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Dr. Chan: How do you strategize to apply and get into medical school? What activities help prepare you for medical school? How should you consider the financial implications when applying to medical school and residency programs? And why are couples slow to announce that they're dating while in medical school? Today on "Talking Admissions and Med Student Life," I interview a couple, Nisha and Milo, both former fourth-year medical students who recently graduated from the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah, School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay. Well, welcome to another edition of "Talking Admissions and Med Student Life." I got two great guests on today, Milo and Nisha. How are you guys doing?

Milo: Doing well.

Nisha: Yeah. Doing well.

Dr. Chan: Fourth-year students about to graduate in a few days, I think, right?

Milo: Yeah, Wednesday.

Dr. Chan: Wednesday . . .

Milo: Friday. Friday.

Nisha: Friday.

Dr. Chan: Friday. Friday, but it feels like tomorrow. Yes.

Milo: Yes, yes.

Dr. Chan: All right.

Milo: Yeah. There was the quarantine.

Nisha: Yeah.

Dr. Chan: Yeah. Yeah. And we'll talk about that. Yeah. So I want to start . . . I love the story. I love hearing people's stories. So let's go back to the beginning, and Nisha, let's start with you. So when did you first want to go to med school? When did that enter your consciousness, and was it like one moment that stood out, or is it a series of moments that led you to become a doctor? Curious to hear when that started for you.

Nisha: You know, when I was very young, I wanted to be a doctor, but that changed as I got older until I went to college and I realized, you know, I really loved biology, especially human biology and at the same time, I was also an English major and I did a lot of work in research with human rights types of issues. And I realized that medicine was a really good combination of the two where, you know, there's a lot of science and stuff like that, but you also can make a really big impact on people's lives and the health of communities. And so that was when I realized that that's what I wanted to do for sure.

Dr. Chan: And then Milo, how about you? When did you come to the decision?

Milo: Yeah. I've always had an interest and aptitude for science. Initially, I thought I was going to get into research. Cancer has kind of run in my family, and growing up, I would always tell people, "Hey, I'm going to go cure cancer." And I didn't really realize how difficult that would be and what would actually be involved even in cancer research until I got into college and started doing some research and realized that full-time research was probably not for me, although I did enjoy the research. I still had a love for science and got introduced into medicine with the research I did but really wanted to work more hands-on with people and have research be part of what I did, but not entirely what I did. So I was talking to my uncle who was actually in maternal and fetal medicine and he said, "Well, come shadow me. It sounds like what you're looking for may actually be a career in medicine." I went and shadowed him, and he was right. I think it just combined the problem solving, the science, working with people. It just combined everything into a package that fit really well for me.

Dr. Chan: And where did both of you grow up? And, like, where did you end up going to undergrad?

Nisha: So I grew up in Emmett, Idaho, which is a pretty little rural town close to Boise. And I did my undergrad at the College of Idaho, which is in Caldwell, about 45 minutes from Emmett where I grew up. And I double majored in English and biology there.

Milo: I grew up all over the West. I was born in Phoenix, Arizona, and then for my dad's work in construction, we moved really pretty much every year or two. We bounced between Utah, Idaho, and Arizona mostly, ended up back in Arizona when I finished high school, and went to University of Arizona for the in-state tuition.

Dr. Chan: Finances do come into play with these things. So I totally get it. I totally get it. And then while you were in undergrad, for both of you, like, what kind of activities did you do that prepared you for med school? What kind of groups or organizations were you part of?

Nisha: I worked at the women's and men's center at the College of Idaho, where we worked with students that had experienced relationship violence in particular, but were also struggling with other mental health issues. And that, you know, had a big impact or prepared me to, you know, talk to people about issues that were difficult and find ways to help them and connect them with resources. And then I also did some shadowing and with the Idaho program involved in shadowing, and then I did research with the Idaho INBRE Program, which is for undergraduate researchers and we did a biochemical and microbiology research, which also really helped prepare me for medical school and helped prepare me for the kind of critical thinking in particular that you need in medicine.

Milo: And I did quite a bit of volunteering in hospice through a hospice facility in Tucson. I founded a chapter of the Medical Reserve Corps at University of Arizona, which focused on getting communities involved in emergency preparedness and how to respond as a community member if they were to be the first person on the scene of an emergency. And then I got involved in research in speech and language and ended up long-term with an MRI lab looking at language learning and language pathology.

Dr. Chan: And what were . . . how did you, like, what was your process like when you started looking at medical schools? I mean, did both of you look at, like, spreadsheets, or did you go by word of mouth? Like, how did you start coming up with a strategy when you looked at medical schools to apply to?

Nisha: So there's a lot of, you know, pieces that you need to apply to medical school. And I actually found that the University of Utah's website and their requirements were pretty in depth and in detail. So those were the guidelines that I used to make sure I had all the boxes checked off for medical school. And then for me, what was important or one of the things that was important was finances. So, you know, I looked into the schools that had, you know, either scholarship opportunities or that would allow me to have in-state tuition, and Idaho works with the University of Washington and the University of Utah. So that had a, you know, pretty big influence on my decision about, you know, where to apply and for medical school.

Milo: For me, I mostly wanted to stay West. It was where I was familiar with, and my family was planning on staying in either Arizona or Utah. So I applied mostly to Western medical schools, which narrowed the list down pretty significantly. And then finances were also something I had to consider. So I picked public universities that typically had better tuition.

Dr. Chan: And then I don't know if we're going to talk about it, but did both of you get in the first time, or what was that process like or, like, talk about that. Like, if there's any bumps in the journey, like, how did that go?

Nisha: So I applied technically twice. The first time I applied, I had some family issues. Right before the secondary applications were due, my grandfather got diagnosed with cancer and ended up dying pretty shortly afterwards. And so I decided that I wasn't ready to start medical school at that time. And so I didn't finish completing the application cycle. I did apply the following year, and that year, I got in off of the waitlist for the University of Utah.

Dr. Chan: And Nisha, was it like an immediate yes in your mind, or were you kind of fielding other offers? I mean, like help me understand what you're going through right then.

Nisha: When I got accepted to the University of Utah?

Dr. Chan: Yeah.

Nisha: So I had actually taken what, you know, probably a pretty big risk, but I had only applied to the University of Utah and the University of Washington that year. And I really loved the University of Utah on my interview day. And when I got accepted off of the waitlist, it was an immediate yes and that's where I wanted to be.

Dr. Chan: I find, I mean, that's great, Nisha. I love that. And it's interesting, because like I've worked in Idaho for many years and I feel that, like, University of Washington, they definitely have like a bigger brand name in Idaho and I just see purple everywhere that I go. And so, yeah, I'm just curious, like with you being in right, I would argue kind of right in the middle of Idaho, kind of in between Utah and Washington. Yeah. Like, yeah. So I'm happy that it sounds like our website and our interview day really helped sell you on the program.

Nisha: Yeah. You know, I really, you know, I liked the people that I met, and I liked the idea of being in one place for all four years of medical school. And, you know, I really liked the campus, and it seemed like, you know, the opportunity to work out in multiple different hospitals in the area was also really appealing to me.

Dr. Chan: How about you, Milo? How was your journey?

Milo: It was on the longer side. It took me three application cycles to get in.

Dr. Chan: So you hated me, but then liked me at the end, right?

Milo: Well, I didn't apply. So the first application cycle, I put in primaries, but I was actually doing some shadowing with the neurosurgeons at U of A, at that point. And there were some things that came up in the shadowing that made me kind of pump the brakes on going all in on medical school right away. I knew that with the debt you accrue in medical school, once I got in, I was kind of locked in. You really want to come out the other side a doctor, or you get into some financial issues. So, you know, I saw some issues with the insurance companies and just some of the policy that I saw in shadowing. There were neurosurgeons there who were working, kind of fibbing their hours so they could work over the 80-hour limit. And they spent a lot of time just arguing with insurance companies over what they thought was necessary and what would get paid for. And I really had to think if that was worth, you know, because if it was just patient care, I knew that that's what I wanted to do, but there were just some things that I thought detracted from that and I had to consider if that was worth it. So I actually didn't finish the secondaries the first year I applied.

And the second year, I think I applied to I think 8 or 10 schools. I got an interview only with University of Arizona and got waitlisted and didn't end up making it in that year. Then actually, I moved out to Utah because my family was out there and wanted to establish residency in case I got into medical school there. I got a job at a lab that I really loved doing neuroimaging and only applied to Utah that third year because I was with my family doing some research that I really loved. And I figured if I get into Utah, that's really where I'm targeting and that would be great, and if not, then I'm in a good situation anyway, but I did get in that year.

Dr. Chan: So both of you, I mean, this kind of flies in conventional advice I give to people, but both of you essentially kind of suicided applied to like one, maybe two programs. Usually, I tell people like, "Oh, 10 to 15," but it sounds like you both felt fairly confident in what you were doing. Is that accurate, would you say?

Nisha: Yeah. And, you know, I think for me, just looking at the numbers as someone from Idaho, I think statistically I was most likely to get into the two schools that I applied for. It was also cheaper for me to just apply to two schools, and the in-state tuition was also very appealing. So those were kind of what led my decision to just apply to those two schools. My plan was that if it didn't work that year and I hadn't got in, then I would extend my application further and, you know, improve my application as necessary, but I was, you know, willing to apply to more programs the following year if I didn't get in.

Milo: Yeah. You said I had a lot of confidence and I don't know if I had a lot of confidence, but I was in a situation that I was happy with, and if I didn't get in that year, I figured I'd get there eventually. And I was enjoying what I was doing at the time. So it wouldn't have been a disaster if I didn't get in that year.

Dr. Chan: And I can tell you from my end, now I can say that since we're having this conversation four years later, I remember talking to you Milo on the phone and you were so excited. I remember like I thought, "Oh, you're definitely coming." And then Nisha, when I talked to you, you were pretty cool, and I think you're holding your cards close to your chest. I don't know. Maybe you were stunned, but I came away from that phone conversation with you going, "I don't know if she'll come here," because you were pretty cool on the phone. So I don't know if you remember that phone call that many years ago, but that's kind of how I remember it.

Nisha: Yeah. I think I was pretty stunned actually. Because I had been waitlisted, I didn't have a lot of hope of getting into the University of Utah. And so I had really mentally prepared myself to do another application cycle. And so, when I got the call, I think I was pretty shocked at first, but also, you know, so that was kind of my initial reaction. But, you know, obviously, I did decide to go here, and I have loved all of it.

Dr. Chan: Do you remember being excited, Milo?

Milo: Yeah. Yeah. I actually woke up to your phone call, and it was earlier than I expected to hear back. But when I saw the number, like it kind of clicked and I picked up the phone kind of thinking that I was going to be on the phone with you. And I was super excited. Like I said, I only applied to Utah because I figured, you know, that's really where I wanted to be and just getting to stay here, stay with my family, go to a really great school, it checked all the boxes for me. So I was very excited.

Dr. Chan: Great. And then I want to jump . . . okay. I love asking this question, especially couples. So what is your first memory of each other? Was it during second look day? Was it during orientation week? Was it . . . were you anatomy lab partners? Like, how did you guys meet initially?

Nisha: So we met and we were in the same clinical skills group actually, which was the first time that I remember meeting Milo. And then we did a lot of studying together that first year. Me and Milo and another one of our friends were kind of in a study group, and we spent, you know, lots and lots of time going through all of the material and writing stuff on the whiteboards. So that's kind of some of my first memories.

Milo: Yeah. Definitely, where we met was the learning communities, like within the first week of medical school. And then I think walking back from classes to our cars, I ran into Nisha and we had like this really nice, in-depth discussion about, like, the world and politics. And it was just such a change from all of the preliminary conversations you have with everyone else kind of like, "Hey, where are you from? Do you know what specialty do you want to do?" Just really kind of superficial small talk and I'm really bad at that. And it was just such a striking change that that really stuck out in my head.

Dr. Chan: Nisha, do you remember this or do you not remember this?

Nisha: Yeah, I definitely remember that and for the same reason because it had been, you know, a lot of just the small talk conversations, which, you know, are obviously important, but were pretty tiring for me. So it was nice to have a conversation about things that I was, you know, that I was interested in and passionate about, and it was just really nice to connect with someone that wasn't the small talk superficial level.

Dr. Chan: And who is your . . . what was the name of your CMC group, and who was your instructor?

Milo: We were Powder Mountain. We started out with Dr. Barrett, who was fantastic, but he had a great job opportunity that he left for. And then we got hooked up with Dr. Glasgow and Dr. English.

Dr. Chan: Okay. I love it. And so it sounds like CMC really brought you together. And then, you know, again, like I've done other podcasts with other couples who ended up doing the couples match. Were you . . . how do you feel about becoming a couple? I mean, I know there's some, sort of . . . sometimes I talk to the med students and there's like this weird code, where they're like, "Okay, we're not going to date each other, but maybe we will." You know, and then, so I've noticed couples are very slow to kind of like announce that they're a couple. I mean, did you guys grapple with that at all, or were you pretty much like, you know, once you guys were together, you're together and you didn't care about like any sort of silly codes like that? Do you understand what I'm saying?

Milo: Yeah. I think it took us a while to get to the point where we were together because yeah, there's complications with dating a classmate who you're going to be in a program with for four years. But I think once we got to that point, I wouldn't say we overtly announced it, but we probably didn't try to hide it either.

Nisha: Yeah. We were really good friends for about two years before we started dating. So it was right before we went into the third year that we were really officially dating. And so we also didn't see a lot of our classmates around that time, which I think kind of made it a little bit easier, at least from the kind of announcing standpoint. And because we had been good friends for so long, at least for me, that made me a less worried about moving forward and becoming a couple and, you know, also with the knowledge that the match was going to come up in two years and so if we were going to stay together, that would probably mean doing couples match together. And so I think, yeah, just . . .

Dr. Chan: I love it. It sounds like it came together quite nicely on a kind of good schedule.

Nisha: Yeah.

Milo: Yeah, it definitely did.

Dr. Chan: And speaking of the first two years, how was that jump from undergrad to med school? Was it relatively easy? Was it kind of like the fire hose analogy? Did you have to redo your entire study kind of skills? Like, how was that jump from undergrad to med school for you?

Milo: Yeah. So I actually took five years between undergrad and med school. So I actually think it was . . . I felt recharged and like ready to go back into the classroom. It was kind of like a fire hose. I forget who told it to me, but when I was a first-year medical student, someone told me the first two years of medical school, like going from undergrad to first year is like going from zero miles per hour to 40 miles per hour. And you just have a lot of adaptation that you need to do. It feels like it's moving really fast, even though the material isn't quite as hard. And it just feels like a really big jump.

And I think I agree with that. I definitely. Maybe it was relearning study strategies after having been out of it for five years, but I felt like it was a pretty big jump and took a lot of adaptation. And then from first to second year is like going from 40 miles per hour to 60 miles per hour where it, you know, it's harder stuff, but you've got a lot of your habits formed at that point, and you just kind of have to lean on them a little bit harder and work a little bit harder for the material.

Nisha: Yeah. I agree with that. I think I had to learn how to process material in a different way. When I was in my undergrad, I took extensive handwritten notes on everything, which was really one of the ways that I learned well, and that was not really possible in medical school or it was at least quite a bit more difficult. So I had to, you know, learn some other strategies besides that. And I had also never really done any group study in undergrad, but I found that in medical school, group study was actually one of the things that worked best for me.

One of the other challenges that I had was going into medical school, I knew that taking multiple-choice tests was not my forte and it was something, you know, that I had not done as well with. In the undergrad, I did not do very many of them. So one of the things I really had to focus on was how to take multiple-choice tests, how to think about those types of questions. And I was actually really lucky because Milo is very good at them, and he was willing to spend a lot of time talking through strategies with me and helping me, you know, focus on the material, learning the material in a way that would kind of let me showcase that knowledge in a different way.

Dr. Chan: Great. It sounds like you guys were like, to you use a business term, a lot of synergy, you know, coming together. It sounds like you were able to kind of really develop some great skills, study skills, academic skills that really paid off.

Milo: Yes, absolutely.

Dr. Chan: And Milo, you alluded to it like a little bit. So if I had a time machine and I went back four years ago and I asked you what specialty you would go into, what would have you said, and then, how did third year either help or not help that decision? So I'm just curious. Yeah. I mean like, what would you have gone into, and then how did third-year kind of play into it?

Milo: Yeah. Mine's pretty easy. I thought I was going to do neurology, and I'm doing neurology. So, yeah. A lot of that was that's the research that really ended up pulling me in towards the end of college, and the five years I took between undergrad and medical school were a lot of neurology research. So I came in with a strong basis in it, knew that I really enjoyed it. Tried to keep an open mind through the first three years of medical school. I gave pathology a good look actually and internal medicine a pretty good look as well. And in the end, it actually came down to internal medicine and neurology, and they're really similar. I think people go into them for a lot of the same reasons, but I've always really liked learning about the brain and the nerves and, you know, they both had similar aspects and I picked the organ system that I liked the most, and that was neurology.

Nisha: For me, I went into medical school thinking I was going to do surgery, either general surgery or urology. And part of that was because I had shadowed a urologist and I got to watch some surgery and I just thought it was like the coolest thing ever. So, you know, I thought that that was going to end up being what I wanted to do. And in third year, my very first rotation was internal medicine, and I really enjoyed it. I think it was, you know, some of the longest hours in third year, but I was always excited to be there the next day and checking on my patients.

And after that rotation, which I enjoyed so much, the rest of the rotations were not as enjoyable as that was for me. Although, for some reason, I was so convinced that I was going to be a surgeon and I was kind of still thinking in my mind that that was the direction I was going to go. And it was Milo who actually said to me, he was like, "It's your life and you can do whatever you want, but you've been kind of miserable since your internal medicine rotation. So I don't really know why you're still going the surgical route." And that made me stop and think and realize, you know, what I really realized that that was what I had enjoyed doing the most. And when I made that decision, it was something that I was really happy with and really excited to do.

Dr. Chan: So a lot of people have told me like it was like finding your people. And it sounds like neurology, internal medicine, you found your people. Would you agree with that?

Milo: Yeah, absolutely. One word that got thrown around about neurologists on the interview trail at least was quirky. And definitely, I'm a little bit quirky. And I just felt like I fit in really well with the neurology crowd.

Nisha: Yeah. You know, I really like, you know, puzzles and problem solving, and that's a lot of what internal medicine is, is you get, you know, someone that comes in with non-specific symptoms and you have to figure out what's going on. And that's something that I really enjoy. And it also made sense because before medical school, I did quite a bit of research in a lab. And one of the things I loved about that was, you know, experiment didn't go the quite the way that we were expecting is, you know, a lot of troubleshooting and trying to figure out what was going on. And, you know, that was an aspect that really carries over into internal medicine, which I enjoy. It's a lot of kind of sitting and thinking. And, you know, one of the things I really love about hospital medicine, in particular, is that you get the answers, you know, you can see improvements and you get, you know, order labs and you can get them back pretty quickly. So there's kind of this real-time feedback on what's going on, which I also really enjoyed.

Dr. Chan: And then going into fourth year, did you, like so, when did, like, the discussion start kind of coalescing around the couples match, and when . . . like, because I know sometimes, students do away rotations. Like how did that kind of factor into, like, as you transitioned to fourth-years?

Milo: Yeah. Neither of us did an away rotation, but I think we had been together and felt like we fit together for a good year and a half previously. And so we just kind of . . . I don't know. We didn't have too big a discussion about it. It was just kind of, "Hey, you want to do this?" "Yeah." "Okay." And we did.

Nisha: Yeah. I agree with that. And neither of us did an away rotation, and for a large part, at least for me, that was just due to some of the advice that I got, which was in internal medicine, it wasn't really necessary unless there was somewhere in particular that you really, really wanted to go. And we didn't feel that strongly about any particular place.

Dr. Chan: So, yeah, I guess that segues to my next question, Nisha and Milo, like, what was your strategy for the couples match? Like, how many programs did you apply to? Did you try to identify like a certain geographical area of the country? Or did you just check all the boxes and just took the money and threw it through the window? Like what did you do? What was your strategy?

Milo: Well, at risk of sounding a little bit snooty, I guess, we just took the NIH, like, top 100, I guess top 50, like, funded schools and just went through those, cut a few of them and applied to most of the top 50. Well, no, about half of the top 50. I think most of the top 30. We ended up applying to like 20 . . .

Nisha: Twenty-two programs I think.

Milo: Twenty-two. And that was kind of our initial cut was the NIH list.

Nisha: Yeah. And I think we were really lucky too that our scores throughout medical school were very, very similar, and neurology and internal medicine are pretty comparable in terms of, you know, a program that was good at neurology was also usually pretty good at internal medicine and vice versa. And, you know, and we were very similar in competitiveness, both in terms of the specialties and in numbers, as I said before. So I think that made it a lot easier for us. I think it would have been more challenging if one of us was going into, you know, a very, very competitive specialty, and we might have had to make more sacrifices if that had been the case. But I think that was something that made it quite a bit easier to couples match, and, you know, we got interviews to pretty much all of the same places, and, you know, they were pretty close together in time as well. So that was nice.

Dr. Chan: I love it. I'd never heard of this NIH method. Are both of you thinking of, like, doing research during your residency careers, or what was kind of the logic behind using the NIH?

Nisha: So I actually had met with one of the internal medicine advisors, Dr. Lappe. And I was trying to sort out, you know, because you're supposed to apply to, like, some reach schools and some safety schools and then, you know, kind of schools that are in your range. And I was trying to figure out like, how do I know the competitiveness of schools? And she just, like, Googled the NIH internal medicine funding list, and that's what came up. And she looked at the list and she was like, "This is . . . the order that these are in is pretty consistent with the competitiveness of the schools." And so, you know, and she said like, "These are the schools that I think are, you know, within your grasp. These are the ones that I think are reach programs." And so that was why we used that list.

Milo: Yeah. I think moral of the story is have a good mentor and speak with them regularly, because Dr. Lappe was just invaluable, honestly, to both of us. And she spoke mostly to Nisha, but she gave advice to both of us and we both told her like, "These are our scores, these are our thoughts." And she was fantastic.

Dr. Chan: And I think, so it sounded like 22. So you each applied to approximately 20 some odd programs?

Nisha: Yeah.

Milo: Mm-hmm.

Dr. Chan: And then the interview offers sounded like coming in. Did you have to make hard decisions about turning down some interview offers, or did you just go out and do them all? Like, how did you approach that?

Milo: Yeah. We had to cut some of them. I think we got the majority of the ones we applied to, and we cut down to, I think, 12 or 13.

Nisha: Yeah.

Milo: So we ended up cutting about 10 each. And again, having a good mentor for that Dr. Lappe and on the neurology side, Dr. Wold and Dr. de Havenon spent a lot of time talking with us about which to keep and which could probably go.

Nisha: Yeah. And, you know, at that point, we started looking a little bit more into, you know, how much does it cost to live in that area, you know, some of, like, the benefits offered by the different schools and kind of some of the lifestyle around the schools, which we had looked into initially, but not quite as hard as when we actually got the interview offers and realized we needed to cut down to fewer programs than we had interviews for. So we used that to make some of our decisions as well.

Dr. Chan: And did you, I mean, like, and again, kind of like back to when you were applying to med school, would you, like, call each other or text each other at night and kind of give like each other's opinions, or was there some sort of Google master document spreadsheet where you would kind of, you know, pros and cons? Like, how did you kind of synthesize all this information you were getting as you both hit the interview trail?

Nisha: So we called each other usually after the resident dinner, the night before the interview, and then usually, like, on the way to the airport or at the airport the day after the interview was over and just kind of talked over our initial thoughts. And, you know, we typed some of the stuff that we really liked or, you know, or were more concerned about in a Google Doc. But in the end, it kind of came down to, I think, the feeling that we got at the different interviews and the places that we just enjoyed being the most or felt like we fit in the best.

Milo: Yeah. While I was at the airport, I would write down like in-depth the handwritten notes in a notebook about each program. And actually, when it came time to make the decision, I don't think I even went and looked at those outside of the top maybe two or three programs that we were thinking of. In the end, I agree it just came down to feel, how well you thought the program would take care of you and how well you thought you would meld into the program.

Dr. Chan: And did you send, like, you know, because like in the world of medical education, we call them love letters, like when you start corresponding with these different programs or love emails as it were, did you feel you had to do that, and what was your, like, who would do the writing? Or was there a place that like interviewed one of you and the other place was like not as quickly sending out interview offers, and did you have to kind of use some love letter-ish maneuvers with them? Like, how did you do that? Nisha: So, in terms of the actual interviews, there was one place where he got an interview that I was waitlisted. And then after his interview, I got an interview there. And then there was a couple of interviews that I went on, but they made sure to ask me if my partner had gotten an interview yet and said that they would, you know, press the other program. But for the most part, we got interviews to the same places. And then at the very end, we sent a love letter to our number one program, individually to our respective programs and said, you know, both that this is our number one program and our partner is also going to be ranking this program number one. But, you know, even in terms of that letter, we weren't really sure as to whether or not we needed to send it or not, but decided that it probably wouldn't hurt us to do that, especially because we said very specifically this is our number one program, and we only sent it to one place.

Milo: Yeah. I think on my end, I thought it was important to send that kind of final you're my top school love letter. Towards the beginning of the interview trail, I did send schools kind of thank you letters detailing some of the things that stuck out to me about their school and some of the things that I liked about their program. That kind of fell off around the middle of the interview trail. And actually, a number of schools just outright said like, "Don't do it. It fills our inboxes. We probably won't read them. Save everyone some time."

Dr. Chan: Unless you have a really catchy header line, we're not going to open this.

Milo: Yeah. That said, there were some that . . . I think there was one that actually it sounded like they really wanted us to send a thank you letter on the neurology side. So I definitely sent emails for those.

Nisha: Yeah. And I think almost all of the internal medicine programs on the day said, "You don't need to send thank you cards to your interviews or to the main program. We're happy that you're here. We know that you're happy that you're here. Please don't send us anything," which I think is different as compared to some other specialties. So that was probably pretty specialty-specific.

Dr. Chan: And when you started looking at your list and you started finalizing it's, like, was the number one choice for both of you pretty crystal clear, or is there some horse-trading negotiation? How did you work that out as a couple, because, like, I get the sense from both of you, your applications were very similar and very competitive, but again, my experience with couples match, you know, it's like all things as you navigate in life, there's trade-offs and there's accommodations and there's and yeah. So a lot of people kind of try to figure out . . . like compromise. The word I'm trying to use is compromise. So, yeah, how did you guys do that? Or was that even an issue for both of you?

Milo: It was an issue. There were some trade-offs for sure. So, actually, I had wanted to just stay at Utah. My family is actually right in Holladay. And I really hadn't seen them. They moved after I graduated from high school, and I hadn't really had a chance outside of med school to, like, be near them and close to them. And so I figured like Utah's a great school, I know the neurology faculty, and I love working with them and my family's here. So I had actually wanted to just stay in Utah. And Nisha said, you know, like, "Let's be a little adventurous. This is our one chance to, like, go out, gain other skills and then maybe come back here after that." And so our compromise ended up being we would each choose our top non-Utah school, put those at one and two, and then put Utah third. And that's what we ended up doing. There was a little bit . . . and then we both got kind of our choice in the top three.

Nisha: Yeah. And I was, you know, really appreciative of Milo's willingness to compromise on this one. And, you know, I think we were also lucky though that our top programs, the ones that we had liked the most were similar. So, but I will say even within that, I mean, there were several programs that we both really, really liked, and there wasn't like a clear number one for us. And I think when we were getting ready for interview season, a lot of people made it sound like, oh, they went to this one program, and they just loved it and they knew it was the program for them and it stood out above all the rest. And we had a lot of programs that we really liked. And so we also did do some, a lot of talking and kind of compromising on how we were going to order those as well. And geography did play some of a role in that, but then so did cost of living and other things that were kind of our future goals.

Milo: Yeah. I think Nisha brought up a really good point. Other students, I heard say like, "I went to this place and it was the one for me." And actually, at the resident dinners, that was an answer a lot of the residents gave us too when you ask them like, "Hey, what made you choose here?" They said like, "I just knew it was the one." And I don't think either of us had that feeling about any one school.

Nisha: Yeah. There's a lot of good programs.

Dr. Chan: There's a lot of excellent programs. And now, I'm going to kind of turn to something before you tell us where you matched because it's kind of pertinent to what's going on. Like, what rotations were you on when, like, when COVID started happening, and how was that communicated to you and kind of like the emotions of, you know, I graduate soon, match is supposed to happen. Like, what were you doing at that time and how was that?

Milo: Yeah. I had just finished my core sub-I on cardiology, and I had a planned two-week break to go be at my brother's wedding and he just snuck it in actually. We got back from the wedding, and like three days later everything shut down, and we were told the classes wouldn't happen and no more, no more clinical clerkships or anything. So I just remember . . . I actually did not think it was going to be that big of a deal to be honest. And my brother-in-law, he's a surgeon, and I saw him at the wedding and we were talking about it and we're both kind of like, "Yeah, you know, it's concerning and definitely something to keep an eye on, but in terms of, like, large-scale impact, maybe not." And then like half a week later, I talked to him again, and we were both like, "Wow, we got that wrong." And it was just weird. It's surreal. And honestly, it's still a little bit surreal. Having gone from a really busy sub-I being in the hospital to just being at home and trying to stay away from everyone and figure out what to do with my time, it's a big change. And the whole experience has just been surreal.

Nisha: Yeah. I was on radiology, and it was kind of confusing for a couple of days in terms of what was actually going to happen because we were about halfway done with the rotation. So, you know, we weren't sure if we were going to have to come into the hospital because we weren't seeing patients, or whether it was going to transition to online. But I thought the school handled it very well, and we were, you know, given updates really regularly. So, you know, that helped eliminate some of those questions.

One of the things that I think was harder was that Milo and I had both planned for our advanced internal medicine rotation to be our very last rotation, because we wanted that to help us get prepared for intern year, and that was done mostly online, which was still a good experience and we still learned a lot, but that also kind of shifted some of the plans that we had or in terms of getting ready for internship.

Dr. Chan: How did it feel, Nisha and Milo, to have, you know, the realization that Match Day because like Match Day is traditionally like, I call it the Super Bowl. Like, you've worked so hard for so long to get to this point, and it's you bring together your loved ones, your family members, and it's a huge celebration and, you know, I know the Dean's office, we mourned that we couldn't offer that to you. What was your feeling? Like, did you go through, like, the five stages of like anger, grief? Like, how did . . . when you realized that you would not have a "normal Match Day" or it was it not that big deal to you? I mean, I'm just curious.

Nisha: I wasn't that . . . I mean, I was excited for Match Day, but I had never been to a previous Match Day before. So I also think because some of my friends who had been to the previous Match Days were a lot more upset about it than I was. I was actually really, really sad about graduation. That was the thing I was looking forward to the most. And I think, in my mind, I was kind of hoping like, "Hey, if we do really good quarantine and, you know, maybe we miss Match Day, but maybe this will be over by graduation," which, obviously, was very wishful thinking on my part. But yeah, for me, Match Day was not as bad as missing graduation was.

Milo: Nisha and I were flip-flopped there. I was really looking forward to Match Day and, you know, graduation as well I think maybe to a lesser extent. I really wanted to be with friends and family and open the letter and see where I was going, and just have it be a big thing with everyone around, and I thought that would be a lot of fun. And obviously, you know, it's sad that it's not happening, but luckily, we've still been able to have contact with family, and all the Zoom meetings and virtual meetings have made it still possible to see friends and peers. And so there's alternatives even if they're not quite as good.

Nisha: And I think some of the, you know, Zoom alternatives that we've figured out how to do with family and friends has actually been a really good experience, because when we leave for our residency, we kind of already have some things in place about how to keep in touch with our family that I think had this not happened, would have been, you know, more difficult to implement.

Milo: That's definitely true.

Dr. Chan: And so how did you celebrate Match Day virtually with the med school or with your families? Or how did you do that, and where did you end up matching to?

Milo: Yeah. So Match Day, we spent with our aforementioned best friend that we studied with. We went over and had brunch with her and her partner, and we all opened our match emails together and then kind of video conferenced with our families all at the same time.

Nisha: Yeah. Our program, and I'll just say we both matched to the Yale. Our program had, I think, sent out, like, an automated email saying, you know, "Oh, this is like your new Yale email," about an hour before the official match results came out.

Dr. Chan: Uh-oh, it sounds like a violation. No, I'm kidding.

Nisha: So we knew kind of where we were going. At that point, we weren't sure if it was real or not real, or if it was like a spam or something. But yeah, that ended up being where we matched at. So that was kind of a spoiler for us, but it was also kind of fun because we asked, you know, our family where they thought that we would match on our list. So that was kind of cool.

Dr. Chan: So where did you match to?

Nisha: Yale.

Dr. Chan: Where? One more time.

Nisha: Yale.

Milo: Yale.

Dr. Chan: You got to say, you got to love it. Ivy League. Whoo. So sell me about Yale. What was great about Yale's program?

Milo: Yeah. So I really loved the people there. I met with the . . . so the program director there was just fantastic. By the time I got around to Yale, it was kind of further in the interview season, and the one-hour program director meetings at the beginning, I just felt like they never really said much, but his was fantastic. He just had such a good grasp on what was important to residents and what people had on their mind in terms of choosing where to go. And he had this really cerebral way of talking about that and then provided very concrete ways of like, "Here's what we're doing or have already done in order to address these issues." So it was very clear that he had his finger very well on the pulse of the residents there and their concerns. And he was just a very thoughtful person.

And then there was a doctor that I interviewed with who was doing almost exactly the same stuff that I foresee myself doing, a lot of medical education, ended up getting his masters after residency during his fellowship. And he kind of said, "Hey, I actually requested to interview you because it seems like we had a lot of the same interests and I would love to mentor you." And he just really pulled me in. And actually, come to find out he is the nephew of Nisha's parents' next-door neighbor and they live in, like, a small Idaho town. So just crazy coincidence.

Dr. Chan: Wow.

Milo: But both him and the program director were just so accessible and eager to jump in and help, and they had some really good medical education opportunities as well.

Nisha: Yeah. You know, I felt like the people there were, you know, very nice and very friendly and very passionate about the things that they were doing, which came out a lot in the interviews. And I, you know, really wanted to go somewhere where people were really excited about the work that they were doing and were willing to involve residents in that work. And, you know, one of the things that really stood out to me was that the program director talked to all of the applicants individually, and he, you know, he knew, like, all of our names and he knew facts about us from our applications, which for as many applicants as he sees I'm sure in a week was really, it stood out to me in terms of, like, how much they care about the people that are coming to their program and are interested in knowing them as individuals.

And, you know, they also had a lot of focus on resident wellness, which I appreciated, and their noon conference education just really kind of blew me away in terms of the way that they talked about the cases that they were looking at and, you know, how they approach testing and diagnosis and how they use the cases, like this is how we've changed our policies because of this. Then, you know, really tried to focus on how to, you know, do medicine in a more efficient, evidence-based way. And I really appreciated that as well. So it was somewhere I knew the people were awesome, and I would also get, you know, a really good education and things that were important to me.

Dr. Chan: Nisha, wow, this has been great. And I guess this last question, and it's more kind of a personal question in just what you're going through, but, you know, from our standpoint, from the Dean's office, this class is very unique for many ways because, you know, you're kind of more or less the COVID generation, and you're about to start your medical careers and to be quite honestly, in an area of the country where there's a lot of COVID cases. And I'm just curious like, how are you feeling internally, like how's Yale kind of like, you know, the onboarding? I'm sure that you've gotten a bajillion emails about this, and in the midst of this, all you're supposed to be doing all the normal residency stuff and finding a place to live and all that. Like, what does this mean to you? Like, how does it feel to just know that you're uniquely positioned to start your residency program in the Northeast, right in the middle of a COVID pandemic?

Milo: Well, there's a lot of emotions. I will say that I am actually kind of itching to get back into the hospital. I think having been taken away from it since mid-March, I'm pretty eager to go back and get back to what I signed up for and what I really want to do. But there are a lot of concerns surrounding COVID. And like you said, Yale borders New York pretty closely. It's just a few hours away. So they're kind of right in the epicenter. All of the messages we've got from them are encouraging in terms of they have protective equipment. They've been incredibly supportive and very accessible in terms of asking or answering questions we have. But yeah, there's a lot going on. It's a big transition to go across the country. It's a big transition just to start up internship in general and trying to find housing and get all the paperwork done for a new program. It's a lot going on, but I think we're trying to take, take it as it comes. And I think once I get out there, I'm excited to dig in and get started.

Nisha: Yeah. I'm also excited to get back into the hospital and back into seeing patients. And the program has been really good about, you know, keeping us aware of what's going on and what things are going to be like when we get there. And a lot of, you know, they send a lot of emails that are like have positive quotes or say, you know, like good things that are happening in the hospital. And it's clear that they're really trying to, you know, keep residents as well as possible, and, you know, focus on taking care of each other as well as taking care of patients. And I think that has alleviated some of my concerns as well about that we're going into an environment that is very, very stressful, but to a program in a place that is trying to make it, you know, as safe and as well as possible for the residents.

Dr. Chan: Well, I'm just really proud of both you, and you're just a great example and I'm excited for you and kind of anxious for you too, but I think that's normal.

Milo: Yeah.

Dr. Chan: As you kind of launch into this new part of your career and journey to becoming full-fledged attendings, you're going to be MDs very soon, which is kind of crazy when you think about, you know, you're going to have doctor, MD as the new name, but, you know, I just want to thank you for coming on the podcast and just kind of talking about what you've gone through. I think it's important to kind of explore it, and like I know there are people out there that are listening that will really benefit from it.

Milo: It was a pleasure, Dr. Chan. Thank you so much for having us.

Nisha: Yeah. Thank you. We're really excited as well.

Dr. Chan: All right. Well, you guys take care and maybe we'll catch up in a couple of years and maybe have you come back on the pod and hear how it's going out in Yale. Being a Yalie, is that the right term? Do you automatically now just hate Harvard, and, you know, you officially kind of adopted the blue, but become a bulldog as it were? I don't know. Yeah. So we'll have to have you come back on the pod in a couple of years. All right?

Milo: That sounds fantastic.

Nisha: All right. That's awesome. Thank you.

Milo: Thank you.

Dr. Chan: All right. Take care, Nisha. Take care, Milo. Bye-bye.

Nisha: And you too.

Milo: You too. Bye.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

If you've ever looked up your medical symptoms online, it can seem like every website assumes the worst possible scenario. These results can be alarming to say the least. So where can you find reliable health information online?

Dr. Troy Madsen has dealt with the stress of trusting bad online information personally and professionally with his patients. He's put together a list of websites he uses and has found to be the most reliable to find information on any medical topic.

• Centers for Disease Control and Prevention (CDC)
• The Mayo Clinic
• The Cleveland Clinic
• University of Utah Health
• MedScape.com
• UptoDate.com

Each of these websites are from reputable health organizations run by professionals. Dr. Madsen highly recommends using these sources over a basic web search to make sure you're getting the best information possible. How Can You Tell if a Health Article is Valid?

When it comes to research you see in your news feed, it's easy to get bad information. There are a lot of potential problems with online health journalism. Media groups often write articles about science and medicine in a way that can get them clicks. Due to limitations, the story is not always able to go as deep into a topic as is necessary to fully understand the complex nature of scientific studies. And finally, most journalists lack the medical or scientific background to accurately present the findings.

Dr. Troy Madsen has a list of tips that he suggests everyone follows when reading any study to help you decide if it's true.

• First and foremost, make sure the article links to a published scientific study. If there's no study, there's a good chance the information in the article is misleading.

• Make sure the linked study actually claims what the article says. Most scientific journals will give access to the abstract or short summary of the research for free. Read through to make sure the journal isn't twisting the findings.

• Make sure the study is published in a reputable scientific journal. There are "predatory journals" that allow any group to pay to publish research in official sounding publications. To be safe, only trust journals like The New England Journal of Medicine, The Journal of American Medical Associations, The Lancet, or The British Medical Journal.

• Avoid studies that make bold and definitive claims. Science is nuanced and seldom makes hard and fast claims about anything.

• Make sure the claims are backed up by multiple studies. For example, if chocolate really did cure cancer, multiple studies would be looking into it.

• Be sure to check the sponsor of the research. It's not uncommon for companies to back skewed research that shows the positives of their products.

Be a skeptic! Next time a scientific story comes across your feed, keep an eye out for these elements to make sure you really are getting reliable information. What Makes a Good Scientific Study?

Troy also suggests a few things to look out for when judging the validity of a study. A good scientific study should have the following:

1. Low "P-values." A p-value is a statistic that describes the likelihood of the collected data having errors. As such, a lower p-value means a more reliable study. Look for data with a p-value less than .05. That means there is less than a 5% chance of the data being wrong.

2. Large numbers of subjects. A scientific study about health should include over a thousand subjects minimum. Ten thousand is even better.

3. The best type of studies use "randomized control trials."

4. The gold standard for medical research are "prospective studies," where the scientist actively follows the patient and their behavior rather than rely on anecdotal information.

Maybe you didn't chew as well as you should have. Now you have a piece of food stuck in your throat. It's not obstructing your airway, but it's definitely uncomfortable or painful. The food won't come up, it won't go down. ER or Not?

First, make sure the food isn't obstructing your airway. Any blockage of the airway needs to be seen at an ER immediately.

If you can't get the piece of food up, you may need to go to the ER to get it removed by a professional. But first, there's a trick you can try at home that may save you a trip and the cost of an ER visit.

Take a drink of a soda, preferably a cola. Try to get a swallow of the cola down your throat and let it sit there for five minutes or so. Carbonated cola has some properties that will help the esophagus relax. It may be able to relax your throat enough to swallow the food the rest of the way. Repeat a few times if necessary.

If the cola trick works, it is important to go talk to your doctor afterwards. There are some conditions that can be related to getting food stuck in your throat that would be important to catch to diagnose and treat.

If the cola didn't help push the food through to your stomach, you will need to go to an ER. You will need to be treated by a gastroenterologist immediately. An urgent care will not have that kind of specialist on hand. Try to go to a larger ER that would have an oncall specialist. Housekeeping - Hello Ladies.

This podcast is called "Who Cares About Men's Health." The goal of the show was very focused and very singular. Create a podcast by men, for men. Yet our our most recent statistics surprisingly show that about 40% of our listeners are women.

Guess this just goes to show that women also care about men's health.

Listener Danielle recently gave us a shoutout on Facebook.

"I love listening to bits and pieces of this podcast Who Cares About Men's Health. You don't have to be a man to find it interesting."

Women, if you are listening, be sure to share it with the men in your life. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy would rather have a broken finger than a long-lasting cold, because he can't get sympathy. Scot has a moment of honesty about his personal health struggles and he reminds us that health is a practice with ups and downs, not a linear journey. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Having a cold is never fun. Neither is the flu. But what treatments are available for these two nasty bugs? Justin Knox is an urgent care physician assistant for University of Utah Health and he sees a lot of colds in his office.

The common cold is a viral infection that is transmitted from person to person. The virus is found in droplets when an infected person coughs or sneezes and potentially as they touch things in their environment.

"It's all over," says Troy, "There's nothing you can do." In the ER Troy washes his hands all the time and even wears a face mask when interacting with some patients, but he still finds himself catching colds.

The cold is a viral infection. Viruses typically need to run their course before you feel better. There is little a physician can do to help treat the cold itself. The best a physician can do is help alleviate the symptoms.

The symptoms of a cold typically include:

• Runny or stuffy nose
• Cough
• Congestion
• Sore throat
• Sneezing
• Low fever
• Body aches and mild headaches

Most cold symptoms are caused by mucus. Cough, congestion, sore throat, etc. all stem from the changes in your snot while your body battles a cold. How to Survive Your Next Cold

"It's all about mucus control," says Justin. He suggests three strategies to help you feel your best during a cold:

• Manage the Mucus: try an over the counter decongestant or expectorants like Mucinex or Sudafed. These should help with most symptoms, including sinus pressure than can lead to headaches. If you live in a particularly dry climate, a humidifier can help keep the mucus from getting too thick.
• Calm the Cough: over the counter cough suppressants like Robitussin work great at getting your cough under control. A frequent cough can cause or further irritate sore throats or headaches.
• Alleviate the Aches: ibuprofen or Tylenol can help minimize the body aches and headaches that come with a viral infection.

While these treatments can go a long way in making your next cold more bearable, remember that a cold is still a virus. It can take your body up to a week to fight off the infection and start getting better.

There is no cure for the common cold. Antibiotics will not help treat a virus. And you're contagious as long as you have symptoms. Spare your coworkers, stay home from work. Is it a Cold or the Flu?

The common cold and influenza are both viral infections that can be very contagious. It can be difficult for doctors to tell the difference between the two. Usually, flu symptoms are similar but noticeably worse than a cold. Other times, the symptoms can be quite mild. It depends on the strain of influenza that is going around that flu season.

There is a test for influenza available. However, most doctors will not use it because the flu is a condition that can be diagnosed and treated easily without waiting for test results. The Center for Disease Control's recommendations are for doctors to treat a patient with flu-like symptoms as if they did have the flu, even without a positive test.

This means that a majority of people can get treatment for their flu through a virtual visit with a doctor or even a quick phone call if you feel you've been exposed to someone with the flu. Treatment and Prevention of the Flu

Having the flu is miserable. It's understandable that people may want some sort of cure to help them get back on their feet faster. Unfortunately, such medication doesn't really exist.

You may have heard of a drug like Tamiflu, and been led to believe it knocks out the flu fast. This antiviral medication was designed to help treat at-risk populations where an infection like the flu could be life-threatening. For young children, older adults, and immuno-compromised individuals, this drug could be a lifesaver. One of the major limitations of the treatment is that it needs to be administered within 48 hours of a person being exposed to the virus for it to be effective.

For otherwise healthy individuals that have the flu, Tamiflu will do little to treat the infection. Research has shown it may shorten the duration of symptoms by only 12 hours over a week or so the flu lasts. And those results are only seen if it was administered within the first two days of infection.

The best way to survive flu season is to prevent catching it in the first place. Influenza is a very contagious disease. In fact, flu victims can be infectious before serious symptoms even present themselves. Those individuals will continue to be contagious throughout the infection, with the most infectious time while experiencing a fever.

If you or someone you know might be coming down with the flu, stay home from work and spare the people around you from being sick.

Even more importantly, protect yourself. An annual flu shot can reduce your chances of catching influenza by 50%. Due to the constantly changing nature of the disease, there is still no 100% effective vaccine, but a fifty percent protection is better than nothing. Dr. Knox's Megaphone Moment:

"Get your flu shot. Wash your hands." Life Expectancies of Men Dropping Due to Deaths of Despair

According to a recent article featured on Yahoo News, life expectancies for U.S. men peaked in 2014 and have been declining since then. One major contributor: ‘deaths of despair."

These deaths of despair include drug overdose and suicide. The mortality rate for drug overdose in men within the U.S. has doubled between 2007-2017. That's twice as many men losing their lives to drugs in just a decade. In that same time period, the suicide rates for both men and women has increased by 24%.

When thinking about a population's health, it's easy to focus on eating right, exercising and avoiding disease or injury. That's not the whole picture. Mental health plays a big role in keeping people alive.

The typical signs of depression include:

• Poor sleep
• Poor diet
• Loss of interest in things they once enjoyed
• Irritability
• Feelings of guilt and helplessness
• Anger
• Thought of suicide

Remember that good health is a battle, especially when it comes to mental health. As a man, recognize that suicide and drug overdose are killing this generation. Take it seriously.

If you are having depressive feelings or extreme stress, or see these signs in others, reach out and seek help.

There is no wrong way to get help for mental health. Go to a physician, doctor, get in touch with therapist, talk to friends or family, just reach out. These interventions do make a difference. Keep working on it and keep trying and don't buy into the stigma that caring about your mental health is a weakness. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot is noticing that as he's eating more vegetables, he's been getting sick less. Could it be his microbiome? And the cold weather is making Troy's early morning run a little miserable. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Chan: What's like to meet your spouse in anatomy lab? How do you navigate the tricky complexity of couples matching? How do you finance your interviews? And how do you tell your spouse that you really don't like their top choice? Today on "Talking Admissions and Med Student Life," I interview Chelse and Marcus, fourth-year medical students here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." I've got two guests today, Marcus and Chelse. How are you doing?

Chelse: We're good.

Marcus: We're great. Thanks for having us.

Dr. Chan: Recently matched fourth years, don't say where you matched because we'll get into that.

Chelse: Suspense.

Dr. Chan: It's suspense. All right, so let's start at the beginning. How did you two meet?

Chelse: Okay. We'll go way back.

Marcus: This is way back, yeah.

Chelse: Yeah. So we've been married now almost six years. We met at BYU. We were both pre-med undergraduates, and I was his anatomy TA.

Dr. Chan: I did not know that.

Chelse: Yeah. I can really tail it back to the moment we met. He came in to an early lab session, and I taught him the GI tract on a cadaver. Yep.

Marcus: Yeah.

Dr. Chan: And Marcus, did you go in early because you knew Chelse was going to be your TA that day, or did you really just need to learn about the GI tract and it didn't matter if . . .

Marcus: So, actually, yes, I did go in early because I knew it was her. I had seen her before that. I was taking the class with my sister, and when I saw Chelse, I think my jaw was like on the floor because she was, my sister is like, "I think you love her, don't you?" That's it.

Dr. Chan: So it's love at first sight.

Chelse: Yeah.

Marcus: I think so.

Dr. Chan: And it wasn't love at the GI tract.

Marcus: No, not necessarily.

Dr. Chan: Okay.

Chelse: No.

Marcus: I had a good friend that was in her TA section, and I was like I'm going to . . . And it was like Tuesday mornings at 7:00 a.m. I could had gone at any point in the day. So yeah, I definitely went to see Chelse, but I could get up the gumption at that point to actually talk to her.

Dr. Chan: So is this is the . . . when was this? What year is this?

Marcus: This was the . . .

Chelse: Oh, man. Of our sophomore year.

Marcus: . . . winter of 2011. It's like January 2011.

Dr. Chan: And does BYU have rules with TAs dating students, or is it kind of a free for all or have about?

Chelse: They sure do. They have rules, but we didn't.

Marcus: We weren't dating.

Chelse: No.

Marcus: I was just admiring at that point. I was just a creepy stalker.

Chelse: I really liked him and thought he was so cute, but he like never looked up at me while I was teaching, so I thought this isn't going to happen because he's more interested in the cadaver than me.

Marcus: I was nervous.

Chelse: Yeah, apparently. He like wouldn't even look at me, so that was winter semester. Nothing happened. He just kept showing up. I kept trying to get his attention. It never worked.

Marcus: That's such a lie though.

Chelse: Whatever, whatever.

Marcus: She did not try to get my attention. She already had it.

Chelse: Yeah. And then we had organic chemistry together in the fall, so that whole next year or junior year, and I was dating someone at that point. He was dating someone at that point so . . .

Marcus: No, I wasn't.

Chelse: Well, whatever.

Marcus: I was single, ready to mingle.

Chelse: Yeah. You were single at the . . .

Marcus: With you.

Chelse: Okay. And . . .

Dr. Chan: I think history is being rewritten as we're talking about it. Okay.

Chelse: But we just became really good friends, because I was in a relationship at that point. So we started becoming study buddies and became really good friends. My mom is a professor at BYU campus, so I introduced him to her. They became best friends. Now, I know they had like secret meetings behind my back.

Dr. Chan: Oh, some plotting, some engineering going on, buddy.

Chelse: He would say that he wanted to date me and that he thought he was falling in love with me. And my mom would say, "It's okay. You're going to be in her family eventually, just hang on." So, yeah.

Dr. Chan: Wow, okay. All right. So, from the time you met, when did you start dating?

Marcus: A year later. Well, actually it was . . .

Chelse: Well, a year and a half.

Marcus: No, it was longer.

Chelse: It was a year and a half.

Marcus: Because we met in the winter and then we didn't start dating until, yeah, a whole year and a half, in like October of 2012.

Chelse: Yeah.

Dr. Chan: And how long did you date for before getting married?

Chelse: So this sounds typical BYU unfortunately, but we knew each other, but we only dated for, well, it was almost a year.

Marcus: We got engaged in February.

Chelse: We got engaged, and we started in November, got engaged in February, and then got married in August.

Dr. Chan: Okay. All right.

Chelse: Yeah.

Marcus: But at that point, when we started dating, we had already talked about like everything. We already knew everything about each other.

Chelse: It was more like, "Can I kiss you and have it not be weird?"

Dr. Chan: Most couples struggle with that.

Chelse: Yes, couples struggle.

Dr. Chan: All right. So one of the things that you talked about is applying to med school. Like when did that, you know, because you said you're both pre-med and we can do a whole separate podcast about like, you know, pre-med culture and how people navigated that. So how did that work at BYU? How did you guys navigate that?

Marcus: So I kind of decided at that point, once we were dating, med school. I was debating between dental and med school for a little bit, but decided on med school. And then Chelse had kind of had this experience where she felt like, I guess you could tell it.

Chelse: Yeah. I was worried about like the double doctor lifestyle, like we both want a family and I think, for better or worse, lots of LDS women maybe don't pursue medical school for a variety of different reasons. And so I kind of fell into that for a moment, trying to think like, "Well, maybe I could do a PhD route, maybe I could do PA school," because I love teaching and then trying to navigate how we would even approach a double doctor life. So I ended up kind of walking away. I didn't end up taking the MCAT, and I finished the semester. I graduated BYU a semester before he did, so I just started working in health care. And then he ended up . . .

Marcus: With like the PA goal, I mean like patient experience.

Chelse: With a PA or PhD goal. Yeah, exactly. And he ended up getting accepted to a school in Washington first.

Marcus: Oregon.

Chelse: In Oregon. Okay. Well, we didn't go, so it's fine. And it was, we thought when he applied, that we apply to places that had corresponding PhD or PA programs only and that school only had an MD program.

Marcus: DO.

Chelse: Yeah, and it was DO. And so, at that point, I thought, "Well, that's all there is, so I'm just going to go for it." So I started prepping. I took the MCAT, and then he got accepted to the U, which is what we always wanted all along, but I was already on the track. So I had made up my mind.

Marcus: But at that point you were committed to it too.

Chelse: I was committed.

Marcus: It was like ever since she was a little girl, like way more than me, she's wanted to be a physician since, you know, she was little. And so it just felt wrong to not have her kind of go after . . .

Dr. Chan: Yeah. So, Chelse, what helped you get back on the medicine trail? I mean was there an event or series of events? Because what you express is not unknown. I mean, like a lot of people feel dissuaded for a variety of reasons.

Chelse: For a variety of things, yeah. But I mean it's what I've always wanted since I was little. And because he got in where there was only like a med school option, I felt like that was the trigger.

Marcus: It's kind of like the motivating factor.

Chelse: It was the motivating.

Marcus: Okay. I guess we're going to both do this, all of it.

Chelse: Because that was the only option for me and I felt like I can't not do it.

Dr. Chan: So once you started going, like so when there was only Oregon. it sounded like you felt like, "Okay. I can only apply to this medical school."

Chelse: Exactly.

Dr. Chan: But then when you got in Utah, it sounds like you'd already put in a lot of blood, sweat, and tears.

Chelse: I was already going. Yeah. And I had, like I had made up my mind now that I had . . .

Marcus: The fire was rekindled.

Chelse: It was back, yeah. Now that I had re-decided I was going to med school like it was done. I realized like I never would, it's just I would have had regrets forever if I hadn't done it, and it's who I am and who I always wanted to be. And so I went for it. The tricky thing then at that point was he was a year ahead of me, and so I applied and I was working here during his first year in med school, just doing research and I just remember running into you all the time.

Dr. Chan: Yeah, yeah. You're up on the second floor.

Chelse: I was up on the second floor.

Dr. Chan: You're in the OB-GYN department.

Chelse: Yes. And so you would keep walking by me, and every time I'd get so nervous because it's like, "Oh, my gosh, I saw Dr. Chan today. He's the master of my fate."

Dr. Chan: It's the committee, it's not me. It's the committee.

Chelse: I know. I know, but I didn't know that at the time and so . . .

Marcus: It definitely seems like.

Chelse: You just felt like this, yeah, like this goal, this unreachable goal.

Dr. Chan: Okay, so let's break this down. So Marcus gets into the U. I remember talking to you, Marcus, on the phone and I would say you're in the top 10 kind of dazed and confused, because I remember I kept on saying welcome and you're just like, "What?" Like, you know, I just remember it.

Marcus: You're joking with me.

Dr. Chan: Yeah.

Marcus: It was early.

Dr. Chan: Yeah. You seemed incredulous. You just seemed like, "This can't be happening. Is this some practical joke? Did Chelse put you up to this?" Because I remember you were very much dumbfounded on some deep level.

Marcus: Yeah. I was driving to work. It was early and unknown number, and I was just like, yeah, I thought it was some kind of joke. People around me probably knew how much I wanted to get into the U.

Chelse: It's just been sort of like humility that he has, he just like couldn't believe it. Yeah.

Marcus: One of the best moments.

Chelse: Oh, my gosh, yeah, it was awesome.

Dr. Chan: So you start school here, but Chelse is a year behind you. How was that for the first year, you know, as far as like amount of work and, you know, studying and, you know, Chelse is getting her application in order?

Marcus: Yeah. It was a little overwhelming for me. I mean, probably not uncommonly. I was a Spanish major, so I didn't have the science background, and I think, for me, I definitely experienced that learning curve of trying to get used to the language of science during that first semester. And so, yeah, it was hard, but we got through it. And Chelse was working hard during that time doing research here at the U and developing good ties there at the OB programs.

Dr. Chan: Yeah.

Chelse: Fortuitous.

Dr. Chan: And then did you only apply to the U, or what was your strategy the next year?

Chelse: Yep, I only applied here, which is why you were so scary every time I saw you. It just felt like all my eggs in one basket, and some of his classmates would be like, "What would happen if you don't get in?" And I would just say, "Good question, but I'm not thinking about it." Because that would have created a two-year gap, which seems it would have been harder. So we were just kind of going forward, hoping it would all work out. Yep.

Dr. Chan: So I remember calling you, and you were very excited.

Chelse: I was so excited.

Dr. Chan: You were even like one floor above us at that point.

Chelse: I was one floor above you literally, and I was so excited. I texted Marcus immediately, and I was like, "You need to leave class. There's an emergency." Because I like . . .

Marcus: I was just like in class aloof, like I didn't . . .

Dr. Chan: Did you walk out or you're just like, "Yeah."

Marcus: I did kind of, yeah. I thought maybe it was like a legit emergency, and then she kind of screamed, "I got in," and then it was pretty close to our class break, so then, at that point, my whole class kind of knew Chelse was applying and so we kind of had a little celebration.

Chelse: We had a little celebration.

Marcus: In the hall, in front of everybody.

Dr. Chan: And when did you start, so like then you knew, like you're a year behind Marcus. When did the discussion pivot to like how do we sync up? How do we . . .?

Chelse: Right then or even before we kind of started planning.

Marcus: Once I got in, we had kind of started planning a little bit. We're kind of planners, especially Chelse.

Chelse: Especially me.

Dr. Chan: So there's many options for someone to take "a year off," pursue a master's degree, do research. How did you end up choosing what you chose?

Marcus: Yeah. I've taken some business courses in undergrad, like statistics, accounting. And I really did enjoy it, so I kind of had a lingering desire to pursue business. At the time, Vivian Lee was pretty motivating as well, as far as kind of pushing physician leadership in health care kind of with an emphasis on business, I felt like. And I'm also not necessarily a business-minded person. It doesn't come naturally to me. So it was appealing to kind of let's strengthen a weakness I guess. So, for those reasons, I decided pretty early on.

Chelse: Yeah. It was an easy decision on the MBA. And so, in between first and second year, when you have that break, he prepped and took the . . .

Marcus: The GMAT.

Chelse: The GMAT.

Dr. Chan: So they still require the GMAT. I know that's been an ongoing discussion.

Chelse: Yeah. At that point he needed it. So since that was kind of his one break in med school without boards, we planned so he could take that and have it ready by the time he needed to apply. Yeah.

Marcus: So what's one more standardized test?

Chelse: Why not?

Dr. Chan: More tests.

Chelse: Yeah.

Dr. Chan: How was it to be . . . So you did your first two years, and then is the MBA after third year or could you go after second year?

Marcus: It's only after third year.

Dr. Chan: So you went ahead. So, Chelse, you were a year behind for three years.

Chelse: Yep, exactly.

Dr. Chan: Okay. How was that?

Marcus: It was kind of unfortunate, honestly, looking back, just because we were study buddies for so long, like we learn really similarly and work really well together, so I would have liked that. It would have been nice to have the experience. I don't know. Maybe a step prep would have torn our marriage apart. I don't know.

Dr. Chan: Or made it stronger.

Marcus: Or made it stronger. But I think, I kind of have like the regret factor as far as that goes. Like I wish I could have experienced that with her, but it ultimately ended up fine. I could kind of put out some fires along her journey where she had . . .

Chelse: Yes, super helpful for me.

Marcus: . . . worries come up but . . .

Chelse: Yeah.

Dr. Chan: What were some fires?

Marcus: Just kind of specific worries pertaining to like course details or assignments or . . .

Chelse: Yeah. I think it was nice, just because he knew the resources. Like I feel when you get into med school, you have this massive learning curve and then all these new resources, and you're just trying to learn like which ones are worth your time. So he had tried the resources and kind of told me, since we learn so similar, what worked best for him. So he kind of shortened my learning curve a little bit just by helping me tailor the resources or how to best study, just . . .

Marcus: She could commit a little earlier.

Chelse: Yeah, like simple things like that. And I also think it helped watching him go through it, because then I feel like I had very realistic expectations of what all it was going to be like going in.

Dr. Chan: With the schedules kind of flipped, so first year is usually the morning is off and have class in the afternoon. And then second year, there's class in the morning and usually the afternoon is off. Like would you study together at nights, or were you kind of library buddies, or how did that work? Or did you go whole periods of time without seeing each other? I mean, what did that look like the first few years?

Marcus: It really wasn't as bad as it sounded. I felt like we still saw each other a lot, and we did, we would kind of review stuff together. And we both had our study groups, so we kind of go and see and hang out for a little while. I think both of us being in it just did set really realistic expectations and we just knew we were studying. We'd meet up and go to the gym or go get some food.

Chelse: We'd just sit by each other. We'd be studying different things, but we'd always just be by each other and it was fun. Yeah.

Dr. Chan: Good.

Chelse: We survived.

Dr. Chan: All right. So I'm going to start with Chelse first, then to you, Marcus. All right. So, Chelse, if you had asked me before you got here and then all throughout the first years in med school, I would have said OB-GYN.

Chelse: Really?

Dr. Chan: All the way.

Marcus: That's what I was thinking too.

Dr. Chan: So how did you arrive at your career choice, your decision, and like how much did third year kind of play into that? So what was your journey towards that?

Chelse: Yeah. So, because I had worked in OB-GYN research before med school, I knew I loved it, but I also didn't want to pigeon hole myself because of that. So I got in, and then I got exposed to the world of dermatology because my mom has had lots of skin cancer and one of my best friends was pursuing it. So then I got sucked into derm. So, for the first two years of med school, I was dermatology all the way. I did tons of research in leadership and kind of departed from OB. And then in third year, that's when . . .

Marcus: And part of that is because it was kind of like almost typical for you, right, or people would kind of think, "Oh, yeah, she's going to go into OB because she worked in OB and because . . ."

Chelse: Right. So I wanted to like prove them wrong kind of. And, anyway, just be stubborn that way and I really did like dermatology a lot and found great mentors. But then in third year, I did my, well, family medicine was my first third year clerkship, and I delivered a baby, and that was it pretty much.

Marcus: She took this Instagram video of her. It wasn't in Instagram, but it was just a video of herself like right after she did it, and it was like all over her face that it was over.

Chelse: It was pretty much over after that. I just loved it. And then I did my OB rotation, and I like wanted to stay and my residents kept telling me I had to go home and I just was so happy. I think that's the fun thing of being in it together. We can see when the other one is like really happy when we're working in something. And that was like a clear difference for me. And then I did a little bit of derm third year, and I just didn't love it. It wasn't the patient relationship I initially went into medicine for. I didn't want to lose certain components of medicine, and so it just became an easy decision. I just felt like I fell right into it, and I just never looked back after that. Marcus' course was much more convoluted.

Dr. Chan: Yes. I remember seeing Marcus a lot. I would hear different stories because it's all about . . .

Chelse: Every time you would talk to him it would change.

Dr. Chan: Yeah. So, Marcus, let's talk about it.

Marcus: Oh, man.

Dr. Chan: Let's talk about how you ended up, I'm not even 100% sure where you ended up because I think everything was on the table at one point, right?

Marcus: Everything was on the table. I started med school thinking family practice. That was kind of like in the back of my mind. And that kind of carried through throughout, but then along the way I was kind of sidetracked by OB, ENT. I mean it's kind of like . . .

Dr. Chan: And psychiatry was up there. Surgery was on there.

Marcus: I love psychiatry. I love psychiatry. I did a whole extra month in child psychiatry, and surgery was there for a while. EM was big for a couple of months. It's so funny because all my friends made fun of me for this, too, because even with my closest friends, every time we talked about it, it would change. And so, when I submitted my application, they had all kind of been thinking, you know, what I was telling them. And then I just, for fun, was like, "I ended up doing this," you know, and it was like they didn't even blink an eye. It wasn't even that good of a joke because they are totally like, "Oh, yeah, that's how Marcus works."

So, for me, after third year that you're off with the MBA was probably the most influential for that just because the time away from medicine kind of helped me gain a little more perspective and what I was looking for. And I settled on anesthesia, which was actually one that I, if you would have asked me in the first year or so of med school, I would have immediately dismissed it. It was like on my quick dismiss list.

But once I did it, I think what kind of grabbed in was the kind of really meaningful, impactful, but shorter interactions with patients. Not that I don't like interacting with patients. I actually love it. But I like the role that you play in patient care and that there's kind of like this service that you provide them, and then kind of you both go on your way. And then also just the mentors and everything, kind of their state of mind and just satisfaction with what they were doing was really influential for me at the time as well. And yeah, I mean there's lots of reasons where I ended up choosing that path.

Chelse: Yeah. And it was at like the very tail end of like . . . very beginning even of fourth year when he was still making his decision. I remember it.

Marcus: So even with the extra year, I was still right up to the . . .

Chelse: Even with the extra year, he was still right up to the deadline.

Dr. Chan: Were you doing like physician shadowing during MBA time and you just kind of little, I don't know, little evening type things?

Chelse: Yeah.

Marcus: I was kind of between like psychiatry, emergency and anesthesia and family.

Chelse: And family, don't forget that.

Marcus: And so my kind of two that I was most involved with was anesthesia shadowing, and then also I was working at the free psychiatric clinic.

Dr. Chan: MLA Clinic or 4th Street?

Marcus: No. It's . . . why am I blanking on the name?

Chelse: I can't even remember the name.

Dr. Chan: It was just called the free psych clinic, yeah.

Marcus: Yeah, the free psych clinic down there on like 45th South or so. Anyway, you know Gardner.

Dr. Chan: I know, yeah, Dr. Gardner.

Marcus: He's kind of the director of that clinic.

Dr. Chan: So how was it like though, like with one partner knowing what they're doing and another partner just kind of like unsure? I mean how much . . . it sounds like did it just dominate like when you guys would talk to each other just trying to figure that out or . . .?

Marcus: Well, it kind of got into the point where I was like, "I'm thinking this." And then she would kind of be like, "Oh, great."

Chelse: That's so great.

Marcus: And I'd be like, "Why are you more excited?"

Chelse: We really had this conversation on that. He's like, "I'm going to do that." And I would say, "That is so great." And I would talk to him all about the pros, and he was like, "I just don't feel like you're really excited." I was like, "We'll give it some time."

Marcus: She's like, "I'm just waiting for you to change again."

Chelse: I was waiting for it to change, but it's kind of funny because that's just very fitting for our personalities, like this is how our marriage has always been. Like I'm a very decisive person, and Marcus is more of a, "I have to see all the options and then I have to really evaluate all my decisions, and then I'll make a choice." And like this is when we go . . .

Marcus: Yeah. I mean even Netflix.

Chelse: Oh, yeah, even Netflix.

Marcus: That's like we'll search for Netflix

Chelse: He'll scroll forever versus I'll look and just decide.

Marcus: Yeah. She looks.

Dr. Chan: I assume you have separate accounts, right?

Chelse: No.

Marcus: No, it's all the same.

Chelse: It's just whoever gets the remote.

Marcus: She just sits there and she like will fall asleep sometimes before I pick one.

Chelse: Or like going shopping, like I can just look. I know what I want, I'm done, versus Marcus can't purchase something until he's seen all of his options. So like this is why we balance each other out. He makes me think about things more. I make him commit and decide. So like we balance one another. So the fact that this is how it happened with our specialty choice is not surprising at all. So we already knew how to handle each other in this way.

Marcus: Yeah.

Dr. Chan: Okay.

Chelse: Yeah. But once you actually committed to anesthesia, you didn't look back, like it felt right.

Dr. Chan: All right. So talk about this moving to the next step, applying as a couple, couples match. What was your initial strategy, and did it change with time? I mean how did that look like at first?

Chelse: Yeah. I feel like it's so daunting. Once you decide what you want, you think you're kind of on this downhill slope. But then you start looking at programs all over the country and realizing you don't know anything. And so both of us kind of took the approach of talking to our individual mentors in our field to get their advice on programs. And so we kind of, and also I think initial strategy for people applying is they'll start geographically limiting themselves, and we did that a little bit but not much, because with the couples match, you just have to apply.

Marcus: We kind of did unwise things as far as the couples match goes through with that regard because we have two dogs and we were kind of like we don't really want to be in New York or LA or which are . . .

Dr. Chan: Because of the dogs.

Chelse: Yeah.

Marcus: Yeah. But just like living situation, we didn't want to end up in like some really expensive apartment with two dogs. And so we actually didn't apply to a lot of those bigger cities which . . .

Chelse: Is a good strategy for couples.

Marcus: . . . as a couples match is not a good thing, right?

Chelse: Well, that's what I'm saying, yeah, yeah.

Marcus: Because that's where tons of programs are within a close vicinity to each other and . . .

Dr. Chan: But what are the values on hearing those, like you wanted to be together, right?

Chelse: Yes.

Dr. Chan: So you wanted to be in the same area, same city.

Marcus: That was always the overarching, yeah, strategy.

Chelse: We always re-emphasized again and again and again, like our number one priority was each other and we couldn't let the match come between that, because if you let it, it will. So we just kept saying like our number one priority is each other. Like any obstacle that would come up that was have trouble that . . .

Dr. Chan: And did you talk to previous couples about the couples match or . . .?

Chelse: Yeah.

Marcus: Yeah. Shout-out to Maddie and Noah.

Chelse: Yeah, they were amazing.

Marcus: Maddie basically wrote us like a script on the how-to of couples match so.

Dr. Chan: And what are some things you can share from that?

Chelse: Yeah. So I think the key thing, one of the very few pros of a couples match is you have always an excuse to cold contact a program. And so you always are trying, after you submit your application. it's this weird limbo time and some will hear from others and that is where the next challenge comes. Once you decide where you're applying, then it becomes challenging because you're getting interviews at different places. But the nice thing of a couples match is you just have an excuse to reach out to them.

So we probably sent over a hundred emails to programs of saying, "My husband has an interview on this day. I'm really interested because of this and this and this." And then actually, it ended up working well for us most of the time, where we were able to secure interviews at each other's programs. So I think that's a pro of just emailing programs a lot because they know the couples match is tricky. And I think some programs, it seemed like they like couples too, because they know they're like committed and you're willing to come if you're both willing to fly out.

And I think that's the other part, sometimes from the West, I think programs in the East or the South are a little skeptical we'd ever really come out there versus, for us, we could really negate that of saying, "We're paying for two tickets all the way out here. We're not doing this because we're not committed or interested." So those were some pros. But we emailed and contacted programs a lot and had no shame or pride and just begged for interviews.

Marcus: And also financially, we had to take out private loans in order to finance both of us doing this, because it was close to almost $20,000 for both of us to do the couples match.

Dr. Chan: And is that where you originally budgeted, or did that just start ballooning?

Chelse: Based on like previous advice from couples, they averaged around like 8 to 10 grand each. So we had an idea that we were getting into that type of horribleness.

Marcus: We did save ourselves a little bit when I was a first year. We got a Southwest card and I would recommend any Skymost card because that most of my interviews with the timing, it worked out that I could use points so that did actually end up saving us a lot of money.

Chelse: It saved a lot of money, so that was good.

Dr. Chan: All right. So, Chelse, how many OB programs did you apply to?

Chelse: Oh, I applied to, we tried not to go crazy, but we applied to 47 programs.

Dr. Chan: Right. And Marcus, how many?

Marcus: The same.

Dr. Chan: Forty-seven.

Chelse: Yeah.

Marcus: But then I had prelim and TY.

Dr. Chan: Okay.

Chelse: Right.

Dr. Chan: How many interview offers to start? I mean like what was the final total?

Chelse: I had a total of 21 offers, and I ended up going on 17, just because those other ones we couldn't match up, so there was no point in me going.

Marcus: Yeah. And I had 18 anesthesia and then with other prelim and TY, and I ended up going on 14.

Dr. Chan: And did you start finding out roughly the same time because some programs, it's like radio silence and it starts causing anxiety on other stuff?

Chelse: Yeah.

Marcus: It was extremely anxiety provoking.

Dr. Chan: Which programs got back, I mean how did that work?

Marcus: Like anesthesia over OB? It was kind of mixed at first. We were so stressed like the week they were starting to . . . I guess it was the week after applications were submitted or a couple of weeks in and invitations started coming in but to different places and we were just like, "What do we . . ." It was like the most stress I've ever been in med school probably.

Chelse: We were panicking, yeah, because we were just getting such different places and then each of us kept having different lull periods. And so it was a little stressful. But I think it's nice in that OB and anesthesia tend to have the same busy interview seasons. It's not like derm where it's the way like in January. That would have been a lot more stressful. So I think what we learned from the couples match is right when you think you get over a hurdle, there's another one waiting. And it's been true the entire time.

Dr. Chan: And did you just have those like Google calendar, where you just like tracking each other across the country?

Marcus: Google sheets.

Chelse: We had a Google sheet.

Marcus: That we would highlight as interviews came in and then quickly put the dates so the other could immediately email. Because in the first couple of weeks we were kind of in this weird limbo where we weren't really sure if we should reach out right away just because one of us got an invite, and so that was probably the most stressful part. But then we just kind of took Maddie's advice eventually, and we were just immediately starting as soon as one person would get an invite, then the other would email.

Dr. Chan: And you felt that worked more often than it didn't?

Chelse: Yeah. Yep. Like all the ones we really wanted to get together, apart from two, we got together.

Marcus: Because also the longer you wait, I mean their invites are going out, and yeah, then they just have the excuse to just tell you, "Oh, sorry, we don't have any open spots right now."

Chelse: So we created like a Google sheet that we could both have on our phones and have live updates all the time that we would keep track of where we were denied, where we were waitlisted, where we had an interview and then the interview dates. And then we also kept track of who had emailed which programs. So we had like a pretty . . . you have to have a pretty good efficient system going, and it took a lot of time because you have to look up these programs because we wanted to make the emails personal to the program, so you have to find unique facts or try to find mentors that may have a connection. So we spent a lot of time sitting on our couch looking up programs and then drafting emails.

Dr. Chan: You probably learned like quickly some programs have great websites, other ones have like this is really vague.

Chelse: Like nothing, yeah.

Dr. Chan: Yeah, there's like nothing.

Chelse: So trying to draft like a fancy personal email was impossible. "I am very excited about your broad case exposure and your great surgical training," like you start . . .

Dr. Chan: And on those Google sheets, would you start just writing notes, impressions after a post interview? Or did you just talk about in person like this program is really good, why or why not?

Chelse: We did it in person. Some people . . .

Marcus: We had a little notebook, like little notebooks that we take with us and write impressions. And then we'd talk about it immediately after the other which . . .

Chelse: I couldn't do it differently. Some people say . . .

Marcus: Yeah. We can't kind of hold it in I guess.

Chelse: Some people say if you're couples matching, like you should try and hold what you think on a program a little closer so that your couple, your other part can just like go into a program unbiased and just open and really evaluate it for themselves instead of thinking, "Oh, my spouse loves this. I have to do well," or, "Oh, my spouse didn't like this."

Dr. Chan: Yeah. Because it just creates pressure on the other person.

Chelse: Exactly.

Marcus: And it totally happened to us. We have to say that we totally experienced that.

Chelse: A hundred percent. But at the same time, like Marcus and I's relationship, like our communication is always solid, so I couldn't not go to this awesome place and not tell him about it.

Marcus: And there was also like one that she didn't like so much that I cancelled my interview for. And so, you know, it's like . . .

Chelse: Which they say you're not supposed to do, but we did that because I just, yeah, it wasn't for me. And so we didn't want to spend the money, so we really talked about it. And so we got over the hurdle of finally getting in the spot where we had enough interviews to feel comfortable with our numbers in the same place, and then the next hurdle was we felt differently about a lot of those programs.

Dr. Chan: Okay, all right. So that kind of segues into creating your rank list. I mean what did that look like?

Marcus: Yeah. It was so hard.

Dr. Chan: Did you like have a, was this all Google docs, or do you have like a whiteboard at home?

Chelse: We did our own.

Marcus: We just talked about it, you know, just straight up and kind of made a list in the notes in our phone. But yeah, it was hard. I will say that I had really good interview experiences across the board. I really liked all the programs that I interviewed at, so I would have felt comfortable going anywhere. Whereas, Chelse, it was much different for her. There's a lot of variability.

Chelse: Yeah. I think for me, the places I interviewed they were all, that's another thing, we only applied to big academic centers. We didn't do community programs, just because academic centers tend to have more options for couples, and then also we both think we might want to do fellowship and so you kind of need those big centers. And so they were all great. But within OB, there's so many different specialties you have to be trained in with like high risk and then GYN oncology, and uro-gyn, that they all had different strengths. And some weren't as well rounded as others, so that was a big concern for me. Especially with wanting fellowship, I needed and wanted a program that had a really good track record of matching fellows because it's becoming more competitive, and then I wanted a good resident research curriculum in place.

And so that just wasn't equal across the board, and so I really try to evaluate every program on the same merit, and I ended up having three tiers really of programs. And the hard part was that some of these lower tier programs for me were really strong for anesthesia and Marcus loved them.

Marcus: So, at one point, it really did feel like she just hated all the ones that were like my favorite.

Chelse: Yeah. It was really hard.

Dr. Chan: It sounds stressful. It sounds tense.

Chelse: And one of his most favorite programs that he just loved, he loves the program, he loved the location and he loved the people, and it was one of my last programs. So I went in and so I'm going to give this everything and after that interview day, I sat in the rental car like dreading calling him.

Marcus: And like I knew immediately when I say, "Hello?" but it's just interesting. Ultimately, there was one I think that was really good, kind of neutral ground.

Chelse: It was always our neutral ground, yeah.

Marcus: That we both were really excited about as well, which ended up being a good thing. That was where we ended up.

Dr. Chan: So you submit your match list February.

Chelse: Yeah.

Dr. Chan: Feeling good between February and March or second guessing or more anxiety or . . .?

Marcus: I will say we had our rank list done like a week before probably, and then moments, an hour before it was due . . .

Chelse: Within an hour before submission, we changed things a little bit.

Dr. Chan: A crisis.

Marcus: We had a crisis.

Dr. Chan: Perceived crisis, pseudo crisis.

Chelse: Yeah. It was probably like the hardest moment of all of it between the two of us.

Marcus: It was probably more like me. I was just mourning my favorites that had died, that like way down on the list.

Chelse: They were so low, yeah.

Marcus: And I was just kind of having . . . and then I realized because anesthesia has, some programs have our advanced meeting, the first year is not included in training. And so I had realized we had ranked some advanced above certain categoricals, and so I was like, "We need to hurry and decide again, is it more important that we're together all four years, or would you rather be at this place and potentially be a year a part at least?"

Chelse: And so we did and we went with our number one priority like an hour before it was due. We rearranged it so that all the programs that included all four years for Marcus, meaning we will be together for all four, we ranked those higher to give us the best shot of being together for all four because we decided that's what was most important. And I will say like our number one strength in our marriage has always been communication, and I think that's why we were able to survive it and come out stronger, because it's just so hard because you're balancing your love for each other within your own career goals and your own love for these programs, and it's hard when you really feel connected with a program and you love the people and you have that feeling while you're there of, "This is my place," and then you talk to your spouse and they're like, "Uh, that's not my place at all." So it's like this very, it's hard.

Marcus: It's hard.

Chelse: It's really . . . I'm not going to sugar coat it. It was a lot of hard moments.

Marcus: And it's okay to be honest about it and have your mourning moment and then kind of move on.

Chelse: Yeah, and that was the other thing. We kept having to say like we have to be honest and not take it personal. So we kept really trying to just be honest with each other. And then when he would diss one of my programs or vice versa, just to not take it personally because it's not about you, it's just trying to find the right fit for both of us.

Dr. Chan: I think anyone going through the match, I think it's doubly hard with couples. I mean you're forced to make decisions on, I would argue, limited information, right, because you have like the websites and you have these interview days and then . . .

Chelse: Which they always present the best face.

Dr. Chan: Yeah. And then like you started talking to other people and other people have all these other opinions. It's like, "Oh, you know, that's a great program. Oh, you know, I heard blah blah blah blah." You know, so it's almost like this rumor mill.

Marcus: And then you have the post-interview communication which you kind of like, "Oh, maybe like they're a little more than I thought." It was sunny there that day and I mean there's, you know, all sorts of . . .

Dr. Chan: The residents seemed to be happy, but why are they happy?

Chelse: Right, and that's the hard thing, too. You're in a city because you're traveling so much interview to interview, you're in the city maybe for, if you're there for a long time, it's like a day, a complete 24-hour stint if that's a long one. So it's hard to re-evaluate can I move here for four years? And that was especially hard when we weren't there together to kind of explore the city together. So it's honestly going off of your gut.

Dr. Chan: All right. So submit the list, last minute changes, feeling good about it. What was more stressful, the Monday or the Friday? And where were you on Monday when you got the email?

Marcus: We were both at home.

Chelse: We stayed at home in our PJs, right by each other.

Marcus: And we just like refresh, refresh, refresh.

Chelse: Yeah.

Marcus: Then finally had to like log in to the website.

Chelse: We didn't wait for the email. We just logged in to the NRNP to look, and then it said we, he found his first and it said that he had matched and mine just said not so eligible. And I was like, "What does that mean?" So then we finally . . .

Marcus: Well, there's just like an area where it says that.

Chelse: So, when we finally found it and when we both matched, we just started screaming and then hugged each other. I cried, he didn't cry.

Marcus: I think it was still stressful on Monday just with the advanced.

Dr. Chan: That's where you learn if you matched and on Friday you learn where you matched.

Chelse: So, Monday, it was really stressful and then there was a little bit of a stress taken off once we knew we had matched but not much just because with both of us, we kept wondering are we together all four years? Are we together that first year?

Dr. Chan: And you couldn't tell on the way it was worded on Monday if you weigh in like the categorical . . .

Marcus: It was just successful, so that could have been any, a combination of things that we did.

Chelse: So there was still so much anxiety.

Marcus: And we actually at the very end of our list, we did rank different programs. So she did like her favorites and I did my favorite. So there was still, you know, theoretically we could be at different places entirely.

Dr. Chan: And that part was your match wasn't coupled together, it was like de-coupled.

Chelse: Right, it was not in the same place. I mean it was way, way at the bottom of our list, but we thought it would be better for us both to start getting a job and start working and then try and get together.

Dr. Chan: Rather than one person not matching.

Chelse: Exactly. So we did that at the very end. And so we thought like there's no way we would fall down that low, but then at the same time you never know. But who knows, maybe I will.

Dr. Chan: Maybe you just checked that wrong box.

Chelse: Exactly, you never know.

Dr. Chan: On February, you shouldn't check that box.

Chelse: I know.

Marcus: Exactly.

Chelse: So that kind of, Monday took off maybe 5% of anxiety for us, but not a whole lot more because we just kept stressing about are we together, are we together, are we together? Yeah.

Dr. Chan: So, Friday, who's there, who did you invite?

Marcus: So we had my parents, Chelse's parents, her parents are divorced so her dad was there, her mom and her stepdad. And then we kind of huddled in a group with . . .

Chelse: My three closest friends in school and all their families.

Dr. Chan: And I'm sure you've tried to explain to them the couples match, but they probably didn't get it.

Marcus: It took a few times.

Chelse: It took so much, and I still think most of them . . . we even ended up sending them the NRNP. NRNP has like this couples match algorithm video that tries to explain it because we had tried so many times and we're like, "Here, watch this." And then after we did, my mom and her husband called me the next day and were like, "We couldn't sleep all night because it was just such this, how can it be like this?"

Dr. Chan: Why did they make it this way? It's like a combination of "The Matrix" and like yeah.

Chelse: It's chaos, so yeah. We had all of our family and then my really close friends in school and all of their family.

Dr. Chan: So they were prepped though for you guys to possibly leave, be of Utah.

Chelse: Oh, yeah.

Marcus: Of course they're like, "Oh, you're just going to go where you want to go." But we tried to set expectations, you know, it could happen.

Chelse: Like this is chaos, yeah.

Marcus: It could happen.

Chelse: Yeah, yeah. I know they were ready for it. We really tried to prep them to be ready for it.

Dr. Chan: Anything like just being apart for a year, yeah, or more, yeah.

Chelse: Yep. And we tried to prep ourselves for that, too.

Dr. Chan: Right. So speeches, speeches, speeches. They cut the red ribbon. You get up there, you get your envelope. Do you open each other's, just the two of you? Do you go back to your family, open in front of them? What was your MO?

Chelse: We went back to our big group. So I've always been like this really close friends group and so we all opened together. So one of my good friends, Marissa, she opened first so we were all there. So we got to watch her and celebrate with her, and then Kaisa opened, so we got to watch her and celebrate with her. All this time we're holding our envelopes, and then we opened after that. And we opened at the exact same time and waited until we both had our envelope out to read it at the same time.

Marcus: I'm getting anxious like thinking about again and then you kind of open your own and then look and see, and then looking at hers to make sure it says the same thing. And she's looking at mine and it feels like tons of time is . . .

Chelse: It was silent because we saw each other's and then just kept looking back and forth, back and forth between each other's papers to make sure it said the same thing.

Marcus: And then we just kind of screamed out.

Chelse: You screamed out where you're going.

Dr. Chan: So where are you going?

Marcus: We're staying at Utah.

Chelse: Yeah. We're staying at University of Utah. So we kept glancing back and forth, back and forth, and finally Marcus just goes, "Utah!" He just screams it.

Marcus: And then my mom is like, "Haa! Haa!"

Chelse: And then his mom starts freaking out, just screaming with joy.

Dr. Chan: That's a new behavior for them?

Chelse: No.

Marcus: That's pretty normal.

Dr. Chan: Okay.

Chelse: She's a pretty loud person. You'll love her. Yeah. So she just was screaming on the video. You can hear her above everyone, just going nuts.

Dr. Chan: So how does it feel? I mean honestly like, you know?

Marcus: I would say the post-match hangover, it was very real for us. Like for two days we just kind of like were recluse and just like hang out with each other and just kind of thought about how the future is going to be. Obviously, I'm excited, but you're like you're mourning, because it's so much buildup and you spent so much time thinking about what would it be like to . . .

Dr. Chan: You spent 20 grand flying around this big country of ours.

Chelse: Yeah.

Marcus: What would it be like here and what would it be like there, and I really like them, but I like this about this program. And so it's like this, for us anyway, for me it was like a lot of mourning all the possibilities that now are no longer possibilities. Even though at the same time being excited for where we're going.

Chelse: Yeah. And we talked about this. Like we always talked about no matter what that envelope says I think we're going to be excited, we're going to be disappointed, we're going to be sad, we're going to be afraid. Like it's just so many emotions, so we really did become recluses for the next three days and just kind of were together. We wanted to just be together and process what had happened and like wrap our . . . because the whole time we were in limbo for the past several months not knowing what our future would look like or what our plans, and that was hard for me being a planner. So we just kind of wrapped our head around what was coming, yeah.

Dr. Chan: I assume the program has reached out to you and welcomed you, congratulated you.

Marcus: Yeah. They've been amazing the whole time.

Chelse: They've been amazing. And I mean especially, yeah, both of our programs here have just been so good to both of us. They've been so supportive of us as a couple, and so they reached out and were great. And then some of the programs that we loved, that we weren't going to also reached out, and so it was this weird bittersweet emotion of like saying they're happy for you but disappointed. And so it was this weird catchall, where you're so excited, but then you're also like saying goodbye for possibilities that you had to explore for the past few months. And that's how everybody feels no matter what. It's so exciting and so wonderful, and then like kind of sad all at the same time. But yeah, we were so happy.

Dr. Chan: Did any of your friends matched into Utah programs with you, or is it brand new, you're going to have a brand new set of friends next year, co-residents?

Chelse: Well, I got super lucky. So one of my . . . I take it back. One of my really good friends who's also doing OB, she matched here as well. And the U's never taken two residents, so we saw each other from across the room and we're looking at each other and like, "Where are you going?" And we both pointed down to the ground and then we just like jumped over tables and people and just ran together and started hugging. So one of my co-residents is one of my closest friends from our class.

Dr. Chan: That's great.

Chelse: That's pretty amazing.

Marcus: Yeah. There's a few.

Chelse: There's a few.

Marcus: So I'm doing the internal medicine first year here, and there's quite a few classmates from Utah as well. And then there's five of us total that matched into the Utah Anesthesia Program, which is it's a lot more than usual.

Dr. Chan: Five internal?

Marcus: So five for anesthesia.

Dr. Chan: Five for anesthesia. How many spots for anesthesia?

Marcus: There's 14 or 15.

Dr. Chan: Okay, so almost a third. That's pretty impressive.

Chelse: Yeah. There was a huge proportion of our class this year though too who did anesthesia. It was a popular year.

Dr. Chan: Amazing, that's great.

Chelse: Yeah, so we're happy. And it's fine because we're staying and our family is close so that's really convenient. And then it's also sad because some of our really close friends are leaving, and we experience that when all of his classmates left for residency, like they're leaving and we're staying because he had to finish the year with me. So it kind of feels like that, again, but exciting because you're moving on to residency, which is an all new beast in and of itself.

Dr. Chan: Yeah. And I assume you've gotten your contracts.

Chelse: Yeah.

Dr. Chan: I remember when I got my first contract, I was like, "Wow, this is a really long document." I've never made that much money before. I've never signed anything like that before.

Marcus: The positive number. Oh, that's good.

Chelse: Oh, my gosh, yeah. We're so excited.

Marcus: That's new to our bank account.

Chelse: It's very new to our bank account, so yeah. I know, it's exciting and we're just ready. We feel like we survived the pre-med course a little bit together, we survived med school together, and now it's just like we're very ready for the next step.

Dr. Chan: When does the next step start?

Marcus: Well, step three is . . .

Chelse: Oh, yeah, step three.

Marcus: We're actually going to prep for a step together.

Chelse: Yeah, we do. We still got to prep for a board. We'll see how we do. We both start orientation like around June 12th or so, and then our start date is June 24th.

Dr. Chan: Okay. Wow. It's happening so fast.

Chelse: I know, and that's why it really does feel surreal. Like we think back, I remember when you called him so vividly and then his white coat. And then when you called me and then my white coat, like these huge milestones, it's crazy to think that I mean for him that was almost five years ago.

Dr. Chan: Yeah. Just to watch you progress and learn and grow into your roles and I'm just excited you're going to stay around, because I'm going to run into you, you know, because I wander around a lot.

Chelse: Yeah. I'll see you on the second floor.

Dr. Chan: Yeah. I'm wandering the hospital all the time, and, you know, you guys will be in and out. I think your hours will probably get much worse.

Chelse: Yes. Yeah, we're ready.

Marcus: To be expected.

Chelse: Yeah. It's weird because we're equal parts excited and terrified, because you know there's a whole other level of responsibility. So that's scary, but at the same time you can't stay a med student, like you're very ready to move on to the next step.

Dr. Chan: Cool. Well, we'll have to have you come back and get little updates and see how like intern year is going.

Chelse: We'll have more wrinkles and gray circles, and grays, and we'll let you know.

Dr. Chan: But have more babies named after you because you helped birth them. Little Chelse babies running around.

Chelse: I know. Hopefully, I get to like birth them on my birthday. I mean it's going to be awesome. I'm so excited.

Marcus: Because you know you'll be working on your birthday.

Chelse: I know, for sure.

Dr. Chan: And then Marcus will be intubating people and bringing people back to life. You know, powerful drugs, yeah.

Chelse: We are hopeful that like one day when I'm in GYN or oncology surgery, he'll be the anesthesia resident and I can . . .

Marcus: She really looks forward to telling me to . . .

Chelse: Table up, table up, table down. Anesthesia, wake up, do your job.

Dr. Chan: The person's moving. What's going on?

Chelse: I know. Do your job. I think it will be fun to like be together.

Marcus: She really looks forward to that.

Dr. Chan: Sparking out some worries for Marcus there.

Chelse: Yeah, mm-hmm.

Dr. Chan: Well, I'm excited for you guys. This is exciting, so this is great.

Chelse: We're excited. We feel really grateful.

Marcus: Yeah. We feel really lucky to be in a great program and together.

Chelse: We're great people. Like we know exactly what we're getting into and we're so excited about it.

Dr. Chan: Cool. All right. Well, thanks for coming on.

Marcus: Thanks.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life," with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of the Scope Health Science Radio online at thescoperadio.com.

Dr. Chan: What did it mean to be a couple in medical school? Why does one change their path to line up with someone else's path? How do you manage a year apart during medical school, and what does organized chaos look like during fourth year? Today on Talking Admissions and Med Student Life, I interview Antigone and Ira, a successful couples match and recent graduates here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is Talking Admissions and Med Student Life with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay. Well, welcome to another edition of Talking Admissions and Med Student Life. I have two super great guests today, Antigone and Ira. Hello.

Antigone: Hello.

Ira: Hello.

Dr. Chan: Thank you for coming. Fourth year medical students, soon to graduate . . .

Ira: Woohoo.

Antigone: Woo.

Dr. Chan: All right. We're going to start back in the beginning. Let's get it out of the way first. How did you two meet?

Antigone: Well, that depends on who you ask.

Dr. Chan: I'm asking you right now, Antigone.

Antigone: Well, I know, but we have different versions of the story.

Dr. Chan: And somewhere is the truth.

Antigone: And somewhere is the truth, yes. We first met during my interview at the U.

Dr. Chan: Really?

Antigone: Yes. Ira was the second year tour guide during that day. So he took us on a tour. We met that day. But then we didn't meet again until I came for second look day. I brought my very Greek mother with me, or rather my very Greek mother wanted to come with me. She met Ira. He was our tour guide again that day. My mom thought he was like the cutest thing and asked him all the questions about medical school.

Dr. Chan: Had you told your mom about him ahead of time, or was this a completely independent assessment, unbiased?

Antigone: No. It was totally independent, because I hadn't seen him since February when I interviewed and now it was May or April. But she asked him a million questions and sat next to him on the bus, and I sat about eight rows behind them on the bus and then promised to never interact with him again. And then I think we met one more time during orientation week.

Dr. Chan: You're hitting all the data points here, that's great. It's building towards something.

Antigone: Yes. We just talked about med school, and he told me if I ever needed help with anything, I could reach out. Then after the first week or so of school I had just done horribly on my first foundations test, and I saw Ira in the English Hub, the England Hub, whatever.

Dr. Chan: The little cafeteria.

Antigone: The cafeteria downstairs is and he told me I looked like I needed a drink. Then we went out for drinks like a month later, but that's how we met. Then after we met for drinks, it's sort of just . . . here we are. We're getting married.

Dr. Chan: It just happened.

Antigone: It just happened.

Dr. Chan: Okay. So that's version A. Ira, what's version B?

Ira: Version B is the same time frame as version A, so of course during the tour.

Dr. Chan: So you remember her on her interview day?

Antigone: No.

Ira: As you can glean from this, I, in my first year of medical school, volunteered for a lot of the tours and . . .

Dr. Chan: You were very active.

Ira: Very active in the admissions and administration and whatnot. I was doing them like once a week. So I saw probably 100 different applicants in that first year, and then of course during second look day, the next 7,500 people that come to second look day and toured all of them through.

Dr. Chan: So you don't remember her from second look day either?

Ira: Or orientation.

Dr. Chan: So you don't even remember the mom?

Ira: I remember her mom.

Dr. Chan: You remember her mom more than herself?

Ira: I remember talking to her mom.

Dr. Chan: Oh, I love doing this.

Antigone: I was very good about staying in the periphery that day.

Dr. Chan: You were hiding behind your mom.

Ira: I do remember her mom and talking to her mom and answering about a trillion questions about medical school and wondering who she's attached to here.

Dr. Chan: This is a very non-traditional student in front of me.

Ira: What I like to tell myself and what I think really happened is after that first tour, Antigone was totally hooked and she was just thinking about me the entire time leading up. She just kept thinking about it and figuring out ways that she could make sure she ended up on my tour and not the other tours.

Dr. Chan: That's a good approach. Antigone is very crafty and intelligent like that.

Ira: She is. And then we finally got to, after her first week, I remember her sitting on like one of the couches outside of English Hub, and she was sitting there staring at the wall with this blank look on her face.

Dr. Chan: This is post-test.

Ira: Post-test.

Dr. Chan: And that's your first memory of Antigone?

Ira: That's my first memory of her, just like totally no color in her skin and just . . .

Antigone: Which is not far off from normal.

Ira: And I sat down next to her and I was just like, "Wow, it's going to be okay. I know that it's a . . . as we were always told, it's like taking a sip of water from a fire hose, that becomes real very, very quickly."

Dr. Chan: The tests are very hard and medical school is hard. It's so much information in a short amount of time. So you get together. What did it mean to be a couple in medical school? How did it help? How did it define your relationship?

Ira: It was interesting because Antigone's father is also one of our clinical instructors.

Dr. Chan: Oh, boy. We're going deep now.

Ira: So I spent the first six months to a year of our relationship . . .

Dr. Chan: Was he your clinical instructor?

Ira: Yes.

Dr. Chan: He was? I did not know that.

Ira: He wasn't my CMC instructor, but he taught classes in front of the whole class.

Dr. Chan: He would randomly grade you.

Ira: Yeah. He didn't know who I was. So I spent the first six months to a year without him actually knowing who I was but within the class. And then one day when Antigone was actually talking to him in the hallway, I turned and walked down the hallway and I saw them both and I tried to dodge behind one of the pillars and she grabbed me and pulled me out and was like, "By the way, this is my boyfriend, Ira."

Dr. Chan: So I guess you had not gone home and met the parents to this point?

Ira: No. I think one of the things that was really nice overall about being a couple in medical school actually was the fact that we were one year apart because we didn't have the same stress cycles. So when one person was really stressed, the other could be the supportive one, and when the other person was really stressed, we could flip flop it. So that really, I think, actually helped our relationship a lot.

Antigone: I never really planned on dating anyone in medical school, but it's always been really nice that I never had to explain anything to Ira, like we've had so many dates that have been pushed back by hours or have had to cancel and we've had parties or events that one of us have been unable to come to because of our time commitment to school. We've never had to explain that to each other and we've never had to worry about our partner being upset with us, and that's really nice to have somebody who gets what you are going through and is supportive of what you are doing.

Ira: And there are dates in the hospital cafeteria.

Dr. Chan: Dates in the hospital cafeteria.

Antigone: We've learned to be very flexible. We have had dates at Primary Children's before I started a night shift. We've met at Starbucks at the University of Utah. We've really just had to learn how to be adaptable sometimes. It's been great.

Dr. Chan: That's great. So you're different years. I know there was a decision made to have Ira step off and do something else. So walk us through that. Were you thinking that before you ever met Antigone, or did this kind of speed up that decision?

Ira: So I've told Antigone this a couple times, but I actually view that decision as probably the biggest moment in our relationship. That was because it was something I was not thinking about at all before. It was the beginning of my third year. The application for this program called the Medical Research Scholars Program at the National Institutes of Health was something I had just heard about, and the decision came in early September. It was, "Am I really going to derail the path that I'm taking right now to line up with somebody else?"

I think that's something that in every relationship you ask yourself at some point, and you know it's the right person when the answer to that is very clearly yes. While I view it as a really big decision, it was a very easy decision. Its was one of those that I was like, "Yeah, this is the right thing to do." So I actually applied to that and I applied to another one at Rockefeller University and another one at the University of Buffalo called the Sarnoff. So, through that, I ended up getting multiple options and chose to go to the NIH.

Dr. Chan: So we're talking leaving for medical school for a year to pursue research?

Ira: Yeah. It was really incredible. I think that as far as us as a couple, it was obviously a very challenging year to do a year of long distance, but we did have an end in sight and we knew that when we got back, it would be better because we would be lined up where we would be graduating together. We're both going to be able to participate in the match together.

Dr. Chan: So a bunch of questions are on my mind. Did you ever explore sticking around here and doing a year of research here? Was that even on the table?

Ira: That was absolutely . . . I hate to say it this way, but that was 100% the contingency plan. Some of these research fellowships are extremely competitive because they're fully funded. So I had actually already reached out to a previous mentor I had here who said that he would welcome me back in his lab if I needed the time.

Dr. Chan: Great. And then when you apply, do you apply to the program, or do you apply to a specific lab? Did you know what you would be doing before you went to these places?

Ira: It depends. Some of them you would reach out and contact a principal investigator at that institution, and then I'd have a Skype interview with that principal investigator. Then if they said that they would sponsor me, they would put in application with me for the scholarship or the fellowship. That's like how the Howard Hughes Medical Institute ones go. That's how the Rockefeller University ones went. For those, I literally completely like cold called the people.

Dr. Chan: "You have a cool website. It sounded really nice online."

Ira: Yep. Completely cold called them.

Dr. Chan: How does that work when you're in medical school? Does that work a little more successful as opposed to the pre-med life? When you say cold call, you mean cold email.

Ira: Yeah. I would say that it's a plus and minus. Ultimately, what you have to show, whether you're a pre-med or in med school is a genuine interest. I think nobody wants to work with somebody that's doing the work for ulterior motives. So, lucky for me, I'm really interested in research and I really enjoy it, so that's an easy thing for me. I get invested in projects and I really enjoy them. I think what they're really looking for is somebody that's actually going to contribute to their group in the same way that they're going to give you by teaching you and taking you under their wing. It worked completely fine, I guess. Everybody replied and everybody . . .

Dr. Chan: Everyone said, "You're hired. We want you."

Antigone: Yes.

Dr. Chan: What did you do for a year?

Ira: The NIH program is completely different. You apply to the program. I think actually this is the coolest thing.

Dr. Chan: They just assign you?

Ira: No. You get to choose. You spend the first two weeks there interviewing with one of the 2,000 investigators at the NIH choosing which lab.

Dr. Chan: Sounds like a buffet.

Ira: And you're funded, so you're very wanted not for your skills in research, but because you come with money.

Dr. Chan: Oh, so it's like the roles are flipped.

Ira: Yeah. So it's an incredible experience.

Dr. Chan: So people are just salivating to have you in the lab. They get your awesome personality, and you come with some money too.

Ira: Yes.

Dr. Chan: Okay. What was this program called again?

Antigone: MRSP.

Ira: MRSP, Medical Research Scholars Program.

Dr. Chan: Okay. Is it open only to medical students?

Ira: Medical, dental, and veterinary students. They want students that are coming between their third and fourth year. So they want students that have had the clinical experience so they can choose what research projects to do based on their clinical experience and what they've observed clinically. But I ended up doing a project in the pediatric oncology branch, working with an investigator on a clinical trial for a drug called vandetanib that's used for patients with a disease called multiple endocrine neoplasia 2.

Dr. Chan: I'm nodding my head like I understand what that means. So, obviously, pediatric cancer and I guess you're just looking at the efficacy of this drug, side effects, things like that.

Ira: Yeah. So we looked at . . . I got to learn how to do all these analysis techniques and look at landmark analysis and all these complicated stats. They taught me how to do it, which was really, really cool. I looked at the 10-year outcomes of this clinical trial. Then the other part that I absolutely loved was I got the chance to try my hand at some genome sequencing.

So I got to learn about how next generation sequencing works and really importantly with the National Institutes of Health, it's how it works and how it applies to the clinic. They have a protocol there where they're enrolling every child that comes through to get their whole genome sequenced. So to learn how that information interacts with patient care and actually helps guide patients, especially patients with cancer through their treatment options and going forward was one of the most amazing experiences of my life.

Dr. Chan: Sounds really cool. You're back there in D.C., great place to live. You're there for the entire year in between third and fourth year. That means, Antigone, you're on your third year. Walk us through that year. Did you just go ahead and buy like 20 plane flights? Did Ira end up coming more back to Salt Lake? Did you go more back to D.C.? How'd you guys work that?

Antigone: So I think we saw each other about once every three months when you average it out. When Ira first got the MRSP, we thought we were going to be able to see each other a lot more often than we ended up being able to do just because of my third year. In third year, you're definitely not in charge of your schedule. Ira also had work hour requirements he was supposed to do for the program. He left in August. The next time I saw him was in October when I flew out to go visit. Then he came home for Christmas.

Ira: Like a 30-hour . . .

Antigone: I went there for 30 hours, like I got there on Friday night and I left on Sunday morning, but otherwise, we weren't going to see each other until Christmas.

Dr. Chan: Did you throw in some D.C. sightseeing on top of it or no?

Ira: That was actually really funny. I made Antigone bike for about 30 miles when she got there, and we went and saw all the national monuments.

Dr. Chan: That's the way to do it is by bike. If you go by car, parking and traffic is really bad.

Ira: Then of course I was living 10 miles away from where the national monuments were. Rather than letting us take the subway down, we biked.

Dr. Chan: I've done that myself. It's gorgeous, people playing softball right there and ultimate Frisbee.

Ira: It was fantastic. We have a great picture on Instagram of Antigone face down on the couch after getting back from her 30-mile bike ride.

Dr. Chan: Did he surprise you with this, or did you know you were going to go on a 30-mile bike ride?

Antigone: You said I was crafty, but Ira is also very crafty. He asked me if I thought it would be fun to bike around the monuments, and I said, "Sure, that sounds great." He's like, "Okay, well, we'll bike there. It's just down the hill." But he didn't mention that it was 10 miles down the hill. So, no, I did not know what I was in for, but I've gotten used to that dating Ira Kraft. I now know to expect the unexpected.

Dr. Chan: Which could include a 30-mile bike ride.

Antigone: Yes, it could include anything.

Dr. Chan: All right, so let's step back a bit. So, before medical school, if I'd asked both of you what you wanted to go into, what would you have told me and then what did you end up choosing and why?

Antigone: I probably would have said I would be a pediatrician because I've always loved working with kids. But I was the medical student that loved everything in third year, and I would call Ira after every rotation except one and say, "I'm going to do this. I love this." It was hard for me to decide. Even when I committed to pediatrics, I still went back and forth between a couple of things. I could have easily seen myself going into OB or internal medicine.

Dr. Chan: So why pediatrics? What attracted you to that field?

Antigone: I think I just like who I am on pediatrics the most. I think there are parts of my personality that really fit with a lot of different specialties. I love working with my hands, which is why I loved OB. I loved working with child psych at uni because I used to work there.

Dr. Chan: I remember those days.

Antigone: Yes. I love those kids. I could still work in behavioral health going to pediatrics. But I just think the person that I am when I work with kids is the person that I want to be the most. For me, working with kids, I have to think about what I want to do not just now but in 30 years when I really, really don't want to get up in the morning or when I have other things going on in my life. For me, I will always, always get up out of bed, leave whatever I'm doing if a child needs help.

Dr. Chan: That's beautiful.

Antigone: Thank you. I was an English major.

Dr. Chan: Ira, before med school, what were you thinking of becoming?

Ira: I was thinking of becoming a doctor.

Dr. Chan: Okay. That's good. I'm glad you found the medical school.

Ira: To be completely honest, I don't think I knew what a doctor did until third year of medical school. That being said, I think one of the really cool things that happens at the beginning of your first year at University of Utah is there's lunch talks of every day of the first couple of weeks from different specialties. During those lunch talks, essentially the residency directors from the University of Utah come in and tell you about their specialty. One of the individuals who came in had me hooked right away, and that was Dr. Lam who gave a talk about a specialty that I didn't even know existed that was a combined internal medicine and pediatrics.

Dr. Chan: It's like the whole existence from birth until death.

Ira: Yeah. The whole thing. What I liked about it and what she sold me on is that you see both sides from a slightly different perspective. So you approach adult medicine, for example, when you're rounding and you say, "Maybe this situation might work better with family centered rounds," which is something that's very common in pediatrics. On the pediatrics side, another example would be you see a teenager that has high blood pressure and you say maybe the adult treatment regimen might actually fit this patient better than the pediatric workup.

So being able to learn that flexibility was what really got me. Of course, I stayed open to everything, similar to Antigone, a little bit less so in the fact that I don't think I loved everything to the same extent that she did, but I kept coming back to med peds, and that was always the thing that I'd find and be like, "Well, med peds is a little bit better for me than that."

Dr. Chan: So, when you did your rotations in internal medicine and pediatrics, did you like them both equally?

Ira: I would say no. First of all, the pediatrics rotation at University of Utah is absolutely outstanding and is done in a way where -- I'm sure you've heard about this on other podcasts --there's a team called the Glasgow Team that's med student run and you feel like you are the primary provider of a patient as early as the beginning of your third year of medical school because you are dictating the treatment for those patients.

Dr. Chan: With supervision.

Antigone: Yes.

Ira: With supervision. Absolutely.

Dr. Chan: The med students are not doing everything on their own.

Ira: No. It's such a time for growth . . .

Dr. Chan: Ownership.

Ira: Ownership. And at least for me, it really embodies the reason why I went to medical school. It's an incredible experience. That plus of course I had some experience in a research lab in internal medicine, so I knew that I liked the medicine and I knew that I liked the research. Actually, again, going back to that NIH program, that was another thing that completely drove home med peds for me. That was the idea of being able to write clinical trials for both adults and kids.

When I was at the NIH, there was one investigator in the pediatric oncology branch who was med peds trained. So she had to be an investigator on every trial that included patients that were both adults and kids so that they could get IRB approved to run that trial so they could have an internal medicine doctor, essentially, on the trial or they would collaborate across. So the idea to be able to do that without limitations and knowing that I want a career in research was like completely ended it for me and I knew that med peds was it.

Dr. Chan: Awesome. Combine medicine and pediatrics, four years?

Ira: Four years.

Dr. Chan: And then pediatrics three years. You guys had made up your mind. Walk me through fourth year. What was your strategy? What did you start doing? How did that work? Did someone in the relationship have the Excel spreadsheet? Was someone master of the money? How did that work?

Antigone: Well . . .

Ira: It didn't.

Dr. Chan: Is it just organized chaos?

Antigone: Yes. I wish we could tell you that we had this amazingly streamlined system and walked through all of this application process smoothly, but we did not. We applied to every med peds program.

Dr. Chan: How many are there?

Ira: Seventy-seven.

Antigone: So, with the geographical pediatrics matches, I applied to 94.

Dr. Chan: Those strike me as very, very high numbers. I'm going to go out on a limb here. I bet you got way too many interview offers.

Antigone: We did. We also went to way too many interviews and now we are broke.

Dr. Chan: Okay. Let's talk through this. This is for the benefit of the rising generations.

Antigone: Okay.

Dr. Chan: What would you have done different, or would you have done anything different?

Antigone: I think we sort of . . . I don't know if panicked is the right word, but we're sort of wired at the beginning, and every offer that came in we took and we planned to go to and a lot of the schools that we really wanted to go to, we didn't end up getting interview offers until a little bit later in the season. So I think just being a little bit more patient would have worked.

Ira: I also think that we scheduled interviews very poorly. Our thought process was that we would schedule our -- I'm doing air quotes here -- our backup programs we scheduled at the beginning of interview season thinking that that would give us some practice and then the programs that we were really excited about and really wanted to go to we scheduled in January.

Dr. Chan: You'd be smooth and suave.

Ira: So we'd be ready to go. What really what happened is we were just exhausted because we'd already gone on 20 interviews. I think that if we could do it again, I know what I would do is almost flip that, put those programs at the end so you can actually cancel them afterwards or once other ones come in of places that you want to go to.

Antigone: We also had a hard time saying no, like cancelling interviews was really hard for us. I also think what I would tell the incoming generations of medical students is not to put yourselves in a box of places you want to go because we worked ourselves up to have one dream school or school that we really thought we were going to end up going to and I went and did an away rotation there and we invested a lot of time and energy into that school and we didn't like it. The school that we are going to was not even on our radar at the beginning of all this.

Dr. Chan: Why didn't you like that unnamed location?

Antigone: The people.

Ira: I think everybody tells you that residency is about fit and finding a program. It truly is a match and it's about fit. I don't think any medical student truly believes that until after they go through the process and then every medical student believes that.

Dr. Chan: You've seen one residency program, you've seen one residency program. Right?

Ira: Yeah, exactly. It was really hard. I would still personally go on as many interviews as we did and be as broke as we are right now, Antigone maybe not quite so many. I got the feeling that I didn't know what a place was like from their website and from researching everything I could online and I still didn't know what a place was like. For me, it was equally as helpful to show up at an interview dinner and within 15 minutes say, "I don't really want to go here," than it was to be like, "Wow, this place would be interesting."

Dr. Chan: So it's about culture and teamwork and the educational environment.

Ira: Yeah. There were those places that 15 minutes in I was like, "This place doesn't fit me."

Dr. Chan: "I would like to order another steak."

Antigone: Less than 15 minutes sometimes.

Dr. Chan: I'm just curious of the numbers. How many interviews did you each end up going on?

Antigone: I went on 24.

Ira: I went on 26.

Dr. Chan: Okay. That's a lot.

Antigone: It was a lot.

Dr. Chan: This is spaced out over . . .

Antigone: Three months.

Dr. Chan: Was there any coordination between the two programs? Were you ever interviewing the same time in the same city, or were you guys crisscrossing the nation like two planes in the night.

Antigone: I think three times we interviewed together.

Dr. Chan: Was that better or more stressful?

Antigone: It was nice.

Ira: It was really nice because we hadn't seen each other for a month and we'd meet in some city we'd never been at before and spend three days there and explore the city a little bit.

Dr. Chan: Did you ever decide to play mind games with people in the interview, like pretend to not know each other?

Antigone: We talked about that.

Dr. Chan: Just start to hit it off and then you're holding hands midway through the day.

Antigone: We talked about doing that. Whenever we would plan to do that, we thought we would be together on the interview a lot of the day because med peds and peds overlap, but we were never together enough to be able to work that out, but we wanted to. It was really nice. It was nice to go to dinners together because we could get two different perspectives on what was going on.

Ira: That's that same thought. Even interviewing at separate times was really nice because we got to see each program twice.

Dr. Chan: Go home and compare notes, impressions.

Ira: We both had different things that we were looking for and looking at specifically. We'd come back from one program and I'd be super excited because I'd be like, "There's like free food at everything and it's outstanding." And then Antigone would come back and be like, "Academically it doesn't really fit our goals and whatnot." It was great because we both saw it through a different lens, and then when we brought it together, we could actually come up with something that really did fit us very well.

Dr. Chan: In every relationship, there's always negotiation, there's always compromise. It's just how it's set up. I'm curious to hear as you start preparing your rank lists, what were the give and takes? What were the things that were absolutely essential, and what were the things you could say, "That's not as important to me," as you've talked and compromised with each other?

Ira: I think that, first of all, we had, by vast majority, we essentially did like a tier system. So we had like places we loved after the interview, places we thought were really good after the interview, and places we thought that were good after the interview. Our tiers lined up almost perfectly. So we didn't really have that many challenging moments where we were like . . .

Dr. Chan: Where someone clearly had a program higher than the other person.

Ira: And then we did have a lot of choosing between one and two or two and three or three and four. But there was, I think that for me, a lot of it was the feel. Like I had, of course, an idea. I wanted free food. I wanted to be able to bike into the program. I wanted a window in the resident room. They all went out the window real quick.

Antigone: There were no windows.

Ira: There are no windows in resident rooms in any hospital all over the country.

Dr. Chan: I had no idea that was so important to you. Now that I think about it, I don't think I've ever sat in a resident room with windows.

Antigone: No, neither have we.

Ira: They're all built the same.

Dr. Chan: I've been in where there's multiple computers and actually some bunk beds and some closets you hope are cleaned out every once in a while.

Antigone: I think we both when we were submitting, getting ready to submit our rank lists, we both independently of each other felt that our number one program should be our number one program. It was a perfect fit for both of us and us together. I think when it came to making our rank list, how we felt we would do it in the beginning didn't really end up being as big of a role, like we applied to a ton of places for geographical match options and then we didn't end up liking a lot of places in the same area.

But also, there were places that Ira loved that I didn't love as much or I thought the peds program was a little bit weaker than other places, and there were places that I loved that Ira really didn't want to live. When we sat down and looked at the paper and actually looked at the possibility of matching somewhere separately, we just decided that matching together was better than that and that we could figure out anything and that four years of our life wasn't a life sentence and that it was the most important that we match together.

Ira: It's of course different for every couple, but it was a balance for us. I think that on our rank list at our 15th-ish mark, we did have us matching at separate programs because they were outstanding, big name programs. I think in the end, that had caused a bit of anxiety because again . . .

Dr. Chan: You guys are not going to drop down to your 15th.

Antigone: You never know.

Ira: When you really think about it, we wanted to match together and we applied to all these geographical options and then we made a rank list that was 512 programs long.

Dr. Chan: Wow.

Antigone: That's a plug for how scary Dr. Stephenson makes this process.

Dr. Chan: Oh my goodness.

Ira: In the end, we just realized we wanted to do it together and, again, it goes back to the decision to take the year off. I think that part of it has also made me become a very large [inaudible 00:36:07] and I've talked to a couple of other couples that are in staggered years about the importance of matching together as opposed to one person following the other person. I think that we really did find a place that was perfect for both of us.

Dr. Chan: All right. So you submit your rank list. Then obviously, it takes a month to run the computer algorithm, obviously, because that's how it works nowadays.

Antigone: I was a wreck.

Dr. Chan: So any second thoughts, any like, "Oh my gosh, we didn't certify the list"?

Antigone: Oh yeah. I was freaked out that we didn't click a button right. I stalked Dr. Stephenson. I sent him screenshots. Ira would have to like hide my computer from me because I was obsessively checking. Did we regret what we put? I don't know if it was so much that we regretted. I don't think we regretted our list. I think we had second thoughts about like Ira said, the program, the match that that had us at separate places.

Dr. Chan: Okay.

Antigone: I think we more so did not expect to match at our number one, so we were sort of planning to not.

Dr. Chan: Well, walk me through the week. Were your more anxious the Monday when you got the email saying you did match, or you weren't worried about that? I know a lot of people say they're so happy to get that email.

Ira: We were very worried. We were worried about it, but I don't think I was as worried.

Dr. Chan: Okay. So you get the email on Monday saying you did match but not where.

Ira: We had 512 options.

Dr. Chan: All right. So, unless there was a computer meltdown . . .

Ira: We thought we had to have done something very wrong if we went 512 options down our list.

Antigone: I think matching on Monday was a little bit of a relief, but in my illogical brain, there were still more options on our rank list that had us separate than had us together and not knowing where we were on that list, I didn't sleep that entire week.

Dr. Chan: My next question, the Friday, the Thursday night before, sleep like babies? Were you freaking out?

Antigone: I don't think I slept.

Ira: It's a rough week. Match week is a rough week.

Dr. Chan: A lot of emotions.

Ira: Our match day celebration was at Rice-Eccles Stadium, and it like hit me in the elevator as we were going up. So Antigone is also very involved in . . .

Dr. Chan: Student government.

Ira: Student government and whatnot. She was getting there early, and I got there early with her to help set up. We're walking in, and we couldn't even like look at each other.

Dr. Chan: It's too stressful.

Ira: Very stressed. It really hit me in the elevator, and I like disappeared for an hour and just stood staring out the window blankly at the football field and was just like, "Okay."

Dr. Chan: Were you worried that he was going to disappear?

Antigone: No, but then he did. He had been . . . I am definitely the worrier, over-reactor stress ball of the relationship, and Ira is always like, "It's fine. I'm going to go skiing." So the whole match week, he had been great, and I would cry and I would walk around my kitchen island in circles. He was fine. Then we went to match day and I was nauseous, but I was trying to focus on like putting up the balloons and doing all that. Ira is just gone. He's not answering his phone. I was just like, "Did he run away? What is happening?"

Ira: I save all the stress for one hour and then just get it all out.

Dr. Chan: So was your mind going there, dark thoughts, calamity?

Ira: Yeah, spend it all in that one hour, because I was totally fine all the way before that, but then that one hour was awful.

Dr. Chan: I'm glad you got it out of your system. All you need to do is stare at a football field. Apparently that's your Walden Pond.

Ira: Stare at a football field, stare at the other side, look at the windows or the mountains on the other side of the valley, gorgeous.

Dr. Chan: So they have the little talks. They cut the ribbon. What did you guys do? Did you get your envelopes simultaneously and go back to your families? How did that unfold?

Antigone: We went and got our bags and went back to our tables with our family. Both our families were there. I, of course, like ripped mine open and I'm ready and Ira takes 45 minutes, it felt like, to get his envelope opened and he can't get the thing out and I'm standing there holding mine waiting and he can't get it out. Then we opened them together. There's a video and we both read ours, and then we both look at each other's to make sure they say the same thing.

Dr. Chan: Where are you headed?

Antigone: We're going to the University of Chicago.

Dr. Chan: Awesome. Congratulations. How'd it feel?

Antigone: I was shocked.

Ira: Total disbelief.

Dr. Chan: Why were you in disbelief?

Antigone: We really didn't think we would go there. I didn't hear from them at all when we applied first and Ira got an interview and we called and emailed and then I got put on the waitlist.

Dr. Chan: For an interview.

Antigone: And then I got an interview at the last minute. We didn't think we were high on their list. But it was absolutely where we wanted to go, like more than any other place. Ira really didn't want to live in a big city, and we're going to a big city. So we were shocked that we got in.

Dr. Chan: So I get the sense it was pretty near the top of your list.

Ira: It was our first choice. I think the other part about it was it was our first choice, like it was something that fit both of us very, very well. As medical students, we're really good at catastrophizing. So we think about all the things that could happen, all the contingency plans, all the . . . like for med peds at University of Chicago, there's four spots total. They interview about 70 people or so for those four spots. I think on my interview day, of course I'm sitting next to someone from Yale and someone from Harvard and all these big name schools.

Dr. Chan: High mucky-mucks.

Ira: Yeah.

Dr. Chan: As my parents would say.

Antigone: These two kids from Utah.

Ira: I'm like wow, this is really . . . how could I be considered when I'm going up against somebody from . . .

Dr. Chan: A big name school.

Ira: These big name schools. I did end up taking sort of a comedic approach to it when I was on the interview trail and every time I'd meet somebody from Yale, I'd come up and say, "Where are you from?" They'd be like, "Yale." And I'd be like, "Oh, Yale, I've heard of that school."

Dr. Chan: I'm sure they loved that.

Antigone: I'm sure.

Dr. Chan: Okay. You're going to Chicago together.

Ira: Together. Same school.

Dr. Chan: Somewhat same programs, some overlap.

Ira: Yeah.

Dr. Chan: Have you already gotten your schedules?

Antigone: No.

Ira: We know parts of it. We actually just came back. We flew out there for three days.

Dr. Chan: Found a place to live.

Ira: Found a place to live.

Dr. Chan: Biking distance?

Ira: Yeah. It's 7 miles straight down the lake front path there.

Dr. Chan: Wow.

Ira: But it's flat there. I used to bike in to school here, and it was like an 800-foot climb elevation gain just to get into school. So I was only 2 miles away, but 800 feet up for those two miles, whereas there, it's 7 miles away, but it's dead flat.

Dr. Chan: And wedding coming up next few weeks?

Antigone: Yeah, May 12th.

Dr. Chan: So 2018 is turning out to be a banner year for you guys.

Antigone: It's been a crazy year.

Ira: It's absurd. What are we doing in like a one-week span?

Antigone: So we get married on the 12th. We're both presenting at pediatric grand rounds on the 17th, and we graduate on the 18th in the morning, and on the 18th in the evening, we leave for Cuba for two weeks. We get back from Cuba and four days later move to Chicago.

Dr. Chan: And Cuba is the honeymoon, or you're going to do research there?

Antigone: It's our honeymoon.

Dr. Chan: Wow. That's cool.

Antigone: We will be researching Cuban food.

Dr. Chan: I hear it's quite yummy and tasty.

Ira: And rum.

Antigone: And rum, yes.

Dr. Chan: All right. You guys have been great. Last question for both of you. Let's bring it back to admissions. So, looking back, I know a lot of applicants do a lot of different activities. They're checking the box, or they're going through the motions. What we always advocate is those experiences really help you in medical school and help you prepare for this journey. So, looking back, can you think of an activity you did before you applied to med school that really made it worth it, that really helped you as you've gone through these four or five years?

Antigone: You want to go? I have to think.

Ira: I think the big thing is, first of all, both Antigone and I did not get into medical school our first time around. While that is so devastating when it initially happens, I think for me, that was one of the best things that could have happened to me.

Antigone: I agree.

Ira: Because of that, I took four years after my initial application to reapply. It really was a soul-searching experience where I traveled and I got a real job. But it was one of those times where I learned that life isn't an arrow. It's a windy path. It really truly is about the journey, not the destination. So if you can find a way to enjoy every step of that journey and take something out of it, that's the beauty.

That's really what helped me in medical school was when I'd walk in to see a patient and be like, "Oh yeah, this is very similar to a patient that I saw when I was a volunteering in a clinic in Tanzania," not because I went to Tanzania to check the box, but because I actually went on this soul searching journey to do that.

Dr. Chan: That's beautiful, Ira.

Antigone: I truly believe that I wasn't meant to get in my first try. I don't think that I would have enjoyed medical school as much. I don't even know if we would be together if it had worked out how it was "supposed" to work out.

Dr. Chan: Yeah, because Ira would not have been on those tours or the second look day.

Antigone: You wouldn't have seen me staring at the wall.

Ira: You wouldn't have had the chance to stalk me for six months.

Antigone: Sure. I think I needed that year to figure out who I was and to stop trying to check boxes. I think the things that stand out and the things that have helped me in medical school are, like Ira said, things that I didn't do just to check boxes. For me, the most worthwhile thing was working at uni. I think when we think about applying to medical school, we see this vision of a doctor in a really clean white coat and a stethoscope and everything is sort of like perfect.

But working with patients and seeing the team effort that goes into helping a patient and working with nurses and seeing what happens when patients don't want to take their medications and seeing what happens to families who have patients in the hospital and all of the complications that go with that. For me, working with little kids, I will never forget that, and I will never forget why I'm doing what I'm doing. I think that's really important to remember when you're studying a million hours a week and when you're taking these board exams that take up all of your life and you're not hanging out with your friends and you feel defeated, you have to remember why you're here, and checking boxes is not why you're here or at least I would hope not why you're here.

So, for me, it's those times at uni or at the AIDS Foundation, taking someone's blood who is really nervous about a test result or telling people about insurance at Planned Parenthood, that's part of being a doctor and that's why we're here, and I wouldn't take any of that back to get in a year earlier.

Ira: And I wanted to add one more thing is that I think that also applies to undergrad classes. I think it's really easy to say, "I'm studying organic chemistry to get an A in organic chemistry," but it's relevant. It's very relevant. If you understand organic chemistry, you're going to understand the pharmacology of the drugs that you learn in medical school. If you understand . . . one of the best classes that I took in undergrad was a technical writing class. It helped me learn how to not only write things like a CV and an instruction manual, but it also taught me how to read things in that manner and how to critique things.

So I think that a lot of the pre-med requirements, they're there for a reason. In the same light of enjoying the journey and taking something from those, they will apply to your future career in medicine and they are there for a reason.

Dr. Chan: That's very beautiful. That's very eloquent from both of you. I look forward to one of you replacing one day because I think you guys are ready. Well, Antigone, Ira, thank you so much.

Antigone: Thanks for having us.

Ira: Thank you.

Dr. Chan: I'm very happy. I'm happy you're going to spend your lives together, you're going to be helping kids and sometimes adults. Chicago is very fortunate to have you. I hope you move back one day.

Ira: Thank you very much.

Antigone: Thank you.

Ira: We're feeling very fortunate that you don't live in the South Side of Chicago maybe during this July when all the interns start. I think that we're ready.

Antigone: And we have loved our time here at Utah and appreciate all that everyone has done for us.

Dr. Chan: You guys are great. We'll have to have you come back one day.

Antigone: You're great.

Announcer: Thanks for listening to Talking Admissions and Med Student Life with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school, a production of The Scope Health Sciences Radio online at thescoperadio.com.

Dr. Chan: What is it like to become the first official couple in your class? How soon do you start thinking about couples matching for residency when dating? What is the most important aspect when couples matching? Finally, how does it feel to have your parents meet for the very first time on match day? Today on Talking Admissions and Med Student Life, I interview Madison and Noah, a successful couples match and recent graduates here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is Talking Admissions and Med Student Life, with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of Talking Admissions and Med Student Life. I've got two great guests today, Madison and Noah. Hello.

Madison: Hey.

Noah: Hi, Dr. Chan.

Dr. Chan: Fourth-year medical students, soon to be full-fledged MDs. So let's start from the beginning. There's a reason why I'm having you both on today. You met in medical school. We were just talking about that. Where did you guys meet for the first time?

Noah: So we didn't really know each other at all. I think the place where we really first started to get to know each other and really started to bond is we were just kind of coincidentally put in the same anatomy lab group and that was where everything started.

Madison: Yeah. The first time we ever spoke was at this bar downtown during orientation week, but it was just like a really . . . I asked you about having Celiac disease because you were drinking a cider instead of a beer and it was like a two-second conversation. Then the next day, we found out our anatomy groups and we were both group eight along with two other of our classmates. We both grew up out West. I'm from Salt Lake City originally. Noah's from Boise, Idaho. We bonded about going away for undergrad and then coming back here to the West for medical school.

Dr. Chan: So, when you say anatomy lab, what does that mean for people that aren't familiar with that?

Madison: Yeah.

Noah: Yeah. So for most people when they enter medical school, I think most medical schools do it. Sometime within your first year, usually within your first semester at The U, for the semester that you're here, they kind of do this intensive anatomy education to give you a baseline in anatomy. You're paired off into groups of four or five-ish, and everyone's assigned a cadaver body that they dissect together and they kind of work from the outside in and kind of go by organ system. And it's just a really great way to have hands-on learning and learn together as a group and get to know your classmates.

Madison: Yeah. Our cadaver, we had one of the few female cadavers. I don't know what it is, but it's mostly male bodies. Ours was female, and we named her Beatrice. I think Chaz D. maybe named her Beatrice, I don't know.

Dr. Chan: One of your fellow . . .

Madison: One of our fellow classmates who was in our group. We called her Miss B. and she was an awesome lady. I think we still talk about her all the time and kind of what a gift she gave us by donating her body. She had bright pink nail polish on, which is something I'll never forget. It was really cool to get to know her.

Dr. Chan: And now, did either of you have anatomy before, or was this kind of leading up to it? When I go out and talk to premedical students, there's this perception that anatomy is really different, it's really hard. Like what was your experience?

Noah: I had not had a lot of anatomy. The only thing I'd ever dissected was a cat and a shark in undergrad, which is pretty different. I don't know about Maddie.

Madison: Yeah. So Noah and I both went to schools that actually didn't offer anatomy. They had other pre-med requirements, but it wasn't something he got, which I know is very different from BYU and The U, where you do have these amazing anatomy courses. So I was nervous I was going to be behind, because people had TA'd these classes and stuff for years, but it ended up being fine. We weren't quite as good at the dissecting. Dr. Morgan, he goes around and he pins like different structures on different bodies, and the very first quiz, our body was wrapped up in plastic because there was nothing identifiable.

Dr. Chan: You did not have the most precise dissection.

Noah: We did not. We found out way after the fact, because we were still friendly with a couple of the TAs that helped us out, that secretly they would make fun of our body and our horrible dissection job after the fact when they'd all pow-wow.

Madison: Disclaimer, we're not going into surgery.

Dr. Chan: Good to know. I think that will be the first question our listeners will think of. So you meet in the gross anatomy lab. You're table mates. You're having this really cool experience together. Were you together right away, or did it take a while? Or were you the first couple in your class? How would you define that?

Noah: To put it on the record, we were the first couple in the class. Very proud of that.

Madison: It was a little scandalous, actually.

Noah: We got a lot of warnings from upper classmen, "Don't date your med school classmates."

Madison: There was actually a pact in our class of people who were like, "We're not going to date or have anything with anyone in your class," because it was supposed to be like a really bad idea.

Noah: Everyone said, "Don't date your classmates because then when you inevitably break up, it's going to be really awkward because it's not a very big class." I think the first thing that we kind of bonded over is we had a really similar sense of humor. I think we noticed right away that we were laughing a lot in anatomy lab.

Madison: The other groups hated us, I think. We were very loud.

Dr. Chan: It sounds like you're having a lot of fun.

Madison: And it's a very serious task. You're dissecting this body of someone who has passed away, and it's a gift in that sense, but we also kept it very light. And you deal with a lot of bodily fluids and a lot of bodily functions in anatomy lab, and we accidentally perfed our colon, which was not a great thing to happen. So, yeah, we had a lot of fun and would come in the weekends too to like study extra. We'd hang out then, and then we just started studying a lot together.

Dr. Chan: So, Noah, you talked about how upper classmates warned you there could be significant drawbacks for dating a classmate, but it sounds like there are significant strengths as well. What are some of those? It sounds like you studied together?

Noah: Yeah. I have to be honest. I can't think of a single negative part of our relationship that came from the fact that we were classmates. I struggle to really think of a single one. It's really nice to come home to someone or to hang out with someone, if you're not living together, who gets it. You can have really supportive significant others, husbands and wives who you can tell them what med school is like and they can do their best and they can say, "I'm here for you 100%."

But at the end of the day, it's really nice to have someone who's going through the same crazy experience and so they just get it. They know that you need to study. They know that your hours are going to be crazy. If you have a question about a topic that's really confusing to you, maybe it's something they're really good at. I think that was kind of one of the other reasons why Maddie and I started studying a lot together is I'm terrible at the things that she's really good at and I think vice versa is true in a lot of cases.

Dr. Chan: So you complement each other well.

Madison: We always joke that we would have gotten like a 280 on boards if we could take it together, which was not our real score at all.

Dr. Chan: That's a very novel strategy.

Madison: For those who haven't take boards yet, 280, I don't even know if you can get that score. Probably you can, someone can. But yeah, in terms of how the logistics, Noah was in a really long relationship in undergrad that ended right before medical school. So even though we were hanging out all the time, I didn't know if he was like damaged and hung up on this girl and . . .

Dr. Chan: Do they still use the term rebound, rebound relationship?

Madison: Yeah. I have a very awesome group of very protective girlfriends from undergrad, and they were very wary of this. One of my friends in particular, Kelly, I went and saw her for a couple days during the fall. And I was telling her about Noah, and she was like, "No, you're going to be his rebound. Don't go there. It's going to be really terrible." You can talk about this. I don't want to steal your thunder.

Noah: No, there's no thunder to steal. It's true. You were a rebound, but you were like a forever rebound.

Dr. Chan: Oh, I love it, the forever rebound.

Noah: Yeah. I think I definitely took my time as far as actually establishing it as an official relationship. I think we both knew that we liked spending time together and that we were a really good pair, but I wanted to make sure that I wasn't turning her into a rebound. I wanted to make sure I was ready.

Madison: He went on a practice date with another girl. Tell him about that. It was a [inaudible 00:09:01] date?

Dr. Chan: Was this with another classmate?

Madison: No, it wasn't a classmate. It was just like this rando.

Noah: It was an OkCupid. She was a really nice girl, and I felt really bad for her because I really was kind of using her to see if I was over my ex, which was not super fair.

Dr. Chan: So, if you still had skills, could you still have conversation, if you could go on a date?

Noah: If for the entire date, I was thinking about my ex, then that would be . . . I hope she found someone. She was a nice girl.

Madison: Yeah.

Dr. Chan: All right. So let's jump back a few years. I'm excited to have you here today because I remember distinctly talking to both of you on the phone, welcoming you to our medical school, and I was beyond delighted that both of you chose to come here. I know both of you got into other schools. Looking back, obviously it was the right decision. You met each other and you're headed towards very wonderful fields, which we'll get into, but thoughts about coming to Salt Lake City. Madison, you used to live here, so coming back from the East Coast, Noah, you're from Idaho, coming here, what were your thoughts about your decision and from there?

Madison: Yeah. It was a really hard decision for a couple reasons. I grew up here, literally blocks away from The U's campus, and I went all the way to Philadelphia for undergrad. Most of my friends just stayed in that area, so moved to New York or down to D.C. or stayed in Philly. I kind of saw myself wanting to like go back out there. I had the option to, but when I kind of looked at . . . people define value as different things, right?

When I actually kind of sat down and looked at the financials with my parents, I was still in state at Utah and just kind of like the quality of education, I wasn't able to convince myself that paying for a private medical school when I had a really good in-state option was going to be the right choice. I didn't want to feel financially pressured to pursue something really lucrative, and then I went to second look date here and we heard from Dr. Morton and some of the other main educators here.

I felt confident that I was going to be able to succeed coming out of here, and I also saw where the fourth years are going, and they had really impressive institutions that they were going to and I didn't feel like just because I was going back to Utah, I wouldn't be able to get back to the East Coast or the West Coast for residency.

Noah: I don't have a lot to add. Mine was pretty similar. I went to undergrad in St. Louis, and so I was in a similar situation of going somewhere kind of out in the other areas of the country or whether to come back home. I remember when I came here for my interview day, it was just a really positive experience overall, both at the school, and then I also had some friends who were in the city, in the area.

Graduating from college is kind of a hard thing, especially when you go away, because the chances you end up in the same way as the people you've bonded with is really low. So I wanted to make sure that I was going to be in a place where I felt like I had a support system both within the school and outside of the school, and I wanted to go somewhere where I would feel comfortable. Salt Lake City just felt a lot like Boise to me. It kind of felt like home, but it was still away. It just ended up being the right fit.

I second everything Maddie said about you look at the match list and people are able to do incredible things out of this medical school. So I didn't really have any concerns about getting to where I wanted to go out of here.

Dr. Chan: All right. Well, let's talk about where you're headed. So when you started medical school, did you have an idea that you would choose the fields you ended up choosing? Help people understand how you came to the decision. Again, for people in the process of applying or maybe in the middle of medical school, it's very mysterious. Like how do doctors choose their fields? What were your journeys?

Noah: For me, I came into medical school and I . . .

Madison: I'm just like laughing, because what he wanted to do was like so not right for him, and I think he feels the same way about me.

Dr. Chan: What did you start with?

Noah: For some reason, I had it in my head that I was going to be a pediatric oncologist, that I was going to treat kid cancer and that that was what was what I was going to do for the rest of my life.

Madison: He wanted to be a chick magnet. Like curing little kids with cancer, just like . . .

Dr. Chan: I don't know if pediatric oncologists have higher rates of attracting members of the opposite sex.

Madison: I'm sure they do. We can do a study. That can be my residency study project.

Dr. Chan: You can do a double blind.

Noah: Yeah. I was so sure that that was what I wanted to do. I did the pre-clinical stuff. The cancer science just didn't really excite me the way that I thought it would, and then I hit clinical rotations. Peds was not a good fit.

Dr. Chan: What happened? What was your experience? Was this a rotation on pediatric oncology or just pediatrics in general?

Noah: Just pediatrics in general.

Madison: He didn't make it to oncology, just like nixed it at the kids level.

Noah: Stopped right there. Yeah, they say that especially when you hit your third year of medical school is when you start to get a feel for the different tribes of medicine, where a lot of the stereotypes you hear about the specialties, they came from somewhere, and it's because a lot of these specialties attract certain personality types. Most people, I think, pick their specialty . . . they have to like the science. They have to like the day to day, but more than anything, they have to like the people and you have to find "your people."

Peds just wasn't my people. I just felt like I wasn't connecting with them the way I wanted to and I wasn't connecting with my colleagues the way that I wanted to. So I kind of had a crisis, and I wasn't sure what to do. I thought I was going to be a surgeon during surgery. I thought I was going to be an orthopedic surgeon for a week. I ended up settling on anesthesiology.

Dr. Chan: Settling.

Noah: Settling because it's the best field and I fell in love with it. The people were great. It was a perfect fit for my personality type. It was all the science I wanted in a field. It was all the procedures I wanted in a field. I for sure was not settling, but that was the specialty that I found was best for me.

Dr. Chan: Were you able to do a rotation in anesthesiology during third year, or did you have to wait until the beginning of fourth year? Or how did that work out? Or just during surgery, were you just kind of more focused on what was going on near the head?

Madison: You kind of found it during OB first.

Noah: Yeah. I found it during OB. I remember peeking around the curtain and being like, "I wonder what that guy or gal is doing."

Madison: He looks way better than the guy pulling out the baby.

Noah: They're having fun back there. Then I kind of paid attention to them during surgery. And then at the end of third year, when I thought that anesthesiology might be a good fit for me, I did the rotation here, and it was kind of like a confirmatory.

Dr. Chan: So you found your tribe?

Noah: I did find my tribe.

Dr. Chan: Really positive experience?

Noah: Absolutely.

Dr. Chan: Wow. That's great. Cool. Madison?

Madison: Yeah. Oh, I was all over the place. Holy cow. I wrote my med school admissions essay -- this is something that all my college friends still give me like major crap for because they all read it -- about like wanting to be a primary care doctor in a small town, which is hilarious because I don't want to do primary care. Literally, being in a tiny town gives me so much anxiety I don't know where I came up with this idea.

So then I worked for an orthopedic surgeon for a year during my gap year, and I thought surgery was really cool, orthopedics was really cool. They're dealing with these healthy patients for the most part. It's pretty happy medicine. I came into med school thinking maybe I want to do that. I did a summer of orthopedic surgery research at Hospital for Special Surgery in New York and decided then that I thought it was a really cool field, but I didn't necessarily want to do the surgery part of it.

Dr. Chan: It was like standing in the OR for long periods of time?

Madison: Yeah. It was kind of like at that level of orthopedic surgery, you're so specialized that you're not even like . . . it's not even that you just take care of all joints, it's like you only take care of knees or you only take care of hands or you only take care of shoulders, and I wanted to be more of a generalist. So then I was like maybe general surgery would be a good fit, because you get to be a little bit more wider in your scope of kind of what you're dealing with in the body.

I went into third year -- Noah will tell you -- being like gung ho about surgery. I had found awesome surgical mentors here at Utah, shout out to Dr. Fenton and Dr. Penucci in plastics. They were incredible. I got some really great research opportunities with them. I actually hit my surgery rotation and I realized that even though I liked the research of surgery and I liked the idea of it, I was not happy in the OR. I was not thriving. I started to like try to avoid cases by like volunteering to do like busy work.

Dr. Chan: The floor work.

Madison: Yeah. There was a great intern who I worked with, who actually graduated from Utah as well, and I just saw how excited she was to go to the OR for like anything. It didn't matter the time of the day or how tired she was.

Dr. Chan: Is this Ryan?

Madison: Yeah, who also was a couples match.

Dr. Chan: Yeah.

Madison: I looked at her and I was amazed by her, and I also realized that I wasn't like her, which was a scary thing to realize. But then the backstory to all this is that, here at Utah, we have these groups called CMC groups and it's this kind of tribe that you get your first year. And these are all led by a physician. Dr. Chan leads one. My CMC leader, who kind of teaches you about how to do physical exams and things like that, was an ER doctor named Jerry Doyle. He and I always got along really well.

Dr. Chan: He loves it when students shadow him and come in for shifts.

Madison: Yeah. He was like so welcoming. So I think, little known to me, I was kind of being indoctrinated with emergency medicine from day one of medical school. I just didn't realize it. So after I did surgery, I sat down with Dr. Doyle at the hospital Starbucks at The U. I had a list. I listed . . . this is what I would suggest to do if people have questions about what to do, what specialty they're going to choose is I wrote down on a piece of paper everything I hate about medicine in general, like these are the activities I don't like. I don't like rounding. I don't like clinic. I don't like all these things.

And then on the other side, I wrote what I love. I love taking care of marginalized populations. I love doing a gazillion things at once. I like procedures. I love being part of a team. I don't like the OR. I found that out. I sat down and I just read this to him. He was like, "That was me when I was a third year." So I just started shadowing more and more in the ER, met Megan Fix, who's been an incredible mentor to me as well, as well as Katie Wells, who's now a PGY3 here. I can't say enough good things about the ER mentorship here.

Dr. Chan: It's a very strong program.

Madison: Yeah. It's an amazing program, amazing residents. I've never looked back. I was like, "This is home."

Dr. Chan: Emergency medicine.

Madison: Emergency medicine, all in. Yeah.

Dr. Chan: We've got emergency medicine and anesthesiology. When on your radar did you starting about the couples match? When did that kind of start entering your consciousness? Third year?

Madison: Before we were dating.

Dr. Chan: Before you were dating?

Madison: Just kidding.

Noah: That's a really good question. I think as soon as we started dating. If you start a relationship in medical school with someone else who's in medicine, I think you can't help but your first thoughts go to couples match.

Madison: Everyone in med school is like a planner. You plan years in advance for stuff.

Noah: So I think as soon as we realized that this was something serious, which was not super long after we started dating, we started thinking about it. As far as logistically when we started really thinking about how this is going to work and how we were going to do this, I would say probably third year is when things started to get really real as far as like, "If you do this and I do this, what is that going to look like?"

Even before we had officially settled on what we're doing, like the week that I wanted to do orthopedics or like, "Would you be okay coming with me wherever I match?"; Or when Maddie wanted to do plastics, it was like, "Would I be okay going wherever she wants to go?" because those are two super competitive specialties. So you start kind of thinking about what that would look like and if it's okay.

Madison: There were also like major logistics that we chose to do differently from other couples in our class I knew. Noah and I knew that we were both pretty competitive people with ourselves and with other people. So we made the decision not to share our Step scores with each other.

Dr. Chan: Oh, wow.

Madison: Yeah. That's like a big deal, right?

Dr. Chan: So the entire time you've been together, you don't know how each other did?

Madison: No.

Noah: I think that we could like guess a range just based on the conversations we've had, but I have no idea of what the number is.

Dr. Chan: I remember my classmates, and it was not just Step scores. It was just grades overall. Some were just I would say over-sharers. You just knew exactly what they do.

Madison: Yeah, and we never wanted to be those people. I know, from Noah's past relationship, they were both pre-med, and it was a little competitive between them. We wanted to stay out of that, and we wanted to be like only supportive. We would still study together and all that jazz. We just never wanted to open our envelope and have the feeling of like, "Well, if Maddie only would have scored five points higher . . ."

Dr. Chan: If she only studied for five more hours.

Madison: Which isn't even true, but it's just like you never want to have those lingering questions in your brain. So we sat down with Dr. Stevenson here, and we wrote them on a little sheet of paper and slid it across the table to him.

Dr. Chan: Wow.

Madison: He literally lifted them up and he just was like, "We're good. You guys are okay." And we applied very broadly too.

Dr. Chan: Before we get to that, so creating your fourth year schedule, did you do away rotations together? Walk us through that.

Noah: It was a little different for both of us. Maddie, because she decided to do emergency, she's required to do a couple of away rotations. So we knew right off the bat that no matter what, she was going to have to go and do them. So we kind of thought this is a perfect opportunity for us to kind of get our foot in the door in some of the bigger cities that we were hoping to maybe match in.

Madison: Compared to a lot of classmates, we really didn't want to stay in the West. So we didn't apply anywhere around here. We didn't apply in most western states. We were really focused on California and the East Coast and a couple dots in between.

Dr. Chan: Did you interview here?

Madison: We applied here and everything. But we were pretty up front with our departments too about wanting to move away.

Dr. Chan: I think it's always a good move to interview with your home institution.

Madison: Oh, yeah. I mean it's a slap in the face if you don't, and they're obviously the people who helped you find your specialty. We also applied and did our away rotations. I did one in New York City and one in Los Angeles, and Noah also did one in Los Angeles.

Noah: Yeah. It was actually just kind of by luck. I got my third choice of date range for my away rotation in Los Angeles, and Maddie got maybe her second choice. I don't think it was her first choice. But either way, just as a fluke, they ended up overlapping perfectly. So we were able to actually go out to Los Angeles and do our away rotations together and survived a real estate scam and a totaled car.

Madison: It was a low point.

Dr. Chan: Real estate scam, did you have like an Airbnb disaster?

Madison: Well, Noah can talk about this.

Noah: I'm going to put this all on myself because it was 100% my fault. It was a situation where it was like a Craigslist thing.

Dr. Chan: I didn't think your generation used Craigslist anymore.

Madison: We've had good luck. I found my housing for New York via Craigslist, and we've done it in the past when we did research and have had really good luck, except for this time.

Noah: I went to L.A. during the summer between first and second year to do research, and I did it exactly the same. It all worked out great. It was going the same way this time. It turned into a thing where we were leaving to drive out there and I had been trying to contact this guy just like, "Hey, we're going out there. Just wanted to make sure you're going to be there."

Madison: Driving 11 hours.

Noah: Radio silence the day before we were leaving. I was like, "That's kind of weird, but what we can we do now?"

We stopped over in Vegas overnight, and we woke up the next morning, the day we were supposed to meet him and move in and he goes, "I was waiting for you all day yesterday, and it's now going to cost you $700 more and you can't move in for another week." I just remember looking at Maddie and being like, "Ruh-roh." So we got to the apartment complex. We showed this guy's picture around. No one had ever seen him before.

Madison: It was bad.

Dr. Chan: You have these Utah license plates. People think you're like these little country bumpkins.

Madison: Yeah. I was literally scheduled to start the next day in the ER, and we were homeless in Los Angeles.

Dr. Chan: Well, you had a car.

Madison: We did. We had two cars at this point.

Noah: We booked a few days at the Gardena Terrace Inn, #DontStayThere.

Madison: I like went on this app on my phone, it's like Hotels Tonight. It's actually a great thing. You should definitely download it for interview season. But I found like the cheapest one closest to the county hospital I was working at. It was like $70 a night. I was like, "That's mostly in the budget." It was really bad.

Dr. Chan: Is this big county?

Madison: This is Harbor.

Dr. Chan: Harbor County.

Madison: Noah slept with this like hunting knife under his pillow.

Noah: My inner-Idahoan came out.

Madison: It was really not great. I got up in the morning and put on my scrubs and went to work. We stayed there for three nights.

Noah: I will say to our credit, despite all of this, we were never really at each other's throats. We got frustrated with the situation, but I don't think we ever took it out on each other. To this day every once in a while, Maddie will be like, "Hey, Noah, it would be really nice to have that $1,000 back." I'll pay her back for it eventually.

Dr. Chan: You sent this individual that you never saw again $1,000?

Madison: $2,000.

Noah: Yeah. That's kind of the point of contention. We paid upfront, which was a bad choice.

Dr. Chan: Well, I won't dwell on that because both of your faces are . . .

Madison: Sad.

Dr. Chan: It sounds like, and I've gathered this from talking to other people who went through the couples match, you targeted large cities with multiple programs, so just in case one of you matched in one program, there may be a neighboring institution.

Madison: Yeah. Given what we're looking for, if anyone's familiar with emergency medicine, emergency medicine is a little different than other specialties in that you have . . . all specialties have community, county, and academic programs. Those are three different flavors of style. The interesting thing about EM is that you have hybrid programs that are county and academic, which is kind of what I was interested in.

Then you also have really, really amazing just straight county or straight academic or straight community programs. So places that might not be as "desirable" for specialties like anesthesia are actually really awesome training experiences for emergency medicine just given that you want to be in a place that has a lot of acuity and a lot of diversity . . .

Dr. Chan: A lot of diversity in patient conditions, illnesses, trauma . . .

Madison: Socioeconomic status, all of the above. You also want to be in a place where you don't necessarily have tons of other services trying to necessarily . . . I don't want to say hone in because they're always valuable and you can always learn a lot from them, but that you are able to kind of like direct your learning when opportunities arise in the ER for that learning. So, basically, getting back to the point, we were looking for places with multiple programs, that would be both beneficial to what we were looking for in a residency program, which was hard.

Noah: I don't have a whole lot to add. But it was kind of interesting when we were trying to build our list of places to apply to and interview at, because the programs for anesthesia that are maybe less desirable or ones that are not super competitive are the ones that Maddie was super excited, and then a lot of times kind of like the bigger, powerhouse academic programs that tend, not always, but tend to be stronger for anesthesiology were the programs that oftentimes don't have a great emergency reputation.

Dr. Chan: Interesting.

Noah: So we were looking at kind of like opposite things. In a lot of ways, that was nice because it gave us a lot of permutations of programs within bigger cities.

Dr. Chan: Would you only interview at a program where the other person was also in there to interview? Or did you just kind of if you got an interview in New York or Philadelphia or Boston, you'd just immediately interview there? What was your strategy?

Noah: So it kind of gets into playing the game of the couples match. You kind of have to play the game for residency application in general, but especially in the couples match it's all about communication. So whenever one of us would get an interview offer at an institution, they would immediately send an email to the department saying, "My partner is Noah, and he's applying in anesthesiology. He hasn't heard back yet."

Madison: And he loves your program, most important part.

Dr. Chan: Emoji smiley face.

Noah: Then there are also sometimes where the other person would send out an email to all the programs within the city that they had applied to that the other person had been offered an interview saying, "My partner is interviewing in the city. I haven't heard back from you and I'm interested." Just really any concrete excuse to reach out to program directors and say, "I'm interested in your program."

Dr. Chan: Do you feel that was successful? Did the programs respond to that?

Madison: Oh, yeah.

Noah: Hugely successful.

Madison: I can only think of a couple ones where it didn't work.

Noah: Like 80% to 90% of the time it was successful.

Dr. Chan: So there was definitely, you feel, communication between the anesthesiology department and the ER department about what was going on?

Madison: Yeah. I think it was happening, for sure. I also think that those two departments are departments that play really well together. EM residents across the country rotate on anesthesia for airways, and anesthesia rotates in the emergency room at least for a couple months during residency. So they're in contact, and I think that was really helpful. The other thing that was good was to play up any and all connection to the area, to the school, to anything.

Noah and I were both successful in getting interviews at our alma maters and getting each other interviews at our alma maters, which was really fun. I have family in the Midwest. I really tried to play that up to help get interviews in Chicago. Noah has long lost relatives in New York City. He played that up. So just anything that you can say to say, "Yes, I'm coming from University of Utah. It's a little bit of a medically isolated area in that we're the only game in town, but please, please, please look at me. I'm willing to . . ."

Dr. Chan: Move to the East Coast.

Madison: Yeah, move to the East Coast, move the West Coast, move wherever.

Dr. Chan: Awesome. So leading up to your match list, was it a negotiation between the two of you, or did both of you just kind of know independently, kind of came to the same conclusion? How did that work?

Noah: So I think what we ended up doing is we both built our own independent rank lists as we were going on interviews, but we were talking to each other all along the way.

Madison: Like after every interview we called each other.

Noah: It wasn't like a big secret, but we were still trying to rank them semi-independently. And then when all was said and done . . . maybe not when it was all done, but towards the end of interview season, we started to kind of sit down and get an idea of what our picture would look like as far as our rank lists. I think that our main goal was to find a few programs that we both liked enough that they could be our top programs. We kind of addressed those first, and we said, "We would both be happy with these. These are both strong training programs for us"

Then we kind of worked our way down to ones where we had to make some compromises where either I liked a program and it just wasn't a good fit for Maddie or vice versa and really tried hard to make it as fair as we could, where if we did one that was unfair to me, we did another one that was unfair to Maddie and just built our rank lists in a way that felt fair, so that not one person was getting everything they wanted and the other person not getting anything they wanted.

Madison: Yeah.

Dr. Chan: Awesome. All right. So you submitted your match lists. What was it like between that day and then match day? That's a month, right?

Madison: Yeah.

Dr. Chan: What were you going through? What were you thinking?

Madison: I started on the ICU.

Dr. Chan: Kind of second thoughts?

Madison: So it was pretty . . . I don't know. I was kept really busy, so I think that definitely helped. We kept it a secret from everyone, what our official ranking was, which was really hard because I tell my mom everything and she was actually really mad.

Dr. Chan: Hello, Madison's mom. Hope you're listening to this.

Madison: We also made . . . so on the interview trail, I knew that this was probably the most we'd ever be traveling in such a short amount of time probably in our entire lives. So Noah and I, we took these little like felt letter boards around with us to every single -- they're like just really small, like a placard size -- to every interview and we made a different sign for that location. And then we had my friend, who works at BuzzFeed Video, she turned it into a YouTube video that was like 15 minutes long. So that was really fun to kind of just build up the excitement and remember. We both sat down and watched it when she sent it to us, and we were like, "I can't believe we made it."

Noah: We're BuzzFeed celebrities.

Madison: Not quite.

Dr. Chan: Can we publish that? Can we do a link?

Madison: Yeah, sure.

Dr. Chan: All right. Well, I'll get that afterwards, yeah.

Madison: We were just like . . . watching it, I was just like, "I can't believe that we did that many interviews." I did 20 interviews.

Dr. Chan: Twenty, wow.

Madison: Noah did 25, 26.

Noah: Twenty-five.

Madison: Twenty-five.

Dr. Chan: That's a lot.

Madison: It was a lot.

Dr. Chan: How much did you budget? What does that look like?

Madison: With or without the L.A. money wheel? No, I'm kidding.

Dr. Chan: Using Craigslist or not using Craigslist.

Madison: Sallie Mae does residency relocation loans. Because we were doing double the interviews, we probably took out double what our single application classmates took out. So I took out $10,000 to pay, and that's probably . . . I don't think I could have done it cheaper. I really don't. I surfed on so many couches and ate so many turkey cheese roll-ups, I don't know if I could have done it much less expensive.

Noah: Mine was about the same. As we were going through the process after the match lists were submitted and we were just kind of looking back on everything that happened, we were like, "Man, where did all of that money go?"

Madison: Oh my gosh, this was a good story.

Noah: It goes to flights. People would guess that flights are just expensive. But when we added up between the two of us Lyft and Uber, we took 298 ride shares.

Madison: No, no, 198.

Noah: Wasn't it 200?

Madison: No, it was 198. That's still a lot though.

Dr. Chan: That's still a lot.

Madison: 198, like that's insane.

Noah: We were like, oh, that's where all our money went.

Madison: At the time, we're like, "It's really cheap. It's only $8 here, $9 here," and then it adds up so fast.

Dr. Chan: Aside from airfare, Uber and Lyft were your biggest expenses.

Madison: Uber and Lyft. There's this credit card now apparently that you can apply that gives you like 4% back on Uber and Lyft. You should consider getting that for your interview season. This is not a sponsored post, but yeah.

Dr. Chan: I'll talk to the Dean's Office. So match day, the night before match, slept like a baby, nervous?

Madison: I slept great.

Noah: Yeah, I think we actually both slept. Yeah, we slept fine.

Madison: Noah was one of our class presidents. So he was like really busy with the actual like logistics stuff of setting up for match day.

Noah: Which was really nice. It also kept me distracted. I had to get there really early and just set things up and do the decorations and stuff, which really helped to just kind of dampen the anxiety a little bit.

Madison: I think Monday was actually a bigger deal for us, because anesthesia does . . . you can either do a one plus three program, where you might be separated for your intern year, or you can do an all-inclusive four-year program. So we had three and four-year programs ranked, so there was a small possibility that he would either be separated for our first year in a different area, or he would not match for that first year. So Monday we found out that he was fully matched.

Dr. Chan: That gave you a hint or no?

Madison: No, it didn't. It meant that he didn't have to scramble somewhere.

Noah: Yeah, I would agree with that. Monday was probably the most anxiety provoking, because I had this nightmare that I would have to scramble for my preliminary year position or whatever. So once we knew that we had both fully matched, we knew that it was super unlikely that we had gone really far down our list, and we knew that . . . I don't know what I'm saying.

Madison: That's okay.

Noah: We knew that we had been fully matched.

Dr. Chan: You'd be together. You wouldn't be separate.

Noah: We wouldn't be separate for probably more than a year was what we knew from that.

Dr. Chan: When you're setting up match day, you see the envelopes on the table, no temptation. Isn't there someone guarding them?

Noah: Yeah.

Dr. Chan: You were there early enough, though.

Noah: I was. Yeah, I had to watch them like put them in each of the individual things.

Dr. Chan: Yeah, alphabetical.

Noah: It was definitely nerve-wracking. I didn't really want to get tackled by student affairs, personnel, and get taken out on match day, spend it in the hospital and find out later where I'd matched.

Dr. Chan: So your families were both there?

Madison: Yeah. It was actually the first meeting of the parents.

Dr. Chan: Really?

Madison: Yes.

Noah: As if the anxiety wasn't high enough.

Dr. Chan: Did you do like a dinner the night before?

Madison: The night after match day we did.

Dr. Chan: Okay. So the parents met for the first time?

Noah: They did, yeah. Everything went well. Everyone got along great.

Madison: Then my little sister was there, and then Noah's best friend was there.

Dr. Chan: All right. So they have all those little speeches. They're kind of delaying it, delaying it. They cut the little red ribbon. Was there a red ribbon this year? I couldn't tell, I was near the back.

Noah: I think so.

Dr. Chan: They cut the red ribbon. You go up there and get your envelopes. What happens next?

Madison: I refused to open my envelope.

Noah: Oh my god, she was driving me crazy.

Madison: I like got it and I was like . . . I didn't know this, but someone was filming it unbeknownst to be and they like put it on the University of Utah total Instagram page, and there's just me doing this nervous dance like I have to pee being like, "I can't open it. I can't open it."

Noah: It took Maddie like three minutes to open her envelope. I was going nuts.

Madison: Some really mean person commented, "Has she ever opened an envelope before?"

Noah: That is the sane question.

Dr. Chan: Was that person Noah?

Madison: No, it wasn't. It was some other meanie.

Dr. Chan: Did you open your envelope before Madison?

Madison: He did.

Dr. Chan: So it was not a simultaneous event.

Noah: Thank god you were matched with an anesthesiologist where you have to be patient.

Madison: I eventually opened it, and we did look at it at the same time, but it just took me a little extra time.

Dr. Chan: So where are you going, and how does it feel?

Noah: We both matched at the same hospital.

Madison: In the best city in the entire world.

Noah: We're going to NYU in Manhattan.

Dr. Chan: Wow.

Madison: Yeah.

Dr. Chan: Fantastic. So I assume that was near the top?

Madison: Yeah.

Noah: Absolutely.

Madison: It has been on my bucket list my entire life to live in New York City.

Dr. Chan: New York City, yes. Awesome.

Noah: NYU was actually my very first anesthesia interview of the entire season. I went there, and I absolutely loved it. I remember I called Maddie after and I said, "I love everything about it. This is exactly what I want."

Dr. Chan: Let's talk about why did you like NYU? What attracted you to their program?

Noah: It was the people. It all comes down to the people. Obviously, it's an incredible medical institution with a great reputation, and even within the anesthesiology world NYU has a great reputation as well. But, for me, it came down to the people. I didn't appreciate it as much until I got further into the interview season, but you can tell so much about a program by how many residents you see in the hallways who are smiling.

So as I went on, I started to keep like a mental tally of how many residents I saw smiling during my interview day, because it's a really good indication of when people aren't really focused and kind of in the intense part of their work day, are they happy? Do they like being around the people that they're around? I'm pretty sure I told Maddie this on the phone after I left NYU. Everyone I saw was smiling. Everyone was happy. People seemed like they had a great quality of life.

Madison: The attending-resident relationship was you said . . . I remember you telling me it was a really good one there.

Noah: Yeah. The program leadership could not have been warmer. My interviews were very warm. It was very casual, and they wanted to get to know me. I was . . .

Madison: In New York, you think of it's more fast-paced, of course, but it's also East Coasters are a little different.

Noah: I also had these kind of talking points locked and loaded, where I would have to convince them about why I would be willing to go to New York, and I was ready to kind of sell that to them. I never really had to. Everyone was very open to it, and they said this was a great time to try something new and exciting. It was just a great . . . I feel like my entire interview process I was always comparing programs back to NYU.

Dr. Chan: Wow. Cool. Madison, why did you like NYU? Is it a three or four-year program?

Madison: Oh my gosh. It's a four-year program.

Dr. Chan: ER is kind of weird. It's like the only field I know that there's not really a [inaudible 00:43:31].

Madison: Yes. That really comes down to how much elective time you get. So NYU is a four-year program, which I actually wanted a four-year program because Noah's program would be four regardless. NYU Bellevue, what drew me to it was the history. I'm someone who has always believed that places hold meaning. That's why I picked the college I did. The history of Bellevue Hospital, it's the oldest public hospital in the United States.

There's actually a book that was recently published that I read about it before I matched or anything, but the history of Bellevue taking care of the most marginalized members of society in the most diverse city is just incredible. They were on the forefront of the AIDS crisis. They took care of immigrants, all the way to when Hurricane Sandy hit, how staff was carrying patients down in stretchers to evacuate them. I'm just so honored to now hopefully be starting my journey as an MD at such a storied hospital that everyone is so proud of the mission and the service to New York City.

Dr. Chan: The history and the legacy.

Madison: Yeah. So when I was talking about the programs before, like the academic and county hybrids, so at NYU, you get Bellevue, which is a true county program, but you also get Tisch, which is a private NYU hospital. So you get two very different populations there. Tisch gets more of the very complicated transplant cancer patients. Then Bellevue you get more of your bread and butter, emergency medicine, trauma. It's the only level one trauma center in Lower Manhattan.

I interviewed actually the day after the New York City subway bombing, and we toured the ICU, and there were people marching through the ICU with assault rifles, because the person who committed it as well as the victims went to Bellevue. It's a crazy, exciting place to be. It's where the Ebola patient went. So I'm excited for what's coming. It's going to be a cool place to train. Noah will get to be there too. We'll actually get to rotate on each other's services because we'll be at the same hospital.

Dr. Chan: That's fantastic.

Madison: Let the battle of the airways begin.

Dr. Chan: Battle of the airways. Who can intubate the best?

Madison: We intubate under worse conditions, I feel like. You do it more, though.

Dr. Chan: Tale as old as time, anesthesiology versus ER when it comes to intubation.

Madison: I still have a lot of friends there, which will be really fun to get to reconnect with them.

Noah: My dad actually grew up in New York, and he lived in New York for a long time. Even though he might not admit it, I think that somewhere deep down inside of him there's still that inner New Yorker that's transplanted in Idaho who's a little bit proud to have someone temporarily going back to the big city.

Dr. Chan: That's fantastic.

Madison: So many bagels. We're so excited.

Dr. Chan: Great restaurants. That's what I tell people. I've never lived in New York. I've visited New York a few times. I used to live on the East Coast. I lived in Washington, D.C. The thing about New York City that I love, if you want sushi on top of pizza at 2:00 in the morning, you can find someplace like that. Literally, the city never sleeps. There's just so much fun stuff to do.

Madison: If you're in a specialty that's 24 hours a day, what better place to be than a city that never shuts down?

Dr. Chan: Fantastic. Well, I'm so excited for both of you. We have graduation coming up in a few short weeks, and then you're off for your medical training. I can't believe you're going to be full-fledged MDs and practicing medicine.

Madison: They sent the offer letter. We have to have the letter that says like, yes, you're going to be a resident physician, this is your salary in order to show that to landlords to qualify for housing. And they sent me my letter and it said, "Madison Hunt, MD," and I was like, "Who's that person?"

Dr. Chan: It's so official looking.

Madison: I'm going to be looking over my shoulder for the next four years.

Noah: I don't know how long it's going to take before we actually feel like we've earned the MD title.

Madison: Never.

Noah: I think it's not going to be soon.

Dr. Chan: Well, I'm excited for you guys.

Madison: Thank you so much.

Dr. Chan: I'm so glad you came here to Utah. I'm so glad you guys found each other. I'm glad you found a field that you're passionate about. It's very obvious. I'm excited for your future patients because you guys are going to be great doctors.

Madison: Oh, thank you, Dr. Chan.

Noah: Thank you. That's nice to say.

Dr. Chan: We'll talk later.

Announcer: Thanks for listening to Talking Admissions and Med Student Life with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school, a production of The Scope Health Sciences Radio online at thescoperadio.com.

Dr. Majersik: Hi, I'm Dr. Jennifer Majersik. I'm a stroke neurologist at the University of Utah Health Care and the Director of the Stroke Center. My guest today is Dr. Alex Terrill. She's a rehabilitation psychologist in the Division of Occupational Therapy at the University of Utah Health Care. So, Alex, I've been very excited about this topic since I take care of stroke patients and when patients come in, I find we talk all about their high blood pressure and whether they're taking aspirin.

But actually, it's difficult for us to talk about the partnership between the two of them and I can see, although I'm not experienced to this, I can see that there's maybe difficulties between them, but I don't always know how to deal with that with the partners. What have you seen that are some of the problems that happen between couples?

Dr. Terrill: They follow and there are some different broader categories. I'm going to focus more on the psychology or emotion-based problems because that's my area of expertise. But one of the big changes for a certain are changes in mood. So post-stroke depression or apathy is extremely common. It occurs in about a third of stroke survivors. But it's also extremely common and some suggest that it's actually more common in caregivers, up to about 50% of caregivers who experienced depression after stroke. And so these changes in mood, they not only affect the individual but it's been shown that there's a reciprocal effect.

So it's very interconnected. When one person isn't doing well emotionally, the other person isn't doing as well either. And so, for example, if you have a caregiver who is depressed, they will have a harder time doing some of the caregiving, having hard taking care of themselves on their own needs and this can actually increase the likelihood that the person who had the stroke will be hospitalized.

Dr. Majersik: I've also seen data saying that the caregivers health themselves is compromised and I somewhat assume that this is because they stopped going to appointments for a breast cancer screening or to get their own cholesterol checked and they're not out socializing as much.

Dr. Terrill: Yes.

Dr. Majersik: Sometimes, I do talk to my patients' spouses about that. "Are you taking care of yourself?" because I worry and I can tell that they probably aren't.

Dr. Terrill: That's great, yeah. We see that all the time and it's something that the message that we are trying to spread is that, again, the caregiver kind of . . . everything focuses on the patient and, of course, they are too and they want to help. Sometimes they don't know what to do, but it's exhausting and they often neglect their own needs in terms of taking care of their health. Just socializing, getting some social support and we believe that that also contributes to depression is that their social circle shrinks because they're not able to get out or will not get out.

Dr. Majersik: So if a spouse is looking for more help in trying to understand his or her new role, where should they go? Should they go to the usual caregiving sources of support or is there something else that they should do?

Dr. Terrill: That's a good question and I think it's very individually based. I mean, certainly, getting resources for caregivers in general could help with some of the more general issues that come up. How do you find time to do some stress management or take care of yourself? And there are some resources out there. There are caregiver support groups specifically. But there's relatively little that's out there for stroke caregivers, per se, and one of the things that is unique or there are actually several things that are very unique to caregivers for stroke survivors that might not be the case in other things like old-timers or spinal cord injury, for example, along with maybe some physical changes that might happen after stroke.

You do have kind of that emotional piece, the emotional component, changes in cognitions. So the way that you're thinking changes the way that you communicate. And if you think about couples talking to each other, and if one of those partners in the couple isn't able to communicate effectively, how difficult that is. And that's a fairly unique thing, I would say, to partners of stroke survivors.

The other thing is that it does happen very suddenly and, often times, I would argue that practically no one is prepared for something like that when it does happen. And so you have that sudden transition to where you're taking on that role and whereas initially, you might have people rallying in helping you, social support at the hospital, once you're back out there, there's few and far between. Things drop off and it's good to know where to go.

Dr. Majersik: What are you doing now to try to help the situation? It sounds like an area that you're obviously very interested in and I'm hoping we're going to learn more in the next few years about how to help spouses and caregivers.

Dr. Terrill: Yes, so one of the things that I'm working on is actually creating an intervention that is done by both partners in the couple. And rather than just focusing on kind of educational pieces for a caregiver, which is something that's more traditionally done, we actually have them both participating in activities on their own and the activities that they do together. So we like for them to have that shared experience and we have them do positive psychology-based activity. So things like expressing gratitude, working on relationships, acts of kindness, savoring. I mean there are all kinds of things that they can work on. And it really kind of helps to give that structure to ways that they can interact and share some positive moments, make that time.

And that's something that we're hearing quite a bit is that after stroke happens, you kind of flail. You just survive and you want to help each other, but you don't know how and you stop interacting altogether. So and that's really a shame because your partner can be one of your biggest sources of strength and resilience and that's mutual, for both the person who have the stroke and the caregiver.

updated: July 29, 2020
originally published: January 20, 2016