This week America celebrated Thanksgiving 🦃, so I had my first day off work since coming here. Sorry to disappoint you, but I mainly used this day to sleep because I was exhausted 😴.

On the other hand, my dear wife and kids took advantage of the long weekend and flew to my brother-in-law in California. They had a great time there; my kids spent time with their cousins, and the whole family enjoyed the warmer weather ☀️. 

It’s funny how fast we’ve gotten used to the cold Boston weather. Wearing a heavy jacket when it’s 8 degrees (46 Fahrenheit) suddenly feels like a sauna, and our kids walk around in short-sleeved shirts. We keep our house windows open even when it’s 0 degrees out (32 Fahrenheit), something we wouldn’t have dreamed of doing back home.

This week my sister will be visiting from Israel. She started her US journey in New York and will then take the train to Boston. I wonder if her New York experience will be different from mine. In any case, we will have a family reunion and catch up on what has been happening since we last met six months ago.

Today’s newsletter will be devoted to my experience of being a fellow. As I approach the end of my fifth month here, I thought it would be an excellent opportunity to share what I have learned.

So without further ado, enjoy issue number 15!

Table of contents

1. Main Article - My Fellowship Experience

2. OMFS World

3. Stuff (App, Gear)

“Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.” - Zen Buddhism

I use this quote a lot. You can read more about its meaning here.

Main Article - My Fellowship Experience

🩻 The field of head and neck surgery is demanding. It requires a high level of skill and training, which is precisely the goal of a two-year-long fellowship. To be accepted into the program, you must first complete dental school (6 years), residency (5 years), and medical school (2-3 years).

🧑‍🏫 The rewards of a fellowship program can be great since you get the opportunity to work with some of the best surgeons in the field and learn from their experience.

🫵🏼 As in all aspects of life, every path has advantages and disadvantages, and being a surgical fellow is no different. In this issue, I will focus on the main aspects of being a fellow, contrasting the good elements with the more challenging ones. Before we dive in, let me note that some fellowship programs include a third year dedicated to research 🔬; I did my research fellowship three years ago in Portland, Oregon, USA, a chapter in my life that I will forever cherish. However, to keep it focused, research fellowship will not be discussed in this issue.

✅ Let’s begin with four main benefits:

🏋️‍♂️First, as a fellow, you get a chance to perfect a specific skill setand improve quickly. During residency, you’re exposed to all the areas of your profession. Oral and maxillofacial surgery includes trauma, infections, dentoalveolar, oncology, craniofacial, orthognathic, esthetics, joint, and salivary glands. So when you divide the total time of your residency between all these fields, the amount you spend in each one is limited ⏳. However, as a fellow, my time is devoted to treating head and neck cancer. Starting at the diagnosis stage, delivering the bad news, staging the disease, and deciding on the treatment plan. It then goes on to plan the surgery, perform it, and deal with its side effects with my patients: mentally, medically, and surgically. Finally, I must continue to follow up on my patients for life and make the hard decisions in cases where their cancer has recurred.

🚚Second, constant friction. The fellowship program is designed to hold you accountable and push you to improve constantly 🏃‍♀️. During the fellowship, you always feel you’re learning something new (sometimes every few minutes!) and continuously work against the friction of feeling that you don’t know enough. This constant pressure keeps you on your toes and helps you learn fast.

🧳Thirdly, you get to establish new and long-lasting connections. Taken out of your home surroundings, you are automatically in a great place for networking as you’re surrounded by professionals who have dedicated themselves to the same path. Former fellows and mentors keep in touch years after fellowship, advising and supporting each other, and thanks to technology 🤳, geographical distance is no longer a barrier.

👨‍👩‍👦‍👦 Fourth, you get to have a meaningful experience as a family: My weekends here are more extended, and we spend more time together as a family. There are various activities and attractions, and the selection is much more extensive than we have back home. As a family, we learned how to adjust to a new country, house, school system, and the list goes on; on top of that, the kids get to experience another country and culture and make friends who speak a different language.

Intermission - a masterpiece performed by a piano superstar:

(Check out her YouTube channel for covers performed in a way you never heard before.)

🪖 But fellowship also has many challenging aspects, so let’s touch on the main ones. You will notice I included a positive twist in each of them:

💰 First, money. This is a huge issue you face as a fellow. Moving your life to a different country while keeping ties to your home country is a significant financial challenge. As a fellow, you usually get paid by your hospital, but in most cases, it’s not enough to live on. So, it would help if you found ways to cut costs and prioritize your expenses. How do I prioritize? Before spending money, I ask myself one simple question: Will it impact our lives five years from today? If the answer is yes, we see it as an investment in ourselves and spend the money. Examples: music lessons for the kids 🎹 🎼, boy scouts and winter camp for firstborn ❄️, having a car, and visiting a museum together as a family. On the other hand, we save money when we: rent a cheaper apartment that is quite old (although we started to love it), taking time to find cheaper alternatives to our day-to-day products (thanks to the internet, we find the same products at a lower price, sometimes even half-price), and keeping an eye on used equipment that people give away. None of these will affect our lives in five years, and I must say, this approach has affected our children immensely. They are hungry for experiences and are less attached to possessions.

“Money in a business is like gas in your car. You need to pay attention so you don’t end up on the side of the road. But your trip is not a tour of gas stations.” - Timothy Ferriss, Tribe of Mentors

🏡 Second, being away from home. I don’t need to elaborate on this too much because it’s self-explanatory. I will say that being away from our family has brought us closer to neighbors and parents from our kids’ schools. Being away from family and my home country is also the main reason for starting this newsletter 🗞️. The outcomes of which are a total mystery at this point, but I like doing things without a clue how they will turn out 🤔.

🚛Third, constant friction. Yes, the same one I described as a positive thing before 😀. I’m pretty used to challenging myself, but the fellowship has brought me to a whole new level of working outside my comfort zone. This is the first time in my life that I don’t have any comfort zone at any point in the day. Having little vacation and always being with a pager and on-call are taking their toll. I wouldn’t change a thing, but if you’re approaching the end of your residency and considering a fellowship, this is something to keep in mind.

Arnold Schwarzenegger, a childhood hero of mine and an inspiration to this day, speaks about his approach to life:

OMFS World

👩‍🎓For the student - Don’t complete your rotation in the Oral and Maxillofacial Surgery service before you ask all the questions and feel confident in the following subjects: bleeding control after extraction 🩸, proper antibiotic and surgical treatment of dental infections 💊, and when to refer a patient to the emergency department 🚨. No matter which field of dentistry you choose, you will need to address these issues throughout your career.

🥼For the OMFS resident - Start planning your fellowship two and a half years before the end of your residency. You don’t necessarily need a fellowship to pursue your career as an Oral and Maxillofacial Surgeon. But suppose you decide to go for it. In that case, you should be aware of the timing: interviewing for a fellow position usually takes place 15-18 months before the start date of that fellowship, and the results of the match for the US positions are announced 12 months before the start date. To get to know the mentors, acquaint yourself with their programs, and allow yourself enough time to leave an impression, you need to start working on these early. This will give you time to research different programs and find the one that best fits your needs.

🩺For the non-MD medical professional - Gallstone pancreatitis is an inflammation of the pancreas caused by a gallstone obstructing the pancreatic duct. Many patients require hospital admission, but the disease’s severity dictates the treatment’s timing and nature. Patients with mild pancreatitis may initially be treated with intravenous fluids and pain relievers and undergo resection of their gallbladder within seven days of clinical improvement (i.e., as soon as possible). In severe cases, it is best to wait longer to prevent complications.

Stuff

📱 Application I use - To edit photos on the go, I use Adobe Lightroom Mobile. It’s a FREE app that allows users to adjust their shots at a highly professional level. For pictures I take in the OR, I usually adjust the brightness and shadows, and sometimes the highlights, blacks, and whites. I prefer doing this myself on the raw image file rather than letting the jpeg preset do it for me. This application IS NOT intended for photo editing, nor is it considered as such (for editing, there is Photoshop).

💡Gear I use - Apple AirPods Pro 2nd generation (2022). Apple recently released its second generation of AirPods Pro. The new earbuds come with features unavailable in the first generation, and some were improved. As someone who has been using the first generation for 2-3 hours daily for the last two years, I wondered if the second generation would be worth the upgrade. The main feature I was interested in was the improved noise cancellation. The first generation did not function well under train and highway traffic noise; I always had to turn the volume up or pause. The second I put the new AirPods in my ears, I noticed a massive improvement in noise cancellation and sound quality. I was surprised by how well they tune out even the loudest train noise and heavy trucks, and the ability to change the volume on the earbud itself is a huge bonus. As for using them outside the Apple ecosystem, I used the first generation on an Android phone, and so does my dear wife. Some features won’t work with Android, but we found this insignificant. Price? I took advantage of Black Friday and got them for 200$ instead of 250$; As time goes by, I assume a similar price will become available during other selling events.

Epilogue

That’s it for this issue.

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Have a great weekend!

Shay