Catching Up on Life / 5 Things You Thought You Knew about Residency

Posting about twice a year seems to be all the hard-working people at "Andrew Langfield Struggles" are capable of.  And I have a sinking feeling it's not going to get better any time soon.  Anyway, good to be back. Hope you all are well, and enjoying the holiday season.

So much has happened, it is definitely time for another life update.  Maybe some of you wish I'd just keep things focused on my failures in triathlon, but I have really enjoyed chronicling some of the medicine-related adventures on the bog here as well.  And as some of you may recall from last winter (or if you are like me and need a quick refresher), last time I posted, Elena and I were hot on the interview trail, having fun traveling, taking high-quality photos along the way and scheming up a fun way to post them.  Unfortunately I dropped my phone in a puddle in Rochester, NY in late December, and all my awesome photos from the interview trail disappeared.  I thought I'd be able to resurrect them, but just officially gave up on that effort about 5 minute ago.

A lot has happened since then, including a race back in May, believe it or not.  And not just any race, but the North American Pro champs race down in St. George, which is one of the more ridiculous ones.  But waaaay more significantly, things have moved along at an alarming pace in the medical arena.  The personal arena as well.  The first aim of this post is to bring everyone up to speed, so here goes:

Last spring - probably the best stretch of good, clean living I've ever had.

Zags in to the Final Four!

Raced down at St. George...

...then had an epic trip into Zion with E Phou.

Enjoyed the hell out of the rest of our time in Portland -
here with med school best buds at classmates' awesome wedding

Graduated...

...and moved to the East Bay for residency.

Another best friend's wedding late summer -
this time on Lopez Island with the college homies.

Then it was our turn!
Best day ever

Sun Valley for the annual fall mathering.

And then my sister finished off the wedding season.
She looked phenomenal, and so did my mom, and my wife.
Connor (new brother!) didn't look so bad either.

And now here we are.

Wow, in hindsight, a lot of weddings this year.  But long story short: Elena and I live in Oakland now.  They let us graduate.  We started our residencies down here in the east bay.  We got married.  We work and pay our taxes.  I swim in an outdoor pool!  One thing I don't do these days: train very much.  But that's the way it goes.  Comes with the job.  I tell most people that I only work on Tuesday mornings (which are suuuuper busy) and take the rest of the week to recover.  And while that may be true some day, I'm actually working slightly more than that at present.  But this seemed like a fun area for a blog post, which brings us to the second aim of this entry: correcting some public misconceptions of what residency life is like.  Because contrary to the impression you may have gotten from Scrubs, Grey's Anatomy, or House, it's not one big bag of laughs.  Or maybe ER was your show, with that young George Clooney?  It's not all dramatic misery either.

-Myth: We don't have any free time-
Reality: I actually get 4 weeks of vacation/year.  And amusingly, Elena gets 3.  Let me tell you, that 4th week makes a huge difference.  But that is still quite a lot of time.  Most people just starting out in new jobs don't get that many weeks off.  Now when we are working, yeah, it can be fairly brutal.  I don't really need to get into the details, but I hear it's a lot better than "the good old days," when residents had to take call every other night and rarely went home.  I learned that's why we're called "residents" - traditionally, the "housestaff" essentially lived at the hospital.  A lot has changed since then, and all things considered, I've still been able to train ~10 hours/week.  Can't complain.

-Myth: We don't make any money-

Reality: We make plenty.  We can basically buy as much ice cream (for me) and cheese (for Elena) as we want.  We live in a charming-ass cottage, and our lifestyle is quite lovely.  Occasionally I remember our loans, and then our salaries seem downright insulting.  But they are a problem for future Andrew and Elena.  Future Andrew and Elena will be super smart, and have no trouble taking care of those.

-Myth: Residents are running around the hospital unsupervised, making disastrous decisions and killing patients-

Reality: Both Elena and I are at programs that our renowned for their resident autonomy.  And even here, there has yet to be a situation where I haven't felt supported, or like I couldn't get help when I needed it.  There are always more senior residents and attendings around.  Residency is basically like an apprenticeship: yes, we are cheap labor.  But we are essentially getting paid to learn.  We are practicing under the supervision and guidance of physicians who are passionate about graduate medical education.  Every patient we see then gets presented and discussed by an entire medical team.  Which is why teaching hospitals and resident clinics are so great for patients: you are always guaranteed to have at least a couple doctors thinking about you.

-Myth: All patients get better, and return to their happy, satisfying lives-
Reality: Not trying to be a downer here, but the right diagnosis is often just the first baby step down a long road back to health, if not completely meaningless.  A lot of super sad stuff happens, and always to people who don't deserve it.  Which reminds me how incredibly lucky I am.  Even after the longest, worst days at the hospital, I get to hop on my bike and pedal home.

-Myth: Drugs are good for you, and offer a great way to be healthy and have fun-

Reality: Don't do drugs that are harder than you.  Better yet, don't do drugs at all.  You really shouldn't drink, either.

So what's residency like?  Like most things, I suppose it's a mixed bag.  Also like most things, it largely depends on how you look at it.  So far I think it's been pretty great.  I've seen so much already, and the learning curve has been ridiculous.  As improbable as it may seem, I can actually see myself coming out the other end of all this as a competent doctor.  In the meantime, life in the cottage is great, and I've been pleasantly surprised by the amount of energy I have to keep up with my hobbies.  And while the days can be long - and sometimes very sad - the work is rewarding, and makes me grateful for what I have.

So that's enough for now.  I could make some well-intentioned prophesy about when I'll post again, but we all know those rarely come to fruition.  I can say that there is at least one race on the horizon, as the California drought is over and Lake San Antonio is full once again: Wildlower 2018!  But will try to squeeze in another post or two before then.

Thanks for reading!
-A

Landing a Residency - Part I

Hope the first couple months of 2017 are off to a good start for everyone.  Been awhile here at Andrew Langfield Struggles, so thought I'd do a short series of posts concerning the residency match process.  Likely many of you reading are painfully familiar with The Match already, either from personal experience or from hearing me talk and talk and talk about it over the fall and winter.  But to those of you triathlon peeps to whom this is all quite foreign, thought it might be fun to shed a little light on the transition from med school to residency in the crazy world of American medicine.  I’ve been putting together a fun, photo-heavy entry with highlights from the interview trail, but first a brief intro.

The 4^th year of med school is hilarious.  Sure, you have to do some tough rotations, keep making the grades and passing tests.  But for the most part, you really only have one job: match into a residency program.  “The Match” is actually an extended process, and it takes most of the year.  Start pulling your application together in late summer, get things submitted exactly on time on a very arbitrary day in mid-September (and if you don’t, you’re late), travel to interviews all winter, agonize over your rank list for a month or two, then sit around and wait for another month to find out if you actually landed a position.  And in some final, archaic ceremony, steeped in rich symbolism and pageantry, every graduating student across the nation actually opens an envelope and reads a form letter – that had to be physically printed, stuffed and sealed into said envelope by a human being – that tells you where you are moving to start the next chapter of your medical training.  And this happens at the same moment.  Noon eastern, to be exact, which is 9 am here in P-town.  Nobody knows why it’s done this way.  I think tradition, mostly.  The only redeeming feature: this year, Match Day falls on St. Patrick’s Day.  So that should be fun.

Don’t get me wrong, I think the match algorithm itself is genius.  Nobel prize worthy, even (and that isn’t just my opinion).  Plus, by going through this process, you do gain some fascinating perspective on how physicians are currently being trained and health care is being delivered in this country.  But for the most part, it seems like a system that ran off the rails a long time ago, forcing applicants and programs to spend exorbitant amounts of money to pair up.  Depending on the specialty, most applicants will apply to 30-100+ programs in the hope of getting 10-15 interviews to ultimately match at a single program.  And if you’re entering the Match as a couple – as Elena and I are – you basically just double everything.  It’s not easy for programs either, as they now have to sort through thousands of applications and interview hundreds of qualified med students to fill the same number of spots.  As one program director put it: “We still have the same number of spots in our program.  But since we have to interview 4 times as many applicants now, it just means each person we interview is only ¼ as likely to come here.”

All that said, if you can keep the right attitude about it, the interview trail is actually pretty fun.  When else do you have an excuse to travel to Burlington, VT and Albuquerque, NM in the same year?  I’ve been to places this winter I never thought I’d make it to.  And even more fun is imagining what life would actually be like in these new towns, and if you can see yourself living there.  Internal (and family) medicine residencies are typically only 3 years long, and I hear that time goes by pretty damn quickly.  It brings some levity to the process.

So there’s a little insight for ya, probably more than you’re used to getting here at Andrew Langfield Struggles.  Hope you aren’t feeling confused, angry or otherwise deceived.  Next up: adventures from the interview trail.  Then Match Day madness.  Stay tuned.

-A