Shock and Awe, Surgery Prelim, and Minimizing Self-Harm

[Descrubbage]

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First, I apologize to those of you who wanted but did not match for a prelim year in surgery (I don't think there are many). My question is thus... My fear of flaring from Crohn's during a surgical prelim year did not stop me from ranking it (albeit last), however my fear of living away from my wife (who is tied to our current area for next year) led me to only apply to programs in or near our current location for Transitional years, and Medicine Prelims, and yes... even the one Surgery Prelim available in area. Aside from re-starting my immunosuppression therapy and "grin-and-bear-the-obstructions" approach, are there any ways or success rates that anyone has heard for me to: 1) Switch programs to a prelim med or transitional (by coaxing another program director to open up a spot now), or 2) Convince the prelim surgery program director at the program i ended up matching at to adjust my prelim surgery schedule to include more electives and be less "inflammation-inducing"? Before any tirades ensue regarding laziness or irresponsibility in ranking... a) the likelihood of me needing another resection if I do a prelim surgery year is very high, and b) I am obviously willing to accept this if ultimately it is my only possibility for an internship before my subspecialty residency as I ranked the program in the first place, but c) I am just trying to keep the few remaining inches of my terminal ileum by minimizing the undeniably high stress of not only a surgery internship but one done at a hospital right on par with Grady. Thanks for all your help 👍

 

[u_r_my_serenity]

I think the match binding agreement will prevent you from getting out of it for another type of intern year, especially before you even start because the PD isn't really friends with you. You don't want to break that because it will really restrict your subsequent options. I would try to be as nice as possible and explain my situation to the PD and see if any accomadations can be made for the schedule, etc. You can try telling him you are even willing to take a pay cut to show how serious you are (I doubt you will actually get a pay cut). If that doens't work I would tell whoever is your specific attending that week to let you go home when you feel your IBD is getting out of hand (PD doesn't even need to be involved in such a case). If it is a large program there may be people who can help cover you. If that doesn't work and they simply refuse to accomadate you in any significant way then I would take it easy anyway and take the bad evaluations. You already matched to your categorical program, right? I wouldn't just plan another resection; that seems like a terrible solution. I think I would have rather been away from my wife for a year.

 

[njbmd]

First, I apologize to those of you who wanted but did not match for a prelim year in surgery (I don't think there are many). My question is thus... My fear of flaring from Crohn's during a surgical prelim year did not stop me from ranking it (albeit last), however my fear of living away from my wife (who is tied to our current area for next year) led me to only apply to programs in or near our current location for Transitional years, and Medicine Prelims, and yes... even the one Surgery Prelim available in area. Aside from re-starting my immunosuppression therapy and "grin-and-bear-the-obstructions" approach, are there any ways or success rates that anyone has heard for me to: 1) Switch programs to a prelim med or transitional (by coaxing another program director to open up a spot now), or 2) Convince the prelim surgery program director at the program i ended up matching at to adjust my prelim surgery schedule to include more electives and be less "inflammation-inducing"? Before any tirades ensue regarding laziness or irresponsibility in ranking... a) the likelihood of me needing another resection if I do a prelim surgery year is very high, and b) I am obviously willing to accept this if ultimately it is my only possibility for an internship before my subspecialty residency as I ranked the program in the first place, but c) I am just trying to keep the few remaining inches of my terminal ileum by minimizing the undeniably high stress of not only a surgery internship but one done at a hospital right on par with Grady. Thanks for all your help 👍

Hi there,
There isn't that much difference between a pre-lim surgery and pre-lim medicine year. Your PD is not going to re-arrange a schedule of rotations for you Crohn's or no Crohn's. If you need a resection, you need a resection be your pre-lim year medicine or surgery or anything else. Besides you stand a better chance of getting a good outcome hanging with surgeons anyway. If you did not want to do a pre-lim surgery year, you should not have ranked it. First year is difficult, medicine or surgery but it is very doable. If you go in with your attitude, you are going to be miserable, surgery or medicine.

The bottom line: Do not rank any place that you do not want to be.

njbmd 🙂

 

[DrNick2006]

So stress triggers your Crohn's? Reduce your stress then. I would resign yourself to being busy, being away from your wife and such and just being at the hospital. Make sure the important people around you understand this will be the case and it has to be. THis will reduce your stess about "neglecting" that part of your life. Remember you are doing this for them as well as yourself. Also, you will give yourself more time to get things done at the hospital because you will not be rushed, and so should reduce your stress. Second, work hard when you are well, and if your disease requires you to take it easy do it, thats the way it is don't feel bad about it. If everyone sees that your awsome when your not sick, the will not look down on you and you should have less anxiety about not pulling your wieght. Then of course there are all the standard things to do for stress reduction, meditation, excercise, a hobby if you have time, music etc. Also, do not consume alcohol ever and if your feeling down or depressed get some treatment immediately. Before you know it you will be doing a great job during your internship and have little undue stress. Good Luck.

 

[Descrubbage]

Thanks for all your advice DrNick2006, njbmd, and u_r_my_serenity. Sounds like solid stuff: 1) I'm matched, 2) Go forth and kicketh ass. I was and am a little nervous about the surg prelim yr, but I think I do just need to ratchet down that anxiety.

 

[Loopo Henle]

Take some asacol and kick some asacol. One of the best surgery residents at my home program has rip roaring UC, and he has managed for 4 years so far. I know, different disease. Just wanted to say that it can be done. Good Luck to you. 👍

 

[Sugar72]

I scrambled into a surgery prelim and I have a little bit of anxiety over it. I have successfully put it out of my mind - worrying about the hours and the stress ahead of time will only make the stress last 15 months instead of 12! You will be fine and in a year you will be that much stronger. And that much happier to be starting your subspecialty.

 

[ladymaven]

Hi -- I have CD as well, and am seriously considering a surgery residency (I'm an MS3 now) and wondering some of the same things. I have your same plan for dealing with inevitable partial SBOs -- as one of my favorite residents once told me re: NEVER calling in sick from home: "On a surgery rotation, either you're in the hospital, or you're IN the hospital." (Let's hope for the former.)

I would look into Remicade -- 3 hours every 8-12 weeks is a lifesaver for many friends. I got it and loved it, but then got Ab's after the FDA realized it needed to be given repeatedly, and so I am now SOL. Oh well, it was still worth getting it, even if only once!

Regardless, good luck with all this -- I hope it goes well for you!! ~LadyMaven