PSA

We could talk all day about the things wrong with using chewable tobacco. But why ever would an eye doctor want to weigh in on the subject?

This story is actually borrowed from a colleague of mine, but nevertheless funny and very shareable.

A kid presents to the emergency department at the children's hospital. He took a blunt object to one side of his face right on the eye. So the questions begin to further learn the details of the event.

"What happened?"
"My kid got hit in the face with a can of Skoal."
"How exactly?"
"The lawnmower."
"Excuse me?"
"I ran over it with the lawnmower. It flew out and hit him and. . ."
"I think I got it."

The moral: Do not leave empty cans of Skoal in your yard, particularly when a lawnmower is about to cross its path. Oh yeah, and bystanders should not be around when a lawnmower is being operated. Ever. I don't care how old they are, but especially kids.

Now I know I'm in Arkansas.

Nom Nom

There come moments for all of us when we wonder what happened to the human race. While it is acceptable and part of the norm to eat human flesh in certain parts of the world, it is generally frowned upon here.

You're called in to the emergency room late at night, or early in the morning. Hell, it really doesn't matter what time of day it is for this to be made ridiculous. The consulting physician on the phone begins the story by telling you, "I have this guy from prison. . ." You know at this point the sky is the limit, or is it that the bottom of the barrel is the limit?

"So these two guys were fighting." I figure they are in prison so weapons are out of the picture. But these are the kind of people who are far from powerless. "This guy here got bit by the other."

Really? Bit? My wife asked me if it was a zombie. But sure enough, this guy's eyelids on one side had been bitten clean off.

He was subsequently discharged from prison into our care. Concerned much?

Stripped

Believe it or not, there is one thing about not matching in a fellowship that is almost as bad as not matching in the first place.

As a resident, I am required to be at work a minimum amount of time over the course of a given time period. This sort of goes without making any explanation as to why; it's obvious. That is why even the ladies in the throws of residency have to be careful about their vacation planning when expecting.

I was told initially that we were "allotted" a certain amount of days for interviews and related activities when needed. What was never specified was how much. Apparently it was far less than the number of days I required for interviews. So, at one point, my boss says to me, "What are we going to do about all these interviews and your time off?"

I wanted to say, "I don't know, deal with it I guess." But that wasn't enough. After further discussion with someone higher on the chain, it was decided I needed to go on these interviews but that my remaining vacation time for the year would be used up. There was even speculation that vacation during my chief year would have to be used. Thank God that last part didn't happen.

So the worst part?  I now know I really can't take any vacation until the next interview season. That's near to ten months without any vacation.

Ten, long, months. And interviews are anything but vacation.

The Matthew Broderick Similarity

If you're looking for one, so am I.

If you have followed by Facebook posts at all, you may recall a post I made some time ago about a particular lady's nugget of a support (I think).  It was during a flight home, I think from Seattle. We were making our descent into Phoenix for my connecting flight and her home airport. We started talking about our recent travels. She was a registered nurse who had taken her career into the educational route and was returning from attending some sort of educational conference. I obviously told her I was interviewing for fellowship positions.  As I had said to so many others previously, I explained that I only hoped all the traveling wasn't in vain.

Her statement of support:
"Well, I'm sure you'll do just fine. You have that whole Matthew Broderick thing going on."

I was unsure how to respond. What exactly did she mean? Were she and Matthew good ol' Skyping buddies, or what?

Was it the young Ferris style with a laissez faire outlook on all of life? I sure hope not, or at least that is definitely not how I wanted to come off during a single interview.

Was it a piss-poor attempt and being sexy with stubble facial hair and mad side burns? Again, not how I wanted to come off. And, oh yeah, I can't.



Perhaps it was a hidden appetite for Sarah Jessica Parker. Nope, don't have one of those. Did somebody say, "horse face?"

No matter. My apparent Matthew Broderick likeness didn't aid me any.

Another Update

You've probably noticed well before now that it has been a very long time since I have blogged about much of anything - nearly four months to be more exact. Clearly it is not as though nothing has happened in that period of time. I just haven't taken the time to write about it all.

The last time I made an appearance with a blog post I was buried deep in the planning and coordinating of a string of interviews in pursuance of a fellowship. That has all obviously since come to an end. The match day was held sometime in April and the news I got was not that unexpected: I didn't match. I interviewed at ten programs (seven in person and three via Skype) and still didn't manage to land a position anywhere. I made multiple statements beforehand about this very real possibility. I was told over and over that surely I wouldn't have a problem and it was just a matter of where I would go. I don't feel it's fair for me to sit here and say, "I told you so," but in all actuality, I did. And it wasn't a lack of self esteem. A bad applicant doesn't interview at half the programs, and it's not like out of 50+ applicants for 20 positions there were 20 good applicants and 30+ bad ones. More like 10 bad ones and 40+ good ones. I don't yet know the official numbers as they aren't posted yet, but I'm not naive.

I was beat down for a day but then got over it. I will apply again. This year I will not only look at 2014 ASOPRS fellowship programs but also seek non-ASOPRS fellowships which may start in 2013 or 2014. We will just have to see.

What else? OKAPs came and went again this year. Resident's Day came and went. Got a paper published. Working on a few other things academically. Busy around the house. The usual. I expect to be writing more frequently again. At least for a while.

It always sounds good in the beginning. . .

Going for a Bit

If I ever thought travel was somewhat complicated and tiring before, I have another thing coming over the next three weeks.

First, I leave tomorrow to go to Kirkland and then Austin - then I will fly back to LR on Friday to be home for the weekend. Then, I leave Sunday to go to San Antonio for a one week review course (blah). I will come back Friday and actually be back for a whole three days. Lastly, that following Tuesday, I will leave for Milwaukee and then Albany, returning Sunday night.

When I said I wanted to see the country, I didn't really mean from the air and airport windows. I will basically have been across the entire northern United States. Why my interviews have been focused so much in the northern states is beyond me. At least I will be flying fairly exclusively with Southwest. They have, in my experience, been the most reasonably priced airline in terms of fare and luggage. They have fewer time options, but that is a trade I'm willing to make for cost. And at least I am earning flight points - although probably not enough for much more than a flight beyond Memphis. But they don't ever expire, so what's the hurry? They aren't in the habit of losing baggage and have far better customer relations than other airlines I have flown. So, kudos to them.

Ups and Downs

I never thought as a dude I would experience a major emotional roller coaster in my life. I tend to be pretty even-mannered with very few reasons to gent bent out of shape. However, recently there is one thing, and as you can probably guess, it is this whole followship application thing.

I think it is fair to say that I have good days and bad days. There have been some days when I feel despite the seven interviwes I have/will have, there is still no way I will match. Not just that my chances are low, but that my chances are frankly nil. Some days it has been because I found out about an interview denial which I had previously thought for sure would be a go. I mean, why would a program just two hours down the road at which one of my letter writer's has been a guest lecturer not want to interview with me, while all three of the ones over 2,000 miles away want interviews? Other days I think I just wake up in a bad mood.

But then there are other days when I think about how I have been fortunate enough to get seven interviews, and they are all at good programs (I think). So then, perhaps my odds aren't as bad as I think. Really, though, they just aren't very good.

I just don't want to keep hearing from people, "Oh, I'm sure you'll do just fine. You'll match." That may be people just trying to be nice, but it also shows a paucity of understanding what I'm up against. The numbers speak for themselves and that's about it. And even if I do match, it's not like it's a "they were right and I was wrong" sort of situation; it will just mean I am that much more thankful and grateful.

We'll just have to see sometime after I close out the remaining four interviews over the coming three weeks.

The Justification

It is not uncommon for patients to casually ask us as residents what our plans are for the future. Many of them ask simply because they don't understand the process and think that we are there in the eye clinic for just a rotation and may eventually become a neuroradiologist. So following, a conversation ensues usually beginning with an explanation as to what it is I'm doing there and that I am, in fact, old enough to do their eye surgery and that is what I plan on doing for the rest of my life.

Then they might want to know more about what my plans are. I may then decide to go into further detail regarding my fellowship plans and desire to become an oculoplastic surgeon. The problem with this is there is a stigma associated with plastic surgery. Much of the general public automatically jumps to boob jobs or face lifts when you mention plastic surgery. The reality is that this field goes much further than this. So before the patient starts to form opinions about how I am simply in the field to make money and not actually help patients, I tell them even more. I explain how I want to go into academics and primarily focus on functional (non-cosmetic) surgery. I tell them I want to work with trauma and tumor patients.

The reality is, if you are putting some one's face back together, you still want a good cosmetic result. And after having been on a few interviews, I have realized that plastic surgery is actually fun in some case. Yes, the strictly cosmetic practice takes a special kind of doctor for a special type of patient population with lots of hand-holding - things I am not willing to make a career for myself doing. But I would like to know how to do this stuff, and maybe even be good at it enough to do it once in a while.

Having Someone Under Me

You've probably heard of my intention of going into academic medicine. You may have hear me mention it. Sure there is a pay cut with it, sometimes quite a large one; although, the hours aren't near as strenuous for the most part.

But now that I've been something more than the most junior of residents for over six months now, I really think I have had a chance to confirm what I want to do. I rather enjoy the opportunity to teach. Since I've had more junior residents around, I have had plenty of opportunity to do this. Even if it's not always teaching a blurb about ophthalmology but rather imparting a gem of practicality in the management of a patient. Presenting a case at grand rounds is not such a bad thing, though sometimes the simple act of putting together the information in the form of a power point can be grueling and hard to begin. And I am supposed to have a lecture with the technician students coming up as well. Good stuff.

If only I could teach some people (no, not just any people; trained and practicing ophthalmologists in group practices) how to manage text book cases and navigate the health care system. I don't know a lot of things, but sometimes I just want to say, "C'mon!!" I've always thought a good reason to stay in academics was easy access to staying up to date on things, but one would think so-called "continuing education" would do the same thing.

Seeking a Travel Agent

Job Description: Must be able to adequately and efficiently book multiple short-duration trips, sometimes at the drop of a hat. Must be flexible in terms of departure/arrival times and able to make changes to any previously arranged trip. Must be able to contact airport security prior to any departure so that they may understand why I have a one-way ticket somewhere so as to minimize suspicion and unwarranted overly friendly body searches. Must use my account with Southwest and my credit card so that I continue to accumulate points with both. Must be able to research and effectively utilize all methods of travel, including plane, car, public transport (rails, buses, carriages), taxis, horseback, and shuttles while minimizing use of rental vehicles. Must be effective and utilizing family, friends, and friends of family for reasonable lodging options. Must be able to select hotels, when appropriate, which combine in the best way possible shuttle service, proximity to target interview and dining locations, cleanliness, and cost while avoid the use of brothels. Must be able to ensure that my suits, shirts, ties, shoes, and underwear are clean before packing for each trip. Must be available via telephone, text message, or email throughout the entirety of the day. Must be willing to coordinate my absenteeism with my superiors and fellow residents in terms of clinic and call duties, respectively.

Oh, and one more thing. Compensation will not be monetary and may be in the form of a hug, small gift or gift card, or dinner where I may or may not cover your meal.

Please contact me if you are interested or need more information.

The Facebook Dilemma

The whole process of applying to fellowship programs has been many things: expensive, stressful and tiring, exciting, humbling, just to name a few. But it is also far more intimate than the residency application process. A few hundred people apply each year to ophthalmology residency programs, and what program would have the time to thoroughly investigate each applicant?

Fellowship is different. In a given match cycle for an ASOPRS oculoplastics fellowship, there are typically between 20 and 25 positions available across the country. These will be applied for by between 40 to 60 or more people. If I haven't mentioned it before, those are the odds I am up against - pretty steep. At any rate, the point is, it's a much more intimate. There are few applicants that can be eliminated early and easily - those who try to "see what will happen" but aren't competitive on paper.

So suppose you've been able to knock your applicant pool down to around 30 to 40 candidates. That's still a lot of people to try to interview for only one position, and you simply don't have the time - your clinic and OR are still booked after all. So how do you further screen these people quickly, without making them pay a bunch of money to come out and talk with you only to find out they don't belong with you? A couple programs have chosen to do Skype interviews - two of which I have done. (I will discuss the pros and cons of a Skype interview later.) 

The other option is Facebook. Let me first point out that I am vehemently against employers using Facebook as an additional source to screen potential employees or candidates. There remains, for most people, a sharp distinction between one's professional life and one's concurrent (or especially past) social life. Let's not forget that Facebook is a social network, not a professional network. There are separate networks for the professional side of things. But still, people do this.

While I used to have my Facebook profile open to viewing by people not listed as "friends," I recently restricted viewing to only my friends. Not that there is anything too incriminating on there - no pictures of me drunk and stupid, barely half dressed (except for some beach photos of my pale bod),  or overly direct, opinionated statements. Nonetheless, some people would think to form opinions of how I would function in a fellowship based on all that stuff.

Well now they can't.

My Own Office Space

You know what I think one of the best things about the VA is?  My own office space. Or at least it's mostly mine. It gets used from time to time by other folks when I'm operating or not there, but overall it's my space. I can organize and run it however I want. At JEI and ACH, we are not afforded this liberty and the rooms are much more public which means searching for what I need every time I see patient. I'm not sure what the best solution for this is, but it can be a problem.

I never understood why people with their own rooms felt the need to put up signs that instructed borrowers of the room to be sure to leave it in its original condition. I always felt it was a little juvenile. But I can see where the point is - I hate it when I walk into my room on a Friday morning after someone else used it Thursday afternoon and there is trash on the desk, bottles of drops strewn all about, and materials not stocked. This is not an exaggeration at all - it's typical. I still don't think I'll put up a sign in colorful, bold letters, but then again, it should be universally understood.

I wonder if it needs new cabinets?

Hiatus

Allow me to apologize for my recent hiatus. December proved to be busier than I planned. But alas, here is a quick update to be followed by more regular posting again in the present future.

The last time I wrote I had only two weeks before submitted the majority of my application materials to the available programs. Well, it's nearly two months later - what's going on?

I have had two interviews so far - at University of West Virginia and Massachusetts Eye and Ear Infirmary (Harvard) - but both via Skype. The up - I didn't have to travel all the way to these places only for them to decide they don't like me well enough to actually want me. This allows them to screen a lot more people, and then only invite out the ones they want. So I know if I ever get invited to actually visit, they are seriously interested in me and I should thus be very interested in them. The down - it is very hard to gauge a program and its personalities through a computer monitor and headphones.

I have also since then booked three more interviews - at Indianapolis, Seattle, and Milwaukee. The worst part about these is paying for lodging, followed by the flight, followed by transportation, and then the actual travelling. We shall see.

And I just found out today that the University of Iowa is only accepting internal applicants this year - sure seems they could have made that decision before I payed the money to send them my application. Their loss overall, I guess. Sounds like some internal shadiness anyway.