I'm on night float right now, forgive any poor editing or spontaneous outbursts

We are in the throes of interview season for residency. Today we had the 3rd of 5 interview days. It is a tough experience on both ends, with both the applicants and the program trying to explain and sell themselves over the span of 18 hours. Later, we will rank our choices and applicants will rank their program choices. Then a proprietary computer algorithm will tell us who our new colleagues are and we will all pretend like it was meant to be.

This process is literally insane. Our program has 4 spots and we are interviewing 100 people. We had something like more than 300 applications. Bigger programs in bigger cities have even higher numbers. Applicants are only limited by their funds regarding the number of programs they can apply to. Which means that people who look really good on paper get a lot of interview offers and take interviews at places they aren’t likely to go. And the people who look less good on paper find it harder to stand out.

I believe that the system needs a serious overhaul (full disclosure: I am in something of a ‘burn it down’ phase right now). There should be a cap to how many programs applicants can apply to. Don’t waste everyone’s time by stacking the numbers.

Many people demonstrate a surprising (to me) lack of scientific thinking when it comes to the Match process. “It all works out” or some variation, is something that you hear a lot. I think that is BS. I think that is “law of attraction” sloppy magical thinking that causes people to feel to blame for their hardships and ignores structural flaws of large systems. I think that it decreases the accessibility of medicine as a profession for traditionally under-represented groups in the field - first generation college grads, low income, members underserved populations, people of color (anyone else see that stat that there are fewer black men in medical school now than there were 30 years ago?). I hate the “it all works out” attitude. It doesn’t all work out. Sometimes people get shitty matches, sometimes they don’t match, sometimes programs misrepresent and sometimes people aren’t who they seem to be in the interview. There are ways the system could be better and having a ‘C’est la vie’ attitude is not helping improve the situation.

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Merciful Zeus, I am going to be on night float for the penultimate interview dinner - a more than adequate reason to miss the damn thing.

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I am in the throes of a fantastic Thanksgiving weekend! My parents came to town and did some cool things with the kids. We had a great meal and today I only had to work for about 90 minutes. We got a Yule tree since the kids will be heading West 3 weeks from tomorrow. It is a beautiful 7 foot tall fraser fir.

My parents = my mother and my step-mother, it is possible that some of you didn’t know that yet. Now you do. I’ve known Judy (step mom) since I was almost 15 years old. She knows lots of things about plants. She bought us 2 new shrubs for our backyard and she & the kids put them in. Then she taught D how to be a tree surgeon (with technical lessons about tree anatomy included) and the two of them trimmed the huge grandmama of a crepe myrtle I have in my front planter space. They also took out 2 homely looking shrubs that were eating up the best light of the front of the house. And she let A drive her truck 3 times around the corner to the brush pile spot. It was nice to get the practice. And she brought the 2 dogs with her. She has a border collie and a small golden retriever-looking dog. I have many pictures of Duncan trying to pet 3 dogs at once from the last few days. It is endearing to watch him lay down on the rug and encourage a dog pile.

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I’m making a point that their father is not a tense topic of conversation. We have discussed the maintenance of traditions, disposition of ornaments, plans for vacation, recent texts, holiday plans. We tell stories of our past that include him as a central character (cuz, you know, he was). I try very hard to keep my tension and disappointment to myself. I am, if I may say, a pretty good compartmentalizer. I do need space to process my divorce (I get it, in therapy), but I also want to be able to talk to the kids about things that matter to them without them feeling like they have to censor themselves or can’t talk about something because of my baggage.

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When one delivers a baby, one puts steady downward traction on the head to deliver the anterior shoulder. Whenever I’m doing this, I’m always thinking, “Is this a shoulder dystocia?” and struggling to identify the myriad of ways an anterior shoulder can look when it comes out and how to distinguish a slowly emerging shoulder from one that gets stuck behind the mother’s pubic bone, a dystocia.

Recently I was delivering a baby at an unmedicated birth. As I was delivering, I was thinking about the downward traction and got to the usual point when I wonder, “Is this a shoulder?” Only this time nothing happened. It was, in fact, a shoulder. Fortunately my chief was right over MY shoulder and very quickly identified the situation and I watched (and sort of helped with) the maneuvers that released the baby from the stuck position.

Thinking, every time, “Is this a shoulder?” is a mindset consistent with being an obstetrician. It is my job to rule out the dangerous stuff. I’m part way there. The crucial next step would of course be DOING SOMETHING about the dangerous stuff. This time I wasn’t really a central actor in the “doing something” part of this part of the delivery. Next time, I will be better prepared.

(I feel like mentioning that I’ve had ample training on the maneuvers to deliver a shoulder dystocia. There is a huge difference between being able to list the stats & steps during didactics, doing it on a model in sim lab and actually taking charge of the chaotic room where the actual dystocia is happening. This is why my chief is present at all my deliveries. She usually stands behind the table and watches, proverbially sitting on her hands. But when our patient needs her, she’s right there.)