Question: Is there an algorithm for the next step of your life or is your match already out there?

I couldn’t keep my feet still, it’s like they were dancing below me with a mind of their own. My hands were shaking. If I waited even another fraction of a second they’d be too tremulous to complete the physical task of opening the envelope currently clenched between my fingers. Just as the sensation of nausea began to makes its way from the pit of my stomach to my mouth, I drew what last remaining strength I had toward my hands as they ripped open the envelope like a taut Band-Aid on the skin and unfolded the letter while my eyes tracked to the take-home-message, the bottom line, the words as my mind lagged behind to comprehend as it read…


This is the moment I had envisioned for weeks since my residency rank list* had been submitted; for months since the interview process began; for years since I first learned of the process; for nearly a decade since I first decided I would shift my studies to a different path –to become a physician. As a 1st through 3rdyear (or more, for students like me, having taken my extra research year at the NIH), we are invited to observe the Match Day ceremony from the balconies above and peering over to the atrium below that was filled with future physicians, the soon to be graduating class of medical students. When I first observed the “Match Day” event—and the subsequent times I did thereafter— I felt much of the angst you might have experienced while reading the above passage. I was also left with a similar sense of suspence echoing, “what did it say???” through my mind as I heard cheers and witnessed tears while the soon to be physicians below me opened their envelopes. Until this March 20th of 2015, the “…” and suspense remained. Until this moment, you nor I knew what the envelope held.


*For those who are unfamiliar with the rank and match process –as, admittedly, I think even my parents still are—it entails a legal binding contract held under penalty that you must attend whatever residency program you match at. Residency training is post-graduate medical education. It is where you will first practice medicine under the title, “Doctor”. It is the step that separates you from medical student and prepares you for indepent medical practice. It differs in duration and curriculum depending on specialty ((and what a process choosing that specialty can be)). I chose a combined residency (two specialities) in internal medicine (medicine for adults) and pediatrics (medicine for children), also known as “med-peds”. The process of pursuing residency begins from the moment you enter medical school where each of your grades, every interaction with faculty, your board scores ((and what a drama those in and of themselves are, let me tell you)), each patient encounter – all add up to your residency application. You submit this application to as many programs as you desire and then you receive interview invites, if you’re so lucky. You interview for months and when complete, you rank your top choice program to your last choice program in numerical order. The programs each rank the applicants they interview (top choice to last).


A computer algorithm that I’ll never understand, takes all of these rank lists and MATCHES them based on the number of positions available at each residency program (med-peds on average holds only 4 spots per program and only 72 programs throughout the country as compared to hundreds for internal medicine alone, for example, though of course, proportionately less applicants). You find out you matched on a Monday and then you wait a painstaking week to find out where at a precise time on that Friday –always in March –always just around the lucky time of the Irish (St. Patty’s Day) – Ha! Talk about pressure. Every school has a different way of disseminating this information and you can choose to attend the festivities or not. As a rite of passage, I chose to attend my school’s ceremony where a few drawn out speeches (including one with the stats on how many students matched in what specialties and in what regions of the country = torture!), precede, “the moment we’ve all been waiting for”.

My moment went like this…


Oh my God,” I murmured under my breath, instantly followed by a reflexive, “AHHH!” I couldn’t control. “HOPKINS!!!” I shouted as my knees buckled and I fell to the ground. The nausea turned into a surge of energy pulsating through my body and the tremors only exacerbated by the adrenaline circulating in my bloodstream with the realization I had matched at my number 1 choice. My parents screamed and fell to the ground to meet me. When we rose up, we were hugging, tears streaming down our faces, surrounded by an aura, an energy, a protective shield of elation that no one, no thing could break. It wasn’t ironic that the only words I managed to speak under witness of my family gathered at my side just moments before opening my envelope were, “protective light”. To me, this meant, God, universe, guardian angels (spirits of those family before me baring witness from beyond), care for me, hold my shaking hands through this moment, support my family. Well, I’ll be damned (pardon my language), but in those moments, I couldn’t have even begun to know what that protective light encompassing that universal energy had in store for me. This program was a special and true MATCH for me (an urban health, primary care oriented program birthed out of the need to give back to the Baltimore community Hopkins was housed among – more details to follow on the amazing program with opportunities …that it is).


The congratulations, the wishes of pride, the elation continued for days. I don’t think I even slept a full night until nearly 4 nights later only because my body was finally so fatigued it gave in. ((Is this how hypomania feels?!)) Over these days I was welcomed by messages from the Hopkins residents, the program directors and my future co-interns. As the wishes soaked in, so did my realization and along with it, a knawing feeling of gratitude. I can’t begin to express the depth of that gratitude. A gratitude for each mentor in my life since I began this path dating back to college and those that lay before me awaiting at Hopkins and beyond, a gratitude for my ancestors who laid the foundation for this path (Ref: semi related post), a gratitude for this life (after all, I did just get back from India where I bared witness to the billions of talented children who didn’t even stand a chance to be in my shoes now based on pure statistics of the limitations of the life they’d been born into.


The gratitude was flowing like Kundalini through my chakras (ok, I’m sorry, if you miss that reference, you’ll have to wait on another post re: yoga/Reiki/energies). It was flowing right out of my head to the heavens above. (Though this feels very real to me, if you’re a skeptic and rightfully so, at least take this metaphorically). So much so, that I think the universe began to flow back… and offered a few signs. One of which I think makes for a good story:


Sir William Osler is known as the father of the modern day approach to the, “history & physical”, or as we come to know very well in medicine, “the H&P”. He emphasized the importance of touching the patient and underlined the significance of that sacred and intimate encounter only privileged to the physician as a crucial foundation for the relationship with their patient. He even went as far as to presume on some level an aspect of the healing response begins with this touch. (See TED TALK on the bottom of this page – ref 2). Modern day, we might refer to that as an aspect of the (oh so real) placebo response. Well, how appropriate given my journey to uncover the significance of this in medicine and healing (I wrote a paper sort of covering this referenced below – ref 1).




Johns Hopkins “dome”


Sir William Osler is also one of the first, if not the first, to have started the practice today known as, “rounding” on patients. The process of discussing a patient’s case with the medical team. The legend goes the history of “rounds” dates back to Johns Hopkins where the inside of the famous dome (the original hospital now home to offices and lab space) housed patient rooms aROUND a circular format. Sir William Osler himself, completed his medical career as a physician and teacher at Johns Hopkins hospital. He is such a prominent figure in the culture here and throughout medicine that the Internal Medicine residency program at Hopkins is now named, the Osler program.


At Loyola, my medical school, each entering medical student is assigned a community in one of the rooms found on the first floor of the atrium. It wasn’t until just this past week, as I walked through the very spot where I opened my letter just a week earlier, I looked up to see the name of my community, “Osler Community”.


Of course, I often passed Sir William Osler’s portrait as I walked to my locker multiple times throughout medical school, but today, for the first time, it seemed to glow. It seemed to say, “the universe ‘placed’ you under the guidance and training of Osler before you even knew it”.


Even if fate exists and trumps free will (wow, getting deep on you, but don’t worry I realize this would be the topic of another post entirely should I even dare to broach a topic still stumping world-famous philosophers to this day). I had to will myself to work damn hard throughout medical school. Further, I know I have just willed myself to work damn hard throughout residency (Hopkins holds the reputation for good reason, as not just anyone can survive the training and practice of medicine here). However, regardless, I hold a sense of pride in my “match”, which I’m sure will linger for quite some time and I hold a sense of gratitude in my heart and all my chakras that will never leave. I am filled with an enthuse to pay it forward to the community this program was built to help. I can only hope to filter these emotions, this energy, through my hands as I go on to touch my first “real” patient as, “Doctor Ortiz” under the same roof as the patients touched by Dr. Osler himself. And so, I pose to you… Is there an algorithm for the next step of your life or is your match already out there?


REFERENCES:

1) Simmons and Ortiz et al. Pain and placebo in pediatrics: A comprehensive review of laboratory and clinical findings. Pain. 2014 Nov;155(11):2229-35. doi: 10.1016/j.pain.2014.08.036. Epub 2014 Aug 29. (http://www.ncbi.nlm.nih.gov/pubmed/?term=colloca ortiz)

2) TED TALK on the “physical exam”:

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