Life In Residency // "Single" Mom of Two

It's been quite some time since I have updated y'all about life in a surgical residency.  Life is no longer like it once was while we were in medical school, things aren't constantly changing anymore, and for that I am thankful.  But the monotony of residency can begin to take it's toll on even the most independent of spouses and physicians alike.  Josh edges nearer and nearer to the end of his PGY1 year every day.  This has truly felt like the never-ending intern year for us because of his preliminary year last year.  And while we are so thankful for his full time position, we are both more than ready to finally leave intern year behind us, 2.5 months to go and counting.

Josh has "easier" months and harder ones.  He has months where he operates almost daily and months, like this month, in the ICU where he won't really see the OR.  The days do change for him in terms of his hospital setting but for me, my days with the girls are rather predictable.  No matter the service he is on, he leaves before the kids are awake and more often than not, he gets home after Rory is asleep and sometimes after Ryan goes to bed as well.  He works most weekends out of the month and it's not uncommon for some of the only weekend time that he spends with us to be at the hospital for a quick lunch in the cafeteria.  There are many many days where I do this parenting thing completely solo.

I know I'm not a single mom.  I don't claim to be.  In fact, I know a number of single moms and my hat goes off to them.  They not only do it on their own 24/7, but many of them also bring in the sole source of income for their family.  Luckily, we have Daddy to bring home the bacon, even if that means we rarely see him and that he makes somewhere around $12.00 an hour to operate on people and keep patients alive.  #residentsalary  Josh regularly tells Ryan that he's going to work to save lives.  Her two year old interpretation of that is that he "eats fries."

The girls and I spend our days as a threesome.  And while there are many great moments with my children, there are also countless others in between where I feel like I am on the verge of losing my sanity.  Between tantrums, missed naps, rough nights, sister fights (I swear it already happens), refused meals, teething episodes, diaper blow outs, endless messes, grocery store meltdowns, and not nearly enough time to myself, I have certainly had days where I feel resentful of the resident family life and the fact that we live across the country from any of our extended family.  Some days it feels as though my arms aren't big enough, my patience isn't long enough, and my coffee isn't strong enough.   If I need a Mommy break I have to call a babysitter and pay her about as much to watch my kids hourly as Josh makes as a physician.  When I think about it like that, it's just not worth it and I reserve the babysitter use to the occasional date night with Josh or really fun things like dentist appointments.

When my kids are sick, or heck, if I'm sick, I don't have anyone to call to come help me.  There would only be rare circumstances where Josh would be able to come home if I called him at work.  And that's if and only if he's not in the operating room and could actually answer the phone or respond to a text.  The one benefit of this resident life is that it has created in me a certain amount of motherhood resiliency.  There are no longer many things that phase me.  I've found things that help me cope like coffee, mom friends, and wine.  Not necessarily in that order.

What I do know is this.  Residency is tough, and it's also a long haul.  I could not have known the reality of the medical profession life when I entered into it.  Nothing can prepare you.  Every part of life is a season and I try to remember that.  I'm sure there will come a day when we have more money and I have more help and I'm also sure that there will be parts of residency that I miss very much, just like there are parts of medical school that I miss.  What I'm also positive of is that Josh works extremely hard for this family and Ryan and Rory, despite how much he works, know that their Daddy loves them very much.  He just has to go to work a whole lot.  Ya know, to eat fries.   Or something like that. :)

Iron Intern

Well, we made it through intern year round #1 successfully.  Praise the Lord.   Last weekend was the annual chief residents graduation dinner and the new intern class has been in the hospital this week doing orientation.   I wish we weren't repeating PGY1 year, but that doesn't take away the fact that we are SO THANKFUL to be staying at UMass for the duration of Josh's general surgery residency.

At the end of every resident year, there are a number of awards given out to residents who demonstrated qualities that were above and beyond the normal expectations.  Most of the awards are for senior residents, however there is one award given to an intern called the "Iron Intern" award.  Now, Josh is not one to ever brag about himself but since I'm his wife and I write this blog, I'm allowed to brag for him.  Of the 11 interns this past year (6 categorical, 5 preliminary) all of whom were very hardworking and strong general surgery interns, Josh was awarded the Iron Intern award for outstanding service this year.

Obviously, we knew that Josh was well-liked and respected enough at UMass to be given a categorical spot for this coming year but it is so amazing that all of his hardwork and dedication to his job this past year was recognized by his co-workers, especially since he was only a preliminary resident which has a tendency to carry with it a negative connotation.  I know that being given this award had to make him feel good and it makes me very proud and makes the sacrifices that we have made over the course of his career feel worth it.

On top of this great award, we got to celebrate with a nice dinner out for the chief resident graduation dinner put on by the program.  My sister-in-law Kristin was actually out here from California and lovingly agreed to watch Ryan for us so that we could enjoy the evening.  We got to get all dressed up and even though I was 30+ weeks pregnant, huge, and unable to drink and Josh had to work the next day, we still had a thoroughly enjoyable evening out.

Dr. and Mrs. Joshua Scurlock

Ryan and her "Iron Intern" Daddy

It was a great evening and strange in some ways because I remember sitting at the same dinner last year, wishing and hoping that maybe I could somehow be there again the next year and the next and eventually be the wife in the room watching her husband be recognized as a chief resident graduate.  And God-willing, that will happen five years from now and it feels so good to know that.  Last year, so much was unknown, so many things were up in the air.  There was a lot of stress and worry and unanswered questions as I sat there.   And this year, though life is still filled with different kinds of stress and worry and questions, I was able to sit there with peace knowing that we did it, together, Josh and I got through this year and the ultimate goal of securing a permanent position at UMass was achieved.  The sacrifice of moving our family across the country was worth it.  I'm so proud of us.   I'm so proud of my Iron Intern.  And hey, maybe he can set a record for receiving the Iron Intern award two years in a row! :)

The Match, The SOAP, and the Reality of being an IMG (Part 2 update)

So, here we are, Match Day 2015.  Can it really be that it has already been a year since Match Day 2014, the day that inspired this ORIGINIAL post?  That post has become far and away my most read post on this blog to date.  I find it both humbling and heartbreaking that so many have found their way to my blog and either felt sorry for our story or inspired by it.

The post has been linked on other medical blogs and has been referenced in multiple forums on Student Doctor Net throughout the last year.  And because I can trace where my page views are coming from, I have seen the comments on those forums and blogs and I have to say, I have had moments where I felt very discouraged.  I realize that those that comment have neither been in our exact position, nor do they know Josh personally, and they are attempting to give a full (albeit harsh) picture of what not matching or perhaps WORSE in their eyes, matching into a prelim position means.  I've read things like "prelim positions are dead end positions," "he will never get a categorical position," "he will be worked to death and will not be respected as a prelim," and one of my personal favorites, after not getting into an American Medical School, "he should do something else and get on with life."

I have one thing to tell all the naysayers and the same thing to tell all those discouraged and disheartened about their Match success or lack their of, especially the IMG's.

Josh Matched Categorical General Surgery at the University of Massachusetts.

It pains me to say that THERE IS NO MAGICAL FORMULA to matching into categorical general surgery as a preliminary resident. Nor is there any perfect outline for finding a spot during SOAP or after.  There have been so many readers who have commented on my blog post and asked me to email you personally to answer your questions.  There have been readers who have tracked me down on Facebook or through my Etsy shop to ask questions about what we did and I understand, I really do.  You are grasping at straws here.  I understand the heartbreak you are going through after not Matching and I know the stress you have felt after not SOAPing.

What I am going to write here is what WE did and what worked for US but I know that our story is a combination of hardwork, determination, prayer, and luck.  Honestly, we needed all four of those components for this to work.  While I think that Josh is the perfect package for a surgical residency program, there was definitely an X-factor at work here.

This past year:

Joshua knew from day one as a preliminary resident that he would have to hit the ground running in his program.  First impressions are important but so are long term impressions.  He knew he couldn't start out strong in July and then begin to teeter off in the coming months.  It is a marathon not a sprint.  What you have to understand about Josh is that he is a very outgoing, competent, and  confident man as well as a natural leader.  It's possible that he thrives more under pressure than anywhere else so when he knows he has to go all-in, he does.   What you have to understand about the surgery program at UMass is that they don't treat their prelims differently than their categorical residents.  Joshua was in surgery regularly alongside attendings and the Program Director.  I'm certain that there are preliminary programs out there where this would not be the case, but Josh got lucky because he was at a program that would give him the chance to get noticed.

He got 4 entirely new letters of recommendation, three from surgical attendings he worked with during the first two months at UMass and one from the Program Director.  We believe this was key in him getting 5 interviews this year.  His test scores (Step 1: 232, Step 2: 235) and grades (graduating GPA: 3.7ish, Basic science GPA: 3.4ish) hadn't changed, if anything, he was at a disadvantage having been out of school for a year.  But we feel his new LOR's were EXTREMELY strong and so they were able to boost his application.

He was also asked to be on a committee for resident education at UMass as one of two PGY1 representatives.  We were surprised that even though he was a preliminary resident, he was given this task.  During the fall, he competed on a 3 person team comprised of one 5th year, one mid-level, and one intern in a "surgical olympics" type competition between other surgical residency programs on the East Coast.  UMass's team came in 2nd place and I feel Josh shined during that competition.  He showed confidence in himself and his surgical skills as well as pride in his program.  All of these things may not have determined his ability to obtain a categorical position, but I feel that getting your name and face out there within your program, especially if you are a prelim is of the utmost importance!  In other words, getting involved in these type of opportunities never hurts.

As it turns out, Josh Matched at his first choice program where he is currently a prelim, the University of Massachusetts.  We loved this program from the start and are so thrilled that not only did we choose them, but that they chose us.  I don't know if Josh would have matched at one of the other 4 programs he interviewed at if UMass didn't pan out, but I do know that he felt confident in all of his interviews and I would like to think that someone else wouldn't have passed him up either.  I guess we will never know and at this point, it no longer matters.

Many many things came together in order for this story to end in the successful manner that it has.  Maybe we just got totally lucky.  And if that's the case, we are thanking our lucky stars.  We have five years of a surgical residency ahead of us and you'd better believe we won't be taking any one day for granted.

Match Day 2015!

**If I haven't answered some of your questions, know that I plan to do a FAQ post as well in the next few days.  I wish I could respond to everyone that has been asking me to email them, but I'm only one person and I'm also a Mom and a wife.  I write this blog as mostly an online journal for family and friends and while I'm thrilled to be "helping" others in similar positions, I also don't know much more than what I've already written or read about online.  

True Life, I'm A Resident: Week of Vacation

It may seem from the rather infrequent posts that I write about life in residency that it is just the pits.  And while some weeks it really does feel like we are navigating the fire swamp, residency does have some pretty good perks.  Like paid vacation!  Josh had to pick three weeks of vacation back in April, so we kind of just picked random months spread throughout the entire year and today marks the beginning of his first entire week off since we started in July.

He has a full 9 days off and I have to say, we don't even know what to do with ourselves!  It's not just a vacation for him, but a vacation for me as well.  I have little to no help from Josh during the week and it's not often that we splurge for a baby sitter or that Josh even has time for us to go out together.  So having him home for a week provides such a nice break for me from solo child-rearing.

This break comes at a great time since Josh just finished his month of nights a week ago and has been in desperate need of a reboot.  He, of course, has some studying to do for the never-ending board exams that always seem to be looming in the not-so-distant future, but other than that, we are planning to relax and spend some quality family time together with little to no mention of doctors, hospitals, patients, and paperwork.  Talk about big plans! :)

So cheers to a full week with the all three of us!  May we make the most of it.

True Life, I'm a Resident: An Entire Month on Nights

Every month, Josh switches services that he's rotating on.  For example, he started out on Vascular Surgery, followed by Thoracic Surgery.  He'll do other services in the upcoming months like Trauma Surgery and Surgical Oncology.  There are two different hospitals in which he switches back and forth between depending on the service he's on.

At one of the hospitals, people switch off during the week of taking the night shift, but at the other hospital, one resident is staffed for the whole month on nights.  It's nice on one hand because it means that certain months, Josh will never/rarely have to work a night shift.  But, pretty much every intern resident has to take their turn as the night shift guy/girl and October is Josh's month.   I've been dreading this month since we got Josh's schedule back in July. He works every Sunday night through Friday night for the entire month.  His only night off is Saturday night, but since he's doing nights all month long, it's near impossible to get off the night schedule for only one night a week.  So last night, despite the fact that he wasn't working, he was up until 4:30am.

What does that look like for family life?  Well, as you can imagine, it's not that great.  Really, residency in general is not that great for family life right?  But, we learn to work with what we've got.  We usually see Josh for 45 minutes or so in the morning when he gets home around 7am while he scarfs some breakfast err dinner?  (Sidenote:  Josh has lost over 20lbs since starting residency. I need to hop on this diet plan).  He sleeps most of the day and wakes up around 4pm where we get another hour or two before he goes in to work at 6pm.  It's tough, but this is resident life.

At least Ryan and I are going to have some visitors in the next couple of weeks to help us occupy our time.  One of my best friends Alexa is coming to visit for a few days followed by my parents at the tail end of the month.  We can't wait.

On another note, Josh got to do his first solo appi (the surgical lingo for an appendectomy).  He completed it all on his own from start to finish, with another surgeon in the room of course.  But still, my husband is just growing up and becoming a real doctor.  Hard to believe that four years ago he was prepping for Biochemistry and Anatomy midterms in England and I was wondering how we were ever going to make it all the way to this point.  Just goes to show that God IS Faithful.

Looking forward to November when Josh can get back to 80 hour DAYTIME work weeks and an entire week of vacation!

Residency: The First Two Weeks

Josh's first two weeks of his surgical residency are over.  Well, okay, he has to work tonight.  So I guess his first two weeks are officially over tomorrow, but close enough.  I am betting there are a number of people out there who are curious how residency really is compared to 3rd and 4th year clinical rotations.  And to be quite honest, there are a lot of similarities while at the same time a lot of differences.

First of all, Josh is loving residency.  He loves finally being a doctor.  He has his own patients, writes orders, creates plans, executes plans, assists in surgery, does procedural stuff in patient's rooms, and basically, gets to make decisions (some not all) without another physician having to sign off on it.  It seems to be at this hospital, that if you prove you can handle the work, you get more work.  Which is actually a good thing.

He is working a lot of hours as an intern, coming close to hitting the 80 hour limit set for interns each week.  It's hard to have him leave the house before 5am every morning and not get home until sometimes as late as 7pm.  He doesn't see much of me or Ryan but it could be worse.  During clinicals, he had to take 24 hour call 2 days a week and had some weeks where he was working 100+ hours.  If anything, ARMC prepared him for long hours.  ARMC also gave him confidence in patient care because he was required/allowed to do so much as a student that being an intern resident isn't quite as overwhelming for Josh as it may be for others.

He is really enjoying working with his senior residents and attendings and feels like it is really a team atmosphere.  Which, as a previous quarterback, he can appreciate.

He feels quite a bit of pressure to perform well, which I am sure is typical for most interns in any residency program, but since he is a preliminary surgical resident, that pressure is increased.  He and I really like Massachusetts so far and considering that he basically fell into this surgical residency position, UMass seems like the most amazing fit for Josh and I.  Despite the long hours of work, we are the happiest we've been in a long time.

We would love to stay here for the remainder of his surgical residency and so it's hard not to think about it on a daily basis. But for now, Josh can only work as hard as he can and hope that that's enough to keep us here.  I have faith that God will keep us here or put us where we are supposed to be.  And He hasn't let me down yet.

Massachusetts Residents

So, we are officially Massachusetts residents now.  Weird.

First impressions of Worcester:

• SUPER green and lush
• Rains almost daily (even in summer)
• Cool
• Slower paced
• Friendly people

Ryan and I got here a week ago and Josh was ready and waiting for us at the Boston airport.  It was a long day of traveling, but Ryan did so well.  The most difficult part of our day was getting through the airport security.  I had decided to carry Ryan on me in the Ergo in order to have my hands free.  This ended up being a good idea.  What was a bad idea was having three carry-ons.  I looked like a straight up pack horse getting through the airport.  Ryan strapped to my front, diaper bag on my back,  duffle bag over one arm, and my computer bag over the other.  I was sweating by the time we made it to the gate but we made it on the plane and Jet Blue was so accommodating, putting us in a bulk head seat so Ryan could play at my feet.  They even gave Ryan a set of "wings" since it was her very first plane ride.

The flight was almost 5.5 hours, but you wouldn't have known that Ryan was even on the plane.  She played, socialized, and took a 1.5 hour nap in my arms.  I don't think she cried one time.  I couldn't have asked for her to be a better baby.  In fact, so many passengers and flight attendants commented on the fact that she was the most well-behaved, happy, good-tempered baby they had ever seen/flown with.  Way to make me look like Mom of the year Ry! :)

We were definitely happy to get to our new apartment and reunite with Josh, even though we knew it would mean sleeping on an air mattress.   The apartment is super nice, minus being a little "hotel-like" but we think that may be an East Coast thing and are sure we'll adapt to it.

We spent the week trying to get out and enjoy all that Worcester has to offer since our apartment was furniture less until this weekend.  We found a local park with swings, went on a couple little hikes near our house, and ate lunch down by Lake Quinsigamond.

We also went to check out the University of Massachusetts Memorial Hospital where Josh will begin working in a few weeks.  It's VERY nice.  Definitely a step up from ARMC county hospital.   And it's super close to our home.  So close that Josh plans to walk!!

Our stuff arrived on Thursday and we were definitely ready for it to get here.  A week without things is a bit challenging, especially with a baby.

We've spent the last couple of days trying to unpack and organize all of our stuff.  It's a process, but I prefer the boxes and chaos to an apartment full of nothing.  Massachusetts is starting to feel a bit more like home now that we have some familiar things and I assume it won't take long before we feel at home here.

Moving East

Have you ever had periods in your life that you want to speed up yet slow down simultaneously?

For instance, as a Mom, I feel like I am constantly anxious to get to the next "phase" of baby hood, always urging Ryan to do the next big thing, crawl, talk, eat, walk, etc.  I couldn't wait to have her sleep through the night, nurse a little less often, entertain herself a little bit more.  It's hard in the midst of the newborn stage to not wish for time to speed up, especially when you haven't had a shower in three days and the most solid meal you've had to date is half of a PB&J.  And yet, you want to keep them your little baby forever and you know you will miss the days when you can't just hold them in the crook of your arm.

Well that's how things are right now.  I want time to speed up and slow down.  We are moving to Massachusetts.  In fact, we moved out of our apartment in Redlands over the weekend and Ryan and I are currently shacking up at Grammy and Grampy Fairman's house.  As I type, my Dad and Josh are more than half way done with their cross-country trek via car.  Last I was told they are somewhere in Illinois.  Ryan and I fly East to meet Josh on Saturday.

Moving Day

Hitting the road!

I am ready for our things to arrive and to get settled in Worcester (apparently pronounced Wustah).  I'm anxious for the solo 5+ hour plane ride with a 10 month old to be over and of course ready to reunite with Josh and begin our new adventure in residency as East coasters.  It's hard for a type A person like me to be living in limbo land.

But, I also want time to slow down.  I'd be lying if I said I wasn't nervous about living so far away from our friends and family.  Sure, we've lived in the UK and the Caribbean and so this should seem like nothing, but we didn't have Ryan then.  I haven't yet done the Mom thing in a place where I have little to no outside support.  And obviously, we are going to miss having our families in Ryan's life tremendously!

So, that's my dilemma, not totally ready to move forward and not necessarily wanting time to stand still.

In other exciting and noteworthy Scurlock family news, Josh received his diploma in the mail the other day.  Like he is for-realsies a doctor and we couldn't be more proud.  I probably should stop saying things like "for-realsies" now that I'm a doctor's wife. Oops!

And not to be one upped by my doctor husband, I've had a few Etsy sales since opening my shop The Dandelion Lane on May 1.  How exciting is that?!?!  If the doctor thing doesn't work out, at least we can count on my savvy business skills to keep us afloat, obviously. ;)

The Match, The SOAP, & the reality of being an IMG

This past week was Match week, which for those of you readers unfamiliar with this term, it is the means by which MD graduates get "matched" into a residency placement.  For many people, Match week is the highlight of your 4 years of medical school, when you finally have a job post graduation and the reality that all of your hard work has in fact, paid off.

However, what many people don't understand is that there are far more MD candidates trying to "match" then there are spots in residencies.  Every year, there are thousands of applicants, many of them international medical graduates (IMG's) who don't receive a spot in a residency.  Therefore leaving them with the degree of MD but unable to be licensed and practice due to the inability to obtain a residency position.

The Facts:

• Josh is finished with all of the requirements to graduate from medical school at SGU and will receive his diploma in June.
• Josh passed all of his board exams, Step 1, Step 2 CS, and Step 2 CK with scores above the average for both IMG's and AMG's (American Medical Graduates)
• He had strong letters of recommendation
• He is in the 1st quartile (top 25%) of his graduating class academically for both the basic science years (first 2 years) and currently
• He applied to 100+ categorical surgery residency programs both community based and university based across the entire US
• Josh only received a few interviews to residency programs
• We found out Monday that Josh did NOT Match

While not Matching did not necessarily come as a complete shock because of so few interviews, we were still very disappointed.  It is extremely scary to know that you not only don't have a job after 4 years of medical school, but you also have no job with $200,000.00 worth of educational debt that will have to start paying back after you graduate.

The SOAP (Supplemental Offer and Acceptance Program):

• When you don't Match into a residency, you can enter the SOAP, a process by which you send out up to 45 more applications to residency programs that did not, for whatever reason, fill their positions during the Match.
• On Monday afternoon, Josh sent out the full 45 applications to programs for Surgery (both categorical and preliminary), Family Medicine, Emergency Medicine, and Internal Medicine.  At this point he was willing to do anything.  We thought FOR SURE he could SOAP into something based on his grades and Step scores.
• From Monday through Thursday, applications are reviewed by programs, phone interviews may happen, and every few hours, offers to those programs are made.
• There were approximately 900 positions in the SOAP.  There were over 1100 AMG's unmatched and over 8000 IMG's unmatched trying to obtain these spots.
• Josh got ZERO phone calls or emails the entire week.  NOT. EVEN. ONE.
• It is our belief that international graduates, regardless of citizenship were filtered out from the start, that Josh's application was not even looked at all week.

Our interpretation of the SOAP from an IMG standpoint was that it was like being stabbed with a knife and then having it twisted around inside of you in order to kill you slowly and painfully.....a slow, painful death.  There is nothing like sitting around all day for a week, waiting for a phone call, and one never coming.  The stress level in our apartment was sky high and yet we knew there was nothing to do but wait and hope and pray that something would work out.  Josh was a part of message boards online for people in the same position and we know that AMG's with significantly lower Step scores were getting multiple phone interviews as well as offers.  Never has the stigma of being an international graduate felt more damning.  Both Josh and I were so discouraged.

Post SOAP:

• On Thursday at 5:00pm EST, the SOAP ends, and unmatched applicants are then allowed to contact programs by phone or email that still have openings.
•  At this point, there were less than 50 spots across all specialties left after the SOAP and programs are not required to fill their positions.
• Josh began sending out what I call hail Mary emails to programs with unfilled spots hoping that someone might throw him a bone and at the very least email him back.
• He received many automated response emails saying either the positions had been filled or that they had decided not to fill their positions this year.
• By Friday morning, Josh was beginning to look into alternative options for the next year.  These included doing an MPH (Masters of Public Health), unpaid medical research, delaying graduation in order to do more hospital rotations, and jumping off a bridge....joking...kind of.

On Friday around noon, Josh received a call from the program director at the University of Massachusetts, one of the programs he had emailed the night before.  He conducted a 10 minute Face Time interview and offered Josh a general surgery residency position for this year on the spot.  Within minutes of getting off the phone, an email with the offer came through, Josh signed it, and that was that.  Relief immediately followed.

What we learned/Our advice:

• Apply on time.  Do not wait even a day to send out your applications. Being the first to get them in is likely key to getting multiple interviews.
• If you can, have all of your Step scores IN before applications are due.  You are best off if you have a COMPLETE application at the time of submitting it.
• Have realistic expectations.  If you are an international grad, it will likely hurt you.  Most IMG's go in to primary care (FM, Peds, IM, Psych).  If you do not want to go into one of these, consider apply to some anyway as a back up choice.
• Avoid the SOAP at all costs!  It is NOT set up to be in the interest of the applicant, especially IMG's.
• It is better to have a residency of any kind than not.  Trust me.

We feel very lucky.  Not only did Josh end up in his residency of choice, surgery, but amazingly he is also going to be at a university program at one of the top surgery programs in the United States.  It is nothing short of a miracle and we are definitely counting our blessings.

****EDIT: Here is a link to the follow up post regarding our match process.  Josh did, in fact, match into categorical surgery in the 2015 Match.  Read about it HERE.