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

Canadian (mis)Adventures

2016 Season Wrap-Up

Well would you look at that?  No blog post in 5 months.  Pretty typical, I’d say.  I’ve come to expect very little from the people at “Andrew Langfield Struggles.”  They work hard, sure, but if you’re looking for timely race reporting, you should really look elsewhere.

But how about 2016?  Almost in the books, damn.  On the tri scene, it was a super fun year of racing for me.  I felt like I really put that “year off” of med school to good use, and was fortunate to get to 6 big events up and down the west coast.  I revisited a few favorites, and made it to a few new ones.  This post is meant to briefly recap the second half of the season, and provide a general round-up for the year as a whole.

As a few of you may recall, I started the season a bit earlier than usual, and with more racing.  Kicked things off down at Oceanside way back in early April.  A month later Elena and I took a 10-day road trip, with racing over back-to-back weekends: first at Wildflower with med school friends, then a bucket-list event over at St. George.  After making the long drive back to Portland, I was eager to absorb the early season race fitness and settle in for another solid block of training before the “main” part of my season.  And by “main,” I basically mean Canadian.

June, July, and August saw me racing one event/month, all of them up in beautiful British Columbia.  Started things off with my fourth and final 70.3 of the season, at Victoria with good friend Sean Haffey.  6 weeks later it was time for IM Whistler, the unofficial “A” race of the year, if you want to call it that.  Then finished things off with a relaxed trip to the Okanagan with best bud Sean Moran and a fun new race course at Penticton.  What did all of these events have in common (besides being hosted by our friendly neighbors to the north)?  They all ended with an absolute death march/drive-through-the-night/kill-or-be-killed/battle-of-wills down the I-5 corridor at 2 am, as Elena and I struggled to make it back to Portland to start our rotations on Monday morning.  But were they all totally worth it?  Of course.

Victoria 70.3

I will remember Victoria as “the race where I actually rode my bike.”  The swim course was truncated due to an overgrowth of some aquatic plant life (great news for me!)  But in addition, I also had arguably my best swim of the year, and came out of the water in 17^th position, within 60-90 seconds of most of the field.

Quick tea party with Yu in T1

In T1 I joined up with friend Yu Hsiao, and the two of us set out on the bike course ready to do some work.  While we are more or less equivalent swimmers, Yu is a much stronger cyclist, and usually puts up a few minutes on me during the bike leg.  I was feeling adventurous, and didn’t really have much to lose, so I decided to go with him as long as it felt like I wouldn’t explode.  At first things felt pretty doable, but he slowly ratcheted up the intensity until I eventually couldn’t hang.  Fortunately that breaking point didn’t happen until about 2 hours in, after we had covered most of the race course and passed about 5 dudes.  Instead of the usual 10-12ish minutes, I surrendered only 6-7 to the top cyclists in the field, and only 45” to Yu.  I came off the bike in 12^th position, full of hope for the ensuing run.  It was my most promising ride of the year.  Maybe I’m not doomed to be a softman forever… booyah.

Happy, heading into T2

I proceeded to $h!t the bed on the run, though, and not in the good way.  I was able to keep the effort up, having eaten and hydrated well on the bike.  But there was a pretty obvious disconnect between my heart rate and actual pace.  The leg speed just wasn’t there, as I struggled my way to a very underwhelming 1:22.  Coach Bagg and I never really figured it out, and ultimately chalked it up to riding a bit too hard.  If I could have put together a run-of-the-mill 1:18 or something, I would have moved up 7 places.  In the end I came 14^th, but in a pretty marked break from my usual style of racing.

Confused, heading into the finish

By the way, Haffey crushed it.  Broke the 5-hour barrier in his fastest half ever, and looked good doing it.

IM Canada

What I didn’t want to admit leading in to Victoria (and in the weeks following) was that there was something seriously wrong with my knee.  Some strategic vitamin I in T2 (great for the kidneys!) helped me get around the course in Victoria without too much trouble, but I wasn’t really able to run at all afterwards.  A full 12 days after the event, I stepped gingerly out in to the streets to test things.  4 minutes later – after shuffling around at 8:00 pace for a half mile – I pulled the plug and walked back home, extremely disheartened.  Contending with injury is just so frustrating, especially when you don’t know what the root cause is.

I paid a few visits to Chris Ramsey, physical therapist extraordinaire and endurance injury guru at PACE here in Portland.  Miraculously, he was able to get me diagnosed and back on my running legs over the course of a couple weeks, just in time to put in some volume for my ironman build.  It definitely wasn’t ideal, as my longest run leading in was only 90 minutes.  But Coach Bagg sorted me out with a few double-run days, and we generally tried to make the most of it.

Not a bad venue

Race day in Whistler could not have been more ideal.  Clear skies and low winds meant the challenging course would likely run about as fast as could be hoped, but with more than 6,000 feet of climbing on the bike we were in for a long day all the same.  I executed on my pre-race routine, gave Elena a big kiss (second to last thing on the list), and waded into the lake feeling pretty damn lucky.  Given certain realities – like recent injury, returning to my last year of school, and really just being a mediocre person in general – I felt so fortunate to have made it to the starting line.  I had taped a simple reminder on my bike stem to remind me to stay grateful, especially on the back half of the ride when the suffering was bound to get real.

View from the cockpit

There isn’t too much to say about the actual race.  I exited the two-lap swim course ahead of schedule, which was awesome.  Near the top of the first climb I saw Andy Potts whiz by in the opposite direction, and was impressed by his sizeable lead over a legit chase pack with guys like Pedro Gomez, Trevor Wurtele, and Callum Milward.  I chased Elmar Hegar around on my bike for awhile, and by mile 70 was riding completely alone.  One of my biggest joys was the PB&J in my special needs bag, which was pretty mashed up and soggy but oh so delicious.  That fueling strategy is definitely a repeat.  I took a little while in T2 and emptied the bladder, then went about trying to find my run legs.

The first 14 miles of the run were the race highlight: spectacular scenery, clipping along pretty well, and feeling better than I should have.  I had the HR right where I expected it, but was surprised to see that equate to faster-than-expected running.  I was holding 6:45 pace and pretty much feeling like a Kenyan (well, maybe a Kenyan after a huge bender the night before, having literally the worst day of his/her life).  But of course things started to unravel where I thought they might, right around 90 minutes, which was essentially the limit of my run training.

Would have been easy to stop running and dive in 

I hung in there for the remainder, but we’ll just say I didn’t even-split that marathon.  In the end I was super pleased with what I got out of myself on race day, and was able to crack the top-10.  Lots of room for improvement, but not bad for a guy with only one lung.

Kidding.  I have both of my lungs.  But I’m doing a rotation in thoracic surgery at the hospital these days and spending a lot of time imagining what it would be like to only have one lung.

Challenge Penticton

The aftermath of IM Whistler wasn’t pretty.  Got home around 2 am and had to show up in the hospital for my sub-internship at 7 the next morning.  Several weeks of long hours and minimal sleep isn’t exactly an ideal way to absorb ironman fitness, but I was having fun and pretending to be an intern, so it was all good.  Plus, I had Challenge Penticton to look forward to at the end of the month, with best bud Sean Moran.

In preparation for the ITU long distance world championships next year, the folks at Challenge Pen had put together a unique 3km/120km/30km racing format that amounts to somewhere between a half and a full ironman.  I was somewhere between half and full fitness, so I thought maybe I was preordained to win the race.  (kidding, obviously, Jeff, if you’re reading)

Well, to put it politely, Sean and I went up there and straight-up slayed that course.  We were done racing and halfway back to Portland by the time our nearest competitors finished.  We went so fast they specifically told us we couldn’t come back for the world champ’s next year, because it wouldn’t be fun for the other participants.  Ha!

In all seriousness, both he and I struggled a bit due to somewhat limited training, but we had such a ball.  We raced with little to no pressure, purely for fun, enjoying the trip, the company and the location.  My fitness left a little something to be desired, especially on the bike where I’m pretty sure I saw people pointing and laughing at me.  The non-wetsuit swim didn’t do me any favors either.  But I put together a decent run on my way to 8^th place and enjoyed the unique format.

Sean Moran's face on my blog always gets me a lot of likes

And so ended the 2016 tri season, way back in late August.  I had hoped to get to a race or two this fall, but the realities of returning to med school set in.  Since my sub-internship, I’ve been fairly preoccupied with the primary/only job of the 4^th year student: specifically, get a residency position somewhere.  It’s an exorbitantly expensive and hugely ridiculous process, albeit a very exciting one.  I’ve been in 6 states over the past 8 days.  But that is the subject of a future blog post, I think.

In conclusion, 2016 was a great year.  I’m definitely satisfied, but definitely will be back for more.  This is a great time of year to reflect on a fun season, and dream big about the next one.  I have a few things I’m eager to accomplish this off season (like learning how to ride my bike).  But my next post is actually going to dive into the crazy world of the residency match.  Stay tuned, if you’re into that kind of thing.

Happy Thanksgiving!

Andrew