EM Residency Applications

Finalized Interview List:

1. Denver -- 10/16
2. UC - Irvine -- 11/12
3. UCSF Fresno -- 11/19
4. Stanford -- 11/26
5. UC - Davis -- 12/4
6. New Mexico -- 12/15
7. UCSF - SFGH -- 12/18
8. Utah -- 1/16
9. OHSU -- 1/21
10. Univ. of Arizona -- 2/3

I ended up canceling tons of interviews and withdrew my application from a bunch of programs early on. I over-applied, but who can know such things? I feel very fortunate to have gotten interviews everywhere I wanted...so fortunate. Now I have to trust my instincts and hope that the programs that are my top choices like me as much as I like them! I cannot wait for match day!!!!!!! :)

Anesthesiology

So this was the first rotation of fourth year. I chose it because I wanted to have lots of practice with airway management, including getting lots of intubations. I got that and much, much more from this rotation. I did my rotation at Swedish Medical Center in Seattle.
I worked with the Anesthesiology group that contracts with Swedish, and that group includes about 80 anesthesiologists. Of those, I worked with approximately 10, but worked several full days with Dr. Richard Solazzi. He was a great teacher and let me do a lot. During the rotation I placed several central lines, lots of peripheral lines, got many intubations (including a nasal intubation), put in a double lumen ETT and dropped a lung for a thoracic surgery, put in a femoral nerve block, put in a couple of spinal blocks, and ran a bunch of cases pretty much on my own. I LOVED THIS ROTATION. If I were not set on EM, I'd consider anesthesiology. I had a blast. I loved all of the procedures and I loved the nature of the work. I think it could get kind of boring for some people, but I'd never be at a loss of things to do, even during "boring" cases. In fact, "bored" isn't part of my vocabulary...

Unfortunately, one cannot get an honors grade without doing a BIG research paper. Part of me really wanted to do it because I got top marks and comments for the clinical grade, but I have EM starting in two days and the boards right after that and I cannot afford to take the amount of time that would be necessary to do the honors paper. So I will settle for a High Pass, great comments on my Dean's Letter, and a letter of recommendation from Dr. Solazzi.

I cannot believe that 4th year has begun and I'm now about to start a series of 3 EM away rotations. As of this date I have exactly 11 months (and zero days) until graduation, and 8 months and 14 days until Match Day. :)

Final 3rd year rotation - Family Medicine

**HONORS**

So I finished up my 3rd year with honors in 3/4 of my last rotations. I got a slow start, but things were really difficult even up until a couple of months ago, so I feel pretty good about this. I feel like things are really coming together and that I am performing at a Sub-I level in most things.
I did my family medicine rotation at the Bremerton Naval Hosptial with their FP residency, which is the top FP residency in the US Navy. The clinics and hospital are beautiful, and the faculty and residents were top notch. I really enjoyed my time there.
I am proud to say that I made a difficult diagnosis of a rare disease that had been puzzling the neurologist and FP doc who were taking care of a middle-aged woman. She came in to the hospital with a 5 day hx of severe headache and altered mental status. Her blood pressure was 170/100 (it usually lives around 110s/70s). She also had a history of early onset microvascular dementia, multiple TIAs, multiple lacunar strokes, associated seizures, HTN, HLD, DM II, and chronic B12 deficiency. She does not use alcohol, tobacco, or drugs. She had been worked up extensively for Lupus, Lyme disease, MS, and has had multiple stroke work-ups (carotid duplex scans, EKGs, echocardiography, stress tests) which were all negative. On CT, she had a new LARGE temporal lobe lesion. So the team called it HSV encephalopathy and began treating her with Acyclovir until we could get better images and get lab results back, particularly from her lumbar puncture.
I kept thinking about what could cause all of these things. I personally thought that it was some sort of vasculitis and mentioned that to the team. But they said she had been worked up extensively by the neurologist for several years and they hadn't found anything.
But then I dug through old records and found a VERY interesting family history. Mom died at the same age of "stroke or heart attack." Sister died much yonger of complications from "seizures." Now son has new onset seizures in his 20s. Sounds like something autosomal dominant to me. So I went home, Googled "vasculitis autosomal dominant tia stroke headache," and I came up with CADASIL - Cerebral Autosomal Dominant Angiopathy with Subcortical Infacts and Leukoencephalopathy. Well, sure enough, I nailed the diagnosis. They started calling me "House" after that. :)

Revised 4th year schedule

So there were some changes to my 4th year schedule, but here is the final version of my last year. It will be a blast!


There have been some modification to this schedule. I really wanted the rads rotation, because I think I would have learned a lot, but the sometimes-3-hour commutes (EACH WAY) were killing me, so I dropped it. I also switched out the rehab for paliative care. Not only do I think I will use the skills of working with dying patients and their families more (in addition to pain management), but it is in Tacoma. So here are the changes:
1). No Rads. -- Paliative care in that slot
2). Rehab switched to Paliative care
3. Opth switched to after post-match vacation
4. 10 days at the McDougall Center (nutrition and lifestyle medicine) in Santa Rosa, CA a couple of weeks prior to the capstone course.

---GOD, I LOVE 4TH YEAR!!!

Sixth Rotation: Clinical Cardiology Madigan Army Medical Center

***HONORS***So this was one of two electives during my 3rd year. The second will be in anesthesiology, which is two weeks long and begins immediately after my next rotation (final required 3rd year rotation in Family Medicine). The rotation was at Madigan Army Medical Center. I worked with a great doc, Dr. Kurt Kinney, who is an interventional cardiologist. I learned a lot during the clinic hours, but I also got to spend a fair amount of time in the Cath lab.

I actually even got to do most of a catheterization, which was very interesting. I was allowed to get femoral venous and arterial access, and I even floated a swan catheter. Dr. Kinney was very good about letting me do a lot.
The most interesting thing I saw on this rotation happened when we assisted another interventional cardiologist during an emergency. The patient, an 80 year old woman, came in with pulseless electrical activity (PEA). CPR had been initiated in the field by her husband, and advanced cardiac life support (ACLS) protocols were initiated when EMS arrived. One of the protocols is to give epinephrine. But no drug is truly benign. When I speed walked into the cath lab, the patient was on a ventilator and they were doing chest compressions while the catheterization was taking place (you don't see THAT every day!). When access was gained and the doc shot the contrast, the coronary arteries were totally clamped down. This was due to the epinephrine. When nitro was introduced into the arteries, they all opened back up. It was very interesting to see how medicines that we use to save a life and are standard protocol can also have a deadly effect. It is an image that will stick with me forever. I will never run a code and think about things the same way again...

Annual Spring Trek Home to Colorado

I look forward to my two weeks in Colorado each year. We always stay with my Dad at his house in Silverthorn, which is nearby a bunch of ski areas. It's always a blast to hang out with he and his wife in the evenings.
The house is very cool. It is along the Blue River, and looks across to Buffalo Mountain. One morning, we actually saw a fox run through toward the river.
I saw an otter, and in the spring, Mr. Bear is often seen raiding the birdseed. The blue jays start asking for their peanuts a bit too early, but otherwise, it is very peaceful to just listen to the river.
One of the things I always look forward to is listening to my dad play the piano. It is one of his favorite things, and even though he is pretty good, he is constantly swearing at the thing when he makes a mistake. Somehow it wouldn't be the same if he didn't do that. :)
There was a very interesting ice and snow formation that formed this year.

The temperature, snow, and wind combination must have been just right to cause this, but my dad had never seen anything like it before.

It was like a twisted monster's mouth with icicles for teeth!During the Day we ski A-Basin. This year we got 12 days in a row.
This is my favorite Colorado resort, because it isn't really a resort. It is a bare bones ski area. There are no hotels, no fancy lodges or restaurants. It is just a very good mountain.
There are tons of steep tree runs, and lots of open chutes to hike to.
You can find challenging terrain here, no matter what your level of skiing is.
But what it DOES have, is a fun little bar in the original A-Frame lodge. They have great local beers on tap.
After skiing non-stop without any breaks from 9-3, we would head down to the 6th Alley Bar for some liquid nutrition.
We got to ski with my Dad one day and he, of course, joined us for a beer. His wife Lucky wasn't able to join us that day.
This has really challenged Seth. Although he is doing really, really, well, it is only his 4th season skiing, and I take him down some really tough stuff.
His favorite is probably the Pali Face, but a close second is West Alley.
It doesn't look that steep in this picture, but it really is.
There has to be a LOT of snow to even get coverage because it is so steep!
My favorite is definitely 3rd alley. It is equally steep, but it is through very narrow tree sections. That, along with just steep chutes, is my favorite kind of skiing.
I cannot wait to go again next year. I will call that the Post-Match Celebration Trip, because it will come the week after the match.
After that, I'll only have one more rotation and I'll be a doctor and moving on to learning how to be an EM physician. I can almost TASTE it!

Fifth Rotation: Ob/GYN - Tacoma

These are Drs. Boutry, Cammarano, Kovanda, and Lenihan (from left to right). Their offices were right across the street from Tacoma General, which is where we did surgeries (including the Da Vinci robotic surgeries, which were cool.

I got another honors grade in the clinical portions of this rotation. Yippie!!! :) Dr. Lenihan offered to write a letter of recommendation for residency as well, so overall this rotation went really well.
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Holy COW! I've been attacked by a Pimp Monster! I'm serious. I am the only student and I'm taking direct hits about every two seconds! In all seriousness, it's great. I'm getting pimped on tons of general medicine, ortho, and other stuff. Half the time I have no clue what the answer is, but I'm living in total fear of looking like a clod, so I'm working my butt off. AND IT'S ONLY THE FIRST DAY! :)

So I am loving the rotation on day one. I got to assist on a robotic hysterectomy case. The DaVinci system is AMAZING. It has to be the coolest thing I've seen in surgery. I was blown away. I will get to see tons of it on this rotation (at least 12 such surgeries). Then I was off to clinic, where I got off to a quick start doing bimanual exams. Then it was back to the OR with another doc for a quick excision of a large labial cyst. Then back to clinic for more experience in the female exam (in addition to pimping on things like metabolic syndrome, what are the six classifications of obesity, and on and on). The cool thing was that I got to watch my first vaginal delivery ON MY FIRST DAY. I get to do the next one. I'm getting the feeling like I'm a magnet for the good stuff and it is going to keep rolling my way. I'm on call tomorrow night, so I'm sure I'll get more then, but I have one under my belt already. Then I went back to clinic for more pimping and prodding.

I have to say that the birth of a little being was a profound experience. My emotions almost overtook me. No one saw it, but I was overcome with emotion, excitement, joy, wonderment, and happiness. It's impossible to describe, really. I wanted to burst out in tears, but I was able to keep it under wraps and I don't think anyone saw. I cannot wait to do more. I will not likely get to do many (if any) of these in the ED, so I want to soak up as many of these experiences as I can get! I loved it. :)

This rotation ended up being very good. Although I only had 7 deliveries, I scrubbed on more than 30 surgeries. And of those, I was first assist on all and closed on all. I also frequently intubated the patients prior to surgery. I did D&Cs, endometrial biopsies, and tons of pelvic exams. I placed trochars, drove the camera, acted as a second surgeon with graspers, and the like, and was generally allowed to do anything I asked to do. I was quite fortunate that there were no other students or residents on this rotation. I felt like I got a ton of good experience. I feel like I can intubate and suture very well, and I also feel like I can evaluate an Obstetrical or Gyn problem that comes into the ER. :)

National Outstanding Medical Student Award!

I cannot believe it. I've been nominated for this award through the ACEP. I will find out in about 6 weeks if I got it. I'm very humbled and honored by this. It was quite a surprise when I found out. I have been doing a lot of work for the College, but it has been a labor of love, and I feel like I am the one who is getting all of the benefits, rather than the other way around. I have worked hard on the medical legal committee and I'm committed to advancing the specialty as best as I can by using my knowledge and experience, but seriously...I am the one who should be recognizing the college and the people I have met and worked with.

I have known all along that I was destined for emergency medicine, so even though I wanted to keep my eyes open and look at other fields, I wanted to get involved with ACEP early. Many medical organization don't even let you join as a student, let alone participate in any meaningful way. I didn't have high expectations that I would be allowed to do so, yet I had so much medical-legal experience, and I thought that I could be of some benefit to the organization. So with just a hope, I submitted an application to the medical legal committee (before I had even set foot in the 1st year medical school classroom!), and to my absolute amazement and happiness, I was accepted. Not only was I accepted, but I was welcomed. I took it upon myself to engage in several projects immediately. I was offered support and mentoring. I have met the greatest group of people ever. I feel like I have found a home. And the farther I advanced through my training, the more obvious it was to me that I MUST do emergency medicine. Nothing else would quite do it for me.

So as embarrassing as this, I'm also so flattered, and I feel like sharing it with my friends. So here goes...

These are some of the comments submitted on my behalf:

"I have had the pleasure of working with Jennifer for the past 3 years as she has served the College on the Medical Legal Committee. Due to her outstanding service to the Committee and the College, I believe she would be an ideal candidate to be nominated for ACEP's newly created "Outstanding Medical Student Award".
Jennifer has excelled as the most productive member of the committee. Her commitment, energy, and wisdom have made her invaluable to work of this group. She has had authored numerous articles on a variety of medical legal issues all of which have been published in a variety of ACEP communication vehicles; she without fail responds to questions posed by members of the College on medical legal issues. Jennifer is without a doubt the most outstanding medical student encountered in the 15 years I have been with the College. She is so bright, articulate, kind, caring and humble. She is truly amazing. Her ideas, energy, enthusiasm, willingness to take on any task, and wisdom have marked her as a future leader in medicine. "

If I get it, there would be a formal presentation at the 2008 ACEP Scientific Assembly in Chicago, Il in October. This is what I'd get:

Award recognition includes:

• a plaque from ACEP
• free one-year membership in ACEP
• free registration to one of ACEP's annual Scientific
  Assembly or a satellite meeting during their residency career
• a reception for award winners at ACEP's annual Scientific Assembly

Also, award winners will be recognized by the publication of their names in ACEP News or other College publications, and State chapters will be notified.

Regardless of whether or not I am among the winners, just being nominated has meant a lot to me. One of the things that I always try to keep in mind when working with people, is that just a little bit or recognition and encouragement of a good job goes such a long way. On my last rotation, I worked with a student who was really struggling socially and was getting some very bad clinical grades and comments. She asked me what to do. I said that you need to show up with a good attitude, a smile on your face, an eagerness to learn, and that everyday, you should find something that you really appreciate about everyone you are working with -- and TELL them. That's it. Everything goes great if you just do those simple things. Plus, not only does it take less energy to have a happy and positive attitude, but the positive energy you get back usually exceeds what you give out, and it is a win-win situation for everyone.

So I didn't get this coveted award this year. While a little disappointed, my happiness that I was even nominated predominates. :)

Fourth Rotation: Pediatrics

(1/7/08 - 2/15/08) Mary Bridge Children's Hospital ***High Pass***

I got an Honors grade on this rotation for my clinical grade, and I was super psyched about that, and I will get a great letter of recommendation for residency, and then got high pass on the test, so I got a high pass for the course. Also, this rotation was a surprise to me. I was not looking forward to peds, primarily because I've heard that everyone gets sick, and that all you see over the winter months is bronchiolitis and that it is boring. That was not at all true for me at this wonderful childrens' hospital in Tacoma. While I was on the inpatient service for the first four weeks, we always had a very interesting mix of patients (in addition to tons of bronchiolitics). I enjoyed the team very much, and the teaching by the attendings was outstanding. I feel like I learned a lot, I'm no longer afraid of the really little guys (in fact, they are my favorite patients so far), and I was pleased to discover that I look forward to kids being about 30% of my ED patient population. I was afraid of the little guys (especially neonates) because I had no experience with them, and I was always worried that I was going to hurt them -- I didn't even know how to pick them up! I love those little guys now, and I look forward to having them in my future practice.

The last two weeks of the rotation was just bouncing around from outpatient office, to outpatient office. Oddly, we were scheduled spend 2 full days (of 8 total working days) in peds dentist offices, a day in immunizations, a half day in peds neuro, a half day in peds pulmonary, and a half day in peds heme/onc, with the rest in either the peds ED or clinic. That is what was scheduled, but during the first week alone, 4/5 of the days were totally screwed up (Dr. was not scheduled there, didn't know I was coming, was out of town, or whatever). It was very poorly coordinated. But I turned that to my advantage and spent a ton of time in the ER. It was WONDERFUL. I learned a lot and had a blast.

I was really lucky, once again, to be paired with a very cool student named Judy McCarty. I felt like we were very similar in a lot of ways, and it made the clerkship more fun having her there, laughing about stuff, and working together. She is going to be a kick butt doc.

Now on to the extra-curriculars and my surfing OBSESSION...

There is nothing new about this obsession, other than a tricked out women's specific long board (8-6) by Stewart called the Mai Tai.

And a 9-6 addition to the family/quiver. Well, that's not exactly true. It's a new board for Seth's quiver. He has a similar affliction. This board is way too big for me.


New Surf Art by Drew Brophy:
A self-taught artist, Drew started painting his lively images on surfboards at a young age when he first began to surf in his native South Carolina. With his sights set on being a professional surfer, he travelled the globe doing artwork here and there to help pay for his travels and surf adventures. Eventually, Drew found himself in California and now lives with his wife Maria and their new son Dylan, close to one of his favorite surf spots in the world.
Drew's art is recognized and collected locally and internationally. Through his travels he has been able to leave a little bit of his art around the globe. Drew's original art peices have become in high demand, and his commission orders are plentiful and keep him busy. His surfboards are sold in art galleries and establishments like the Hard Rock Casino, Las Vegas, as well as to many individuals around the world. He holds several art shows a year in different locations. A prolific artist, Drew completes about 100 new pieces of art a YEAR!
These days, if the waves aren't good, you'll find Drew sitting on a beach, somewhere in the world, doing what he loves: painting magical characters and exotic places. That is, 'til the swell picks up!
Someday when we can afford it, we want to buy some of the surfboard art for our walls. Here is a sampling of what he does:

Winter Vacation and FINALLY HOME!

(12/21/07 - 1/06/08). So after the surgery rotation, my away rotations were over. That means that even though I'll be very busy, I'll at least be home every night that I don't have overnight call at the hospital for the rest of 3rd year. What a relief. I'm glad that I front loaded everything, though, because it is over now. It was a tough six months for me and Seth.

So the day I arrived, so too did the three girls. I got home from my 5.5 hour drive from the East side of Washington about an hour before Seth arrived with Bex, Rach, and Mel.

The first few days we just relaxed, and did some fun pottery down at Art and Clay Cafe in Gig Harbor.



We all made noodle bowls and plates. Here is what Seth and I made.



I also made an incense burner and two little sake cups for me and Seth that are actually used as sipping glasses for things like vanilla vodka or other spirits.

We loved it, and everything came out so cool looking. We have decided to slowly replace our flatware with what we create ourselves. It will be much more fun that way. It is a nice, relaxing, and creative outlet.

The Menu was made by Seth a few years ago, and the Penguin serving plate was made by me.

We had forgotten how much fun this stuff is!

We enjoyed Christmas dinner with Trudy, Frank, and the Girls. :)The main Christmas present for the girls was skiing or snowboarding lessons.
Unfortunately, we could only convince Bex that skiers are much higher life forms, so the younger girls stuck to snowboarding. They got three days of lift tickets and rentals, one full-day lesson, and two half-day lessons. They were totally blessed with some of the best snow I've ever seen in Washington. It was like Utah powder: deep, light, and fluffy. The first day it was there, it dumped a foot in the afternoon alone. The next day was wonderful, too.

We enjoyed apres ski snacks and beers (well, no beer for the kiddos) at the lodge. That is always a fun way to end the days.















Thank goodness we had the mornings to ourselves, because we got tons of fresh tracks, especially in the new area of the mountain that was recently opened.





It used to be the North Backcountry, but they put in a new lift. It is all black or double black, and we found some wicked trees with waist deep powder. It was AMAZING.
A-Basin also opened up some of their backcountry this season with lift service, and we are looking forward to enjoying that over spring break. We will spend ten wonderful days up in Summit County with my dad. I cannot wait to see him, and I cannot wait to be at the Basin again. It is my home away from home.
It is always sad to say goodbye to the girls, especially for me, because with my schedule, sometimes it is a YEAR before I see them again. It seems crazy, but it's almost impossible to match up schedules. Plus, I have so little vacation time myself, that I need some time for just me and Seth, so it's tough to balance it all. So the girls went back to Georgia, and we went on to Part II of our vacation...

Part II: Surfing with family in Northern California. We had a blast visiting with Seth's parents in Moraga, and we got to surf with Mike and Chuck. We surfed Bolinas ( one of the sharkiest beaches in the world, being the closest land to the Faralon Islands where Great Whites breed)
and Pleasure Point (Santa Cruz) with Mike,
and Pacifica with Chuck.
The cool thing is that we spent Seth's birthday at home with his family for the first time in decades. Chip, Chuck, Pam, Anna, Adolf, Mike, Becky, Sophie, Ellery, and Georgia were all able to enjoy a birthday dinner with us. We ate at a vegan restaurant that was FABULOUS, and Chip brought some good wines to enjoy with the meal. We finished off with a vegan chocolate mouse cake that was to die for.

It was a little bit of a bummer, because we had five days to surf, and two of them were way too stormy. When I say stormy, I mean one of the biggest storms to hit the coast in 50 years. But it gave us time to spend with family, to check out Santa Cruz, and to see something very unusual. There were TWENTY FOOT SWELLS at Fort Point just under the Golden Gate Bridge. That is unheard of. The place was packed with people watching some crazy and talented guys get out in the outrageously big waves and ripping currents. This isn't a picture of that day, but it is a good picture of the break. Imagine this wave four times bigger, and you'll get an idea of how crazy it was. It was very cool to see, and I doubt I'll ever see it again, so I'm glad I was there. :)

It made for an interesting last day, and Mike, Becky, and the girls were able to join us, as they only live about 10 minutes away from there. We also had fun checking out Fort Point, and looking at the old pictures of the bay before the Golden Gate Bridge was built. It's a very interesting museum if you ever get the chance to check it out. It's also fun to drive through the old Presidio on the way there. There is a lot of history in this place, but somehow the waves seem to transform time and space and blend it all into one, in their never ending magnificence and power.