My room at the
Crowne Plaza Hotel
in Dallas, Texas.


Hello to all from Dallas! Why am I in Dallas? I am currently on my second of ten scheduled interviews. In order:

SLU in St. Louis, MO
UTSW in Dallas, TX
UMKC in Kansas City, MO
UAB in Birmingham, AL
OUHSC in Oklahoma City, OK
MU in Columbia, MO
UT Memphis in Memphis, TN
UAMS in Little Rock, AR
UK in Lexington, KY
U of Cincinnati in Cincinnati, OH

I was in St. Louis earlier this week and am spending today and tomorrow in Dallas. The first interview went pretty well I think. Before you ask, "Do you think they will offer you a spot?" let me just say that them offering me an interview was offering me a spot already. As noted in a previous blog, a rank list is submitted by the program and all the applicants. So now it's just a matter of how applicants rank that particular program and how the program ranks all the interviewees. Of note, St. Louis has a great program, with hospital-paid benefits. The residents were all nice people, and the faculty seemed nice as well. I wasn't sure what to expect at first since many of the residents at UAMS seemed to dislike SLU. I can't figure why since the program seems as good or better than UAMS - perhaps a few less cataract cases. This is not likely to be too important to me since I plan on being fellowship trained one day.

I would really like to add an interview at Duke to this list, but I haven't heard from them yet. I have been denied by three places, two in Boston and the other being John's Hopkins; I have turned down four programs now. That leaves about 13 programs I haven't heard from just yet. Some of them might not ever respond, including Duke. We shall see.

We're having a girl in case you haven't heard! Mia Kathryn Thuro.

I am off from school from now until we return in January. This isn't the case for all of my class, it's just how I have scheduled it. Many of my peers took July or August off. I couldn't do that for obvious reasons - rotations I needed to get done early. Two months off to travel and celebrate the holidays isn't too bad if you ask me. I'll be plenty busy.

I'm not sure what else to talk about right now, so see you next time!

So What's Going On?

You're probably wondering why I haven't posted anything in awhile. Why, Bradley, your wife has announced her pregnancy - have you nothing to say? Don't you have interviews by now? Has your cat grown a brain yet? Well, the answers to these questions and more may be ahead.

First, and perhaps most importantly, the baby. Rachel has already announced the news, so that's why I haven't had much to say about it here. Don't worry, it doesn't make me any less excited, happy, scared - you name it. Any time someone asks, "Do you know what you're gonna have?" I wanna say "A heat attack." Of course I'm kidding, and then I say we don't know just yet, but I want a girl. This draws up many looks and comments of surprise - "Really?" Maybe it's because I grew up with four brothers and only one sister. We'll find out in about three weeks. Right now we're just in the pahse of buying diapers every week while we shop for groceries, and trying to figure out what baby furniture we want. Adding a family member and needing new furniture means needing to completely rearrange some things around the house. Closets have to be reorganized multiple times, furniture must be relocated or sold, and clothes must be donated or boxed up. This is all happening, but at a slow pace since we have several months to go.

Interviews. It's interesting. Even though ophthalmology matches its applicants two months sooner than the other programs, the interviews aren't much earlier. I know someone going into pediatrics who is interviewing, like, yesterday while I continue to wait for my first one. I have so far booked five interviews, I'm trying to decide on a sixth offer, and UAMS has yet to contact me (which, barring some unforeseen earth-shattering catastrophe, will happen eventually). I am going to Dallas and St. Louis the last week of October, Oklahoma City sometime in November, and Lexington and Memphis in December. Cincinnati is the one I am trying to decide whether I want to go to or not. My goal is to get around 10 - 12 interviews, and since most programs haven't even begun informing applicants of interview selection, I don't think I have anything to worry about. Here's hoping. I have finally begun working on my application materials for the transitional year - yep, a separate application process meaning twice the money and time.


And no, the cat still has no brain. Any unanswered questions can be posed here at your leisure.

Return to Near-Normalcy

Many people asked if I was a Kentucky fan; I told them I was from Arkansas and that promptly ended the conversation.



A week back from Kentucky, and still no blog? Shame on me. Well, my punishment is to sit here and write one. That's right, I'm foregoing studying, foregoing filling out paper work for the eye bank, foregoing cleaning up the weather's havoc on our driveway and porch, to sit down and blog about recent events. I'm so hard on myself (no comments, please, RCT, GMA, and KGW!).

Kentucky was nice. Lexington is a nice area with lots to do within a two hour radius. I can't find any reason in my mind, though, to pick Lexington over Little Rock, or the other way around. Oh, aside from the fact that this is where we already live and live closer to both families than if we moved over to KY. As far as the residency program, it's par with UAMS - not as good for some reasons, better for other reasons - the kind of program that attracts me. If I were to decide to be retina surgeon, Lexington would be the place to go. If I were to decide to do oculoplastics, UAMS would be the place to go.

Let's not get too far ahead, though. I am FAR from a legitimate decision. Assuming I am invited, I will definitely return there for an interview and ultimately rank UK somewhere on my match list. But now that my application is in, and already redistributed to the various programs, it will be a matter of waiting for interview invitations and special requested additions to already submitted application material. I have to get an eye exam for the program down in San Antonio, TX - but this isn't uncommon for ophtho programs. I've gotten confirmation also from SLU. The 28 other programs I have yet to hear from. Time to hurry up and wait.

And study for Step 2, the written part. Yep, another eight hour test to be taken on the 26th of this month, which I am not taking off for study time. Many folks don't take time off to study for this exam, but that doesn't make it any less big or important than Step 1 from last summer. All I can do is come home from school everyday and jump right into my studies. Sorry, babe.

Don't have much else to say right now other than I am happier than ever to be back home and I must get back to studying. Peace.

New Yorkers

Top 10 reasons not to live in New York City, associate with New Yorkers, or even look at them:

10. They're certainly not any better looking, even though they think so.

9. They probably coined the phrase "metrosexual."

8. They believe that forgoing botox means not caring about how you look.

7. They believe that having money means you should buy more stuff (crap), not provide for your future or your family. The concept of old money doesn't exist to them, and never will.

6. They think watching ballets makes them more cultured. Nevermind that doing labor on a farm with people from all over provoides plenty of culture.

5. While David Letterman is fairly comical, most of them just plain aren't.

4. They don't have cars. They can't even say "car" correctly.

3. They also believe if you don't spend a small fortune on your clothes, you don't care about how you look.

2. They have long forgotten what trees and grass look like, and certainly can't appreciate it when they see it.

1. Have you ever met one, for cryin' out loud?

Optho Update

This is how we roll.





So I am finished with my first ophtho (sorry, I am not going to type out ophthalmology every time) rotation which lasted four weeks. I actually started this blog well over a week ago, but now that I am in Kentucky with time to spare and nothing to do, it is time I finish this piece. So ophtho was great - good hours, great people, cool surgeries, fast-paced clinic - all that one could ask for. There were some types of surgeries I didn't get to see that I would've liked to, like glaucoma shunt surgery, but four weeks is only a very brief window of time. I didn't get to see a whole lot of oculoplastic work either, making me further question whether or not that's really what I want to do. I know my lovely wife has been telling everyone that my plan was to do that, but in reality, it's simply a possibility my inexperienced mind has considered. I may in fact find that I want to do retinal surgery or cornea/external disease stuff or even pediatrics, although in peds I think I would quickly grow tired from all the prisms and strabismus surgeries. Let's just wait a while and see what happens. Pre-residency is far too early to start thinking about post-residency fellowships.

As previously mentioned, I am now in Lexington, Kentucky, doing basically the same thing I was doing in Little Rock. I am staying in a ladies basement (dungeon) for only $350 for the month. There is a big tree park, the Arboretum, near by where I can jog around a 2 mile trail a few times. I have been walking too the hospital, about a 1 to 2 mile walk each way, every day. I may grow tired of this soon. I can't say much about the program just yet as yesterday was merely an orientation to the hospital and department day. I am curious to see what the next four weeks bring me. I miss my wife terribly, but I am sure we'll both manage.

I did a grand rounds presentation at UAMS in ophtho, but now I must decide about what to do here in KY. I could do the same case presentation again, or take a completely different approach. My thoughts are that I could do a presentation on corneal tissue donation and baking since hardly any resident knows anything about it. The case presentation I did was nothing spectacular or unusual, just a typical case seen in a slightly younger than usual patient.

My application is essentially done, sans one letter of recommendation. This letter comes from the guy who called me a procrastinator. ME! He has taken longer than the other two letter writers. He keeps saying, "Oh I will have it done in a couple days," only to tell me a couple days later that, "Oh it's been busy this week. I just haven't gotten it done." Like this is different than any other week at the VA eye clinic? Was me signing up for the match the first day it opened procrastinating? Was me wanting to turn in the application by the beginning of this week, several weeks before the target date, procrastinating? Was me moving my CS exam up from November to last week procrastinating? Was me. . .OK, enough of this. Just a sore spot, I guess. I'm still waiting on his letter, which he now has to mail to me out here in Kentucky so that I can make the target date. If I wait to pick it up until I come back, the target date will only be a couple days away. I still feel strongly that the match's target date of September 3 is a little late considering some programs have deadlines in early September and the match claims it will take 3 weeks to process the application before they send it to any program. If I could get it in before the match experiences a surge of near-deadline submissions, there's less of a chance of them losing my paperwork, which they have a history of doing.

Well, that's all for now. I'm posting in the morning since there isn't anyone for me to work with this morning. Better luck this afternoon.

Fin

"Oh my dear treats, how I dream of you always."

The third year of medical school has finally come to an end. First, a little bit about the most recent rotation: neurology/neurosurgery. You may recall from my belated blog about geriatrics that life did, in fact, get worse after geriatrics. As if it wasn't bad enough, neurology was so much worse. Why, you ask? I had an attending who, while nice and with a good sense of humor, hardly acknowledged us for the whole two weeks. Nearly everyone in the department is from the Middle East and speak amongst themselves in tongues in the presence of others as if others didn't even exist. I'm not sure why, but I find that kind of rude. I know that in most other countries there are people from several different backgrounds all speaking different languages at the same time. The thing is, if you don't want the lame American sitting nearby to know what you're talking about, just go have the conversation elsewhere. For two weeks, I did practically nothing, and yet I had to stay in sights of the residents (who had a hundred better things to do than watch us) until four, five, or even close to six in the afternoon sometimes. The last two weeks were spent in neurosurgery. Again, we did next to nothing and were only rarely acknowledged, but at least we could go home early. At least then the resident recognized that we really didn't care to see yet another ventriculoperitoneal shunt placement or revision in a kid with a big head, and would instead let us go for the day. He was a cool resident. Overall, it was probably the worst rotation I've done all year. Thank the Lord it was a pass/fail rotation and I didn't have to study hard after going home.

Now, on to more exciting stuff. Third year is over, and after my one week of vacation, the fourth year kicks off. Not to mention it kicks off after what is likely to be an awesome weekend of camping near the White River. My new schedule will be off to the side here soon. I start in July with a month of ophthalmology - FINALLY! I have waited years (literally) to get at least to this point. In August, it's off to do the same in Lexington, KY. What's special about Lexington? Nothing, really - it's just that their program at least sounds really good and it's in beautiful Kentucky. I was about to give up on doing the rotation there after I found out that the graduate housing options were all filled up. I called the visiting student coordinator and she gave me a list of locals who rented out space in their homes or had attached apartments for short-term living. I called all the folks and one of them has offered me an excellent lodging deal. She has a house where her and her husband live upstairs, and the basement has three bedrooms, each rented out to separate people, with a shared kitchen and living room. It's only a mile or two from the university hospital.

Things with residency are shaping up nicely. The application is well under way. I have a rough personal statement written. I have finished selecting the 30 programs to which I will apply. I have already requested one letter of recommendation, but need to request two more. I have submitted my paper for publication which should be happening before too long. I'm also about to start studying for the USMLE Step 2 exams. That's right, plural - two exams. One is a written test much like the one I complained about when I started this blog. The other is a huge waste of money clinic on-your-feet exam that must be taken in one of five cities, and serves little more than to be sure you can speak English correctly. This part was originally designed for foreign medical graduates wishing to pursue an American residency, which is all fine and dandy. When the board decided to add American students to the test, it was for nothing more than to make money. 25,000 students per year x $1,000 per test / 5 testing centers = 5 million dollars per center per year. Do they really need that much money?

Well, I best be off for now. I have a lot to do and a lot to look forward to in the next year or so.

Residency

I love my wife; but, I saw this comic in the AMA newsletter and couldn't help but think of her fretting turning 27 years old - HAPPY BIRTHDAY!!





As you can see, Rachel's birthday is upon us; so, happy birthday to her. My birthday was excellent, as already stated. It was made more excellent with more birthday gifts from my own parents consisting of more camping supplies. I believe we are all set to visit the woods on 4th of July weekend.

So, I said previously that I would explain the matching process. Here it goes. Let's take the disposition of ten applicants applying for eight positions between four programs. For illustration purposes, the applicants are numbered 1 to 10, and the programs are A, B, C, and D. Program A will have four positions, B will have one, C will have two, and D will have one position. The process works according to how each applicant ranks the programs to which they applied, and also how each program ranks the applicants they interviewed. Each of the ten applicants ranks the four programs as follows:

1. A C D B
2. A B D C
3. B D A C
4. B A C D
5. C D A B
6. C B D A
7. D A C B
8. D C B A
9. A D B C
10. A C D B

Notice applicants 1 and 10 had the same rank list. Now, the programs submitted the following rank lists:

A. 5 2 3 1 10 6 9 8

B. 10 2 7 6 5

C. 8 1 10 4

D. 9 2 7 10 4

Since applicants 1, 2, 9, and 10 all ranked program A as their top choice, this is where they are initially placed in the first round. Applicants 3 and 4 ranked program B as their top choice, but B didn't want 3 or 4, so B matches no one in this round. Program C was ranked first by applicants 5 and 6, so neither is placed here as C didn't rank applicants 5 or 6 at all. Program D gets 7 as he ranked it first; as did 8, but D didn't want 8. So, thus far, applicants 3, 4, 5, 6, and 8 are unmatched after the first round. But, they have second choices to consider.

In the second round, applicant 3 chose D as its second choice, but D doesn't want 3 either. Too bad for 3. Applicant 4 chose A second, but A didn't want this applicant. Applicant 5 ranked D second, but didn't want 5 either. Applicant 6 ranked B second, so B acquires 6. Applicant 8 chose C as its second choice. Program C now acquires 8. Now, applicants 3 4, and 5 remain unmatched.

In the third round, applicant 3 has A as its third choice, which A considers better than 1, 9 , or 10. So now program A has 2, 3, 1, and 10 knocking 9 into an unmatched position for now. Applicant 4 has C as its third choice, so C no acquires 4. Applicant 5 has A as its third choice, which A considers better than 10. Program A gets 5 and loses 10. As this is the third round, one must consider the second and third picks for applicant 9 which are D and B, respectively. Program D just loves 9, so 7 gets ousted. Applicant 10 has C and D as second and third choices. Program C considers 10 better than 4, so it acquires 10 and loses 4. Applicant 7 has programs A and C as choices two and three, but neither A nor C want applicant 7. So, applicants 4 and 7 are now unmatched.

In the final round, applicants 4 and 7 hope to gain a spot. Applicant 4 ranked D fourth, but D didn't like 4 compared to its recent gain of applicant 9. Applicant 4 thus remains unmatched. Applicant 7 ranked B fourth, and B considers its 7 better than 6. B acquires 7 and loses 6. The third and fourth choices of applicant six are now considered, which are D and A. Program D likes its 9 better than 6, and 6 just missed program A since applicants 1, 2, 3, and 5 are ranked above 6.

Alas, the final result is here:

Program A got applicants 1, 2, 3, and 5; Program B got applicant 7; Program C go applicants 8 and 10; and Program D got applicant 9. Applicants 1 and 2 got their first choice, while everyone else got their second, third, or fourth choice. Two applicants, 4 and 6, finished unmatched, which is to be expected when 10 people apply for 8 positions. Although it didn't happen in this example, it is possible that a program will have a position to which no one matches. Suppose of all the people program C ranked highly, none of them ranked C quite so high and matched elsewhere; additionally, those who didn't match higher up on their rank lists didn't rank program C. This scenario would lead to no one matching in one or both of C's positions. These open spots are then vied for by unmatched applicants in what is known as the scramble - where unmatched applicants contact via phone program directors whose programs have open spots. This is a very stressful time as these applicants already failed to match, and now must be more aggressive than ever.

I don't know if any of this blog helps people to understand how the residency match works - but I felt the need to explain it to people. It me the longest time to figure out it worked until I found something that diagrammed it out for me. Only time will tell what shall happen.

The Misery That is Neurology

No, Daddy, I don't think I can quite reach the pedals.



First, let me tell you about geriatrics. A couple folks out there were hoping I would turn around and decide that I like geriatrics. Well, sorry to disappoint, but no, it didn't happen. Now, it wasn't the older patients that bothered me. It was the sitting around for two weeks with little to do, then sitting around in a clinic room boring myself to death with a whole two to four patients a day, and getting very little to nothing from it all. On the wards, we saw three or four patients in the morning, rounded, and then sat around the rest of the day since we weren't allowed to leave until after 4:30 every day. The clinic was everything but educational. See the hospice patient and nursing home patients weekly was a near waste of time. Worst of all, it's a graded rotation. It ought to be a pass/fail rotation considering no other medical school in the entire country dedicates (read: wastes) a month of their students' time on seeing patients who are no different from any other patient. What if I end up with a B, ultimately screwing up my GPA over a rotation incomparable to any rotation taken by another student at another school The things they harp on being extra careful about in the elderly are true all right, but these same things are just as important in nearly every patient on the medicine service at the VA, which I worked for two months.

As the rotation neared its end, I saw a light at the end of the tunnel. But that light quickly went out when neurology started. My discussion about this will be at some other time.

I have my paper undergoing its last revision by a transplant surgeon. After this, I will submit if for publication. I have registered for the ophthalmology matching site, and I am almost finished coming up with a list of the programs to which I will apply. It's an exciting time, so exciting in fact that I totally lost site of the fact that yesterday was my birthday. It came up on me so fast that the only reminder of the day was the wonderful pie my wonderful wife made for me. Oh, and a few b-day cards, text messages, and a million phone calls.

I don't have much else to say tonight. Guess I just have a lot else on my mind. Goodnight.

Spring Awakening

Below is a listing of pictures taken to commemorate the colors to spring blooming. These are the reasons we couldn't live in a city like, say, Chicago.

Welcome to our road. Yes, it's a gravel road.

So the mail person doesn't have to drive way out to all our neighbors - and they still screw it up.

The center of our "driveway." The stump, and the iron pot.

I planted these around the stump and iron pot. Hopefully, they will grow to be much bigger.

Our land, and iron pot, are infested with this bulbous plant. I was unsure of the type until. . .

A bloom! Which eventually became. . .

A flower: An iris, to be specific.

Another one, beside the house.

I'm telling you, these babies are everywhere!

Other types of purple flowers can be seen in the area.

And more.








The flowering bushes on the side of our house.









A closeup.

A different kind of flowering bush.








Same as previous, different color. Notice these are in front of our front porch.






In fact, the view from the porch.

In our back "yard," one can find many of these numbers.







Also in our back yard - WILD STRAWBERRIES!!!

Just outside the yard, the path from which Bailey's friend, Rosie, comes.

Venturing away from the house, it's amazing what can be found - a scary shed.

What appears to be an ancient torture device.

Chicks in a mailbox that hasn't received the Post in years.

Not sure how this one got here. It's about seventy years old.







A field of little, yellow flowers.

Now this field would be perfect for a game of ultimate!

As a result of all the storms in Arkansas, a babbling brook.

Also from the storms, a very wind-blown tree.







And finally, we look to the heavens to thank God for all this beauty.

As a side note, I can't begin to tell you how long it took to get all this formatted the way my anal-retentive self wanted it done. I hope you enjoy. If you haven't looked, below is also a new blog about my most recent rotation.

Family Medicine

I guess my kids actually love me.



So the rotation known as family medicine has ended. Let me preface any further comments by saying that I initially dreaded this rotation. This, in my mind, was to be the second worst rotation of the year, the first being geriatrics starting in two days. Despite my preconceived notions, I actually enjoyed the rotation. Don't worry folks, I didn't like it so much that I am changing my mind about ophthalmology - that is unlikely to change. I still hold that geriatrics will likely suck.

So what made family medicine somewhat enjoyable? A few things. The first was my fellow student. His name is Jon Chung, a 40-year old Korean-American who, after working as a psychologist for awhile, decided to reenter school and become a psychiatrist. With his age and former experience, he has a story to tell about every situation. You would think he was more like 60 years old, but looks thirty. He's just a very eccentric person and fun to work with. Since we were working down in Pine Bluff, we carpooled about three days a week. The 45-minute car ride provided ample opportunity to talk about our past lives as less productive members of society.

Secondly, we had autonomy down in the Bluff. From the very first day, we were seeing patients on our own, presenting them to the residents, and then working with the residents on a treatment plan. It actually made us feel like we were a more useful cog in the line of medicine. We were able to tell patients how stupid they were for coming to the ER for a two-year rash that was itching and required a work excuse (which we didn't give, pointed to the door, and said, "Get the f**k out!"). We never worked with the same resident two days in a row, which was great since no group of residents is perfect. There were those we chose to avoid for one or another reason, but this isn't the point of the discussion. The attendings were nice; they felt the need to actually teach us a thing or two.

Thirdly, we didn't have to do a lot of OB/Gyn. Let me explain. I worked at an AHEC, the so-called Area Health Education Center. There are several of these in different regions of the state, and other states have a similar program. Our family practice rotation distributes its students to the different centers. The only real disadvantage is that every site is a little different. At some sites, the students do a lot of OB, or a lot of inpatient internal medicine, or whatever. At Pine Bluff, it's all clinic, no OB/Gyn, and some ER. I liked the OB/Gyn rotation OK, but I didn't want to keep doing it elsewhere for four more weeks. I think I only had to do a couple pelvic exams.

The one unpleasant thing about the rotation was the last day, yesterday, and all the busy work leading up to it. After most classes/rotations, we take what is known as an NBME exam, the National Board of Medical Examiners exam. These are standardized, nationalized exams which take over two hours to go through and over three weeks to get scores. OK, so I am used to that, whatever. But after a break for lunch, we had to come back to take a lame 16-question quiz. How cruel is that? After the exam, we all had to give our presentations over an article to show that we still know how to analyze research data appropriately. Everyone's presentation was way too long. I've never had a last day of the rotation last so long.

Coming soon: a post of pictures.