Let the great debate begin

Alright so there would be no great debate had my first rotation not thrown a complete kink into my life plan - but I guess that is the purpose of rotations, to show us possibilities our minds could not ever imagine. Needless to say, that is what they have done with mine. Even though it seems so far away right now, the time when residency applications open up and I need to make a decision as to how I want to spend the rest of my life is closing in on me very fast. Anyone who knows me, knows that I have always said from the beginning that there was no way in God's green earth you would ever find me wanting to go into surgery. Yet here I sit, complete with 2 full rotations and 3/4 of the way through my third one more confused than I ever have been. I started out in orthopedic surgery after being transferred from my ENT subspecialty due to a scheduling conflict. Then the surprise of my life came - I loved, and I mean LOVED, my ortho surgery rotation. I could see myself doing this as a living. I could see myself working as an orthopedic surgeon specializing in sports medicine. Talk about a reality check. Next came my general surgery rotation which I merely existed through. I can definitely say I can cross this off my list of possible futures. I loved the patient part but was not thrilled with the surgery part. One possibility off the list. Then my general internal medicine which only served to confuse matters for me. I have been considering either a general hospitalist or an intensivist as possibilities for my future. So when I was assigned to an inpatient internal medicine rotation I was thrilled. Well, I found myself in a situation where I did not get to do much, where I wrote notes but they did not "count" nor were they reviewed so I never knew if I was thinking right or on the right track. So while I was okay with it, it did not thrill me and I did not enjoy it as much as I thought I would. So it left me wondering if I would want to do this - and given the fact that I did not get a good feel for what the experience would be like, is it fair to make a judgement on whether to pass or not to pass at this point in my journey and close that door? Then my rotation in Hematology-oncology. Four weeks of pure grief and sadness...four weeks of death and people who are facing death. It was the hardest and most emotionally draining four weeks of my life. I had been briefly considering this as an option at one point in time and I can safely say that I can climate this from any future possibility of career. Then when I was least expecting it comes another curveball. As part of our preparation for Step 2 we had to run through a practice PE (physical exam) portion with 4 patients. One of my patients was resenting to an ER type situation with acute abdominal pain. ER or urgent care has been in the fore from of my option consideration for a very long time. When I reviewed my patient feedback on my interpersonal skills, there were comments from my ER patient that I displayed "very real empathy" and that I was "detective-like" in my questioning. And the comment at the bottom of the page stuck out to me like a sore thumb: "I definitely felt like I came to the right place.". That one sentence literally took my breath away and again had me thinking ER. But I keep coming back to Ortho surgery with a fellowship in Sports medicine. I want something where I will be able to use my OMM skills and this seems like such a perfect fit. The question is can I handle the 5 years of an Ortho surgery residency with people who have personalities that are so dramatically different than mine?? I really do not know. I am leaning toward doing a semi-audition rotation early next year in July in Ortho surgery to see if I really like it and to see if I would thrive in that environment then following that with an ER rotation to have a back to back comparison on which one I like better. I do not know if this will serve to place things into focus better or if it will only serve to confuse matters more. If only I had not fallen in love with Orthopedic surgery - so now this debate over what I want to do with my life begins. And I only have until Juneish to figure it out *eek*.

Finished with 8 weeks surgery!!

So to those reading who are doing this will smallish or even not so smallish children, let me tell you that scheduling surgery during the summer months was a must. Now my 8 weeks was split into 4 weeks of a subspecialty and 4 weeks or general, but when we selected which 8 week time period it would be in we had no clue which would be first. I decided I wanted mine during the summer for two reasons: 1. I thought I was not that terribly interested in surgery (more on that relevation later) and 2. I had heard from upper classmen that general surgery hours could be brutal and I wanted it in the summer when the kids had less stuff going on than during the school year. I was so right on point 2. General surgery has to be by far the craziest rotation yet that I have experienced - but take that with a grain of salt becuase I am only on my 3rd rotation in and have not even come close to OB/GYN yet. I had to be at the hospital by 4:30ish to get all my prerounding and notes done by 6am rounds, then we were often there until 5 or 6 pm. I ended up staying closer to the hospital during the week and tehn coming home on the weekends. It was the hardest four weeks of my life. I missed my kids like crazy, and they were velcroed to me on the weekends when I did come home. Thankfully my husband switched his work schedule to alter in the day so they did not have to get up as early in the morning and my parents also helped out, but it was definitely a challenging 4 weeks. I can not imagine having to do that during a time when the kids were in school and there are many more after school commitments like sports, activities and homework to contend with. The biggest surprise of the entire rotation for me was the revelation that I actually like surgery - well orthopedic surgery that is. I ended up doing ortho first and I went in it expecting not to like it and to just survive. However, I ended up with a fabulous preceptor who was passionate about what he did and let me do things rather than sitting like a bump on a log or wall deecoration and I loved it. I loved the blend of clinic and procedures, I loved the office, and I loved the power tools!! :) This took me totally and completely by surprise becuase from day 1 I have always said no surgery for me - but I could completely see myself being an orthopedic surgeon. Dealing with the personalities one is bound to run into during the 5 years of residency is an entirely different question - but the end result is something I could do. I guess that is my other point. I know we all have inklings and ideas - but try to keep an open mind. I know at times this can be easier said than done, especially if you think you woudl enver do something or you could never do something. But you never know, you may run across something during your rotations that totally and completely takes you by surprise and opens your eyes to a possibility that you never thought of before or even considered. That is the point of all these rotations - that is the point of the experience of third year.

Half way through: one chapter closes, another one opens

I can hardly believe I am here writing this, I can hardly believe it has been 2 years since this part of my life has began. I feel like they have flown by, I swear we just started yesterday. I was weepy yesterday as I finished my last finals and talked in the hall with some of my dear friends, as we are all on different tracks and in different places and I will not see some of my closest friends for at least the next year of my life. It felt in some ways like a graduation, you know you will not see these people again yet you hope to see them sometime in the future. So the chapter of my life where I spent hours in classrooms has come to an end and I am now onto the chapter of my life where I am ready to be in the working world - even if it is doings cut work or running around like a chicken with my head off. I figure now would be a good time to share everything I have learned about myself and this process over the last two years with you all in hopes that it helps someone along the way :) 1. Second year really is better than first year. I remember in the middle of first year and anatomy that some of my second year friends told me to hang in there that second year was so much better. And I also remember looking at them and thinking that they were crazy and that I wanted stock in whatever they were sneaking in their cup of coffee in the morning. I was beyond pleasantly surprised to find that they were right. Personally for me the courses were mor interesting and more applicable to what we are going to be doing a future doctors, and the tests seemed to be different in their focus and in the way the questions were asked. There seemed to be far fewer questions focused on the can you remember the random fact on the third line from the bottom on page 12 of the 9th lecture, a blessing for this non-photographic memory student, and far more oriented on the understanding of how you differentiate between one cause and another which I found was much more suited to the way I learn. Now I will say that this was not true for everyone in my class, there are people who found second year more challenging. I think the difference in how people have felt about it all hinges on how you learn and how your brain thinks. But without a doubt I can 100% say that second year was so much better. 2. The good, the bad and the ugly - other wise known as the roller coaster No matter how prepared you are, no matter what you think you will go through, no matter your background I think everyone has had ups and downs throughout these past two years. You can literally go from the lowest of lows to the highest of highs within 72 hours.....sometimes it feels a bit bipolar but that is how it can be. You can go from struggling with something or not getting a position you applied for to being on top of the mountain and getting a complement on how well you did something or doing something right the first time of getting a good score on something. There will be times when you feel like nothing can go right and no matter what you do or try it will turn out wrong, and those times will push you to the verge of wanting to quit. There were times first year I myself looked at the administration building and thought about walking into the dean's office and saying "I surrender", in fact probably more than I expected. The things that got me through those times were the fact that I knew they would pass, and I also knew that I have lived through worse. It was those times that I had to remind myself how hard I worked to get where I was and how hard I was working to be where I was and how many people took pride in where I was. It was those times that I would find the simple thing like doing well in something that I did not expect to do well in that would give me the gumption to continue. It was those times that you find out what you are made of and will make you the person and the doctor you know you can be. You will be pushed, often to your limits, you will cry, you will want to quit, you will think about quitting - rest assured you are not alone in how you are feeling, you will not be alone in how you are feeling and that there is a light at the end of the tunnel and a good day will come before you know it. 3. You will have friends you did not expect and they will get you through the madness. It took me a while to find my groove, I am by no means a quiet person but I found myself very reserved around the 20-somethings sitting next to me. After al what did we have in common?? They were sitting here at the start of their lives, and while I was no where near the end, I was certainly more established in my general life timeline. They were going out and drinking or celebrating after tests and I could not drink due to the bypass and I also wanted to get home to my family since my time with them was so limited. Then every thing started going south, and I started talking to people more and I found I had support and friends in places I would have never expected. And second year I made more of an effort and I made more friends, again with people I would not have expected. But through all things they have been one of my saviors. If I was feeling frustrated on a case or a test its as nice to vents with someone and discover that someone felt the same as me and that I was not alone. The moral of the story is that even if you are slower to make friends, you will find your group and they will be your lifeline. And of course I could not have done any of this without my incredible family. They have been so supportive and have pitched in wherever they can and the last two years have been a group effort.

Calling on help from my blog followers

Hello ladies and gentlemen!!

My son and I are participating in St. Baldrick's day at my school and will be shaving our heads in solidarity with children affected with pediatric cancers.
Please help in any way you can - spread the word among your family and friends, donate any amount you can there is no amount that is too small or insignificant.

Thank you all for your help in spreading the word and helping us raise funds to battle pediatric cancer :)

me:
http://www.stbaldricks.org/participants/beckycostello

little man:
http://www.stbaldricks.org/participants/declancostello

Reflections: 2 years since my life changed

Today 2 years ago, my life forever changed - it was my interview day.
That day will forever be etched into my mind. The clothes I wore, the snow on the ground, being in the glass room...every detail will forever stay with me and be part of me. It was a day I thought I would never see, the day I know some others also thought I would never see and it was finally here. That day my life changed......that day began the journey that has forever changed me.
On that day if you had told me that the last year and a half of school and life would be filled with the highest of highs and the lowest of lows and that somehow I would survive it all, I do not know if I would have believed you.
The last year I have faced tremendous challenges, some of which have left me speechless and shocked that somehow I had the strength to get through it all. I find myself stopped on more than one occasion and just in awe on how far I have come and the amount I have learned about myself as well as in school over the last two years. There have been times when I have been pushed to my very limits of what someone can handle - faced with issues with my son's school, the gossiping of classmates, the health issues my grandmother faced and just the general stress of being in medical school and whether or not I would succeed. All of the things in my personal life just placed so much stress on top of what was supposed to be a dream come true and turned it at times into a living nightmare. It made me dig to depths I did not know I had, doing my best impression of a phoenix on more than one occasion, and bring everything I had. And somehow, someway, much to my surprise still occasionally, I made it through and got to a much needed break.
I am so glad that I got to go with my family this summer to Disney. It held so many echoes, as the last time we were there I was still pregnant with little and we had brought my granny with to enjoy the sites with us. It was a welcome trip but at the same time just held so many echoes of what was, yet it was great to enjoy what is. The sheer enjoyment of watching little at the Princess lunch, the enjoyment of the dude as he got to experience it all again (even though he really has no memory of the first time) and the tolerance of the teen as she was pressing getting to the edge of age for enjoying the trip.
Then the realization that second year was completely different. I remember there were times during the first year when my second year friends would tell me that second year was so different than first year and wondering to myself what they were thinking and that they were completely off their rocker. Well lo and behold I will be the first to admit they were all right. This year has been completely different, I feel like it is much more suited to how I think and how my brain thinks and the classes are more interesting. Of course it could just be the Disney effect ;)
So two years later, and numerous times of wondering if I was doing the right thing, knowing I am doing the right thing, back to wondering if I am doing the right thing - I am still here. I am enjoying successes in the small victories - every step made is a step forward in the right direction, every victory is cherished, every challenge embraced. I will forever be grateful for the chance to be here, I am forever grateful that I sat in the room that day - despite all the bad, the good has far outweighed it.
Here is to a year and a half down - and roughly 4 1/2 months until d-day :)

waiting - the holding pattern and the other shoe

As the end of January comes closer and the start of February comes rushing towards me, I feel like I am in a perpetual state of waiting.
Part of me feels like I am waiting for the other shoe to drop. It was about this time last year that things started going to heck in a hand basket. My grandmother was gearing up for a d&c and we knew there was a likelihood that she would need a hysterectomy. And I was so worried, so scared. Not nearly as scared or worried as I would be come February and things with her really went wrong. I was so trying to hold out hope, so trying to just get through the day. I was also dealing with my son and his teacher who for some reason did not like or care for my son and made his life a living heck, which was an incredible amount of stress on our family and me as a mom. Then on top of the stress and the waiting in my personal home life, the crap came raining down at school in my professional life. I found out through a friend I trusted that people were circulating rumors which were nasty and false about me, then I ended up having to talk to the Dean about said rumors and life was just so incredibly stressful. It was not a good time this time a year ago, and if I said otherwise I would be lying.
So here I am, same time a year later and part of me marvels at the fact that somehow someway I survived everything that was thrown at me, I marvel that I had the strength and the wherewithal to survive the onslaught of chaos and stress that was thrown at me. But at the same time, right now I can feel the anxiety in me welling up. I can feel my heart sink every time my phone rings and it is my parents, even though I know they are not calling for anything bad. I can feel my stomach turn every time I check my email, even though there is no chance that anything bad could be there. I just feel like I am waiting for something bad to happen, even though this year has been so remarkably different from last year for me, part of me somewhere deep inside feels like something bad is around the corner waiting to rear its ugly head at me.

Then I am waiting to figure out what is going on with rotations and scheduling and the like so I feel like I am in a perpetual holding pattern like and airplane waiting to make its final descent to he ground on a busy day. I feel like so much is up in the air right now. Aside from the obvious waiting for the big bad board exam in June, which will keep me waiting forever it feels like some days and like it s on top of me others, I am also now waiting to find out if I will get the OMM fellowship at school. I decided to apply and was offered an interview coming up next month. So of course this puts everything in a potential state of flux. If I get the position, I will be pulled out of the track I am currently in and placed in another track for the fellowship spots. I have no problem with this, but I feel like I will not truly know my schedule for third year until i know if I will stay in the track that I am in or if I will be switched out. Of course there is the obvious waiting that is going on right now - the waiting for the interview. I want this fellowship so much and I can honestly see myself doing it that it is driving me crazy to wait.

So as I wait, for good or bad, I decided all I can really do is be true to myself and who I am because that is all I can do and if it is not to be then it is not to be. So each day I wake up, place one foot in front of the other and decide that today will be a good day.

new year, new beginning, long roads and same fears

Time for long overdue update. I must apologize for being gone so long. I am afraid the holidays, especially these first holidays without my grandma have been really difficult and required my attention directed more to family matters and supporting my family so I am afraid the blog has gone neglected.
I think my new years resolution is to try to update at least once a week, especially now that we enter that really crazy time which we all know and love as Board prep time *eek* and *double eek*....more on d-day later :)
Even though this marks the start of a new year, I am faced with many of the same fears and doubts. It was shortly after this time last year that everything started going to heck in a hand basket. While the rational part of me says I lived through what can only be described as he&l last year with everything that happened with my grandma plus the added stress of having unfounded accusations being thrown at me by someone at school and that there is no way that anything like that could happen again this year, the decidedly un-rational part of me still has a heartbeat skip when I sit down to take a test, still longed to call and talk to my grandma about making the decision to apply or not apply for the fellowship, or just to talk to her and hear her voice, part of me still panics before exams as I go through last minute material but I also then have to go through my mini mental checklist of picking out a focal point and things like that - things that I should not have to think about but do. But enough about that, let me update on everything that has happened as well as the decisions I have made over the last few months.

Okay, first the big bad board exams. Based on the specialties I am most interested in and the availability of fellowships in both the allopathic and osteopathic world, I have decided that if I go straight residency without fellowship I will do an osteopathic residency while if I decide to pursue the option that leads e down the fellowship program I will be applying to dually accredited or straight allopathic residency programs. Couple that with the fact that I am limited as to where I can apply due to the whole house/family/husband job situation I have decided ultimately to take the USMLE in addition to the COMLEX as I would like to keep as many doors open to me as possible. However, after a long thought process I decided not to take the USMLE in June like most of my classmates are doing. But why would you not want to do that Becky?? Quite simply it comes down to one word - preparation!!!!! I know how I like to prepare for exams, I know if I opt to take the USMLE that I need to ensure I do reasonably well as it is bad to take it and do not so well, and I know I could not handle the stress and havoc of prepping for two major life and career determining exams at the same time. Yes there are similarities, yes they are essentially over the same material - BUT, there are enough differences that they require separate preparation and dedicated study time. When I was talking to my classmates the other day, one of them said he thought we had to take the USMLE in June which is not true. As part of our education to continue we have to take the COMLEX by a certain date in June in order to continue on in rotations and meet graduation requirements. There is no requirements for me regarding the USMLE, none. AS an osteopathic student it is not required of me to take the USMLE during any part of my educational process, so since it is essentially another hoop I am willingly putting myself through why not optimize my chances of doing the best I can do and do what I feel is the best in order to achieve that goal. To that end, I am registering for the three month window of October-December of the end of this year. This allows me to tackle the COMLEX between now and June 11th (my d-day) and then knowing what I feel I was weaker on as well as the differences between the exams, I can then focus my attention on the USMLE and performing the best on an exam that while I know the material I am not really prepped in school to take due to differences in testing styles etc. I have been so used to saying next year, well I guess it is now *this* year that is all abut the board exams. Plus I figure if i take the USMLE later in the year, it gives me a bit more time to explore where I would need it and what score I am shooting for etc.
So why does this all matter you ask. And well I have to say that is a really good question. It all comes down to a two word answer - track preferences. Since we all go through the same hoops rotation wise third year, my school chooses to organize them into tracks. Each track has the rotations scheduled in different orders and then we rank which track we would like first, second, and on down the line. So when I looked at tracks, I was looking to rank the ones towards the top that met the criteria of not having a "heavy" schedule before the end of the year (not doing both surgery and OB before december for instance), the possibility of having an elective toward the end of the year during which I can opt to take 2 wks off to really do intensive prep or having the elective in the latter half of the year leaving the possibility open to be able to do one in Emergency medicine. And of course the big no-no from everyone I talked to or posted an opinion about it - ABSOLUTELY NO surgery and OB/GYN back to back unless you want to audition for a role in the next "Night of the Living Dead". Since we do our OB/gyn and pads in one 12 weeks block with 6 weeks of each and there is no way to guarantee that you will do pads first if you have that block right after surgery I avoided any track that had those two blocks of rotations back to back so those were my very last options. After all things were said and done, I ended up with my first option starting with surgery then a fairly light load of family med and psych until elective between thanksgiving and new year, my second option has the elective in late feb/early march but very similar in early scheduling with internal med at the end of the year, my third option has the elective near the holiday again but slightly earlier and then the fourth again has the elective near march. So I will find out sometime this month which track is the winner and then I can go forward with further scheduling and thinking and planning from there.
Of course this all goes out the window if I get the fellowship as far as rotation scheduling. Good thing about that is that it will require me to do surgery and OB in separate summers because they length of the rotations it is virtually impossible to schedule them both during the summer after MS-2.
That was the other big decision made later in the year. After much back and forth and weighing of pros and cons, I decided to apply for the Osteopathic Manipulative Medicine Fellowship at my school. OMM has been something I will freely admit I knew practically nothing about when I started this path as the DOs I worked with did not use it to any great extent. However, OMM is something I truly love and enjoy and found I have a natural talent for both in the doing and the teaching. This fellowship is so unique and such an incredibly wonderful opportunity, I ultimately decided that I could not let things go by without at least tossing my hat into the ring. I do not think I will know anything until March or so, so any positive thoughts or prayers are appreciated - I could certainly use any help I can get.

So here I am, new year - a ton of new hopes and dreams, all marked with a tinge of sadness at those who are not with us, all marked with the echoes of the things that happened last year but all very different and exciting and full of possibilities.
At the end of the day, I am still chugging along, still doing okay in my classes, still keeping life together at home and still plugging away at this amazing journey one day at a time while being blessed to have an absolutely amazing family at my side throughout the whole thing.

May all your new year dreams come true and may the year bring many blessings to each and every one of you no mater where on this journey you may be.