Bittersweet Match Day - Please advise

[AnonymousEye]

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Hi all,

Congrats to all that matched today. I'm having a pretty rough time and wanted to get some advice, particularly from those who have been in a similar situation.

About an hour after I found out I matched today I got word that my father went to the hospital and was diagnosed with bilateral PE's. He's stable, but has been dealing with an undiagnosed autoimmune condition for 5 years, has been getting worse, and these PE's are likely related with it.

I am freaking out a bit, mostly because any of the places I've potentially matched at are far from home. All I can think of now is somehow getting out of wherever I match so I can spend next year with my parents because it seems he will continue to get worse slowly.

I'm thinking maybe I can get into a prelim surgery or medicine year at a program that didn't fill in the city where my parents live. It is very unlikely that there will be an open categorical spot in the specialty I matched into in that city.

Thoughts? Thanks again and congrats to all

 

[DarthNeurology]

Hi all,

Congrats to all that matched today. I'm having a pretty rough time and wanted to get some advice, particularly from those who have been in a similar situation.

About an hour after I found out I matched today I got word that my father went to the hospital and was diagnosed with bilateral PE's. He's stable, but has been dealing with an undiagnosed autoimmune condition for 5 years, has been getting worse, and these PE's are likely related with it.

I am freaking out a bit, mostly because any of the places I've potentially matched at are far from home. All I can think of now is somehow getting out of wherever I match so I can spend next year with my parents because it seems he will continue to get worse slowly.

I'm thinking maybe I can get into a prelim surgery or medicine year at a program that didn't fill in the city where my parents live. It is very unlikely that there will be an open categorical spot in the specialty I matched into in that city.

Thoughts? Thanks again and congrats to all

Very sorry to hear about your father. You really are in a tough spot. I have not been in exactly the same situation, but personal problems that family members have can be a big stressor during medical training. You might have too much stress to do well in residency, which is critical. Only you know.

The problem I see is that via the match you are bound to go to whatever program selected you. I would not plan on not showing up, and when you find out Thursday where you matched, you should talk to the PD and explain your situation, i.e. perhaps you could take off a couple months at the begining of residency. While your father getting sick is nobody's problem, I could see a residency program having to cite you for a match violation and this would make matching in a couple years much harder.

You can do one year at a program far away from home, and then transfer back to a residency program closer to home, especially if home is new york or another big city.

Whatever you do talk to your new PD when you know thursday, and try to work out something and gauge whether he/she is understanding.

 

[bjackrian]

Sorry to hear about your father.

In addition to the post above, you might also review the NRMP waiver policy which discusses under what circumstances you can apply to break the NRMP committment without adverse consequences in future matches. One of their case studies might bear on your situation depending on whether you would actually be assisting your father or just want to be in the same city:

I. Waiver Granted - Applicant

Description
After the 2008 Main Residency Match, Dr. John Smith wrote to the NRMP and requested a waiver of his match commitment to the Internal Medicine program at National Hospital. Dr. Smith informed the NRMP that his father had been diagnosed with a serious illness since the release of match results, and he needed to return home to help his mother care for his father. The NRMP initiated a waiver review and requested medical information from Dr. Smith along with information from the director of the program to which Dr. Smith had matched. Because Dr. Smith was a medical student, the NRMP also wrote to his school official to request information. After reviewing all pertinent information, the NRMP granted Dr. Smith a waiver of his match commitment.

Policy
Sections 2.5 and 3.4 of the Match Participation Agreement for Applicants and Programs authorizes the NRMP to grant a waiver of the binding match commitment if honoring the match would cause serious hardship. Waivers must be requested from, and can be granted only by, the NRMP; applicants and programs are not authorized to release each other. Moreover, applicants may not discuss or accept a position in another program until the NRMP has approved a waiver request. All waivers must be submitted to the NRMP in writing, with a copy to the program to which the applicant matched. The NRMP solicits information from all relevant parties prior to deciding whether to grant the waiver. If the waiver is granted, the applicant may accept a position in another program or participate in future NRMP matches.

 

[AnonymousEye]

Sorry to hear about your father.

In addition to the post above, you might also review the NRMP waiver policy which discusses under what circumstances you can apply to break the NRMP committment without adverse consequences in future matches. One of their case studies might bear on your situation depending on whether you would actually be assisting your father or just want to be in the same city:

Thanks for the responses guys/gals - this waiver information is particularly useful and thank you so much for pointing it out. Given that I'll know where I matched in a couple of days, I'm going to have to be on the ball and this will be very useful.

If anyone else has been in a similar situation (i.e. breaking a match contract prior to starting) please feel free to post. Thanks again.

 

[error404]

Don't really have any advice... just wanted to say that I'm sorry to hear about your dad.

 

[LadyGrey]

I'm sorry to hear that, AnonymousEye.

It might make sense to wait a while before initiating discussion with your new PD. It sounds like things are very uncertain with your dad -- what the problem is exactly, and thus what the likely course and treatment are. I think you'll be in a better position to make a decision about what you want to ask for if you wait until you have clearer information rather than just assuming that things will only get worse.

 

[dragonfly99]

agree with darth and ladygrey.
Don't make any rash decisions, although I know you are under stress.
The NRMP and most program directors are not ogres and while they may not be thrilled to let you out of a match contract, they might given your family situation, if that is what you really want...particularly if they can easily find another resident (which would be true in certain specialties). I think you should wait a couple of weeks, see how things shake out with your dad's illness, and then see what you want to do.

 

[Impromptu]

Family is very important. If you were close to your dad, then being close to him during these rough times is very important. If you weren't close to your dad, then now is the time to bridge that gap. If your religion places strong emphasis on the eternal relationships in families (LDS, maybe others), then you will have that strength to rely on.

You have made committments. Plan on keeping them. There are many ways to stay close to relatives who live far away. Phone and email him often. Collaborate on famly projects together, like some geneology research. Use all your vacation weeks to be with your family.

One other thing came to mind which might be your situation: your father is likely to have high medical bills, and may have been the sole supporter of your mother. He may rest much easier knowing that you will be an attending sooner, making an attending's salary, so that you can support your mother should the worst case happen. No one wants to leave burdens behind on those they love, and children have a duty to support their parents.

 

[medicienne]

Hi all,

Congrats to all that matched today. I'm having a pretty rough time and wanted to get some advice, particularly from those who have been in a similar situation.

About an hour after I found out I matched today I got word that my father went to the hospital and was diagnosed with bilateral PE's. He's stable, but has been dealing with an undiagnosed autoimmune condition for 5 years, has been getting worse, and these PE's are likely related with it.

I am freaking out a bit, mostly because any of the places I've potentially matched at are far from home. All I can think of now is somehow getting out of wherever I match so I can spend next year with my parents because it seems he will continue to get worse slowly.

I'm thinking maybe I can get into a prelim surgery or medicine year at a program that didn't fill in the city where my parents live. It is very unlikely that there will be an open categorical spot in the specialty I matched into in that city.

Thoughts? Thanks again and congrats to all

I am in a slightly different but similar position. I wish I had not matched so I could scramble into an unfilled prelim spot but match violation will be tricky in my position.

Hope everything goes well with your Dad.

 

[Steiner]

Family is very important. If you were close to your dad, then being close to him during these rough times is very important. If you weren't close to your dad, then now is the time to bridge that gap. If your religion places strong emphasis on the eternal relationships in families (LDS, maybe others), then you will have that strength to rely on.

You have made committments. Plan on keeping them. There are many ways to stay close to relatives who live far away. Phone and email him often. Collaborate on famly projects together, like some geneology research. Use all your vacation weeks to be with your family.

One other thing came to mind which might be your situation: your father is likely to have high medical bills, and may have been the sole supporter of your mother. He may rest much easier knowing that you will be an attending sooner, making an attending's salary, so that you can support your mother should the worst case happen. No one wants to leave burdens behind on those they love, and children have a duty to support their parents.

Type A?

 

[mercaptovizadeh]

Type A?

Agreed. Anyone thinking that phoning and emailing an ailing father and "collaborating on genealogy projects" during residency, no less, can substitute for being with him as his condition deteriorates is not being realistic.

To the OP: there must be something that can be done. Is it possible to switch residencies with someone at a program closer to home?

 

[AnonymousEye]

To the OP: there must be something that can be done. Is it possible to switch residencies with someone at a program closer to home?

Thanks for all the kind words everyone, its very kind of you and I appreciate it. My dad did make it out of the ICU and is resting at home with me now - he's doing better (despite having one of the nastiest chest CT scans I've ever seen!), and hopefully will do well on anticoagulation.

I'm not sure what to do still. I'm happy with where I matched. But this undiagnosed autoimmune disease which has been causing him to deteriorate slowly, and the bullet he dodged with these PEs make me and my family very nervous. I'm dreading the day when I get another phone call saying that he is in the hospital, and that could happen sooner than later.

I'm still debating whether I should go ahead trying to talk with my PD. I risk alienating myself with him and the rest of the faculty, and I'll be labeled as the guy who "doesn't want to be here" if trying to find something in my parents city doesn't work out. I'm gonna have to marinate on it a little longer.

Although I'd like to switch with someone closer to home, I think I'll be hard pressed to find another newly matched resident who is unhappy with where they are. I dunno...anyone else have suggestions? Thanks again for all who have responded.

 

[BlondeDocteur]

What specialty did you match in?

How large is your parents' city? Is your medical school in that city?

You could certainly get a waiver to get out of your match, but of course you would have to work on finding something in your hometown. Like you said, the chance that another dissatisfied resident would want to swap your program for theirs is slim-- unless your newly matched program is in a highly desirable location, or is considered superior. Is it?

If your medical school is in your hometown, perhaps they would be sympathetic and help find you a spot?

Lastly, what are the chances that your parents would want to move to the city you matched in?

 

[mercaptovizadeh]

Thanks for all the kind words everyone, its very kind of you and I appreciate it. My dad did make it out of the ICU and is resting at home with me now - he's doing better (despite having one of the nastiest chest CT scans I've ever seen!), and hopefully will do well on anticoagulation.

I'm not sure what to do still. I'm happy with where I matched. But this undiagnosed autoimmune disease which has been causing him to deteriorate slowly, and the bullet he dodged with these PEs make me and my family very nervous. I'm dreading the day when I get another phone call saying that he is in the hospital, and that could happen sooner than later.

I'm still debating whether I should go ahead trying to talk with my PD. I risk alienating myself with him and the rest of the faculty, and I'll be labeled as the guy who "doesn't want to be here" if trying to find something in my parents city doesn't work out. I'm gonna have to marinate on it a little longer.

Although I'd like to switch with someone closer to home, I think I'll be hard pressed to find another newly matched resident who is unhappy with where they are. I dunno...anyone else have suggestions? Thanks again for all who have responded.

Not necessarily. Perhaps your match is highly desirable and someone else would gladly take your position. Granted, if your parents live in a highly desirable place like SF or NYC it might be hard to find a switch.

Also, how do they know it is an autoimmune condition, but don't know which one? Perhaps you should consider taking him to one of those renowned rheumatology centers like Hopkins so he can get a proper diagnosis and treatment, if possible.

As BlondeDocteur mentioned, consider the possibility of your parents living with you for a while.

 

[AnonymousEye]

Not necessarily. Perhaps your match is highly desirable and someone else would gladly take your position. Granted, if your parents live in a highly desirable place like SF or NYC it might be hard to find a switch.

Also, how do they know it is an autoimmune condition, but don't know which one? Perhaps you should consider taking him to one of those renowned rheumatology centers like Hopkins so he can get a proper diagnosis and treatment, if possible.

As BlondeDocteur mentioned, consider the possibility of your parents living with you for a while.

Well, the city I matched in is in NYC...and it is a good program, in a moderately competitive specialty.

It is definitely an autoimmune condition...positive ANA but negative almost everything else. It is really an amazing medical mystery that dozens of doc's have taken on (I won't get too much into it here because its incredibely complex). He's had it for 8 years now and it only responds to steroids, but only in high doses (i.e. 30-40mg). He's unsuccessfully been treated with MTX, immuran, colchicine and others. It has stumped rheumatologists from UPenn, dermies from Columbia, countless internists from various hospitals, an immunologist in DC who trained at Hopkins, and every health care person who has (happily) taken his case on. In the end, they abandon his case because it gets too frustrating that they can't figure it out.

These PEs came out of nowhere, but they found elevated Factor XIII (associated with recurrent thromboembolisms), and are working him up for antiphospholipid syndrome (despite a negative viper venom test). If anyone knows of any lupus-like zebra conditions out there, please feel free to comment!

I am trying to convince them to move to NYC, but in his state right now its not possible...maybe in the future but I figure I only have a few months to figure this thing out. Thanks to all of you for your suggestions!

 

[mercaptovizadeh]

Well, the city I matched in is in NYC...and it is a good program, in a moderately competitive specialty.

It is definitely an autoimmune condition...positive ANA but negative almost everything else. It is really an amazing medical mystery that dozens of doc's have taken on (I won't get too much into it here because its incredibely complex). He's had it for 8 years now and it only responds to steroids, but only in high doses (i.e. 30-40mg). He's unsuccessfully been treated with MTX, immuran, colchicine and others. It has stumped rheumatologists from UPenn, dermies from Columbia, countless internists from various hospitals, an immunologist in DC who trained at Hopkins, and every health care person who has (happily) taken his case on. In the end, they abandon his case because it gets too frustrating that they can't figure it out.

These PEs came out of nowhere, but they found elevated Factor XIII (associated with recurrent thromboembolisms), and are working him up for antiphospholipid syndrome (despite a negative viper venom test). If anyone knows of any lupus-like zebra conditions out there, please feel free to comment!

I am trying to convince them to move to NYC, but in his state right now its not possible...maybe in the future but I figure I only have a few months to figure this thing out. Thanks to all of you for your suggestions!

Have they checked serum interferon-alpha or complement C4 levels (both serum and circulating cell bound)?

 

[BlondeDocteur]

Might I deduce from the institutions to which you've take him (Columbia, Penn, Hopkins, "DC") that your parents live on the East Coast, somewhere between DC and New York?

In that case, you're a very short train ride away from them. And if the "moderately competitive specialty" is either anesthesia or EM, you'll have lots of flexibility to see them (save off-service rotations). Anesthesia has strict 24 hour call after which you must get the post-call day off; EM of course works in shifts. So perhaps the situation isn't as dire as you thought!

 

[grhopper]

do you have to furnish actual medical records in order to obtain the nrmp waiver?

 

[CanGas]

I'm going to 2nd this. Commuting home on the weekend is reasonable. Heck, with flights as cheap as they are you could simply rack up a little more debt and fly back each weekend. To be honest residency is busy and your weekday evening are going to be full either with late days, catching up on sleep post/pre-call, or studying. Good luck with your decision.

CanGas

Might I deduce from the institutions to which you've take him (Columbia, Penn, Hopkins, "DC") that your parents live on the East Coast, somewhere between DC and New York?

In that case, you're a very short train ride away from them. And if the "moderately competitive specialty" is either anesthesia or EM, you'll have lots of flexibility to see them (save off-service rotations). Anesthesia has strict 24 hour call after which you must get the post-call day off; EM of course works in shifts. So perhaps the situation isn't as dire as you thought!