’ve had a few months between finishing my medical school classes and starting residency. It’s been a time of celebration and doing things I didn’t have time for during school and won’t have time for during residency. I’ve also taken time to reflect on my medical school experience. “What exactly was the utility of medical school?” I’ve asked myself often during these months of the happy stillness between.

You can guess what medical school was like on a superficial level – it was school. I spent hours studying and hours listening to people instruct me on all kinds of things. I spent more hours practicing skills as varied as suturing cuts shut in the operating room to writing patient medical notes. I attended lectures, engaged in simulated patient interactions, and I worked with real patients and physicians in real hospitals and clinics. I took written exams of various lengths that were proctored by various organizations. Through these actions I learned how the body works and breaks and how we try to make bodies function better with medications and interventions like surgery.

Yet, while learning about the body and how to improve health was the backbone of my medical school learning, it wasn’t the heart of it. The heart of medical school was the exercise of continually starting at the bottom, a place of not knowing much, and climbing to some place of better understanding. Medical school is a lot like the process of doing a hard workout after not working out for a long time and being unable to finish it, then engaging in a few weeks of intent and thoughtful exercise, and finally being able to do the original workout and more.

Medical school taught me that I can learn anything with time and effort. The hardest concepts can be cracked. The first year, I struggled to understand how the body worked. The second year, I expanded my knowledge from how the body worked to how it can go wrong and what we can do about it. Then, years three and four, I learned more about how different specialties in medicine address different diseases and injuries. Each year built on the year prior and then expanded beyond what I knew to things I didn’t yet know. Each time the curriculum expanded I felt like I was starting over. Much like starting in the beginner exercise class and working my way to the advanced class…repeatedly.

I bet you’ve had the experience of riding the rollercoaster of being excellent then falling to subpar and then, through sheer will, climbing to a place of excellence again. And if you have experience doing that in any area of life, then you can imagine what medical school is like. Because it’s just like that. Every month or so you start at the bottom of one area of medicine and climb to the top just to fall again and start the process all over in a different area of medicine.

Medical school is an exercise in being mediocre with a drive to be extraordinary. Each lesson helps move your personal dial from mediocre to better, but there’s a catch. Medicine is founded in science and research and, as such, it’s forever expanding and changing as we (humans) learn more. And so, there is no possible way to ever know everything. To be a physician is to be forever learning while also mastering the knowledge that you explored before. There is no end to medicine, no time when you can’t get better.

Medical school taught me that I can learn anything while I can’t know everything. It taught me not to be intimidated by an obviously hard road, but to take it one step at a time just like I take my plank exercises after a long time not engaging my core. Medical school taught me that experts are built with time and effort. It also taught me that experts remain humble and equally aware of the things they know and the things they don’t know. Medical school taught me that I can do whatever it is I choose to do if I’m willing to put in the effort. The heart of medical school for me was learning that when faced with a challenge to think “yes, I can” instead of “maybe it’ll work out.”

They Said It Would Change Me Forever: Now Almost 10 Years Later

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I recently returned to Paraguay after 5 years away – COVID delayed my return. It’s the third time I’ve been back since finishing my Peace Corps service there. I also realized during the trip that 2024 will mark my 10-year anniversary of first arriving in Paraguay as a just-starting, excited, and (yet) terrified volunteer. What I remember most about the pre-departure materials and pre-departure orientation speakers for the Peace Corps is how often they said that my service would change me forever.  At that time, I thought their message was a bit sentimental and dramatic.

It would take 27 months for me to understand how right they were – aka it took exactly the duration of my Peace Corps service. I remember returning to the US after more than 2 years away and realizing that the person who lived in the US before (pre-Peace Corps me) didn’t exist anymore.

When I returned from Paraguay after my service, US life hit me like an overloaded moving truck. There were glorious aspects such as being able to throw toilet paper in the toilet rather than into a trash can next to it, no days without running water or power, and not having to run around to unplug everything at the start of a rainstorm in case the power surged. Yet, there were also terrible things about returning. Perhaps the worst was that I lost the community that I’d built over the years, which had become central to my life. I transitioned to a cold region of the US where few people spoke Spanish – two things that made me sad because I find joy in the sun (and its warmth) and the interesting way that Spanish captures our thoughts.

Now having had a decade to think about my Paraguayan self and my US self, I’ve come to understand how the Peace Corps in Paraguay changed me. Thinking about it, I’m not remorseful if I sound a bit sentimental and dramatic because, perhaps, I’m appropriately both of those things.

Having just graduated medical school I can say with a certain amount of pride that my Peace Corps service remains the hardest experience of my life as well as the period where I learned the most (more reflection on my medical school experience to come in future blog posts). This may be because my Peace Corps service came first so I applied what I learned from it to my medical school experience, but I suspect that the challenge the Peace Corps poses is unique and may still have outcompeted medical school even if it came second.

I should clarify that hard doesn’t mean miserable. By “hard” I mean an experience that pushed me to problem solve frequently and on the fly, find new ways to tackle obstacles because every known way didn’t work when I applied it, challenged me to revise and revisit ideas, placed me face-to-face with my own preconceived notions so that I could consider how they may not be absolute truths, forced me to define my values, and required me to look inward both to reflect and to find strength.

When I say “learned the most” I don’t mean I sat and studied all day (I did do that sometimes in medical school though). What I mean is that finding a way to navigate two second languages (Spanish and Guaraní) and to operate in a culture that wasn’t my own required unlearning, relearning, and new learning behavior, vocabulary, customs, traditions, and systems that may have been similar or completely different form my native equivalent and may (or may not) have been in line with my belief system.  

The Peace Corps in Paraguay stretched me to look at things differently. It forced me to decide what parts of myself I was willing to give up to assimilate into Paraguayan culture and what parts I would keep even if they accentuated my otherness. Living in Paraguay was a give and take between, on one hand, being open to new ideas and experiences that required flexibility because often situations were unpredictable or not completely understood and, on the other hand, defense of individual needs and goals that did not fit nicely into Paraguayan life.

The experience of navigating conflicting parts of daily life in Paraguay and shifting self are what changed me so much during my Peace Corps service. It showed me that I have multiple identities that come together to form me and how the pecking order of those identities shifts depending on the situation and the activity I’m doing. Also, the amount of self-reflection I engaged in during the Peace Corps (both as a factor of my strange schedule there and as a byproduct of living in a different culture) is what made me who I am today. No time before or after the Peace Corps (so far anyway) has given me so much time to look inward and examine who I am and how that relates to who I hope to be.

When I returned to Paraguay after 5 years away, I was struck by how much I’ve grown since I finished the Peace Corps (and last visited Paraguay). I was surprised and content that who I am today (a doctor about to start residency) is still grounded in the self I created in Paraguay starting now almost a decade ago. When they said my Peace Corps service would change me forever, they undersold exactly how much. Even now, having done and achieved many things since returning to the US, I find my mind drifting back to those days in the land of the Guaraní as a volunteer and falling back on the strategies of perseverance I developed then to help me through rough patches now. These days, I remain skeptical when someone tells me that something will change me, but I also remain humble and open to the possibility because Paraguay taught me that one experience has the capacity to change everything. 

What do you want to be when you grow up?

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“What do you want to be when you grow up?” one of my Paraguayan friends, who used to be my student, asked during my last visit to Paraguay.

I paused a moment before answering. I was surprised by the question because he and I don’t often talk about abstract things and because I’ve been feeling awfully grown up recently. “A doctor,” I said.

“That’s it? You don’t want to be a diplomat or someone rich or famous?” my friend asked.

“Nope,” I said.

“Oh, that’s cool,” my friend said. The conversation continued as I asked him about what he wanted to be when he grew up and we discussed more details of what I hope to do as a doctor.

I graduated from medical school on May 21, 2023. I received my resident medical license yesterday. I’m officially an MD! All that remains between me and practicing independently as a physician is residency (and fellowship if I further specialize).

People like to say “it’s hard to believe” when they achieve a particularly hard goal like graduating from medical school. But, let me tell you the truth, I don’t find it hard to believe that I graduated medical school. Why? Because I was there every minute that I studied at my desk and learned how to care for patients in the clinic and hospital. I read every test question and picked an answer. I showed up on time, managed my email inbox, pestered school administrators to get answers, and did voluntary projects to expand my learning beyond the medical school curriculum.

Becoming a MD is a lot of work; I did the work to earn my degree. Becoming an MD is also an amazing quest. I was excited when my patients were cured, I was humbled that so many people allowed me to take part in their journey to death or to better health, and I loved uncovering the mysteries of how the body works and what medicine can do. I’m grateful for every person who helped me along the way – from my family who cheered me on to the patients who let me care for them, from my classmates who struggled and soared beside me to the numerous physicians who taught me. I did the work, but becoming an MD takes a village. There were many people in my village who were my heroes and who guided and supported me as I journeyed through medical school.

The last months of medical school left me feeling awfully grown up. Grown up in the tiring kind of way. My friend’s question helped remind me how much growing is left. And how, somehow, I’m lucky enough to be growing while building my dream. Next stop on the Doctorhood Quest, residency!   

The Happy Stillness Between

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I find myself sipping mate and gazing over my desk and plants out at a new skyline. Several days ago, I moved to Richmond, VA from Danbury, CT. The move was a grueling 28-hours of loading the truck, driving overnight, and unloading the truck. My partner and I took only a 30-minute nap to get us through the driving, knowing that there are an infinite number of less tiring ways to move, we wanted it done as quickly as possible. Our main hiccup was finding a way to navigate the ~400 miles along the East Coast on highways that allowed trucks because our U-Haul was quite robust. We learned that there is no setting on Google maps for truck routes. Luckily, we know how to read maps despite the prevalence of technology in our lives and found a route using our brains, yes unusual.

We’re mostly unpacked now, just a few more projects to do before we will be completely settled. We’re chipping away at these tasks, such as hanging paintings and donating no-longer needed items. Knowing our apartment is in a good place, my focus has shifted to the next adventure. Later this week we travel to Paraguay to visit my friends there. It’ll be my partner’s first time to the country where I did the Peace Corps and where my mind always wanders when time slows. Slow as it is now.

Medical school, at least as it is organized at my school, is a sprint that comes to a halt not at graduation but at Match Day, several months before graduation. It’s not a bad system. It leaves time for vacation and residency onboarding tasks while also giving us students a moment to enjoy non-medical pursuits before we plunge into the rigors of residency. But, when one is accustomed to a sprint too fast to breathe, as those of us in medical school are, the slowness of these days between Match Day and residency is as strange as a journey to a new, very different country. I’ve read more books for fun these past few months than I have in years. I’ve hiked and slept and pondered life. I started baking again, something I hadn’t done since I returned to the US from Paraguay in 2016. I’ve planned trips and moved.

I wanted to come to Richmond early, many of my peers won’t move to their residency locations until weeks prior to our start date this summer. I’m a person who centers at home, regardless of how new the home is to me. I like moving, but I also like time to settle before I’m expected to excel in life pursuits. I like time to find the grocery store and walk the neighborhoods that’ll be my stomping ground. Yesterday I did both of those things – I found a grocery store which had nice spinach (the primary way I grade grocery stores) and I strolled through a giant cemetery not far from my house with trees that had new, full leaves and singing birds.

It’s beautiful in Richmond and the politeness of the South is a welcome kindness after living in New England for years. New Englanders don’t, for example, say “hi” when you pass them on the street in a city or let you cross the street without threatening to run you over, even though there’s a red light for oncoming traffic. I’m too new to Richmond to have major complaints, but so far, the things that bothered me in Connecticut aren’t present to the same extent. I do admit, I’m not used to having streets named after important people from the Confederacy. I don’t yet fully understand how those imposing names from the past will impact my life though I know they already do and will in new ways here.

Richmond is green and quiet for a city. My apartment is high up without taller buildings around it. It has ample windows. What this means is that I’m surrounded by sun and have a stunning view of the sky. My few days living in Richmond have taught me that it’s a place of expressive skies – which is something I always loved about Paraguay too. The clouds cross the sky with bright colors and exciting shapes. The morning, afternoon, and evening look different in the clouds and sky of Richmond. My apartment, specifically, has a magnificent view of the sunset.

I lived in Washington, DC for 6 years before I did the Peace Corps. And while Richmond is distinct from DC, coming back to the DC-VA-MD area feels like returning home. I’m happy to be back. I’m happy to have arrived when the weather is absolutely perfect, just before the humidity and heat of the summer set in. I have about a month to explore Richmond before I start work. Richmond feels completely different from Vermont or Connecticut. I’m happy to uncover the opportunities hidden in this new place. Opportunity to learn to be an excellent doctor but, also, opportunities to explore life beyond medicine. I’m excited to reconnect with the urban passions I have and to find new ones that suit me in a green, urban home. And small mountains aren’t too far away in Shenandoah. I’m grateful for the slowness of these days so that I can sit with my happiness. Life has taught me that, much like sorrow, complete happiness is fleeting. So, I’m pleased to have time to revel in this happiness storm until the next emotion rolls in.

Goodbye Danbury, CT

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I rose before the sun because that’s what I like to do sometimes. I looked out the window as I sipped my mate. The horizon over the buildings on Main Street slowly changed from black to blue to gray to yellow. I surveyed my plants which sat merrily between the window and me. I watered the dry ones and sipped my mate a little more. I could tell from the sunrise that the day was going to be sparkly and sunny. It was a slow morning, so I didn’t load my backpack into my car while it was still dark to go to the Catskill Mountains as I might have a different day.

Later in the morning, my husband and I crossed Main Street and went to our favorite café in Danbury. They served delicious guayaba pastries and a very good breakfast skillet. Later, I walked down Main Street, which was lined with family-owned businesses. I passed my favorite corner store where I could buy all the ingredients to make chipa. I then passed my favorite Danbury restaurant – a Peruvian place that served ceviche and had the most colorful murals depicting the collision between a traditional Peru and a futuristic one. My favorite mural included a llama and a UFO. Next came the public library where my husband so reverently got a library card as soon as he moved here; his love of libraries comes from his mom, and he takes library cards very seriously. I turned up a side street and walked by the newish office of a nonprofit I’d worked with for a few years. They did many things, but in our work together we strove to increase health literacy among Spanish speaking communities. I then turned up another side street. This street was lined with giant, fancy houses. There were also flowers along the way.

I continued my walk through the streets to a large park. I climbed a small mountain (perhaps better called a hill) and stopped at the lookout. The view was especially good because the leaves weren’t out yet. I saw Danbury spread before me. I could see the hospital where I’d spent the last few years training as a medical student. I was done with my studies there and was preparing to move to a new city for residency. It was odd to look at the hospital from this vantage point at this stage in my medical training. I did this same walk shortly after moving to Danbury. That first time, I remember being so excited to see the hospital view which then foreshadowed the learning I would do there. It seemed that both a million years and only seconds had passed since I first saw this view of the hospital.

Medical school was consuming. Yet, the years I lived in Connecticut and the year I lived in Danbury were filled with many non-school endeavors not limited to having ice cream from many different local shops, exploring the abundant water features in Connecticut’s parks, and trotting more than 100 miles of trails in parks surrounding the city. As I reflected on my years in Connecticut, the sun twinkled around me. I dwelled on my mixed feelings of on one hand being excited to move and to start a new adventure while on the other hand being sad to leave Danbury.

Danbury surprised me.  I didn’t know anything about it before I moved to Connecticut to do my clinical training. The city quickly won me over. Danbury treaded a perfect line between being an urban region reasonably close to New York City while also being far enough from the big city to have many parks and proximity to natural spaces. Many things on my Danbury bucket list remained uncrossed off as I prepared for departure. And, yet, while life in Danbury could have continued, it felt like the perfect time to move. I wasn’t seeking greener grass, the grass was plenty green, just a new place with different opportunities.

There’s nothing fantastic about Danbury like The Mall in Washington, DC or Broadway in New York City. The small details and the community of Danbury held my attention during my time here. I liked the down-to-earth nature of the people in Danbury. I liked the brightly colored murals that dotted the buildings along Main Street. I liked that I could easily find empanada shells, plantains, and all the ingredients for chipa. I liked that I heard many languages in the hospital. I liked that there were many different cultures represented in the parades I was never aware of ahead of time and always got caught in somehow. I liked the green spaces within the town. Thinking about leaving, I’d most miss the people I worked with in the city and in the hospital. I’d also miss having the Catskill Mountains nearby. Those mountains filled my soul with joy each time I hiked them.

I turned from the view of Danbury and the hospital and started walking down the small mountain. I’d started out this walk with the intent to reflect on my favorite things about Danbury and I had done that. Now, it was time to be present. It was spring. I’d done this walk so many times that I knew where to expect the skunk cabbage that was always the first spring plant in the wetlands here. It seemed right that as Danbury was coming alive with spring, I was preparing for my own new beginnings. I knew the seasons in Danbury well. I was curious how they’d compare to my new city many 100s of miles south. I knew they’d be different.

I smiled. I liked how sunny Danbury was and how mild the weather was for a New England city. “Goodbye for now, Danbury,” I thought as I saw a skunk cabbage near the trail. I noted the contrast between the sunlight and tree shadows on the leaves below my feet. I started back toward my Danbury home, not home for much longer but still my home that day. “Goodbye for now, Danbury,” I thought. I watched a robin hop near me. I loved spring in Connecticut.

6 Pieces of Advice for Just-Starting Third Year Medical Students

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Now that I know where I’m headed for residency and recently worked with some just-starting 3rd year medical students as a teaching assistant, I feel ready to offer a few practices that helped me through my 3rd and 4th years of medical school. Years 3-4 of medical school are clinical practice years and years 1-2 are academic years, so the transition between the 2nd and 3rd year is challenging for most students.

My survival tidbits aren’t profound, but survival isn’t that profound either.

In no particular order:

  1. Use a sunrise light alarm clock. You’ll be surprised how waking to light transforms even the grimmest before-sunrise wakeups.
  2. Have a pump-up song and listen to it as you arrive at the hospital each morning. Switch up the song as frequently (or infrequently) as needed to ensure it helps you put on your game face…every…single…time…you…enter…the…hospital.
  3. Work hard, do all your work and beyond, and then strive to leave if you aren’t needed. Of course, only leave if you’re done with your work and it won’t compromise your grade or learning. I call this practicing self-dismissal. You’ll have plenty of time to be in the hospital at all hours during residency and at least you’ll be meagerly paid then, so go home when you’re done during medical school.
  4. Fight for moments to eat if they aren’t given. Try to eat all the food groups, just like you teach your patients to do. I know eating properly seems impossible at times, but anemia and other diet doldrums will make learning harder.
  5. Periodically take a moment to remember why you went into medicine in the first place – it can be a literal moment. This is most important during those periods when you aren’t sure you will survive. You will survive and there’s a reason you went to medical school so try to remember it.
  6. During the busiest rotations you can’t sleep enough, see friends, exercise enough, and study… so pick the two most important ones each busy rotation. It doesn’t have to be the same two each rotation. Know that there are slower rotations where you can do all these things, but sometimes you simply can’t have it all.

That’s it. You got this.

At Long Last, I Know Where I’m Doing Residency

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Last time I wrote, I was waiting for Match Day (the day graduating medical students find out where they’re headed to residency). I’m now on the other side and know that I’m heading to Richmond, VA for internal medicine residency! I’m stoked!

Having never applied to residency before, I wasn’t sure what it would be like when I started the application process last April. Now that the year-long application cycle is done, the thing that surprised me most about applying to residency programs was how hard it was to decide which program/location I wanted to go to most. Let me explain a little bit about how the residency application process works to put my challenge into context. Then I’ll explain my process.

Applying to Internal Medicine Residency

When applying for residency, medical students rank all the residency programs where they interviewed from their favorite to least favorite, and residency programs rank all the applicants they interviewed from their preferred to least preferred. Both the applicant’s list and the program’s list are called “rank lists” because they rank their options in order of preference. Then, a computer program attempts to match the students with the highest program choice on their rank list and the programs with preferred applicants on their rank list – if you’re familiar with sororities then you’ll realize it’s the same system used to place new recruits in sororities.

There are many internal medicine residency programs each with multiple positions to fill, so entering internal medicine is less competitive than entering a specialty with fewer available residency positions (for example surgery or radiology). What this means is that, if they have between 10-15 interviews (the magic number that almost guarantees a match somewhere), US-based MD internal medicine applicants (like me) have a lot of control over where they go for residency. According to my research, most US-based MD students will end up in one of their top 5 internal medicine residency choices. So, I knew the order in which I placed the top 5 programs on my rank list had a large influence on where I’d end up for residency.

Challenge of Forming My Program Rank List

Having the above background, here’s my processes for creating my rank list (realizing every medical student has their own process). You might think that the programs (themselves) would have enough unique features to guide how I ranked them. However, the more I researched and thought, the more it seemed that all my programs were more similar than disparate when it came to almost everything except location. Using program culture as gathered from my interview and academic rigor together, I was able to determine which programs I would rank in my bottom third (well below the top 5). I still had to put all the programs in order from my first to last choice with special emphasis on the top 5. In other words, I felt confident that I’d become a good physician regardless of which of the programs in my top two thirds I attended. I also came to realize that the location could potentially change the course of who I would become as a physician and my future life. This did not simplify things but rather made them more challenging.

Being a geographically flexible person, I interviewed with programs mostly on the West Coast and in the mid-Atlantic region (plus a few outliers) with no preference for one region over another. The geographic clustering came out of a long list of criteria I used to define the ideal place where I’d like to live and was how I determined which residency programs to apply to in the first place. As I continued to research after interviewing, I found that these same criteria (which I hoped to use to rank program locations) were often mutually exclusive. For example, I wanted a location with a diverse patient and physician population that was also close to mountains. My list of comparisons went in a similar fashion with all programs missing several criteria (just different ones). I realized the hard truth that I simply couldn’t have it all when it came to location.

“Great,” I thought. “I can’t have it all when it comes to location and I’m confident that any program in my top two thirds will teach me to be a good physician…Now how do I put them in order?”

Having exhausted external factors to rank programs, I turned to self-reflection on my personal values and how those values might be upheld in the different program locations. Reflecting on personal values is a funny exercise and it’s not one I’ve had time to do since starting medical school (however it was a large part of my life as a Peace Corps volunteer so it’s quite familiar to me). It’s an odd and uncomfortable place looking inward and trying to make sense of the thoughts and feelings zooming around your mind. It’s uncomfortable in a different way than standing in the operating room for 8 hours or getting up at 4am to go to hospital so you can see patients are uncomfortable. I felt lucky and privileged to be in a place where I had enough choice over where I’d go to residency to grapple with something like personal values as a key part of my choice, but it was still uncomfortable.

The curious thing about values is that they form the core of who you are and while they shift with time my experience suggests they don’t change dramatically. Despite going around in circles trying to decide how to rank residency programs, I found myself most valuing the same things that sent me to Washington, DC for undergrad so many years ago: weather, quality of life, diversity, and politics. (I also value challenge, but residency is always challenging so that wasn’t helpful). So weather, quality of life, diversity, and politics are what ultimately determined my residency rank list order. All that hullabaloo to decide on a program based on 4 things that have nothing (and yet, perhaps, everything) to do with medicine.

Like many things in life, I won’t be able to go back and see how attending a different residency program would change the course of my career and life. But, in addition to being thrilled with where I matched, I’m at peace knowing I had a chance to look inward before I cast my dice this time. I find that in America we spend a lot of time looking outward, yet often the answer comes from within and not from without. I try to break this trend and make space to sit uncomfortably for a while to find the answer within when it comes to big decisions. I was successful this time around.