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It’s been an achingly long time since I have written an entry here. I miss this place, but this final year of pharmacy school has proven much too demanding for the little pleasures in life it seems. I still lurk on occasion, but it’s so very inadequate to truly keep pace with the lives of my favorite diarists. My sincerest apologies to you all.

Tonight, writing in this journal when I should be carefully constructing responses to two drug information questions with carefully analyzed studies from the primary literature, my mind is elsewhere. Change looms somewhere beyond the horizon. For the first time in my life, I only have a preliminary sketch of what awaits me around the bend. I am supremely elated. I am utterly terrified. Merely thinking about tomorrow sets my heart to pounding.

In eight weeks and four days, I will reach the end of a seemingly epic journey. Not that I am counting or anything. I will graduate from pharmacy school with my Doctor of Pharmacy degree. Only a mere twenty-five years in the making, the last seven of which spent in post-secondary education. It’s been both a ceaseless road and a blur at the same time. It’s hard to believe that it will be finished. I remember the first day of pharmacy school thinking how distant four years seemed. Now, the feeling is surreal. The excitement and sense of accomplishment is vastly different than the feel of graduation from high school. As far as I know, I am the first person in a sizeable branch of my family tree to achieve the distinction of adding “Dr.” prefix to my name. Yet, this is not what has kept me up at night.

Somewhere, a hammer pounds a chisel into marble. My very future is being written into the stone. I have labored for the past four years, challenging myself at every turn, developing my clinical knowledge and skills, taking on as many leadership roles as I could fill (many at the state and national level), networking, and curriculum vitae building. Tomorrow, I will see the fruits of my labor. The Doctor of Pharmacy degree was never enough for me. I knew that I wanted to become an Infectious Diseases Clinical Pharmacy Specialist. I knew that I would pursue two years of post-doctoral residency training for this very purpose. Tomorrow, the results of the Pharmacy Residency Match program will be released. My hands tremor and my stomach flutters at the very thought.

An innocuous email will arrive quietly at 11:00 am announcing in a plain, unadorned font, the place where I will spend the next two years of my life.

I began to seriously evaluate my options last year, and this has been far from a simple task. There are some 560 residency programs across the country, and I decided against limiting myself geographically to maximize my post-doctoral training opportunities. Fortunately, there are only 32 programs that offer the second year in Infectious Diseases. I attended three national meetings held by: SIDP and ICAAC  (Society of Infectious Diseases Pharmacists and the Interscience Conference on Antimicrobial Agents and Chemotherapy), ACCP (the American College of Clinical Pharmacy), and ASHP (American Society of Health-System Pharmacists) this past fall to network with various residency directors and to try to make an early positive impression; to become a familiar name and face. The last of the meetings was held in Las Vegas, NV, and boasts a showcase of all the residency programs in the country and allows for potential residents to meet and ask questions of all the programs across the country in three sessions of complete pandemonium. Of those programs, I agonized and decided upon the seven programs to which I applied.

Of these seven programs, I received invitations from on-site interviews at six. Before the seventh program sent me a letter rejecting my application, I had already entertained ideas of rejecting any offers they might have sent. So, it was certainly best for both the program and myself. They encouraged me to keep them in mind for their PGY2 (post-graduate year 2) programs,  but I will not.

The programs that offered interviews to me were:

1.       University of Mississippi Medical Center; Jackson, MS

2.       Thomas Jefferson University Hospital; Philadelphia, PA

3.       Memorial-Hermann Hospital – Texas Medical Center; Houston, TX

4.       Johns Hopkins Hospital; Baltimore, MD

5.       Barnes-Jewish Hospital; St. Louis, MO

6.<span style="FONT: 7pt "Times New Roman&quot;”>       The Cleveland Clinic; Cleveland, OH

Residency interviews are unbelievably exhausting. Five on this list were  conducted over a three week period. I was encouraged by the Lubbock SOP Campus Dean to limit my list to five programs for this very reason. I almost wish I had heeded his advice.

I would have to say Memorial-Hermann was by far the biggest disappointment. I actually took the initiative to set up an infectious diseases clinical rotation at the hospital, which I finished almost five weeks ago. It was the most challenging and most rewarding rotation that I have had in all of pharmacy school. I cannot express how much I enjoyed my preceptor, the resident physicians, the ID fellows, and the amazing ID attendings from the University of Texas Medical School in Houston. The attending that I think I enjoyed the most actually offered to write me a letter of recommendation to the pharmacy residency program in Houston. I cannot describe how exciting that was for me, even though it was long past the time for applications. He told me that I really have a knack for infectious diseases, which considering his substantial knowledge and clinical acumen, might be the greatest compliment I have ever received. I must be doing something right. The disappointment came from the interview itself. Every other interview I went on, had an air of “we’re trying to get to know you and you are trying to get to know us. So, hopefully in this one day, we can make an informed decision about whether or not we are a good match for each other.” The interview at Hermann was not in anyway like this. Although they claimed the same philosophy, I have never encountered an interview so hostile. Their real interview philosophy might have been better expressed: “We are not interested in ranking you as a candidate, convince us otherwise.” I have talked to friends who’ve interviewed there and felt the same way. It was the only interview I remember desperately hoping for the day to end. One individual with whom I endured an hour long interview asked fifty minutes of nothing but behavioral-type questions (“tell me about a time you failed”,” tell my about a time you set a goal and didn’t achieve it”, “tell me about a recommendation you made to a physician that was rejected and how you dealt with it”, “tell me about a time you had a conflict and how you resolved it”). It was awful. I expect a couple of these questions, they’re a given for any interview. But not  nearly an hour of them. This person, with whom I would have to spend an entire rotation, made me feel like I was being interrogated. It was like he was trying to convince me that I wasn’t even qualified for the program. At the end of all of this, he clearly stated, “it really doesn’t matter what you say in this interview, we’re going to ask your preceptor what he thinks of you and that’s how we’ll decide.” I told my preceptor that I wanted to do the rotation like a resident rather than a student, and upon completion of the rotation the day before the interview,  he gave me an “A.” I left that house at 5:30 AM and usually didn’t return home until 9:00 PM. I have never worked so hard in my life. My preceptor told me that the 30-minute presentation I put together in two weeks was better than he expected from his residents. He asked permission to hang on to it to use for teaching future medical residents. I am qualified for the program, and I have no doubt about it. So, if the director of pharmacy’s intention was to completely dissuade me from choosing their program, mission accomplished. If that was the only thing I didn’t like, I might have still considered them, but it wasn’t. It certainly would have been nice considering I already knew the computer system , my way around the hospital, and my way around Houston. I heard from one of the medical residents who still calls me that one of the other preceptors and the resident staying on for a second year in critical care were hoping that I matching to their program. Too bad.

The biggest surprise was Mississippi. I almost did not even apply to their program. If the ID residency director had not accidently offered me an on-site interview for his program by mistake, I might not even have applied. I am glad that I did. The director of the PGY1 program was absolutely amazing. Her attention to detail and personality was breathtaking. She even took me on a two hour tour of the Jackson area on her day off when taking me to the airport. She could tell me where every past and current resident lived, what they said about liking their living quarters, and what the past residents were doing currently. She made sure I had a bag of candy and water to keep me energized throughout the day and slipped in an apartment guide so that I could already get an early start on looking at places to live in Jackson. She was the only director to send a handwritten note thanking me for interviewing. She even sent handwritten thank you notes to the professors who wrote my letters of recommendation. Having her as a director alone might certainly be worth the residency program. Not to mention the excellent director of the second year program, who I met back in September at the SIDP meeting and confused me for a candidate to his ID program.

My youngest sister is now engaged to be married and will be moving to Birmingham, Alabama in August after her wedding. Jackson would be a mere three hour drive from here. St. Louis, a seven hour drive.

I lied. The biggest surprise came two days before I had to submit my rank order list for the residency programs. Chris, the absolute love of my life, told me that he had decided that he was going to move with me. I think my heart came close to exploding in a supernova of joy and relief. After spending over two-and-a-half years together, I cannot imagine living apart for two years. The dread of separation has been terrible. Nothing in the world could have made me happier. I cannot help but marvel at the sacrifice he is making for me. He is giving up the life and job he’s known for over nine years now. He will be moving far from his family and friends. The future is scary, but I have a goal to work towards. He does not have this overwhelming, all-consuming passion for a specific goal to guide him through all of the uncertainty. He merely has faith in me and a stated desire for a change in his life. It’s incredibly humbling. Could I make the same sacrifice for him? I am terrified that I already know the answer to that question.

I wish I could have had a little more advanced notice ofhis decision to allow more time to factor in more of his input into this decision. In an overwhelming month of interviews, putting together two thirty minute presentations and one forty minute presentation, moving from Houston back to Lubbock, organizing an induction dinner, and putting together a last minute speech for the induction dinner after the faculty speaker cancelled, I already felt that I really did not have enough time to fully consider my options. I’ve never felt so unsure about my final decision.

Fortunately, of the six programs at which I interviewed: four were outstanding and at each I felt excited to be there, once was high quality, but failed to inspire me the way I had hoped, and one was a great disappointment. Perhaps this list should be keep highly secret, but what I entered into the system was:

1.       Barnes-Jewish Hospital

2.       University of Mississippi Medical Center

3.       The Cleveland Clinic

4.       Johns Hopkins Hospital

It was incredibly difficult to put any sort of order to these programs. A decision that will determine my next two years and possibly my entire future. But not just my future, but Chris’s as well. Truthfully, even if I match with very my last choice I will not be disappointed. All programs are outstanding and at each program I left feeling full of excitement about the program, the institution, and the people. Hopkins was very surprising how progressive the pharmacy department is and how very laid back and warm the people were at such a prestigious institution.

Of course, there is always that possibility that I will match with none of these programs and will have to participate in the scramble and hope for a decent program somewhere else. It’s a terrifying prospect. I find myself laying awake at night, thinking about how I could have answered many interview questions with greater eloquence and made a stronger impression. It’s all too late for that now. My fate is sealed. I cannot help but feel a little bit trapped.

I find myself checking the website hoping that the results will be posted by a fluke IT error. Without success, so far.

Tomorrow,  the future dawns. Meanwhile, I desperately want the second-hand on my watch to either speed up or slow down.

Tomorrow.

ADDENDUM:

I just found out that I MATCHED TO THE  PGY1 RESIDENCY PROGRAM AT THE JOHNS HOPKINS HOSPITAL!!! I am unbelievably excited! I haven’t felt this giddy in a long time!! I am going to be completely useless today!! 😀