Travel experiences from a newbie on the fellowship interview trail

It seems like just the other day I got done with the residency interview trail and now I am going for the fellowship interviews! Please note the following is for fellowship interviews. If you are a medical student applying for residency I would use my earlier post.

Couple of differences that I noticed between residency and fellowship interviews is as follows

1. Given you are earning in dollars now, the pinch of money is NOT too much but still palpable
2. Most hospitals generally provide accommodation. The really fancy ones even pay for the airfare!
3. The fellowship programs are trying to sell themselves to you instead of vice-versa (at least that is what I felt)

One goes for interviews generally in the 3rd year of residency OR 4th year if you are Med-Peds/Chief in your program. So if you are in residency you generally travel on post-call days, eat pre-interview dinner and sleep at night in the hotel accommodation the program provides. Therefore as mentioned in point 1, you want the fastest yet cheapest option. This is generally flights unless the distance is not too far in which case people do drive.

Couple of tips that I felt that a candidate can do to make the experience easier (at least in my case; please note that different people have different options. This is my experience)
I highly recommend getting the Amex Platinum credit card since it gives you HUGE perks. My referral link is this. To list a few

• 60,000 membership reward points for spending 4k. You will definitely hit this depending on the number of places you interview at
• $200 airline credit- It works with only single airline
• $200 Uber credit ($15 per month)- One uses this feature A LOT on your interview trail. 
• $100 credit for TSA pre-check which is something US citizens can do but for IMG's only if you are one of the global entry countries can you do the same
• Access to a LOT of lounges during flights. I feel this is another BIG perk for residents who are interviewing and frequently flying
• You get complimentary gold access to Hilton, Marriot and Starwood preferred. (The hotels treat you like royalty)- As mentioned in point 2 on the top, the programs pay for the stay. So you can give your account number at check-in and you get rewarded for the stay.

The annual fee though high ($595), I feel the above perks are worth it.

Please note- 
- In case the program does not pay for accommodation, you can check Airbnb for a place to stay at a cheap rate and maybe rent a car to the interview/uber it.
- One can also apply for the Chase sapphire reserve since that has travel deals as well.

I flew the following airlines. Highlighted the perks and features which I liked. All the airlines generally give you pretzels/cookie with a drink (coke, Pepsi etc). You can spend money on hard drinks should you want to indulge in the same.

JetBlue- Loved this airline since there is free wi-fi with amazon prime video streaming. The food is amazing as well. The leg space is GREAT! Given I am a tall person, I love when I can stretch my legs without feeling like I am cramped in my seat.

Southwest- There is NO predetermined seating. Your seat is dependent on WHEN you check in. You get a boarding group number and at the time of boarding, you are broken into groups based on the same. You board the plane and call dibs on the seats. The biggest perk is the 2 checked bags for free, which you can use if you are changing your base-camp. You get wifi to watch cable channels to kill time. You have to pay for internet though.

Delta- The service was great. Loved the food. But depending on when you book your tickets you may get a good deal.

American Airlines- Cheap low cost but no special perks that I would run wild for. Had a couple of bad experiences but the flight crew made up for the same.










Just to get myself organized, I used the following apps. They are available for Android, Apple and windows.

Tripit Pro version- It is $49 for a year subscription which is okay per me for the interviews. It gives you notifications on when you can check in and gives you the shortest route to take to the next gate, which helps when your layover is just half hour and you have to run to the next gate. You can even store your hotel reservation, so you know your itinerary is not missing anything.

Awardwallet pro/free version- Helps you track your miles and know when miles are expiring. It also has a feature of letting you know when to check-in. My referral link is this 

Taxes in the US

This time, I thought would just write about tax paying in the US for my fellow residents or new residents starting this year. First off the basics, a tax year is counted from January 1 to December 31, and you are required to file federal income tax returns by April 15.

There are multiple ways to pay taxes

• Online - Turbo tax etc which are really simple and free, at least the basic outline
• Through an agent for a fee

I personally did mine through an agent since I am new to the States and I did not have much free time as an intern. In the first year of residency, you get a decent amount of money back and hence I recommend going with an agent. So, as usual, I asked my senior on who to contact and he gave me the contact details of his tax agent and she kinda ran me through the entire process. There were some colleagues and seniors of mine who have stated that one can get the same amount of refund via online software's (Turbo-tax), but I personally did not have much time or luck to go through the same.

To file taxes you need the following documents 

1. W2 from your employer
2. 1099-INT if you had any miscellaneous incomes (see below for more details)
3. Moving expenses (a rough estimate)

Once you get those details you send the same to your tax agent who gives you an estimate of how much refund you get and then you are set.

Note

If I am not mistaken there are 3 taxes in total

- Federal (USA)

- State (Ohio)

- City - The general consensus is that one does not owe city tax if you live and work in the same city. 

Elaborating on some terms

Form W4

When you join a company, your employer will ask you to fill Form W4. That form gives information to the employer regarding how many deductions an employee can make. For every deduction claimed, the employee is able to deduct a certain amount of income from the income tax. The number of deductions claimed in the W4 form is just an estimate regarding how much tax you may owe. 

1099

There are several types of 1099 forms:

• 1099INT: For interest paid by a bank.
• 1099DIV: For dividends and distributions paid by financial institutions.
• 1099R:Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
• If you paid interest on a mortgage or real estate taxes, you will receive 1098 with that information.

Drivers License in the states PART 2

Read the previous test for documents needed for the knowledge (written) test.

Once you pass the driving test you will have to produce the following documents to get your driving license

1. Utility bill or something that has your name and address on it (Lease agreement might not work from what I got by the look of the guy)
2. Passport
3. i94
4. Letter from employer
5. Indian license
6. SSN card
7. The paper which your examiner gives you stating that you have passed
8. A USA CHEQUE to pay the money for the license. CARDS ARE NOT ACCEPTED!!
9. And do dress nicely since you ll be taking a picture which will be on your license :P

That's all folks :)

P.S: The sad part is that the license is for the duration of your visa. So most of us will have to renew it yearly :(

Driver's License in the States

The Driver's license test generally has 2 parts. 

Knowledge and the ACTUAL driving test

If you have an Indian license, take the same along with the following documents

1. Passport
2. I-94 printout
3. Letter from employer stating that you work there
4. SSN- Details on how to get one is in the previous post.

For the knowledge test, you can practise online by doing practise one's according to your respective States. You can get few here (http://driving-tests.org/) In Ohio, the test has 40 questions and you just have to get 75% of the questions to clear the exam and then schedule your DRIVING test.

Best of luck!

P.S.- I read the manual and did the above questions. Most of the questions just need plain common sense answers :) So it really won't take too much time.

Steps to H1B for new medical residents

1. Apply for the medical license to your respective state board- From Receipt to Acknowledgement around a week; from there to the actual license around 2 weeks. So, a total of 3 weeks.
2. Get yourself an attorney from the list that your program sends you/ ask your colleagues where they are doing theirs from
3. Talk to the attorney regarding fees and stuff (generally program pays for all except the premium processing fees) Fees find below
4. Depending on your attorney’s liking, apply for a visa based on an acknowledgment letter/Training license certificate
5. He then sends the application to the USCIS who then will issue you a petition number
6. Based on that you CAN complete the next 2 forms i.e. [you need the petitioner’s name and dates approved for, and your point of contact in the States which generally is your PC]
1. DS 160 - Tips for filling the forms can be found HERE (thanks to Dr. Vikas)        
2. US travel docs form 
7. OR  
8. You can wait for the approval and use the exact dates the petition got approved for and the Petitioner
9. Get an appointment- Pay the visa fees according to the exchange rate.
10. Go for the interview with the documents the Attorney sends and ta-da you have your visa.

OFC DAY

Take the following for the appointment

1. DS 160 confirmation page
2. Appointment confirmation
3. Passport

Stand in line, get your fingerprints and photo clicked and you are done for day 1. If you have already done for visitor visa(B1/B2), this should be a cake-walk since you know what to doJ

P.S. Please take a photo according to the instructions on the consulate website since there have been problems with the IT aspect for quite a number of my colleagues and me. {2*2 inches and stuff}

INTERVIEW DAY

Take the above and supporting documents which HAS to include (I-797B i.e. H-1B petition approval notice)

Please note- Some people also say that you have to take the other forms like i129 (Petition application for H-1B), I-797C (Receipt for the premium processing). But frankly speaking, they are not needed, if you have it, then well and good but, the I-797 B is a MUST.

Questions asked

• Where will you be working? – In a Hospital
• Oh, so you are a doctor? – Yes
• *He was delighted by that* May I know your salary? $ XXX
• Good, your visa is approved.

And I walked out a happy man J

For Chennai, passport collection is from the OFC. Please refer to the consulate site for documents to be taken while collecting the Passport.

Fee  Type	Fee	Who Pays for it ? Why ?
Base filing fee	$325	Program It is employer’s business expense
Fraud prevent & detection fee	$500	Program It is employer’s business expense. Just like above, it is mandated by law.
Fee based on attorney charges	$1000-$2000	Program. It is employer’s business expense.
Premium processing fee (Optional)	$1,225	Generally we pay for it ourselves, but you never know if the program will be good enough to pay for you J Please read the note at the end of the post
Visa fee (fee involved in getting H1B visa at US consulate)	varies by country	Your expense. All the costs involved in obtaining visa, including cost involved in translation of your credentials, etc. It will NOT be an employer’s expense. The employer will only send you the documents required for visa stamping.

NOTE THE FOLLOWING:

• Even if you are approved well in advance of your start date at your program, you cannot enter the US in H-1B until 10 days before the start date of your Residency i.e. June 20 considering your start date is July 1^st
• The Attorney generally requests for the full 3 years of H-1B, however, there is no guarantee that the immigration Service will give all 3 years. According to their regulations, they should give 1 year (even if we request 3 years) since the Training license is for 1 year (license issued by the State of OH). Some examiners will give 3 years (depends on your luck as to which examiner gets your case). So if you get 3 years, count yourself lucky. If you are approved for 1 year, there is no problem renewing the H-1B status again next year in the US.
• You will need someone, who has a bank account with a US bank to send a cheque for the $1225 premium processing fee. At least that is what my attorney insisted on, but guess this part varies from attorney to attorney.

Google Voice and it's uses for USMLE

Did it ever happen that try what you may, your mobile service provider’s voice-mail just refuses to get set-up??!!

I experienced that and I am thankful that it happened, else I would not have stumbled upon Google Voice. The only unfortunate part was that I really did not realized the potential of it until late in the interview season, to be frank towards the end.

So before I go into the details let me explain the reason why this post is here. The first thing that most of us do when our plane lands in the States is to hunt for a USA mobile service provider. Once that is done, it becomes the mode of contact for you and almost everyone else you get in touch with. But have you ever thought that once you are done with your electives, and it’s time to come back how will they contact you or vice versa? I do agree WhatsApp is a wise alternative, but it is generally registered on your home country number, which I do not think you will share with all of them except for the residents or your colleagues. Here is where Google Voice comes to the rescue.

So once you have finalized a decent USA mobile service provider and have the sim in hand, it is the ideal time to set up your Google Voice account. The different options for buying a sim are mentioned in my other post here. Registering for Google Voice is pretty simple and straightforward and the link is here. Once registered, there is an option to opt for a Google Voice mobile number, where you get pretty cool phone numbers to choose from to be frank. My number for example is +1-916-936-3451 (+1-916-93NEIL1). You can try various combinations and options to get a cool one for yourself. Once you have finished fiddling around to get a number, I would recommend you share this number with all your colleagues instead of the USA service provider’s number. The reason being, should anyone call you it automatically gets forwarded to your USA service provider’s number and, supposing you are unable to answer your phone when they call, Voice offers a voicemail service which even transcribes the voicemail to text which you can read when you do check your phone.

The advantage of Google Voice is that it does not lapse like the number that you get from your service provider should you not recharge it for 2-3 months. I mean once you  are back in your home country, why will you want to recharge your US number and not even use it? So even though your US number will be disconnected, should people message or call your Google voice number you will still receive the messages or calls on Voice or Hangouts, whichever is convenient for you. Last but not the least you can also call and send messages (SMS) from your Google Voice number as long as you have a working internet connection.

Hope this post helps future USMLE aspirants who can make complete use of this simple but potentially amazing offering from Google.

Disclaimer – I am not being paid anything by Google for this :P

Finances in the States

Regarding finances the general notion or idea is that we take maybe say around $1000 cash in hand and $1000 in cards as I mentioned in my earlier post which you can find here. Now the problem with carrying $1000 in hand or in the luggage is that you have the eternally worried about getting mugged, if not that, then where to keep the money and last but not the least remembering these places and trust me it is no small joke. I almost lost $200 in a day, thanks to my awesome super secret hiding spot, that my mind so conveniently kept it a secret even from me. Thankfully one rainy day I remembered where it was, retrieved the money and became $200 richer. My advice in this post would be to open an account in Bank of America [BOA] (since this is the easiest and most accessible bank all over the States). Easiest in the sense that this is the ONLY BANK that I know off that does not require an address proof to open an account in the States. The steps to be followed when you go to open an account would be as follows

1. Carry 2 forms of ID (a) Passport containing a valid visa (b) Driver’s license or election card from your home country. Please note that it should be in ENGLISH for it to be valid. 

1. Money to open the account- Either your entire cash-in-hand or $100-$200

The features of the account are that the minimum balance should be $300 if not mistaken, or you will be charged a monthly fee which I think is around $ 5-10. Now BOA is kind enough to give you a grace period of 2 months to build your balance to the target minimum balance of say $300. This 2 months period is generally the time by which you would be done with your electives or interviews and can close the account, withdraw the money and return home for no additional cost to you.The advantages that I felt of having an BOA account were as follows

• The card that they give has your photo on it, along with your name and hence you can use it as an ID proof instead of whipping out your passport every single time.

• The bank statement that you get has your name and the address that you staying at and you can use it as address proof in various places.

• The staff are really courteous and sweet and generally answer all queries

• You can withdraw the needed amount, when and where you want without having an additional transaction fee of $2 should one use their countries' foreign currency cards. This I think was the MAIN reason I opened the account. Saved me the need to roam around with wads of cash in my pocket :P

I may be wrong in some things and they might change the rules later. But I used the bank and was very happy with my experience and hence the post. Pardon the grammar, was half asleep when I typed this out.

100 Rules for Step 3

1. If a patient has a fever, give acetaminophen (unless it is contraindicated)
2. If a patient is on a statin or you order a statin, get baseline LFTs and check frequently
3. If a patient is found to have abnormal LFTs, get a TSH
4. If a patient is going to surgery (including cardiac catheterization), make them NPO
5. All NPO patients must also have their urine output measured (type "urine output")
6. If a woman is between 12 and 52 years old and there is no mention of a very recent menses (that is, < 2 weeks ago), order a beta-hCG
7. Don't forget to discontinue anything that is no longer required (especially if you are sending the patient home)
8. When a patient is stable, decide whether or not you should change locations (if you anticipate that the patient could crash in the very near future, send the patient to the ICU; if the patient just needs overnight monitoring, send to the ward; if the patient is back to baseline, send home with follow-up)
9. In any diabetic (new or long-standing), order an HbA1c as well as continuous Accuchecks.
10. If this is a long-standing diabetic, also order an ophthalmology consult (to evaluate for diabetic retinopathy)
11. In any patient with respiratory distress (especially with low oxygen saturations), order an ABG
12. In any overdose, do a gastric lavage and activated charcoal (no harm in doing so, unless the patient is unconscious or has risk for aspiration)
13. In any suicidal patient, admit to ward and get "suicide contract" and "suicide precautions"
14. Patients who cannot tolerate Aspirin get Clopidogrel or Ticlopidine
15. Post-PTCA patients get Abciximab
16. In any bleeding patient, order PT, PTT, and Blood Type and Crossmatch (just in case they have to go to the O.R.)
17. In any pregnant patient, get "Blood Type and Rh" as well as "Atypical Antibody Screen"
18. In any patient with excess bleeding (especially GI bleeding), type "no aspirin" upon D/C of patient
19. If the patient is having any upper GI distress or is at risk for aspiration, order "head elevation" and "aspiration precautions"
20. In any asthmatic, order bedside FEV1 and PEFR (and use this to follow treatment progress)
21. Before you D/C a patient, change all IV meds to PO and all nebulizers to MDI
22. In any patient who has GI distress, make them NPO
23. All diabetic in-patients get Accuchecks, D/C oral hypoglycemic agents, start insulin, HbA1c, advise strict glycemic control, recommend diabetic foot care
24. All patients with altered mental status of unknown etiology get a "fingerstick glucose" check (for hypoglycemia), IV thiamine, IV dextrose, IV naloxone, urine toxicology, blood alcohol level, NPO
25. If hemolysis is in the differential, order a reticulocyte count
26. If you administer heparin, check platelets on Day 3 and Day 5 (for heparin-induced thrombocytopenia), as well as frequent H&H
27. If you administer coumadin, check daily PT/INR until it is within therapeutic range for two consecutive days
28. Before giving a woman coumadin, isotretinoin, doxycycline, OCPs or other teratogens, get a beta-hCG
29. If you give furosemide (Lasix), also give KCl (it depletes K+)
30. All children who are given gentamycin, should have a hearing test (audiometry) and check BUN/Cr before and after treatment
31. Don't forget about patient comfort! Treat pain with IV morphine, nausea with IV phenergan, constipation with PO docusate, diarrhea with PO loperamide, insomnia with PO temazepam
32. ALL ICU patients get stress ulcer prophylaxis with IV omeprazole or ranitidine
33. If you put a patient on complete bedrest (such as those who are pre-op), get "pneumatic compression stockings"
34. If fluid status is vital to a patient's prognosis (such as those with dehydration, hypovolemia, or fluid overload), place a Foley catheter and order "urine output"
35. If a CXR shows an effusion, get a decubitus CXR next
36. If you intubate a patient you ALSO have to order "mechanical ventilation" (otherwise the patient will just sit there with a tube in his mouth!)
37. With any major procedure (including surgery, biopsy, centesis), you MUST type "consent for procedure" (typing consent will not reveal any results)
38. With any fluid aspiration (such as paracentesis or pericardiocentesis), get fluid analysis separately (it is not automatic). If you don't order anything on the fluid, it will just be discarded.
39. With high-dose steroids (such as in temporal arteritis), give IV ranitidine, calcium, vitamin D, alendronate, and get a baseline DEXA scan.
40. In all suspected DKA or HHNC, check osmolality and ketone levels in the serum.
41. In ALCOHOLIC ketoacidosis, just give dextrose (no need for insulin), in addition to IV normal saline and thiamine
42. All patients over 50 with no history of FOBT or colonoscopy should get a rectal exam, a FOBT, and have a sigmoidoscopy or colonoscopy scheduled.
43. All women > 40 years old should get a yearly clinical breast exam and mammogram (if risk factors are present, start at 35)
44. All men > 50 years old should get a prostate exam and a PSA (if risk factors are present, start at 45)
45. If a patient has a terminal disease, advise "advanced directives"
46. In any patient with a chronic disease that can cause future altered mental status, type "medical alert bracelet" upon D/C
47. Any patient with diarrhea should have their stool checked for "ova and parasites", "white cells", "culture", and C.diff antigen (if warranted)
48. Any patient on lithium or theophylline should have their levels checked
49. All patients with suspected MI should be given a statin (and check baseline LFTs)
50. All suspected hemolysis patients should get a direct Coombs test
51. Schedule all women older than 18 for a Pap smear (unless she has had a normal Pap within one year)
52. Pre-op patients should have the following done: “NPO”, “IV access”, “IV normal saline”, “blood type and crossmatch”, “analgesia”, “PT”, “PTT”, “pneumatic compression stockings”, “Foley”, “urine output”, “CBC”, and any appropriate antibiotics
53. If a patient requires epinephrine (such as in anaphylaxis), and he/she is on a beta-blocker, give glucagon first
54. If lipid profile is abnormal, order a TSH
55. All dementia and alcoholic patients should be advised “no driving”
56. To diagnose Alzheimer’s, first rule out other causes. Order a CT head, vitamin B12 levels, folate levels, TSH, and routine labs like CBC, BMP, LFT, UA. Also, if the history suggests it, order a VDRL and HIV ELISA as well
57. Also rule out depression in suspected dementia patients
58. For all women who are sexually active and of reproductive age, give folate. In fact, you should give ALL your patients a multivitamin upon D/C home
59. All pancreatitis patients should be made NPO and have NG suction so that no food can stimulate the pancreas
60. Send patients home on a disease-specific diet: diabetics get a “diabetic diet”, hypertensives get a “low salt diet”, irritable bowel patients get a “high fiber diet”, hepatic failure patients get “low protein diet”, etc
61. Do not give a thrombolytic (tPA or streptokinase) in a patient with unstable angina patient
62. Patients who are having a large amount of secretions, order “pulmonary toilet” to reduce the risk of aspiration
63. Every patient should be advised to wear a “seatbelt”, to “exercise”, and advised about “compliance”
64. In any patient who presents with an unprotected airway (as in overdoses, comatosis), get a CXR to rule out aspiration
65. In any patient with one sexually transmitted disease (such as Trichomonas), check for other STDs as well (Gonorrhea, Chlamydia, HIV, syphilis, etc.) and do a Pap smear in all women with an STD
66. Remember to treat children with croup with a “mist tent” and racemic epinephrine
67. Any acute abdomen patient with a suspected or proven perforation, give a TRIPLE antibiotic: Gentamycin, Ampicillin, Metronidazole
68. Get iron studies in patients with microcytic anemia if the cause is unknown. Order “iron”, “ferritin”, “TIBC”
69. Women with vaginal discharge should get a KOH prep, saline (wet) prep, vaginal pH, cervical gonococcal, chlamydia culture
70. If a woman is found to have vaginal candida, check her fasting glucose
71. When the 5 minute warning screen is displayed, go through the following mnemonic (RATED SEX). I know it probably is not the best mnemonic, but it is difficult to forget!:

• Recreational drugs / Reassurance
• Alcohol
• Tobacco
• Exercise
• Diet (eg. high protein, no lactose, low fat, etc.)
• Seat belt / Safety plan / Suicide precautions
• Education (“patient education”)
• X (stands for safe seX)

72. All suspected child abuse patients should be admitted and you should order THREE consults: consult “child protection services”, consult “ophthalmology” (to look for retinal hemorrhages), consult “psychiatrist” (to examine the family dynamics)
73. When a woman reaches menopause, she should have a “fasting lipid profile” checked (because without estrogen, the LDL will rise and the HDL will drop), a DEXA scan (for baseline bone density), and of course, FOBT and colonoscopy (if she is over 50)
74. If colon cancer is suspected, order a CEA; if pancreatic cancer, order CA 19-9; if ovarian cancer, order CA 125.
75. Remember to give “phototherapy” to a newborn with pathologic unconjugated bilirubinemia (it is not helpful if it is predominantly conjugated). Also, with phototherapy, keep the neonate on IV fluids (the heat can dehydrate them), and give erythromycin ointment in their eyes
76. Before giving a child prednisone, get a PPD
77. If a patient is found to have high triglycerides, check “amylase” and “lipase” (high triglycerides can cause pancreatitis)
78. Remember that any newborn under 3 weeks of age who develops a fever is SEPSIS until proven otherwise. Admit to the ward and culture EVERYTHING: “blood culture”, “urine culture”, “sputum culture”, and even “CSF culture”. And give antibiotics to cover EVERYTHING.
79. If you get a high lead level in a child, you have to check a “venous blood lead level” to confirm. If the value is > 70, admit immediately and begin IV “dimercaprol” and “EDTA”. Order “lead abatement agency” and “lead pain assay” upon discharge.
80. If you perform arthrocentesis, send the synovial fluid for “gram stain” and the 3 Cs: “crystals”, “culture”, and “cell count”
81. If a patient has exophthalmos with hyperthyroidism, it is not enough to just treat the hyperthyroidism (as the eye findings may worsen). You should give prednisone.
82. If any patient has cancer, get an “oncology consult”.
83. In a patient with rapid atrial fibrillation, decrease the heart rate first (then worry about converting to sinus rhythm). Use a CCB (diltiazem) or a beta-blocker (metoprolol) for rate control.
84. In any patient with new-onset atrial fibrillation, make sure you check a TSH
85. In any patient with suspected fluid volume depletion, order “postural vitals” to detect orthostasis
86. Before a colonoscopy or a sigmoidoscopy, you should prepare the bowel: make the patient NPO, give IV fluids (if necessary) and order “polyethylene glycol”.
87. Any patient with Mobitz II or complete heart block gets an immediate “transcutaneous pacemaker”. Then order a cardiology consult to implant a “transvenous pacemaker”
88. If calcium level is abnormal, order a “serum magnesium”, “serum phosphorus”, and “PTH”
89. Treat both malignant hyperthermia and neuroleptic malignant syndrome with “dantrolene”
90. All splenectomy patients get a “pneumovax”, an “influenza” vaccine, and a “hemophilus” vaccine if not previously given.
91. If you give INH (for Tb), also give “pyridoxine” (this is vitamin B6)
92. If you give pyrazinamide, get baseline “serum uric acid” levels
93. If you give ethambutol, order an ophthalmology consult (to follow possible optic neuritis)
94. If you perform a thoracocentesis (lung aspirate), send the EFFUSION as well as a peripheral blood sample for: LDH and protein (to help differentiate a transudate versus an exudates) and pH of the effusion
95. Give sickle cell disease children prophylactic penicillin continuously until they turn 5 years old
96. Any patient with a recent anaphylactic reaction (for any reason), should get “skin test” for allergens (to help prevent future disasters) and consult an allergist
97. Do not give cephalosporins to any patient with anaphylactic penicillin allergies (there is a 5% cross-reactivity)
98. Order Holter monitor on patients who have had symptomatic palpitations.
99. Any patient with a first-time panic attack gets a “urine toxicology” screen, a TSH, and “finger stick glucose”
100. All renal failure patients get: “nephrology consult”, “calcium acetate” (to decrease the phosphorus levels), “calcium” supplement, and erythropoietin.

Original post : http://www.usmlerockers.net/forum/topics/1393035:Topic:14067

For more amazing stuff: usmlerockers.net

First trip to the States

After getting your visa your next major hurdle is the packing regarding what to take to US on your first trip since everything looks important when you look at it. Initially I was very apprehensive about this trip because this was my first trip to the States and was scared of being profiled due to ethnicity. However my siblings and cousins told me that it is seen only in movies and not in reality and my god how true they are. People are extremely friendly to the point that even if you randomly meet a stranger and ask him for directions which are not in his path, he may not only guide you but might actually give a drop to that place. I was pleasantly surprised. 

Just a note before you start reading. This post is meant for people who like me are really worried about what to carry and what not. Also there may be a lot of grammatical errors in the post. Kindly ignore them and take what is required :) 

BEFORE FLYING

THINGS TO BUY & DO in India/ Home country

Hospital: Carry a decent number say 3-4 trousers, 5 shirts and 3 ties as these are allowed to wear at hospital. You can add sweaters too if you are going in winter or cold weather. One suit or blazer is enough, although I never used it but it differs from place to place. You usually wear an apron in the hospital, so you can use the suit in presentations or formal meeting or when asking for an LOR. Also a stethoscope and maybe even a torch

Apron/ Lab coats: Do carry two, since it is expensive to get a lab coat in the States. They are generally compulsory everywhere in hospital. For medical students like us, the style of lab coat is short waist length (just crossing your hips) and full sleeves. Better look at the HOUSE MD TV show to get an idea :P

Shoes: Plain black or brown shoes normal leather style is used. Do take an extra pair if you feel that it might break before going to the States.

Casual wear: Carry few jeans (2) and casual t-shirts (4) for roaming around the city. Good pair of sneakers.

Innerwear & socks: Buy at least 10 sets of them, coz you will not be doing your laundry every day, but usually weekly or even fortnightly.

Medicines & Stationery: I carried one packet of medicines (PCT, Cetirizine, Volini etc.). Do carry since they are very expensive and NOT OTC in the States. I highly doubt a prescription is needed unless you have a serious disease like asthma or DM and you would need to carry your medications on the flight.

Gifts from your country: Always take small tokens as gifts when you part with each of your mentors. People like them a lot and it indirectly tells them that you cared enough to bring them gifts all the way from home. Would advise taking small size items, nothing huge.

Miscellaneous stuff: Stationery, pens, soap, tooth paste brush and other daily items. Here’s a tip I got from someone, have a paper in your hand and write down things that you need to use daily so you don’t forget to take them when needed. Even though you have weight limitations it is always better to buy it cheap from India rather than buy the expensive stuff in the States.

Plugs & Convertors: Best is to buy a multi-convertor from India and an extension cord with multiple ports in order to use your laptop, cell phone charger (they generally have 110-220v on the adaptor.)

Food: Learn some basic cooking before coming which can help you to save a lot of money. Prepared food is expensive in USA, compared to eating at home, even if packaged. If you want to save money, try to have 1-2 meals every day at home. Finally try to meet all your ‘long distant relatives/long lost family friends’ in the nearby areas to satisfy your cravings for home cooked desi food. Trust me you will want to eat Indian food after a few weeks. I tried not to spend more than 10$ a day on food, either outside or at home.

Finances/ Cards: I used the ICICI bank travel card which gives you a good rate if you buy a minimum of 500 $ and goodies like travel insurance. Best is to ask the sales representative about the details of the card. They charge if not mistaken 150 bucks for the card and later no charges. I also bought a Thomas Cook multiple currency Card which is also decent. You can do the entire procedure online rather than visiting the agent since they charge an additional 250 bucks if you do it via the agent. The online version is cheaper and easier. Lastly bought a card from HDFC from the travel agent who was sweet enough to give me a decent discount on the rate since have been doing business with them for the earlier trips to Europe. (Trade Wings for the guys in Mangalore) PS - I am not being paid anything for this, but recommend them since they are really friendly.

FINAL PACKING:  You have to fit all the above into the following bags

·         Check-in baggage- 2 bags 23 Kgs each (50 pounds)

·         Carry-on bags -A laptop bag (1) and a small trolley bag (1).

In summary 2 check-ins plus 2 carry-ons equalling a total of 4. The carry-ons generally have a limit of 8 kgs and in general should be able to fit the overhead compartment of seats. Usually, any liquid, gel, knife, scissor, blade, shampoo or aerosol items are not allowed in the carry-on baggage; though one can carry all these in the checked in baggage. Generally they do not weigh the carry-ons, however once they had weighed my bag and even though it was a bit on the heavier side, the lady on the counter was courteous enough to allow me to check-in that bag for no additional charge J  

You will get your check in luggage at your FINAL destination, but always confirm with the person who checks it in where you would have to transfer or collect your baggage, since different airlines have different policies regarding that. Also at the counter they give you a baggage tag, THIS IS IMPORTANT at-least till you collect your luggage at the final destination, since if you do lose your luggage, god forbid you do, you will NEED THE TAGS. I also strongly recommend to write your name, address, contact number on a piece of paper and then paste it on all your bags. Sometimes, the bags gets lost and such information on bags helps airlines identify your baggage; the last thing you would like to have after landing in US, would be to get your bags lost!

AT THE AIRPORT:

Security checks in the airports: Before entering any gate/ lounge area for connecting flights, you have to go through security check again. You have to remove your belt, shoes, wallet, cell phone and any other metallic item. If you are carrying a laptop/ notebook, make sure you take it out of the laptop bag and put it separately in a tray without anything else in it. Note: You can carry an empty water bottle.

First of all, you pass your luggage and yourself through security check. Then you go to the counter of your airlines, show them your e-ticket/passport/visa, get your boarding passes and submit your baggage except the carry-ons. After that, you might have to pass through another security check and then through the immigration/visa officers. After that you enter the lounge go to the gate number mentioned on the boarding pass. When it is boarding time, they make an announcement and you board the plane. Make sure you are at the gate at the boarding time (generally 30-60 min before departure time).

Note you need a ROUND TRIP TICKET for entering into the States, else you will have to buy the return ticket then and there and it will NOT be to your liking. If you are unsure of your dates, it would be best to buy your tickets via a travel agent since you really do not want to have the additional burden of cancelling and rescheduling your tickets when you are in the States. Also in case you plan to buy stuff from the States like electronic stuff like a mobile phone or Laptop, better declare the stuff like the ones you carrying at India else you would have to pay a hefty price when you get them back.

BEFORE LANDING:

Customs: Before landing US, you are given a customs form in the flight. You have to mention the total worth of all your baggage, your name, passport number and other details on it. You have to submit your filled and completed custom form over there and then do a security check on your bags.

Visa Clearance at the Point of Entry: Once you reach US, stand in a queue with the other passengers and then wait for your turn to be called to the visa officer. There are separate queues for US Citizens, Green Card holders (US Permanent Resident), Immigrant Visas and Non-immigrant Visas; make sure you are standing the right queue (generally immigrant visa); look closely towards all the signboards before going towards any queue. It is always better to be in the start of the queue when de-boarding; you get free early and thus might be in time for your connecting flight.

Once your turn comes, the visa officer takes your passport, looks at the visa, takes a small interview (from where you are coming, why you are coming, when you plan to leave, who would be paying for your stay etc.) and stamps your passport allowing you to stay in US. Carry almost all copies of documents you carried for visa interview. Maximum duration on a B1/B2 visa is 6 months. Make sure you collect all your belongings, carry-on baggage and especially passport before leaving.

The things they always ask for is

1. Return ticket (vide supra)

2. Reason for travel (elective acceptance letters, CS confirmation letter etc.)

3. Place of stay in USA (carry an email or invitation letter with address, phone number of the person you staying with)

They may ask you stuff like what is an elective and stuff like that. So at times it may sound like a re-interview of the visa. But note that you are a medical student going for a US clinical experience/ CS exam and not a thief, be sure of what you say and be confident.

Collecting Baggage: Once cleared from visa, you now have to collect your checked-in baggage at the baggage claim area; follow the signboards to find the baggage claim area. You should have their tags with you all the time, which are provided to you when you checked/submitted your baggage and got boarding pass for your first flight. It’s convenient to have a cart to carry your baggage. Once you have the trolley look for the station number where your baggage would come, it is displayed on the monitors in the baggage claim area. Once identified, go there and collect your baggage. Once you have collected your bags you would have to your passport and visa to another person before proceeding towards the next flight. 

Connecting Flights: Once you have your bags, go towards the counter of your connecting domestic flight, show your passport and boarding pass, check in your baggage, you may have to show the baggage tags to them otherwise you will have to pay for baggage.

Remember, on domestic flights you have to pay for checked bags but if you have a connecting domestic flight as an international passenger, you don't have to pay for checked bags (if they are not over-sized or over-weight) and to prove that, you need to show your baggage tags. Once your baggage is checked in, you head towards the gate number of your connecting flight.

Generally it takes 2-4 hours to get cleared from customs, visa, collecting and checking in baggage and then reach the connecting flight gate. So it is advisable to have at least 4-5 hours of lay-over on your port of entry (first city you land in US). No meals are served on a domestic flight, so it is better if you eat something if you have a long connecting flight.

AFTER REACHING USA

Once you have reached your final destination, you head towards the baggage claim area, collect your baggage and go to your new home. Welcome to USA! Have a nice time! :D :P

Travelling from/to Airport: You can get a taxi if you live near to the airport. I recommend Super shuttle- It is way cheaper than the normal cab fare. They generally take $20-25 to take you from/to Airport from/to your place. You can make the booking and pay online but I recommend paying at the airport (PS- They may have a discount online, which reduces the cost). Usually they have a counter near the baggage claim area; just look around and you would find a Super shuttle counter (ROYAL BLUE COLOR). Tell them your destination, pay them and they ask you to write your name and contact number on a paper for them. Then you wait for 10-20 minutes and their shuttle arrives. It is a shared transport (like a minivan Eg- Big huge ass TATA SUMO/ Omni) and you might have to wait a bit to reach your place because the driver might drop other passengers before you. If the taxi cab/super shuttle driver (or a waiter at your hotel) is really helpful you can give him  a $1-2 tip. However it is NOT A MUST as I feel you are technically a student and not earning.

Residence: People find it difficult to find places to stay before visiting US for the first time. Though on-campus housing is the best/ safe it is not always available. People have said trying craigslist.org or airbnb.com can help. Never used them but it is wise to ask for the pictures of the room and the place and to confirm the total rent including all the utilities (including gas, electricity, water, internet etc.).

Google Maps: This tiny app is a life saver in the States. You can use it to get around places in the States. If you are selecting public transport, make sure you select the right time of travel, you will be provided with all the details e.g. bus number, route, stops etc.

Travelling within US- Frankly, people in the States generally do not use public transport very often. So you might have trouble finding local buses like you find in India. But always good to check on google maps before giving up hope.

Travel by air is the fastest and best I feel. If you book early (1 month in advance you can get good rates. You can also use an app called skyscanner and put a watch list) Airlines charge $ 25 for the 1^st checked in bag and $35 for the 2^nd which is a lot. You can try booking on Jet Blue or Southwest airways where they seem to have free checked in baggage, but the flight cost is equally expensive. So choose wisely!

Finances: Please note that for withdrawing there is an additional $2 charge per transaction. However if you use it while shopping i.e. swiping for payments they don't have any surcharge. Also a trick that I happened to stumble upon, while making purchases in the stores there generally is a cash back option, so just in case you happen to run out of cash, you can use this method to get up to $10 without any additional charges.

Cell phone: Please do not go by what people tell you regarding Sims and plans and stuff like that. I would advise you to go to the nearest supermarket store like Target or Walmart. They generally have a host of options. In my case I bought a sim card which was only $35 compared to the plans which the rest had to offer like 50$ or 60$ for T mobile or AT&T (H2O wireless- The plan details were unlimited calls and messages plus an additional 500 MB data, with an hour or so of international calling which was more than enough for my needs; since the hospital generally has guest Wi-Fi which is a KILL, and is unlimited with good quality speed) I mean the number is ONLY for people to contact you on an emergency basis and for fellows or residents to contact you in case there is an exciting new case so why spend a fortune on it?

Online calling / VoIP: There are a host of applications which can suit your needs. But I would say Google voice calling is the best. I initially had no number to call people, so I used it to make free calls. There is an app called Hangout dialler + which helps you to make calls via the phone. Skype has an offer called unlimited world calling and you get the first month free. This is a bogus I feel since if you do not ask for a refund before the month ends they charge you for the entire month regardless of whether you used the feature or not.

Lastly best of luck to all you guys. You will be awesomeJ

I had found the following sites very useful during my intial data gathering for my trip: http://umartariq.com/node/158 and http://www.umartariq.com/node/171

Additional info by Bhaumik Shah 

• For free call within US&Canada = MagicJack App ;
• backpage.com to check for shared accomodation & HostelWorld.com for hostels & cheap hotels for people who are visiting for a week or two; 
• Skype/Viber for India Calling if someone doesnt want to get US number..as it will save atleast 55 bucks...
• For food= Deep paratha ( paneer maratha & many more), Haldiram sabji, from Rumi's market or Patel Brothers or some local indian store...
• Look for a host who has bike(bicycle) if you want to save money for local transport specially when couple of miles away...or one can buy new bike(bicycle) which costs approx 70 bucks and then you can sell..