The Match Makers Looking Glass

It was my third weekend working in the Rose Medical Center's Emergency Department in Denver when the call came in. It was a Sunday morning -- often the quietest (oh no! somebody said the "q" word! I actively rally against the silly superstitions that stop us actually enjoying a moment of peace between the storms of chaos. Let the comment on the temporary tranquil present be met with a smile and a nod instead of derision and threats of bodily harm, as they most often are) time in the ED and maybe 8:30 in the morning at the latest. 

I was standing close to the phone, leaning on my "COW" (which we were told were to be referred to as WOW -- for Workstation On Wheels, versus Computer On Wheels, as Nancy in HR got offended that one time she was on a clinical floor and heard the doctor tell the scribe to "grab the cow") and immediately was alarmed by the nurse's reaction. 

We were a level III trauma, if I remember correctly, with no dedicated pediatric care on site. 

The nurse was understandably alarmed when she learned the two and a half year old male with a gunshot wound to the chest was only three minutes away by EMS. 

I specifically remember everyone in the ED calling looking for a pediatric chest tube kit, as the crash cart didn't have one. 

At that time, I had no medical background, experience or knowledge other than a year or two of basic biology and chemistry. 

People went sprinting down the hall to the stairwell leading to the L&D floor looking for a pediatric chest tube kit. 

Sure enough, a few minutes after the call the paramedics and EMTs brough the little blond boy in through the double doors. I often parked the COW in the short hallway by these door and I was there when they burst through. 

I'll never forget the young man kneeling on the gurney giving two finger chest compressions. The small bag mask was held by another young man who was also pushing the gurney. 

Even before the patient arrived, many of the nurses and other staff were loud in their concerns that this child be brought here. Afterall, Denver General, and University of Colorado hospitals, amongst a few others were probably better equipped. 

The little boy didn't make it despite running the code for, I don't know, ten or twenty minutes? I didn't have any information on the little boy. 

I should probably explain that I worked as a registrar, meaning my main job was putting the patient in the computer -- making sure that I didn't create a duplicate account. From there I was always being asked for stickers. Sheets and sheets of stickers. Oh, and bracelets. 

I registered the little girl as a "John Do" which is a real thing. There were a lot of John and Jane Dos over the years I worked there. 

Things eventually quieted down. I learned that this child was shot through the heart by his mom's estranged lover, as her husband, and father of the child tried to retreat from the house where the mom and the lover lived.  

The father was shot through the hand by the same bullet that tore through the heart of the child. A few other rounds were fired, missing. Some rounds were fired at the mother. Then, the estranged lover barricaded himself in the house, causing a standoff for part of that Sunday. 

This house was very close to Rose Medical Center. Also, it was all to apparent at the scene that the little boy was dead and if there was any chance at resuscitation, it was getting her to the nearest ED, not driving an extra fifteen minutes to get to another one. 

I was sitting in the front, reception area of the ED when I saw the mother come through the doors. Immediately it was apparent who this was. One of the EMTs I was chatting with took charge and brought her to the back area, with the patients and the doctors. 

She kept screaming "where is my baby!" and I'm not sure if she had been told what had happened yet, or not. I was definitely a wall-flower at this stage in my medical journey. I'm sure I was standing flat footed and wide eyed as this all went down in the main hallway area of the ED. The doctor told her that her baby was dead. She collapsed in his arms. He sat her down and scooted her toward the wall and had her sit up against it. He sat down next to her, put his arm around her and she shook with sobs. 

I remember the doctor telling a nurse to get some ativan. That kind of shook me out of my situational hypnosis. I remember wondering if I should register as a patient. Thankfully I had enough poise to stay quiet. 

I started working at the hospital because I was halfway finished with undergrad, with eyes on medical school matriculation. Back then I was so naive -- and if not for that naivety I would have never thought a guy like me could become a physician!

It is important to know that yes, a guy like me, can indeed become a physician, and can be a damn good one, to boot! 

In this season of residency interviews, this, the fifth edition of Doctor, Doctor, Give Me The News we explore what exactly your physician had to do to get where she or he is. 

If any of you actually read the article in the hyperlink (I get it, I hardly every click either these days) you'd see that that Sunday morning tragedy took place in October of 2008. I was approaching a year and a half of undergraduate study. Medical school was on my mind. 

Here we are in 2018 and it is very hard to imagine myself and my mind in those days. I'm still me, yeah, I'll always be, but I try to identify with that person who didn't have the mind of a doctor, who had yet to have that "boot camp" experience -- that rite of passage, so to speak. Now I feel comfortable taking charge, or at least a pre-ordained leadership role that is mine in most clinical scenarios. 

In 2008 I felt intimidated by EMTs and their medical knowledge. I was awkward, relatively speaking, around patients and felt inadequate when they'd ask me questions I had no idea how to answer. 

As I approach the halfway point of post graduate training I still have a long way to go. Afterall, they don't call it a "medical practice" for nothing. Always aiming to improve. 

I've had a few interview sessions already this year where medical students interested in coming to our program show up in their black or blue suits or pant-suits, with their obligatory smiles and pad for note taking. Such an exciting but anxiety ridden time in the life of a soon-to-be doctor. 

The Match. 

In more than a few people's lives this process has indeed lit a match to their hopes and dreams. They adjust. 

Medical students apply to programs to interview through a centralized clearing house. Many programs have cut off minimums for board scores, GPAs, or decline to interview those who have failed a board exam, or are DO vs an MD, or from one school vs another. 

A student has to be realistic in their applications. Each application to a program costs money. One can take a shotgun approach but this will be spendy. Also, applying to multiple types of specialties at the same institution can cause a red flag. 

While in the middle of clinical rotation, a student has to figure out exactly how to travel all across the country, on their own dime, to interview at programs. No interview, no chance of matching there. 

After the interview season is over both the student and the programs make a rank list. The student ranks, in order of preference, the programs the they interviewed with. The programs rank all the students that came through to interview. 

These lists are sent off to a computer, presumably in a locked, but somehow smoke filled room, and it churns and churns and churns away until it matches the lists of the hospitals and the students and comes up with it. 

The Match List. 

That video only minimally clears things up, and I went through this process. Went through it twice, actually. Thankfully, I matched to my first choice -- twice.

I find myself becoming very protective of medical students. Sure, there are annoying ones, but even those I view through a different lens than just some regular old annoying bloke. Stressful situations act to accentuate pre-existing dysfunctions. 

Perceived arrogance is usually just masked insecurity. Meekness is often a variation of the manifestation of insecurity. Insecurity is the mainstay of medical students. I argue that feelings of insecurity often stem from a misinterpretation of lack of experience meaning lack of intelligence. Sometimes students are afraid to lean on their own knowledge base. Usually students know way more than they give themselves credit for. 

We as residents and some attendings sometimes forget this too, and serve to reinforce that misunderstanding. Sometimes I think we do it to buffer our own insecurities. The cycle of abuse is a real thing. 

What happens if a student doesn't match? 

SOAP, or what was known as the scramble, starts the week of the announcements of the match list. 

On a Monday in March students learn if they matched, or if they did not. It's just a yes or no reveal -- the specific program is revealed on Friday. 

Those don't have a home then fight all the other soon to be homeless soon to be doctors for open positions. Often in specialties they did not wish to join. 

All of this is public knowledge and hopefully every medical student has done their due diligence loooooooooong before even applying. But this doesn't make the process any easier. 

To you, the medical students of today and residents of tomorrow that I dedicate this post to you. I wish you all the best as you embark in the best and worst adventure of your life. 

I also implore you to remember what inspired you in the first place to embark on this path. 

I started working at the hospital in 2008 because I wanted to get a glimpse of what working in healthcare was like. I mean, I wanted to be a doctor but really had no idea what a doctor did. 

Helping people is easy, and really quite simple. One needs not be a physician in order to simply help people. 

One thing has stuck with me from that awful Sunday morning over ten years ago. It's that the doctors, nurses and EMTs, other registrars -- hell, even the janitorial staff was affected by the death of that little boy. 

I realized that these doctors were just human, just like I was. Of course they were, but seeing them affected by something that I thought they'd be somewhat numb from (I realize how relatively rare of a situation that actually was, now -- and thankfully so) encouraged me. I had confirmation that I thought I could be more than just the wallflower, helplessly watch the suffering of others.