And the winner of the CaRMS lottery is...

Cause that's all CaRMS is, a big honkin' lottery. CaRMS stands for Canadian Residency Matching Service, also affectionately referred to as 'the match'. It sucks. There's no other way to put it. All of the medical students in Canada (or at least, all the ones continuing on to residency the following year) apply to a big centralized application system. From there, they are offered interviews (hopefully) at the programs to which they've applied. Then, they submit ranked lists of all the programs they've interviewed at, from the one they want most to least. Every program ranks the people they interview the same way. Both lists (the medical students and the programs) are entered into a big computer, and on a designated day at a designated time you find out the course of the rest of your life. And it's binding. No room for negociation.

Lovely. And of course, everyone lives happily every after. Sigh.

In my case, the match was just supposed to be a formality. I was applying to emergency medicine... a fairly competitive specialty (the year before had seen about 45 applications for 25 spots) but not crazy competitive like dermatology or plastic surgery. And I wanted to stay at my home university. The staff knew me, and I was fairly well liked (according to the nurses and some other residents, at least). I really liked the program, and it felt like a good fit. I loved the other residents... they were such a cool bunch, and they were so close-knit. They'd have golf tournaments and retreats, and they were the type who would always be hiking or windsurfing on their days off. It was exactly the kind of life I saw for myself in the future. The program was nothing special... it wasn't any different from the other emerg programs across the country. It was more the people, and the fact that I loved the city and had made it my home. I really didn't want to leave.

And it looked like I didn't have to. The program director had become my mentor since I had first become interested in emergency medicine. In his words, the program was 'very interested in keeping me around'. He told me on a few occasions that if I had applied to the program in any previous year I'd certainly be training with them now. He met with me a few times during my final year, when I was going through the process. He advised me and counselled me and told me that if I needed to go elsewhere for personal reasons that he'd understand, but that I could expect to stay if I ranked them highly. This was even confirmed by an emergency room nurse who told me that I was one of their top two picks. And I knew I wanted to stay. There was only one other program that I liked more, but it was on the other side of the country and I didn't know if I wanted to move that far from my family.

So I went on the CaRMS tour. I was lucky enough to get interviews at nearly every place I applied. I think they were impressed by my masters (obtained in my pre-medical life) cause otherwise I didn't think that I was anything special. I had good letters, like everyone else, and a bit of research, like everyone else... who knows what they were looking for? But I did the tour. From east to west, with the same core group of people. Exhausting, but fun.

I did struggle a bit with the ranking when I came home. I was tempted to rank that far off program first... I really enjoyed the elective I did there, and I liked the city. There was another program that had impressed the hell out of me as well... but it was even further away, in a city with a crazy high cost of living.

In the end, I stayed with my original instinct. My first choice was my home school. I just couldn't ignore what a good fit it felt like. My second choice was the school on the other side of the country where I did the elective, and the third was the program that had impressed me on the tour. My fourth choice was a program I liked in a city I wasn't crazy about, and the fifth was a program I was unsure of in a city I liked (both of these cities were relatively close to my family, as well as that of my significant other). I ended up ranking 8 programs in total.

This entry is getting way too long... more on the outcome of the match later.

Decisions, decisions.

My medical school was a four year program-- two of the programs in Canada are squished into three. If I thought that my friends and I were forced into choosing a specialty ridiculously early, I can't imagine how the people in the three year programs do it. By the end of second year, it was already all we thought about. My two best friends were already committed to their specialties-- one was going into pediatrics, and the other into psychiatry. Since they were among the top students in the class (I was nowhere close, but comfortably sitting around the middle) they didn't have to worry about getting a spot. Of course they both did anyway, but that's the nature of the super-competitive medical school mentality... it doesn't matter how good you are, there's always that underlying fear that you're not good ENOUGH.

My first interest was plastic surgery. Not the boob-job-tummy-tuck kind of surgeon, but the kind that puts people together after horrible disfiguring accidents. I loved surgery, and I loved the variety of stuff I saw. Most of all, though, I loved that it was more careful than other surgical specialties. And you really saw the results of what you did. Most of all, though, it was cool.

There were definitely a few drawbacks to opting for plastic surgery. First and formost, it's a bloody hard specialty to match into. There are all of about 8 spots in all of Canada. You have to be the best of the best to match into it, and I definitely wasn't. I didn't have the inclination or the patience to do what was needed to secure one of those spots-- I had no urge to put in the crazy surgery hours (easily 6am-7pm on a regular day), was no good at sucking up to the 'right' people, and had too many interests outside of medicine that I had no intention of giving up. There were other things to consider too-- the surgical lifestyle, for one. It's brutal. At least it certainly is during residency, which could be anywhere from 5 to 7 years. Are you kidding me? I was late to start medical school to start with, and now I could be delaying the start of my life until I'm pushing 40? Not freaking likely. And don't even get me started on what that could mean if my biological clock ever finally kicked in...

Thankfully, that was at about the same time as I did my clerkship rotation in emergency medicine. It seemed the best of all worlds, and combined everything I loved about medicine. I got to do procedures (enough to satisfy the 'working with my hands' aspect that surgery gave me without having to endure the marathon enduro-surgeries that some of the reconstructive ones seemed to be). I got to see the variety I was craving. The pace was fast enough that I was always able to get through a shift without looking at my watch. I got along well with other emergency medicine residents and staff... they were 'my kind of people'-- friendly, outgoing, usually athletic and always with a short attention span. I felt very 'at home' in the ER environment. And I was equally interested in the sore throats and sprained ankles as I was in the heart attacks and trauma. Best of all, it was a lifestyle I could live with.

But the decisions didn't stop there. In Canada, there are two roads to working in the emergency room. The shortest and most common is to do family medicine. After a 2 year family medicine residency (of CCFP, for the Canadian Council of Family Physicians) you are free to work shifts in emergency medicine in most smaller centres in the country. If you want to be more specialized, you can add a third year onto that residency to concentrate on emergency medicine. With the 2+1 option (aka CCFP-EM) you're equipped to work in almost any emergency room in Canada. Even most of the ones in big cities like Toronto and Vancouver are staffed largely by CCFP-EM's. The second path is through the FRCP program (Fellow of the Royal College of Physicians). The FRCP program is a five year program that is meant for physicians who want to specialize in emergency medicine and work in an academic setting. This will usually combine emergency medicine with teaching, research and administration. For some reason that I continue to question to this day, I chose the latter.

Let's Get This Started...

I've wanted to be a doctor since I was about 7. That was how old I was when I found out that vets (my previous life's calling) had to put animals to sleep. That's all it took. I was going to be a doctor.

Unfortunately for me, I didn't grow out of it. With the exception of a brief period when I decided that I was going to be a dancer on Solid Gold (fortunately for the rest of the world, I DID grow out of that one), I never wavered. But boy, did I take a helluva long path to get there. My first undergraduate degree was in Exercise Science, with a specialization in Athletic Therapy. I applied to medical school in my last year, but with my 3.5 GPA I didn't even score an interview. My plan B didn't work out either. Did you know that in order to become certified as an Athletic Therapist in Canada you have to volunteer for 1600 hours? Who the hell can afford that? I figured I'd work as a personal trainer for awhile first. Instead, I ended up following a guy to a new town, where I ended up working at a staffing agency. Whatever, it paid the rent. And not much else. It didn't take me long to realize that the 9-5 thing wasn't going to work for me. I hated every minute.

So the next step was a master's degree. People convinced me that it would help get me into medical school. Not so much. And I hated it. I hated research, I didn't like the politics, and the subject matter (Clinical Epidemiology) was far from thrilling. So again, two more years had gone by and I was no closer to being a doctor, now had student loans to pay back and didn't much relish the kind of work I was now qualified to do. If any of you out there are thinking of doing a master's solely to get into medical school... don't. Really.

Since I had nothing better to do, I followed my then-significant-other of 3 years to yet another city where he was starting his PhD in History. I decided to start taking some classes while I was there to jump-start the 3.5 GPA that was apparently still keeping me from getting past the admissions committee. The department I was taking classes in told me that they'd give me a whole other degree in just two years if I stayed on. So I did. I worked, studied, and did pretty much nothing else for two years. I didn't know anyone in the city anyway. So by the time I left, I had a B.Sc., an M.Sc., a B.A.... and a letter of acceptance to three different medical schools.

And that's how it all began.