Thursday, September 26, 2013

Team S.J.G.R. Thursday Huddle #13: The 7-UP Challenge.

What's up, Team? Okay, so this week's huddle is short and sweet. You ready?



I'm inviting you to join me in a 14 or 21 day challenge. I made it up in my head yesterday so you're the first to be privy to this warped little idea of mine. Dying of curiosity, are you?

Wonder no more. I bring you what I affectionately call "The 7-UP Challenge."  (No, it has nothing to do with drinking 7-UP instead of Sprite, so let that go.)

Here's how it works:

  • 14 days minimum, 21 days if you're feeling bad ass.
  • Take the stairs, not the elevator! (Relax--not twenty flights up or anything.)
  • BUT--any destination that is 7 flights up or less you have to take the stairs.
  • No elevators for anything 7 flights or less away.
  • Going DOWN the stairs is up to you. It's not so good for your knees so feel free to catch the lift for that if you'd like. 
  • Clarifications for cheaters: If you are already on the tenth floor and now you need to go to the fifteenth floor, that is five flights. You need to take the stairs. If you eventually plan to go to the eighteenth floor but you stopped on the fifteenth floor to do something, that interruption makes it under seven. STAIRS, baby.

It's as simple as that. I'm doing the 21 day version because I am hoping to ultimately make this a habit. Some experts allege that to form a perceivable change in mental outlook (or form a habit of something) you need about 21 days of something. So there you go.


So who's in? If you are, make your mark here:


(or just say so in the comment section.)

Day ONE is the day you read this post. Are you doing the 14 day version or are you feeling bad ass? What you got, people?

Oh yeah, and for those who need some incentive, here's some:

When you strengthen large muscle groups like the quads, hamstrings and glutes, your body becomes a more effective fat-burner at rest. That's why squats can make you more lean than bulky (which is always the excuse people offer when they don't want to squat or lunge.) Just imagine the ridiculous amount of fat you'll burn (and time you'll save) from hitting the stairs and not waiting on the elevator?


Happy Huddle Day! Fitbit users, let's see how many flights we can get in a day!

Oh--and in case you don't get the CHAL-LENGE!!!! reference? It's from that old Cosby Show episode with Sandman Simms . . . .here you go. (JoLai, I know you remember it. Ha ha ha!)


*You're welcome.*

Sweet basil.

The room was mostly quiet and so were you. Head sinking into the top of two pillows that I personally stacked under your head because it's how you said you liked it. A man was building an herb garden on HGTV over your head and he was really into it.

"There's nothing like cilantro!" he says in this fluffy, tv-man, sing-songy voice. "And basil!" He sticks his nose straight into that finished garden box and inhales an exaggerated breath. "Aaaaah."

With your eyes still on the television you said, "Cilantro. I ain't never been much of a fan of that at all."

And me, I was just sitting on a chair next to your bed that afternoon. Not really for anything necessarily medical but just because you'd been here for some time and it was the only thing in my arsenal of internal medicine tricks that I thought might make you feel better. "Cilantro is like that, you know. There's no in between."

This time you took your eyes off of the television and rested them on me. "What's that you say?"

"Oh. I was just saying that cilantro is one of those things that you either love or you want nothing to do with. When you love it, you can't get enough of it. When you don't, even the smallest piece is too much."

"Yes!" You chuckled at my take on it. You gave your head a hard nod and then repeated yourself. "Yes!"

"You know? Sometimes I think people can be like that."

You were with me. With me 100%. "Like cilantro?" You jutted out your bottom lip and narrowed your eyes. "That's actually kinda deep. But yeah, I can see that. Definitely. Either you can't get enough of 'em or you don't want a thing to do with 'em." You released a soft laugh once again.

"I sometimes wonder what's best. Like, to be cilantro or to be basil. You know?" I really did wonder that. But you had a quick answer.

"I'd say basil. It's kinda pleasant in just about everything, don't you think? But you know it's there."

This time I was the one with the slit-like eyes taking in that analogy. I cocked my head sideways and raised an eyebrow. "Hmmm. But you know it's there. Hmmm. I like that."

After that we sat in silence for a bit. The HGTV man was now on to building a wooden gate for tomatoes. He kept pronouncing it tomah-toes which made us both smile in unison.

You spoke first. "Something 'bout calling it a toe-MAH-toe make it sound better, don't it?"

"I think you're right."

After a few more animated instructions, the show went to commercial. You pulled the covers under your chin and sighed. "I sure don't like cilantro. But I'd take it over radiation treatments any day."

I reached out and squeezed your hand. That was my only response because there wasn't any words for that. Your diagnosis sucks. You getting baked like a casserole every day and being in pain sucked, too. Especially since it was all just for symptoms and not for some foreseeable cure.

You closed your fingers around mine and returned the gesture. Your eyes filled with unexpected gratitude. "Thanks, hear?"

And even though I hadn't seen that coming I knew you meant that-- not for some specific pinpoint thing-- but just for sitting there and not being in a rush. And that made me happy because that was my goal. "I'm glad I'm here," I said.

"Me, too."

"What else can I get for you? What do you need that I might be able to help with?"

You tapped your lip for a second and squinted one eye. "Aaah! I got it. If you see that man building that garden, get me one'a them toe-MAH-toes, hear?" And that made us both laugh out loud. But only for a moment since we both knew that with such low blood counts a fresh tomato couldn't come anywhere near you.

I thought about those big, red tomatoes that the HGTV man plucked off of his homemade fence. I wished I could get you one right that second. I tried to lighten things up some more. "Ha ha. . . those things didn't even look real, did they?"

"Sure didn't, did they, doctor? Looked too good to be true."

Too good to be true.

Something about that statement made my breath hitch and my eyes prickle. I took in a drag of air and stood to leave. "Okay. I've bothered you enough. You try to get some rest, okay?"

You nestled under the blankets and turned on your side to face me. All that I could see was a portion of your nose and eyes and the hairless top of your head. I reached down and tucked you in as tenderly as I could. "You comfortable?"


I tip-toed to the door and turned to wave one more time. "I'll see you tomorrow, okay?"


"Alright then, pretty lady."

"Alright then, sweet basil."


I paused with my hand on the handle and then turned to look at you once more. You lifted your chin and moved your smiling face out of the mounds of sheets to let me see your soft expression. And then you closed your eyes and drifted to sleep.

And all I could think was this:

I am so, so glad to be here. Right here, right now. I am. Damn, I am.


Happy Thursday.

Wednesday, September 25, 2013

A day in the life of an academic hospitalist.

The other day I came in to round with my team. Two interns, one fourth year medical student and a third year student, too. My senior resident was enjoying a much needed off day so I assumed the role of what we attendings affectionately refer to as "resattending." Whether we like it or not, we wear two hats on those days.

Mostly, I like those days. The work is substantially harder but in a good way. The teaching is hands on and the level of interaction with the most junior members of the team is more intimate. You get exposed to the nitty gritty that is often lost on the more senior people. So this is what was going on with my team the other day.

So I get there and briefly make a game plan with the team for our morning. "Let's see our sickest people first," I said, "then our discharges. Is that cool?" And they all gave me answers in the affirmative. We briefly chatted about the patients slated for departure and then emerged from our team room ready for rounds.

"So our sickest is. . .hmmm.. . who would you all say?"

"My patient is the most acute, I'd say." This is what Erin, my fourth year medical student said quietly.

"Okay," I replied. And off we went.

She was right. That patient wasn't just sick. This patient was sick-sick. And you know? Even though the patient was indeed sick-sick, we saw that patient and did the thing we've been doing all month: communicate with the nurses and each other. We listened to the nurse caring for that patient and let her know what we were concerned about. And that part was good.

Out we went. Half way down the hall. That nurse came and broke right into our circle. "Our patient has become hypotensive and is working harder to breathe. I'm getting a crash cart." That nurse was calm. She pushed a button and firmly summoned others to join her when they had a moment.

And you know what? They did.

And so. We returned to the bedside just like that nurse asked. And everyone moved in quiet concert while that medical student held her patient's hand and explained what was happening while it was happening. No one was hollering or running or acting erratic. Instead, everyone seemed to just respect the urgency of the situation and act accordingly.

That patient could have coded. But didn't. Those nurses were absolutely outstanding. From start to finish. And you know what? When it was all over and that patient had been moved to a higher acuity setting, I took the time to tell the unit director just that. I wrote down names and called them. Because that's the kind of stuff that saves lives.


So that? That was good. But on the flip side, a patient was ill. Critically so--and when that happens, doctors feel angst. Like, if someone takes a turn for the worse first thing in the morning or really abruptly, it feels wrong. And even if you did all that you were supposed to do, some part of it makes you feel like shit. Particularly if you're the primary person on the patient.

So we carried on with our rounds and at some point I noticed this look on Erin (the fourth year medical student's) face. I could see that her waters were troubled and she was doing that thing that good and caring doctors do. Strapping the burden of better onto her back and feeling bothered that she hadn't been able to lug it up to the top of the mountain.

"You feel bad." I looked at her and just blurted it out. "Do you feel like you did something wrong?"

And her face turned red and she just sort of gave this semi-shrug. A very tiny wrinkle furrowed between her eyebrows and her mouth twisted sideways as she tried to express her feelings. And I stayed quiet and let her. I let her talk through the if I coulda-woulda-shouldas that she needed to talk through.

Next, I fought the urge to pat her hand and launch into some soliloquy about how when I was an intern something twenty times more awful happened. Instead, I sat the whole team down and we walked through the event and used the checklist that my mentor and I put together for processing adverse events in the hospital. And you know what? That part was good, too.

That day was long. We had a lot of patients with a lot of things going on and it involved a lot of really challenging things to think about. But we did it. We put our heads together and powered on through.

I was exhausted when I got home. Completely exhausted yet unbelievably fulfilled. That was my day the other day. And, for the most part, that day was really, really good.

Happy Wednesday.

Tuesday, September 24, 2013

Pieces of This American Life in Pictures: Here lately.

Casual 43rd birthday girls gathering--
here with my BFF of 20+ years Lisa D.

And here with my partner in Jack and Jill crime, Kathy T.

Ran 7 miles on my 43rd birthday ('cause 4 + 3 = 7. Duh!)

Reviewing the literature in hair salon. Obvi.

The carousel at Centennial Olympic Park!
So gonna ride that soon.

Personal Statement review over breakfast with sweet Jen K.
Heart her so!

They put love into this cappuccino. Like, literally.

 Getting it in early in the morning. (Reflectors sold separately.)

Stacy H. and her team stamping out disease.

 A reminder that the future is in good hands.

 A happy day witnessing my SG Gamma girl, Courtney, saying "I do."

One of America's most drop dead gorgeous (and smart) power couples. 

White coat ceremony with SG Delta--
putting a coat on my tallest advisee!

Of course, we mean mugged the whole time. Obvi.

And smiled once everyone got their jackets.


Young, gifted and black.


A proud day.

Can't wait to watch this one become a doctor.

Fun in the park.

Brothers = built in BFFs

My partner in crime, balloon-related and otherwise.

He was getting some "inner peace"
(while at the frozen yogurt spot.)

A super proud moment watching a friend give a big lecture.

Big hugs and good people can be infectious. For real.

Sorority meeting -- first of the year.
(Yes, I'm a legit and financial Delta.)

I love his social hope and dream. It's mine, too.

Self portrait by Isaiah Manning.

Laptops. Yes, in elementary school.
(Courtesy of their Papa, not their parents.)

Learning to talk to patients

Step one: Listen. They nailed it.

I was proud of this medal.

My little Delta sister from Georgia State who aspires to be a doctor. . . .

. . and here with my other little Delta sister (and SG Delta advisee)
who will be a doctor in four years.

This was to show JoLai that I'd worked out after leaving the hair salon. Ha!

Live. Love. Savor. Celebrate. Repeat.


Happy Tuesday.

Monday, September 23, 2013

Think about such things.

 Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable--if anything is excellent or praiseworthy--
think about such things.

Philippians 4:8

I approached you carefully. Not because I was nervous or any such thing but because when I saw you, I knew that you were probably sleeping. And since I'm pretty sure I wouldn't be a big fan of being jolted out of my sleep by the lights-cameras-action of doctors or nurses flicking on lights and calling out my name in an unnecessarily booming voice, I made a point of descending gently upon my bedside position.

That said, there is a such thing as coming in too quietly, though. Equally jarring, I'd say. One minute you're fast asleep and the next some face is peering into yours and jostling your shoulder. Your eyes open and -- yikes! A person--no people--surrounding your bed in a big semicircle as you try your best to adjust the drool that has leaked from the side of your mouth. (That same mouth that someone is going to ask you to "open up wide" before you've had a chance to freshen up.)

I found the happy medium. A soft knock on the wall after I passed that first bed to reach yours. Feet light but firm enough to make just enough noise to let you know that someone was in your room. And like clockwork, the mound of covers that represented you began to stir a bit. You rolled to your back and pulled down the blankets just enough for me to see your eyes. With a playful squint, you shook your head hard and then hid your face again. It was early.

"Good morning," I said with a chuckle.

Down came the curtain. This time, under your chin and signaling that you were now ready. "Good morning, sweet girl."

That made my face erupt into a big, wide smile. For every day of this hospitalization you'd called me that. Sweet girl. And something about the way you looked into my face so warmly whenever you did made me believe that you meant it.

"I see you're laying down flat. How are you breathing?"

You took a deep breath and let it out. "I'm breathing a heap better than I was before. 'Reckon I am breathing a lot better since I'm flat, huh?"


You already began sitting up in preparation for my lung exam. Normally when my patient is lying in bed already, I like to examine the heart first, but I also try to go with the flow. And so I did.

"How they sound? Do you hear the cracklies?"

"Nope." I pulled my scope out of my ears. "Those lungs are clear today. Not a crackly in sight."

"Or earshot." We both smiled at your correction.

I went on with the exam as you assisted me. I called it assisting because you did more than just cooperate. You pulled down sheets and unfastened snaps on your gown. You parted your lips and took big deep breaths and turned in positions before I could even ask.

"I think if the procedure goes well today, we might be able to get you going."

"That sounds good to me. What time you think they gon' take me down there?"

I looked up at the clock. "I think in the next hour or two."

"Okay. I hope so. 'Cause I ain't ate nothin' since midnight. And you know I'm starting to get a little lunchy."

We laughed out loud at that word "lunchy." That was the term you'd told me on the first day I examined you. My stethoscope was on your abdomen and your bowel sounds were so loud and gurgly that I raised my eyebrows in response.

"I'm feeling kinda lunchy, Miss Manning," you'd said. "That's what you hearing. Go on see what's taking them trays so long, hear?"

And something about that word "lunchy" amused me so much that you said it over and over again just to make me smile. That and calling me "sweet girl."

And so. You went for your procedure. It went fine. And afterwards you were discharged from the hospital--but not until you'd had your lunch.

Before you left, you grabbed my hand tight and said, "You be good, hear? I appreciate you taking care of me, sweet girl."

"And I appreciate you, too. You have no idea how much."

That is what I said. Because that is what I felt.

And this? This is this the part I love so much about being a doctor. Nothing exotic or cutting edge. Just one person looking into the eyes of another person and letting them know that they matter. The relationship is deeply symbiotic; we need each other to survive.

The everyday, the people, the words and inside jokes like "lunchy" and the tender names like "sweet girl" spoken to woman who gets that it's a term of endearment and receives it as such. This is the best part and this is what I am thinking about this morning. And all of it excellent and praiseworthy--it is. And yes. It feels good to think about such things. And so I do.


Happy Monday.

Thursday, September 19, 2013

Team S.J.G.R. Thursday Huddle #12: Playlist.

What's up, Team?

I hope everyone is having a GREAT week so far. I'm on the hospital service right now taking care of the inpatients so things are kind of busy. I admit that I'm about to have to go super hard this weekend to make up for how far I am from my 150 minutes this week. I ran for 57 minutes on Sunday and got in a 35 minute walk on Tuesday. Otherwise, I've been kind of raggedy with the deliberate exercise.

That said. . . .the Fitbit has been a great motivator this week, though. Taking care of hospitalized patients involves a lot of walking around. Maybe that's why they call it rounding? Hmmm. I don't know. But for reals? I have easily clocked 5 miles in that hospital each day just from regular work.  My Fitbit has inspired me to climb more flights of stairs and walk more.

So that got me thinking. You know? Team S.J.G.R. has really been an inspiration for a lot of us to adopt healthier lifestyles for the right reasons. For more than just sashaying around that high school reunion or college homecoming. We've decided to be transparent about what really matters and what stands in the way of us doing what we need to do.

So we nudge each other. We hold each other accountable with our reports and our posts. And that is totally inspiring. But here's what I've found. There are the big things that inspire us and then there are some little things, too. When it comes to exercise. . . . what can possibly be more inspiring than some good music?  Maaaaan, please. A really good music playlist? Tha's what I'm t'ambout!


Matter of fact, I wrote a little top ten about it. Like to hear it? Here it go.


Note:  I could probably listen to every one of these songs over and over again on a thirty minute loop given the mood I'm in. That's a sign of a good playlist jam.

#10  Rock Steady by Aretha Franklin.

"Rock steady, baby
That's what I feel now
Let's call this song exactly what it is.
It's a funky and low down feeling. . .(what it is)
in your hips from left to right. . .(what it is)
What it is is I might be doing. . .this funky dance all night, OH!"

I feel so bad ass when this song is on. I love to listen to this at the very start of my run. It gets me through my first mile with a big smile.

#9  Who Runs the World? Girls! by Beyonce

"My persuasion can build a nation. . ."

As soon as those drums come in and Beyonce starts saying, "WHO RUNS THIS MOTHA? YUP!" I start hauling ass, do you hear me? Ha ha ha. That song plays -- literally -- four times on my play list. Even though it's not a song I like hearing just for G.P. I do like it for running.

"Strong enough to bear the chil'ren . . .and get back to biz'ness!"


#8  American Boy by Estelle

What is it about this catchy tune? I don't know. It's just a great song for cardio. Especially when Kanye West comes in with his part. I know. I know. He's arrogant and somewhat annoying at times. But he's talented and hypes me up with his riff on this one.

"I'm like Mike at his badddd-dest. Like the Pips with they Gladys."

Ha ha. Yeah. That's the cut, man.

#7  Anything by Rihanna.

I can run to her music all day. No. I'm not necessarily a big fan of HER. But her music? It's all so good for running and working out, man. Specifically:

Love in a Dangerous Place
What's my name?
Only Girl in the World

I have a one and a half hour long playlist with all Ri-Ri. As in Rihanna. (Not to be confused with my Re-Re playlist. As in Aretha Franklin.)

#6  I Feel Like Going On by Bishop Marvin Wayans

I cannot get enough of this song. I cannot. I listened to it probably 30 times per day in November of 2012. And I tell you this song ministered to me in a way that few others could.

Now? I like to run to it. I cry the whole time it's on. But no matter how tired I am or how tall the wall I've hit has become, when I hear this song I feel like going on.

"I don't know how you feel about it but I. . .I feel like. . I feel like going on. Even though trials . . .they come. . . on every, every, every hand. . . .oh. . I feel. . .I feel like going. . .I feel like going on."

#5 How to Save a Life by The Fray

I love this song. Something about it makes me imagine a different story every time I hear it. I love that because I imagine that story while I'm exercising which allows me to zone out.

#4  Tom Ford by Jay Z (The Clean or the Instrumental Version)

That beat is SICK. Once I found this version, I could better enjoy it.

I also like Roc Boys by Jay Z. That song gets me equally hyped. Ha ha ha.

#3  The Best of What's Around by Dave Matthews Band

Us heading to DMB concert last December

 DMB is Will and JoLai's favorite band of all time. Hearing this song always makes me feel so connected to all of my sibs. I used to just like that song. Now it moves me in a different way because now I hear the lyrics. It's a great inspiration when I'm exercising.

"Turns out not where but who you're with
That really matters
And hurts not much when you're around"

I love this song for that line more than any other. Because that? That's a good word.

I could run to it all day.

#2   I Believe I Can Fly by R. Kelly

See, I was on the verge of breaking down
Sometimes silence can seem so loud . . . .

Corny, I know. But this is another song that really inspires me to push it. What could be better than that as a mantra? I believe I can fly? Come on, people.

There are miracles in life I must achieve. 
But first I know it starts inside of me.
If I can see it, then I can do it. 
If I just believe it, there's nothing to it.
I believe I can fly.

#1  GET UP OFFA THAT THANG! by James Brown

Come on. Now you KNEW this would be my number one.

My favorite line?
"I'm back! I'm back! I'm back! I'm back! I'm back!"

Because even if I've fallen off of the wagon, hearing that part makes me feel good. I laugh out loud while I say, "I'm back! I'm back!" I have this at the beginning and end of every one of my playlists. Not even kidding.

Plus it hypes me up to groove like J.B. Don't believe me?

Watch me!

Like that. Hee hee.

What music is inspiring you? Share a few jams off of your playlist!

Happy Thursday!

Peep my shirt for the Army Ten Miler! This inspires me, too!

Nice. Hardworking. Smart.

The electronic applications for residency programs just opened up on Sunday. Four plus years of medical school and lifetime accomplishments all nestled inside of one click of a mouse. Medical students all over the country have been sending off emails that escalate in their urgency to faculty who've agreed to write letters of recommendation and the residency program directors who will be reading them. I happen to wear both of those hats.

And so. Over the next week or two, students finalize this really important profile of who they are. They cross their fingers hoping that they crossed all of their t's enough to get the attention of the right program in the right city offering the right training in the right specialty. For them, that is. And it's funny because what many of them forget is that we, the program directors, are doing the same thing in a way. Hoping our programs appears attractive to the most attractive applicants. Attractive in terms of academic profile, that is.

All of this--these electronic applications, the interviews that follow, and the subsequent mind-wracking that ensues as everyone tries to finalize a decision ultimately leads to that big day where medical students all over the country find out their temporary destiny. But long before the tears and hugs and scraps of torn match day envelopes is all of this. Students putting their best face forward on this computerized application and us, the programs, doing our best to get a glimpse of who these people are based upon what we find when we click on their names.

How apropos that it all leads up to Match Day, isn't it? I mean, really, it is considering all of this is a bit like "" if you ask me. One person creates this shiny, pretty profile on line complete with their most cheerful and I'm-so-super-nice looking snapshot so that some other person will look at it and say, "Hey. I'd like to meet that person." That is, after learning that in addition to going spelunking on weekends they also won the gluten-free cake baking contest for the entire region last year. Or something or other.

And we, the programs, tidy up our websites with chummy photographs of our trainees plastered everywhere. Their eyes are earnest during bedside teaching and then on the handful of candid shots, the esprit de corps is so palpable that any student viewing it feels a yearning in their soul to belong to our group.

And really, isn't that a lot like

And let's be clear. I see nothing wrong with I know several people who have met awesome mates there and have even found a spouse. Yep. But they will all tell you -- just like we who open those ERAS (electronic residency application service) files will -- that sometimes the profile doesn't quite match up with the person. Good, bad, or indifferent.

So check it. I can't speak for what somebody looks for specifically on I can't. I'm not fully certain if there are a set of rules for how you can know if it's going to be eHarmony or not, man. Surely every person is different and they want different things just as every residency program or applicant varies in what they want. But you know? There are some things that are fairly universal that no one seems to talk about. And, for me, this is what I'm always sifting through the application to find. Then, during the interview, I try to confirm that impression.


So what is it, you ask? I'll tell you. I believe that the very best applicants--no matter WHAT the specialty they have chosen--meet this criteria on most days:

  1. Nice.
  2. Hardworking.
  3. Smart.
In that order.

I am NOT kidding. Literally, I have a little scrap of paper where I create a score for myself to see if the person is nice, hardworking and smart. Then, when I meet them, I try my best to see if, on most days, it's in that order. And if it is? Eureka. But even if it isn't, all three qualities are imperative. And when they aren't? That is, when ALL THREE of those qualities are not evident to me from the application and/or the interview? It's a no for me.

Not. Even. Kidding.

Let's look at this more closely. Let's say an applicant got straight A's. Let's say they scored high on the boards and made honor society, too. But then, when you read the letters, you see that they're all nondescript and the personal statement is bland. You meet them and they sit in front of you smugly or come across as bored and disconnected. This applicant might be smart. And I'd go so far as to say that they are also hardworking since they achieved such a great academic record. But nice? That could be debatable. Really.

Then there's the person who is super-smart and mostly nice. But lazy. And that? That's a horrible combination because you get tricked. By the time you realize they're lazy, it's too late. And laziness is really, really hard to remediate. Matter of fact, it could border on impossible. I think of "hardworking" as kind of synonymous with "professionalism" in the medical field. It's hard work to uphold our end of the bargain. And what makes a person do that without cutting corners is professionalism.

Lastly, there's the sweet-as-pie person who works their behind off. And, okay, just maybe they aren't the sharpest crayon in the box. But honestly? Of all of the combinations I've listed (outside of the preferred triple threat) I'd take this combination over the others. Yes. I'll take nice-and-hardworking over hardworking-and-smart-but-not-nice or nice-and-smart-but-lazy any day of the week.  Because at least with hard work the not-super-smart part can get better as far as medical knowledge goes. And sure. I'll admit that to do this--medicine--there is just some amount of intellect required. But I am a firm believer in the "growth mindset" which says that diligence and hard work can make up for what we lack in "natural" ability. Not to mention the fact that not working hard can make innate talents a total waste.


What does this mean concretely for medical students? Simple. Nice people do things outside of just studying. They do things for the greater good of the world and others. They do. They also have a life and hobbies and personal richness to talk about. Because medical school is a selfish pursuit. It's easy to get wrapped up only in yourself and your grades. But what is the point of getting that far and not having your eyes on the real prize? To be a competent and empathic provider? That requires more than books.

It takes a certain amount of "nice" and unselfishness to volunteer somewhere or tutor or participate in anything other than studying. So me? I look for that. I look to see if you worked hard in something, anything other than just sitting on your bum with a laptop. I look to see if you bake cakes or organize students to do good things. I want to know if you learned to speak Spanish or ran a half marathon or painted with water colors. Something. Anything. Not just books. Because being a doctor calls for more than that. It calls for humanism and a scrappiness that can't be found just with studying. That part comes from living.

"Hardworking" people complete things. They finish things they start and if they don't, there's often a reasonable explanation for it that doesn't sound like a typical excuse. They are resilient. They don't crumble under pressure and they keep trying no matter what. And again, they do things outside of just studying. And yes, that can mean a research paper or project. But a lot of times it can mean something else. I look to see if you did something that required planning and time to execute. Because that kind of thing requires hard work. And being a hard worker is a good quality to have in medicine.

And perhaps "smart" is the easiest part. Because to reach the finish line of med school, either you were simply smart or you had a growth mindset and worked SO DAMN HARD that you grew smarter. And we can see that easily on paper. Or from just talking to you.

But the other parts? Those are more nebulous and tricky. 

So listen up med students. And residents applying for fellowships and jobs. This is what we want. We want the triple threat. We are looking for people to come to our residency programs that are:

  1. Nice.
  2. Hardworking.
  3. Smart.

In other words, to use a term coined by one of my favorite students of all time Antoinette Nguyen, we are looking for someone who is a "non-douchebag." 

Yes. That. A non-douchebag. (So all-encompassing, that word.)


Is this what your application says about you? Is this what people would say about you? Are you nice, hardworking and smart--in that order? If you are, you're a great candidate. If you're not, you need to ask yourself why that is and you also need to recognize that this is what OUR PATIENTS want, too.

Our patients. Remember them?


Happy Residency Application Process! May the odds be forever in your (and my) favor.

Bryan O., MD -- who personifies nice, hardworking and smart--in that order.